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Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer

Slide: 27 of 36

Evidence on the Comparative Effectiveness Regarding Quality of Life and Adverse Events

One unpublished, randomized, controlled trial, reported by Nutting, et al. at the 2009 annual meeting of the American Society of Clinical Oncology, showed a large advantage for IMRT in the frequency of late xerostomia of grade 2 or higher. The risk difference was 35 percentage points with a 95 percent confidence interval (95% CI) between 12.6 and 55.5 percentage points.

• Six observational studies favored IMRT. Of the five studies that reported frequencies, the reported range of differences is 7 to 79 percentage points.

• Quality of life was reported in three observational studies and generally favored IMRT over 3DCRT, although not all of the domains that were measured were statistically significant. Significant advantages for IMRT were found in these domains: dry mouth, sticky saliva, taste/smell, fatigue, and feeling ill.

• Acute xerostomia, acute mucositis, late mucositis, acute dysphagia, late skin toxicity, and late osteoradionecrosis and bone toxicity were reported in some studies and typically favored IMRT over 3DCRT. These differences, however, were not consistently statistically significant. Among studies of acute skin toxicity, neither the size of the difference nor the direction was consistent.