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

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Evidence on the Comparative Effectiveness Regarding Quality of Life and Adverse Events: IMRT vs. 2DRT

Nine studies reported on late xerostomia; the results of eight of those studies were statistically significant in favor of IMRT. Among the studies that reported frequency of late xerostomia, the range of differences between IMRT and 2DRT was 43 to 62 percentage points.

• Quality of life was reported in one randomized controlled trial and two observational studies and generally favored IMRT, although not all domains measured were statistically significant. Domains significantly favoring IMRT included dry mouth and sticky saliva.

• Indirect evidence from the comparison of IMRT vs. 3DCRT shows that greater conformality of radiation reduces late xerostomia and improves quality of life. Thus, inference from the comparison of IMRT vs. 3DCRT provides additional support for this conclusion.

• Acute and late mucositis, acute and late dysphagia, acute and late skin toxicity, and late osteoradionecrosis and bone toxicity were reported in some studies. Few studies reported significant results; these studies tended to be small or reported 2DRT data that were from an earlier time period than IMRT.