Comparison of survival outcomes of transoral surgery with or without adjuvant chemoradiotherapy vs chemoradiotherapy alone for oropharyngeal cancer: A systematic review and meta-analysis.
Bibliographic record
Abstract
e18109 Background: Oropharyngeal cancer is a type of head and neck cancer that starts in the tissues of the oropharynx. Optimal treatment strategies for oropharyngeal cancer remain debated, particularly the role of transoral surgery (TOS) with or without adjuvant chemoradiotherapy compared to definitive chemoradiotherapy (CRT) alone. This study aimed to compare survival outcomes, including overall survival (OS) and disease-free survival (DFS) between these approaches. Methods: A systematic review and meta-analysis were conducted following PRISMA guidelines. Eligible studies were identified through databases (PubMed/MEDLINE, Web of Science, Scopus and Google Scholar) published until December 2024. Studies reporting survival outcomes in oropharyngeal cancer patients treated with transoral surgery (TOS) and/or chemoradiotherapy were included. Primary outcomes were overall survival (OS) and disease-free survival (DFS). A random-effects model was used for meta-analysis and a narrative synthesis when this was not possible. Heterogeneity was assessed using the I² statistic. For risk of bias the Newcastle-Ottawa Scale (NOS) was used. Certainty of evidence was graded using GRADE criteria. This systematic review initially aimed to evaluate the therapeutic efficacy of transoral laser microsurgery (TLM) with or without adjuvant radiotherapy vs radiotherapy alone for oropharyngeal cancer. However, the final analysis focused on transoral surgery and chemoradiotherapy as these emerged as the most consistent and clinically significant results reported across included studies. Results: Six studies (n = 587 patients) comparing transoral surgery (TOS) with or without adjuvant chemoradiotherapy (CRT) vs definitive chemoradiotherapy (CRT alone) for oropharyngeal cancer were included. All patients had Oropharyngeal squamous cell carcinoma (OPSCC). Patients treated with TOS + CRT showed longer 5-year overall survival (OS) 95% CI: (75% - 80% vs 62% - 65%) and disease-free survival (DFS) 95% CI: (70% vs 50%), with lower grade 3-4 toxicity 95% CI: (20% vs 40%, p < 0.05). Survival benefits were more pronounced in early-stage tumors (T1-T2), whereas no significant differences were observed in advanced stages. Heterogeneity was high in OS and DFS (I² = 80%). All studies had a moderate risk of bias based on the NOS scale. The certainty of the evidence was rated as low. Conclusions: Patients treated with transoral surgery (TOS) and adjuvant chemoradiotherapy (CRT) demonstrated superior overall and disease-free survival, along with reduced treatment-related toxicity, compared to definitive chemoradiotherapy (CRT alone), particularly in early-stage disease. However, due to the low certainty of the evidence and the limited number of studies, further research is recommended to confirm these results.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Meta-analysis | high |
| gpt | Meta-epidemiology (broad) Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Systematic review | high |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.145 | 0.009 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
The models disagree on parts of this classification; every voice is preserved in the section at the end of the page.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".