State of head and neck surgical oncology research—A review and critical appraisal of landmark studies

Abstract

Surgical literature has been criticized for the lack of high-quality research. The present review examines methodological quality of literature published in head and neck surgical oncology. We focus on landmark studies published on topics of best practice controversy, namely (1) the role of chemotherapy and organ-preservation protocols in the management of head and neck mucosal malignancies; (2) the role of selective neck dissection versus radical neck dissection; and (3) the role of laser microsurgery in the management of larynx cancer. Similar flaws were evident in selected landmark studies with the major issue being multiplicity in the form of multiple outcome analysis, comparison of multiple treatment groups, repeated measures over time, planned interim analyses, and subgroup analyses. The open nonrandomized controlled trial may be a feasible option in head and neck surgical research allowing for standardization, uniformity, consistency, and blinded outcome assessment. V

The fragility of statistically significant findings from randomized trials in head and neck surgery

“…These results echo the broader analysis of surgical RCTs using CONSORT . Higgins and Wang reviewed several landmark RCT trials in the head and neck literature and highlighted that the major limitation in most cases related to multiple outcome analysis . Another group looked at the quality of head and neck cancer RCTs according to the Jahad scale and commented that they were moderate at best .…”

Effects of tumour stage, comorbidity and therapy on survival of laryngeal cancer patients: a systematic review and a meta-analysis

“…As stated by Higgens and Wang [67], clinical recommendations for HNSCC treatment based on evidence are difficult due to the disproportion between surgical and non-surgical trials. This conflict is triggered by the fact that instruments for evaluating best surgical practice are different from methodological standards in non-surgical phase-II or -III trials [67]. Regarding current literature, induction chemotherapy before radiation treatment offers the possibility of chemoselection of good responders before therapy [26].…”

Impact of radiotherapy on laryngeal intrinsic muscles

“…Radiotherapy and surgery are considered the primary and most important treatment modalities. Despite its image as a less invasive treatment, ionizing radiation aVects healthy as well as neoplastic tissues leading to numerous adverse eVects [2][3][4][5][6]. Well-known side eVects in the head and neck region include mucositis, xerostomia, osteoradionecrosis, trismus, reduction in taste perception, reduction in muscular strength, dysphagia and vocal weakness [7].…”