IMRT versus 2D/3D conformal RT in oropharyngeal cancer: A review of the literature and meta‐analysis.

Based on literature, intensity‐modulated radiation therapy (IMRT) provides less related toxicity compared with conventional 2D/3D‐RT with no impact on oncological outcomes for oropharyngeal cancer. The aim of this systematic review and meta‐analysis is to assess whether IMRT might provide similar clinical outcomes with reduced related toxicity in comparison with conventional 2D/3D RT in patients treated for clinically advanced oropharyngeal cancer (OPC). Inclusion criteria for paper selection included: squamous OPC patients, treatment performed by concomitant CRT or RT alone, four treatment performed for curative intent, and presence of clinical outcome of interest, namely, overall survival (OS) and disease‐free survival (DFS) and full paper available in English. Acute and late toxicities were retrieved together with OS and DFS. Crude relative risk estimates of relapse and death comparing 2D/3D‐RT versus IMRT were calculated from tabular data, extracting events at 2–3 years of follow‐up. Eight studies were selected. Six of them were included in the meta‐analysis considering summary relative risk. Considering both acute and late toxicities, the considered studies evidenced advantages for IMRT populations, with the 2D/3D‐RT population showing higher frequencies than the IMRT one. No statistical difference between IMRT and 2D/3D‐RT in terms of death (SRR = 0.93, 95% CI: 0.83–1.04 with no heterogeneity I2 = 0%) and relapse (SRR = 0.92, 95% CI: 0.83–1.03, with no heterogeneity I2 = 0%) was found. Results of our study suggest the improvement in the therapeutic index with IMRT with evidenced reduced toxicity without any worsening in clinical outcome when compared to 2D/3DCRT. [ABSTRACT FROM AUTHOR]