A comprehensive Cochrane review of 100 randomized trials including 18,813 participants evaluated whether adding chemotherapy to radiotherapy and/or surgery improves outcomes in oral cavity and oropharyngeal squamous cell carcinoma. The findings showed no clear survival benefit for induction chemotherapy before radiotherapy, surgery, or chemoradiation, with evidence remaining insufficient across modern platinum-based and docetaxel-containing regimens. Post-surgical adjuvant chemotherapy alone also did not improve overall survival, while the combination of postoperative chemoradiation reduced mortality by 16% compared with radiotherapy alone.
The review demonstrated that concurrent chemoradiation provides the strongest survival advantage, decreasing the risk of death by more than 20% compared with radiotherapy alone. However, survival gains appear dependent on specific clinical contexts rather than universal application of chemotherapy. Evidence also showed variability in study quality, and further research is required to determine which chemotherapy regimens provide additional benefit across different treatment settings.