***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Data on preoperative chemotherapy in resectable oral cavity cancer are conflicting . We present the long-term results of a r and omized trial of induction chemotherapy in resectable oral cavity cancer . PATIENTS AND METHODS A r and omized , parallel , multicentre trial evaluated the impact of three cycles of cisplatin 100 mg/m2 and fluorouracil 1000 mg/m2 ( 120-h infusion administered every 21 days ) in stage T2-T4 , N0-N2 , previously untreated patients with advanced disease . Control group received upfront surgery . Postoperative radiation was offered to both arms when pathologic risk features were identified . The co- primary end points were the occurrence of locoregional or distant tumour relapse , and death . RESULTS Among the 198 enrolled patients , with a median follow-up of 11.5 years , there was no difference in the incidence of locoregional relapse between chemotherapy and control group ( P=0.6337 ) , nor in distant metastasis development ( P=0.1527 ) . There was also no difference between groups in overall survival ( P=0.3402 ) . Patients with a pathological complete response ( pCR ) had higher probability of survival than those without ( 10-year OS : 76.2 % versus 41.3 % , P=0.0004 ) . Late toxicities in patients with a minimum follow-up of 60 months ( 42 in each group ) were similar between arms , except from fibrosis ( cumulative incidence 40 % versus 22 % in chemotherapy arm ) and grade 2 dysphagia ( 14 % versus 5 % ) . CONCLUSIONS Long-term follow-up of this r and omized trial confirmed the absence of survival benefit with preoperative chemotherapy in oral cavity cancer . Late toxicity was similar in the two arms except for fibrosis and dysphagia , which were less in the chemotherapy arm . The survival benefit for patients achieving a pCR was maintained PURPOSE To date , consensus has not been reached on which treatment modality , that is , in-continuity neck dissection or discontinuous neck dissection , is more appropriate for managing patients with squamous cell carcinoma ( SCC ) of the tongue and floor of the mouth . This study aim ed to perform a meta- analysis to compare discontinuous neck dissection with in-continuity neck dissection as a treatment modality for SCC of the tongue and floor of the mouth . MATERIAL S AND METHODS The PubMed , Web of Science , China National Knowledge Infrastructure , and Wanfang data bases were search ed for articles that compared discontinuous neck dissection with in-continuity neck dissection in SCC of the tongue and floor of the mouth until March 1 , 2017 . The predictor variable was whether discontinuous neck dissection or in-continuity neck dissection was performed in each group . The primary outcome variable was the incidence of locoregional recurrence . Two authors individually extracted the data and assessed the study quality . The meta- analysis was performed using Stata ( version 13.0 ; StataCorp , College Station , TX ) . RESULTS We included 8 studies with 796 patients in our meta- analysis . The results showed that in-continuity neck dissection had a statistically significantly lower incidence of locoregional recurrence than discontinuous neck dissection ( r and om-effects model : relative risk , 0.459 ; 95 % confidence interval , 0.240 to 0.877 ; P = .019 ) . Because significant heterogeneity among studies ( I2 = 74.5 % , P < .001 ) was found in the heterogeneity evaluation , a separate analysis was performed . However , the results still showed that in-continuity neck dissection had a statistically significantly lower rate of locoregional recurrence than discontinuous neck dissection in patients with T2 and T3 SCC of the tongue and floor of the mouth ( fixed-effects model : relative risk , 0.281 ; 95 % confidence interval , 0.183 to 0.433 ; P < .001 ) . CONCLUSIONS Compared with discontinuous neck dissection , in-continuity neck dissection can significantly reduce the rate of locoregional recurrence in patients with SCC of the tongue and floor of the mouth The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions The current r and omized , multicenter , Phase III trial was conducted to determine whether the disease free interval and overall survival of patients with T2–T4,N0–N3,M0 squamous cell carcinoma ( SCC ) of the oral cavity or oropharynx could be extended through the combination of surgery ( and radiotherapy , if required ) with perilymphatic recombinant IL‐2 ( rIL‐2 ) Either intra-arterial infusions of MTX ( 500 mg over 10 days ) or intra-arterial infusions of BLM ( 95 mg over 13 days ) were administered as initial treatment to 85 patients with untreated squamous cell carcinomas of the oral cavity . Tumour regression was assessed 10 - 15 days after the end of chemotherapy . A sequential analysis was used , and BLM demonstrated a significantly greater local efficacy after the 32nd matched pair was assessed . The same results were observed when tumour response rates were compared , ignoring the matching , on the 85 patients , ( P less than 0.001 ) . The response rate for patients with neck nodes was low ( 10/38 ) . Catheter management problems , toxic effects and lethal reactions were 2.5 times more frequent in the MTX group Between February 1978 and January 1984 , 222 eligible patients were r and omised in a multicentre trial of preoperative intra-arterial chemotherapy in the treatment of oral cavity and oropharynx carcinoma . Patients were r and omised between either surgery or preoperative chemotherapy .  This latter group received vincristine and bleomycin for 12 days . Patients were stratified according to the primary site : floor of the mouth ( FM ) versus posterior oral cavity or oropharynx ( POC ) and institution . The FM group received postoperative radiotherapy depending upon quality of the margins and lymph-node pathological involvement , when it was systematic ally applied in the POC group . Tumour regression after chemotherapy either complete ( CR ) or partial ( PR greater than 50 % ) was observed in 48 % in the FM group and 41 % in the POC group , and lymph-node regression ( CR + PR ) was respectively 15 % and 23 % . Some discrepancies appeared between clinical regression and pathological response , and the number of cases without histological response was clearly higher than the number of cases without clinical response . The overall survival showed a statistically significant difference ( P = 0.048 ) between FM and POC groups . In the FM group , median survival in the chemotherapy arm was estimated at 7 years compared with 3 years in the surgery arm . In the POC group , median survival was estimated at 3 years in both treatment arms . Chemotherapy lowered the uncontrolled disease and local recurrence in the FM group . These differences do not exist in the POC group , which may be due to the systematic ally postoperative radiotherapy PURPOSE To evaluate induction chemotherapy with docetaxel , cisplatin , and fluorouracil ( TPF ) followed by surgery and postoperative radiotherapy versus up-front surgery and postoperative radiotherapy in patients with locally advanced resectable oral squamous cell carcinoma ( OSCC ) . PATIENTS AND METHODS A prospect i ve open-label phase III trial was conducted . Eligibility criteria included untreated stage III or IVA locally advanced resectable OSCC . Patients received two cycles of TPF induction chemotherapy ( docetaxel 75 mg/m(2 ) on day 1 , cisplatin 75 mg/m(2 ) on day 1 , and fluorouracil 750 mg/m(2 ) on days 1 to 5 ) followed by radical surgery and postoperative radiotherapy ( 54 to 66 Gy ) versus up-front radical surgery and postoperative radiotherapy . The primary end point was overall survival ( OS ) . Secondary end points included local control and safety . RESULTS Of the 256 patients enrolled onto this trial , 222 completed the full treatment protocol . There were no unexpected toxicities , and induction chemotherapy did not increase perioperative morbidity . The clinical response rate to induction chemotherapy was 80.6 % . After a median follow-up of 30 months , there was no significant difference in OS ( hazard ratio [ HR ] , 0.977 ; 95 % CI , 0.634 to 1.507 ; P = .918 ) or disease-free survival ( HR , 0.974 ; 95 % CI , 0.654 to 1.45 ; P = .897 ) between patients treated with and without TPF induction . Patients in the induction chemotherapy arm with a clinical response or favorable pathologic response ( ≤ 10 % viable tumor cells ) had superior OS and locoregional and distant control . CONCLUSION Our study failed to demonstrate that TPF induction chemotherapy improves survival compared with up-front surgery in patients with resectable stage III or IVA OSCC PURPOSE Prognosis of patients with advanced oral cavity cancer is worth improving . Chemotherapy has been reported to be especially active in oral cavity tumors . Here we repeat the results of a r and omized , multicenter trial enrolling patients with a resectable , stage T2-T4 ( > 3 cm ) , N0-N2 , M0 untreated , squamous cell carcinoma of the oral cavity . PATIENTS AND METHODS Patients were r and omly assigned to three cycles of cisplatin and fluorouracil followed by surgery ( chemotherapy arm ) or surgery alone ( control arm ) . In both arms , postoperative radiotherapy was reserved to high-risk patients , and surgery was modulated depending on the tumor 's closeness to the m and ible . Patients ' accrual was opened in 1989 and closed in 1999 . It included 195 patients . RESULTS In the chemotherapy arm , three toxic deaths were recorded . No significant difference in overall survival was found . Five-year overall survival was , for both arms , 55 % . Postoperative radiotherapy  was administered in 33 % of patients in the chemotherapy arm , versus 46 % in the control arm . A m and ible resection was performed in 52 % of patients in the control arm , versus 31 % in the chemotherapy arm . CONCLUSION The addition of primary chemotherapy to st and ard surgery was unable to improve survival . However , in this study , primary chemotherapy seemed to play a role in reducing the number of patients who needed to undergo m and ibulectomy and /or radiation therapy . Variations in the criteria used to select patients for these treatment options may make it difficult to generalize these results , but there appears to be room for using preoperative chemotherapy to spare destructive surgery or radiation therapy in patients with advanced , resectable oral cavity cancer Tumours of the oral cavity/oropharynx occur relatively infrequently in the UK . The management of such lesions , especially the squamous cell carcinomas , is still a little controversial . Some centres advocate radiotherapy while others adopt surgery and radiotherapy . In an attempt to resolve the question of which approach gives the better results , a multicentre r and omized trial was established to compare surgery plus postoperative radiotherapy with radical radiotherapy alone . It was anticipated that 350 patients would be required to give a statistically significant result , but , after 35 patients had been entered , the trial was closed prematurely with a marked difference in overall survival in favour of the combination arm ( P = 0.0006 ) . At this analysis , carried out 23 months after trial closure , the survival difference between the two arms remains statistically significant for all causes of mortality ( P = 0.001 ; relative death rate = 0.24 ; 95 % CI 0.10 - 0.59 ) In the final report of a prospect i ve , r and omized controlled clinical trial , we report the results of using adjuvant perioperative chemotherapy in patients with oral cancer . Our study is based on the hypothesis of Goldie and Coldman . A total of 135 patients with alveolobuccal carcinoma , classified as clinical ly stage III and IV , were entered on the protocol . After a curative resection , they were r and omized . The patients in the test arm of the study received methotrexate 50 mg/m2 on the 3rd , 10th , and 17th postoperative days . The patients in the control arm underwent observation . This analysis at 24 months showed a disease-free survival rate of 61 % in the test arm versus 37 % in the control arm , which is statistically highly significant ( P < 0.01 ) . Analysis of the recurrence pattern showed that recurrence at the primary site was dramatically reduced during the first 6 postoperative months ( P =  
    Output:
    
Conclusion There is limited available evidence on treatments for oral cancer .
The main beneficial treatment reported by authors for patients with resectable oral cancer is surgery alone or in combination with radiotherapy or chemotherapy .
Evidence about the benefits of the treatments for unresectable oral cancer is lacking .