Moderate hypofractionation for early laryngeal cancer improves local control
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LETTER TO THE EDITOR
Moderate hypofractionation for early laryngeal cancer improveslocal control Meng‑Si Luo1 Received: 7 May 2020 / Accepted: 21 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, With great interest, I read the systematic review and meta‑analysis about moderate hypofractionation for early laryngeal cancer [1]. Benson and colleagues concluded that compared to conventional fractionation, moderate hypof‑ ractionation is associated with significantly improved local control without an impact on overall survival in laryngeal cancer. However, several unprofessional concerns need to be addressed. First, I am confused which cancer was assessed by the authors. As the article’s title showed, this study was designed to evaluate the role of hypofractionation in early laryngeal cancer. But the abstract part stated that the authors conducted the study to assess early glottic cancers. Though it is acknowledged that glottic cancer is the most common laryngeal cancer, glottic cancer is not equal to laryngeal can‑ cer. Thus, the authors may better need to describe it clearly. Second, a comprehensive search should always contain the medical subject headings (MeSH) search and text word search. But the authors only searched MeSH terms. Moreo‑ ver, in the searching strategy of Pubmed, some MeSH terms of this article were not correct. For example, “Radiation Dose Hypofractionation” was used as MeSH in Pubmed, not “Hypofractionation”. Furthermore, as the authors depicted in the abstract and methods parts, PubMed, Embase, and Google scholar were used to seek out all the eligible stud‑ ies. However, the authors’ Fig. 1 showed that only Pubmed and Google scholar were finally used and only 18 articles This comment refers to the article available online at https://doi. org/10.1007/s00405-020-06012-9. * Meng‑Si Luo [email protected] 1
Department of Anesthesiology, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, 3 Kangxin Road, Zhongshan 528400, Guangdong, China
were identified. I am also wondering whether Embase was searched or not. Thus, it seems that it is insufficient to screen out all related studies, and the authors should focus specifi‑ cally on the veracity of the search strategy report. Third, in the methods part, the authors stated, “Other outcomes and adverse events were calculated as risk ratios (RRs) with 95% CIs.” But, the authors did not use RR in this meta-analysis. Actually, it is more appropriate to use RR, not “odds (OR)”, to act as the pooled-effect estimate of dichotomous variables according to the Cochrane Handbook [2]. Besides, the number of total patients in the experimen‑ tal group of Yamazai’s study was 91 in Table 1 and Fig. 2, whereas the number was 92 in the authors’ Figs. 4 and 5. In conclusion, the results of this meta-analysis should be interpreted with caution due to these above concerns. And I am looking forward to their positive responses. Acknowledgements I am grateful to Dr. Guan-Ji
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