Dataset Information

Institutional clinical trial accrual volume and survival of patients with head and neck cancer.

ABSTRACT:

Purpose

National Comprehensive Cancer Network guidelines recommend patients with head and neck cancer (HNC) receive treatment at centers with expertise, but whether provider experience affects survival is unknown.

Patients and methods

The effect of institutional experience on overall survival (OS) in patients with stage III or IV HNC was investigated within a randomized trial of the Radiation Therapy Oncology Group (RTOG 0129), which compared cisplatin concurrent with standard versus accelerated fractionation radiotherapy. As a surrogate for experience, institutions were classified as historically low- (HLACs) or high-accruing centers (HHACs) based on accrual to 21 RTOG HNC trials (1997 to 2002). The effect of accrual volume on OS was estimated by Cox proportional hazards models.

Results

Median RTOG accrual (1997 to 2002) at HLACs was four versus 65 patients at HHACs. Analysis included 471 patients in RTOG 0129 (2002 to 2005) with known human papillomavirus and smoking status. Patients at HLACs versus HHACs had better performance status (0: 62% v 52%; P = .04) and lower T stage (T4: 26.5% v 35.3%; P = .002) but were otherwise similar. Radiotherapy protocol deviations were higher at HLACs versus HHACs (18% v 6%; P < .001). When compared with HHACs, patients at HLACs had worse OS (5 years: 51.0% v 69.1%; P = .002). Treatment at HLACs was associated with increased death risk of 91% (hazard ratio [HR], 1.91; 95% CI, 1.37 to 2.65) after adjustment for prognostic factors and 72% (HR, 1.72; 95% CI, 1.23 to 2.40) after radiotherapy compliance adjustment.

Conclusion

OS is worse for patients with HNC treated at HLACs versus HHACs to cooperative group trials after accounting for radiotherapy protocol deviations. Institutional experience substantially influences survival in locally advanced HNC.

SUBMITTER: Wuthrick EJ

PROVIDER: S-EPMC4279235 | biostudies-literature | 2015 Jan

REPOSITORIES: biostudies-literature

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Publications

Institutional clinical trial accrual volume and survival of patients with head and neck cancer.

Wuthrick Evan J EJ Zhang Qiang Q Machtay Mitchell M Rosenthal David I DI Nguyen-Tan Phuc Felix PF Fortin André A Silverman Craig L CL Raben Adam A Kim Harold E HE Horwitz Eric M EM Read Nancy E NE Harris Jonathan J Wu Qian Q Le Quynh-Thu QT Gillison Maura L ML

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 20141208 2

<h4>Purpose</h4>National Comprehensive Cancer Network guidelines recommend patients with head and neck cancer (HNC) receive treatment at centers with expertise, but whether provider experience affects survival is unknown.<h4>Patients and methods</h4>The effect of institutional experience on overall survival (OS) in patients with stage III or IV HNC was investigated within a randomized trial of the Radiation Therapy Oncology Group (RTOG 0129), which compared cisplatin concurrent with standard ver ...[more]

PMID: 25488965

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Dataset Information

Institutional clinical trial accrual volume and survival of patients with head and neck cancer.

Purpose

Patients and methods

Results

Conclusion

Publications

Institutional clinical trial accrual volume and survival of patients with head and neck cancer.

Similar Datasets

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