Institutional Experience Significantly Affects Overall Survival in Locally Advanced Head and Neck Cancer
In a study reported in the Journal of Clinical Oncology, Wuthrick et al found that patients with stage III or IV head and neck cancer in the Radiation Therapy Oncology Group (RTOG) 0129 trial who were treated at historically high-accruing centers in RTOG clinical trials had significantly better overall survival compared with those treated at historically low-accruing centers.
Study Details
In the study, historically high- and low-recruiting centers were identified based on accrual to 21 RTOG trials in head and neck cancer conducted between 1997 and 2002. The effect of accrual status on outcomes was assessed among 471 patients with stage III or IV disease in the RTOG 0129 trial (which compared cisplatin concurrent with standard vs accelerated fractionation radiotherapy in 2002–2005) with known human papillomavirus (HPV) and smoking status.
Median accrual at the historically low- vs high-accrual centers was 4 vs 65 patients. Patients in RTOG 0129 treated at low-accruing centers had better Zubrod performance status (0 in 62% vs 52%, P = .04) and lower T stage (T4 in 26.5% vs 35.3%, P = .002). Radiotherapy protocol deviations were more frequent at low-accruing centers (18% vs 6%, P < .001).
Overall and Progression-Free Survival
Five-year overall survival was 51.0% at low-accrual centers vs 69.1% at high-accrual centers (hazard ratio [HR] = 1.67, P = .002), and 5-year progression-free survival was 42.7% vs 61.8%, HR = 1.64, P < .001). Treatment at low-accrual centers remained associated with significantly increased risk of death (HR = 1.91, P < .001) and progression or death (HR = 1.89, P < .001) after adjustment for age, T and N stages, performance status, smoking pack-years, tumor HPV status, and treatment assignment; and with increased risk of death (HR = 1.72, 95% confidence interval [CI] = 1.23–2.40) and progression or death (HR = 1.73, 95% CI = 1.28–2.36) after adjustment for radiotherapy compliance.
The investigators concluded: “[Overall survival] is worse for patients with [head and neck cancer] treated at [historically low-accruing centers] versus [historically high-accruing centers] to cooperative group trials after accounting for radiotherapy protocol deviations. Institutional experience substantially influences survival in locally advanced [head and neck cancer].”
Evan J. Wuthrick, MD, of Ohio State University Medical Center, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by a Radiation Therapy Oncology Group grant and a Community Clinical Oncology Program grant from the National Cancer Institute. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
