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Original Investigation |

Combined Modality Treatment Outcomes for Head and Neck Cancer:  Comparison of Postoperative Radiation Therapy at Academic vs Nonacademic Medical Centers

Jonathan R. George, MD, MPH1; Sue S. Yom, MD, PhD2; Steven J. Wang, MD1
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, School of Medicine, University of California, San Francisco
2Department of Radiation Oncology, School of Medicine, University of California, San Francisco
JAMA Otolaryngol Head Neck Surg. 2013;139(11):1118-1126. doi:10.1001/jamaoto.2013.4539.
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Importance  Patients with head and neck squamous cell carcinoma (HNSCC) who undergo surgical resection in an academic medical center (AC) often receive postoperative adjuvant external beam radiation therapy (RT) at non-ACs closer to home. Few data exist to compare outcomes of these populations.

Objective  To evaluate treatment metrics and outcomes in patients with HNSCC who underwent surgical resection at an AC and then received postoperative adjuvant external beam RT at an AC vs a non-AC.

Design, Setting, and Participants  Retrospective cohort study in 1 AC and several community RT non-ACs of patients with primary HNSCC treated with surgery at an AC followed by adjuvant therapy at an AC or a non-AC from January 1, 2002, to January 1, 2012.

Interventions  We evaluated for between-groups differences in demographics, RT metrics, and survival outcomes. Subgroup analysis by tumor site was then performed.

Main Outcomes and Measures  Overall survival, disease-specific survival, and locoregional control rates.

Results  A total of 286 patients underwent surgery at the University of California, San Francisco, followed by adjuvant therapy. A total of 214 patients were analyzed. Significant differences in demographic and oncologic variables emerged, including important differences in RT metrics. Patients treated at a non-AC received a lower total RT dose, lower fractional dose, more delays in RT initiation, more breaks in RT, and more early termination of RT. Adjuvant treatment at an AC was associated with improved survival on univariate but not multivariate analysis. Subgroup analysis by SCC tumor site normalized many of the differences between groups, yet still revealed persistent differences in RT metrics. On multivariate analysis, AC treatment was not an independent predictor of survival for any tumor site.

Conclusions and Relevance  Better oncologic outcomes were seen in the AC group on univariate analysis, but these improved outcomes were not found on multivariate analysis. Important differences in RT metrics were noted for non-AC treatment sites compared with AC sites. Subgroup analysis by tumor site demonstrated persistent differences in treatment metrics. Standardization of adjuvant HNSCC treatment according to national guidelines should be prioritized at non-AC treatment facilities.

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Figure 1.
Kaplan-Meier Survival Curve of Overall Survival for the University of California, San Francisco, Head and Neck Squamous Cell Carcinoma Cohort, by Adjuvant Treatment Site, 2002-2012

Log-rank P = .01.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Kaplan-Meier Survival Curve of Disease-Specific Survival for the University of California, San Francisco, Head and Neck Squamous Cell Carcinoma Cohort, by Adjuvant Treatment Site, 2002-2012

Log-rank P = .002.

Graphic Jump Location

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