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IMRT improved cause-specific survival in head and neck cancers
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Intensity-modulated radiation therapy improved cause-specific survival and reduced toxicity compared with non–intensity-modulated radiation therapy in patients with head and neck cancers, according to study results.
Beth M. Beadle, MD, PhD, of the department of radiation oncology at The University of Texas MD Anderson Cancer Center, and colleagues used the SEER-Medicare database to identify 3,172 patients with head and neck cancers treated between 1999 and 2007.
The mean age of patients at the time of diagnosis was 72.2 years (range, 66-80).
Most patients (58.3%) had cancer of the oral cavity and oropharynx. Eighteen percent of patients had cancer of the larynx and 10.7% had cancer of the hypopharynx.
Fewer patients (n=1,056; 33.3%) received IMRT than non-IMRT treatment (n=2,116; 66.7%).
Median follow-up was 40 months.
During this time, 1,783 patients (56.2%) died, 888 of whom died of head and neck cancer-related causes.
Median OS was 40 months (range, 3-133).
Cause-specific survival was significantly higher in patients who underwent IMRT compared with those who underwent non-IMRT (84.1% vs. 66%; P<.001).
Researchers observed superior cause-specific survival among patients who underwent IMRT vs. non-IMRT regardless of the anatomic subsite of their cancer.
To account for potential biases in patients selected for IMRT vs. non-IMRT, researchers also compared IMRT recipients with a propensity score matching cohort that accounted for sex, race/ethnicity, marriage, rural vs. urban residence, income, education, year of diagnosis, Charlson comorbidity index, head and neck subsite, and physician experience.
Results of the matched-pair analysis indicated cause-specific survival was still significantly improved in patients treated with IMRT (HR=0.72; 95% CI, 0.59-0.9).
“This analysis revealed that patients treated with IMRT have less cancer-related deaths than those treated with traditional techniques,” Beadle said in a press release. “So, not only do they have fewer side effects, but they also have fewer life-threatening recurrences. An investment in IMRT may be cost-effective because it is better at both preventing side effects and cancer recurrence.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Daniel J. Haraf, MD
In the environment of increasingly expensive technology and limited health care dollars, doctors and insurers wonder whether newer, more expensive technology results in a better outcome. This debate is certainly ongoing with proton therapy. The paper by Beadle and colleagues is an insightful analysis that provides evidence to help answer the cost-vs.-benefit question for IMRT in the treatment of head and neck cancers. Several papers have shown a decrease in toxicity with IMRT. This paper reports an improvement in survival with IMRT. Thus, the increased cost associated with IMRT can be justified. Although all retrospective studies must be interpreted with caution, the authors were as rigorous as possible in the analysis considering the limitations inherent in the data. The gold standard has always been a randomized phase 3 trial. I think that would be unethical for head and neck cancer at this time.
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