Impact of the treating institution on the survival of patients with head and neck cancer treated with concomitant alternating chemotherapy and radiation

Benasso, Marco; Lionetto, R.; Corvò, Renzo; Ponzanelli, A.; Vitale, Vito; Rosso, Riccardo

doi:10.1016/s0959-8049(03)00487-8

Cited by 24 publications

(29 citation statements)

References 7 publications

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“…Furthermore, most of these studies implemented short-term measures of morbidity and mortality, which are not appropriately extrapolated to cancer care. However, specific to head and neck cancer care, the previously discussed study by Benasso et al 15 indicates that treatment center volume significantly affects the prognosis of patients with head and neck cancer who are undergoing chemoradiotherapy. To improve the quality of head and neck cancer care through increased compliance with national guidelines, steps need to be taken toward educating community providers through dissemination of guidelines, implementation of multidisciplinary conferences, and regionalization of the care of this patient population.…”

Section: Commentmentioning

confidence: 99%

“…Furthermore, they found that these nonindicated procedures resulted in a higher rate of complications than indicated cases. Specific to head and neck cancer, Benasso et al 15 reported that patients in a clinical trial of chemoradiotherapy had a significantly better 3-year survival if they were treated by the coordinating medical center instead of by community affiliates. They attributed this to their finding that community hospitals had lower treatment compliance: they treated patients with lower doses of chemotherapy and radiation therapy than the coordinating medical center and were more likely than the coordinating medical center to delay treatment despite no reported differences in toxicity.…”

Section: Commentmentioning

confidence: 99%

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Prereferral Head and Neck Cancer Treatment

Lewis¹,

Hessel²,

Roberts³

et al. 2010

Arch Otolaryngol Head Neck Surg

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Objective To evaluate the prereferral treatment of patients referred to our tertiary care center with recurrent or persistent head and neck cancer for compliance with National Comprehensive Cancer Network (NCCN) guidelines. Design A prospective recruitment and retrospective chart review. Patients The study included new patients identified at multidisciplinary treatment planning conference from October 1, 2008, to February 1, 2009, who had received prior treatment at an outside institution and presented to our department with recurrent or persistent disease. Main Outcome Measures All facets of prior care were examined, including the time from initial symptoms to diagnosis and whether their prereferral treatment was compliant with or deviated from NCCN guidelines for head and neck cancer. Results A total of 566 consecutive new patients were identified, of whom 107 (18.9%) had persistent or recurrent disease. The average time from first presentation with initial symptoms to diagnosis among patients who presented with persistent disease was 23.8 weeks. Nearly half of the patients who presented with persistent or recurrent disease had either endocrine (21.5%) or cutaneous (24.2%) primary cancers, with the rest of the cases being distributed among 10 other sites. Of the patients who presented with recurrent or persistent disease, 43.0% had prereferral care that was noncompliant with NCCN guidelines. Of these patients, 58.7% had inadequate surgical management, 15.2% were treated for the wrong diagnosis, 10.9% received inadequate adjuvant therapy, 4.4% received inadequate radiotherapy, and 10.9% refused indicated recommended treatment. Conclusions Significant deviation from NCCN guidelines for head and neck cancer treatment was observed in the cohort of study patients. The failure to administer adjuvant therapy when indicated by NCCN guidelines is particularly concerning. Economic and noneconomic costs, including lost wages, cost of “do-over” therapy, and potentially diminished survival, are substantial. Measures to ensure that patients receive therapy according to guidelines should be a national priority.

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Section: Commentmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

Prereferral Head and Neck Cancer Treatment

Lewis¹,

Hessel²,

Roberts³

et al. 2010

Arch Otolaryngol Head Neck Surg

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“…In different studies, the stages (II-IV) are usually used for tumor size measure [5,[14][15][16], but we have not found detailed information on the possible correlation between N0 or N+ stages for chemotherapy response or recurrence rate. So far, in our earlier studies, we have not investigated these correlations [17,18].…”

Section: Introductionmentioning

confidence: 92%

Induction chemotherapy response and recurrence rates in correlation with N0 or N+ stage in oral squamous cell cancer (OSCC)

Olasz

Orsi

Markó

et al. 2010

Cancer Metastasis Rev

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The authors compared N0 with N+ cases in neoadjuvant chemotherapy regression and recurrence. During a 12-year period, 180 consecutive oral squamous cell cancer patients were observed. Of these patients, 78 were N0 and 102 N+ stages. The drugs used were as follows: bleomycin, vincristine, methotrexate, and mitolactol. After three courses of chemotherapy, the regression (complete response (CR), partial response (PR), and no response (NR)) and side effect rate were determined. All patients were operated on and observed for the number and localization of recurrences during 3 year follow-up time. The N0 cases came from T2-3, while N+ was from T2-4a (AJCC 2002). The regression in the N0 group was CR 46%, PR 53%, and NR 1%; but in the N+ group, it was CR 12%, PR 72%, and NR 16%. The regression rate was significantly higher (p = 0.00025) for N0 group than N+ group. The regression rate for T3 N0 was significantly higher (p = 0.055) than for T3 N+ cases. In the N0 stage, the regression rate was significantly higher (p = 0.0174) for T2 than T3. In N+ stage, there was no significant difference (p = 0.183) for T2-4a. The side effects were slight. The recurrence rate for the N0 group was significantly lower (15%, p = 0.000069), while for N+ group, it was 59%. The dependence in the T3 cases was also significant (p = 0.009) in the 3-year tumor-free survival. The N stage seems a more important prognostic factor for chemotherapy response and recurrence rate than the T stage. Stage III can be divided into subgroups without metastasis (III.a) and with metastasis (III.b.), based on significant difference in regression and recurrence rate.

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“…Protocol adherence affects the final results, and therefore, is of great importance in patients with a high risk of relapse. Benasso et al [37] and Peters et al [28] demonstrated that expertise (including the ability to maintain protocol adherence) has a great significance. The low compliance and safety issues related to platinum-RT treatment led the researchers to look at new combinations that may ensure activity with less toxicity.…”

Section: State Of the Artmentioning

confidence: 99%

Postoperative Therapy in Head and Neck Cancer: State of the Art, Risk Subset, Prognosis and Unsolved Questions

et al. 2011

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Head and neck cancer may be easily controlled at early stages, but resectable locally advanced disease often relapses at T and N sites. Therefore, adequate adjuvant treatment is of crucial importance for improving local control and/or survival. Unfortunately, little data are available on the adjuvant setting. Adjuvant radiotherapy is regarded as a standard approach for patients with locally advanced radically resected head and neck cancer, while postoperative chemotherapy alone cannot be considered outside of clinical trials. However, chemoradiotherapy is widely considered superior to radiotherapy in patients at a high risk of relapse and may be considered the standard treatment in this population. In this respect, in the last few decades, there has been a growing interest due to the emerging data on both tumor biology and clinical trials. Several pathological and molecular factors, affecting behavior and head and neck cancer prognosis, could allow for a better selection of postoperative treatment. More recently, new prognostic and predictive factors were identified, including biomolecular aspects, human papillomavirus infection and lifestyle. The integration of these new factors deserves dedicated clinical studies, but the available knowledge already allows some deductive hypotheses. We performed a review of the literature to analyze the role of therapy in the postoperative setting and to discuss both the possibility of a different approach to each class of risk and the unsolved question for which randomized trials are warranted.

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Impact of the treating institution on the survival of patients with head and neck cancer treated with concomitant alternating chemotherapy and radiation

Cited by 24 publications

References 7 publications

Prereferral Head and Neck Cancer Treatment

Prereferral Head and Neck Cancer Treatment

Induction chemotherapy response and recurrence rates in correlation with N0 or N+ stage in oral squamous cell cancer (OSCC)

Postoperative Therapy in Head and Neck Cancer: State of the Art, Risk Subset, Prognosis and Unsolved Questions

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