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document
Institutional clinical trial accrual volume and survival of patients with head and neck cancer . 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 .
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Intervention_Physical
cisplatin concurrent with standard versus accelerated fractionation radiotherapy
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Intervention_Pharmacological
.
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Outcome_Other
Median RTOG accrual
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Outcome_Other
Radiotherapy protocol deviations
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Outcome_Mortality
OS
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Outcome_Mortality
death risk
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Participant_Condition
head and neck cancer
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Participant_Condition
head and neck cancer
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Participant_Condition
HNC
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Participant_Condition
stage III or IV HNC
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Participant_Condition
HNC
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Participant_Sample-size
471
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Participant_Condition
known human papillomavirus and smoking status