This work has been accepted for an oral presentation at the 2013 Annual Meeting of the American Society for Radiation Oncology (ASTRO), September 22-25, 2013, Atlanta, Georgia.
Improved survival using intensity-modulated radiation therapy in head and neck cancers: A SEER-Medicare analysis
Article first published online: 13 JAN 2014
© 2013 American Cancer Society
Volume 120, Issue 5, pages 702–710, 1 March 2014
How to Cite
Beadle, B. M., Liao, K.-P., Elting, L. S., Buchholz, T. A., Ang, K. K., Garden, A. S. and Guadagnolo, B. A. (2014), Improved survival using intensity-modulated radiation therapy in head and neck cancers: A SEER-Medicare analysis. Cancer, 120: 702–710. doi: 10.1002/cncr.28372
We acknowledge that this study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute; the Office of Research, Development and Information, Centers for Medicare and Medicaid Services; Information Management Services (IMS), Inc.; and the SEER Program tumor registries in the creation of the SEER-Medicare database.
- Issue published online: 19 FEB 2014
- Article first published online: 13 JAN 2014
- Manuscript Accepted: 26 AUG 2013
- Manuscript Revised: 1 AUG 2013
- Manuscript Received: 28 JUN 2013
- head and neck cancer;
- intensity-modulated radiation therapy;
- oropharynx cancer;
- radiation oncology
Intensity-modulated radiation therapy (IMRT) is a technologically advanced, and more expensive, method of delivering radiation therapy with a goal of minimizing toxicity. It has been widely adopted for head and neck cancers; however, its comparative impact on cancer control and survival remains unknown. The goal of this analysis was to compare the cause-specific survival (CSS) for patients with head and neck cancers treated with IMRT versus non-IMRT from 1999 to 2007.
CSS was determined using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and analyzed regarding treatment details, including the use of IMRT versus non-IMRT, using claims data. Hazard ratios (HRs) were estimated by the frailty model with a propensity score matching cohort and instrumental variable analysis.
A total of 3172 patients were identified. With a median follow-up of 40 months, patients treated with IMRT had a statistically significant improvement in CSS compared with those treated with non-IMRT (84.1% versus 66.0%; P < .001). When each anatomic subsite was analyzed separately, all respective subgroups of patients treated with IMRT had better CSS than those treated with non-IMRT. In multivariable survival analyses, patients treated with IMRT were associated with better CSS (HR = 0.72, 95% confidence interval = 0.59 to 0.90 for propensity score matching; HR = 0.60, 95% confidence interval = 0.41 to 0.88 for instrumental variable analysis).
Patients with head and neck cancers who were treated with IMRT experienced significant improvements in CSS compared with patients treated with non-IMRT techniques. This suggests there may be benefits to IMRT in cancer outcomes, in addition to toxicity reduction, for this patient population. Cancer 2014;120:702–710. © 2013 American Cancer Society.