NEW YORK (Reuters Health) Jan 13 - Intensity-modulated radiation therapy (IMRT) offers better cause specific survival than other methods of delivering radiation therapy in patients with head and neck cancer, according to data from the SEER-Medicare linked database.
"We were surprised that IMRT conferred better cancer outcomes than conventional treatment, and we did multiple rigorous statistical analyses to support this conclusion," Dr. Beth Michelle Beadle from the University of Texas MD Anderson Cancer Center in Houston told Reuters Health.
"We believe that this is due to the ability to better target the tumor, increase the dose to the area of interest, and not need to compromise coverage in order to spare normal tissues," she said.
An earlier analysis showed no differences in survival between IMRT and non-IMRT for patients treated from 2002 through 2005.
In light of the increase in the use of IMRT and in the expertise of practitioners over the last decade, Dr. Beadle and colleagues used data from the SEER-Medicare linked database to analyze cause-specific survival (CSS) for patients with head and neck cancer treated with IMRT, compared with those treated with conventional radiotherapy (non-IMRT).
Among the 3172 patients in their January 13th Cancer online report, 1,056 (33.3%) received IMRT and 2,116 (66.7%) did not.
Median overall survival was 40 months, and cause specific survival was significantly better with vs without IMRT (38.9% vs 18.9%; p<0 .0001="" p="">
When a propensity score model was used to account for differences in the IMRT and non-IMRT populations, patients treated with IMRT continued to have a 28% lower risk of dying from head and neck cancer than did patients treated with non-IMRT. An instrumental variable method yielded similar results.
In the adjusted analyses, overall survival did not differ significantly between IMRT and non-IMRT patients.
"I believe that the randomized data comparing IMRT to conventional therapy, including the PARSPORT trial among others, firmly establish that IMRT confers fewer side effects than conventional radiation," Dr. Beadle said. "Our work shows that it may also improve cancer outcomes. For both of those reasons, it should be standard of care for head and neck cancer."
"Fundamentally, all of us want to cure cancer with a minimum of short and long term side effects," Dr. Beadle said. "This is especially true for head and neck cancer, which can be devastating in terms of long term side effects (speaking, swallowing, dry mouth, dental complications, etc.) and in the event of life-threatening recurrence."
"IMRT is superior in both reducing side effects, as shown in prior studies, and in improving outcomes, as shown here," Dr. Beadle concluded. "Although it has a higher upfront cost, both in time and money, it is ultimately cost-effective and, most importantly, it benefits our patients."
SOURCE: http://bit.ly/19q9qfZ
Cancer 2014.
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