Study Suggests IMRT Improves Survival in Head and Neck Cancer

Beth Beadle, MD, PhD

Intensity-modulated radiation therapy (IMRT) improved survival and reduced toxicities compared with conventional radiation treatment in patients with head and neck cancer, according to a recent database analysis. The review was conducted by researchers at The University of Texas MD Anderson Cancer Center and was recently published in the journal Cancer.

IMRT was approved in 1999 to treat head and neck cancers and is designed to precisely target cancer cells while sparing nearby tissue. Although it is more expensive than conventional radiation, it has been widely adopted because it lowers toxicities such as xerostomia, dental complications, fibrosis, and motion impairments.

“Previous studies indicated that patients treated with IMRT did better when it came to treatment-related side effects, however these studies were not designed to examine survival,” said lead author Beth Beadle, MD, PhD, assistant professor in MD Anderson’s Department of Radiation Oncology, in a press release. “The survival data was not well-known because IMRT is intended to spare normal tissues but still deliver radiation to the tumor so previous models assumed it was equivalent survival at best.”

The researchers identified 3172 patients in the SEERMedicare database who had been treated for head and neck cancer between 1999 and 2007. Of the overall population, 1056 patients (33.3%) had received IMRT and 2116 (66.7%) were treated with conventional radiation. Overall, 1018 patients (32.1%) had surgery and adjuvant radiation therapy, and 2154 patients (67.9%) had definitive radiation therapy.

The most common type of head and neck cancer, squamous cell carcinoma, accounted for 91.2% of the study population. The primary cancer site among patients was oral cavity and oropharynx (58.3%), followed by larynx (18%) and hypopharynx (10.7%). The mean age at diagnosis was 72.2 years (range, 66-80). Primary outcome was identified as cause-specific survival (CSS), reflecting the chances of dying from head and neck cancer after 40 months of follow-up.

The study found that patients who were treated with IMRT had significantly improved CSS rates compared with patients who received conventional therapy: 84.1% versus 66% (P <.001).

“From a scientific perspective, the findings support the use of IMRT and suggests we can provide excellent care while optimizing cancer outcomes and reducing toxicities,” said Beadle. “At a more global level, with concerns about healthcare financing and resource allocation, IMRT is more expensive than conventional radiation therapy, but the data suggest it’s worth it.”

In their analysis, Beadle et al referenced a separate study by Yong et al that examined the cost-effectiveness of using IMRT to treat oropharynx cancer. The study by Yong et al concluded that the IMRT technology could prove to be more cost-effective and therapeutically effective by reducing the need for costly salvage therapy for tumor recurrences and for side-effect management expenses, even if the upfront radiotherapy costs are higher.

Beadle said that additional work is needed to further examine the cost-effectiveness of IMRT, but if the therapy can reduce or eliminate subsequent disease recurrences or treatment-related side effects, the impact on cost would be favorable.

References

1. Beadle BM, Liao KP, Elting LS, et al. Improved survival using intensity-modulated radiation therapy in head and neck cancers: a SEER-Medicare analysis [published online January 13, 2014]. Cancer. doi:10.1002/cncr.28372.
2. Yong JH, Beca J, O’Sullivan B, et al. Cost-effectiveness of intensity-modulated radiotherapy in oropharyngeal cancer. Clin Oncol (R Coll Radiol). 2012;24(7):532-538.