Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2012 Dec 1;118(23):5783-92. doi: 10.1002/cncr.27609. Epub 2012 May 8.
Detailed information about how patients with head and neck carcinoma (HNC) are treated across practice settings does not exist. The authors conducted a prospective, observational study to examine the patterns of care for a series of patients with newly diagnosed HNC in the United States and to test 2 hypotheses: 1) There is no difference in the pattern of care between community and academic settings; and 2) the results of major randomized clinical trials will change the pattern of care in both practice settings within 1 year of publication in peer-reviewed journals.
Patients aged ≥ 18 years were enrolled in the Longitudinal Oncology Registry of Head and Neck Carcinoma (LORHAN) after providing written informed consent if they had a confirmed diagnosis of new HNC and were scheduled to receive treatment other than surgery alone.
Between 2005 and 2010, 100 centers enrolled 4243 patients, including 2612 patients (62%) from academic investigators and 1631 patients (38%) from community centers. Initial treatments were radiation with concurrent chemotherapy (30%) or cetuximab (9%), adjuvant radiotherapy (21%), induction chemotherapy (16%), and other (24%). Intensity modulated radiation therapy was the dominant radiation technique (84%). Single-agent cisplatin was prescribed in nearly half of patients and more often in academic centers (53% vs 43% of patients; P < .0001). Single-agent cetuximab was the next most common drug used (19%) and was prescribed more frequently in community settings (24% vs 17%; P = .0001). The data rejected the 2 prospective hypotheses.
LORHAN documented differences in patient characteristics and treatments between community and academic settings for a large series of patients in the United States.
关于头颈部癌（HNC）患者在不同实践环境下的治疗细节信息尚不清楚。作者开展了一项前瞻性、观察性研究，以调查美国一系列新诊断为 HNC 的患者的治疗模式，并检验以下两个假设：1）社区和学术环境下的治疗模式没有差异；2）主要随机临床试验的结果将在同行评议期刊发表后 1 年内改变这两种实践环境下的治疗模式。
如果患者年龄≥18 岁，经书面知情同意后确诊为新发 HNC，且计划接受除单纯手术以外的治疗，将被纳入头颈部癌纵向肿瘤学登记（LORHAN）。
2005 年至 2010 年期间，100 个中心共纳入 4243 例患者，其中 2612 例（62%）来自学术研究者，1631 例（38%）来自社区中心。初始治疗包括放化疗同步（30%）或西妥昔单抗（9%）、辅助放疗（21%）、诱导化疗（16%）和其他（24%）。调强放疗是主要的放疗技术（84%）。近一半患者接受顺铂单药治疗，且学术中心接受顺铂单药治疗的患者更多（53%比 43%；P<0.0001）。其次常用的药物是西妥昔单抗单药（19%），且更多地应用于社区环境（24%比 17%；P=0.0001）。数据否定了前两个假设。
LORHAN 记录了美国大量患者在社区和学术环境下的患者特征和治疗方法的差异。
