title: Guidelines in head and neck oncology compliance and consequences of deviations from the standard protocol for tongue and floor of mouth squamous carcinoma.
abstract: OBJECTIVE
  To investigate the extent of violation of a regional guideline for the treatment of patients with carcinoma of the tongue/floor of mouth (ICD0 C02, C04). Different aspects of protocol violation (i.e. undertreatment or overtreatment) and consequences for treatment outcome were evaluated.
  
  
  METHODS
  Retrospective analysis of data from medical records.
  
  
  METHODS
  The Department of Maxillofacial and Oral Surgery and the Department of Otorhinolaryngology and Head and Neck Surgery of the University Medical Centre Utrecht.
  
  
  METHODS
  A total of 217 patients treated between 1991 and 2001 for a stage II and stage III carcinoma of the tongue/floor of mouth.
  
  
  METHODS
  Protocol violation, tumour recurrence.
  
  
  RESULTS
  The overall adherence to the guideline was 55%. In the non-adherence group of patients, 21% were overtreated, 71% were undertreated, and 8% were both overtreated and undertreated. There was no statistically significant difference in tumour recurrence between the two groups for stage II (P=0.68) or stage III (P=0.97) disease, or between undertreatment and overtreatment of patients with stage II (P=0.47) or stage III (P=0.90) disease.
  
  
  CONCLUSIONS
  Although protocol violation occurs in as many as 45% of patients, this does not result in a worse tumour recurrence. Neither overtreatment nor undertreatment appears to affect the overall tumour recurrence.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands. m.c.j.aarts@kmb.azu.nl
authors.forename: M C J
authors.initials: MC
authors.lastname: Aarts
authors.forename: T T
authors.initials: TT
authors.lastname: Hogen Esch
authors.forename: C H J
authors.initials: CH
authors.lastname: Terhaard
authors.forename: R
authors.initials: R
authors.lastname: Koole
authors.forename: G J
authors.initials: GJ
authors.lastname: Hordijk
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009060:Mouth Floor; D009062:Mouth Neoplasms / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014062:Tongue Neoplasms / Q000628:therapy*; D016896:Treatment Outcome