title: Importance of treatment institution in head and neck cancer radiotherapy.
abstract: OBJECTIVE
  The treatment for head and neck cancer (HNC) often involves radiotherapy. Many HNC patients are treated at the academic center (AC) where the initial surgery or diagnosis was made. Because of the lengthy time course for radiotherapy, some patients are treated at community radiation facilities (non-AC) rather than the AC despite potential AC advantages in terms of experience and technology. Our goal is to determine if these potential AC advantages correspond to a difference in treatment outcome.
  
  
  METHODS
  Historical cohort study.
  
  
  METHODS
  University of Kansas Medical Center, Kansas City, Kansas.
  
  
  METHODS
  Review of records of patients with HNC cancers evaluated at the otolaryngology (ENT) department of an AC. Each patient's information and treatment characteristics were recorded, including radiotherapy treatment venue and treatment outcome.
  
  
  RESULTS
  Three hundred seventy-four patients were analyzed, 263 were treated at an AC and 101 at a non-AC. Patients treated at a non-AC were more likely to present with earlier stage tumors, be treated with radiation alone rather than chemoradiotherapy, and be treated with adjuvant rather than primary radiotherapy. There was no difference in overall survival or recurrence rates between AC and non-AC.
  
  
  CONCLUSIONS
  Patients treated at an AC are more likely to have advanced stage tumors and receive chemoradiotherapy as their primary treatment. In analyses of matching patient subsets, there was no significant difference in patient outcomes. Patients can be treated at a non-AC without affecting outcome compared with treatment at an AC.
authors: Department of Radiation Oncology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19147, USA. greg.Kubicek@jeffersonhospital.org
authors: Gregory J
authors: GJ
authors: Kubicek
authors: Fen
authors: F
authors: Wang
authors: Eashwar
authors: E
authors: Reddy
authors: Yelizaveta
authors: Y
authors: Shnayder
authors: Cristina E
authors: CE
authors: Cabrera
authors: Douglas A
authors: DA
authors: Girod
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007615:Kansas / Q000453:epidemiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000401:mortality / Q000532:radiotherapy* / Q000628:therapy; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome