title: Patterns of care and outcomes associated with intensity-modulated radiation therapy versus conventional radiation therapy for older patients with head-and-neck cancer.
abstract: OBJECTIVE
  Intensity-modulated radiation therapy (IMRT) requires a high degree of expertise compared with standard radiation therapy (RT). We performed a retrospective cohort study of Medicare patients treated with IMRT compared with standard RT to assess outcomes in national practice.
  
  
  METHODS
  Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, we identified patients treated with radiation for cancer of the head and neck from 2002 to 2005. We used multivariate Cox models to determine whether the receipt of IMRT was associated with differences in survival.
  
  
  RESULTS
  We identified 1613 patients, 33.7% of whom received IMRT. IMRT was not associated with differences in survival: the 3-year overall survival was 50.5% for IMRT vs. 49.6% for standard RT (p = 0.47). The 3-year cancer-specific survival was 60.0% for IMRT vs. 58.8% (p = 0.45).
  
  
  CONCLUSIONS
  Despite its complexity and resource intensive nature, IMRT use seems to be as safe as standard RT in national community practice, because the use of IMRT did not have an adverse impact on survival.
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA. james.b.yu@yale.edu
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.forename: Pamela R
authors.initials: PR
authors.lastname: Soulos
authors.forename: Richa
authors.initials: R
authors.lastname: Sharma
authors.forename: Danil V
authors.initials: DV
authors.lastname: Makarov
authors.forename: Roy H
authors.initials: RH
authors.lastname: Decker
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Smith
authors.forename: Rani A
authors.initials: RA
authors.lastname: Desai
authors.forename: Laura D
authors.initials: LD
authors.lastname: Cramer
authors.forename: Cary P
authors.initials: CP
authors.lastname: Gross
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018426:SEER Program / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology