title: Institutional clinical trial accrual volume and survival of patients with head and neck cancer.
abstract: OBJECTIVE
  National Comprehensive Cancer Network guidelines recommend patients with head and neck cancer (HNC) receive treatment at centers with expertise, but whether provider experience affects survival is unknown.
  
  
  METHODS
  The effect of institutional experience on overall survival (OS) in patients with stage III or IV HNC was investigated within a randomized trial of the Radiation Therapy Oncology Group (RTOG 0129), which compared cisplatin concurrent with standard versus accelerated fractionation radiotherapy. As a surrogate for experience, institutions were classified as historically low- (HLACs) or high-accruing centers (HHACs) based on accrual to 21 RTOG HNC trials (1997 to 2002). The effect of accrual volume on OS was estimated by Cox proportional hazards models.
  
  
  RESULTS
  Median RTOG accrual (1997 to 2002) at HLACs was four versus 65 patients at HHACs. Analysis included 471 patients in RTOG 0129 (2002 to 2005) with known human papillomavirus and smoking status. Patients at HLACs versus HHACs had better performance status (0: 62% v 52%; P = .04) and lower T stage (T4: 26.5% v 35.3%; P = .002) but were otherwise similar. Radiotherapy protocol deviations were higher at HLACs versus HHACs (18% v 6%; P < .001). When compared with HHACs, patients at HLACs had worse OS (5 years: 51.0% v 69.1%; P = .002). Treatment at HLACs was associated with increased death risk of 91% (hazard ratio [HR], 1.91; 95% CI, 1.37 to 2.65) after adjustment for prognostic factors and 72% (HR, 1.72; 95% CI, 1.23 to 2.40) after radiotherapy compliance adjustment.
  
  
  CONCLUSIONS
  OS is worse for patients with HNC treated at HLACs versus HHACs to cooperative group trials after accounting for radiotherapy protocol deviations. Institutional experience substantially influences survival in locally advanced HNC.
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA. evan.wuthrick@osumc.edu.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Wuthrick
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Machtay
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Phuc Felix
authors.initials: PF
authors.lastname: Nguyen-Tan
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: André
authors.initials: A
authors.lastname: Fortin
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Craig L
authors.initials: CL
authors.lastname: Silverman
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Adam
authors.initials: A
authors.lastname: Raben
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Harold E
authors.initials: HE
authors.lastname: Kim
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Horwitz
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Read
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Harris
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Qian
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Quynh-Thu
authors.initials: QT
authors.lastname: Le
authors.affiliation: Evan J. Wuthrick and Maura L. Gillison, Ohio State University Medical Center, Columbus; Mitchell Machtay, Case Western Reserve University, Cleveland, OH; Qiang Zhang, Jonathan Harris, and Qian Wu, Radiation Therapy Oncology Group Statistical Center; Eric M. Horwitz, Fox Chase Cancer Center, Philadelphia, PA; David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Phuc Felix Nguyen-Tan, Centre Hospitalier de l'Université de Montréal-Notre Dame, Montreal; André Fortin, Hôtel-Dieu de Quebec, Quebec City, Quebec; Nancy E. Read, Western University, London Regional Cancer Center, London, Ontario, Canada; Craig L. Silverman, James Graham Brown Cancer Center, University of Louisville, Louisville, KY; Adam Raben, Christiana Care Helen F. Graham Cancer Center, Newark, DE; Harold E. Kim, Wayne State University, Detroit, MI; and Quynh-Thu Le, Stanford University, Palo Alto, CA.
authors.forename: Maura L
authors.initials: ML
authors.lastname: Gillison
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000627:therapeutic use*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D011446:Prospective Studies
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin