Excerpt

This is a comparative effectiveness review of alternative radiation therapy (RT) modalities in the treatment of head and neck cancer including: conventional or two-dimensional (2DRT), three-dimensional conformal (3DCRT), intensity-modulated (IMRT), and proton beam radiotherapy. Key questions that will be addressed are whether any of these modalities is more effective than the others: (1) in reducing normal tissue toxicity and adverse events, and improving quality of life; (2) in improving local tumor control, time to disease progression, and survival; (3) when used in certain anatomic locations or patient subpopulations; and, finally, (4) whether there is more variation in patient outcomes with any modality secondary to user experience, treatment planning, or target volumes.

Contents

• Preface
• Acknowledgments
• Executive Summary
  • Background
  • Key Questions
  • Conclusions
  • Remaining Issues
• Introduction
  • Background
  • Key Questions for this Comparative Effectiveness Review
• Methods
  • Topic Development
  • Search Strategy
  • Study Selection
  • Data Extraction and Analysis
  • Assessment of Study Quality
  • Assessment of Applicability
  • Data Synthesis
  • Rating the Body of Evidence
  • Quality of Life and Symptom Measurement
  • Peer Review and Public Commentary
• Results
  • Search Results
  • Organization of Results Chapter
  • Key Question 1. What is the comparative effectiveness of IMRT, 3DCRT, 2DRT, and proton beam therapy regarding adverse events and quality of life? AND Key Question 2. What is the comparative effectiveness of IMRT, 3DCRT, 2DRT, and proton beam therapy regarding tumor control and patient survival?
  • Key Question 3. Are there differences in comparative effectiveness of IMRT, 3DCRT, 2DRT and proton beam therapy for specific patient and tumor characteristics?
  • Key Question 4: Is there variation in comparative effectiveness of IMRT, 3DCRT, 2DRT and proton beam therapy because of differences in user experience, target volume delineation, or dosimetric parameters?
  • Proton Beam Therapy
• Summary and Discussion
• Future Research
• References
• Abbreviations
• Appendixes
  • Appendix A Exact Search Strings
  • Appendix B Excluded Studies
  • Appendix C Summary Tables and Figures
  • Appendix D Comparative Studies: Full Evidence/Data Abstraction Tables
  • Appendix E Single-Arm Studies

Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services.¹ Contract No. 290-02-0026. Prepared by: Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center.

Suggested citation:

Samson D J, Ratko TA, Rothenberg BM, Brown HM, Bonnell CJ, Ziegler KM, Aronson N. Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer. Comparative Effectiveness Review No. 20. (Prepared by Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center under Contract No. 290-02-0026.) Rockville, MD: Agency for Healthcare Research and Quality, May 2010. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.

This report is based on research conducted by the Blue Cross and Blue Shield Association Technology Evaluation Center Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-02-0026).The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of the Agency for Healthcare Research and Quality or of the U.S. Department of Health and Human Services.

This report is intended as a reference and not as a substitute for clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information.

This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.

None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.

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