Treatment of upper aerodigestive tract cancers in England and its effect on survival

The evidence base for head and neck cancers is low with relatively few rand omized controlled trials of the two main treatments, surgery and radiothera py. The aim of the study was to investigate the patterns of surgery and rad iotherapy treatment for head and neck cancers in three large areas of Engla nd and to investigate their effects on survival. This was a retrospective s tudy of 13 510 cases of head and neck cancers (ICD10: C00-C14, C30-C32) dia gnosed and treated from 1984 to 1992 in England. We undertook multivariate analyses of survival using a step-wise Cox proportional hazard model and Ka plan-Meier analysis. There were regional variations in the treatments given to patients. Four in ten patients did not receive currently recommended tr eatments. In multivariate analyses treatment content and timing had an inde pendent effect on survival. Better survival was associated with surgery for mouth cancers, radiotherapy for laryngeal cancers and combined treatment f or pharyngeal cancers independent of tumour and demographic factors. Furthe r research is needed to investigate the findings of this study through targ e randomized controlled trials and multi-centre audits. (C) 1999 Cancer Res earch Campaign.