Explore This IssueMay 2013
The idea was to use a prospective, observational study to get a better handle on the value of coordination in these complex cases, although at this point in the research, outcomes haven’t been ascertained. “Surgery, radiation therapy and chemotherapy all have significant and overlapping roles in the treatment of head and neck cancers,” Dr. Zanation said.
Researchers characterized the frequency of changes in the histopathological diagnosis, tumor staging and treatment as a result of the MDTC, along with the nature of those changes. All new head and neck tumor patients who were presented at the MDTC were included in the study, but patients previously treated or receiving follow-up care were not. Ultimately, 413 patients were enrolled.
The most common tumor sites were the oral cavity and oropharynx, followed by sinonasal and skull base, with 287 malignancies, 88 benign lesions and 38 masses that couldn’t be definitely diagnosed at the outset. Primary squamous cell carcinoma was the most common histopathological diagnosis, accounting for 44 percent of the tumors. Data collected by the intake physician was compared with data collected after MDTC re-review, and the main outcomes were straightforward, Dr. Zanation said: “Did we change pathologic diagnosis? Did we change stage? Did we change treatment?”
Researchers found a change in the histopathological diagnosis in 12 percent of the cases, including 7 percent originally designated as malignant, 8 percent of those that were benign and 61 percent in which the pathology was initially unknown.
Nine percent of patients had a change in T classification, 9 percent had a change in N classification and 4 percent had a change in M classification, with 24 percent having a change in more than one classification. Changes in stage appeared to be associated with an initial T classification, but not with N or M. Patients with an initial T2 classification had a change in stage 15 percent of the time, compared with 8 or 9 percent of the time for T0, T1 and T3 classifications and in no cases for T4.
An “intermodality” treatment change (in which a treatment method was changed, added or deleted) happened in 27 percent of cases, with escalation of treatment in 17 percent. An “intramodality” treatment change, such as moving from a unilateral to a bilateral neck dissection, occurred in 14 percent of all cases.
For both intermodal and intramodal changes, the change was more likely to be an escalation—an addition of a modality, such as adding radiation to chemotherapy—rather than a de-escalation or a lateral change, Dr. Zanation said. The same pattern was seen for intramodal changes.