Lack of Evidence
Making matters more difficult, there is no good evidence to guide doctors on surgery, he said.
Explore This IssueJune 2011
“The best data, the Level I evidence, is all about irradiation and chemotherapy,” he said. “There is no Level I evidence in surgery. What are we going to do about it? Well, we need articulate leadership. We need Level I evidence.”
He complimented a plan recently discussed by Randal Weber, MD, FACS, of the M.D. Anderson Cancer Center in Houston, to formally develop clinical investigators. But that alone won’t be enough, Dr. Johnson said.
“I think it’s great—I think the major medical centers should do that,” he said. “But I think it’s too late. If we wait until Randy Weber makes clinical investigators for us, we will not know how to do the procedures that need to be done to save people from chemoradiation. We have to collaborate today. We have to talk about it, figure it out, and do it.”
Dr. Mendenhall, a professor at the University of Florida College of Medicine in Gainesville who specializes in head and neck cancer, recently wrote an editorial for Cancer on the same topic.
“I agree completely with Dr. Johnson,” he said. “Organ preservation, for advanced laryngeal and hypopharyngeal cancer in particular, is being overused with, in cases of high-volume cancers, resultant poor cure rates and bad functional outcomes,” he said. “There are other outcomes of importance in addition to overall survival.”