Longitudinal Oncology Registry Of Head And Neck Carcinoma (Lorhan): Preliminary Report Regarding Radiation Patterns Of Care

We report initial patterns of care findings for LORHAN, a new, prospective, longitudinal, observational national registry of head and neck carcinoma (HNC) patients (pts). This report describes initial patient characteristics and therapies with a focus on radiation practice for pts who have completed therapy. Pts with newly diagnosed HNC, scheduled to receive radiotherapy (RT) or drug therapy, >/=18 years of age and providing written informed consent are being enrolled. Patient data are entered in the registry from initial diagnosis through follow-up for a minimum of 2 years and up to 10. Detailed information on initial treatment and re-treatment is collected. Both community and academic investigators are participating in LORHAN. LORHAN was launched in October 2005 and as of February 2008, 1447 pts have been enrolled; 1101 are evaluable for baseline assessment and 746 have completed initial treatment, of which 724 received RT. Baseline characteristics are similar between academic and community settings, except for age, performance status and staging. Pts treated in academic settings are significantly younger (61 vs. 57; p < 0.0001), have a poorer performance status (mean Zubrod: 1 vs. 0.7; p < 0.0001) and have more advanced disease (Stage IV: 71 vs. 47%; p < 0.0001) than pts treated in the community. The 3 most common tumor sites treated were oropharynx, 42%, larynx, 21% and oral cavity, 17%. Less than 20% of pts overall were enrolled in clinical trials. Sixty-six percent of pts received chemotherapy concurrently with RT and 33% received postoperative RT. The most common form of RT delivered in both settings was IMRT; however, IMRT was delivered more frequently to pts treated in academic settings (87 vs. 71% pts; p < 0.0001). The most common fractionation schedule used in 80% of pts was once daily, 5 fractions per week. Concomitant boost was delivered more frequently in academic vs. community settings (16 vs. 2% patients; p < 0.0001). The median dose was 69 Gy (interquartile range (IQR), 65 -70 Gy). The median number of fractions was 33 (IQR, 30 - 35) and the median number of treatment days was 47 (IQR, 43 - 53). Ninety-two percent of pts were noted as having completed the RT schedule intended. The most common drugs delivered concurrently with RT were cisplatin (59% of pts), followed by cetuximab (21% of pts). LORHAN is a new national initiative that intends to further the understanding of the pattern of care of HNC pts across practice settings. This initial report indicates that the majority of HNC pts are treated with concurrent chemoradiation regimens and that IMRT has been broadly adopted into both community and academic practice. The majority of pts are treated with once daily fractionation. Outcome data are maturing.