The Laryngoscope Lippincott Williams & Wilkins, Inc. © 2006 The American Laryngological, Rhinological and Otological Society, Inc. Changes in Treatment of Advanced Oropharyngeal Cancer, 1985–2001 Amy Y. Chen, MD, MPH, FACS; Nicole Schrag, MSPH; Yongping Hao, PhD; Andrew Stewart, MS; Elizabeth Ward, PhD Objective: The aim of this study is to describe patterns of care of advanced oropharyngeal cancer during 1985 to 2001. Methods: We extracted oropha- ryngeal squamous cell cancer cases from the National Cancer Database. Type of initial treatment, type of facility, stage of tumor, payer status, and demo- graphic variables were collected. Fisher exact test was used to compare the patient demographic and clinical characteristics across facility types. Weighted least squares regression analysis was used to analyze treatment trends over time and t-tests were done to test for significance in trends. Results: A total of 54,801 cases were available for analysis. Teaching/research facilities treated a disproportionately higher number of advanced- stage cancers (81%, P < .01). In addition, these facilities treat a higher percentage of uninsured (7%, P < .01) and nonwhite patients (27%, P < .01). The use of organ preservation protocols (chemo- radiation) increased from 15% in 1985 to 29% in 2001 ( 1  0.0080, P < .05), whereas the use of radiation alone decreased from 42% in 1985 to 27% in 2001 ( 1 0.0118, P < .05). The use of cancer- directed surgery remained stable. There was no difference in rates of chemoradiation for ad- vanced oropharyngeal cancer across facility types. Conclusions: Our results suggest that che- moradiation is increasingly becoming more prev- alent at all facility types. The use of radiation alone as primary treatment significantly declined during the study period. In view of the complexity and multidisciplinary nature of treatment for oro- pharyngeal cancer, it is recommended that care of such patients be discussed at institutional tumor boards and that the recommendations be system- atically recorded and documented in hospital can- cer registries. Key Words: Oropharyngeal cancer, patterns of care, chemoradiation. Laryngoscope, 117:16 –21, 2007 INTRODUCTION Oropharyngeal cancer involves the soft palate, tonsil, base of the tongue, and vallecula and is diagnosed in nearly 9,000 men and women in the United States annu- ally. 1 The majority of these cancers originate in the base of the tongue and tonsils and more than 90% are squamous cell carcinomas. 2 For many years, surgery followed by radiotherapy or radiotherapy alone was considered the standard treatment for advanced oropharyngeal cancer. Unfortunately, patients with advanced disease treated with surgical resection experience impairment of swallow- ing and speech, leading to decreased quality of life in many aspects, including nutrition, social functioning, and personal hygiene. 3 Progress in nonsurgical treatment for advanced- stage head and neck cancer began more than a decade ago, in 1991. The results of a prospective, randomized clinical trial, the Veterans’ Administration (VA) Laryngeal Can- cer Study, were published. 4 In this landmark study, more than 300 patients with stage III or IV laryngeal cancer were randomized to two arms of treatment: induction chemotherapy with cisplatin and fluorouracil and radio- therapy or total laryngectomy followed by radiotherapy. Close to two-thirds (62%) of the patients in the chemother- apy and radiation arm were able to preserve their larynx with no significant differences in overall survival between the nonsurgical and surgical arms of the study. After the completion of the VA Laryngeal Cancer Study, the Head and Neck Intergroup in the United States initiated the RTOG 91 to 11 study to determine the precise role of chemotherapy. 5 Concurrent chemotherapy with radiation offered the highest laryngeal preservation rate (88%) as compared with radiation alone (70%, P  .001) and induc- tion chemotherapy followed by radiation (74%, P = .005). This study solidified the use of chemotherapy and radia- tion as a valid treatment option for patients desiring laryngeal-preservation treatment. The findings of the laryngeal cancer clinical trials were extrapolated for use in other organ sites, including the oropharynx. In 1999, Calais and colleagues reported From Emory University School of Medicine (A.Y.C.), Atlanta, Georgia, U.S.A.; the American Cancer Society (A.Y.C., N.S., Y.H., E.W.), Atlanta, Geor- gia, U.S.A.; and the American College of Surgeons (A.S.), Chicago, Illinois, U.S.A. Editor’s Note: This Manuscript was accepted for publication July 17, 2006. Presented at the Annual Meeting of the Triological Society, Chicago, Illinois, U.S.A., May 21, 2006. Send correspondence to Amy Y. Chen, MD, MPH, FACS, 1599 Clifton Rd. NE, Atlanta, GA 30329, U.S.A. E-mail: amy.chen@cancer.org DOI: 10.1097/01.mlg.0000240182.61922.31 Laryngoscope 117: January 2007 Chen et al.: Changes in Treatment of Advanced Oropharyngeal Cancer 16