Abstract
Simple SummarySurgery, radiotherapy, and chemotherapy/immunotherapy as monotherapy or in combination are the pillars of the treatment of head and neck cancer (HNC). Nation-wide population-based data on treatment rates per population and year for HNC are sparse. The data of virtually all HNC cases (apart from thyroid cancer) treated as inpatients in Germany between 2005 and 2018 were analyzed. Treatment rates for nearly all treatment types increased for cancer of the oral cavity, oropharynx, and salivary glands. Treatment rates for nasopharyngeal cancer in both sexes and hypopharyngeal cancer in men mainly decreased. In women, surgery for hypopharyngeal cancer decreased, but radiotherapy, chemotherapy, or in combination, increased. Laryngeal cancer showed a mixed picture: Surgery and neck dissection decreased in men and remained unchanged in women, whereas radiotherapy, chemotherapy, or in combination, remained unchanged in men, but increased in women. Changes in treatment are dependent on the subsites and are different for men and women for several subsites.Advances in head and neck cancer (HNC) treatment might have changed treatment strategies. This study determined, with focus on gender disparity, whether treatment rates have changed for inpatients in Germany between 2005 and 2018. Nation-wide population-based diagnosis-related groups (DRG) data of virtually all HNC cases (1,226,856 procedures; 78% men) were evaluated. Poisson regression analyses were used to study changes of annual treatment rates per German population. For surgery, the highest increase was seen for women with cancer of the oral cavity (relative risk (RR) 1.14, 95% confidence interval (CI) 1.11–1.18, p < 0.0001) and the highest decrease for men with laryngeal cancer (RR 0.90, CI 0.87–0.93). In women with oropharyngeal cancer, the highest increase of radiotherapy rates was seen (RR 1.18, CI 1.10–1.27, p < 0.0001). A decrease was seen in men for hypopharyngeal cancer (RR 0.93, CI 0.87–0.98, p = 0.0093). The highest increase for chemotherapy/immunotherapy was seen for women with oropharyngeal cancer (RR 1.16, CI 1.08–1.24, p < 0.0001), and a decrease in men with hypopharyngeal cancer (RR 0.93, CI 0.88–0.97, p = 0.0014). Treatment patterns had changed for nearly all subsites and therapy types. There were relevant gender disparities, which cannot be explained by the DRG data.
Highlights
Head and neck cancer (HNC) is the seventh most common type of cancer worldwide [1]
Radiotherapy rates were headed by cancer of the oral cavity (5.95 ± 0.54), followed by oropharyngeal cancer (4.13 ± 0.44)
The chemotherapy/immunotherapy rates were dominated by oral cavity cancer (5.82 ± 0.59), oropharyngeal cancer (4.15 ± 0.42), and hypopharyngeal cancer (4.08 ± 0.39)
Summary
HNC represents a diverse group of tumor entities covering several anatomical subsites in the upper aerodigestive region. These entities differ greatly in terms of etiology, risk factors, histology, and therapeutic management. A monotherapeutic approach (surgery alone or radiotherapy alone) is used for early-stage disease, whereas locally-advanced stages are treated by multimodal approaches [1,4,5]. Cetuximab as a first monoclonal antibody was licensed in 2006, first in systematic treatment concepts for recurrent or metastatic disease, and later on as substitute for chemotherapy/immunotherapy in curative radiotherapy concepts [6]. The first checkpoint inhibitor as new treatment option was licensed in 2017, did not play a role in the examined period from 2005 to 2018 [7]
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