What is the impact of delays in postoperative head and neck (HN) chemoradiotherapy on overall survival?
An overall treatment time (OTT) of greater than approximately 14 weeks most consistently increased the risk of death. Assuming they can complete a six-week treatment regimen without breaks, patients should start chemoradiotherapy within eight weeks of surgery.
Explore this issue:October 2018
Background: Delays in adjuvant HN treatment can result in decreased disease control and survival. Two large clinical trials established the role of combined adjuvant radiation therapy with chemotherapy in selected high-risk locally advanced HN cancers. Limited data has been reported on the timing of adjuvant HN radiation therapy when given concurrently with chemotherapy.
Study design: Retrospective case review of 16,733 patients with non-metastatic HN cancer (oral cavity, oropharynx, larynx, hypopharynx) who underwent curative intent surgery and received adjuvant chemoradiotherapy between 2004 and 2012.
Setting: National Cancer Database.
Synopsis: The median follow-up time was 37 months, and in the entire cohort, the median age was 56 years; seventy-five percent had pathologic stage III to IV disease; 41% had oral cavity subsite; 28% had pathologic ECE; 29% had a positive margin; and 81% had a Charlson/Deyo score of 0. An overall OTT of >13 weeks was associated with higher stage, female gender, black race, lower grade, pathologic extracapsular extension (ECE), higher Charlson/Deyo score, oral cavity subsite, non–HPV-positive, negative margins, lower education, lower income, and lower likelihood to have private insurance/managed care.
On multivariate analysis, an OTT of >13 weeks versus <13 weeks independently increased mortality risk. Additional independent increased mortality risk predictors included older age, advanced stage (stage III–IV), grade, non–HPV-positive disease, ECE, Charlson/Deyo score, positive margins, non-oropharyngeal HN subsites, positive pathologic nodes, lower income, insurance that was not private insurance/managed care, and distance to treatment center. The median time-to-treatment initiation (TTI) was 45 days. The median treatment duration (TD) was 51 days. A TTI of >6 weeks versus <6 weeks and a TD of >8 weeks versus <8 weeks independently predicted increased mortality risk.
Limitations included lack of cancer-specific outcomes, as well as potential selection bias, incomplete data, coding errors, and unreported data.
Citation: Tam M, Wu SP, Gerber NK, et al. The impact of adjuvant chemoradiotherapy timing on survival of head and neck cancers [published online ahead of print February 26, 2018]. Laryngoscope.