Abstract
OBJECTIVE:This study aimed to evaluate the effect of the delay to initiate postoperative radiation therapy (RT) on locoregional control to head and neck squamous cell carcinoma patients.METHODS:Retrospective cohort study that included patients submitted to surgery followed by adjuvant RT (with/without chemotherapy). The time interval between surgery and RT was dichotomized by the receiver operating characteristics curve method at 92 days. Other possible sources of heterogeneity with potential impact on locoregional control were explored by regressive analysis.RESULTS:A total of 168 patients were evaluated. The median time for locoregional recurrence (LRR) was 29.7 months. The relapse-free survival rates were 66.4% and 75.4% for patients who initiated RT more than and within 92 postoperative days (p=0.377), respectively. Doses lower than 60Gy were associated with worse rates of locoregional control (HR=6.523; 95%CI:2.266-18.777, p=0.001). Patients whose total treatment time (TTT) was longer than 150 days had LRR rate of 41.8%; no patient with TTT inferior to 150 days had relapses (p=0.001).CONCLUSIONS:The interval between surgery and RT did not show influence on locoregional control rates. However, doses <60Gy and the total treatment time >150 days were associated with lower locoregional control rates.
Highlights
Two-thirds of all head and neck squamous cell carcinoma (HNSCC) patients are diagnosed at advanced clinical stages, which is related to a dismal prognosis [1,2]
Patients included were those diagnosed with HNSCC without distant metastasis who underwent surgical resection with curative intent followed by postoperative radiation therapy (RT), with or without adjuvant chemotherapy, from January 2009 to January 2015 at a single institution
In order to quantify the percentage of patients who were able to follow the National Comprehensive Cancer Network’s recommendation and started RT within 6 weeks postoperatively [11], Ho et al [24] evaluated a database of 15 064 patients and Graboyes et al [13] evaluated 41,291 patients with HNSCC submitted to surgical resection followed by postoperative RT
Summary
Two-thirds of all head and neck squamous cell carcinoma (HNSCC) patients are diagnosed at advanced clinical stages, which is related to a dismal prognosis [1,2]. The management of these patients with locally advanced disease must include a multimodal strategy including surgery, radiation therapy (RT), and systemic therapies [3]. Received for publication on March 9, 2020. Accepted for publication on April 8, 2020
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