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Effect of time to initiation of postoperative radiation therapy on survival in surgically managed head and neck cancer
Author(s) -
Graboyes Evan M.,
GarrettMayer Elizabeth,
Ellis Mark A.,
Sharma Anand K.,
Wahlquist Amy E.,
Lentsch Eric J.,
Nussenbaum Brian,
Day Terry A.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30939
Subject(s) - medicine , hazard ratio , propensity score matching , confidence interval , proportional hazards model , surgery , port (circuit theory) , head and neck squamous cell carcinoma , head and neck cancer , cancer , radiation therapy , survival analysis , oncology , electrical engineering , engineering
BACKGROUND The objective of this study was to determine the effects of National Comprehensive Cancer Network (NCCN) guideline–adherent initiation of postoperative radiation therapy (PORT) and different time‐to‐PORT intervals on the overall survival (OS) of patients with head and neck squamous cell carcinoma (HNSCC). METHODS The National Cancer Data Base was reviewed for the period of 2006‐2014, and patients with HNSCC undergoing surgery and PORT were identified. Kaplan‐Meier survival estimates, Cox regression analysis, and propensity score matching were used to determine the effects of initiating PORT within 6 weeks of surgery and different time‐to‐PORT intervals on survival. RESULTS This study included 41,291 patients. After adjustments for covariates, starting PORT >6 weeks postoperatively was associated with decreased OS (adjusted hazard ratio [aHR], 1.13; 99% confidence interval [CI], 1.08‐1.19). This finding remained in the propensity score–matched subset (hazard ratio, 1.21; 99% CI, 1.15‐1.28). In comparison with starting PORT 5 to 6 weeks postoperatively, initiating PORT earlier was not associated with improved survival (aHR for ≤ 4 weeks, 0.93; 99% CI, 0.85‐1.02; aHR for 4‐5 weeks, 0.92; 99% CI, 0.84‐1.01). Increasing durations of delay beyond 7 weeks were associated with small, progressive survival decrements (aHR, 1.09, 1.10, and 1.12 for 7‐8, 8‐10, and >10 weeks, respectively). CONCLUSIONS Nonadherence to NCCN guidelines for initiating PORT within 6 weeks of surgery was associated with decreased survival. There was no survival benefit to initiating PORT earlier within the recommended 6‐week timeframe. Increasing durations of delay beyond 7 weeks were associated with small, progressive survival decrements. Cancer 2017;123:4841‐50 . © 2017 American Cancer Society .