medwireNews: Oncologists should work towards prompt delivery of postoperative radiotherapy in head and neck cancer patients, say US researchers who confirmed that delaying treatment has a negative impact on overall survival (OS).
“This study supports the use of adjuvant radiation therapy and current national guidelines to prevent delays over 50 days”, write Jeremy Harris, from Stanford University in California, and co-workers.
“A multitude of factors contribute to delayed radiation, so multidisciplinary teams and patients must be educated about the importance of timing, with all efforts made to avoid unnecessary delays”, they write in JAMA Otolaryngology – Head & Neck Surgery.
Using the National Cancer Database, the team identified 25,216 patients with nonmetastatic stage III–IV squamous cell carcinoma of the head and neck who underwent definitive surgery and adjuvant radiation between 2004 and 2013.
Median OS was determined to be 10.5 years for the 39% of patients who began radiotherapy within 42 days of their operation, falling to 8.2 years for the 19% of patients whose radiation started 43–49 days after surgery and 6.5 years for the remaining patients whose radiotherapy was started on day 50 or later.
Compared with patients whose surgery to radiotherapy interval was no longer than 42 days, patients with a delay of 50 days or longer had a significantly higher risk of mortality, with a hazard ratio (HR) of 1.07 after adjusting for a raft of confounding factors such as type of facility, length of postoperative hospital stay and treatment received.
The difference in survival did not reach significance for patients with a delay of 43–49 days versus 42 days or smaller, the authors report, but poor survival was also significantly predicted by a hospital stay of more than 7 days (HR=1.24), radiation dose (HR ranging from 1.08 to 1.68 for doses outside of 60–66 Gy), and no receipt of chemotherapy (HR=1.10).
Further analysis indicated that the impact of radiotherapy timing varied by tumour site. Whereas a delay of 50 days or longer versus no longer than 42 days did not impact the OS of patients with oral cavity or larynx disease, the delay was associated with significantly inferior OS for those with tumours of the hypophyarynx (HR=1.27), tonsil (HR=1.20) and nontonsil oropharynx (HR=1.38).
Indeed, even a delay of 43–49 days versus 42 days or shorter was significantly associated with poorer survival in patients with tonsil tumours, with a HR of 1.22, the investigators say.
Analysis of radiation fractionation data for 22,689 patients revealed that patients given accelerated fractionated (≥5.2 fractions/week) had a median OS of 9.5 years versus 8.3 years for those given standard treatment, and after adjusting for other factors, this translated to a significant OS benefit for accelerated fractionation (HR=0.93).
“Thus, this study supports considering accelerated fractionation for patients at high risk for locoregional failure, and supportive measures during treatment should be employed to prevent breaks”, Jeremy Harris et al conclude.
Harris JP, Chen MM, Orosco RK, et al. Association of survival with shorter time to radiation therapy after surgery for US patients with head and neck cancer. JAMA Otolaryngol Head Neck Surg; Advance online publication 8 March 2018.
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