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Showing content from https://pubmed.ncbi.nlm.nih.gov/29522072/ below:

Association of Survival With Shorter Time to Radiation Therapy After Surgery for US Patients With Head and Neck Cancer

Observational Study

. 2018 Apr 1;144(4):349-359. doi: 10.1001/jamaoto.2017.3406. Association of Survival With Shorter Time to Radiation Therapy After Surgery for US Patients With Head and Neck Cancer

Affiliations

¹ Department of Radiation Oncology, Stanford University, Stanford, California.
² Palo Alto Veterans Affairs Health Care System, Palo Alto, California.
³ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California.
⁴ Department of Head and Neck Surgery, University of California San Diego, San Diego.

PMID: 29522072
PMCID: PMC5876822
DOI: 10.1001/jamaoto.2017.3406

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Observational Study

Association of Survival With Shorter Time to Radiation Therapy After Surgery for US Patients With Head and Neck Cancer

Jeremy P Harris et al. JAMA Otolaryngol Head Neck Surg. 2018.

. 2018 Apr 1;144(4):349-359. doi: 10.1001/jamaoto.2017.3406. Affiliations

¹ Department of Radiation Oncology, Stanford University, Stanford, California.
² Palo Alto Veterans Affairs Health Care System, Palo Alto, California.
³ Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California.
⁴ Department of Head and Neck Surgery, University of California San Diego, San Diego.

PMID: 29522072
PMCID: PMC5876822
DOI: 10.1001/jamaoto.2017.3406

Item in Clipboard

Abstract

Importance: Shortening the time from surgery to the start of radiation (TS-RT) is a consideration for physicians and patients. Although the National Comprehensive Cancer Network recommends radiation to start within 6 weeks, a survival benefit with this metric remains controversial.

Objective: To determine the association of delayed TS-RT with overall survival (OS) using a large cancer registry.

Design, setting, and participants: In this observational cohort study, 25 216 patients with nonmetastatic stages III to IV head and neck cancer were identified from the National Cancer Database (NCDB).

Exposures: Patients received definitive surgery followed by adjuvant radiation therapy, with an interval duration defined as TS-RT.

Main outcomes and measures: Overall survival as a function of TS-RT and the effect of clinicopathologic risk factors and accelerated fractionation.

Results: We identified 25 216 patients with nonmetastatic squamous cell carcinoma of the head and neck. There were 18 968 (75%) men and 6248 (25%) women and the mean (SD) age of the cohort was 59 (10.9) years. Of the 25 216 patients, 9765 (39%) had a 42-days or less TS-RT and 4735 (19%) had a 43- to 49-day TS-RT. Median OS was 10.5 years (95% CI, 10.0-11.1 years) for patients with a 42-days or less TS-RT, 8.2 years (95% CI, 7.4-8.6 years; absolute difference, -2.4 years, 95% CI, -1.5 to -3.2 years) for patients with a 43- to 49-day TS-RT, and 6.5 years (95% CI, 6.1-6.8 years; absolute difference, -4.1 years, 95% CI, -3.4 to -4.7 years) for those with a 50-days or more TS-RT. Multivariable analysis found that compared with a 42-days or less TS-RT, there was not a significant increase in mortality with a 43- to 49-day TS-RT (HR, 0.98; 95% CI, 0.93-1.04), although there was for a TS-RT of 50 days or more (HR, 1.07; 95% CI, 1.02-1.12). A significant interaction was identified between TS-RT and disease site. Subgroup effect modeling found that a delayed TS-RT of 7 days resulted in significantly worse OS for patients with tonsil tumors (HR, 1.22; 95% CI, 1.05-1.43) though not other tumor subtypes. Accelerated fractionation of 5.2 fractions or more per week was associated with improved survival (HR, 0.93; 95% CI, 0.87-0.99) compared with standard fractionation.

Conclusions and relevance: Delayed TS-RT of 50 days or more was associated with worse overall survival. The multidisciplinary care team should focus on shortening TS-RT to improve survival. Unavoidable delays may be an indication for accelerated fractionation or other dose intensification strategies.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures
Figure 1.. Association of Delay From Surgery…

Figure 1.. Association of Delay From Surgery to Radiation (T _S-RT ) With Overall Survival

A, Kaplan-Meier…

Figure 1.. Association of Delay From Surgery to Radiation (T_S-RT) With Overall Survival

A, Kaplan-Meier estimates of overall survival according to a T_S-RT of 42 days or less, 43 to 49 days, or 50 days or more. The adjusted hazard ratio (HR) was determined from a Cox multivariable regression model with a T_S-RT of 42 days or less as the reference. B, Adjusted HR for mortality by T_S-RT modeled as a continuous variable with a restricted cubic spline with 3 knots. A 42-day T_S-RT was used as the reference. Shading indicates the 95% CI for HR estimates.

Figure 2.. Subgroup Effects of Covariates With…

Figure 2.. Subgroup Effects of Covariates With Significant Interactions With T _S-RT

Adjusted hazard ratio for…

Figure 2.. Subgroup Effects of Covariates With Significant Interactions With T_S-RT

Adjusted hazard ratio for mortality according to a T_S-RT of 43 to 49 days or 50 days or more compared with 42 days or less varied by disease site. T_S-RT indicates time from surgery to the start of radiation.

Figure 3.. Association of Accelerated Fractionation With…

Figure 3.. Association of Accelerated Fractionation With Overall Survival (OS)

Kaplan-Meier estimates of OS according…

Figure 3.. Association of Accelerated Fractionation With Overall Survival (OS)

Kaplan-Meier estimates of OS according to standard (<5.2 average fractions per week) or accelerated (≥5.2 average fractions per week) fractionation. The adjusted hazard ratio was determined from a Cox multivariable regression model with standard fractionation as the reference.