Vasu Tumati1, Lawrence Hoang1, Baran D Sumer2,3, John M Truelson2,3, Larry L Myers2,3, Saad Khan3,4, Randall S Hughes3,4, Lucien Nedzi1,3, David J Sher1,3,5. 1. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas. 2. Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas. 3. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas. 4. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. 5. Department of Outcomes and Health Services Research, University of Texas Southwestern Medical Center, Dallas, Texas.
Abstract
BACKGROUND: This study sought to determine the oncologic impact of delays to surgery, radiotherapy, and completion of therapy in patients with head and neck squamous cell carcinoma. METHODS: The impact of biopsy to surgery (BTS) time, surgery to start of radiation time (STSR), and radiation treatment time (RTT) on locoregional recurrence (LRR), distant metastases (DMs), and cancer-specific mortality (CSM) was examined. The cumulative incidences (CI) of LRR, DMs, and CSM were examined using Fine-Gray testing. RESULTS: A total of 277 patients treated with surgery and adjuvant radiotherapy were analyzed. On multivariable testing, BTS >50 days was associated with DM (P = .03), whereas RTT and STSR were not. RTT >43 days was associated with LRR (P = .02) in patients with non-p16-positive-oropharynx cancer. CONCLUSIONS: An increase in DM appears to be the mechanism by which prolonged time to treatment initiation leads to worse overall survival. Prolonged RTT has the greatest impact on patients with non-p16 positive oropharynx cancers.
BACKGROUND: This study sought to determine the oncologic impact of delays to surgery, radiotherapy, and completion of therapy in patients with head and neck squamous cell carcinoma. METHODS: The impact of biopsy to surgery (BTS) time, surgery to start of radiation time (STSR), and radiation treatment time (RTT) on locoregional recurrence (LRR), distant metastases (DMs), and cancer-specific mortality (CSM) was examined. The cumulative incidences (CI) of LRR, DMs, and CSM were examined using Fine-Gray testing. RESULTS: A total of 277 patients treated with surgery and adjuvant radiotherapy were analyzed. On multivariable testing, BTS >50 days was associated with DM (P = .03), whereas RTT and STSR were not. RTT >43 days was associated with LRR (P = .02) in patients with non-p16-positive-oropharynx cancer. CONCLUSIONS: An increase in DM appears to be the mechanism by which prolonged time to treatment initiation leads to worse overall survival. Prolonged RTT has the greatest impact on patients with non-p16 positive oropharynx cancers.
Authors: Roy Xiao; Rohan R Joshi; Qasim Husain; Jennifer R Cracchiolo; Nancy Lee; Jillian Tsai; Yao Yu; Linda Chen; Jung J Kang; Sean McBride; Nadeem Riaz; Benjamin R Roman; Ian Ganly; Viviane Tabar; Stacey T Gray; Marc A Cohen Journal: Head Neck Date: 2019-07-11 Impact factor: 3.147