Presenter(s)
M. Mallick1, V. Chennupati1, D. Alvarez2, E. Gogineni3, S. Baliga4, D. J. Konieczkowski3, D. L. Mitchell3, S. R. Jhawar5, J. C. Grecula3, P. Bhateja6, L. Miller7, J. W. Rocco7, M. Bonomi6, D. M. Blakaj3, S. Zhu8, and S. J. Ma2; 1The Ohio State University College of Medicine, Columbus, OH, 2The Ohio State University, Columbus, OH, 3Department of Radiation Oncology, James Cancer Hospital/Wexner Medical Center, The Ohio State University, Columbus, OH, 4Department of Radiation Oncology, James Cancer Hospital, The Ohio State University Medical Center, Columbus, OH, 5Department of Radiation Oncology, The James Cancer Center, Ohio State University Wexner Medical Center, Columbus, OH, 6The Ohio State University Wexner Medical Center, Columbus, OH, 7The Ohio State University Department of Otolaryngology - Head & Neck Surgery, Columbus, OH, 8University of Florida, Gainesville, FL
Purpose/Objective(s):
National Comprehensive Cancer Network (NCCN) guideline recommends adjuvant radiation or chemoradiation to start within 6 weeks after surgery. However, prior studies suggested that over half of patients in the United States did not adhere to the NCCN guideline and started adjuvant treatments more than 6 weeks after surgery. In addition, there is a paucity of real-world, institutional studies reporting the long-term outcomes among patients with versus without delays in starting adjuvant treatments. We performed an observational cohort study of patients with head and neck cancer treated with upfront surgery followed by adjuvant radiation or chemoradiation.Materials/Methods:
A single-institution database was queried for patients with head and neck cancer diagnosed between March 2012 and December 2023 who underwent upfront surgery followed by adjuvant radiation or chemoradiation. Delays in adjuvant treatments were defined as starting treatments more than 6 weeks after surgery. Cox multivariable analysis (MVA), Fine-Gray MVA, and logistic MVA were performed to evaluate treatment outcomes. Sensitivity analyses were performed by repeating the MVA with the timing of adjuvant treatments as a continuous variable and a binary variable with 8 weeks as a cutoff. Interaction term analysis was performed between human papillomavirus (HPV) status and delays in adjuvant treatments.Results:
A total of 447 patients were identified (n=204 [45.6%] who started within 6 weeks after surgery; n=243 [54.4%] who started 6 weeks after surgery). Median follow up was 51.8 months (95% confidence interval [CI] 48.1-56.2). On Logistic MVA, those with laryngeal cancer were less likely to have delays in adjuvant treatments (versus oral cavity cancer; adjusted odds ratio [aOR] 0.40, 95% CI 0.21-0.73, p=0.004). On Cox MVA, there was no statistically significant difference in overall survival (OS; adjusted hazard ratio [aHR] 1.18, 95% CI 0.84-1.68, p=0.34), progression-free survival (PFS; aHR 1.12, 95% CI 0.82-1.53, p=0.48), locoregional failure (LRF; aHR 1.24, 95% CI 0.74-2.09, p=0.41), and distant failure (DF; aHR 0.85, 95% CI 0.53-1.36, p=0.49) between those with versus without delays in adjuvant treatments. On sensitivity analyses, similar results were observed when timing of adjuvant treatments was analyzed as a continuous variable and a binary variable with 8 weeks as a cutoff. Interaction term analyses were not statistically significant for OS (p=0.17), PFS (p=0.47), LRF (p=0.47), and DF (p=0.84).Conclusion:
Our real-world study suggested that over half of patients started adjuvant treatments more than 6 weeks after surgery. Those with laryngeal cancer were more likely to start adjuvant treatments within 6 weeks. However, such delays in adjuvant treatments were not associated with survival and oncologic outcomes, regardless of HPV status. Prospective studies to optimize coordination in multidisciplinary care are warranted.