The Radiation Oncology Feed For radiation oncologists · physicists · RTTs · dosimetrists
High relevance larynx postoperative

Most pT4 laryngeal cancer patients started postoperative RT beyond six weeks

Only 21% started PORT within 42 days after laryngectomy, while each additional week of delay was associated with 3.7% higher mortality.

RadOncToday · ·1 min read

KEY POINTS

  • The National Cancer Database analysis included 6,079 adults with nonmetastatic pT4 laryngeal squamous cell carcinoma treated with total, radical or pharyngolaryngectomy between 2010 and 2022.
  • PORT timing was classified as ≤42 days, 43–180 days, or no PORT within 180 days. Only 1,289 patients (21.2%) received timely PORT; 4,026 (66.2%) started late and 764 (12.6%) received none within 180 days.
  • Among patients who eventually received PORT, the median surgery-to-RT interval was 54 days. Only 24.3% met the 42-day benchmark, while 32.3% did not start until more than 63 days after surgery.
  • Delay was associated with progressively poorer survival. In the 90-day landmark analysis, every additional 7 days between surgery and PORT was associated with a 3.7% higher adjusted mortality risk (HR 1.04, 95% CI 1.02–1.05; p<0.001).
  • Compared with PORT ≤42 days, starting at 50–63 days was associated with an adjusted HR of 1.16, while starting >63 days was associated with an HR of 1.21. Median overall survival was approximately 1.25 and 1.63 years shorter, respectively.
  • Receiving RT at a different facility from the surgical centre independently increased the odds of delay (OR 1.28, 95% CI 1.10–1.48; p=0.001). Unplanned readmission (OR 1.69) and postoperative stay ≥12 days (OR 1.64) were also associated with delayed PORT.
  • Omission represented a different problem: age ≥65 (OR 1.89), Charlson-Deyo score ≥3 (OR 1.65), unplanned readmission (OR 2.44) and prolonged hospital stay (OR 2.66) increased the odds of receiving no PORT. Among those without PORT, 73% were documented as patient/family refusal.

CLINICAL TAKEAWAY

The six-week postoperative RT benchmark is being missed in the majority of patients after laryngectomy for pT4 laryngeal cancer. The strongest actionable signal is care coordination: delays were especially common when surgery and RT occurred at different facilities, suggesting that earlier radiation-oncology involvement and tighter postoperative pathways may be more important than simply identifying “high-risk” patients.

SOURCE

Head & Neck

Browse more research Suggest a correction