Influence of time between surgery and postoperative radiation therapy and total treatment time in locoregional control of patients with head and neck cancer: a single center experience

Abstract

OBJECTIVE: This study aimed to evaluate the effect of the delay to initiate postoperative radiation therapy (RT) on locoregional control to head and neck squamous cell carcinoma patients. METHODS: Retrospective cohort study that included patients submitted to surgery followed by adjuvant RT (with/without chemotherapy). The time interval between surgery and RT was dichotomized by the receiver operating characteristics curve method at 92 days. Other possible sources of heterogeneity with potential impact on locoregional control were explored by regressive analysis. RESULTS: A total of 168 patients were evaluated. The median time for locoregional recurrence (LRR) was 29.7 months. The relapse-free survival rates were 66.4% and 75.4% for patients who initiated RT more than and within 92 postoperative days ( p =0.377), respectively. Doses lower than 60Gy were associated with worse rates of locoregional control (HR=6.523; 95%CI:2.266-18.777, p =0.001). Patients whose total treatment time (TTT) was longer than 150 days had LRR rate of 41.8%; no patient with TTT inferior to 150 days had relapses ( p =0.001). CONCLUSIONS: The interval between surgery and RT did not show influence on locoregional control rates. However, doses <60Gy and the total treatment time >150 days were associated with lower locoregional control rates.

Efficacy of Larynx Preservation Surgery and Multimodal Adjuvant Therapy for Hypopharyngeal Cancer: A Case Series Study

“…Radiotherapy doses <60 Gy was associated with lower locoregional control rates. 27 Doses over 60 Gy after partial laryngectomy showed little evidence of additional toxicity. 28 This regimen can lead to good OS and functional outcomes in most patients with early-stage HPC, but it should be carefully applied to selected patients with advanced disease.…”

Mechanical Fatigue Performance of Patient-Specific Polymer Plates in Oncologic Mandible Reconstruction

“…In the future, it is advisable to also test fatigue strength of polymer plates bridging larger mandibular defects, especially when the midline is crossed. Since time of postoperative radiation therapy in tumor patients at advanced clinical stage should ideally not exceed 6 weeks, mechanical properties of f-PEEK and PEEK plates presumably suffice [ 25 ]. In case of a two-stage surgical approach, prolonged plate stability becomes particularly important to prevent plate fracture before reconstruction with a bone graft.…”

Influence of time between surgery and adjuvant radiotherapy on prognosis for patients with head and neck squamous cell carcinoma: A systematic review

“…Eight studies 27,[30][31][32][33][34]39,40 reported associations between locoregional control and TTI (Table 4).…”

“…Another two studies showed that TTI greater than 4 weeks or 30 days could lead to a significantly higher locoregional failure rate (i.e., within the field borders) than TTI of 4 weeks and less. 39,40 The remaining five studies 27,[30][31][32][33] reported no statistically significant associations between starting postsurgical radiotherapy and locoregional control of more than 8 weeks (vs. less than 6 weeks or 6-8 weeks), greater than 92 days (vs. 92 days or less), 50 days or more (vs. 20-50 days), more than 44 days (vs. 44 days or less), and greater than 45 days (vs. 45 days or less).…”

“…Four studies 22,28,31,35 compared relapse-free survival between patients who started postoperative radiotherapy at different time intervals (Table 5).…”