Duration of radiation therapy is associated with worse survival in head and neck cancer

Mazul, Angela L.; Stepan, Katelyn; Barrett, Thomas F.; Thorstad, Wade L.; Adkins, Douglas R.; Daly, Mackenzie; Rich, Jason T.; Paniello, Randal C.; Pipkorn, Patrik; Zevallos, José P.; Jackson, Ryan; Kang, Stephen Y.; Puram, Sidharth V.

doi:10.1016/j.oraloncology.2020.104819

Cited by 19 publications

(19 citation statements)

References 20 publications

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“…We found that RTD had a significant association with OS, with increased RTD being linked to decreased survival. These results are consistent with the current body of literature on HNC examining treatment delay, with studies examining oropharyngeal, hypopharyngeal, and laryngeal malignancies all showing that increased RTD results in decreased OS 8,9,20,29 . It is theorized that extended RTD may be due to breaks in radiation therapy.…”

Section: Discussionsupporting

confidence: 87%

“…Furthermore, increased RT dose in the post‐surgical period is likely to be more taxing mentally and physically, risking increased breaks in therapy, leading to increased RTD. In previous studies, such breaks in RT has been linked to decreased survival 29 . It is pertinent to take these clinical variables into account when starting postoperative adjuvant radiation treatment, especially because our study showed that increased RTD and positive margins are independent risk factors for decreased survival.…”

Section: Discussionmentioning

confidence: 59%

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Impact of esthesioneuroblastoma treatment delays on overall patient survival

et al. 2022

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Objectives To characterize clinical factors associated with esthesioneuroblastoma treatment delays and determine the impact of these delays on overall survival. Study Design Retrospective database analysis. Methods The 2004–2016 National Cancer Database was queried for patients with esthesioneuroblastoma managed by primary surgery and adjuvant radiation. Durations of diagnosis‐to‐treatment initiation (DTI), diagnosis‐to‐treatment end (DTE), surgery‐to‐RT initiation (SRT), radiotherapy treatment (RTD), and total treatment package (TTP) were analyzed. The cohort was split into two groups for each delay interval using the median time as the threshold. Results A total of 814 patients (39.6% female, 88.5% white) with mean ± SD age of 52.6 ± 15.1 years who underwent both esthesioneuroblastoma surgery and adjuvant radiotherapy were queried. Median DTI, DTE, SRT, RTD, and TTP were 34, 140, 55, 45, and 101 days, respectively. A significant association was identified between increased regional radiation dose above 66 Gy and decreased DTI (OR = 0.54, 95% CI 0.35–0.83, p = 0.01) and increased RTD (OR = 3.94, 95% CI 2.36–6.58, p < 0.001) durations. Chemotherapy administration was linked with decreased SRT (OR = 0.64, 95% CI 0.47–0.89, p = 0.01) and TTP (OR = 0.59, 95% CI 0.43–0.82, p = 0.001) durations. Cox proportional‐hazards analysis revealed that increased RTD was associated with decreased survival (HR = 1.80, 95% CI 1.26–2.57, p < 0.005), independent of age, sex, race, regional radiation dose, facility volume, facility type, insurance status, modified Kadish stage, chemotherapy status, Charlson‐Deyo comorbidity index, and surgical margins. Conclusions Delays during, and prolongation of radiotherapy for esthesioneuroblastoma appears to be associated with decreased survival. Level of Evidence 4 Laryngoscope, 133:764–772, 2023

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 59%

Impact of esthesioneuroblastoma treatment delays on overall patient survival

et al. 2022

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“…In the United States, one report analyzing 19,531 head and neck patients found that prolonged radiation duration was associated with worse OS in the patients who underwent primary RT, but had minimal effect on the overall survival in patients with postoperative RT [ 41 ]. Another study showed that prolonged radiation duration led to inferior overall survival in 129,055 head and neck patients who received either primary or postoperative RT [ 44 ]. A population-based study from the Taiwan Cancer Registry analyzed 8988 all-stage oral cavity squamous cell carcinoma patients who underwent curative surgery and adjuvant RT, and found that patients with RT duration over 8 weeks had worse overall survival, cancer-specific survival, and locoregional control [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Comorbidity, Radiation Duration, and Pretreatment Body Muscle Mass Predict Early Treatment Failure in Taiwanese Patients with Locally Advanced Oral Cavity Squamous Cell Carcinoma after Completion of Adjuvant Concurrent Chemoradiotherapy

et al. 2021

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Few prospective cohort trials have evaluated the potential risk factors of early treatment failure of locally advanced oral cavity squamous cell carcinoma (LAOCSCC) patients following the completion of postoperative adjuvant concurrent chemoradiotherapy (CCRT). We collected clinicopathological variables, nutrition-inflammatory markers and total body composition data assessed by dual-energy X-ray absorptiometry (DXA) before and after CCRT. A factor analysis was used to reduce the number of DXA-derived parameters. Cox proportional hazard models were applied to determine the risk factors associated with early treatment failure defined as tumor progression or death within 180 days of CCRT completion. A total of 69 patients were eligible for analysis. After CCRT, the body weight, body mass index, nutritional markers, and muscle mass decreased, whereas C-reactive protein level increased. Five factors reflecting different body composition statuses were identified. A total of 21 patients (30.4%) developed early treatment failure. Comorbidities (hazard ratio ((HR)), 2.699; 95% confidence interval ((CI)), 1.005–7.913; p = 0.044), radiation duration (HR, 1.092; 95% CI, 1.015–1.174; p = 0.018) and the pretreatment body muscle mass (HR, 0.578; 95% CI, 0.345–0.957; p = 0.037) independently contributed to early treatment failure. Comorbidities, longer radiation duration, and lower pretreatment body muscle mass are predictive factors for early treatment failure in LAOCSCC patients following postoperative adjuvant CCRT completion.

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“…56,57 The association of treatment delay with survival also varies by stage, with an increased hazard of mortality for stages I/II head and neck cancer relative to stages III/IV. 58 Other intervals of timely head and neck cancer care also have a strong and consistent association with recurrence and survival, including initiation of postoperative radiation therapy within 6 weeks of surgery, 54,59,60 the duration of radiation therapy, [60][61][62] and treatment package time. 63,64 The oncologic impact of treatment delays for patients with head and neck cancer is extensive; the excess hazard conferred by delayed initiation of postoperative radiation therapy or prolonged radiation duration are comparable in magnitude to the mortality risk associated with adverse features such as positive margins or extranodal extension.…”

Section: Drivers Of Oncologic Outcomes: Delivery Of Timely Head and Neck Cancer Carementioning

confidence: 99%

Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer

Fagan

Noronha

Graboyes

2021

American Society of Clinical Oncology Educational Book

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The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.

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Duration of radiation therapy is associated with worse survival in head and neck cancer

Cited by 19 publications

References 20 publications

Impact of esthesioneuroblastoma treatment delays on overall patient survival

Impact of esthesioneuroblastoma treatment delays on overall patient survival

Comorbidity, Radiation Duration, and Pretreatment Body Muscle Mass Predict Early Treatment Failure in Taiwanese Patients with Locally Advanced Oral Cavity Squamous Cell Carcinoma after Completion of Adjuvant Concurrent Chemoradiotherapy

Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer

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