Postoperative Radiation Therapy for Head and Neck Cancer in the Setting of Orocutaneous and Pharyngocutaneous Fistula

Lau, Valerie H.; Chen, Leon M.; Farwell, D. Gregory; Luu, Quang; Donald, Paul J.; Chen, Allen M.

doi:10.1097/coc.0b013e3181dea5bf

Cited by 6 publications

(10 citation statements)

References 19 publications

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“…The pooled frequency of PORT delay > 6 weeks was 48.6% (95% CI, 41.4‐55.9) (Figure 2). 3,16,19,22,23,52‐55,57‐61 The pooled frequency of PORT delay was unchanged in the sensitivity meta‐analysis excluding the NCDB study (pooled delay frequency = 48.0; 95% CI, 39.2‐56.8; Supplemental Figure S3, available online).…”

Section: Resultsmentioning

confidence: 99%

“… 8,22,53,55,57‐59 In the sensitivity meta‐analysis excluding the NCDB study, the mean time‐to‐PORT was 46.5 days (95% CI, 42.4‐50.7 days; Supplemental Figure S4, available online). The median time‐to‐PORT was 45.8 days (95% CI, 42.4‐49.3 days) in the meta‐analysis of 12 articles (n = 62,078) 9,16,22,23,45,50‐56 . We then analyzed median time‐to‐PORT stratified by PORT delay (ie, initiation of PORT ≤6 weeks vs >6 weeks) among 4 studies where data were available to calculate both 16,22,23,53 .…”

Section: Resultsmentioning

confidence: 99%

“…Eleven articles reported ranges of time-to-PORT. 16,19,22,23,45,50,[52][53][54][55][56] The shortest PORT interval reported was 13 days 16 and the longest was 369 days 50 (although NCDB studies frequently excluded patients with time-to-PORT > 180 days due to concerns about data accuracy and perceived clinical relevance). Ten studies reported mean time-to-PORT, with means ranging from 40.8 ± 9.7 57 to 67.8 ± 36.6 days.…”

Section: Time-to-portmentioning

confidence: 99%

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Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

Duckett,

Kassir,

Nguyen

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveInitiating postoperative radiotherapy (PORT) within 6 weeks (42 days) of surgery is the first and only Commission on Cancer (CoC) approved quality metric for head and neck squamous cell carcinoma (HNSCC). No study has systematically reviewed nor synthesized the literature to establish national benchmarks for delays in starting PORT.Data SourcesFollowing Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines, we performed a systematic review of PubMed, Scopus, and CINAHL.Review MethodsStudies that described time‐to‐PORT or PORT delays in patients with HNSCC treated in the United States after 2003 were included. Meta‐analysis of proportions and continuous measures was performed on nonoverlapping datasets to examine the pooled frequency of PORT delays and time‐to‐PORT.ResultsThirty‐six studies were included in the systematic review and 14 in the meta‐analysis. Most studies utilized single‐institution (n = 17; 47.2%) or cancer registry (n = 16; 44.4%) data. Twenty‐five studies (69.4%) defined PORT delay as >6 weeks after surgery (the definition utilized by the CoC and National Comprehensive Cancer Network Guidelines), whereas 4 (11.1%) defined PORT delay as a time interval other than >6 weeks, and 7 (19.4%) characterized time‐to‐PORT without defining delay. Meta‐analysis revealed that 48.6% (95% confidence interval [CI], 41.4‐55.9) of patients started PORT > 6 weeks after surgery. Median and mean time‐to‐PORT were 45.8 (95% CI, 42.4‐51.4 days) and 47.4 days (95% CI, 43.4‐51.4 days), respectively.ConclusionDelays in initiating guideline‐adherent PORT occur in approximately half of patients with HNSCC. These meta‐analytic data can be used to set national benchmarks and assess progress in reducing delays.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Time-to-portmentioning

confidence: 99%

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Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

Duckett,

Kassir,

Nguyen

et al. 2023

Otolaryngol.--head neck surg.

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“…

Each year an estimated 200.000 people worldwide are newly diagnosed with laryngeal and hypopharyngeal squamous cell carcinoma (SCC). 6 We sought to investigate the correlation between PCF-related delay of PORT and its impact on survival and to investigate the incidence of secondary complications of radiotherapy in the setting of persistent PCF in patients with advanced laryngeal or hypopharyngeal SCC treated at our department between 1994 and 2016.

| PATIENTS AND ME THODS

| Ethical considerationsThe study was conducted according to the Helsinki Declaration guidelines and received approval by the ethics committee of the Vienna Medical University (Ref: 1375/2012, with annual extensions to date).

| Inclusion and exclusion criteriaTreatment records of all patients diagnosed with stage III and stage IV laryngeal or hypopharyngeal SCC (AJCC 8th edition) at the Department of Otorhinolaryngology, Head and Neck surgery of the Medical University of Vienna, Austria in the years from 1994 to 2016 were investigated. About 50%-70% of patients with stage III or IV disease will have passed away 5 years after the diagnosis.

…”

mentioning

confidence: 99%

“…6 We sought to investigate the correlation between PCF-related delay of PORT and its impact on survival and to investigate the incidence of secondary complications of radiotherapy in the setting of persistent PCF in patients with advanced laryngeal or hypopharyngeal SCC treated at our department between 1994 and 2016. 6 We sought to investigate the correlation between PCF-related delay of PORT and its impact on survival and to investigate the incidence of secondary complications of radiotherapy in the setting of persistent PCF in patients with advanced laryngeal or hypopharyngeal SCC treated at our department between 1994 and 2016.…”

mentioning

confidence: 99%

Post‐laryngectomy adjuvant radiotherapy in patients with pharyngocutaneous fistulae: Treatment regimens, outcomes and complications in 67 patients

Parzefall

Wolf

Grasl

et al. 2019

Clinical Otolaryngology

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Each year an estimated 200.000 people worldwide are newly diagnosed with laryngeal and hypopharyngeal squamous cell carcinoma (SCC). In many of these cases, the diagnosis is made at an advanced stage and survival in these patients has remained poor over the last decades. About 50%-70% of patients with stage III or IV disease will have passed away 5 years after the diagnosis. 1The treatment of choice in locally advanced cases is either primary chemoradiotherapy or laryngopharyngectomy followed by adjuvant radiotherapy (RT). Timely postoperative radiotherapy (PORT) enhances the treatment and significantly improves the outcome compared to patients receiving adjuvant radiation later than 6 weeks after surgery. 2 Pharyngocutaneous fistulae (PCF) are the major complication after laryngopharyngectomy and frequently cause delay of PORT due to fear of wound healing disturbance with potentially lethal consequences such as carotid artery blowout. [3][4][5] Hence, the attending physicians frequently face a conflict when dealing with patients with PCF to weigh up the benefit of early PORT against the hazards of radiation damage before wound healing completion.A literature research resulted in only minimal available data about the complications of RT at the stage of active PCF, and there are no data regarding the influence of PCF-related delayed RT on survival. 6 We sought to investigate the correlation between PCF-related delay of PORT and its impact on survival and to investigate the incidence of secondary complications of radiotherapy in the setting of persistent PCF in patients with advanced laryngeal or hypopharyngeal SCC treated at our department between 1994 and 2016. | PATIENTS AND ME THODS | Ethical considerationsThe study was conducted according to the Helsinki Declaration guidelines and received approval by the ethics committee of the Vienna Medical University (Ref: 1375/2012, with annual extensions to date). | Inclusion and exclusion criteriaTreatment records of all patients diagnosed with stage III and stage IV laryngeal or hypopharyngeal SCC (AJCC 8th edition) at the Department of Otorhinolaryngology, Head and Neck surgery of the Medical University of Vienna, Austria in the years from 1994 to 2016 were investigated. All patients undergoing primary laryngopharyngectomy and bilateral neck dissection followed by adjuvant postoperative radiotherapy were eligible for the study. Patients who had a previous history of malignant disease, patients with unclear records or patients with tumour-positive resection margins (R1) in the final histological report were excluded.

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Fistulae After Successful Free Tissue Transfer to Head and Neck

Deek

Wei

Tsao

2016

Clinics in Plastic Surgery

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Postoperative Radiation Therapy for Head and Neck Cancer in the Setting of Orocutaneous and Pharyngocutaneous Fistula

Cited by 6 publications

References 19 publications

Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta‐analysis

Post‐laryngectomy adjuvant radiotherapy in patients with pharyngocutaneous fistulae: Treatment regimens, outcomes and complications in 67 patients

Fistulae After Successful Free Tissue Transfer to Head and Neck

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