Introduction and objective: It is unclear if time to initiation of adjuvant radiotherapy affects endoscopic reconstruction outcomes. In this study we present our experience with adjuvant radiotherapy after endoscopic endonasal procedures, to determine if the time to radiation therapy impacts post-RT reconstruction complication rates.
Methods: A retrospective cohort study of 164 patients between 1998 and 2021 was conducted. Using Cox proportional hazard ratios, we analyzed different variables and the complications occurred during the one-year period after starting RT.
Results: Seventy-eight (47.5%) and eighty-six patients (52.5%) received RT before and after the 6th postoperative week, respectively. The overall post-RT complication rates were 28%, most of them were severe infectious diseases (n=20, 12.2%) and delayed CSF leak (n=4, 2.5%). There was no significant difference in the post-RT complications between the patients who received postoperative RT before or after the 6th operative week (HR 1.13, CI 0.63-2.02, p=.675). Univariate analysis demonstrated negative impact associated with smoking history (p=.015), the use of neoadjuvant chemotherapy (p=.0001) and the use of photon therapy (p=.012); and we found a positive impact with the use of multilayer reconstruction techniques (p=.041) with fat (p=.038), and/or fascia graft (p=.035). After a multivariate analysis only smoking history was an independent risk factor for post-RT complications (p=.012).
Conclusion: Delaying RT more than 6 weeks after endoscopic endonasal surgery has no benefit for reconstruction outcomes. Special attention might be warranted in patients with smoking history who have received neoadjuvant chemotherapy, or patients who will receive photon-based radiotherapy after surgery.