Impact of Delayed Radiation on Head and Neck Squamous Cell Carcinoma Outcomes: Examination of HPV-Status

Tuesday, October 1, 2024

9:36 AM – 9:42 AM EDT

Location: MBCC, 208

Disclosure(s):

Azmi Marouf, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nicole M. Fowler, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Akina Tamaki, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: The Committee on Cancer recommends the time from ablative surgery to postoperative adjuvant radiation therapy (PORT) be ≤42 days (6 weeks) in patients with head and neck squamous cell carcinoma (HNSCC). The impact of exceeding this timeframe on HNSCC outcomes, particularly recurrence and overall survival, remains a debated topic. This study examines the impact of delayed PORT on recurrence and survival in HNSCC, stratified by human papilloma virus (HPV) status in oropharyngeal (OP) SCC.

Methods: We retrospectively reviewed the charts of HNCSS patients who underwent ablative surgery followed by PORT between 2018 and 2022 at a single tertiary care center. Patients who had cutaneous HNSCC and those who underwent radiation for palliative purposes was excluded. We acquired demographic information, tumor characteristics, surgery details, PORT information, and recurrence and survival status. Kaplan-Meier analyses and Cox regressions were used to study the impact of delayed PORT on outcomes.

Results: A total of 306 patients were included in our study. The median age was 63 years, and 207 (67.6%) were males. The majority of tumors were in the oral cavity and oropharynx (56.2% and 17.0%) and were late stage at presentation (80.1%). PORT was ≤42 days in 98 patients (32%). Patients were significantly more likely to have PORT delay when there were postoperative complications, flap reconstruction, increased length of stay, and advanced staging. Delaying PORT more than 42 days did not affect survival in the overall sample but was associated with higher recurrence (p = 0.612 and 0.032 respectively). Subgroup analysis of OP SCC by HPV status showed HPV-positive patients had better survival and disease control, especially in the non-delayed group (p = 0.049 and p < 0.001, respectively).

Conclusions: While delaying PORT beyond 42 days showed no impact on overall survival in our cohort of patients with HNSCC, it was associated with an increased risk of recurrence. Further, HPV-positive OP cancer patients who received PORT within 42 days exhibited better outcomes than their HPV-positive delayed counterparts and all HPV-negative OP cancer patients.

Presenting Author(s)

Azmi Marouf, MD

Research fellow
University Hospitals Cleveland Medical Center
CLEVELAND, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Azmi Marouf, MD

Research fellow
University Hospitals Cleveland Medical Center
CLEVELAND, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
CC

Claudia I. Cabrera, MD, MS

Post doctoral
Case Western Reserve University Medical School/University Hospitals
Cleveland, OH, United States

Disclosure information not submitted.
Nicole M. Fowler, MD

Associate Professor
University Hospitals Cleveland Medical Center
Cleveland, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
Rod P. Rezaee, MD

Professor, Otolaryngology-Head and Neck Surgery Director, Head and Neck Surgical Oncology and Reconstruction
University Hospitals Cleveland Medical Center/Seidman Cancer/Center/Case Western Reserve University
cleveland, OH, United States

Disclosure information not submitted.
Akina Tamaki, MD

Associate Professor
Case Western Reserve University/ University Hospitals Cleveland Medical Center
Cleveland, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Akina Tamaki, MD

Associate Professor
Case Western Reserve University/ University Hospitals Cleveland Medical Center
Cleveland, OH, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.