Timing of Postoperative Radiotherapy and Outcomes in Oropharyngeal Squamous Cell Carcinoma
Ismail M. Khaderi, David Strum, Nazineen Kandahari, Ahmad J. Odeh, Annie X. Wang, Abdullah W. Saleh, Trevor G. HackmanABSTRACT
Background
Timely postoperative radiotherapy (PORT) is recommended for head and neck cancer, but adherence and its impact in oropharyngeal squamous cell carcinoma (OPSCC) remain unclear.
Methods
A retrospective cohort study of 3723 adults with OPSCC undergoing surgery (2015–2025) in the TriNetX US Collaborative Network was performed. Patients receiving PORT were compared by timing (< 6 weeks vs. 6–12 weeks) using propensity score matching. A 5‐year mortality and salvage surgery were assessed from a 6‐week landmark.
Results
In total, 69.3% initiated PORT within 6 weeks, with increasing compliance over time. After matching ( n = 1108 per group), delayed PORT was associated with higher mortality (RR = 1.27, 95% CI = 1.06–1.54) and salvage surgery (RR = 1.46, 95% CI = 1.10–1.94). The greatest risk was observed with delays of 10–12 weeks.
Conclusions
Delayed PORT is associated with worse OPSCC outcomes, supporting efforts to minimize treatment delays. Although guideline adherence has improved, the optimal compliance threshold remains uncertain.