Importance of the treatment package time in surgery and postoperative radiation therapy for squamous carcinoma of the head and neck

Background. To determine the effect of treatment time-related factors on outcome in patients treated with surgery and postoperative radiation therapy (FIT) for locally advanced squamous cell carcinoma of head and neck (SCCHN). Methods. A retrospective review was performed on 208 consecutive patients treated from 1992 to 1997 with surgery and postoperative FIT (greater than or equal to55 Gy) for SCCHN. The treatment time factors considered were (1) interval from surgery to the start of FIT; (2) FIT duration; and (3) the total time from surgery to completion of FIT (treatment package time). Treatment package time was dichotomized into short (less than or equal to100 days) vs long (>100 days) categories. Other variables considered were clinical and pathologic staging, margin status, FIT dose, and tumor site. Patients were also divided into intermediate- and high-risk groups on the basis of eligibility for RTOG 95-01. Univariate (logrank) and multivariate analyses were performed. Results. Median follow-up for surviving patients was 24 months. Actuarial 2-year locoregional control (LRC) and survival rates were 82% and 71%, respectively. In univariate analysis, factors associated with! higher locoregional failure were high-risk group (p =.011), margin status (p =.038), pathologic stage (p =.035), clinical N stage (p =.006), package time (p =.013), and FIT treatment time (p =.03). Package time was also a significant predictor of survival in univariate analysis (p =.021). The other two individual time factors, tumor factors, and FIT dose were not significant. Both risk status: and treatment package time were significant factors in a multivariate model of LRC. Conclusions. A total treatment package time of <100 days is associated with improved tumor control and survival. Every effort should be made to keep the time from surgery to the completion of postoperative FIT to <100 days. (C) 2002 John Wiley Sons, Inc.