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. 2023 Aug 8:42:100668.
doi: 10.1016/j.ctro.2023.100668. eCollection 2023 Sep.

The impact of national holidays on postoperative radiotherapy of squamous cell carcinoma of the head and neck

Michael S Kim  1 , Margaret Sheridan  2 , Murali Rajaraman  1 , Helmut Hollenhorst  1 , Amanda Caissie  1 , Ashraf Mahmoud-Ahmed  3 , Nathan Lamond  2 , Stephanie Snow  2 , Martin Corsten  4 , S Mark Taylor  5 , Jonathan R B Trites  5 , Matthew H Rigby  5 , Martin Bullock  5 , Derek Wilke  1
Affiliations

The impact of national holidays on postoperative radiotherapy of squamous cell carcinoma of the head and neck

Michael S Kim et al. Clin Transl Radiat Oncol. .

Abstract

Background: Delays in starting postoperative radiotherapy (PORT) have been established as negative predictors for clinical outcomes in head and neck squamous cell carcinomas (HNSCC). Our study aimed to examine the effect of delays during PORT, and the impact of national holidays in Canada, a publicly funded system, on oncologic outcomes such as Overall Survival (OS) and Local Recurrence (LR).

Methods: The provincial cancer registry was queried to obtain demographic, pathologic, and outcomes data from cancer patients treated for all squamous cell carcinomas of the head and neck region treated between January 1, 2007 and November 30, 2019. All extracted information was cross-referenced and supplemented by chart review of patient electronic medical records. Extracted data were analyzed for OS and LR, in the context of Canadian national holidays causing delays during PORT.

Results: 1433 patients treated for HNSCCs were identified, of whom 338 were treated curatively with surgery followed by PORT. 68.6% of patients experienced at least one day of interruption during treatments due to holidays. LR was 15.4% and OS was 59.6% at 5 years. Treatment interruptions by holidays were predictive of local recurrence (HR, 2.38; 95% CI 1.17-4.83; p = 0.017). Patients that developed early recurrence prior to PORT had very poor oncologic outcomes.

Conclusion: Our findings were consistent with previously published studies in limiting the interval between surgery and PORT. We identified the novel finding of paired holidays as a significant predictor in determining LR, suggesting the importance of modifying RT delivery schedules and timing.

Keywords: Accelerated radiotherapy; Clinical oncology; Head and neck cancer; Public health systems; Radiotherapy; Resource management.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Local recurrence for patients treated with postoperative radiotherapy within 61 days or beyond 61 days of surgery.
Fig. 2
Fig. 2
Local recurrence for patients with early recurrence prior to PORT, compared to patients without early recurrence.
Fig. 3
Fig. 3
Kaplan-Meier survival curve as a function of early postoperative recurrence.
Fig. 4
Fig. 4
Kaplan-Meier survival curve as a function of local recurrence.
See this image and copyright information in PMC

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