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Meta-Analysis
. 2025 May;135(5):1563-1570.
doi: 10.1002/lary.31990. Epub 2025 Jan 2.

Delayed Postoperative Radiotherapy in Head & Neck Cancers-A Systematic Review and Meta-Analysis

Noémie Villemure-Poliquin  1   2   3 , Rui Fu  1   2   3 , Karolina Gaebe  4 , Jin Kwon  5 , Marc Cohen  3 , Marianne Ruel  6 , Kennedy Ayoo  4 , Andrew Bayley  7 , Madette Galapin  3   7 , Julie Hallet  3   8   9 , Antoine Eskander  1   2   3   8
Affiliations
Meta-Analysis

Delayed Postoperative Radiotherapy in Head & Neck Cancers-A Systematic Review and Meta-Analysis

Noémie Villemure-Poliquin et al. Laryngoscope. 2025 May.

Abstract

Objectives: To evaluate the impact of delayed postoperative radiotherapy (PORT) on overall survival (OS) in patients with head and neck cancers (HNC).

Data sources: A systematic review and meta-analysis were conducted by searching MEDLINE, Embase, CENTRAL, Web of Science, and CINAHL databases.

Review methods: Studies assessing the impact of delayed PORT in adult HNC patients were included. A total of 11,171 titles and abstracts were screened, with 52 studies meeting the inclusion criteria. Data were extracted, and a pooled random-effects analysis was performed. The primary outcome was overall survival (OS), comparing patients receiving timely PORT (within 42 days) to those with delays.

Results: Of the included studies, 31 were conducted in the United States, with 16 using the National Cancer Database (NCDB). Patients who did not receive PORT within 42 days had a 4% increase in mortality (adjusted Hazard Ratio [aHR]: 1.04 [1.03-1.06]; I2 = 78%; N = 254,189; 16 studies). Excluding time-overlapping NCDB-based studies, the OS benefit for timely treatment persisted (aHR: 1.10 [1.01-1.20]; I2 = 39%; N = 52,003; 5 studies).

Conclusions: Initiating PORT within 42 days is significantly associated with decreased mortality in HNC patients, reinforcing CoC recommendations. However, more research is needed to understand the relationship between different time cutoffs and outcomes, and to identify factors contributing to PORT delays. Future studies should explore the impact of treatment delays on patient-centered outcomes, such as Quality of Life (QoL).

Level of evidence: NA Laryngoscope, 135:1563-1570, 2025.

Keywords: head and neck cancer; postoperative radiotherapy; quality metric; squamous cell carcinoma; treatment delay.

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Figures

Fig. 1
Fig. 1
Study flow diagram in accordance with the Preferred Reporting Items of Systematic Reviews and Meta‐analyses (PRISMA) statement. SPORT—surgery to postoperative radiotherapy.
Fig. 2
Fig. 2
Origin of included studies. SPORT—surgery to postoperative radiotherapy interval; NCDB—National Cancer Database; US—United States.
Fig. 3
Fig. 3
Factors associated with SPORT delays., , , Diagnosis to treatment interval (DTI), surgery to postoperative radiotherapy (SPORT), treatment package time (TPT), length of stay (LOS), socioeconomic status (SES).
See this image and copyright information in PMC

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