Timing of Postoperative Radiotherapy and Outcomes in Oropharyngeal Squamous Cell Carcinoma.

Khaderi, Ismail M; Strum, David; Kandahari, Nazineen; Odeh, Ahmad J; Wang, Annie X; Saleh, Abdullah W; Hackman, Trevor G · Head Neck · 2026

retrospective_cohort · Level III

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Abstract

Timely postoperative radiotherapy (PORT) is recommended for head and neck cancer, but adherence and its impact in oropharyngeal squamous cell carcinoma (OPSCC) remain unclear. 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. 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. 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.