Predictors of Delayed and Omitted Postoperative Radiotherapy After Laryngectomy for pT4 Laryngeal Cancer.

Abstract

Postoperative radiotherapy (PORT) improves locoregional control and survival in high-risk head and neck cancer, and guidelines recommend initiation within 42 days of surgery. Timeliness after laryngectomy for pathologic T4 (pT4) laryngeal cancer is poorly characterized. In a retrospective National Cancer Database cohort of adults with nonmetastatic pT4 laryngeal squamous cell carcinoma undergoing total laryngectomy (2010-2022), multivariable logistic regression identified predictors of delayed (43-180 days post-operative receipt) and omitted PORT, and a 90-day landmark Cox model evaluated overall survival based on surgery-to-PORT interval. Among 6079 patients, 21.2% received timely PORT, 66.2% delayed, and 12.6% omitted within 180 days. Each additional week of delay carried a 3.7% higher adjusted mortality risk. Delay was associated with receipt of radiation at a facility other than the operating institution. Node-positive disease was associated with higher odds of delay but lower odds of omission. Omission was also associated with older age, greater comorbidity, and lower neighborhood income. Timely PORT after laryngectomy is rare; delays and omissions are associated with distinct factors that may benefit from specific interventions.