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Video

Head and Neck Surgery

(A603) Postoperative Radiotherapy Delay and Survival in Oropharyngeal, Hypopharyngeal, and Laryngeal Cancer: Propensity-Score Matched, Site-Specific Analysis

Monday, October 13, 2025
12:00 PM - 1:00 PM EDT
Location: OTO EXPO, Posters

    Presenting Author(s)

  • Beverly J. Fu, AB, AM

    Medical Student
    Department of Otolaryngology - Head & Neck Surgery, Stanford University
    Stanford, California, United States

    • Co-Author(s)

  • AP

    Alexandra L. Potter, BA

    Department of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, United States

  • MC

    Michelle M. Chen, MD, MHS

    Department of Otolaryngology - Head & Neck Surgery, Stanford University, United States

  • Vasu Divi, MD

    Assistant Professor of Otolaryngology/Head and Neck Surgery
    Department of Otolaryngology - Head & Neck Surgery, Stanford University
    Stanford, California, United States

  • Chris Holsinger, MD, FACS

    Professor
    Department of Otolaryngology - Head & Neck Surgery, Stanford University
    Stanford, California, United States

  • Robert M. Brody, MD

    Assistant Professor
    University of Pennsylvania School of Medicine
    Philadelphia, PA, United States

  • RC

    Ryan Carey, MD

    Assistant Professor
    Department of Otorhinolaryngology: Head & Neck Surgery, Hospital of the University of Pennsylvania
    Philadelphia, Pennsylvania, United States

  • CY

    Chi-Fu J. Yang, MD

    Department of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, United States

    • Senior Author(s)

  • JL

    Jake J. Lee, MD, MSCI

    Department of Otolaryngology - Head & Neck Surgery, Stanford University, United States

Disclosure(s):
Beverly J. Fu, AB, AM: No relevant relationships to disclose.
Chris Holsinger, MD, FACS: No relevant relationships to disclose.
Ryan Carey, MD: No relevant relationships to disclose.


Introduction: The initiation of postoperative radiotherapy (PORT) within 6 weeks of surgery is the only quality metric for head and neck cancer (HNC) care. Conflicting findings exist regarding PORT delay’s impact in human papillomavirus-related (HPV+) oropharyngeal (OPSCC), hypopharyngeal (HPSCC), and laryngeal squamous cell carcinoma (LSCC). Thus, this study’s aim was to examine the impact of PORT delays in HPV+ OPSCC, HPSCC, and LSCC using recent nationwide data and site-specific analyses.

Methods: The National Cancer Database was queried for HPV+ OPSCC, HPSCC, and LSCC patients who underwent definitive surgery (2015-2021) and stratified by PORT timing (≤42/>42 days post-surgery). Exclusion criteria were prior HNC, neoadjuvant chemoradiotherapy, palliative/specialized RT, surgery >180 days after diagnosis, PORT >180 days after surgery, metastases, and unknown survival status. Overall survival (OS) was measured from surgery to death or last follow-up using Kaplan-Meier analysis.

Results: Among 5,997 patients (826 HPV+ OPSCC, 481 HPSCC, 4,690 LSCC), delayed PORT was most frequent in HPSCC (n=318, 66%), OPSCC (460, 56%), then LSCC (2,533, 54%). Propensity score (PS) matching adjusted for age, sex, race, comorbidity, education, income, insurance, facility type, clinical stage, year of diagnosis, and tumor location. The matched cohort included 143 per arm for HPV+ OPSCC, 87 for HPSCC, and 1,134 for LSCC. OS did not differ significantly for timely vs. delayed PORT in HPSCC (adjusted HR 1.20; 95% CI 0.71-2.04) and HPV+ OPSCC (1.25; 95% CI 0.59-2.67). However, delayed PORT was associated with decreased OS in LSCC (1.27; 95% CI 1.07-1.50).

Conclusions: After PS matching, PORT delay demonstrated significantly decreased OS in LSCC but had no significant impact in HPSCC or HPV+ OPSCC.