Head and neck patients who undergo surgery first are more likely to complete radiation therapy, according to Seattle-based researchers. Megan Dann Fesinmeyer, PhD, MPH, and colleagues noted that radiation dose and treatment duration correlated with tumor control and survival, but that breaks in radiotherapy have been associated with inferior tumor control.
Dr. Fesinmeyer and colleagues are from the Fred Hutchinson Cancer Research Center, the Swedish Cancer Institute, Swedish Medical Center, and the University of Washington. They culled data from SEER and Medicare claims (1997 to 2003) on patients who were 66 years and older. Completion of uninterrupted radiotherapy was the outcome of interest for regression analyses and logistic regression models were used to estimate odds ratios (Arch Otolaryngol Head Neck Surg 135:860-867, 2009).
They defined treatment interruptions as gaps or lapses of more than four days but less than 31 days. A total of 5,086 patients met the study’s inclusion criteria. According to the results, early discontinuation or interruptions in therapy were less frequent in patients who underwent surgery before radiotherapy compared with those who did not have surgery first (29.6% vs 48%; P < .001). Overall, 14.8% of patients had chemotherapy in addition to radiation treatment and 44.6% underwent surgery before radiotherapy. Surgical patients started radiation 74.4 days after diagnosis vs 52.8 days for nonsurgical patients. The authors offered some reasons for this trend including eligibility (good surgical candidates make for good radiotherapy candidates) and better general patient health and patient motivation.
In an ancillary finding, the group noted that concurrent chemotherapy reduced the likelihood of patients with oral, pharyngeal, or laryngeal tumors completing radiotherapy. “Future research is needed to identify specific agents, doses, and schedules that specifically reduce the likelihood of completing treatment in community settings,” they wrote.