College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA.
Department of Radiation Oncology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA.
Head Neck. 2023 Jul;45(7):1676-1691. doi: 10.1002/hed.27380. Epub 2023 Apr 27.
A prior study reported that over half of patients with HNSCC initiated PORT after 6 weeks from surgery during 2006-2014. In 2022, the CoC released a quality metric for patients to initiate PORT within 6 weeks. This study provides an update on time to PORT in recent years.
The NCDB and TriNetX Research Network were queried to identify patients with HNSCC who received PORT during 2015-2019 and 2015-2021, respectively. Treatment delay was defined as initiating PORT beyond 6 weeks after surgery.
In NCDB, PORT was delayed for 62% of patients. Predictors of delay included age >50, female sex, black race, nonprivate insurance/uninsured status, lower education, oral cavity site, negative surgical margins, increased postoperative length of stay, unplanned hospital readmissions, IMRT radiation modality, treatment at an academic hospital or in the Northeast, and surgery and radiation at different facilities. In TriNetX, 64% experienced treatment delay. Additional associations with prolonged time to treatment included never married/divorced/widowed marital status, major surgery (neck dissection/free flaps/laryngectomy), and gastrostomy/tracheostomy dependence.
There continue to be challenges to timely initiation of PORT.
先前的一项研究报告称，在 2006-2014 年期间，超过一半的头颈部鳞癌（HNSCC）患者在手术后 6 周后开始接受预防性颈部放疗（PORT）。2022 年，癌症中心协作组织（CoC）发布了一项质量指标，要求患者在 6 周内开始接受 PORT。本研究对近年来 PORT 的时间进行了更新。
分别查询国家癌症数据库（NCDB）和 TriNetX 研究网络，以确定在 2015-2019 年和 2015-2021 年期间接受 PORT 的 HNSCC 患者。治疗延迟定义为在手术后 6 周后开始接受 PORT。
在 NCDB 中，有 62%的患者 PORT 延迟。延迟的预测因素包括年龄>50 岁、女性、黑人、非私人保险/无保险状态、教育程度较低、口腔部位、阴性手术切缘、术后住院时间延长、非计划住院再入院、调强放疗（IMRT）放射治疗模式、在学术医院或东北地区治疗以及手术和放疗在不同的机构进行。在 TriNetX 中，有 64%的患者出现治疗延迟。与治疗时间延长相关的其他因素包括未婚/离婚/丧偶的婚姻状况、大手术（颈部解剖/游离皮瓣/喉切除术）和胃造口术/气管造口术依赖。
及时开始 PORT 仍存在挑战。
