Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina, USA.
Otolaryngol Head Neck Surg. 2024 Feb;170(2):320-334. doi: 10.1002/ohn.538. Epub 2023 Sep 20.
Initiating postoperative radiotherapy (PORT) within 6 weeks (42 days) of surgery is the first and only Commission on Cancer (CoC) approved quality metric for head and neck squamous cell carcinoma (HNSCC). No study has systematically reviewed nor synthesized the literature to establish national benchmarks for delays in starting PORT.
Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a systematic review of PubMed, Scopus, and CINAHL.
Studies that described time-to-PORT or PORT delays in patients with HNSCC treated in the United States after 2003 were included. Meta-analysis of proportions and continuous measures was performed on nonoverlapping datasets to examine the pooled frequency of PORT delays and time-to-PORT.
Thirty-six studies were included in the systematic review and 14 in the meta-analysis. Most studies utilized single-institution (n = 17; 47.2%) or cancer registry (n = 16; 44.4%) data. Twenty-five studies (69.4%) defined PORT delay as >6 weeks after surgery (the definition utilized by the CoC and National Comprehensive Cancer Network Guidelines), whereas 4 (11.1%) defined PORT delay as a time interval other than >6 weeks, and 7 (19.4%) characterized time-to-PORT without defining delay. Meta-analysis revealed that 48.6% (95% confidence interval [CI], 41.4-55.9) of patients started PORT > 6 weeks after surgery. Median and mean time-to-PORT were 45.8 (95% CI, 42.4-51.4 days) and 47.4 days (95% CI, 43.4-51.4 days), respectively.
Delays in initiating guideline-adherent PORT occur in approximately half of patients with HNSCC. These meta-analytic data can be used to set national benchmarks and assess progress in reducing delays.
术后放疗（PORT）在手术后 6 周（42 天）内开始是头颈部鳞状细胞癌（HNSCC）首个也是唯一经癌症委员会（CoC）批准的质量指标。尚无研究系统地回顾和综合文献，以确定开始 PORT 延迟的国家基准。
根据系统评价和荟萃分析的首选报告项目指南，我们对 PubMed、Scopus 和 CINAHL 进行了系统评价。
纳入了 2003 年后在美国治疗的 HNSCC 患者的时间到 PORT 或 PORT 延迟描述的研究。对非重叠数据集进行了比例和连续测量的荟萃分析，以检查 PORT 延迟和时间到 PORT 的汇总频率。
36 项研究被纳入系统评价，14 项研究被纳入荟萃分析。大多数研究使用了单机构（n=17；47.2%）或癌症登记处（n=16；44.4%）的数据。25 项研究（69.4%）将 PORT 延迟定义为手术后>6 周（CoC 和国家综合癌症网络指南使用的定义），4 项研究（11.1%）将 PORT 延迟定义为>6 周以外的时间间隔，7 项研究（19.4%）描述了时间到 PORT，而没有定义延迟。荟萃分析显示，48.6%（95%置信区间[CI]，41.4-55.9）的患者在手术后>6 周开始 PORT。中位和平均时间到 PORT 分别为 45.8（95% CI，42.4-51.4 天）和 47.4 天（95% CI，43.4-51.4 天）。
大约一半的 HNSCC 患者存在指南一致的 PORT 启动延迟。这些荟萃分析数据可用于设定国家基准，并评估减少延迟的进展。
