title: Importance of the treatment package time in surgery and postoperative radiation therapy for squamous carcinoma of the head and neck.
abstract: BACKGROUND
  To determine the effect of treatment time-related factors on outcome in patients treated with surgery and postoperative radiation therapy (RT) for locally advanced squamous cell carcinoma of head and neck (SCCHN) METHODS: A retrospective review was performed on 208 consecutive patients treated from 1992 to 1997 with surgery and postoperative RT (> or =55 Gy) for SCCHN. The treatment time factors considered were (1) interval from surgery to the start of RT; (2) RT duration; and (3) the total time from surgery to completion of RT (treatment package time). Treatment package time was dichotomized into short (< or =100 days) vs long (>100 days) categories. Other variables considered were clinical and pathologic staging, margin status, RT dose, and tumor site. Patients were also divided into intermediate- and high-risk groups on the basis of eligibility for RTOG 95-01. Univariate (logrank) and multivariate analyses were performed.
  
  
  RESULTS
  Median follow-up for surviving patients was 24 months. Actuarial 2-year locoregional control (LRC) and survival rates were 82% and 71%, respectively. In univariate analysis, factors associated with higher locoregional failure were high-risk group (p =.011), margin status (p =.038), pathologic stage (p =.035), clinical N stage (p =.006), package time (p =.013), and RT treatment time (p =.03). Package time was also a significant predictor of survival in univariate analysis (p =.021). The other two individual time factors, tumor factors, and RT dose were not significant. Both risk status and treatment package time were significant factors in a multivariate model of LRC.
  
  
  CONCLUSIONS
  A total treatment package time of <100 days is associated with improved tumor control and survival. Every effort should be made to keep the time from surgery to the completion of postoperative RT to <100 days.
authors.affiliation: Department of Radiation Oncology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Donner, Philadelphia, PA 19104, USA.
authors.forename: David I
authors.initials: DI
authors.lastname: Rosenthal
authors.forename: Li
authors.initials: L
authors.lastname: Liu
authors.forename: Jason H
authors.initials: JH
authors.lastname: Lee
authors.forename: Neha
authors.initials: N
authors.lastname: Vapiwala
authors.forename: Ara A
authors.initials: AA
authors.lastname: Chalian
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Weinstein
authors.forename: Irina
authors.initials: I
authors.lastname: Chilian
authors.forename: Randal S
authors.initials: RS
authors.lastname: Weber
authors.forename: Mitchell
authors.initials: M
authors.lastname: Machtay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome