title: The Impact of Radiation Treatment Time on Survival in Patients With Head and Neck Cancer.
abstract: To assess the impact of radiation treatment time (RTT) in head and neck cancers on overall survival (OS) in the era of chemoradiation.
  
  
  
  Patients with diagnoses of tongue, hypopharynx, larynx, oropharynx, or tonsil cancer were identified by use of the National Cancer Database. RTT was defined as date of first radiation treatment to date of last radiation treatment. In the definitive setting, prolonged RTT was defined as >56 days, accelerated RTT was defined as <47 days, and standard RTT was defined as 47 to 56 days. In the postoperative setting, prolonged RTT was defined as >49 days, accelerated RTT was defined as <40 days, and standard RTT was defined as 40 to 49 days. We used χ2tests to identify predictors of RTT. The Kaplan-Meier method was used to compare OS among groups. Cox proportional hazards model was used for OS analysis in patients with known comorbidity status.
  
  
  
  19,531 patients were included; 12,987 (67%) had a standard RTT, 4,369 (34%) had an accelerated RTT, and 2,165 (11%) had a prolonged RTT. On multivariable analysis, accelerated RTT (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.73-0.97) was associated with an improved OS, and prolonged RTT (HR 1.25; 95% CI 1.14-1.37) was associated with a worse OS relative to standard RTT. When the 9,200 (47%) patients receiving definitive concurrent chemoradiation were examined, prolonged RTT (HR 1.29; 95% CI 1.11-1.50) was associated with a worse OS relative to standard RTT, whereas there was no significant association between accelerated RTT and OS (HR 0.76; 95% CI 0.57-1.01).
  
  
  
  Prolonged RTT is associated with worse OS in patients receiving radiation therapy for head and neck cancer, even in the setting of chemoradiation. Expeditious completion of radiation should continue to be a quality metric for the management of head and neck malignancies.
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Talha
authors.initials: T
authors.lastname: Shaikh
authors.affiliation: Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Handorf
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Colin T
authors.initials: CT
authors.lastname: Murphy
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Ranee
authors.initials: R
authors.lastname: Mehra
authors.affiliation: Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
authors.forename: John A
authors.initials: JA
authors.lastname: Ridge
authors.affiliation: Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. Electronic address: Thomas.Galloway@fccc.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Galloway
mesh_terms: D000704:Analysis of Variance; D059248:Chemoradiotherapy / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D009959:Oropharyngeal Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D011878:Radiotherapy / Q000401:mortality; D016019:Survival Analysis; D013997:Time Factors; D014062:Tongue Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D014067:Tonsillar Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy