Non-adherence to recommended adjuvant radiation after total laryngectomy.

Autor: Chen B; University of Missouri Department of Otolaryngology, United States of America. Electronic address: bonnie.chen@health.missouri.edu., Topf MC; Vanderbilt University Medical Center Department of Head and Neck Surgery, United States of America., Zitsch RP; University of Missouri Department of Otolaryngology, United States of America., Biedermann G; University of Missouri Department of Radiation Oncology, United States of America., Tassone PT; University of Missouri Department of Otolaryngology, United States of America.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2024 Aug 05; Vol. 45 (6), pp. 104483. Date of Electronic Publication: 2024 Aug 05.
DOI: 10.1016/j.amjoto.2024.104483
Abstrakt: Objectives: Investigate trends and associated factors in guideline adherence to adjuvant radiation therapy in locally advanced laryngeal and hypopharyngeal cancer after primary total laryngectomy (TL).
Methods: Previously untreated, non-metastatic patients who underwent TL for pathologic T4 larynx or hypopharynx squamous cell carcinoma (SCC) were queried using the National Cancer Database (NCDB). Patients were excluded if they had regional or distant metastasis or positive margins. Patient characteristics were evaluated for association with non-adherence to adjuvant radiation by logistic regression analysis. Association between non-adherence and overall survival (OS) was investigated by Cox proportional hazard analysis.
Results: Among 2823 eligible T4 N0 patients, 841 (29.8 %) did not receive adjuvant radiation. Associated factors include increasing age, a Charlson Comorbidity Index of 2, greater per-mile distance to treatment center, and treatment at an academic cancer center. Delivery of adjuvant radiation was associated with improved OS on multivariable (HR 0.82, 95 % CI 0.72-0.93) analysis.
Conclusions: Within the NCDB, non-adherence to adjuvant radiation treatment after TL for pathologically T4 N0 larynx and hypopharynx SCC is common. Older patients with more comorbidities and greater travel distance may be at higher risk for non-adherence. Treatment at an academic cancer center is associated with non-adherence to recommended adjuvant radiation. Lack of adjuvant radiation is associated with worse overall survival.
Competing Interests: Declaration of competing interest None.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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