Predictors of Delayed and Omitted Postoperative Radiotherapy After Laryngectomy for pT4 Laryngeal Cancer
In brief
Each week of delayed radiotherapy after laryngectomy raises death risk by about 4%
In a national cohort of 6,079 patients with pathologic T4 laryngeal cancer, only 21% started postoperative radiotherapy within the recommended 42 days, while 66% were delayed and 13% never received it. Every extra week of delay added roughly 4% to the adjusted mortality risk, with delays linked to treatment at a different facility and omissions tied to older age, comorbidities, and low-income neighborhoods.
- Journal
- Head & neck (Q1)
- Published
- 21 September 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- George Ashji, Arun Rajan, Elias Dahl, Sudarshan Ramanan, Nishant Chadha, Yingzhi Wu, et al.
- PMID
- 42765406
- DOI
- 10.1002/hed.70482
Why clinicians should know about it
- Picked for Otorhinolaryngology (paper of the day, 23 September 2026): Predictors of delayed/omitted PORT after laryngectomy for pT4 cancer
Abstract
BACKGROUND: Postoperative radiotherapy (PORT) improves locoregional control and survival in high-risk head and neck cancer, and guidelines recommend initiation within 42 days of surgery. Timeliness after laryngectomy for pathologic T4 (pT4) laryngeal cancer is poorly characterized. METHODS: In a retrospective National Cancer Database cohort of adults with nonmetastatic pT4 laryngeal squamous cell carcinoma undergoing total laryngectomy (2010-2022), multivariable logistic regression identified predictors of delayed (43-180 days post-operative receipt) and omitted PORT, and a 90-day landmark Cox model evaluated overall survival based on surgery-to-PORT interval. RESULTS: Among 6079 patients, 21.2% received timely PORT, 66.2% delayed, and 12.6% omitted within 180 days. Each additional week of delay carried a 3.7% higher adjusted mortality risk. Delay was associated with receipt of radiation at a facility other than the operating institution. Node-positive disease was associated with higher odds of delay but lower odds of omission. Omission was also associated with older age, greater comorbidity, and lower neighborhood income. CONCLUSIONS: Timely PORT after laryngectomy is rare; delays and omissions are associated with distinct factors that may benefit from specific interventions.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.