Timing of Adjuvant Radiotherapy in Head Neck Cancer: A Safe Option in Resource Limited Settings

Background:

In resource-limited settings from low- and middle-income countries, patients often suffer due to delays in starting radiotherapy. Our objective was to find out which patients with head and neck cancer can safely wait more than 6 weeks after surgery for adjuvant radiotherapy without compromising loco-regional recurrence, and which patients need to start within 6 weeks. This will help us prioritize and schedule treatment more effectively based on risk.

Methods:

A retrospective review was conducted using a prospectively maintained database of patients with histologically confirmed squamous cell carcinoma (T1-T4, N0-N3) of the head and neck region involving buccal mucosa, oral tongue, and parotid gland who underwent surgery followed by adjuvant RT (60-66Gy) between 2019-2021 at a tertiary level hospital. The study aimed to evaluate the impact of the timing of adjuvant radiotherapy (RT) and clinicopathological factors on recurrence in operable head and neck squamous cell carcinoma (HNSCC) in a resource-limited setting. Patients were divided into three groups based on the interval between surgery and initiation of adjuvant RT( 8weeks). Clinicopathological factors including T and N stage, margin status, lymphovascular space invasion (LVSI), and perineural invasion (PNI) were analyzed for their association with recurrence. Chi-square test and Kaplan–Meier survival analysis were used; Cox regression identified independent predictors of recurrence.

Results:

In this retrospective study of 99 patients with oral cavity carcinoma, the median age was 52 years, and the majority had buccal mucosa involvement. Recurrence occurred in 37.4% of patients. Positive margin status (HR=3.02), LVSI (HR=2.45), and advanced T/N stage were significant predictors of recurrence. Delaying radiotherapy beyond 8 weeks showed a higher recurrence rate (65.2% vs. 48.6%) in high-risk patients, though not statistically significant (p=0.18). Timely RT is especially critical in high-risk cases, while delays may be acceptable in low-risk patients without compromising outcomes.

Conclusion:

In resource-limited settings where the average waiting time for radiotherapy is at least 2 months, it is crucial to prioritize patients based on individual risk factors. Our study suggests that not all head and neck cancer patients require adjuvant RT within 6 weeks. Patients with low-risk features may safely initiate RT up to 8 weeks post surgery without compromising outcomes. A risk-adapted, individualized approach is essential to optimize resource use and patient care.