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Delay of Postoperative Radiotherapy in Head and Neck Cancer Patients

Department of Oncology, Henri Becquerel Center, Rouen, France
Frederic Joliot Center, Rouen, France

To the Editor:

We have read with interest the review article by Jenny Huang et al¹ regarding delay in starting radiotherapy in the February 1 issue. The authors concluded that delay affects the outcomes in breast and head and neck cancers. Nevertheless, they cautiously reported the considerable and statistically significant heterogeneity between the seven publications dealing with postoperative radiotherapy in head and neck cancer patients. As a consequence, the results of three low-quality studies (comprising 237 patients) were secondly excluded from the analysis. The combination of the remaining four studies (corresponding to 614 patients) resulted in a significant, but reduced, decrease of local recurrence rate. Considering that one of the four high-quality studies enrolled 420 patients² (ie, more than two thirds of all patients), it seems questionable whether it was meaningful to add the results of these four studies. Indeed, this addition produced a result in contradiction with the conclusion of the largest study.² Finally, it was shown in Figure 4 that only one high-quality study³ resulted in a significant association with local recurrence rate. In fact, this study reported an influence in delay in starting radiotherapy only in the subgroup of patients with close surgical margin. This result therefore underlines the strong prognostic significance of surgical excision, which remains the main therapeutic factor influencing both locoregional relapse and survival.²

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Huang J, Barbera L, Brouwers M, et al: Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 21:555-563, 2003[Abstract/Free Full Text]

2. Bastit L, Blot E, Debourdeau P, et al: Influence of the delay of adjuvant postoperative radiation therapy on relapse and survival in oropharyngeal and hypopharyngeal cancers. Int J Radiat Oncol Biol Phys 49:139-146, 2001[CrossRef][Medline]

3. Dixit S, Vyas RK, Toparani RB, et al: Surgery versus surgery and postoperative radiotherapy in squamous cell carcinoma of the buccal mucosa: A comparative study. Ann Surg Oncol 5:502-510, 1998[CrossRef][Medline]

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