Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta-analysis

Kelsey A. Duckett, Mohamed Faisal Kassir, Shaun A. Nguyen, Emily A. Brennan, Bhishamjit S. Chera, Katherine R. Sterba, Chanita Hughes Halbert, Elizabeth G. Hill, Jessica McCay, Sidharth V. Puram, Vlad C. Sandulache, Russel Kahmke, Salma Ramadan, Brian Nussenbaum, Anthony J. Alberg, Evan M. Graboyes

Research output: Contribution to journalReview articlepeer-review


Objective: Initiating postoperative radiotherapy (PORT) within 6 weeks (42 days) of surgery is the first and only Commission on Cancer (CoC) approved quality metric for head and neck squamous cell carcinoma (HNSCC). No study has systematically reviewed nor synthesized the literature to establish national benchmarks for delays in starting PORT. Data Sources: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed a systematic review of PubMed, Scopus, and CINAHL. Review Methods: Studies that described time-to-PORT or PORT delays in patients with HNSCC treated in the United States after 2003 were included. Meta-analysis of proportions and continuous measures was performed on nonoverlapping datasets to examine the pooled frequency of PORT delays and time-to-PORT. Results: Thirty-six studies were included in the systematic review and 14 in the meta-analysis. Most studies utilized single-institution (n = 17; 47.2%) or cancer registry (n = 16; 44.4%) data. Twenty-five studies (69.4%) defined PORT delay as >6 weeks after surgery (the definition utilized by the CoC and National Comprehensive Cancer Network Guidelines), whereas 4 (11.1%) defined PORT delay as a time interval other than >6 weeks, and 7 (19.4%) characterized time-to-PORT without defining delay. Meta-analysis revealed that 48.6% (95% confidence interval [CI], 41.4-55.9) of patients started PORT > 6 weeks after surgery. Median and mean time-to-PORT were 45.8 (95% CI, 42.4-51.4 days) and 47.4 days (95% CI, 43.4-51.4 days), respectively. Conclusion: Delays in initiating guideline-adherent PORT occur in approximately half of patients with HNSCC. These meta-analytic data can be used to set national benchmarks and assess progress in reducing delays.

Original languageEnglish
Pages (from-to)320-334
Number of pages15
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number2
StatePublished - Feb 2024


  • Commission on Cancer
  • National Comprehensive Cancer Network
  • adjuvant therapy
  • head and neck cancer
  • quality
  • radiotherapy


Dive into the research topics of 'Delays Starting Postoperative Radiotherapy Among Head and Neck Cancer Patients: A Systematic Review and Meta-analysis'. Together they form a unique fingerprint.

Cite this