Ang 2001 (Post-Op RT Risk Factors & Time)

Background

Phase III, multi-institutional, prospective randomized. N=213 evaluable, advanced (stage III–IV) head and neck SCC after surgery. Validated a pathologic risk-stratification system for need/dose of post-operative RT (PORT) and tested whether accelerating PORT via concomitant boost improves outcomes.

Interventions and follow up

Arm A (standard PORT): 7-week schedule
Arm B (accelerated PORT): 5-week concomitant boost technique
Risk stratification: low/intermediate/high risk by pathologic features to guide PORT need and dose
Primary endpoint: locoregional control and overall survival
mFollow up: multi-year (NR)

Results

LRC by risk group: low/intermediate significantly higher LRC and survival than high-risk (P=.003, P=.0001)
Accelerated vs standard PORT (high-risk): trend toward higher LRC and survival with 5-week schedule (NS)
Surgery-to-PORT interval: prolonged interval (7-week arm) associated with lower LRC (P=.03) and survival (P=.01)
Overall treatment duration impact on LRC: P=.005

Adverse events

Accelerated PORT (5-week concomitant boost): did not increase late treatment toxicity vs 7-week schedule
Detailed toxicity rates: NR in source

Conclusions

Pathologic risk features reliably predict need and dose of PORT. Overall surgery-plus-PORT duration significantly impacts LRC and survival—a prolonged surgery-to-PORT interval is harmful; accelerated PORT with concomitant boost does not increase late toxicity.

Key Limitations

Acceleration benefit was a non-significant trend; modest sample (N=213); interval/duration findings are exploratory; median follow-up not reported; no concurrent chemotherapy (pre-chemoradiation era).

Clinical Context

Established that overall treatment package time (surgery-to-PORT interval plus RT duration) matters for resected high-risk H&N SCC; supports timely initiation of PORT, a principle retained in current practice.

References