Time to Initiation of Radiation Therapy following Surgical Treatment of Sinonasal Malignancy: Does Surgical Approach Delay Treatment?

Introduction: The National Cancer Comprehensive Network guidelines recommend postoperative radiation treatment (RT) for larger sinonasal tumors and pathology with positive margins or negative prognostic factors. Recent literature evaluating all head and neck malignancy has demonstrated a survival advantage with the onset of postoperative RT within 6 weeks. The current study utilized the National Cancer Database (NCDB) to identify differences between open and endoscopic surgery for sinonasal malignancy with respect to timing of postoperative RT.

Methods: The National Cancer Database was queried for patients with sinonasal malignancies treated between 2010 and 2015. The primary outcome was the time to initiation of RT following surgical treatment of sinonasal tumors. The two groups analyzed were those that underwent endoscopic surgery compared with open surgery. Specific differences in time to RT with respect to demographic, socioeconomic, clinical, and pathologic factors were assessed. A multivariate analysis was used to identify potential differences between surgical approaches. Secondary outcome measures included length of stay and 30-day readmission rates.

Results: A total of 10,193 patients with sinonasal malignancies were identified in the NCDB database; of these, 1,170 patients underwent surgical resection with postoperative RT and had complete data regarding onset of RT, length of stay, and readmission rate. 73.8% (n = 863) of patients had an open approach for surgical resection and 26.2% (n = 307) underwent an endoscopic procedure. The average time to RT from surgery was 55.7 days (7.9 weeks) for both groups combined. At 6 weeks (42 days) postoperatively, 34.6% of the entire cohort initiated RT. At this time point, 42.9% of the endoscopic group initiated RT compared with 31.6% of the open group (p < 0.001). This finding maintained significance at 8 weeks (67.8% endoscopic vs. 61.4% open, p = 0.048); however, by 10 weeks there was no longer a significant difference between the endoscopic and open cohorts (80.8 vs. 81.1%, p = 0.899). When evaluating the entire surgical cohort, there were significant differences in longer time to RT for female gender, black race, being uninsured, and esthesioneuroblastoma pathology, while a shorter time to RT for those treated at comprehensive community centers. While there was a significant difference between average length of stay for the open group compared with the endoscopic group (5.9 vs. 3.3 days, p < 0.001), there was no difference found in 30-day readmission rates (5.75 vs. 4.86%, p = 0.73).

Conclusion: Overall, a relatively small percentage of patients received postoperative RT within 6 weeks of surgery, 34.6% of the entire cohort. Patients undergoing surgery initiated postoperative RT within 6 weeks in 31.6% of open cases compared with 42.9% of endoscopic cases.