What question did this study set out to answer?

The study aims to evaluate the adherence to post-operative radiotherapy (PORT) and its outcomes in oral cavity cancer patients with intermediate adverse pathological features.

April 7, 2026Clinical and Translational Radiation Oncology0 citationsOpen Access

Indication adherence and outcome of post-operative radiotherapy in oral cavity cancer patients with intermediate adverse pathological tumor features: A nationwide population-based analysis

HOHanneke Doremiek van OorschotDutch Institute for Clinical Auditing JHJosé A. HardilloErasmus MC Cancer Institute FHFrank J.P. HoebersMaastricht University Medical Centre

Key Points

The study aims to evaluate the adherence to post-operative radiotherapy (PORT) and its outcomes in oral cavity cancer patients with intermediate adverse pathological features.
Included first primary OSCC patients treated from 2018 to 2021 in the Netherlands.
Calculated odds ratios for receiving PORT using multivariable regression analysis.
Assessed hospital variation via funnel plots.
Evaluated two-year overall survival and local control using multivariable Cox regression analysis.
PORT adherence increased with the number of adverse features; from 4.0% with one feature to 67% with all features present.
Significant predictors for PORT included pT3-T4, 1-5 mm resection margin, WPOI 4-5, and perineural invasion.
Patients with vaso-invasive growth and older individuals received PORT less often.
Hospital differences in PORT adherence persisted even after correcting for confounders.
PORT did not significantly enhance local control or overall survival.

Abstract

All first primary OSCC patients (n = 683) with intermediate-risk adverse pathological features from the tumor treated between 2018 and 2021 in the Netherlands were included.Features were 1-5 mm resection margins, pT3-T4 classification, perineural invasion, worst pattern of invasion (WPOI) 4-5, or vaso-invasive growth.Odds ratios (ORs) for receiving PORT were calculated using multivariable regression analysis.Hospital variation was assessed using funnel plots.Two-year overall survival (OS) and local control (LC) were evaluated using multivariable Cox regression analysis. Results:The percentage of patients receiving PORT increased when more features were present (4.0% for 1 feature, 67% for all features).Significant predictors for PORT were pT3-T4 (OR 23.3), 1-5 mm margin (OR 3.72), WPOI 4-5 (OR 1.83) and perineural invasion (OR4.75).Patients with vaso-invasive growth (OR 0.19) and increasing age (OR 0.96) received PORT less often.Hospital differences in PORT treatment remained after correction for confounders.PORT did not significantly improve the adjusted hazard ratio for LC (1.56, p=0.36) and OS (0.55, p=0.08). Conclusion:Of the tumor-related pathological features, pT3-pT4 contributed the most to PORT treatment in OSCC.Significant hospital differences remained after correction for confounding factors.Future research should focus on guideline consensus to prevent over-and undertreatment.

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