Multicentre patterns-of-care analysis of adjuvant and definitive (chemo)radiotherapy for pharyngeal and laryngeal carcinoma in Franconia, Germany

PURPOSE: To compare treatment patterns and oncologic outcomes of patients with pharyngeal and laryngeal squamous cell carcinoma treated at a tertiary hospital versus three secondary regional hospitals in Franconia, Germany. METHODS: We retrospectively analyzed 308 consecutive patients (tertiary hospital n = 164; secondary regional hospitals n = 144) diagnosed between 01/2017 and 12/2019 and treated with primary or adjuvant radiotherapy (RT), with or without concomitant chemotherapy. Primary endpoints were overall survival (OS), progression-free survival (PFS), and locoregional recurrence-free survival (LRRFS). Kaplan-Meier estimates, multivariable Cox regression models, and a 1:1 matched-pair analysis were applied. Residual confounding was quantified using E‑values. RESULTS: (HR > 3) as independent prognostic factors. CONCLUSION: Radiotherapy for pharyngeal and laryngeal cancer achieved comparable OS and PFS in tertiary and secondary hospitals that adhere to current quality benchmarks. The observed difference in locoregional control, which was limited to the primary (non-surgical) cohort, is consistent with the higher proportion of HPV-negative and functionally impaired patients treated in secondary hospitals. Residual imbalance after adjustment and matching indicates that unmeasured clinical or treatment-related factors may also contribute. Prompt initiation of RT and adequate cumulative cisplatin dosing remain critical.