Predictors of Delayed and Omitted Postoperative Radiotherapy After Laryngectomy for pT4 Laryngeal Cancer

BACKGROUND: Postoperative radiotherapy (PORT) improves locoregional control and survival in high-risk head and neck cancer, and guidelines recommend initiation within 42 days of surgery. Timeliness after laryngectomy for pathologic T4 (pT4) laryngeal cancer is poorly characterized. METHODS: In a retrospective National Cancer Database cohort of adults with nonmetastatic pT4 laryngeal squamous cell carcinoma undergoing total laryngectomy (2010-2022), multivariable logistic regression identified predictors of delayed (43-180 days post-operative receipt) and omitted PORT, and a 90-day landmark Cox model evaluated overall survival based on surgery-to-PORT interval. RESULTS: Among 6079 patients, 21.2% received timely PORT, 66.2% delayed, and 12.6% omitted within 180 days. Each additional week of delay carried a 3.7% higher adjusted mortality risk. Delay was associated with receipt of radiation at a facility other than the operating institution. Node-positive disease was associated with higher odds of delay but lower odds of omission. Omission was also associated with older age, greater comorbidity, and lower neighborhood income. CONCLUSIONS: Timely PORT after laryngectomy is rare; delays and omissions are associated with distinct factors that may benefit from specific interventions.