Examining adjuvant radiation dose in head and neck squamous cell carcinoma

Background Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC). Methods Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD-RT) was defined as an equivalent dose in 2 Gy (EQD2) >= 56.64 and <= 60 Gy and high-dose radiation (HD-RT) as an EQD2 >60 and HD-RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD-RT was associated with increased mortality (HR1.09; 95%CI 1.02-1.16). In nonoropharynx or human papillomavirus-negative oropharynx primary that had positive margins, >= 5 positive lymph nodes, and/or extranodal extension, HD-RT was still not associated with improved survival (HR 1.01, 95% CI 0.91-1.12). Conclusions There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high-risk cohort.