ObjectivesIn patients with head and neck carcinoma, “treatment package time” (TPT) was proven to impact outcomes in cases receiving adjuvant radiotherapy alone. Its impact in patients receiving radiotherapy with concurrent systemic therapy has not been studied previously. The TPT influence on survival endpoints for patients treated with surgery followed by radiation and concurrent systemic therapy was analyzed.MethodsInstitutional database to identify head and neck carcinoma cases treated with definitive surgery followed by concomitant chemo(bio) radiotherapy (CRT) was used. TPT was the number of days elapsed between surgery and the last day of radiation. %FINDCUT SAS macro tool was used to search for the cutoff TPT that was associated with significant survival benefit. Kaplan–Meier curves, log-rank tests as well as univariate and multivariate analyses were used to assess overall survival (OS) and recurrence free survival (RFS).ResultsOne hundred and three cases with a median follow up of 37 months were included in the study. Oropharyngeal tumors were 43%, oral cavity 40% and laryngeal 17% of cases. Concurrent systemic therapy included platinum and cetuximab in 72% and 28%, respectively. Optimal TPT was found to be < 100 days with significantly better OS (P = 0.002) and RFS (P = 0.043) compared to TPT ≥100 days. On multivariate analysis; TPT<100 days, extracapsular nodal extension, high-risk score, lymphovascular space and perineural invasion were independent predictors for worse OS (P < 0.05). T4, extracapsular nodal extension and high-risk score were all significantly detrimental to RFS (P < 0.05).ConclusionsAddition of concomitant systemic therapy to adjuvant radiotherapy did not compensate for longer TPT in head and neck squamous cell carcinoma. Multidisciplinary coordinated care must be provided to ensure the early start of CRT with minimal treatment breaks.

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4%-90.4%) and regional control was 88.2% (95% CI: 80.3%-96.9%). Distant metastatic-only failure occurred in 2.7% of patients. Seventeen patients experienced a locoregional recurrence with 15 treatment plans available for review. Eighty percent of failures were 95% contained within the dPTV70Gy. There were no factors associated with overall survival or disease control on multivariate analysis. Gastrostomy tube rate at last follow-up was 3.7% and 7.4% of patients required permanent tracheostomy tube placement. Mean dose and the volume of DARS receiving 70 Gy was significantly lower for dPTV70Gy compared to a consensus-defined PTV70Gy (cPTV70Gy). Conclusions: These data support that judicious reduction in high-dose target volumes can preserve high tumor control rates while reducing dose to normal surrounding structures. Distant metastatic-only failure was a rare event further underscoring the potential benefit of minimal target volumes enabling intensification of local therapies to further improve locoregional control.