In real life.
Here is an NCDB analysis of 7084 patients with resected stage III-IV squamous cell carcinoma of the oral cavity. In other words, 7084 patients with unequivocal indications for post-op radiation. Nonetheless, almost 1 in 3 patients (n=2140) did not receive adjuvant radiation. Unsurprisingly, living closer to a treatment center and younger age was associated with receiving radiation. It’s therefore important to highlight that receiving adjuvant radiation of an adequate dose (>56 Gy) was associated with improved survival on multivariate analysis at every age—the hazard ratio for death was 1.65 without radiation even among those older than 80 years. Whether this survival detriment is due purely to radiation omission or more broadly to limited access to healthcare among older and more rural populations, either way supports interventions aimed at decreasing the travel and time burden of life-prolonging radiation. | Awan, JAMA Otolaryngol Head Neck Surg 2021