Impact of Surgeon-Radiation Oncology Dyads in Oral Cavity Cancer Outcomes

Jacob Wihlidal; Alex O Esemezie; Shao Hui Huang; Erin Watson; Ralph W Gilbert; John Waldron; Patrick J Gullane; Andrew Hope; Jonathan C Irish; Brian O'Sullivan; Douglas B Chepeha; John J H Kim; Dale Brown; B C John Cho; Ian J Witterick; Eric Monteiro; Joel C Davies; Jolie Ringash; David P Goldstein; Scott Bratman; Andrew Bayley; John R de Almeida; Timothy C Y Chan; Ali Hosni; Christopher M K L Yao

doi:10.1245/s10434-024-16385-4

Impact of Surgeon-Radiation Oncology Dyads in Oral Cavity Cancer Outcomes

Ann Surg Oncol. 2024 Oct 28. doi: 10.1245/s10434-024-16385-4. Online ahead of print.

Authors

Jacob Wihlidal¹, Alex O Esemezie², Shao Hui Huang^{1

3}, Erin Watson⁴, Ralph W Gilbert^{1

2}, John Waldron^{1

3}, Patrick J Gullane^{1

2}, Andrew Hope³, Jonathan C Irish^{1

2}, Brian O'Sullivan³, Douglas B Chepeha⁵, John J H Kim³, Dale Brown^{1

2}, B C John Cho³, Ian J Witterick^{1

6}, Eric Monteiro^{1

6}, Joel C Davies^{1

6}, Jolie Ringash^{1

3}, David P Goldstein^{1

2}, Scott Bratman³, Andrew Bayley³, John R de Almeida^{1

2}, Timothy C Y Chan⁷, Ali Hosni³, Christopher M K L Yao^{8

9}

Affiliations

¹ Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
² Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada.
³ Department of Radiation Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
⁴ Department of Dental Oncology, Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
⁵ Department of Otolaryngology - Head and Neck Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
⁶ Department of Otolaryngology - Head & Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.
⁷ Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada.
⁸ Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada. christophermkl.yao@uhn.ca.
⁹ Department of Otolaryngology - Head and Neck Surgery, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada. christophermkl.yao@uhn.ca.

PMID: 39467971
DOI: 10.1245/s10434-024-16385-4

Abstract

Background: Multidisciplinary care is paramount in patient-specific decision making, especially as pertaining to oral cavity squamous cell cancer (OCSCC) treatment. Protracted surgery-postoperative-radiation (S-PORT) has a detrimental impact on OCSCC patients' outcomes. This study examined the impact of surgeon-radiation oncologist dyads on the treatment of OCSCC, focusing on S-PORT interval and disease specific outcomes.

Methods: All OCSCC patients treated in a tertiary cancer center between 2009 to 2017 were included. Patients were categorized into "dyad" and "nondyad" groups defined as whether they were treated by a paired surgeon-radiation oncology team with joint multidisciplinary clinic or shared >30% patient volumes. Univariate and multivariate logistic regression were performed to identify factors associated with a prolonged S-PORT time interval (≥8 weeks). Overall survival and locoregional recurrence were estimated and compared.

Results: A total of 444 OCSCC were eligible. Treatment by a dyad was significantly less likely associated with S-PORT ≥ 8 weeks (odds ratio [OR]_unadjusted: 0.65; 95% confidence interval [CI] 0.44-0.96; p = 0.03). Obtaining pre-operative radiation oncology consultation also decreased the S-PORT interval. Advanced T-category and the need for free tissue flap reconstruction increased the likelihood of prolonged S-PORT on univariate but not multivariate analysis. No significant differences were observed in overall survival or locoregional recurrence by dyad status nor S-PORT (p > 0.05).

Conclusions: Surgeon-radiation oncology dyads significantly minimized time from surgery to postoperative radiation in OCSCC. While improvement in overall survival or locoregional recurrence was not observed, these findings support close knit collaborative multidisciplinary treatment care models, including dyad-based care.

Keywords: Models of Care; Multidisciplinary Teams; Oral Cancer; Post-op Radiation Treatment; Surgeon Radiation Oncology Dyads; Treatment Package Time.