Basic Original Report Treatment Package Time in Node-Positive Cutaneous Head and Neck Squamous Cell Carcinoma Christopher P. Daniels, MBBS, a Mathias Bressel, MSc, b June Corry, MD, c Aidan Cole, PhD, a,d Margaret S.-T. Chua, MBBS, a Albert Tiong, MBBS, a Nir Hirshoren, MD, e Ben Dixon, PhD, e and Lachlan McDowell, MBBS, a,f, * a Department of Radiation Oncology and b Centre of Biostatistics and Clinical Trials (BaCT), Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; c Department of Radiation Oncology, GenesisCare, St Vincent’s Hospital, Melbourne, Victoria, Australia; d Centre for Cancer Research and Cell Biology, Queen’s University Belfast; e Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; and f Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia Received 24 July 2019; revised 4 September 2019; accepted 6 September 2019 Abstract Purpose: Treatment package time (TPT) prolongation is associated with lower overall survival and locoregional control in mucosal head and neck squamous cell carcinoma (SCC), but there are few reports in cutaneous HNSCC (cHNSCC). We sought to test the effect of TPT in a cohort of patients with cHNSCC. Methods: This is a single institution retrospective study of node-positive cHNSCC patients involving either the parotid or cervical nodes treated with curative intent surgery with macroscopic tumor clearance followed by standard fractionation postoperative radiation therapy (PORT) from 2001 to 2014. We assessed the effect of TPT and other prognostic variables on overall survival (OS), cHNSCC specific survival (CSS) progression free survival (PFS), and freedom from locoregional failure (FFLRF). Results: In the present study, 152 patients met the inclusion criteria. The 5-year OS, CSS, PFS, and FFLRF were 62% (95% confidence interval [CI], 54-71), 78% (95% CI, 71-87), 54% (95% CI, 46-64), and 76% (95% CI ,68-85), respectively. In a multivariable model, TPT 14 weeks was associated with worse outcomes in all endpoints (OS [hazard ratio (HR) 4.93; 95% CI, 2.54-9.56, P < .001], CSS [HR 6.09; 95% CI, 2.33-15.92; P Z .001], PFS [HR 4.29; 95% CI, 2.21-8.34; P < .001], and FFLRF [HR 4.63; 95% CI, 1.71-12.51; P Z .007]). Immunosuppression and the presence of 2 pathologically involved lymph nodes were also significant adverse factors for both OS and FFLRF, although extracapsular extension was also associated with lower FFRLF. Delays to commencing PORT rather than treatment breaks accounted for the majority of cases with prolonged TPT. An initial analysis of these data was presented in abstract form at the 2019 Trans-Tasman Radiation Oncology Group meeting. Sources of support: None. Disclosures: None. * Corresponding author: Lachlan McDowell, MBBS; E-mail: Lachlan.McDowell@petermac.org https://doi.org/10.1016/j.prro.2019.09.009 1879-8500/Crown Copyright Ó 2019 Published by Elsevier Inc. on behalf of American Society for Radiation Oncology. All rights reserved. Practical Radiation Oncology (2020) 10, 29-35 www.practicalradonc.org