Surgical complications following twice-a-day versus once-a-day radiation therapy

With increasing numbers of radiotherapists using twice-a-day (BID) rather than conventional once-a-day (QD) radiation therapy to treat carcinomas of the head and neck, we attempted to determine whether the increased tissue reaction seen with a BID program results in greater morbidity for subsequent surgery. Postoperative complications in 24 patients receiving prior BID irradiation were compared with 37 controls receiving QD treatments. The incidence of major surgical complications for BID and QD groups was equivalent (20.8% and 18.9%, respectively). The incidence of minor complications was almost three times greater for the BID group (37.5% vs. 13.5%). Patients receiving BID radiation therapy required twice as many intraoperative transfusions (2.13 vs. 1.11) and five additional days of postoperative hospitalization (23.7 vs. 18.2). These differences are statistically significant with p-values of less than 0.5 and less than 0.1, respectively. We consider this increase in surgical morbidity to be acceptable if BID radiation therapy leads to improved tumor control.