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4% [36.2%-40.7%]). In the surgical cohort, survival decreased 16.5% when DRT extended beyond 75 days (40-46 days 68.2% [67.3%-69.1%] vs. 75+ days 53.3% [50.1%-56.7%]). Multivariate analyses showed increased hazard of death with increased DRT (primary radiation 81+ days HR 1.69 [1.58-1.81]); surgical 75+ days HR 1.61 [1.37-1.88]), with effects intensifying when restricting to those receiving full-dose radiation. Conclusion A prolonged DRT was associated with worse OS in head and neck cancer. Radiation treatment delays of even a week lead t