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Multivariable logistic and Cox regression models were implemented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 6694 patients with 1 indication for aRT, 1906 (28.5%) received no further treatment and missed aRT. Age, race, comorbidity status, facility type, and distance to reporting facility were associated with missed aRT (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.025). Among 4003 patients with \u22651 possible indication for adjuvant chemoradiotherapy (aCRT), 914 (22.8%) received aCRT. Patients with pENE only (38.5%) and both pENE and PSM (44.0%) received aCRT more frequently than those with PSM only (17.0%) (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). Academic facility was associated with aCRT utilization (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05). aCRT utilization increased between 2006 and 2017 in both academic (14.8% vs\u00a023.9%) and nonacademic (8.8% vs\u00a013.5%) facilities (<jats:italic>P<\/jats:italic>\u2009&lt;\u2009.05). Among 2691 patients with \u22651 indication for aRT alone, missed aRT portended poorer OS (hazard ratio [HR]: 1.61, 95% confidence interval [CI]: 1.28\u20102.03, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001). Among 4003 patients with \u22651 possible indication for aCRT, aRT alone (HR: 1.02, 95% CI: 0.89\u20101.18, <jats:italic>P<\/jats:italic>\u2009=\u2009.780) and aCRT were associated with similar OS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Missed aRT in MSGC occurs frequently and portends poorer OS. 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