Effect of time to simulation and treatment for patients with oropharyngeal cancer receiving definitive radiotherapy in the era of risk stratification using smoking and human papillomavirus status

Amsbaugh, Mark J.; Cash, Elizabeth; Silverman, Craig L.; Potts, Kevin

doi:10.1002/hed.24963

Cited by 6 publications

(9 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The first negative impact of waiting for treatment to begin is the risk that the tumor will increase in size and/or metastasize during this time, making it harder to treat or resulting in it becoming untreatable [ 7 , 8 ]. However, the time for a tumor to grow is only one of the factors that determines prognosis and the absence of a statistically significant association between TTI and the treatment outcome in our study (and many other reports) is thus not surprising [ 10 – 18 ]. Moreover, no obvious methodological differences could be found between these (negative) studies and the positive studies that confirmed the association between TTI and treatment outcomes [ 33 – 35 ].…”

Section: Discussionsupporting

confidence: 56%

“…In addition, physical findings documented in clinical records and, when available, diagnostic MRIs were used for this purpose and labelled tumor volumes represented a consensus between two experienced radiation oncologists and a radiologist, all dedicated to HNC management. Like many other studies [ 10 – 18 , 33 – 36 ], the comorbidity burden was not registered in our patients, although it should be taken into account when assessing survival outcomes [ 49 ]. Finally, lags in the pre-biopsy period were not addressed in our study, including patient delay and delays in referral and diagnostics, which may add significantly to the total TTI.…”

Section: Discussionmentioning

confidence: 94%

“…Indeed, a systematic review of pertinent literature from the period 1975-2005 by Chen et al showed an increase in the risk of local HNC recurrence of 3.7% for every month of delay in definitive RT [9]. However, certain studies included in Chen's meta-analysis, and also some more recent reports, negated the association between the delay in definitive RT and the increased risk of treatment failure [10][11][12][13][14][15][16][17][18]. Several different biases, inherent in retrospective analyses, either related to the quality of diagnostic procedures and treatment or to the inhomogeneity of the studied population, as well as a selection bias (i.e., patients with fast tumor progression or a higher burden of symptoms receive priority in treatment) and significant variability in the kinetics of individual HNC cases, may abolish the effect of TTI in outcomes [19][20][21][22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Impact of delays in radiotherapy of head and neck cancer on outcome

et al. 2020

View full text Add to dashboard Cite

Background: In head and neck cancer (HNC), the relationship between a delay in starting radiotherapy (RT) and the outcome is unclear. The aim of the present study was to determine the impact of the amount of time before treatment intervention (TTI) and the growth kinetics of individual tumors on treatment outcomes and survival. Methods: Two hundred sixty-two HNC patients with 273 primary tumors, treated with definitive (chemo) RT, were retrospectively analyzed. The TTI was defined as the time interval between the date of histopathologic diagnosis and the first day of the RT course. Volumetric data on 57 tumors were obtained from diagnostic and RT planning computer tomography (CT) scans in order to calculate the tumor growth kinetic parameters. Results: No significant association between locoregional control or cause-specific hazards and TTI was found. The log hazard for locoregional recurrence linearly increased during the first 40 days of waiting for RT, although this was not significant. The median tumor volume relative increase rate and tumor volume doubling time was 3.2%/day and 19 days, respectively, and neither had any impact on locoregional control or cause-specific hazards. Conclusion: The association between a delay in starting RT and the outcome is complex and does not harm all patients waiting for RT. Further research into imaging-derived kinetic data on individual tumors is warranted in order to identify patients at an increased risk of adverse outcomes due to a delay in starting RT.

show abstract

Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of delays in radiotherapy of head and neck cancer on outcome

et al. 2020

View full text Add to dashboard Cite

show abstract

“…HPV negative patients had increased TTI in two studies [38,40]. However, four other studies revealed no association between HPV status and delay [37,39,42,43].…”

Section: Oropharynxmentioning

confidence: 95%

Determinants of delay and association with outcome in head and neck cancer: A systematic review

Schoonbeek

Zwertbroek

Plaat

et al. 2021

European Journal of Surgical Oncology

View full text Add to dashboard Cite

Introduction: Head and neck cancers (HNC) are relatively fast-growing tumours, and delay in treatment initiation is associated with tumour progression and adverse outcome. An overview of factors contributing to delay can provide critical insights on necessary adjustments to optimize care pathways. This systematic review aims to identify factors associated with delay and summarize the effect of delay on oncological outcome measures. Methods: A search strategy was conducted according to PRISMA guidelines to search electronic databases for studies assessing the carepathway interval (days between first visit in head and neck oncology center and treatment initiation) and/or time-to-treatment-initiation interval (days between histological diagnosis and treatment initiation) and 1) determinants of delay and/or 2) effect of delay on outcome within these timeframes. Due to heterogeneity between included studies, a meta-analysis was not possible. Results: Fifty-two studies were eligible for quantitative analysis. Non-Caucasian race, academic setting, Medicaid/no insurance and radiotherapy as primary treatment were associated with delay. Advanced tumour stage was related to increased time-to-treatment initiation in the four common sites combined (oral cavity, oropharynx, hypopharynx, larynx). Separate determinants for delay in different tumour locations were identified. In laryngeal, oral cavity cancer and the four common HNC sites combined, delay in start of treatment is associated with decreased overall survival, although no cut-off time point could be determined. Conclusion: Race, facility type, type of insurance and radiotherapy as primary treatment were associated with delay and subsequent inferior survival in the four common sites combined.

show abstract

“…[ 18 ] Two other reports from the same study described the effect of time to simulation and treatment for patients with oropharyngeal cancer receiving definitive radiotherapy in smokers and non-smokers. [ 19 ] Our search found 8 review articles on the effect of smoking during cancer treatment. While these publications suggest that smoking is a negative factor for cancer treatment, there is a lack of analyses specifically comparing the variables of drug treatment, current or former smoking status, and cancer type.…”

Section: Introductionmentioning

confidence: 99%