Effect of treatment delay on outcome of patients with early-stage head-and-neck carcinoma receiving radical radiotherapy

Fortin, A.; Bairati, Isabelle; Albert, Michele; Moore, Lynne; Allard, Josée; Couture, Christian

doi:10.1016/s0360-3016(01)02606-2

Cited by 116 publications

(116 citation statements)

References 10 publications

Supporting

Mentioning

111

Contrasting

Order By: Relevance

“…They described that a waiting time of over 40 days was correlated with significant increased risk of local and neck failure, as well as a decrease of OS rate of 15% compared with other patients (26) This resulted in a marginally significant decrease in survival with a relative risk for death/month of 1.16. The authors concluded that the risk of local recurrence increases with increasing waiting time, and that the increase in local recurrence rates may translate into reduced survival in some clinical situations.…”

Section: Discussionmentioning

confidence: 99%

Impact of Time Factors on Outcome in Patients with Head and Neck Cancer Treated with Definitive Radio(Chemo)Therapy

Dahlke

Steinmann

Christiansen

et al. 2018

View full text Add to dashboard Cite

Abstract. Aim: To evaluate treatment-related factors such as overall treatment time (OTT) and radiation treatment time (RTT) in head-and-neck cancer. Patients and MethodsSquamous cell carcinoma of the head and neck (SCCHN) is a cancer with worldwide impact. Oral cavity cancer as subgroup of SCCHN for instance accounts for approximately 300,400 new cases and 145,400 deaths every year (1). Most of these cases, approximately 90%, are SCCs. The most important risk factors in that etiology are tobacco and alcohol consumption, followed by other risk factors such as human papilloma virus infection, dietary factors and genetic susceptibility (2). Small SCCHN without lymphatic involvement can be cured in 70-90% of cases with either surgery or radiotherapy alone (3). For locally advanced SCCHN i.e. stage III or IV, surgery, radiotherapy and chemotherapy are the main treatment modalities for curative management. However, local and distant failure rates remain high despite intensified and combination therapy (4). If surgery is not possible due to co-morbidities or is refused due to potential loss of organ function, definitive radiotherapy with or without chemotherapy or targeted therapy e.g. cetuximab can be applied as a curative approach (5). The combination of therapies has shown to be superior in comparison to radiotherapy alone in several randomized studies and meta-analysis regarding overall survival and local control (4, 6,7).Up to 40% of patients treated for head and neck cancer develop a recurrence within 5 years after treatment. Reirradiation should definitely be considered for patients with a recurrent or second primary head and neck cancer (8). Therefore, improved local control is likely to lead to improved disease-free and overall survival (OS) (9). There are different prognostic treatment factors with impact on the further course of disease such as simultaneous application of chemotherapy or targeted therapy and total dose, dose per fraction or fractions per day/per week (10, 11). As well as these established factors, there may be other treatment-related factors with influence on further outcome, such as treatment time. In other cancer types, a prolonged overall treatment time (OTT) had a negative impact on survival (12). The influence of time as a factor may also become more important in countries with an imbalance between increased demand and availability of radiotherapy treatment units (13). Therefore, in addition to established prognostic factors, we analyzed the influence of different time periods influencing the OTT on further outcome of disease in patients with locally advanced SCCHN in terms of locoregional recurrence-free survival (LRFS), metastasis-free survival (MFS) and OS. 949This article is freely accessible online.Correspondence to: Sören Dahlke,

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of Time Factors on Outcome in Patients with Head and Neck Cancer Treated with Definitive Radio(Chemo)Therapy

Dahlke

Steinmann

Christiansen

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Fortin et al [10] looked at time waited from consultation to start of treatment for radically treated head-and-neck tumours, which are considered to have similar doubling times to cervical cancers. Their study demonstrated diminished locoregional control and overall survival for patients who waited longer than 40 days for radiation treatment.…”

Section: Discussionmentioning

confidence: 99%

A prospective study on the impact of waiting times for radiotherapy for cervical cancer at Charlotte Maxeke Johannesburg Academic Hospital

2015

View full text Add to dashboard Cite

Background. Radiotherapy plays a vital role in the management of cervical cancer. However, because of high patient load and limited resources, waiting lists are unacceptably long. This is a highly curable malignancy that often occurs in economically active, relatively young women. The impact of treatment delays on society is therefore disproportionately large when compared with many other malignancies. Delays also impact negatively on the healthcare system and place further stress on an already burdened department. Objective. To evaluate the potential impact of radiotherapy delays. Methods. Eighty-one patients requiring radical radiotherapy for cervical cancer were selected. Patients were re-evaluated every 4 weeks while waiting, and again at simulation. Results. Median delay from first consultation to simulation was 55 days. Longer delays were not statistically correlated to tumour progression. Most of the upstaging occurred around 40 -65 days. One in four patients received blood transfusions and required hospital admission. Four patients needed haemostatic brachytherapy for bleeding. Conclusion. A relationship between time waited and disease progression could not be proven. However, numbers were small and statistical tests were probably underpowered. The study does, however, highlight unacceptably long delays for radiotherapy, and a wait of less than 40 days is recommended. Despite significant advances in screening and management over the past few decades, cervical cancer remains a significant burden, particularly in developing countries, where more than 80% of cases are diagnosed.[1] Cervical cancer comprises 22.2% of all cancers in women of sub-Saharan Africa and carries the highest rate of cancer-related mortality.[2]

show abstract

“…Waaijer et al (2003) investigated tumour growth of oropharyngeal tumours in the waiting time for radiotherapy and estimated an average control loss of 16 -19% for these tumours during the waiting time. Fortin et al (2002) concluded that delaying radiotherapy had a deleterious effect on patients with early head-and-neck squamous cell carcinomas. Radiotherapy should be started as soon as possible, preferably within 20 -30 days after evaluation by a radiation oncologist.…”

Section: Discussion Waiting Timementioning

confidence: 99%

Accelerated regrowth of non-small-cell lung tumours after induction chemotherapy

2003

View full text Add to dashboard Cite

Induction chemotherapy of non-small-cell lung cancer (NSCLC) stage III with gemcitabine and cisplatin for downstaging of the tumour with the aim for further treatment with ionising radiation is one of the treatments for lung cancer patients. The purpose of this study was to investigate the influence of the waiting time for radiotherapy, that is, the interval between induction chemotherapy and radiotherapy, on the rate of tumour growth for patients with NSCLC. Interval times between the end of induction chemotherapy and date of diagnostic CT, planning CT and first day of radiotherapy were determined for 23 patients with NSCLC. Increase in gross tumour volume was measured for 18 patients by measuring the dimensions of the primary tumour and lymph node metastases on the diagnostic CT after induction chemotherapy and on the CT used for radiotherapy planning. For each patient, the volume doubling time was calculated from the time interval between the two CTs and ratio of the gross volumes on planning CT and diagnostic CT. The mean time interval between end of chemotherapy and day of diagnostic CT was 16 days, and till first day of radiotherapy 80.3 (range 29 -141) days. In all, 41% of potentially curable patients became incurable in the waiting period. The ratio of gross tumour volumes of the two CTs ranged from 1.1 to 81.8 and the tumour doubling times ranged from 8.3 to 171 days, with a mean value of 46 days and median value of 29 days. This is far less than the mean doubling time of NSCLC in untreated patients found in the literature. This study shows that in the time interval between the end of induction chemotherapy and the start of radiotherapy rapid tumour progression occurs as a result of accelerated tumour cell proliferation: mean tumour doubling times are much shorter than those in not treated tumours. As a consequence, the gain obtained with induction chemotherapy with regard to volume reduction was lost in the waiting time for radiotherapy. We recommend diminishing the time interval between chemo-and radiotherapy to as short as possible.

show abstract

Effect of treatment delay on outcome of patients with early-stage head-and-neck carcinoma receiving radical radiotherapy

Cited by 116 publications

References 10 publications

Impact of Time Factors on Outcome in Patients with Head and Neck Cancer Treated with Definitive Radio(Chemo)Therapy

Impact of Time Factors on Outcome in Patients with Head and Neck Cancer Treated with Definitive Radio(Chemo)Therapy

A prospective study on the impact of waiting times for radiotherapy for cervical cancer at Charlotte Maxeke Johannesburg Academic Hospital

Accelerated regrowth of non-small-cell lung tumours after induction chemotherapy

Contact Info

Product

Resources

About