Waiting times for radiotherapy: consequences of volume increase for the TCP in oropharyngeal carcinoma

Waaijer, Annet; Terhaard, Chris H.J.; Dehnad, Homan; Hordijk, G. J.; Leeuwen, Maarten S. van; Raaymakers, Cornelius P.J.; Lagendijk, J J W

doi:10.1016/s0167-8140(03)00036-7

Cited by 116 publications

(114 citation statements)

References 18 publications

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“…Within a waiting time interval of 2-4 weeks, 68% of patients showed measurable tumor progression, and after 4 weeks, 70% of patients had an increase in total tumor volume (22). A mean increase in tumor volume of 70% during a mean waiting time of 56 days was also found by Waajier et al (23).…”

Section: Discussionsupporting

confidence: 55%

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

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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,

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Section: Discussionsupporting

confidence: 55%

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

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“…These nine patients had progression of their tumour to stage III-B at the time of planning CT and became ineligible for high-dose radiotherapy. 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.…”

Section: Discussion Waiting Timementioning

confidence: 99%

“…Furthermore, tumour progression during the waiting time till the start of radiotherapy for lung cancer and head-and-neck tumours, respectively, was reported, indicating a possible negative influence on treatment results (O'Rourke and Edwards, 2000;Waaijer et al, 2003). Owing to restaging procedure after induction chemotherapy and waiting times for radiotherapy, we were interested to know to what extent the OTT and, in our case, the waiting period between the end of induction chemotherapy and the start of radiotherapy might influence tumour behaviour.…”

mentioning

confidence: 94%

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

2003

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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.

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“…Early diagnosis of head and neck cancer is important as it has been shown that diagnostic delay increases risk of mortality [6]. Furthermore, it is known that head and neck cancer proliferate rapidly and that delay in treatment initiation can result in stage progression [7,8] and have a negative effect on survival [9]. This emphasises the importance of reducing diagnostic delay and treatment delay to ensure better prognosis for patients with head and neck cancer.…”

Section: Introductionmentioning

confidence: 99%

Improved survival of head and neck cancer patients in Greenland

Lawaetz

Jensen

Friborg

et al. 2018

International Journal of Circumpolar Health

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Previously, head and neck cancer (HNC) patients in Greenland have had significant diagnostic delay and poor survival rates. From 2005-2009 several initiatives have been made to ensure faster diagnosis and better survival. The aim of this study was to compare the prognosis before and after these initiatives were introduced.All Greenlandic patients diagnosed with HNC between 2005 and 2012 were included. Data were retrieved from medical records and national databases and compared with the period 1994-2003. A total of 98 patients were identified. Diagnostic delay was significantly lower compared to the period 1994–2004 (p=0.048). The 3-year overall survival was 56% for all HNC and 47% for nasopharyngeal carcinomas. We found that patients with HNC between 1994 and 2003 had a higher risk of death from all reasons compared with the period 2005–2012 (HR 2.17; CI 1.46–3.23) after adjustments for stage and diagnostic delay.Patients with head HNC in Greenland from 2005-2012 were diagnosed earlier and had a better overall survival compared to the period 1994–2003. The change in survival is more likely to be due to improvement in treatment rather than the initiated interventions. Although survival has improved in Greenland, demographic problems and lack of specialists remain a challenge.

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Waiting times for radiotherapy: consequences of volume increase for the TCP in oropharyngeal carcinoma

Cited by 116 publications

References 18 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

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

Improved survival of head and neck cancer patients in Greenland

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