Does waiting time affect the outcome of larynx cancer treated by radiotherapy?

Bartoň, Michael; Morgan, Gary J.; Smee, Robert; Tiver, K. W.; Hamilton, C.S.; Gebski, Val

doi:10.1016/s0167-8140(97)00093-5

Cited by 69 publications

(51 citation statements)

References 13 publications

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“…Well-known and established factors are tumor stage as a tumor-related factor, gender as a patient-related factor and total radiation dose and simultaneous application of chemotherapy as treatment-related factors (2,6,7,20). We clearly demonstrated an impact of simultaneous application of chemotherapy on OS, with a 2-year OS of 50% versus 26% for radiotherapy alone that is also in the range reported by other authors (6,21).…”

Section: Discussionsupporting

confidence: 77%

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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: 77%

“…Barton et al evaluated 581 patients with early laryngeal cancer and found that a longer RTT was statistically significantly associated with reduced local control in multivariate analysis. Their treatment durations ranged from 16 to 117 days, with a median of 46 days (20).…”

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

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“…However, no significant correlation between waiting time and the outcome of early-stage laryngeal and nasopharyngeal cancers was found (Barton et al, 1997;Brouha et al, 2000). Lee et al (1993) however, have shown that advanced stage of head-and-neck tumours have a clear negative effect on treatment results.…”

Section: Discussion Waiting Timementioning

confidence: 99%

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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“…1 However, prior analyses of treatment delays in patients receiving definitive chemoradiation have not shown a consistent correlation between treatment delay and local control, metastatic disease, or overall survival. 7–9 Furthermore, it is unclear whether treatment delays have a detrimental effect for patients with OPSCC, the majority of whom have HPV-associated tumors. 10 For example, it has been hypothesized that the significance of progression prior to treatment may decrease as the incidence of HPV positive tumors increases.…”

Section: Introductionmentioning

confidence: 99%

Clinical impact of prolonged diagnosis to treatment interval (DTI) among patients with oropharyngeal squamous cell carcinoma

et al. 2016

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Purpose/Objective(s) We examined practice patterns using the National Cancer Database (NCDB) to determine risk factors for prolonged diagnosis to treatment interval (DTI) and survival outcomes in patients receiving chemoradiation for oropharyngeal squamous cell carcinoma (OPSCC). Methods and Materials We identified 6,606 NCDB patients with Stage III-IV OPSCC receiving chemoradiation from 2003-2006. We determined risk factors for prolonged DTI (>30 days) using univariate and multivariable logistic regression models. We examined overall survival (OS) using Kaplan Meier and multivariable Cox proportional hazards models. Results 3,586 (54.3%) patients had prolonged DTI. Race, IMRT, insurance status, and high volume facilities were significant risk factors for prolonged DTI. Patients with prolonged DTI had inferior OS compared to DTI ≤ 30 days (Hazard Ratio (HR)=1.12, 95% CI 1.04-1.20, p=0.005). For every week increase in DTI there was a 2.2% (95% CI 1.1%-3.3%, p<0.001) increase in risk of death. Patients receiving IMRT, treatment at academic, or high-volume facilities were more likely to experience prolonged DTI (High vs. Low volume: 61.5% vs. 51.8%, adjusted OR 1.38, 95% CI 1.21-1.58; Academic vs. Community: 59.5% vs. 50.6%, adjusted OR 1.26, 95% CI 1.13-1.42; non-IMRT vs. IMRT: 53.4% vs. 56.5%; adjusted OR 1.17, 95% CI 1.04-1.31). Conclusions Our results suggest that prolonged DTI has a significant impact on survival outcomes. We observed disparities in DTI by socioeconomic factors. However, facility level factors such as academic affiliation, high volume, and IMRT also increased risk of DTI. These findings should be considered in developing efficient pathways to mitigate adverse effects of prolonged DTI.

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Does waiting time affect the outcome of larynx cancer treated by radiotherapy?

Cited by 69 publications

References 13 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

Clinical impact of prolonged diagnosis to treatment interval (DTI) among patients with oropharyngeal squamous cell carcinoma

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