Trends in postoperative radiotherapy delay and the effect on survival in breast cancer patients treated with conservation surgery

Abstract

The adequate timing of adjuvant radiotherapy (RT) in breast cancer has become a subject of increasing interest in recent years. A population-based study was undertaken to determine the influence of demographic and clinical factors on the postoperative RT delay in patients treated with breast-conserving surgery (BCS) and to assess the impact of delay on survival. In total, 7800 breast cancer patients treated with BCS and adjuvant RT between 1986 and 1998 in Yorkshire were included in the study. The median interval between surgery and the start of RT (S -RT interval) was 8 weeks (7 weeks for chemotherapy negative and 11 for chemotherapy positive patients). This interval increased substantially over time from 5 weeks during 1986 -1988, irrespective of patients' chemotherapy status, to 10 and 17 weeks among chemotherapy negative and chemotherapy positive patients, respectively, in 1997 -1998. The S -RT interval was also significantly influenced by travel time to RT centre, year and at which RT centre patient had the treatment (Po0.001). Overall, 5-year survival was 82%. Patients with S -RT intervals longer than 9 weeks had a trend towards an increased relative risk of death. This reached a statistical significance at 20 -26 weeks (RR 1.49, 95% CI (1.16 -1.92)). The findings of our study suggest that delaying the initiation of RT for 20 -26 weeks after surgery is associated with decreased survival in patients treated with conservation surgery.

Immediate post-mastectomy breast reconstruction followed by radiotherapy: risk factors for complications

“…Thus, the delay between surgery and RT was longer (at least 8 weeks after the end of CT). Although this delay may account to some extent for the low reconstruction failure rate, it could also jeopardize the carcinogenic efficacy of irradiation [19].…”

Full-dose intra-operative radiotherapy with electrons (ELIOT) during

“…An additional advantage of ELIOT is that there is no delay in administering RT in cases that need adjuvant anthracyclines. There is evidence that the delay might increase the risk of local recurrences [30][31][32][33].…”

Waiting times for radiotherapy: variation over time and between cancer networks in southeast England

“…Mikeljevic et al (2004) found that the mean interval between conservative breast surgery and radiotherapy increased from 5 to 12 weeks over a 10-year period from the late 1980s to the late 1990s. Factors likely to contribute to this effect include availability of trained staff and equipment and increases in workload due to either an increased incidence of cancer or changes in the management of tumours over time, with larger numbers being referred for radiotherapy.…”

“…A recent study by Mikeljevic et al (2004) found an increased relative risk of death in breast cancer patients treated with conservative surgery who subsequently waited longer than 9 weeks for radiotherapy. Likewise, there is some evidence that a longer wait for postoperative radiotherapy adversely affects survival for patients with head and neck cancers, small-cell-lung cancer and high-grade gliomas (Seel and Foroudi, 2002).…”