Abstract
BackgroundIn 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.MethodsTwo 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.ResultsNo 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.ConclusionThe 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.
Highlights
In head and neck cancer (HNC), the relationship between a delay in starting radiotherapy (RT) and the outcome is unclear
In order to determine what would be an acceptable treatment intervention (TTI) in HNC patients treated with definitive RT or concurrent chemoradiation, we aimed to analyze the impact of TTI and growth kinetics of individual tumors on the occurrence of local/regional failure, distant metastasis, and survival in the present study of a cohort of Slovene patients with HNC
No obvious methodological differences could be found between these studies and the positive studies that confirmed the association between TTI and treatment outcomes [33,34,35]
Summary
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. Due to obvious ethical reservations, the only way to study the impact of delays in starting RT on treatment outcomes are retrospective, observational analyses of cohorts from different institutions or countries [6]. One would expect that the prolongation of the time taken before treatment intervention (TTI) is harmful to patients. Both the likelihood of tumor growth and the acquisition of a metastatic phenotype increases as a function of time [7]. Advanced tumors are more difficult to treat than smaller tumors [8]
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