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Bhandari S, Wadhwa Soni B, Gupta A, Ghoshal S. Time required for prophylactic oral care in head and neck cancer patients scheduled for radiotherapy: A single center, prospective cohort study. Head Neck 2023; 45:913-920. [PMID: 36794635 DOI: 10.1002/hed.27317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 01/21/2023] [Accepted: 02/05/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Prophylactic oral care (POC) before radiotherapy (RT) is an adjunct but an integral process toward preparing patients for RT, however, time to be invested in POC remains unexplored. METHODS Prospective treatment records were maintained in head and neck cancer patients, who received POC following a standardized protocol with definite timelines. Data collected for oral treatment time (OTT), interruption in RT due to oro-dental issues, future extraction(s), and incidence of osteoradionecrosis (ORN) up to 18 months after treatment were analyzed. RESULTS Three hundred thirty-three patients, 275 males and 58 females, mean age 52.45 ± 11.2 years were included. Mean OTT was 21.0 ± 6.2 days and was influenced significantly with the number of extractions (p < 0.00). There was no interruption in RT schedule due to oro-dental issues. Five patients were diagnosed with ORN. CONCLUSION Performing POC as demonstrated aid in timely removal of nidus of infection(s), perform RT as scheduled, and maintain satisfactory oral health through the survivorship of patients.
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Affiliation(s)
- Sudhir Bhandari
- Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavita Wadhwa Soni
- Unit of Prosthodontics, Oral Health Sciences Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankita Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research, and Education in Cancer, Tata Memorial Centre, HBNI, Navi Mumbai, India
| | - Sushmita Ghoshal
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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2
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Ming W, Zuo J, Han J, Chen J. Establishment of prognostic nomogram for T1N0M0 glottic squamous cell carcinoma: an SEER database analysis. Eur Arch Otorhinolaryngol 2022; 280:2397-2410. [PMID: 36454384 DOI: 10.1007/s00405-022-07763-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVES The study aimed to construct prognostic models for OS and CSS in patients with T1N0M0 glottic SCC. In addition, we used PSM to re-assess the effect of surgery alone and radiation alone. METHODS The Surveillance, Epidemiology, and End Results database was searched for patients with confirmed T1N0M0 glottic SCC. Patients with complete data were randomly divided into the training and the validation cohort (7:3), Cox-regression analysis was performed to identified significant predictors of OS and CSS. PSM was used to mimic randomized controlled the trials. Kaplan-Meier survival method and log-rank tests were utilized for survival analysis. RESULTS A total 1827 patients met the inclusion criteria. Survival analysis indicated that the patients who underwent the primary site surgery had a better OS (P = 0.002) and CSS (P = 0.008), compared with non-surgery patients. Cox-regression analysis proved that age, marital status, T1 stages, surgery, radiation, sequential treatments, and chemotherapy had significant effects on OS. While age, marital status, histologic grade, surgery, radiation, sequential treatments, and chemotherapy were substantially associated with CSS. Patients who received primary site surgery had a better OS and CSS, compared with non-surgical patients. Patients receiving radiation had a better CSS than non-radiation patients. However, patients who received sequential treatments or chemotherapy had a worse OS and CSS, compared with controlled groups. Predictive nomogram models were established to predict patients' prognosis with good consistency between the actual observation and the nomogram prediction. Before PSM, patients who underwent surgery alone had a better OS and CSS than those who received radiation alone. After PSM, patients receiving surgery still had a better OS than those receiving radiation. However, there were no statistically significant differences in CSS. CONCLUSIONS Nomogram models were developed to predict OS and CSS in patients with T1N0M0 glottic SCC. Primary site surgery could definitely increase OS and CSS, while radiation could significantly increase CSS. Using PSM, surgery alone could significantly enhance OS, as compared to radiation alone. Chemotherapy should not be recommended for early glottic carcinoma.
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Affiliation(s)
- Wei Ming
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Jingjing Zuo
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jibo Han
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jinhui Chen
- Department of Otolaryngology, Renmin Hospital of Wuhan University, Wuhan, China
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3
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The effect of delayed treatment initiation on adverse events and recurrence in older head and neck cancer patients. Radiother Oncol 2022; 173:154-162. [DOI: 10.1016/j.radonc.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022]
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4
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Jafari Nivlouei S, Soltani M, Shirani E, Salimpour MR, Travasso R, Carvalho J. A multiscale cell-based model of tumor growth for chemotherapy assessment and tumor-targeted therapy through a 3D computational approach. Cell Prolif 2022; 55:e13187. [PMID: 35132721 PMCID: PMC8891571 DOI: 10.1111/cpr.13187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/09/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Computational modeling of biological systems is a powerful tool to clarify diverse processes contributing to cancer. The aim is to clarify the complex biochemical and mechanical interactions between cells, the relevance of intracellular signaling pathways in tumor progression and related events to the cancer treatments, which are largely ignored in previous studies. MATERIALS AND METHODS A three-dimensional multiscale cell-based model is developed, covering multiple time and spatial scales, including intracellular, cellular, and extracellular processes. The model generates a realistic representation of the processes involved from an implementation of the signaling transduction network. RESULTS Considering a benign tumor development, results are in good agreement with the experimental ones, which identify three different phases in tumor growth. Simulating tumor vascular growth, results predict a highly vascularized tumor morphology in a lobulated form, a consequence of cells' motile behavior. A novel systematic study of chemotherapy intervention, in combination with targeted therapy, is presented to address the capability of the model to evaluate typical clinical protocols. The model also performs a dose comparison study in order to optimize treatment efficacy and surveys the effect of chemotherapy initiation delays and different regimens. CONCLUSIONS Results not only provide detailed insights into tumor progression, but also support suggestions for clinical implementation. This is a major step toward the goal of predicting the effects of not only traditional chemotherapy but also tumor-targeted therapies.
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Affiliation(s)
- Sahar Jafari Nivlouei
- Department of Mechanical Engineering, Isfahan University of Technology, Isafahan, Iran.,Department of Physics, CFisUC, University of Coimbra, Coimbra, Portugal
| | - Madjid Soltani
- Department of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran.,Department of Electrical and Computer Engineering, University of Waterloo, Waterloo, ON, Canada.,Centre for Biotechnology and Bioengineering (CBB), University of Waterloo, Waterloo, ON, Canada.,Advanced Bioengineering Initiative Center, Computational Medicine Center, K. N. Toosi University of Technology, Tehran, Iran.,Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Shirani
- Department of Mechanical Engineering, Isfahan University of Technology, Isafahan, Iran.,Department of Mechanical Engineering, Foolad Institute of Technology, Fooladshahr, Iran
| | | | - Rui Travasso
- Department of Physics, CFisUC, University of Coimbra, Coimbra, Portugal
| | - João Carvalho
- Department of Physics, CFisUC, University of Coimbra, Coimbra, Portugal
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Schoonbeek RC, Zwertbroek J, Plaat BEC, Takes RP, Ridge JA, Strojan P, Ferlito A, van Dijk BAC, Halmos GB. Determinants of delay and association with outcome in head and neck cancer: A systematic review. Eur J Surg Oncol 2021; 47:1816-1827. [PMID: 33715909 DOI: 10.1016/j.ejso.2021.02.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Head and neck cancers (HNC) are relatively fast-growing tumours, and delay in treatment initiation is associated with tumour progression and adverse outcome. An overview of factors contributing to delay can provide critical insights on necessary adjustments to optimize care pathways. This systematic review aims to identify factors associated with delay and summarize the effect of delay on oncological outcome measures. METHODS A search strategy was conducted according to PRISMA guidelines to search electronic databases for studies assessing the carepathway interval (days between first visit in head and neck oncology center and treatment initiation) and/or time-to-treatment-initiation interval (days between histological diagnosis and treatment initiation) and 1) determinants of delay and/or 2) effect of delay on outcome within these timeframes. Due to heterogeneity between included studies, a meta-analysis was not possible. RESULTS Fifty-two studies were eligible for quantitative analysis. Non-Caucasian race, academic setting, Medicaid/no insurance and radiotherapy as primary treatment were associated with delay. Advanced tumour stage was related to increased time-to-treatment initiation in the four common sites combined (oral cavity, oropharynx, hypopharynx, larynx). Separate determinants for delay in different tumour locations were identified. In laryngeal, oral cavity cancer and the four common HNC sites combined, delay in start of treatment is associated with decreased overall survival, although no cut-off time point could be determined. CONCLUSION Race, facility type, type of insurance and radiotherapy as primary treatment were associated with delay and subsequent inferior survival in the four common sites combined.
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Affiliation(s)
- Rosanne C Schoonbeek
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands.
| | - Julia Zwertbroek
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Boudewijn E C Plaat
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - Robert P Takes
- Radboud University Medical Center, Department of Otolaryngology/Head and Neck Surgery, Geert Grooteplein Zuid 10, 6525, GA, Nijmegen, the Netherlands
| | - John A Ridge
- Fox Chase Cancer Center, Department of Surgical Oncology, Head and Neck Surgery Section, 333 Cottman Avenue, 19111, Philadelphia, PA, USA
| | - Primož Strojan
- Institute of Oncology, Department of Radiation Oncology, Zaloška Cesta 2, 1000, Ljubljana, Slovenia
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
| | - Boukje A C van Dijk
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Godebaldkwartier 419, 3511, DT, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
| | - György B Halmos
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Hanzeplein 1, 9713, GZ, Groningen, the Netherlands
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Medina-Lara A, Grigore B, Lewis R, Peters J, Price S, Landa P, Robinson S, Neal R, Hamilton W, Spencer AE. Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-332. [PMID: 33252328 PMCID: PMC7768788 DOI: 10.3310/hta24660] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tools based on diagnostic prediction models are available to help general practitioners diagnose cancer. It is unclear whether or not tools expedite diagnosis or affect patient quality of life and/or survival. OBJECTIVES The objectives were to evaluate the evidence on the validation, clinical effectiveness, cost-effectiveness, and availability and use of cancer diagnostic tools in primary care. METHODS Two systematic reviews were conducted to examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. Bibliographic searches were conducted on MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Library and Web of Science) in May 2017, with updated searches conducted in November 2018. A decision-analytic model explored the tools' clinical effectiveness and cost-effectiveness in colorectal cancer. The model compared patient outcomes and costs between strategies that included the use of the tools and those that did not, using the NHS perspective. We surveyed 4600 general practitioners in randomly selected UK practices to determine the proportions of general practices and general practitioners with access to, and using, cancer decision support tools. Association between access to these tools and practice-level cancer diagnostic indicators was explored. RESULTS Systematic review 1 - five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 - 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools. DECISION MODEL In the absence of studies reporting their clinical outcomes, QCancer and risk assessment tools were evaluated against faecal immunochemical testing. A linked data approach was used, which translates diagnostic accuracy into time to diagnosis and treatment, and stage at diagnosis. Given the current lack of evidence, the model showed that the cost-effectiveness of diagnostic tools in colorectal cancer relies on demonstrating patient survival benefits. Sensitivity of faecal immunochemical testing and specificity of QCancer and risk assessment tools in a low-risk population were the key uncertain parameters. SURVEY Practitioner- and practice-level response rates were 10.3% (476/4600) and 23.3% (227/975), respectively. Cancer decision support tools were available in 83 out of 227 practices (36.6%, 95% confidence interval 30.3% to 43.1%), and were likely to be used in 38 out of 227 practices (16.7%, 95% confidence interval 12.1% to 22.2%). The mean 2-week-wait referral rate did not differ between practices that do and practices that do not have access to QCancer or risk assessment tools (mean difference of 1.8 referrals per 100,000 referrals, 95% confidence interval -6.7 to 10.3 referrals per 100,000 referrals). LIMITATIONS There is little good-quality evidence on the clinical effectiveness and cost-effectiveness of diagnostic tools. Many diagnostic prediction models are limited by a lack of external validation. There are limited data on current UK practice and clinical outcomes of diagnostic strategies, and there is no evidence on the quality-of-life outcomes of diagnostic results. The survey was limited by low response rates. CONCLUSION The evidence base on the tools is limited. Research on how general practitioners interact with the tools may help to identify barriers to implementation and uptake, and the potential for clinical effectiveness. FUTURE WORK Continued model validation is recommended, especially for risk assessment tools. Assessment of the tools' impact on time to diagnosis and treatment, stage at diagnosis, and health outcomes is also recommended, as is further work to understand how tools are used in general practitioner consultations. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068373 and CRD42017068375. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Bogdan Grigore
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jaime Peters
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sarah Price
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Paolo Landa
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Hamilton
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
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7
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Žumer B, Pohar Perme M, Jereb S, Strojan P. Impact of delays in radiotherapy of head and neck cancer on outcome. Radiat Oncol 2020; 15:202. [PMID: 32819389 PMCID: PMC7441656 DOI: 10.1186/s13014-020-01645-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND 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. METHODS Two 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. RESULTS No 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. CONCLUSION The 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.
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Affiliation(s)
- Barbara Žumer
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000, Ljubljana, Slovenia
| | - Maja Pohar Perme
- Institute of Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Simona Jereb
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000, Ljubljana, Slovenia. .,Chair of Oncology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Schutte HW, Heutink F, Wellenstein DJ, van den Broek GB, van den Hoogen FJA, Marres HAM, van Herpen CML, Kaanders JHAM, Merkx TMAW, Takes RP. Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review. Otolaryngol Head Neck Surg 2020; 162:446-457. [PMID: 32093572 DOI: 10.1177/0194599820906387] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE An increased interval between symptomatic disease and treatment may negatively influence oncologic and/or functional outcomes in head and neck cancer (HNC). This systematic review aims to provide insight into the effects of time to treatment intervals on oncologic and functional outcomes in oral cavity, pharyngeal, and laryngeal cancer. DATA SOURCES PubMed, EMBASE, and Cochrane library were searched. REVIEW METHODS All studies on delay or time to diagnosis or treatment in oral, pharyngeal, and laryngeal cancer were included. Quality assessment was performed with an adjusted version of the Newcastle-Ottawa scale. Outcomes of interest were tumor volume, stage, recurrence, survival, patient-reported outcome measures (PROMs), toxicity, and functionality after treatment. RESULTS A total of 51 studies were included. Current literature on the influence of delay in HNC is inconsistent but indicates higher stage and worse survival with longer delay. The effects on PROMs, toxicity, and functional outcome after treatment have not been investigated. The inconsistencies in outcomes were most likely caused by factors such as heterogeneity in study design, differences in the definitions of delay, bias of results, and incomplete adjustment for confounding factors in the included studies. CONCLUSION Irrespective of the level of evidence, the unfavorable effects of delay on oncologic, functional, and psychosocial outcomes are undisputed. Timely treatment while maintaining high-quality diagnostic procedures and decision making reflects good clinical practice in our opinion. This review will pose practical and logistic challenges that will have to be overcome.
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Affiliation(s)
- Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Floris Heutink
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carla M L van Herpen
- Department of Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thijs M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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Mucha-Małecka A, Chrostowska A, Urbanek K, Małecki K. Prognostic factors in patients with T1 glottic cancer treated with radiotherapy. Strahlenther Onkol 2019; 195:792-804. [PMID: 31214734 PMCID: PMC6704086 DOI: 10.1007/s00066-019-01481-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 06/03/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Presentation of long-term results of radiation treatment in patients with T1 glottic cancer and evaluation of prognostic factors. METHODS We performed a retrospective analysis in a group of 569 patients with T1 squamous cell glottic carcinoma treated with radiotherapy at the Center of Oncology in Cracow between 1977 and 2007. In all, 503 (88%) patients presented with T1a stage disease and 66 (12%) with T1b. Anterior commissure infiltration was present in 179 (31%) patients. Average hemoglobin level prior to therapy was 13.9 g/dl. Using the body mass index (BMI), 114 (20%) patients were underweight, and 91 (16%) were overweight. Median time between collecting tumor specimen and beginning of radiotherapy was 56 days (range 14-145 days). Treatment regimen was normofractionated with single fraction ≤2 Gy in 102 (18%) and hypofractionated in 467 (82%) patients. RESULTS The 5‑ and 10-year overall survival (OS), disease-specific survival (DSS) and local control (LC) rates were 85 and 68%, 88 and 86%, 89 and 87%, respectively. Multivariate analysis showed that tobacco smoking, low hemoglobin level (<13 g/dl), anterior commissure infiltration, fraction dose ≤2 Gy and time from collecting specimen to beginning of therapy longer than 30 days had negative impact on LC and DSS. Patients' age over 60 years, worse performance status and malnutrition (BMI <18.5) had negative impacts on OS. CONCLUSIONS Radiotherapy is a highly effective treatment method in patients with T1N0M0 glottic cancer. LC and DSS may be improved following hypofractionation, smoking cessation, and shortening of waiting-time until start of treatment. OS was mainly influenced by nutritional and performance status.
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Affiliation(s)
- A Mucha-Małecka
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
| | - A Chrostowska
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - K Urbanek
- Clinic of Oncology and Department of Radiotherapy, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - K Małecki
- Department of Radiotherapy for Children and Adults, University Children's Hospital of Cracow, Wielicka 265, 30-663, Cracow, Poland
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10
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Evaluating radiotherapy treatment delay using Failure Mode and Effects Analysis (FMEA). Radiother Oncol 2019; 137:102-109. [DOI: 10.1016/j.radonc.2019.04.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 11/22/2022]
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The effect of time between diagnosis and initiation of treatment on outcomes in patients with head and neck squamous cell carcinoma. Oral Oncol 2019; 96:148-152. [PMID: 31422206 DOI: 10.1016/j.oraloncology.2019.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 07/10/2019] [Accepted: 07/24/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To quantify the effect that time to initiation of treatment after diagnosis has on the outcomes of patients with head and neck squamous cell carcinoma (HNSCC). METHODS This is a single institution retrospective analysis of 633 HNSCC patients treated from 2004 to 2017. Clinical information was abstracted from the medical records. Patients were divided into quartiles based on the time to treatment initiation (0-27 days, 28-41 days, 42-60 days, and >60 days). Kaplan-Meier overall survival (OS) curves and multivariate cox proportional hazard ratios were determined for time to treatment quartiles. RESULTS Differences in Kaplan-Meier estimates for OS based on treatment time quartiles were statistically significantly (p = 0.02), and multivariate Cox Proportional hazard ratios for OS revealed that patients in the 42-60 day treatment time group had better OS (hazard ratio = 0.55) compared to patients treated >days after diagnosis (p < 0.01). CONCLUSIONS For our study population, increased time to initiation of treatment did not impact overall survival. These results may help to alleviate patient anxiety while allowing time for useful interventions such as smoking cessation, nutritional counseling, and others that can affect clinical outcomes.
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Delahaut G, Témam S, Ambroise J, Tao Y, Janot F, Van der Vorst S. Prognostic impact of tumor growth velocity in head and neck squamous cell carcinoma treated by radiotherapy: A pilot study. Head Neck 2019; 41:3041-3048. [PMID: 31087727 DOI: 10.1002/hed.25789] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 02/10/2019] [Accepted: 04/16/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND When a patient is seen with a newly diagnosed oropharyngeal squamous cell carcinoma, it remains unclear to the treating physicians how fast the tumor growth rate is. METHODS From patients with oropharynx squamous cell carcinoma treated by radiotherapy, the investigators selected comparable diagnostic CT-scan (DiCT) and radiotherapy planning CT-scan (RtCT). Tumor and pathological lymph node volumes were measured in order to calculate tumor progression. RESULTS From the selection of 19 patients, the mean absolute tumor progression rate was 0.23 ± 0.2 cm3 /d and mean relative progression rate was 1.84 ± 1.64%/d. Mean tumor doubling time is 286 days (range 7-1282 days), demonstrating a wide range of tumor growth pattern. Significant tumor progression (>20%) between DiCT and RtCT was shown in 73% of patients, and 53% of the patients were seen a tumor progression of >50% within a mean waiting time of 42.1 days. Kaplan-Meier curves showed a non-significative link between fast progression tumors (>1%/d) and higher risk of recurrence (HR: 2.2; P = .23). CONCLUSIONS Tumor progression can be assessed based on DiCT and RtCT. Treatment delay should be avoided at all cost. Different growth patterns were evidenced. For the fast-growing tumors subgroup, pejorative clinical outcomes were suggested. Prospective studies are needed to confirm a link between fast-growing tumors and higher risk for recurrence.
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Affiliation(s)
- Gilles Delahaut
- Department of Head and Neck Surgery, Université catholique de Louvain, CHU UCL Namur-site Godinne, Yvoir, Belgium
| | - Stéphane Témam
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Jérôme Ambroise
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Centre de Technologies Moléculaires Appliquées, Brussels, Belgium
| | - Yungan Tao
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Francois Janot
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Sébastien Van der Vorst
- Department of Head and Neck Surgery, Université catholique de Louvain, CHU UCL Namur-site Godinne, Yvoir, Belgium
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Centre de Technologies Moléculaires Appliquées, Brussels, Belgium
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13
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Yang S, Fu X, Huang G, Chen J, Luo S, Wang Z, Kong F, Wu G, Lin S, Wang F, Chen L. The impact of the interval between the induction of chemotherapy and radiotherapy on the survival of patients with nasopharyngeal carcinoma. Cancer Manag Res 2019; 11:2313-2320. [PMID: 30962719 PMCID: PMC6434908 DOI: 10.2147/cmar.s195559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background There have been no reliable scientific studies examining whether the interval between induction chemotherapy (IC) and initiating radiotherapy is associated with poor outcomes of nasopharyngeal carcinoma (NPC). Patients and methods In this retrospective study, we included a total of 239 local advanced NPC patients who underwent concurrent chemoradiotherapy and IC. Based on the interval between IC and intensity-modulated radiation therapy (IMRT), the patients were classified into three groups as follows: Group A (≤7 vs >7 days), Group B (≤14 vs >14 days), and Group C (≤ 21 vs >21 days). Univariate and multivariate regression analyses were performed to determine the prognostic factors of survival outcomes. The differences between the two groups were compared by the log-rank test. Results The median IC-IMRT interval was 9 days (range, 1–76 days). The median follow-up time was 40 months (range, 4–58 months). The IC-IMRT interval including Group A, Group B, and Group C was not significantly associated with overall survival (OS), distant metastasis-free survival (DMFS), locoregional relapse-free survival (LRFS), or disease-free survival (DFS). Multivariate analysis showed that the tumor stage was the independent significant predictor for OS, DMFS, LRFS, and DFS. But it appears that there was a trend toward improvement in the outcome of ≤7 days group in OS from the Kaplan–Meier curves. Conclusion It is also feasible to postpone radiotherapy for 1–3 weeks if patients were unable to receive treatment immediately due to chemotherapy complications such as bone marrow suppression. However, we suggest that patients should start IMRT as soon as possible after IC.
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Affiliation(s)
- Shiping Yang
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China, .,Department of Radiation Oncology, Hainan General Hospital, Haikou, Hainan, China
| | - Xiaoling Fu
- Blood Transfusion Department, Maternal and Child Health Hospital of Hainan Province and Hainan Children's Hospital, Haikou, Hainan, China
| | - Guang Huang
- Department of Radiation Oncology, Hainan General Hospital, Haikou, Hainan, China
| | - Junni Chen
- Department of Radiation Oncology, Hainan General Hospital, Haikou, Hainan, China
| | - Shishi Luo
- Department of Radiology, Hainan General Hospital, Haikou, Hainan, China
| | - Zhenping Wang
- Department of Radiology, Hainan General Hospital, Haikou, Hainan, China
| | - Fanzhong Kong
- Department of Radiation Oncology, Hainan General Hospital, Haikou, Hainan, China
| | - Gang Wu
- Department of Radiation Oncology, Hainan General Hospital, Haikou, Hainan, China
| | - Shaomin Lin
- Department of Radiation Oncology, Hainan General Hospital, Haikou, Hainan, China
| | - Fen Wang
- Department of Radiation Oncology, Hainan General Hospital, Haikou, Hainan, China
| | - Longhua Chen
- Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China,
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14
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Morse E, Fujiwara RJ, Judson B, Mehra S. Treatment delays in laryngeal squamous cell carcinoma: A national cancer database analysis. Laryngoscope 2018; 128:2751-2758. [DOI: 10.1002/lary.27247] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 03/13/2018] [Accepted: 03/29/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Elliot Morse
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Rance J.T. Fujiwara
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin Judson
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
| | - Saral Mehra
- Department of Surgery, Division of Otolaryngology; Yale University School of Medicine; New Haven Connecticut U.S.A
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15
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How Long Are Cancer Patients Waiting for Oncological Therapy in Poland? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040577. [PMID: 29570661 PMCID: PMC5923619 DOI: 10.3390/ijerph15040577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 01/07/2023]
Abstract
Background: The five-year relative survival rate in Poland is approximately 10% lower compared with the average for Europe. One of the factors that may contribute to the inferior treatment results in Poland could be the long time between cancer suspicion and the beginning of treatment. The aim of the study was to determine the real waiting time for cancer diagnosis and treatment in Poland. Methods: The study was carried out in six cancer centers on a group of 1373 patients, using a questionnaire to interview patients. The median waiting time was estimated as follows: (A) from suspicion (the date of the first visit, with symptoms, to a doctor or a preventive or screening test) until histopathological diagnosis; (B) from suspicion until initial treatment; and (C) from diagnosis until initial treatment. Results: The median times from suspicion to treatment, from suspicion to diagnosis, and from diagnosis to treatment, were 10.6, 5.6, and 5.0 weeks, respectively. Using multivariate analysis, the strongest influence was estimated, in a case of tumor localization, to be the method of initial treatment and facilities. Conclusion: The waiting time for cancer treatment in Poland is too long. The highest influence on waiting time was determined, in the case of tumors, as the type of cancer and factors related to the health care system.
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16
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Amsbaugh MJ, Yusuf M, Cash E, Silverman C, Potts K, Dunlap N. Effect of time to simulation and treatment for patients with oropharyngeal cancer receiving definitive radiotherapy in the era of risk stratification using smoking and human papillomavirus status. Head Neck 2018; 40:687-695. [DOI: 10.1002/hed.24963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/03/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mark J. Amsbaugh
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Mehran Yusuf
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Elizabeth Cash
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders; University of Louisville; Louisville Kentucky
| | - Craig Silverman
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Kevin Potts
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders; University of Louisville; Louisville Kentucky
| | - Neal Dunlap
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
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Dahlke S, Steinmann D, Christiansen H, Durisin M, Eckardt A, Wegener G, Bremer M, Meyer A. Impact of Time Factors on Outcome in Patients with Head and Neck Cancer Treated with Definitive Radio(Chemo)Therapy. In Vivo 2017; 31:949-955. [PMID: 28882964 PMCID: PMC5656871 DOI: 10.21873/invivo.11152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 01/07/2023]
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 METHODS A total of 216 patients with locoregionally advanced inoperable head and neck cancer were treated with definitive radio(chemo)therapy. Mean follow-up was 37 months. RESULTS Median time from diagnosis to start of radiotherapy (total waiting time) was 34 days, and comprised of referral waiting time and time for preparatory work. Median RTT was 40 days, and median OTT was 91 days. At 6, 12 and 24 months local recurrence-free survival (LRFS) was 75%, 65% and 60%; metastasis-free survival (MFS) was 84%, 77% and 70%; overall survival (OS) was 72%, 58% and 40%. Tumor stage, boost and chemotherapy were significant for OS, waiting time for preparatory work and RTT were significant for MFS, and referral waiting time and total radiotherapy dose for LRFS. CONCLUSION RTT ≤40 days was a prognostic factor for better MFS. Prolonged waiting time had a converse effect for radiotherapy with better outcome on MFS and LRFS.
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Affiliation(s)
- Sören Dahlke
- Department of Radiation Oncology, Medical School Hannover, Hannover, Germany
| | - Diana Steinmann
- Department of Radiation Oncology, Medical School Hannover, Hannover, Germany
| | - Hans Christiansen
- Department of Radiation Oncology, Medical School Hannover, Hannover, Germany
| | - Martin Durisin
- Department of Otolaryngology, Medical School Hannover, Hannover, Germany
| | - Andre Eckardt
- Department of Cranio-Maxillo-Facial Surgery, Medical School Hannover, Hannover, Germany
| | - Gerd Wegener
- Tumour Centre Hannover, Medical School Hannover, Hannover, Germany
| | - Michael Bremer
- Department of Radiation Oncology, Medical School Hannover, Hannover, Germany
| | - Andreas Meyer
- Department of Radiation Oncology, Medical School Hannover, Hannover, Germany
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18
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Cheraghlou S, Kuo P, Judson BL. Treatment delay and facility case volume are associated with survival in early-stage glottic cancer. Laryngoscope 2016; 127:616-622. [DOI: 10.1002/lary.26259] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 07/09/2016] [Accepted: 07/28/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Shayan Cheraghlou
- Department of Surgery; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Phoebe Kuo
- Department of Surgery; Yale School of Medicine; New Haven Connecticut U.S.A
| | - Benjamin L. Judson
- Department of Surgery; Yale School of Medicine; New Haven Connecticut U.S.A
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19
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Chen PC, Liu WS, Huang WL, Wu CJ, Yang CC, Lee CC. The impact of time factors on overall survival in patients with nasopharyngeal carcinoma: a population-based study. Radiat Oncol 2016; 11:62. [PMID: 27117713 PMCID: PMC4847176 DOI: 10.1186/s13014-016-0638-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 04/19/2016] [Indexed: 11/10/2022] Open
Abstract
Background Nasopharyngeal carcinoma (NPC) is most common in Southeast Asia. The purpose of this study is to investigate the correlation between wait time and length of radiotherapy and overall survival (OS) of NPC patients in Taiwan. Methods From Taiwan’s National Health Insurance Research Database, this nationwide population-based cohort study identified 3605 NPC patients who received radiotherapy between 2008 and 2011. The impact of time factors on NPC survival rates was estimated with Kaplan-Meier survival curves. A multivariable Cox hazards regression model tested the significance of results after adjustment for other covariables. Results In all, 317 patients had wait times >4 weeks, 1404 patients had longer duration of radiotherapy (i.e., >10 weeks) and 499 died. Patients with wait times > 4 weeks and length of radiotherapy ≤ 10 weeks didn’t have significantly inferior survival. Patients with wait times >4 weeks and length of radiotherapy >10 weeks had significantly lower OS than other groups, with an adjusted hazard ratio of 1.7 (95 % CI, 1.10–2.60). Conclusion Time was a significant prognostic factor for NPC patients who had both >4 weeks wait times and length of radiotherapy >10 weeks. Patients with wait time > 4 weeks and length of radiotherapy ≤ 10 weeks had a trend toward an inferior survival.
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Affiliation(s)
- Po-Chun Chen
- Department of Radiation oncology, Pingtung Christian Hospital, Pingtung, Taiwan.,Graduate Institute of Bioresources, National PingTung University of Science and Technology, Pingtung, Taiwan
| | - Wen-Shan Liu
- Department of Radiation oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Lun Huang
- Department of Radiation oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Jung Wu
- Department of Otolaryngology, Shung Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ching-Chieh Yang
- Department of Radiation oncology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ching-Chih Lee
- School of Medicine, National Defense Medical Center, Taipei, Taiwan. .,Department of Otolaryngology, Kaohsing Veterans General Hospital, No.386, Dazhong 1st Rd., Kaohsiung, Taiwan.
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20
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Cuny F, Babin E, Lacau-Saint-Guily J, Baujat B, Bensadoun R, Bozec A, Chevalier D, Choussy O, Deneuve S, Fakhry N, Guigay J, Makeieff M, Merol JC, Mouawad F, Pavillet J, Rebiere C, Righini C, Sostras MC, Tournaille M, Vergez S. French Society of ENT (SFORL) guidelines for care pathway organization in head and neck oncology (short version). Early management of head and neck cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:205-8. [PMID: 26183548 DOI: 10.1016/j.anorl.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Early management in oncology is based on coordination and high-quality exchange between the various health-care partners. The present guidelines are based on a literature search with levels of evidence. Treatment waiting time can be optimized by performing assessment as early as possible (Expert opinion), to limit the interval (ideally, less than 4 weeks) between first consultation and data collection. In the first specialist consultation, diagnostic work-up should be scheduled and the data required for management should be determined (Grade B). Work-up may be conducted on a day-care basis or with conventional admission (Expert opinion). The patient's medico-social context should be taken into account from the outset, with social work involvement whenever necessary (Expert opinion). Pain and nutritional management should be planned for (Grade A) and realistic therapeutic education be provided (Expert opinion). Community-hospital teamwork for supportive care should be optimized (Expert opinion). Management should be early and multidisciplinary, to shorten delay between diagnosis and treatment initiation.
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Affiliation(s)
- F Cuny
- Inserm U1086 cancers et prévention, service d'ORL et chirurgie cervico-faciale, CHU, avenue de la Côte-de-Nacre, 14000 Caen, France.
| | - E Babin
- Inserm U1086 cancers et prévention, service d'ORL et chirurgie cervico-faciale, CHU, avenue de la Côte-de-Nacre, 14000 Caen, France
| | | | - B Baujat
- Service d'ORL, hôpital Tenon, 4, rue de la Chine, 75018 Paris, France
| | - R Bensadoun
- Service de radiothérapie, centre Antoine-Lacassagne, 33, avenue Valombrose, 06100 Nice, France
| | - A Bozec
- Service d'ORL et chirurgie cervico-faciale, centre Antoine-Lacassagne, 33, avenue Valombrose, 06100 Nice, France
| | - D Chevalier
- Service d'ORL et chirurgie cervico-faciale, hôpital Claude-Huriez, CHRU, rue Michel Polonovski, 59037 Lille cedex, France
| | - O Choussy
- Service d'ORL et chirurgie cervico-faciale, hôpital Charles-Nicolle, 1, rue de Germont, 76000 Rouen, France
| | - S Deneuve
- Service d'ORL et chirurgie cervico-faciale, CRLCC centre Léon-Bérard, 28, promenade Léa-et-Napoléon-Bullukian, 69008 Lyon, France
| | - N Fakhry
- Service d'ORL et de chirurgie cervico-faciale, hôpital de la Conception, CHU, 147, boulevard Baille, 13005 Marseille, France
| | - J Guigay
- Unité de cancérologie médicale en cancérologie cervico-faciale, centre Antoine-Lacassagne, 33, avenue Valombrose, 06100 Nice, France
| | - M Makeieff
- Service d'ORL et chirurgie cervico-faciale, hopital Robert-Debré, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - J-C Merol
- Service d'ORL et chirurgie cervico-faciale, hopital Robert-Debré, CHU, avenue du Général-Koenig, 51100 Reims, France
| | - F Mouawad
- Service d'ORL et chirurgie cervico-faciale, hôpital Claude-Huriez, CHRU, rue Michel Polonovski, 59037 Lille cedex, France
| | - J Pavillet
- Service d'oncologie médicale, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700 La Tronche, France
| | - C Rebiere
- Service social, CHU, avenue de la Côte-de-Nacre, 14000 Caen, France
| | - C Righini
- Clinique universitaire d'ORL, pôle TCCR, CHU de Grenoble Site Nord, Pavillon Dauphiné, 38043 Grenoble cedex, France
| | - M-C Sostras
- Service social, hôpital Tenon, 4, rue de la Chine, 75018 Paris, France
| | - M Tournaille
- Service social, CLCC François-Baclesse, avenue du Général-Harris, 14000 Caen, France
| | - S Vergez
- Service d'ORL et chirurgie cervico-faciale, pôle voies respiratoires, hôpital Larrey, 24, chemin de Pouvourville, 31400 Toulouse, France
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21
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How do patients receiving radiotherapy in a Dutch hospital value their time? A contingent valuation study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAimCancer patients spend a lot of time receiving medical care. Our study investigates patients’ preferences regarding reducing the time involved in non-palliative radiotherapy care.MethodsA total of 142 Dutch patients were included in our study. Using a contingent valuation survey, we measured the proportion of patients who preferred to reduce their patients’ time, splitting it into five different categories, and, for those who did, whether and how much they were willing to pay for this to happen.ResultsAbout 50% of the patients preferred to reduce their time waiting for admission by 1 week and their travel time by half; 20 and 62% wanted to reduce their waiting time by half and their treatment time from 20 to 5 minutes, respectively; 36% preferred to be treated 7 instead of 5 days a week; and 20% of those wishing to reduce their patients’ time were willing to pay, and their mean willingness to pay (WTP) ranged from £0·32 to £18·1 per hour’s reduction of their time.ConclusionHalf of the patients seem to assess their patients’ time as reasonable. The other half preferred to reduce it, but only about 20% of them were willing to pay for it to happen and their mean WTP was low.
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22
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Neal RD, Tharmanathan P, France B, Din NU, Cotton S, Fallon-Ferguson J, Hamilton W, Hendry A, Hendry M, Lewis R, Macleod U, Mitchell ED, Pickett M, Rai T, Shaw K, Stuart N, Tørring ML, Wilkinson C, Williams B, Williams N, Emery J. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? Systematic review. Br J Cancer 2015; 112 Suppl 1:S92-107. [PMID: 25734382 PMCID: PMC4385982 DOI: 10.1038/bjc.2015.48] [Citation(s) in RCA: 653] [Impact Index Per Article: 72.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND It is unclear whether more timely cancer diagnosis brings favourable outcomes, with much of the previous evidence, in some cancers, being equivocal. We set out to determine whether there is an association between time to diagnosis, treatment and clinical outcomes, across all cancers for symptomatic presentations. METHODS Systematic review of the literature and narrative synthesis. RESULTS We included 177 articles reporting 209 studies. These studies varied in study design, the time intervals assessed and the outcomes reported. Study quality was variable, with a small number of higher-quality studies. Heterogeneity precluded definitive findings. The cancers with more reports of an association between shorter times to diagnosis and more favourable outcomes were breast, colorectal, head and neck, testicular and melanoma. CONCLUSIONS This is the first review encompassing many cancer types, and we have demonstrated those cancers in which more evidence of an association between shorter times to diagnosis and more favourable outcomes exists, and where it is lacking. We believe that it is reasonable to assume that efforts to expedite the diagnosis of symptomatic cancer are likely to have benefits for patients in terms of improved survival, earlier-stage diagnosis and improved quality of life, although these benefits vary between cancers.
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Affiliation(s)
- R D Neal
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - P Tharmanathan
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - B France
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - N U Din
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - S Cotton
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - J Fallon-Ferguson
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - W Hamilton
- University of Exeter Medical School, Exeter EX1 2LU, UK
| | - A Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - M Hendry
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - R Lewis
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - U Macleod
- Centre for Health and Population studies, Hull York Medical School, University of Hull, Hull HU6 7RX, UK
| | - E D Mitchell
- Leeds Institute of Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - M Pickett
- Betsi Cadwaladr University Health Board, Wrexham Maelor Hospital, Wrexham LL13 7TD, UK
| | - T Rai
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - K Shaw
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Stuart
- School of Medical Sciences, Bangor University, Bangor, LL57 2AS UK
| | - M L Tørring
- Research Unit for General Practice, Aarhus University, Bartholins Alle 2, Aarhus DK-8000, Denmark
| | - C Wilkinson
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
| | - B Williams
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - N Williams
- North Wales Centre for Primary Care Research, Bangor University, Bangor LL13 7YP, UK
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor LL57 2PZ, UK
| | - J Emery
- Primary Care Collaborative Cancer Clinical Trials Group, School of Primary, Aboriginal, and Rural Healthcare, University of Western Australia, M706, 35 Stirling Highway, Crawley, Western Australia 6009, Australia
- General Practice & Primary Care Academic Centre, University of Melbourne, 200 Berkeley Street, Melbourne, Victoria 3053, Australia
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23
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Murphy CT, Galloway TJ, Handorf EA, Wang L, Mehra R, Flieder DB, Ridge JA. Increasing time to treatment initiation for head and neck cancer: an analysis of the National Cancer Database. Cancer 2014; 121:1204-13. [PMID: 25490875 DOI: 10.1002/cncr.29191] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 11/07/2014] [Accepted: 11/11/2014] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective of this study was to identify trends and predictors of the time to treatment initiation (TTI) for patients with head and neck squamous cell carcinoma (HNSCC). METHODS The National Cancer Database (NCDB) was reviewed for the following head and neck cancer sites: oral tongue, oropharynx, larynx, and hypopharynx. TTI was defined as the number of days from diagnosis to the initiation of definitive treatment and was measured according to covariates. Significant differences in the median TTI across each covariate were measured using the Kruskal-Wallis test, and the Spearman test was used to measure trends within covariates. For multivariate analysis, a zero-inflated, negative, binomial regression model was used to estimate the expected TTI, which was expressed in the predicted number of days; and the Vuong test was used to identify the predictors of TTI. RESULTS In total, 274,630 patients were included. Between 1998 and 2011, the median TTI for all patients was 26 days, and it increased from 19 days to 30 days (P < .0001). Treatment with chemoradiation (CRT) (P < .0001), treatment at academic facilities (P < .0001), and stage IV disease (P < .0001) were associated with increased TTI. TTI significantly increased for each disease stage (P < .0001), treatment modality (P < .0001), and facility type (P < .0001) over time. In addition, patients became more likely to transition care between facilities after diagnosis for treatment initiation (P < .0001) over time. On multivariate analysis, treatment at academic facilities (33 days), transitioning care (37 days), and receipt of CRT (39 days) predicted for a longer TTI. CONCLUSIONS TTI is rising for patients with HNSCC. Those who have advanced-stage disease, receive treatment with CRT, are treated at academic facilities, and who have a transition in care realized the greatest increases in TTI.
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Affiliation(s)
- Colin T Murphy
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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van Bockel LW, Verduijn GM, Monninkhof EM, Pameijer FA, Terhaard CH. The importance of actual tumor growth rate on disease free survival and overall survival in laryngeal squamous cell carcinoma. Radiother Oncol 2014; 112:119-24. [DOI: 10.1016/j.radonc.2014.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 05/30/2014] [Accepted: 06/02/2014] [Indexed: 11/26/2022]
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Soyfer V, Geva R, Michelson M, Inbar M, Shacham-Shmueli E, Corn BW. The impact of overall radiotherapy treatment time and delay in initiation of radiotherapy on local control and distant metastases in gastric cancer. Radiat Oncol 2014; 9:81. [PMID: 24655942 PMCID: PMC3994343 DOI: 10.1186/1748-717x-9-81] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 03/09/2014] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To study the impact of time factors on local and distant metastases in stomach cancer. METHODS 67 patients with gastric cancer who received adjuvant treatment were reviewed for the time to initiation of radiotherapy, overall duration of RT and the events of first local recurrence or distant metastasis. RESULTS The risk probability of local recurrence is increased by 10% (HR=1.1, p=0.0009) in association with each additional day of radiotherapy and by 3.8% (HR=1.038, p=0.13) per increased day of waiting time before the initiation of RT. The risk probability of distant recurrence was associated with an increase of 7.4% (HR=1.074 p=0.0031) with each additional day of RT time and by 2.3% (HR=1.023, p=0.0598) following the increase of a day of waiting time. Each day of prolongation of RT beyond 36 days was associated with an increased risk of local recurrence by 10% (OR=1.1, p=0.015). Prolongation of waiting time prior to initiation of irradiation retained significance in multivariate analysis. CONCLUSION There is an association between total treatment time and, to some extent, the time between the surgery and the initiation of radiation on local control and distant metastases.
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Scoccianti S, Agresti B, Simontacchi G, Detti B, Cipressi S, Iannalfi A, Marrazzo L, Mangoni M, Paiar F, Livi L, Biti G. From a Waiting List to a Priority List: A Computerized Model for an Easy-to-Manage and Automatically Updated Priority List in the Booking of Patients Waiting for Radiotherapy. TUMORI JOURNAL 2012; 98:728-35. [DOI: 10.1177/030089161209800609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Waiting time for radiotherapy is a major problem in clinical practice. We developed a model to create a priority list of patients waiting for radiotherapy according to clinical criteria, where booking of patients is not on a “first-come, first-served” basis and where prioritization has not been left up to individual discretion. Methods The system is based on an algorithm that assigns to each patient a personal code (priority code, PC) that can be used as a continuous variable to have a priority list. PCpatient = D0patient + PWTsubgroup of treatment. Palliative treatments were categorized according to the clinical urgency. Radical treatments were stratified by primary tumors, by the setting of treatment (preoperative, curative, postoperative) and by the main prognostic factors. Each subgroup of patients has a “priority waiting time” (PWT subgroup of treatment). Calculation of the PC starts from a differentiated date according to clinical scenario [Reference date (D0)], which is taken from the clinical history of the patient. Results Patients are differentiated according to clinical criteria and according to time elapsed from diagnosis. The priority list can be automatically updated day by day. Delays in patient referral or imaging availability are minimized. Conclusions The model represents a tool for an objective and automatic prioritization of the patients who are waiting for radiotherapy.
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Affiliation(s)
- Silvia Scoccianti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Benedetta Agresti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Samantha Cipressi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Alberto Iannalfi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Livia Marrazzo
- Medical Physics, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Monica Mangoni
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Fabiola Paiar
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Giampaolo Biti
- Radiation Oncology Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
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Noel G, Huchet A, Feuvret L, Maire JP, Verrelle P, Le Rhun E, Aumont M, Thillays F, Sunyach MP, Henzen C, Missohou F, de Crevoisier R, Bondiau PY, Collin P, Durando X, Truc G, Kerr C, Bernier V, Clavier JB, Atlani D, D'Hombres A, Vinchon-Petit S, Lagrange JL, Taillandier L. Waiting times before initiation of radiotherapy might not affect outcomes for patients with glioblastoma: a French retrospective analysis of patients treated in the era of concomitant temozolomide and radiotherapy. J Neurooncol 2012; 109:167-75. [PMID: 22660920 DOI: 10.1007/s11060-012-0883-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 04/16/2012] [Indexed: 11/28/2022]
Abstract
Purpose of this study was to determine the effect of waiting time for radiotherapy on overall survival of patients with glioblastoma treated in the EORTC-NCIC trial at 18 centers in France. A total of 400 adult patients with glioblastoma who were treated between January 1, 2006 and December 31, 2006 were included. There were 282 patients with "minimum criteria" according to the EORTC-NCIC trial: (i) concurrent chemotherapy with temozolomide; and (ii) age between 18 and 70 years old. Among these patients, 229 were treated with adjuvant temozolomide and were classified as "maximal criteria". One-hundred and eighteen patients were in the "without minimal criteria" group. Waiting time from the first symptom (FS-RT), pathology diagnosis (P-RT), multidisciplinary meeting (MM-RT), surgery (S-RT), and CT scan for delineation (CT-RT) until the start of radiotherapy were recorded. Median follow-up for all patients was 327 days. Overall, median FS-RT, P-RT, MM-RT, CT-RT, and S-RT times were 77, 36, 32, 12, and 41 days, respectively. Median, and 12 and 24-month overall survival were 409 days, and 56.3 ± 2.1 % and 27.6 ± 2.6 %, respectively. Univariate analysis failed to reveal a difference in survival, irrespective of the delay. In multivariate analysis, independent favorable prognostic factors for overall survival were age (p ≤ 0.0001) and type of surgery (p = 0.0006). In this large series treated during the EORTC-NCIC protocol period, waiting time until radiotherapy did not seem to affect patient outcome.
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Affiliation(s)
- Georges Noel
- CLCC Paul Strauss, 3 Rue de la Porte de l'Hôpital, 67065, Strasbourg Cedex, France.
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Ambrosch P, Fazel A. Functional organ preservation in laryngeal and hypopharyngeal cancer. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2012; 10:Doc02. [PMID: 22558052 PMCID: PMC3341579 DOI: 10.3205/cto000075] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The principles of open versus laser microsurgical approaches for partial resections of the larynx are described, oncologic as well as functional results discussed and corresponding outcomes following primary radiotherapy are opposed. Over the last decade, the endoscopic partial resection of the larynx has developed to an accepted approach in the treatment of early glottic and supraglottic carcinomas thus leading to a remarkable decline in the use of open surgery. Comparing the various surgical approaches of laryngeal partial resections, the oncological outcome of the patients, as far as survival and organ preservation are concerned, are comparable, whereas functional results of the endoscopic procedures are superior with less morbidity. The surgical procedures put together, are all superior to radiotherapy concerning organ preservation. Transoral laser microsurgery has been used successfully for vocal cord carcinomas with impaired mobility or fixation of the vocal cord, supraglottic carcinomas with infiltration of the pre- and/or paraglottic space as well as for selected hypopharyngeal carcinomas. It has been well documented that laser microsurgery achieves good oncological as well as functional results with reasonable morbidity. However, patients with those tumours have been successfully treated by open partial resections of the larynx at medical centres with appropriate expertise. The initially enthusiastic assessment of study results concerning the efficacy of various protocols of chemoradiation with the intent of organ preservation for laryngeal and hypopharyngeal carcinomas are judged more cautious, today, due to recent reports of rather high rates of late toxicity complications.
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Affiliation(s)
- Petra Ambrosch
- Department of Otorhinolaryngology - Head and Neck Surgery, Christian-Albrechts-University of Kiel, Kiel, Germany
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Prognostic value of the interval from surgery to initiation of radiation therapy in correlation with some histo-clinical parameters in patients with malignant supratentorial gliomas. Contemp Oncol (Pozn) 2012; 16:34-7. [PMID: 23788852 PMCID: PMC3687387 DOI: 10.5114/wo.2012.27334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/05/2012] [Accepted: 01/18/2012] [Indexed: 11/22/2022] Open
Abstract
Aim of the study To determine the relationship between the interval from surgery to initiation of radiation therapy (ISRT) and prognostic factors, such as age, performance status, tumour location, extent of surgical resection and tumour histology in patients with malignant gliomas. Materials and methods From 1995 to 2005, 308 adults patients with supratentorial malignant gliomas (198 glioblastomas, and 110 anaplastic astrocytomas) received postoperative radiotherapy with radical intent. A total tumour dose of 60 Gy in 30 fractions in 6 weeks was delivered. ISRT varied from 15 to 124 days, with median time of 37 days, and it was a cut-off value to assess the results. The end point in our study was two-year overall survival. Results The two-year overall survival rate in the whole group was 17%, with 24% for patients with ISRT value ≤ 37 days, and 14% for patients with an interval longer than 37 days (p = 0.042). Univariate analysis showed that delayed initiation of radiotherapy influenced the outcome of patients with glioblastoma older than 40 years, and with other than frontal location of tumour. Two-year overall survival rates for ISRT ≤ 37 days were 15%, 18% and 22% respectively, compared to 8%, 4% and 11% for ISRT > 37 days. In a multivariate analysis (Cox's model) the only variables that were significantly associated with worse survival were older age and ISRT prolonged for more than 37 days. Conclusion The study showed longer than 37 days waiting time from surgery to initiation of radiotherapy to be a significant predictor of overall survival for adult patients with malignant supratentorial gliomas.
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Blumenthal DT, Won M, Mehta MP, Curran WJ, Souhami L, Michalski JM, Rogers CL, Corn BW. Short delay in initiation of radiotherapy may not affect outcome of patients with glioblastoma: a secondary analysis from the radiation therapy oncology group database. J Clin Oncol 2008; 27:733-9. [PMID: 19114694 DOI: 10.1200/jco.2008.18.9035] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To analyze the Radiation Therapy Oncology Group (RTOG) database of patients with glioblastoma and appraise whether outcome was influenced by time to initiation of radiation therapy (RT). PATIENTS AND METHODS From 1974 through 2003, adult patients with histologically confirmed supratentorial glioblastoma were enrolled onto 16 RTOG studies. Of 3,052 enrolled patients, 197 patients (6%) were either initially rendered ineligible or had insufficient chronologic data, leaving a cohort of 2,855 patients for the present analysis. We selected four patient groups based on the interval from surgery to the start of RT: <or= 2 weeks, 2 to 3 weeks, 3 to 4 weeks, more than 4 weeks to the protocol eligibility limit of 6 weeks. Survival times were estimated by the Kaplan-Meier method. Multivariate analysis incorporated variables of time interval, recursive partitioning analysis (RPA) class, and treatment regimen. RESULTS No decrement in survival could be identified with increasing time to initiation of RT. Among our four temporal groupings, median survival time was unexpectedly and significantly greater in the group with the longest interval (> 4 weeks) than in those with the shortest delay (<or= 2 weeks): respectively, 12.5 months versus 9.2 months (P < .0001). On multivariate analysis, with overall survival as the end point, time interval more than 4 weeks and lower RPA class were both significant predictors of improved outcome. Treatment regimen was not a significant factor. CONCLUSION There is no evident reduction in survival by delaying initiation of RT within the relatively narrow constraint of 6 weeks. An unanticipated yet significantly superior outcome was identified for patients for whom RT was delayed beyond 4 weeks from surgery.
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Sjögren EV, Langeveld TPM, Baatenburg de Jong RJ. Clinical outcome of T1 glottic carcinoma since the introduction of endoscopic CO2 laser surgery as treatment option. Head Neck 2008; 30:1167-74. [PMID: 18528901 DOI: 10.1002/hed.20852] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Since the introduction of endoscopic laser surgery at our institution in 1996, 189 patients have been treated for T1 glottic carcinoma. METHODS Treatment allocation (radiotherapy vs laser surgery) and outcome were evaluated. RESULTS Fifty-one percent of T1a lesions were considered suitable for laser surgery. Sixteen percent of T1a patients treated with laser surgery needed additional treatment because of positive resection margins. Overall local control and larynx preservation were 89% and 96%. Both were poorer in T1a patients with larger lesions treated with radiotherapy (local control 75% versus 89%, p = .05, larynx preservation 83% vs 100%, p = .001). CONCLUSION Outcome for T1a patients selected for laser surgery is excellent. In patients with larger lesions treated with radiotherapy, outcome is inferior to patients selected for laser surgery, but also to that reported for (unselected) T1a carcinomas treated with radiotherapy in literature. Strategies to improve treatment results in patients deemed unsuitable for laser surgery should be designed.
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Affiliation(s)
- Elisabeth V Sjögren
- Department of ENT, Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands.
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Outcome of radiotherapy in T1 glottic carcinoma: a population-based study. Eur Arch Otorhinolaryngol 2008; 266:735-44. [PMID: 18839197 DOI: 10.1007/s00405-008-0803-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Accepted: 08/29/2008] [Indexed: 12/20/2022]
Abstract
We evaluated the radiation outcome and prognostic factors in a population-based study of early (T1N0M0) glottic carcinoma. Survival parameters and prognostic factors were evaluated by uni- and multivariate analysis in 316 consecutive irradiated patients with T1 glottic carcinoma in the Comprehensive Cancer Center West region of the western Netherlands. Median follow-up was 70 months (range 1-190 months). Five and ten-year local control was 86 and 84%. Disease specific survival was 97% at 5 and 10 years. In multivariate analysis, pre-existent laryngeal hypertrophic laryngitis was the only predictive factor for local control (relative risk = 3.0, P = 0.02). Comorbidity was prognostic for overall survival. No factor was predictive for disease specific survival. Pre-existent laryngeal hypertrophic laryngitis is a new risk factor associated with reduced local control in T1 glottic carcinoma treated with radiotherapy.
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Chen Z, King W, Pearcey R, Kerba M, Mackillop WJ. The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature. Radiother Oncol 2008; 87:3-16. [PMID: 18160158 DOI: 10.1016/j.radonc.2007.11.016] [Citation(s) in RCA: 271] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Revised: 11/13/2007] [Accepted: 11/14/2007] [Indexed: 10/22/2022]
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Wyatt RM, Jones BJ, Dale RG. Radiotherapy treatment delays and their influence on tumour control achieved by various fractionation schedules. Br J Radiol 2008; 81:549-63. [PMID: 18378526 DOI: 10.1259/bjr/94471640] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There is often a considerable delay from initial tumour diagnosis to the start of radiotherapy treatment. This paper extends the calculations of a previous paper on the effects of delays before the initiation of radiotherapy treatment to include results from a variety of practical fractionation regimes for three different types of tumour: squamous cell carcinoma (head and neck), breast and prostate. The linear quadratic model of radiation effect, logarithmic tumour growth (coupled with delay times where relevant) and the Poisson model for tumour control probability (TCP) are used to calculate the change in TCP for delays between diagnosis and treatment. Within the limitations of radiobiological modelling, these data can be used to tentatively assess the interactions between delays, dose fractionation and TCP. The results show that delays in the start of radiotherapy treatment do have an adverse effect on tumour control for fast-growing tumours. For example, calculations predict a reduction in local tumour control of up to 1.5% per week's delay for head and neck cancers treated following surgery. In addition, there may be a variety of fractionation regimes that will yield very similar clinical results for each tumour type. It is shown theoretically that, for the tumour types considered here, it is possible to increase the dose per fraction and decrease the number of fractions while maintaining or increasing TCP relative to standard 2 Gy fractionation regimes, although there may be some advantage to using hyperfractionated regimes for head and neck cancers in order to reduce normal tissue effects.
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Affiliation(s)
- R M Wyatt
- Department of Radiotherapy Physics, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
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Jensen AR, Nellemann HM, Overgaard J. Tumor progression in waiting time for radiotherapy in head and neck cancer. Radiother Oncol 2007; 84:5-10. [PMID: 17493700 DOI: 10.1016/j.radonc.2007.04.001] [Citation(s) in RCA: 216] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Revised: 04/01/2007] [Accepted: 04/04/2007] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Waiting-time prior to radiotherapy is a well-known problem. This study aims to determine the impact of time on tumor growth in a patient population with squamous-cell carcinoma of the head and neck (SCCHN). MATERIAL AND METHODS In a consecutive cohort, all patients with both a diagnostic scan and a treatment-planning scan were identified. In total 648 patients were seen, and 414 treated with primary radiotherapy. Ninety-five had two scans and 61 sets were eligible for comparison. Endpoints were change in tumor volume, tumor volume doubling time (TVD) and disease progression measured by TNM-classification and RECIST criteria. RESULTS Median interval between eligible scans was 28 (5-95) days. Thirty-eight (62%) had measurable increase in tumor volume, median 46% (6-495%). For all patients TVD was median 99 days, but for the half of patients with fastest growing tumors TVD was 30 days (15-41). Tumor volume increase was significantly correlated to time and histological differentiation. Twelve (20%) developed new lymph-node metastasis and 10 (16%) progressed in TNM-classification. Evaluated by RECIST criteria 18 (30%) patients had progressive disease. INTERPRETATION This study shows a negative impact of waiting time in patients with SCCHN. Within an average time of 4 weeks the majority of the patients developed significant signs of tumor progression. It was not possible to define a threshold for acceptable time intervals in order to avoid volume changes, or to define a subgroup that has no negative impact of delay.
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Affiliation(s)
- Anni Ravnsbaek Jensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Nørrebrogade 44, Building 5, DK-8000 Aarhus C, Denmark.
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Berthelet E, Truong PT, Lesperance M, Lim JTW, Wai ES, MacNeil MV, Liu M, Joe H, Olivotto IA. Examining time intervals between diagnosis and treatment in the management of patients with limited stage small cell lung cancer. Am J Clin Oncol 2006; 29:21-6. [PMID: 16462498 DOI: 10.1097/01.coc.0000195092.25516.19] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine time intervals between diagnosis and treatment of limited stage small cell lung cancer (L-SCLC) and to evaluate its effect on clinical outcomes. MATERIALS AND METHODS Data on 166 patients with L-SCLC referred to a regional cancer center between January 1991 and December 1999 were analyzed. The time intervals studied were defined as: interval A, first abnormal chest x-ray to pathologic diagnosis: interval B, diagnosis to first oncology consultation; interval C, oncology consultation to first day of thoracic radiotherapy (RT); interval D, oncology consultation to first day of chemotherapy; and interval E, first day of chemo to first day of RT. Cox proportional hazards models were used to examine associations between the time intervals and thoracic relapse (TR) and overall survival (OS) outcomes. Logistic regression analysis was used to model associations between time and complete response (CR) rates. RESULTS The median time duration of intervals A to E were 20, 12, 63.5, 15, and 48 days, respectively. When time was analyzed as a continuous variable, no statistically significant association between the interval lengths and outcomes studied was observed. Dichotomizing each interval using the median value as cut-off revealed that interval A >20 days was significantly associated with improved CR (odds ratio = 3.573; P = 0.027) whereas interval B >12 days was associated with a trend toward lower CR (odds ratio = 0.348; P = 0.073). CONCLUSIONS Short median times from first abnormal chest x-ray to diagnosis and from diagnosis to oncology consultation indicate that L-SCLC patients were diagnosed and referred promptly in the community setting. OS and TR appeared independent of the time intervals analyzed. Individual variations in disease presentation and tumor biology may explain the observed associations between early pathologic diagnosis and inferior CR rates.
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Affiliation(s)
- Eric Berthelet
- Radiation Therapy and Systemic Therapy Programs, British Columbia Cancer Agency, Vancouver Island and Fraser Valley Centres, Victoria, BC, Canada.
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Schlienger M. Délais et retards à la radiothérapie : réflexion à propos de trois types de tumeurs. Cancer Radiother 2005; 9:590-601. [PMID: 16168693 DOI: 10.1016/j.canrad.2005.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 06/18/2005] [Accepted: 07/07/2005] [Indexed: 11/28/2022]
Abstract
In the following review of the literature, the reasons and consequences of a tendency to the increase of the delay between the diagnosis and the first irradiation session will be studied. The duration of the delay varies according to the protocol of treatment, which itself depends on the tumour. Moreover, all types of radiotherapy are concerned by the increase in delay. A retrospective study enables to determine for a given series of similar tumours and treatments the mean duration of delay and find the excessive duration. The increase of delay phenomenon exists in different countries. We know that before irradiation the tumour grows according to its biological characteristics and the TNM initial determination will no longer be true. On the other hand, effective treatments such as chemotherapy and hormone therapy are increasingly used alone, before or in combination with radiotherapy. Consequently, the classical timing of radiation therapy could be modified often delayed. It is difficult to consider that successive treatments are a real increase of delay and compare its results with previous data from radiotherapy alone. We will study its impact in three types of tumours, including tumours of head and neck, of the breast and prostate, which are the most widely reported. The consequences of prolonged delay are not easily evaluated: one of the more important parameters is the possible modification of the stage of tumour. This phenomenon is not restricted to the studied types of tumours. We will try to find possible ways of reducing abnormal delays before irradiation.
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Affiliation(s)
- M Schlienger
- Service de radiothérapie, hôpital Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Robinson D, Massey T, Davies E, Jack RH, Sehgal A, Møller H. Waiting times for radiotherapy: variation over time and between cancer networks in southeast England. Br J Cancer 2005; 92:1201-8. [PMID: 15785752 PMCID: PMC2361967 DOI: 10.1038/sj.bjc.6602463] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to investigate variations in the length of time that patients with cancer wait from diagnosis to treatment with radiotherapy. A total of 57 426 men and 71 018 women diagnosed with cancer between 1992 and 2001 and receiving radiotherapy within 6 months of diagnosis were identified from the Thames Cancer Registry database. In total, 12 sites were identified for which a substantial number or proportion of patients received radiotherapy: head and neck, oesophagus, colon, rectum, lung, nonmelanoma skin cancer, breast, uterus, prostate, bladder, brain and non-Hodgkin's lymphoma. Median waiting times from diagnosis to radiotherapy were calculated, together with the proportion of patients who received radiotherapy within 60 days of diagnosis, and analysed by year of diagnosis, cancer site, deprivation quintile, age at diagnosis, sex and cancer network of either residence or treatment. Logistic regression was used to adjust the proportion receiving treatment within 60 days for the effects of the other factors. There were significant differences in the proportions receiving radiotherapy within 60 days between different networks and different cancer sites, which remained after adjustment. Median waiting times varied from 42 to 65 days across networks of residence, with the adjusted proportion treated within 60 days ranging from 44 to 71%. There was no difference between male and female patients after adjustment for the other factors, particularly site. There was a highly significant trend over time: the median wait increased from 45 days in 1992 to 76 days in 2001, while the adjusted proportion being treated within 60 days declined by almost a half, from 64 to 35%, over the same period.
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Affiliation(s)
- D Robinson
- Thames Cancer Registry, Division of Cancer Studies, Guy's King's and St Thomas' School of Medicine, Capital House, 42 Weston Street, London SE1 3QD, UK.
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Hansen O, Larsen S, Bastholt L, Godballe C, Jørgensen KE. Duration of symptoms: impact on outcome of radiotherapy in glottic cancer patients. Int J Radiat Oncol Biol Phys 2005; 61:789-94. [PMID: 15708258 DOI: 10.1016/j.ijrobp.2004.07.720] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 07/09/2004] [Indexed: 11/24/2022]
Abstract
PURPOSE To study the relationship between the durations of symptoms before the start of radiotherapy and treatment outcome in Stage I-III glottic cancer. METHODS AND MATERIALS From 1965 to 1997, 611 glottic cancer patients from the Southern Region of Denmark were treated with primary radiotherapy. A total of 544 patients fulfilled the criteria for inclusion to the study (Stage I-III glottic cancer, a duration of symptoms less than or equal to 36 months, primary radiotherapy with at least 50 Gy and sufficient data for analysis). The total radiation dose ranged from 50.0 to 71.6 Gy in 22 to 42 fractions, and the median dose per fraction was 2.00 Gy (range, 1.56-2.29 Gy). All patients had 5 years of follow-up, and the 5-year recurrence-free survival rate was used as the primary endpoint. RESULTS The 5-year recurrence-free survival rate was 74%. In a multivariate Cox regression analysis, duration of symptoms was a significant factor (p < 0.0001) with a hazard ratio of 1.045 (95% CI 1.023, 1.069). Other significant factors included tumor stage and radiation dose, whereas duration of treatment time was borderline significant (p = 0.06). CONCLUSIONS The duration of symptoms was statistically significantly related to a decrease in recurrence-free survival. One-month delay from onset of symptoms to start of radiotherapy was equivalent to a 4.5% decrease in recurrence-free survival.
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Affiliation(s)
- Olfred Hansen
- Department of Oncology R, Odense University Hospital, 5000 Odense C, Denmark.
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E C, Dahrouge S, Samant R, Mirzaei A, Price J. Radical radiotherapy for cervix cancer: The effect of waiting time on outcome. Int J Radiat Oncol Biol Phys 2005; 61:1071-7. [PMID: 15752886 DOI: 10.1016/j.ijrobp.2004.09.030] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2003] [Revised: 07/21/2004] [Accepted: 09/07/2004] [Indexed: 11/23/2022]
Abstract
PURPOSE To assess the effect of treatment waiting time on clinical outcome for patients with cervix cancers treated with radical radiotherapy. METHODS AND MATERIALS A retrospective analysis was conducted on all cervix cancer patients treated with radical radiotherapy between 1990 and 2001 at the Ottawa Regional Cancer Centre. Analyses were performed according to the three following separate definitions of waiting times: interval from start of radiotherapy to (1) date of initial biopsy, (2) date of examination under anesthesia, and (3) date of radiation oncology consultation. Associations between waiting times and patient characteristics and disease control were investigated using t-tests, analyses of variance, and Cox regression analyses. RESULTS A total of 195 patients were studied. The vast majority of patients were treated within 5, 6, and 8 weeks of their consultation (91%), examination under anesthesia (88%), and biopsy (81%), respectively. On average, delays between initial biopsy and treatment start were greater for older patients (p = 0.025) (5.8 weeks for <40 years old vs. 6.6 weeks for >70 years old) and those with smaller tumors (p < 0.001) (5.0 weeks for >4 cm vs. 6.3 weeks for < or =4 cm). Univariate analysis revealed no adverse effect of treatment delay on tumor control. Multivariate analysis, with the inclusion of multiple prognostic tumor and treatment parameters, revealed an adverse effect of treatment delay on survival outcomes. CONCLUSIONS Longer radiotherapy waiting times were found to be associated with diminished survival outcomes for patients treated radically for cervix cancer. The significance of this observed association requires further investigation.
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Affiliation(s)
- Choan E
- Department of Radiation Oncology, The Ottawa Hospital Regional Cancer Centre, 503 Smyth Road, Ottawa, ON K1H-1C4, Canada.
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41
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Nguyen PL, Whittington R, Koo S, Schultz D, Cote KB, Loffredo M, McMahon E, Renshaw AA, Tomaszewski JE, D'Amico AV. The impact of a delay in initiating radiation therapy on prostate-specific antigen outcome for patients with clinically localized prostate carcinoma. Cancer 2005; 103:2053-9. [PMID: 15816048 DOI: 10.1002/cncr.21050] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND To determine whether a delay in initiating external beam radiation therapy (RT) following diagnosis could impact prostate-specific antigen (PSA) outcome for patients with localized prostate cancer, 460 patients, who received 3D conformal RT to a median dose of 70.4 Gy for clinically localized prostate cancer between 1992 and 2001, were studied. METHODS The primary endpoint was PSA failure (American Society for Therapeutic Radiology and Oncology definition). Estimates of PSA control were made using the Kaplan-Meier method. Delay was defined as the time between diagnosis and the start of RT. Risk groups were defined based on known predictors of PSA outcome, namely, baseline PSA level, clinical T-category, Gleason score, and percentage of biopsy cores positive for tumor. Cox multivariate regression analysis was used to determine the ability of treatment delay to predict time to PSA failure after adjusting for the other known predictors. RESULTS Treatment delay independently predicted time to PSA failure following diagnosis for high-risk (Adjusted Hazard Ratio = 1.08 per month; P = 0.029) but not low-risk patients (P = 0.31). Patients with high-risk disease (n = 240) had 5-year estimates of PSA failure-free survival of 55% versus 39% (Plog-rank = 0.014) for those with delay < 2.5 months versus > or = 2.5 months respectively. The median delay was 2.5 months. CONCLUSIONS Treatment delay adversely affected PSA outcome for high-risk patients but not for low-risk patients following RT.
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Affiliation(s)
- Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA
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El Sharouni SY, Kal HB, Battermann JJ. Accelerated regrowth of non-small-cell lung tumours after induction chemotherapy. Br J Cancer 2004; 89:2184-9. [PMID: 14676792 PMCID: PMC2395273 DOI: 10.1038/sj.bjc.6601418] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
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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Affiliation(s)
- S Y El Sharouni
- Department of Radiation Oncology Q00.118, University Medical Centre, Post Box 85500, Heidelberglaan 100, 35 84 CX Utrecht, The Netherlands.
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Lehman M, Jacob S, Delaney G, Papadatos G, Jalaludin B, Cail S, McCourt J, Wright S, O'Brien C, Barton M. Waiting times for radiotherapy—a survey of patients' attitudes. Radiother Oncol 2004; 70:283-9. [PMID: 15064014 DOI: 10.1016/j.radonc.2004.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2003] [Revised: 12/10/2003] [Accepted: 01/19/2004] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE To determine the maximum time cancer patients were willing to wait for radiotherapy. PATIENTS AND METHODS Using a trade-off technique (TOT) the maximum time patients were prepared to wait for treatment at the centre closest to home before electing to transfer their care to a centre located (1) at a distance necessitating an extra 30 min travelling each day (MWT 1) or (2) at a distance necessitating staying away from home for the duration of therapy (MWT 2) was determined. A TOT was utilised to determine the loss in treatment effectiveness (LIE 1, LIE 2) patients were willing to accept as a consequence of their MWT 1 and MWT 2 choices. RESULTS The median MWT 1 was 4 weeks while the median MWT 2 was 8 weeks. A longer MWT 1 was associated with increasing patient age and a problem with travelling an extra 30 min. Symptomatic patients were less likely to accept a longer MWT 1. The MWT 2 increased as the expected duration of treatment increased but patients in regional areas were less likely to accept a longer MWT 2. The majority of patients indicated that they were unwilling to accept any loss in treatment effectiveness. Patients who had a problem with travelling an extra 30 min daily or who were unable to drive were willing to accept a loss in treatment effectiveness. CONCLUSIONS This study provides an estimate of the waiting times cancer patients are prepared to accept for radiation therapy and suggests that cancer patients are unlikely to trade-off effectiveness for convenience.
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Affiliation(s)
- Margot Lehman
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Kenny L, Lehman M. Sequential audits of unacceptable delays in radiation therapy in Australia and New Zealand. ACTA ACUST UNITED AC 2004; 48:29-34. [PMID: 15027918 DOI: 10.1111/j.1440-1673.2004.01239.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Delays in accessing radiation treatment are of concern in Australia and New Zealand, both in terms of the proportion of patients who are actually able to access care, and in the timeliness of starting treatment. For those who are able to access treatment, one in three patients experience an unacceptable delay in starting treatment, and only one in four patients starts radiotherapy within standard good practice times. During the year 2002, more than 15 000 Australians who potentially could have benefited from radiotherapy, did not receive this treatment. For those who were able to access radiotherapy treatment, worsening delays were experienced in Australia, with greater than 40% of patients receiving curative treatment, 30% receiving palliative treatment, and 56% receiving emergency treatment starting outside of standard good practice times. Delays of up to 151 days were experienced in Australia. In Australia, delays in implementing recommendations to improve the infrastructure are resulting in a declining service for cancer patients. In New Zealand, the situation, in general, is improving, although there needs to be an ongoing commitment to grow the service according to the population needs. Urgent implementation of strategic planning is required.
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Franchin G, Minatel E, Gobitti C, Talamini R, Vaccher E, Sartor G, Politi D, Trovò MG, Barzan L. Radiotherapy for patients with early-stage glottic carcinoma: univariate and multivariate analyses in a group of consecutive, unselected patients. Cancer 2003; 98:765-72. [PMID: 12910521 DOI: 10.1002/cncr.11575] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Radiotherapy (RT) has a remarkable success rate in the treatment of patients with glottic carcinoma. The objectives of the current study were to assess the results in a group of consecutive patients with comparable characteristics who were treated with RT (6-megavolt photon linear accelerator) and to determine the prognostic factors that may influence local control in patients with early-stage glottic carcinoma. The impact on local control of tobacco smoking and second primary malignancies also was investigated. METHODS Four hundred ten patients with T1-T2 squamous cell carcinoma of the glottis who were treated between 1986 and 2001 were analyzed retrospectively with regard to local control and overall survival. Potential prognostic factors for local control were evaluated with univariate and multivariate models. The impact of technologic advances also was evaluated. RESULTS The 5-year and 10-year overall survival rates were 83% and 63.5%, respectively. The overall 10-year local control rate for patients with T1-T2 glottic carcinoma was 89%. The median time to recurrence was 7 months. Univariate analysis showed that tumor category, tumor size, macroscopic appearance of the lesion, RT fraction size, persistent edema, year of RT treatment, unchanged dysphonia, and surgical option all had a significant influence on local control; whereas multivariate analysis showed that only persistent dysphonia and year of RT treatment were significantly associated with increased local control. A 22.2% rate of second primary malignancies was reported: second primary tumors were the major cause of death in the patients studied. Only 2 patients died of laryngeal carcinoma; 304 patients were alive with their disease in complete remission, 1 patient was alive with recurrent laryngeal carcinoma after undergoing salvage surgery, and 103 patients died of either intercurrent disease or a second primary tumor. CONCLUSIONS The use of a 6-megavolt photon linear accelerator achieved a high rate of local control in patients with T1-T2 glottic carcinoma. Dysphonia and the year of RT treatment were the most important prognostically significant factors for patient outcome. The occurrence of a second primary tumor was the most frequent cause of death, especially among patients who did not stop smoking after a diagnosis of glottic carcinoma.
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Affiliation(s)
- Giovanni Franchin
- Department of Radiotherapy, Centro di Riferimento Oncologico, Aviano, Italy.
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Coles CE, Burgess L, Tan LT. An audit of delays before and during radical radiotherapy for cervical cancer--effect on tumour cure probability. Clin Oncol (R Coll Radiol) 2003; 15:47-54. [PMID: 12708710 DOI: 10.1053/clon.2002.0178] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To evaluate the potential impact of time delay before and during radical radiotherapy for cervical carcinoma at Addenbrooke's Hospital. MATERIALS AND METHODS An audit was undertaken which recorded the number of gaps during external beam radiotherapy (EBRT), overall treatment time, and delay between first oncology consultation to start of radiotherapy, for patients receiving primary radical radiotherapy for cervical cancer in 1996, 1998 and 2001. Radiobiological modelling was used to calculate the tumour control probability (TCP). A questionnaire survey of 62 oncology departments in the U.K. was carried out for comparison. RESULTS The percentage of patients completing EBRT without any interruptions was 22, 67 and 94% in 1996, 1998, and 2001, respectively (P = 0.0009). The median overall treatment time was 49, 42 and 39 days in 1996, 1998 and 2001, respectively (P = 0.001). However, the median waiting time to start of radiotherapy increased from 14 days in 1996 to 18 days in 1998 and 35 days in 2001 (P = 0.007). CONCLUSION The results from the national survey showed that this pattern of improved overall treatment times accompanied by deterioration in waiting times was also seen in most other U.K. centres. Radiobiological modelling showed that any potential gain in TCP resulting from shorter overall treatment times could be offset entirely by the adverse effect of increasing waiting times. The calculations suggest that the tumours most likely to be adversely affected by long waiting times are those with shorter volume doubling times or a medium chance of tumour control at the outset of treatment. A system of patient triage, and prioritization of patients deemed most likely to benefit from a reduced waiting time, may be necessary in the current climate of limited radiotherapy resources.
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Affiliation(s)
- C E Coles
- Oncology Centre, Addenbrooke's Hospital, Cambridge, U.K.
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León X, de Vega M, Orús C, Morán J, Vergés J, Quer M. The effect of waiting time on local control and survival in head and neck carcinoma patients treated with radiotherapy. Radiother Oncol 2003; 66:277-81. [PMID: 12742267 DOI: 10.1016/s0167-8140(03)00022-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE To determine the influence of waiting time for radiotherapy on local control and survival in a cohort of patients with head and neck carcinoma of different locations and stages treated with radiotherapy. MATERIAL AND METHODS Retrospective study of 797 patients with squamous cell carcinoma located in the oral cavity, pharynx or larynx, treated with radiotherapy, and with a minimum follow-up of 3 years. Local recurrence and survival were analyzed in function of the waiting time, defined as the interval between date of histologic diagnosis and date of radiotherapy. A univariate and multivariate analysis was carried out. RESULTS Median waiting time to radiotherapy was 44 days (25 and 75% quartiles: 33 and 60 days). There were significant differences in the waiting time period in relation to the primary location and the local extension of the tumor. Both univariate and multivariate analysis showed that waiting time had no significant impact either on local control or survival. CONCLUSION Within the range of the waiting time observed in our study, delay in the initiation of radiotherapy did not affect local control or survival in patients with head and neck carcinoma.
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Affiliation(s)
- Xavier León
- Department of Otolaryngology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Avda. San Antoni Ma Claret, 167, 08025 Barcelona, Spain
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Waaijer A, Terhaard CHJ, Dehnad H, Hordijk GJ, van Leeuwen MS, Raaymakers CPJ, Lagendijk JJW. Waiting times for radiotherapy: consequences of volume increase for the TCP in oropharyngeal carcinoma. Radiother Oncol 2003; 66:271-6. [PMID: 12742266 DOI: 10.1016/s0167-8140(03)00036-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Waiting lists for radiotherapy have become longer over the past years. Apart from the psychological distress for the patient we are concerned about tumour growth during this waiting time, which may worsen prognosis. The purpose of this pilot study was to investigate tumour growth in the waiting time and to obtain an indication of its clinical consequences for patients with oropharyngeal carcinoma. A tumour control probability (TCP) model was applied to evaluate consequences for outcome. METHODS AND MATERIALS Increase in tumour volume was measured for 13 patients with oropharyngeal carcinoma by outlining the tumour on the diagnostic as well as on the treatment planning CT scan. Waiting time was defined as time between histopathological diagnosis and start of radiotherapy. For each tumour we calculated the increase in tumour volume and the tumour doubling time. The potential increase in TCP was calculated for each tumour for the situation without treatment delay. RESULTS The mean increase in tumour volume was 70%. The mean waiting time was 56 days. Expected TCP with incorporation of delay was 47%, without delay it might have been 63-66%. CONCLUSION This study shows tumour progression during the time between the diagnostic CT scan and the treatment planning CT scan in oropharyngeal cancer. As a consequence of waiting time, which allows tumour volume increase, there may be an average control loss of 16-19 % for these tumours during the total waiting time before radiotherapy.
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Affiliation(s)
- Annet Waaijer
- Department of Pediatric Surgery of the UMC Utrecht, Lundlaan 6, 3583 CX Utrecht, The Netherlands
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Huang J, Barbera L, Brouwers M, Browman G, Mackillop WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 2003; 21:555-63. [PMID: 12560449 DOI: 10.1200/jco.2003.04.171] [Citation(s) in RCA: 403] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE The objective of this study was to synthesize what is known about the relationship between delay in radiotherapy (RT) and the outcomes of RT. METHODS A systematic review of the world literature was conducted to identify studies that described the association between delay in RT and the probability of local control, metastasis, and/or survival. Studies were classified by clinical and methodologic criteria and their results were combined using a random-effects model. RESULTS A total of 46 relevant studies involving 15,782 patients met our minimum methodologic criteria of validity; most (42) were retrospective observational studies. Thirty-nine studies described rates of local recurrence, 21 studies described rates of distant metastasis, and 19 studies described survival. The relationship between delay and the outcomes of RT had been studied in diverse situations, but most frequently in breast cancer (21 studies) and head and neck cancer (12 studies). Combined analysis showed that the 5-year local recurrence rate (LRR) was significantly higher in patients treated with adjuvant RT for breast cancer more than 8 weeks after surgery than in those treated within 8 weeks of surgery (odds ratio [OR] = 1.62, 95% confidence interval [CI], 1.21 to 2.16). Combined analysis also showed that the LRR was significantly higher among patients who received postoperative RT for head and neck cancer more than 6 weeks after surgery than among those treated within 6 weeks of surgery (OR = 2.89; 95% CI, 1.60 to 5.21). There was little evidence about the impact of delay in RT on the risk of metastases or the probability of long-term survival in any situation. CONCLUSION Delay in the initiation of RT is associated with an increase [corrected] in LRR in breast cancer and head and neck cancer. Delays in starting RT should be as short as reasonably achievable.
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Affiliation(s)
- Jenny Huang
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, and Kingston Regional Cancer Centre, Kingston, Canada
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50
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León X, Quer M, Orús C, de Vega M, Vergés J, Gañán L. [Treatment of T1N0 glottis carcinoma with radiotherapy. Results at our center and review of the literature]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2003; 54:39-47. [PMID: 12733319 DOI: 10.1016/s0001-6519(03)78382-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the results of radiotherapy in the treatment of patients with T1N0 glottic squamous cell carcinoma. MATERIAL AND METHODS Retrospective study of a cohort of 338 patients with T1N0 glottic carcinoma treated with radiotherapy at our institution between 1985-1997. A review of the literature published during the last ten years was carried out. RESULTS Local control with radiotherapy in our patients was 82%, reaching 97% when salvage surgery was included. The local control with radiotherapy in most of the published series ranges between 81.90%. CONCLUSIONS Treatment with radiotherapy achieves local control in early glottic carcinomas (T1N0) in 80-90% of cases. In our centre such treatment achieved local control in 82% of cases.
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Affiliation(s)
- X León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Avda, San Antoni Ma, Claret, 167, 08025 Barcelona
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