Waiting timeTumor progression in waiting time for radiotherapy in head and neck cancer
Section snippets
Materials and methods
All patients with squamous cell carcinoma in pharynx, larynx or oral cavity seen at the Department of Oncology, Aarhus University Hospital from January 2000 up to May 2005 were identified. Altogether 648 patients were seen and 414 received primary radiotherapy with curative intent (Fig. 1). Ninety-five patients were identified, with both a diagnostic scan (MR or CT) and a treatment planning CT scan (Fig. 1). The final study group consisted of 61 patients with two sets of comparable scans, on
Results
Ninety-five patients had two scans performed and compared to all the patients treated with curatively intended radiotherapy these patients had more advanced disease, primarily because the group contained relatively less patients with small larynx tumors. Of the 95 sets of scans, it was possible to find comparable scans for 61 patients, and there were no differences between all the 95 patients and the 61 patients with comparable scans. Eligible for the study were 47 men and 14 women with a
Discussion
Several studies have analyzed the impact of patient and/or professional delay on local control probability and overall survival with conflicting results. These studies are all retrospective and the interpretation is difficult due to random variations and confounding factors. A Danish study found a significant longer waiting time for patients with small tumors than for patients with large tumors [17], and it might be that patients with a history of fast growth or advanced state might bypass the
Conclusion
This study shows a negative impact of waiting time in a substantial part of patients with SCCHN. With a median of 4 weeks interval between two scans did the majority of patients develop significant increase in measurable parameters for tumor volume or 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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