Waiting time
Tumor progression in waiting time for radiotherapy in head and neck cancer

https://doi.org/10.1016/j.radonc.2007.04.001Get rights and content

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.

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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