Tumor progression in waiting time for radiotherapy in head and neck cancer
- PMID: 17493700
- DOI: 10.1016/j.radonc.2007.04.001
Tumor progression in waiting time for radiotherapy in head and neck cancer
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.
Comment in
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Killing time: the consequences of delays in radiotherapy.Radiother Oncol. 2007 Jul;84(1):1-4. doi: 10.1016/j.radonc.2007.05.006. Epub 2007 Jun 14. Radiother Oncol. 2007. PMID: 17574695 No abstract available.
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Finding solutions for the endless wait--reducing waiting times for radiotherapy.Radiother Oncol. 2008 Apr;87(1):153-4. doi: 10.1016/j.radonc.2007.11.021. Epub 2008 Feb 20. Radiother Oncol. 2008. PMID: 18083258 No abstract available.
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