1
|
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: 25] [Impact Index Per Article: 8.3] [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.
Collapse
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
| |
Collapse
|
2
|
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: 5] [Impact Index Per Article: 1.3] [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.
Collapse
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.
| |
Collapse
|