Impact of waiting time on nodal staging in head and neck squamous-cell carcinoma treated with radical intensity modulated radiotherapy

Cédric Chevalier; Aurélie Bertaut; Magali Quivrin; Noémie Vulquin; Cédric Desandes; Mireille Folia; Christian Duvillard; Gilles Truc; Gilles Crehange; Philippe Maingon

doi:10.1016/j.ctro.2016.11.002

Impact of waiting time on nodal staging in head and neck squamous-cell carcinoma treated with radical intensity modulated radiotherapy

Clin Transl Radiat Oncol. 2016 Dec 21:1:27-32. doi: 10.1016/j.ctro.2016.11.002. eCollection 2016 Dec.

Affiliations

¹ Department of Radiation Oncology, Georges François Leclerc Cancer Center, Dijon, France.
² Department of Statistics, Georges François Leclerc Cancer Center, Dijon, France.
³ Ear Nose and Throat Department, University Hospital of Dijon, Dijon, France.
⁴ Radiation Oncology Department, GHU La Pitié Salpêtrière, Paris, France.

Abstract

Background and purpose: To evaluate the influence of delays for radiotherapy on survival, recurrence and upstaging for head and neck squamous-cell carcinoma (HNSCC) with no nodal involvement treated with intensity modulated radiotherapy (IMRT).

Material and methods: This retrospective study included 63 consecutive patients with HNSCC located in the pharynx and larynx and treated with exclusive IMRT with or without chemotherapy. Survival, loco-regional or distant failure and upstaging were analyzed according to the waiting time.

Results: Mean waiting time for treatment was 62.5 days for the hypopharynx subgroup (range = 37-102), 63 days for the larynx subgroup (range = 19-128) and 58.5 days for the oropharynx subgroup (range = 29-99) (p = 0.725). Nine patients (14%) experienced upstaging. Loco-regional or distant failure occurred in 18 patients. Beyond a delay of 50 days, 19% of patients had local failure, 17% nodal recurrence and 11% distant failure. Within a delay of 50 days, no nodal or distant failure was observed and only 1 patient experienced local recurrence. Upstaging and overall survival were not significantly affected by an increased waiting time.

Conclusion: For N0 patients treated with IMRT for HNSCC, waiting time around 50 days after the diagnosis was not significantly associated with an excessive risk of upstaging or recurrence.

Keywords: Head and neck squamous-cell carcinoma; Intensity modulated radiation therapy; Loco-regional failure; Quality assurance; Upstaging; Waiting time.