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Does Delay in Starting Treatment Affect the Outcomes of Radiotherapy? A Systematic Review

Jenny Huang, Lisa Barbera, Melissa Brouwers, George Browman, William J. Mackillop

From the Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, and Kingston Regional Cancer Centre, Kingston; and Cancer Care Ontario Program in Evidence-Based Care, McMaster University Health Sciences Centre, Hamilton Regional Cancer Centre, Hamilton, ON, Canada.

Address reprint requests to William J. Mackillop, MD, Radiation Oncology Research Unit, Division of Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Apps Level 4, Kingston General Hospital, Kingston, ON K7L 2V7, Canada; email: william.mackillop{at}krcc.on.ca.

Purpose: The objective of this study was to synthesize what is known about the relationship between delay in radiotherapy (RT) and the outcomes of RT.

Methods: A systematic review of the world literature was conducted to identify studies that described the association between delay in RT and the probability of local control, metastasis, and/or survival. Studies were classified by clinical and methodologic criteria and their results were combined using a random-effects model.

Results: A total of 46 relevant studies involving 15,782 patients met our minimum methodologic criteria of validity; most (42) were retrospective observational studies. Thirty-nine studies described rates of local recurrence, 21 studies described rates of distant metastasis, and 19 studies described survival. The relationship between delay and the outcomes of RT had been studied in diverse situations, but most frequently in breast cancer (21 studies) and head and neck cancer (12 studies). Combined analysis showed that the 5-year local recurrence rate (LRR) was significantly higher in patients treated with adjuvant RT for breast cancer more than 8 weeks after surgery than in those treated within 8 weeks of surgery (odds ratio [OR] = 1.62, 95% confidence interval [CI], 1.21 to 2.16). Combined analysis also showed that the LRR was significantly higher among patients who received postoperative RT for head and neck cancer more than 6 weeks after surgery than among those treated within 6 weeks of surgery (OR = 2.89; 95% CI, 1.60 to 5.21). There was little evidence about the impact of delay in RT on the risk of metastases or the probability of long-term survival in any situation.

Conclusion: Delay in the initiation of RT is associated with a decrease in LRR in breast cancer and head and neck cancer. Delays in starting RT should be as short as reasonably achievable.

This work was presented at the Annual Scientific Meeting of the Canadian Association of Radiation Oncologists in Quebec City, PQ, Canada, September 21–23, 2001.

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Related Correspondence

• Impact on Outcome of Delay in Starting Radiotherapy
  Abram Recht
  JCO 2004 22: 1341-1342 [Full Text]
• Delay of Postoperative Radiotherapy in Head and Neck Cancer Patients
  Emmanuel Blot, Emilie Astruc, and Laurent Bastit
  JCO 2004 22: 1342 [Full Text]
• Delay of Radiation Therapy and Outcomes of Breast Cancer
  Nicole Hébert-Croteau, Carolyn Freeman, Jean Latreille, and Jacques Brisson
  JCO 2004 22: 1342-1343 [Full Text]

Related Reply

• In Reply:
  W.J. MacKillop, J. Huang, L. Barbera, M. Brouwers, and G. Browman
  JCO 2004 22: 1343-1344 [Full Text]

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