Radiotherapy & Oncology
Volume 87, Issue 1 , Pages 3-16, April 2008

The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature

  • Zheng Chen

      Affiliations

    • Queen’s Cancer Research Institute, Queen’s University, Kingston, Ont., Canada
    • ,
  • Will King

      Affiliations

    • Queen’s Cancer Research Institute, Queen’s University, Kingston, Ont., Canada
    • ,
  • Robert Pearcey

      Affiliations

    • Cross Cancer Institute, Edmonton, Alta., Canada
    • ,
  • Marc Kerba

      Affiliations

    • Queen’s Cancer Research Institute, Queen’s University, Kingston, Ont., Canada
    • ,
  • William J. Mackillop

      Affiliations

    • Queen’s Cancer Research Institute, Queen’s University, Kingston, Ont., Canada
    • Corresponding Author InformationCorresponding author. William J. Mackillop, Division of Cancer Care and Epidemiology, QCRI Level 2, Queen’s University, Kingston, Ont., Canada.

Received 12 July 2007; received in revised form 13 November 2007; accepted 14 November 2007. published online 21 December 2007.

Abstract 

Purpose

To synthesize the direct clinical evidence relating waiting times (WTs) for radiotherapy (RT) to the outcomes of RT.

Methods and materials

We did a systematic review of the literature between 1975 and 2005 to identify clinical studies describing the relationship between WTs and outcomes of RT. Only high quality (HQ) studies that had adequately controlled for confounding factors were included in the primary analysis. WTs that had originally been reported as a categorical variable were converted to a continuous variable based on the distribution of WTs in each category. Meta-analyses were done using a fixed-effect model.

Results

The systematic review identified 44 relevant studies. Meta-analyses of 20 HQ studies of local control demonstrated a significant increase in the risk of local failure with increasing WT, RRlocal recurrence/month=1.14, 95% Confidence Intervals (CI): 1.09–1.21. For post-operative RT for breast cancer; RRlocal recurrence/month=1.11, 95%CI: 1.04–1.19. For post-operative RT for head and neck cancer, RRlocal recurrenc/month=1.28, 95%CI: 1.08–1.52. For definitive RT for head and neck cancer, RRlocal recurrence/month=1.15, 95%CI: 1.02–1.29.

There was little evidence of any association between WTs and the risk of distant metastasis. Meta-analyses of the 6 HQ studies of breast cancer showed RRmetastasis/month=1.04, 95%CI: 0.98–1.09. Meta-analyses of 4 HQ studies of breast cancer showed no significant decrease in survival with increasing WT, RRdeath/month=1.06, 95%CI: 0.97–1.16, but there was a marginally significant decrease in survival in 4 HQ studies of head and neck cancer, RRdeath/month=1.16, 95%CI: 1.02–1.32.

Conclusions

The risk of local recurrence increases with increasing WTs for RT. The increase in local recurrence rate may translate into decreased survival in some clinical situations. WTs for RT should be as short as reasonably achievable.

Keywords: Systematic review, Meta-analyses, Radiotherapy, Waiting time, Local recurrence, Metastasis, Survival

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 31.50 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

PII: S0167-8140(07)00588-9

doi:10.1016/j.radonc.2007.11.016

Radiotherapy & Oncology
Volume 87, Issue 1 , Pages 3-16, April 2008

Article Tools

* Image Usage & Resolution