title: Effect of treatment delay on outcome of patients with early-stage head-and-neck carcinoma receiving radical radiotherapy.
abstract: OBJECTIVE
  Access to radiotherapy (RT) has been considerably reduced in Quebec since the late 1980s. The aim of the present study was to analyze the impact of delaying treatment on the outcome of patients with early head-and-neck squamous cell carcinomas.
  
  
  METHODS
  This retrospective analysis examined the outcome for all 623 patients with early-stage disease (T1-2, N0-1) who received radical RT between 1988 and 1997 at the Hotel Dieu of Quebec Hospital. Delay was defined as the time from initial evaluation by a radiation oncologist to the beginning of RT. Delay intervals were divided as follows: <30 days, 31-40 days, and >40 days.
  
  
  RESULTS
  A delay of >40 days was significantly associated with an increased risk of local and neck failure and poorer survival relative to patients treated in <30 days or between 31 and 40 days. The adjusted hazard ratio and (in parentheses) the 95% confidence interval was 2.6 (1.07-6.4), 2.73 (1.38-5.4), and 1.7 (1.1-2.6), respectively, for local failure, neck failure, and survival. In the subgroup of patients with T2N0 disease, delaying RT for >30 days was associated with a poor outcome, as measured by the same end points.
  
  
  CONCLUSIONS
  Delaying RT had a deleterious effect on these patients. RT should be started as soon as possible in patients with squamous cell carcinoma of the head and neck, preferably within 20-30 days after evaluation by a radiation oncologist.
authors.affiliation: Department of Radiation Oncology, Laval University Cancer Research Center, L'Hôtel-Dieu de Québec, Québec City, Québec, Canada. afortin@videotron.ca
authors.forename: André
authors.initials: A
authors.lastname: Fortin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bairati
authors.forename: Michele
authors.initials: M
authors.lastname: Albert
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Josée
authors.initials: J
authors.lastname: Allard
authors.forename: Christian
authors.initials: C
authors.lastname: Couture
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome