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

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). 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. Mean waiting time for treatment was 62.5days for the hypopharynx subgroup (range=37–102), 63days for the larynx subgroup (range=19–128) and 58.5days 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 50days, 19% of patients had local failure, 17% nodal recurrence and 11% distant failure. Within a delay of 50days, 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. For N0 patients treated with IMRT for HNSCC, waiting time around 50days after the diagnosis was not significantly associated with an excessive risk of upstaging or recurrence.