Radiotherapy treatment time delay evidence, part I: Update on cervical, anal, prostate, and head and neck cancers

Table 1 Resume and basic recommendations to deal with delays

Localization (number of articles negative/published)	LRC and/or SV lost	RT intention	Stages	Recommendations
Head and neck cancer (59/70, 84.3%)	Yes, both	Radical and adjuvant	All	Avoid/compensate if delays ≥ 3-5 days (3, preferable; 5, obligatory), especially if G1 (or even G-2) histological grade. Do so for every pathological stage and RT intention (especially in II-IV stages and radical intention) and regardless if QT is used
Cervix cancer (32/37, 88.8%)	Yes, both	Radical	≥ II-B, and maybe in I-B/II-A, at least	Complete EBRT + BT in < 8-9 weeks (8, preferable), although if chemoradiotherapy the limit could be up to 9-10 weeks. Timing EBRT/BT: Keep on ≤ 10 days (7, if possible). Pelvic adjuvant EBRT: For precaution, in treatments of 45-50 Gy in 5-5.5 weeks, avoid/compensate delays > 5-7 days
Anal cancer (5/15, 33.3%)	LRC: Probable, yes. SV: No, except, maybe, CSS and free-progresion survival	Radical	Likely more important in T3-4 and more dubious in T1-2	In continuous RT schemes at usual doses of 45-60 Gy, avoid/compensate OTT > 40-42 days for lower doses and OTT > 53 days (or delays > 8 days) for higher doses. QT could inhibit repopulation if delays < 7 days, especially in T1 and T2
Prostate cancer (8/12, 66.6%)	LRC: Yes, and biochemical control, too. SV: No, except, maybe, CSS	Radical	Likely more important in localized stages/Low risk groups, more dubious in intermediates and less likely in advanced/high risk	Avoid/compensate especially in localized stages/Low risk groups, more dubious in intermediates. Avoid/compensate if delays ≥ 5-7 days in patients without concurrent hormonotherapy. Normofx: Avoid/compensate if OTT > 8-9 weeks (> 52-58 days). MHipofx (about 2.5 Gy/day): Avoid/compensate on precaution delays > 4-7 days, especially if concur at least one of the first two points. MHipofx (around 3 Gy/day): Avoid/compensate on precaution delays ≥ 7-10 days, especially if concur at least one of the first two points. Adjuvant RT (Normofx and MHipofx, 1.8-3 Gy/day): Avoid/compensate on precaution delays ≥ 7-10 days, especially if concur at least one of the first two points

BT: Brachytherapy; CSS: Cancer-specific survival; EBRT: External beam radiotherapy; LRC: Locoregional control; MHipofx: Moderate hipofraccionation; Normofx: Normofraccionation; OTT: Overall treatment time; QT: Chemotherapy; RT: Radiotherapy; SV: Survival.