Prolonged overall treatment time (OTT) in radiotherapy (RT) for head and neck cancer (HNC), particularly beyond 49 days, has been linked to poorer tumour control and survival, primarily due to accelerated tumour repopulation. Identifying modifiable factors contributing to treatment delays may help improve outcomes. This study aimed to evaluate the association between pre-treatment clinical, nutritional and inflammatory factors and prolonged OTT.

We retrospectively analysed patients with non-metastatic HNC treated with definitive or postoperative RT (with or without chemotherapy) between 2020 and 2022. Pre-treatment factors included Eastern Cooperative Oncology Group (ECOG) performance status, tumour stage, treatment modality, body mass index (BMI), weight loss, sarcopenia (via C3 computed tomography imaging), neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count. Logistic regression was used to identify predictors of prolonged OTT (> 49 days).

Among 465 patients, 287 (61·7%) experienced prolonged OTT. Multivariable analysis identified ECOG status (OR 1·42, p = 0·004), significant weight loss > 5% (OR 1·26, p = 0·036), concurrent chemotherapy (OR 1·96, p = 0·005), NLR (OR 1·03, p = 0·041) and sarcopenia (OR 1·18, p = 0·042) as independent predictors. Patient-related delays accounted for 53·3% of OTT prolongation, while public holidays contributed to 42·5%.

Several modifiable pre-treatment factors—including poor performance status, pre-treatment weight loss, sarcopenia and systemic inflammation—were independently associated with OTT prolongation. These findings provide evidence to support early, patient-tailored interventions such as prehabilitation and intensive nutritional counselling before and during RT. In addition, system-level strategies, including staffing adjustments and compensatory scheduling during public holidays, may further reduce avoidable treatment delays and enhance care delivery.

This study aims to clarify the influence of overall treatment time (OTT) on the efficiency of combined chemo-radiotherapy in cervical cancer.

This retrospective study enrolled 122 cervical cancer patients who had squamous cell carcinoma and had undergone definitive chemo-radiotherapy from 2009 to 2013. All patients received whole pelvic radiotherapy (WPRT) with the dose of 50 Gy in 25 fractions (with central shielding after 44 Gy) plus intracavitary brachytherapy with the dose of 28 Gy in four fractions. During WPRT, all patients received concurrent chemotherapy with weekly platinum-based regimen. The data of patient characteristics, OTT, treatment results and toxicities were collected and evaluated.

The mean follow-up time was 36 months. The mean age of patients was 52 years old; 68% of patients were stage IIB related to International Federation of Gynaecology and Obstetrics staging. Pelvic control (PC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) rates did not differ significantly in the data-derived cut points of 55·8 and 53 days. No statistically significant difference in treatment results between the two groups of OTT<49 and OTT≥62 days was observed.

In our data-derived cut point, OTT did not influence to PC, DMFS, DFS and OS. The influence of OTT on treatment results may be found in longer periods.