{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T01:12:58Z","timestamp":1755825178657,"version":"3.44.0"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>Non-completion of radiotherapy courses (NCRC) may happen in patients undergoing intensity-modulated radiotherapy (IMRT). Analyzing the reasons and risk factors for NCRC can lead to possible targeted measures to reduce the incidence rate. This six-year retrospective study will present a cohort analysis of NCRC from a single center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from patients treated with IMRT between January 2018 and December 2023 were collected for analysis. The collected characteristics included age, gender, residential area, body mass index (BMI), tumor clinical stage, tumor type, tumor location, therapeutic intent, number of fractions, insurance status, treatment completion status, and reasons for NCRC. The radiotherapy process rigorously followed Chinese basic guidelines of quality control for radiotherapy. NCRC was defined as the failure to complete the course after starting the radiotherapy. Patients were categorized into the completion group (CG) and the non-completion group (NCG). Comprehensive analyses included six-year overall NCRC rate and annual trends, inter-group (CG vs. NCG) characteristic disparities, the reasons and risk factors for NCRC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among total collected 2,112 IMRT patients, the overall rate of NCRC was 5.68% (n=120), with annual values ranging 4.15\u20136.69% (p=0.718). The patient-driven reasons for NCRC encompassed: perceiving the final several fractions as non-essential (n=8, 6.67%); perceived insufficient therapeutic efficacy (n=34, 28.33%); financial constraints (n=3, 2.5%). The clinician-driven reasons for NCRC included: severe radiation-induced toxicities (n=39, 32.5%); disease progression (n=30, 25%); death(n=6, 5%). Significant inter-group (CG vs. NCG) differences (p&amp;lt;0.05) were observed in age, gender, body mass index (BMI), therapeutic intent, tumor clinical stage, tumor location, and number of fractions; however significant differences were not observed in the residential area and insurance status. Multivariate analysis revealed that the age, BMI, therapeutic intent, and tumor clinical stage were independent risk factors for NCRC (p&amp;lt;0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rigorous adherence to the basic guidelines of radiotherapy quality control helped maintain a stable NCRC rate (ranging 4.15%\u20136.69%). While 62.5% of NCRC cases were attributable to unpredictable radiation-induced toxicities, disease progression or death, the remaining 37.5% (35% due to insufficient awareness of radiotherapy and 2.5% to financial constraints) were potentially preventable. These findings underscore the need for implementing risk-stratified interventions to address modifiable barriers and reduce NCRC rates, particularly in high-risk subgroups characterized by advanced age, lower BMI, later clinical tumor stage, and palliative radiotherapy intent.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2025.1582201","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T05:27:20Z","timestamp":1755754040000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Analysis of reasons and risk factors for non-completion of radiotherapy courses in patients with tumors"],"prefix":"10.3389","volume":"15","author":[{"given":"Meihua","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kexin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuan","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xia","family":"Ye","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongjian","family":"Ju","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2024.02.001","article-title":"Esophagogastric cancer: The current role of radiation therapy","volume":"38","author":"Tchelebi","year":"2024","journal-title":"Hematol Oncol Clin North Am"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1111\/odi.13599","article-title":"IMRT versus 2D\/3D conformal RT in oropharyngeal cancer: A review of the literature and meta-analysis","volume":"27","author":"Alterio","year":"2021","journal-title":"Oral Dis"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2024.1841","article-title":"Long-term prospective outcomes of intensity modulated radiotherapy for locally advanced lung cancer: A secondary analysis of a randomized clinical trial","volume":"10","author":"Chun","year":"2024","journal-title":"JAMA Oncol"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2018.10.018","article-title":"Survival impact of radiotherapy interruption in nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A big-data intelligence platform-based analysis","volume":"132","author":"Yao","year":"2019","journal-title":"Radiother Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e238504","DOI":"10.1001\/jamanetworkopen.2023.8504","article-title":"Association of radiotherapy duration with clinical outcomes in patients with esophageal cancer treated in NRG oncology trials: A secondary analysis of NRG oncology randomized clinical trials","volume":"6","author":"Hallemeier","year":"2023","journal-title":"JAMA Netw Open"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.3580","article-title":"Prognostic value of radiation interruption in different periods for nasopharyngeal carcinoma patients in the intensity-modulated radiation therapy era","volume":"10","author":"Yang","year":"2021","journal-title":"Cancer Med"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djad127","article-title":"Effect of treatment interruptions on overall survival in patients with triple-negative breast cancer","volume":"115","author":"Chow","year":"2023","journal-title":"J Natl Cancer Inst"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2021.796496","article-title":"Treatment interruptions during stereotactic body radiotherapy for prostate cancer","volume":"11","author":"Pepin","year":"2022","journal-title":"Front Oncol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"646","DOI":"10.1186\/s12885-024-12383-7","article-title":"Influence of radiotherapy interruption on esophageal cancer with intensity-modulated radiotherapy: A retrospective study","volume":"24","author":"Mou","year":"2024","journal-title":"BMC Cancer"},{"key":"B10","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1186\/s13014-022-02006-5","article-title":"Radiotherapy interruption due to holidays adversely affects the survival of patients with nasopharyngeal carcinoma: a joint analysis based on large-scale retrospective data and clinical trials","volume":"17","author":"Xu","year":"2022","journal-title":"Radiat Oncol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2023.1114652","article-title":"Effect of radiotherapy interruption on nasopharyngeal cancer","volume":"13","author":"Zhao","year":"2023","journal-title":"Front Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(23)00625-3","article-title":"Radiotherapy trial quality assurance processes: a systematic review","volume":"25","author":"Brooks","year":"2024","journal-title":"Lancet Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2024.06.002","article-title":"Treatment terminations during radiation therapy: A 10-year experience","volume":"14","author":"Nosrati","year":"2024","journal-title":"Pract Radiat Oncol"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1186\/s13014-014-0260-0","article-title":"Quality assurance in radiotherapy: Analysis of the causes of not starting or early radiotherapy withdrawal","volume":"9","author":"Arenas","year":"2014","journal-title":"Radiat Oncol"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(24)00032-9","article-title":"Use of radiotherapy in patients with oesophageal, stomach, colon, rectal, liver, pancreatic, lung, and ovarian cancer: an International Cancer Benchmarking Partnership (ICBP) population-based study","volume":"25","author":"McPhail","year":"2024","journal-title":"Lancet Oncol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J Clin"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.7314\/apjcp.2013.14.5.2829","article-title":"Clinical audit in radiation oncology: results from one academic centre in Delhi, India","volume":"14","author":"Kaur","year":"2013","journal-title":"Asian Pac J Cancer Prev"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afz089","article-title":"New horizons in radiotherapy for older people","volume":"48","author":"Cree","year":"2019","journal-title":"Age Ageing"},{"key":"B19","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1186\/s13014-023-02379-1","article-title":"Quality assurance in a phase III, multicenter, randomized trial of POstmastectomy radioThErapy in Node posiTive breast cancer with or without Internal mAmmary nodaL irradiation (POTENTIAL): a planning benchmark case","volume":"18","author":"Song","year":"2023","journal-title":"Radiat Oncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/1754-9485.13348","article-title":"Quality management in radiotherapy treatment delivery","volume":"66","author":"Kron","year":"2022","journal-title":"J Med Imaging Radiat Oncol"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1002\/pon.3634","article-title":"Psycho-oncologic interventions to reduce distress in cancer patients: a meta-analysis of controlled clinical studies published in People\u2019s Republic of China","volume":"24","author":"Tao","year":"2015","journal-title":"Psychooncology"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3390\/cancers15235515","article-title":"Coping styles and quality of life in breast cancer patients undergoing radiotherapy","volume":"15","author":"Roszkowska","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-022-07395-7","article-title":"Health-related quality of life among breast cancer patients in India","volume":"30","author":"Gupta","year":"2022","journal-title":"Support Care Cancer"},{"key":"B24","doi-asserted-by":"publisher","first-page":"360:k821","DOI":"10.1136\/bmj.k821","article-title":"Palliative radiotherapy","volume":"3","author":"Spencer","year":"2018","journal-title":"BMJ"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-019-0415-8","article-title":"Palliative radiotherapy near the end of life","volume":"18","author":"Wu","year":"2019","journal-title":"BMC Palliat Care"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.6004\/jnccn.2020.7664","article-title":"Early and midtreatment mortality in palliative radiotherapy: emphasizing patient selection in high-quality end-of-life care","volume":"19","author":"Ning","year":"2021","journal-title":"J Natl Compr Canc Netw"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/JCMA.0000000000001125","article-title":"Exploring the influence of the impending death discharge tradition on home death rate in Taiwan","volume":"87","author":"Lin","year":"2024","journal-title":"J Chin Med Assoc"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2021.100301","article-title":"Place of death and phenomenon of going home to die in Chinese adults: A prospective cohort study","volume":"18","author":"Weng","year":"2021","journal-title":"Lancet Reg Health West Pac"},{"key":"B29","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/s12904-023-01315-0","article-title":"Exploring the needs and coping strategies of family caregivers taking care of dying patients at home: a field study","volume":"22","author":"Zhang","year":"2023","journal-title":"BMC Palliat Care"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1002\/hed.26128","article-title":"Insurance status and head and neck radiotherapy interruption disparities in the Mid-Southern United States","volume":"42","author":"Yarn","year":"2020","journal-title":"Head Neck"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2020.03.016","article-title":"Location as destiny: Identifying geospatial disparities in radiation treatment interruption by neighborhood, race, and insurance","volume":"107","author":"Wakefield","year":"2020","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.5634","article-title":"Facing problems in radiotherapy for breast cancer patients in Yogyakarta, Indonesia: A cohort retrospective study","volume":"12","author":"Suryanegara","year":"2023","journal-title":"Cancer Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1007\/s00066-018-1318-y","article-title":"Factors predicting intolerance to definitive conventional radiotherapy in geriatric patients","volume":"194","author":"Rim","year":"2018","journal-title":"Strahlenther Onkol"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.4103\/0973-1075.185037","article-title":"Factors influencing compliance to radical treatment of middle thoracic esophageal cancer: An audit from a regional cancer centre","volume":"22","author":"Kapoor","year":"2016","journal-title":"Indian J Palliat Care"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3390\/nu16091363","article-title":"Nutritional prognosis of patients submitted to radiotherapy and its implications in treatment","volume":"16","author":"Irigaray","year":"2024","journal-title":"Nutrients"},{"key":"B36","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1007\/s00520-023-07952-8","article-title":"Impact of weight loss on treatment interruption and unplanned hospital admission in head and neck cancer patients undergoing curative (chemo)-radiotherapy in Hong Kong","volume":"31","author":"Choi","year":"2023","journal-title":"Support Care Cancer"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol30120730","article-title":"An analysis of clinical and systemic factors associated with palliative radiotherapy delivery and completion at the end of life in Alberta, Canada","volume":"30","author":"Goutam","year":"2023","journal-title":"Curr Oncol"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1582201\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T05:27:21Z","timestamp":1755754041000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1582201\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,21]]},"references-count":37,"alternative-id":["10.3389\/fonc.2025.1582201"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1582201","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2025,8,21]]},"article-number":"1582201"}}