In regard to Kim et al

Our team conceptually aligns with Kim et al.'s original article on "The impact of national holiday on post-operative radiotherapy of squamous cell carcinoma of head and neck" [1Kim M.S. Sheridan M. Rajaraman M. Hollenhorst H. Caissie A. Mahmoud-Ahmed A. et al.The impact of national holidays on postoperative radiotherapy of squamous cell carcinoma of the head and neck.Clin Transl Radiat Oncol. 2023 Sep; 1100668Google Scholar], this paper highlights the detrimental impact that national holidays have on local control in post-operative head and neck radiation. This study unequivocally demonstrates 15.4 % risk of local recurrence at five years (p value: 0.017) due to this influence. This matter is a stumbling point in patient centered management for our head and neck patients, specifically in Low- and Middle-Income Countries (LMIC). It is very frequent in these regions to allocate four to five treatment gaps to accommodate public holidays, a practice that markedly affects local control as emphasized in your published article. Furthermore, Ferreira et al. highlights that any extension in treatment duration results in a progressive decline in local control ranging from 1 to 1.2 % per day to as high as 12–14 % per week [2Ferreira J.A. Olasolo J.J. Azinovic I. Jeremic B. Effect of radiotherapy delay in overall treatment time on local control and survival in head and neck cancer: review of the literature.Rep Pract Oncol Radiother. 2015; 20: 328-339Crossref PubMed Scopus (98) Google Scholar]. Our team would humbly request the authors to add their inferences gained as per their observations gathered in other types of RT gaps, of these which occurred due to causes other than national holidays. Furthermore, in LMIC we wish to request authors to make some comments on our strategy pertinent to discussion of all cases in Multidisciplinary Tumor board meetings [3Abbasi A.N. Karim M.U. Ali N. Hafiz A. Qureshi B.M. Multidisciplinary team tumour boards are a lifeline for our cancer patients in lower and middle income countries.Clin Oncol. 2016 Dec 1; 28: 799Abstract Full Text Full Text PDF Google Scholar] and intradisciplinary peer review meetings, these two processes help in ensuring quality of radiation with appropriate delivery of prescribed sessions without any gaps [4Qureshi B.M. Mansha M.A. Karim M.U. Hafiz A. Ali N. Mirkhan B. et al.Impact of peer review in the radiation treatment planning process: experience of a tertiary care university hospital in Pakistan.J Global Oncol. 2019 Aug; 5: 1-7PubMed Google Scholar]. In Yao et al.'s study about locally advanced nasopharyngeal carcinoma, they delineated Radiotherapy Interruption (RTI) as the deviation between the actual time taken to complete radiation therapy and the originally planned treatment duration. Their findings indicated that an RTI exceeding 5.5 days significantly correlated with a reduced capacity for achieving favorable local control outcomes. At 5 years specifically, patients who adhered to designated treatment schedule achieved an impressive loco regional recurrence free survival rate of 97 %, as contrary to those who experienced treatment interruptions lasting more than 5 days, among whom the rate dropped notably to 83 % (p-value 0.001).[5Yao J.J. Jin Y.N. Wang S.Y. Zhang F. Zhou G.Q. Zhang W.J. et al.The detrimental effects of radiotherapy interruption on local control after concurrent chemoradiotherapy for advanced T-stage nasopharyngeal carcinoma: an observational, prospective analysis.BMC Cancer. 2018 Dec; 18: 1-7Crossref PubMed Scopus (31) Google Scholar]. Dale et al. specifically emphasized the effect of unscheduled treatment prolongation or gaps and the dire need to preemptively identify expected breaks resulting from public holidays. It was suggested to compensate these breaks by scheduling them on weekends. Extensive knowledge on radiobiological behavior can further modify and assist in compensating treatment gaps [6Dale R.G. Hendry J.H. Jones B. Robertson A.G. Deehan C. Sinclair J.A. Practical methods for compensating for missed treatment days in radiotherapy, with particular reference to head and neck schedules.Clin Oncol. 2002 Oct 1; 14: 382-393Abstract Full Text PDF PubMed Scopus (0) Google Scholar]. Moreover for unscheduled gaps due to machine breakdown, twin LINAC installment is mandated to ensure uninterrupted treatment delivery in cases of unforeseen technical issues, as similar machine can substitute planning without need to re plan patients for complex VMAT/IMRT planning [7Treutwein M, Härtl PM, Gröger C, Katsilieri Z, Dobler B. Linac twins in radiotherapy. Evolution of Ionizing Radiation Research. Rijeka: InTech. 2015 Sep 17:171-86.Google Scholar]. We agree that early recognition and development of need-based radiation therapy delivery schedules and timing is of paramount importance. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.