Chemoradiotherapy With Generic Cisplatin Formulations for Head and Neck Cancers

The use of generic drugs has been increasing. However, studies of the safety of generic cisplatin (CDDP) for the treatment of head and neck cancer (HNC) have not been reported. This study investigated the treatment completion rates and incidence of CDDP-related adverse events in patients with advanced HNC treated with concurrent chemoradiotherapy (CRT) using generic CDDP. This study included 72 patients who received concurrent CRT using generic CDDP. The number of courses of CDDP was 3 in 45 patients, 2 in 19 patients, and 1 in 8 patients. During 154 courses of 80 mg/m² generic CDDP, grade 3/4 leukopenia in 21 (14%), neutropenia in 18 (12%), and hypochromia in 8 (5%) cases were reported. Grade 2 elevated serum creatinine occurred in 4 cases (3%), but no grade 3/4 elevated serum creatinine was reported. These results suggest that CRT using generic CDDP is well tolerated in patients with HNC.

Parapharyngeal space tumor surgery using a modified cervical-parotid approach

OBJECTIVES

The cervical approach to parapharyngeal space tumors is blind in cases involving an approach to the vicinity of the skull base from below. We therefore devised a procedure to improve the safety of surgery in the vicinity of the skull base.

METHODS

With this surgical technique, the temporal branch from the main trunk is first identified, as in the case of parotid gland tumor surgery. We then approach the skull base by entering the posterior aspect of the parotid gland tissue from above the temporal branch and anterior auricular space, allowing clear visual confirmation of the upper part of the tumor. Combining this approach with the conventional cervical approach, which is used for the lower part, the tumor can be separated from top to bottom.

RESULTS

We have applied this combined approach in eight patients to date, and post-operative courses have been good, with no cases of facial paralysis.

CONCLUSION

This modified cervical-parotid approach offers a very useful surgical procedure for parapharyngeal space tumors with respect to preservation of the facial nerve and tumor separation in the vicinity of the skull base.

Mild pulmonary emphysema a risk factor for interstitial lung disease when using cetuximab for squamous cell carcinoma of the head and neck

BACKGROUND

Interstitial lung disease (ILD) is an occasionally fatal adverse event associated with cetuximab (Cmab) therapy. Our objective was to clarify to what degree pulmonary emphysema is a risk factor in the treatment of head and neck cancer with Cmab through a retrospective analysis.

METHODS

Subjects were 116 patients who were administered Cmab for head and neck squamous cell carcinoma. The degree of pulmonary emphysema before initiating treatment with Cmab was visually assessed retrospectively, with scoring according to the Goddard classification used in Japanese chronic obstructive pulmonary disease (COPD) guidelines for chest computed tomography (CT). Scoring was conducted by two diagnostic radiologists and mean scores were used. Cutoffs for the development and nondevelopment of ILD were examined by receiver operating characteristic (ROC) analysis and Fisher's exact test. Values of p < .05 were considered to indicate a significant difference.

RESULTS

Among the 116 patients, 11 (9.5%) developed ILD, and 105 (90.5%) did not. In ROC analysis, the optimal Goddard score cut-off of <3.0 offered 55% sensitivity and 81% specificity (p = .015). With a cutoff of <3.0, even very mild pulmonary emphysema would represent a risk factor for ILD when using Cmab.

Characterization of patients at high risk of melanoma in Austria

BACKGROUND

Risk of melanoma is determined by genetic and exogenous factors. Only a few studies have included both characteristics in a comprehensive multivariable analysis.

OBJECTIVES

To find determinants of patients at high risk of melanoma in Austria, including phenotype, genotype and lifestyle characteristics in comprehensive analyses.

METHODS

In total, 1668 patients with melanoma from the M3 case-control study were studied. Overall, 567 participants were sequenced for CDKN2A, 232 for CDK4, 123 for MITF encoding the variant E318K and 964 for MC1R.

RESULTS

Patients with melanoma with a positive family history (n = 190, 11·6%), multiple primary melanomas (n = 261, 15·7%) and younger age (< 50 years, n = 675, 40·5%) were defined as being at high risk. All other patients with melanoma were defined as the reference group. We found significant differences between those two groups and between the high-risk subgroups (positive family history, multiple primary melanomas and younger age). Pigmentation phenotype was associated with the high-risk group in general (childhood freckling, odds ratio 1·46, P = 0·007; blond/reddish hair colour, odds ratio 1·43, P = 0·011). Patients with a positive family history and patients with early-onset disease were similar regarding both their phenotypic characteristics and external factors. Established high-risk mutations in CDKN2A were found in cases with a positive family history (n = 12) or multiple melanomas (n = 2). Moreover, we found three patients carrying the MITF p.E318K variant, two with a CDK4 variant and seven with nonsynonymous MC1R variants with undescribed biological significance, of which four were predicted as damaging.

CONCLUSIONS

Austrian patients could represent a reservoir for novel genetic variants. Further investigation of populations in Central and Eastern Europe might reveal more novel and disease-relevant variants.