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Lohynska R, Jirkovska M, Malinova B, Novakova-Jiresova A, Pechacova Z, Kratka Z. Tumour volume and radiotherapy prolongation in locally advanced head and neck cancer patients treated with radical IMRT. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:405-411. [PMID: 34498610 DOI: 10.5507/bp.2021.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/13/2021] [Indexed: 12/16/2022] Open
Abstract
AIMS The relationship of tumour volume, radiotherapy treatment time and other prognostic factors affecting prognosis was evaluated. METHODS 184 patients with locally advanced head and neck cancer were treated with radical intensity modulated radiotherapy (IMRT) and compared retrospectively. RESULTS In the multivariate analysis the overall survival was dependent on gross tumour volume (GTV), clinical stage (CS), radiotherapy treatment time (RTT) and p16 status. Local control was influenced by GTV, overall RTT and age. DFS was significantly affected by GTV, CS, RTT, p16 status and concomitant chemotherapy (CHT). CONCLUSIONS The tumour volume and the radiotherapy treatment time were the most significant prognostic factors with the best outcomes in patients with GTV ≤ 55 cc and RTT ≤ 48 days (mean LC 8.1, DFS 7.1 and OS 6.4 years) and worst outcomes with GTV > 55 cc and RTT >48 days (mean LC 4.4, mean DFS 3.2 and mean OS 2.6 years).
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Affiliation(s)
- Radka Lohynska
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Michaela Jirkovska
- Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Bela Malinova
- Department of Oncology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Alena Novakova-Jiresova
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | - Zdenka Pechacova
- Institute of Radiation Oncology, First Faculty of Medicine, Charles University and Bulovka University Hospital, Prague, Czech Republic
| | - Zuzana Kratka
- Department of Otorhinolaryngology, Thomayer University Hospital Prague, Czech Republic
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Magnetic resonance imaging-derived radiomic signature predicts locoregional failure after organ preservation therapy in patients with hypopharyngeal squamous cell carcinoma. Clin Transl Radiat Oncol 2020; 25:1-9. [PMID: 33426314 PMCID: PMC7780126 DOI: 10.1016/j.ctro.2020.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/16/2020] [Accepted: 08/24/2020] [Indexed: 01/08/2023] Open
Abstract
The first study to develop and validate an MRI-derived radiomic signature (RS) for the prediction of 1-year locoregional failure in HPSCC patients receiving OPT. The RS-based model (RS of 0.0326 as the cut-off value) provides a novel and convenient approach for the prediction of the 1-year clinical outcomes. The proposed RS-based model can help physicians characterize and facilitate decision-making for the clinical management of patients with locally advanced HPSCC.
Background and purpose To develop and validate a magnetic resonance imaging (MRI)-derived radiomic signature (RS) for the prediction of 1-year locoregional failure (LRF) in patients with hypopharyngeal squamous cell carcinoma (HPSCC) who received organ preservation therapy (OPT) Material and methods A total of 800 MRI-based features of pretreatment tumors were obtained from 116 patients with HPSCC who received OPT from two independent cohorts. The least absolute shrinkage and selection operator regression model were used to select the features used to develop the RS. Harrell’s C-index and corrected C-index were used to evaluate the discriminative ability of RS. The Youden index was used to select the optimal cut-point for risk category. Results The RS yielded 1000 times bootstrapping corrected C-index of 0.8036 and 0.78235 in the experimental (n = 82) and validation cohorts (n = 34), respectively. With respect to the subgroup of patients with stage III/IV and cT4 disease, the RS also showed good predictive performance with corrected C-indices of 0.760 and 0.754, respectively. The dichotomized risk category using an RS of 0.0326 as the cut-off value yielded a 1-year LRF predictive accuracy of 79.27%, 79.41%, 76.74%, and 71.15% in the experimental, validation, stage III/IV, and cT4a cohorts, respectively. The low-risk group was associated with a significantly better progression-free laryngectomy-free and overall survival outcome in two independent institutions, stage III/IV, and cT4a cohorts. Conclusion The RS-based model provides a novel and convenient approach for the prediction of the 1-year LRF and survival outcome in patients with HPSCC who received OPT.
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Liu K, Lin S, Ke L, Xia W, Zhang C, Li J, Gao M, Qiang M, Chen X, Liu J, Xie C, Guo X, Lv X. Prognostic value and the potential role of treatment options for cervical lymph node necrosis in nasopharyngeal carcinoma. Oral Oncol 2020; 109:104864. [PMID: 32604061 DOI: 10.1016/j.oraloncology.2020.104864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/28/2020] [Accepted: 06/14/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE There were few studies focused on the cervical lymph necrosis (CNN) of nasopharyngeal carcinoma (NPC) patients to develop a nomogram and guide the treatment decision at the era of intensity modulated radiation therapy (IMRT). MATERIAL AND METHODS The prognostic accuracy of CNN in the training cohort (n = 1940) was validated in Guangzhou internal validation cohort (n = 832) and two external validation cohorts (Dongguan, n = 232; Foshan, n = 134). RESULTS The primary end point was progression-free survival (PFS), calculated using the Kaplan-Meier method. After a median 60.0 months' follow-up, patients with CNN in the training cohort had worse 5-year PFS (70.8% vs. 89.1%, P < 0.001) than patients without CNN, which was validated in the validation cohorts. The nomogram based on CNN predicted an individual PFS risk (training: C-index 0.733; Guangzhou validation: C-index 0.736; Foshan: C-index 0.722; Dongguan: C-index 0.756). Stage N2 patients in the CNN group and stage IV patients no matter the status of CNN, PFS was better with induction chemotherapy (ICT) and CCRT than CCRT (P < 0.05). CONCLUSION Taken together, CNN reliably predicts survival risk in NPC patients. N2 patients in the CNN group and stage IV patients may receive survival benefit from ICT.
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Affiliation(s)
- Kuiyuan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China
| | - Siting Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China
| | - Liangru Ke
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Radiology, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China
| | - Weixiong Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China
| | - Chun Zhang
- Department of Radiotherapy, Dongguan People's Hospital, Dongguan 523000, People's Republic of China
| | - Jianpeng Li
- Department of Radiology, Dongguan People's Hospital, Dongguan 523000, People's Republic of China
| | - Mingyong Gao
- Department of Radiology, Foshan No.1 People's Hospital, Foshan 528000, People's Republic of China
| | - Mengyun Qiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China
| | - Xi Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China
| | - Jia Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Intensive Care Center, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China
| | - Chuanmiao Xie
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Radiology, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China.
| | - Xiang Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China.
| | - Xing Lv
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong 510060, People's Republic of China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, Guangzhou, Guangdong 510060, People's Republic of China.
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Moan JM, Amdal CD, Malinen E, Svestad JG, Bogsrud TV, Dale E. The prognostic role of 18F-fluorodeoxyglucose PET in head and neck cancer depends on HPV status. Radiother Oncol 2019; 140:54-61. [DOI: 10.1016/j.radonc.2019.05.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 11/25/2022]
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Lin CY, Chang CC, Su PL, Lin CC, Tseng YL, Su WC, Yen YT. Brain MRI imaging characteristics predict treatment response and outcome in patients with de novo brain metastasis of EGFR-mutated NSCLC. Medicine (Baltimore) 2019; 98:e16766. [PMID: 31415376 PMCID: PMC6831109 DOI: 10.1097/md.0000000000016766] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Patients with non-small cell lung cancer (NSCLC) and de novo brain metastasis (BM) have poor prognosis. We aim to investigate the characteristic of brain magnetic resonance (MR) imaging and the association with the treatment response of epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) for lung cancer with BM.EGFR-mutated NSCLC patients with BM from October 2013 to December 2017 in a tertiary referral center were retrospectively analyzed. Patient's age, sex, cell type, EGFR mutation status, treatment, and characteristics of BM were collected. Survival analysis was performed using Kaplan-Meier method. The efficacy of different EGFR-TKIs were also analyzed.Among the 257 eligible patients, 144 patients with Exon 19 deletion or Exon 21 L858R were included for analysis. The erlotinib group had the best progression free survival (PFS) (median PFS 13 months, P = .04). The overall survival (OS) revealed no significant difference between three EGFR-TKI groups. Brain MR imaging features including tumor necrosis, rim enhancement and specific tumor locations (frontal lobe, putamen or cerebellum) were factors associated with poor prognosis. Patients with poor prognostic imaging features, the high-risk group, who received erlotinib had the best PFS (median PFS 12 months, P < .001). However, the OS revealed no significant difference between 3 EGFR-TKI groups. The low risk group patients had similar PFS and OS treated with three different EGFR-TKIs.In NSCLC patients with common EGFR mutation and de novo BM, those with poor prognostic brain MR characteristics, erlotinib provided better PFS than afatinib or gefitinib.
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Affiliation(s)
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University
| | | | - Chien-Chung Lin
- Department of Internal Medicine and Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University
| | - Wu-Chou Su
- Department of Internal Medicine and Institute of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University
- Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan, Taiwan
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Nishio N, Fujimoto Y, Hiramatsu M, Maruo T, Tsuzuki H, Mukoyama N, Yokoi S, Wada A, Kaneko Furukawa M, Furukawa M, Sone M. Diagnosis of cervical lymph node metastases in head and neck cancer with ultrasonic measurement of lymph node volume. Auris Nasus Larynx 2019; 46:889-895. [PMID: 30857763 DOI: 10.1016/j.anl.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/16/2019] [Accepted: 02/05/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the usefulness of ultrasound (US) volume measurement of the cervical lymph nodes for diagnosing nodal metastasis in patients with head and neck cancer using a node-by-node comparison. METHODS Thirty-four consecutive patients with head and neck cancer from one tertiary university hospital were prospectively enrolled from 2012 to 2017. Patients with histologically proven squamous cell primary tumors in the head and neck region scheduled to undergo a therapeutic neck dissection were eligible. For each patient, 1-4 target lymph nodes were selected from the planned neck dissection levels. Lymph nodes with thickness >20 mm or in a cluster were excluded. Node-by-node comparisons between the pre-operative US assessment, the post-operative actual measurements and histopathological results were performed for all target lymph nodes. Quantitative measurements, such as three diameters, ratios of the three diameters and volume were analyzed in this study. Lymph node volume was calculated using the ellipsoid formula. RESULTS Patients comprised 28 men and 6 women with a mean age of 60.0 years (range, 29-80 years) at the time of surgery. In total, 67 target lymph nodes were analyzed in this study and the thickness ranged from 3.9 to 20.0 mm (mean 8.0 mm). There was a strong correlation between the US volume and post-operative actual volume (ρ = 0.87, p < 0.01). The US volume measured 2156 ± 2156 mm3 for the tumor positive nodes, which was significantly greater than the US volume of 512 ± 315 mm3 for tumor negative nodes (p < 0.01). Significant differences between tumor positive and tumor negative nodes were found in five variables (volume, thickness, major axis, minor axis and ratio of minor axis to thickness) for total lymph nodes. To identify predictors of lymph node metastasis, ROC curves of the US variables of target lymph nodes were compared, of which 4 variables were considered acceptable for predicting the lymph node metastasis: volume (AUC 0.86), thickness (AUC 0.86), major axis (AUC 0.79), and minor axis (AUC 0.79) for total lymph nodes. The optimal cut-off level for US volume in total lymph nodes was found to be 1242 mm3, whereby a 62% sensitivity and 98% specificity was reached (likelihood ratio: 25.2). CONCLUSION Pre-operative ultrasonic volume measurement of the cervical lymph nodes was useful for early detection of cervical nodal metastasis in head and neck cancer.
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Affiliation(s)
- Naoki Nishio
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Otolaryngology, Stanford University, Stanford, CA, USA.
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mariko Hiramatsu
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Maruo
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidenori Tsuzuki
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sayaka Yokoi
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihisa Wada
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Masaki Furukawa
- Department of Otorhinolaryngology, Hiro-Yama Clinic, Tokyo, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Dua B, Chufal KS, Bhatnagar A, Thakwani A. Nodal volume as a prognostic factor in locally advanced head and neck cancer: Identifying candidates for elective neck dissection after chemoradiation with IGRT from a single institutional prospective series from the Indian subcontinent. Oral Oncol 2018; 87:179-185. [DOI: 10.1016/j.oraloncology.2018.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/16/2018] [Accepted: 10/17/2018] [Indexed: 10/27/2022]
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Albert A, Giri S, Kanakamedala M, Mangana S, Bhanat E, Shenoy V, Thomas TV, Joseph S, Gonzalez M, Shalaby A, Vijayakumar S. Racial disparities in tumor features and outcomes of patients with squamous cell carcinoma of the tonsil. Laryngoscope 2018; 129:643-654. [DOI: 10.1002/lary.27395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Ashley Albert
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Shankar Giri
- Department of Radiation Oncology; G.V. (Sonny) Montgomery VA Medical Center; Jackson Mississippi U.S.A
| | - Madhava Kanakamedala
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Sophy Mangana
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Eldrin Bhanat
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Veena Shenoy
- Department of Pathology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Toms Vengaloor Thomas
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Sanjay Joseph
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Maria Gonzalez
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Akram Shalaby
- Department of Pathology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology; University of Mississippi Medical Center; Jackson Mississippi U.S.A
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Crispin-Ortuzar M, Apte A, Grkovski M, Oh JH, Lee NY, Schöder H, Humm JL, Deasy JO. Predicting hypoxia status using a combination of contrast-enhanced computed tomography and [ 18F]-Fluorodeoxyglucose positron emission tomography radiomics features. Radiother Oncol 2018; 127:36-42. [PMID: 29273260 PMCID: PMC5924729 DOI: 10.1016/j.radonc.2017.11.025] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/11/2017] [Accepted: 11/26/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE Hypoxia is a known prognostic factor in head and neck cancer. Hypoxia imaging PET radiotracers such as 18F-FMISO are promising but not widely available. The aim of this study was therefore to design a surrogate for 18F-FMISO TBRmax based on 18F-FDG PET and contrast-enhanced CT radiomics features, and to study its performance in the context of hypoxia-based patient stratification. METHODS 121 lesions from 75 head and neck cancer patients were used in the analysis. Patients received pre-treatment 18F-FDG and 18F-FMISO PET/CT scans. 79 lesions were used to train a cross-validated LASSO regression model based on radiomics features, while the remaining 42 were held out as an internal test subset. RESULTS In the training subset, the highest AUC (0.873±0.008) was obtained from a signature combining CT and 18F-FDG PET features. The best performance on the unseen test subset was also obtained from the combined signature, with an AUC of 0.833, while the model based on the 90th percentile of 18F-FDG uptake had a test AUC of 0.756. CONCLUSION A radiomics signature built from 18F-FDG PET and contrast-enhanced CT features correlates with 18F-FMISO TBRmax in head and neck cancer patients, providing significantly better performance with respect to models based on 18F-FDG PET only. Such a biomarker could potentially be useful to personalize head and neck cancer treatment at centers for which dedicated hypoxia imaging PET radiotracers are unavailable.
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Affiliation(s)
- Mireia Crispin-Ortuzar
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA; Cancer Research UK Cambridge Institute, University of Cambridge, UK.
| | - Aditya Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Milan Grkovski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - John L Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Joseph O Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
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Zhang L, Zhou G, Li Y, Tang L, Mao Y, Lin A, Ma J, Qi Z, Sun Y. Combined prognostic value of pretreatment anemia and cervical node necrosis in patients with nasopharyngeal carcinoma receiving intensity-modulated radiotherapy: A large-scale retrospective study. Cancer Med 2017; 6:2822-2831. [PMID: 29034992 PMCID: PMC5727247 DOI: 10.1002/cam4.1233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/17/2017] [Accepted: 09/23/2017] [Indexed: 01/02/2023] Open
Abstract
This study investigated the combined prognostic value of pretreatment anemia and cervical node necrosis (CNN) in patients with nasopharyngeal carcinoma (NPC). Retrospective review of 1302 patients with newly diagnosed nonmetastatic NPC treated with intensity-modulated radiotherapy (IMRT) ± chemotherapy. Patients were classified into four groups according to anemia and CNN status. Survival was compared using the log-rank test. Independent prognostic factors were identified using the Cox proportional hazards model. The primary end-point was overall survival (OS); secondary end-points were disease-free survival (DFS), locoregional relapse-free survival (LRRFS), and distant metastasis-free survival (DMFS). Pretreatment anemia was an independent, adverse prognostic factor for DMFS; pretreatment CNN was an independent adverse prognostic factor for all end-points. Five-year survival for non-anemia and non-CNN, anemia, CNN, and anemia and CNN groups were: OS (93.1%, 87.2%, 82.9%, 76.3%, P < 0.001), DFS (87.0%, 84.0%, 73.9%, 64.6%, P < 0.001), DMFS (94.1%, 92.1%, 82.4%, 72.5%, P < 0.001), and LRRFS (92.8%, 92.4%, 88.7%, 84.0%, P = 0.012). The non-anemia and non-CNN group had best survival outcomes; anemia and CNN group, the poorest. Multivariate analysis demonstrated combined anemia and CNN was an independent prognostic factor for OS, DFS, DMFS, and LRRFS (P < 0.05). The combination of anemia and CNN is an independent adverse prognostic factor in patients with NPC treated using IMRT ± chemotherapy. Assessment of pretreatment anemia and CNN improved risk stratification, especially for patients with anemia and CNN who have poorest prognosis. This study may aid the design of individualized treatment plans to improve treatment outcomes.
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Affiliation(s)
- Lu‐Lu Zhang
- Department of Radiation OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhou510060China
| | - Guan‐Qun Zhou
- Department of Radiation OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhou510060China
| | - Yi‐Yang Li
- Department of Oncologythe First affiliated Hospital of Guangdong Pharmaceutical UniversityGuangdong510080China
| | - Ling‐Long Tang
- Department of Radiation OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhou510060China
| | - Yan‐Ping Mao
- Department of Radiation OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhou510060China
| | - Ai‐Hua Lin
- Department of Medical Statistics and EpidemiologySchool of Public HealthSun Yat‐sen UniversityGuangzhouChina
| | - Jun Ma
- Department of Radiation OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhou510060China
| | - Zhen‐Yu Qi
- Department of Radiation OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhou510060China
| | - Ying Sun
- Department of Radiation OncologySun Yat‐sen University Cancer CenterState Key Laboratory of Oncology in South ChinaCollaborative Innovation Center for Cancer Medicine651 Dongfeng Road EastGuangzhou510060China
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Zhang LL, Li JX, Zhou GQ, Tang LL, Ma J, Lin AH, Qi ZY, Sun Y. Influence of Cervical Node Necrosis of Different Grades on the Prognosis of Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy. J Cancer 2017; 8:959-966. [PMID: 28529607 PMCID: PMC5436247 DOI: 10.7150/jca.17998] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/23/2016] [Indexed: 12/27/2022] Open
Abstract
Background: To analyze the prognostic value of cervical node necrosis (CNN) observed on pretreatment magnetic resonance imaging (MRI) in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Patients and Methods: The medical records of 1423 NPC patients with cervical node metastasis who underwent IMRT were retrospectively reviewed. Lymph nodes in the axial plane of pretreatment MRI were classified as follows: grade 0 CNN, no hypodense zones; grade 1 CNN, ≤33% areas showing hypodense zones; and grade 2, >33% areas showing hypodense zones. Results: CNN was detectable in 470/1423 (33%) patients. Of these 470 patients, 213 (15%) and 257 (18%) exhibited grade 1 and grade 2 CNN. The grade 0 and grade 1 CNN groups showed significant differences with regard to distant metastasis-free survival (DMFS), but not overall survival (OS), regional relapse-free survival (RRFS), local relapse-free survival (LRFS), and disease-free survival (DFS). Significant differences were observed among the grade 0 and grade 2 CNN groups with regard to OS, RRFS, LRFS, DMFS, and DFS. Moreover, OS, LRFS, RRFS, and DFS were significantly different between the grade 1 and grade 2 CNN groups, whereas DMFS showed no significant differences. Univariate and multivariate analyses revealed CNN on MRI as a significant negative prognostic factor for OS, LRFS, RRFS, DMFS, and DFS in NPC patients. Conclusions: NPC patients with CNN of different grades show various prognosis and failure patterns after IMRT. CNN on MRI can be adopted as a predictive factor for formulating individualized treatment plans for NPC patients.
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Affiliation(s)
- Lu-Lu Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Jia-Xiang Li
- Department of Oncology, First People's Hospital of Zhaoqing City, Guangdong, People's Republic of China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Ling-Long Tang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhen-Yu Qi
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Road East, Guangzhou 510060, People's Republic of China
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Huhn JL, Regine WF, Valentino JP, Meigooni AS, Kudrimoti M, Mohiuddin M. Spatially Fractionated GRID Radiation Treatment of Advanced Neck Disease Associated with Head and Neck Cancer. Technol Cancer Res Treat 2016; 5:607-12. [PMID: 17121437 DOI: 10.1177/153303460600500608] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Advanced nodal disease associated with head and neck cancer warrants aggressive, often multi-modality therapy to maximize local-regional control. The expansion of a novel treatment paradigm developed by our institution includes the addition of a single-fraction of high dose spatially-fractionated radiation (GRID) to a conventional course of treatment. Between 1995 and 2002 a series of 27 patients (median age 65) with bulky N2-3 disease were treated. Median nodal tumor size was 7 cm. Two groups of patients were evaluated. Group 1 (N=14) patients received a median neck dose 69 Gy (range 54–79 Gy) plus GRID treatment. Group 2 (N=13) patients received a median neck dose of 59 Gy (range 54–72 Gy) plus GRID treatment followed by planned neck dissection. Patients were evaluated for local-regional control, pathological response, survival, and morbidity. Median time to follow-up for Group 1 was 10 months (range 3–44 months). Neck control was 93%. Disease specific survival was 50%. Morbidity was limited to soft-tissue related damage and was mild. Median time to follow-up for Group 2 was 38 months (range 5–116 months). Pathologic complete response rate was 85%. Overall neck control rate was 92%. Disease specific survival was 85%. Surgical morbidity was limited to three wound healing complications. GRID treatment may be safely added to conventional treatment management of locally advanced neck disease related to cancer with acceptable morbidity. It may improve pathologic complete response rates in those patients who undergo planned neck dissection, possibly leading to improved survival. In patients with inoperable bulky disease, addition of GRID enhances local-regional control.
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Affiliation(s)
- Jeniffer L Huhn
- University of Kentucky, 800 Rose St. N15, Lexington, KY 40536, USA.
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Tumour volumes: Predictors of early treatment response in locally advanced head and neck cancers treated with definitive chemoradiation. Rep Pract Oncol Radiother 2016; 21:419-26. [PMID: 27489511 DOI: 10.1016/j.rpor.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/08/2016] [Indexed: 11/22/2022] Open
Abstract
AIM To analyse and predict early response 3 months post definitive chemoradiation (CCRT) utilising tumour volume (TV) measurement in locally advanced head and neck cancers (LAHNC). BACKGROUND LAHNC are 3-dimentional lesions. The largest diameter of these tumours measured for T-classification may not necessarily reflect the true tumour dimensions. TV accurately reflects the tumour burden because it is a measurement of tumour burden in all three dimensions. MATERIALS AND METHODS It is a single institutional prospective study including 101 patients with LAHNC treated with definitive CCRT. TV data noted were primary tumour volume (PTV), total nodal volume (TNV) and total tumour volume (TTV). Response evaluation was done at 3 months after the completion of definitive CCRT and patients were categorised either having achieved complete response (CR) or residual disease. RESULTS Patients who had not achieved CR were found to have larger TV compared with those who had achieved CR. There were significant inverse correlations between PTV and response (median 16.37 cm(3) vs. 45.2 cm(3); p = 0.001), and between TTV and response (median 36.14 cm(3) vs. 66.06 cm(3); p < 0.001). Receiver operating characteristic (ROC) analysis identified an "optimal cut-off" value of 41 cm(3) for PTV and 42 cm(3) for TTV above and below which the magnitude of difference in response was the greatest. CONCLUSIONS If response evaluation 3 months post CCRT is to be predicted it is simply not enough to measure the largest single dimension of the tumour. TV seems to be a better and more accurate reflection of the true total tumour burden or extent of the disease.
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Issa MR, Samuels SE, Bellile E, Shalabi FL, Eisbruch A, Wolf G. Tumor Volumes and Prognosis in Laryngeal Cancer. Cancers (Basel) 2015; 7:2236-61. [PMID: 26569309 PMCID: PMC4695888 DOI: 10.3390/cancers7040888] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 10/19/2015] [Accepted: 10/27/2015] [Indexed: 01/22/2023] Open
Abstract
Tumor staging systems for laryngeal cancer (LC) have been developed to assist in estimating prognosis after treatment and comparing treatment results across institutions. While the laryngeal TNM system has been shown to have prognostic information, varying cure rates in the literature have suggested concern about the accuracy and effectiveness of the T-classification in particular. To test the hypothesis that tumor volumes are more useful than T classification, we conducted a retrospective review of 78 patients with laryngeal cancer treated with radiation therapy at our institution. Using multivariable analysis, we demonstrate the significant prognostic value of anatomic volumes in patients with previously untreated laryngeal cancer. In this cohort, primary tumor volume (GTVP), composite nodal volumes (GTVN) and composite total volume (GTVP + GTVN = GTVC) had prognostic value in both univariate and multivariate cox model analysis. Interestingly, when anatomic volumes were measured from CT scans after a single cycle of induction chemotherapy, all significant prognosticating value for measured anatomic volumes was lost. Given the literature findings and the results of this study, the authors advocate the use of tumor anatomic volumes calculated from pretreatment scans to supplement the TNM staging system in subjects with untreated laryngeal cancer. The study found that tumor volume assessment after induction chemotherapy is not of prognostic significance.
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Affiliation(s)
- Mohamad R Issa
- Department of Otolaryngology/Head and Neck Surgery, The University of Michigan Health System, 1903 Taubman Bldg, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Stuart E Samuels
- Department of Radiation Oncology, The University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Emily Bellile
- Department of Biostatistics, The School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Firas L Shalabi
- Department of Otolaryngology/Head and Neck Surgery, The University of Michigan Health System, 1903 Taubman Bldg, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Avraham Eisbruch
- Department of Radiation Oncology, The University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Gregory Wolf
- Department of Otolaryngology/Head and Neck Surgery, The University of Michigan Health System, 1903 Taubman Bldg, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Schütze C, Bergmann R, Brüchner K, Mosch B, Yaromina A, Zips D, Hessel F, Krause M, Thames H, Kotzerke J, Steinbach J, Baumann M, Beuthien-Baumann B. Effect of [18F]FMISO stratified dose-escalation on local control in FaDu hSCC in nude mice. Radiother Oncol 2014; 111:81-7. [DOI: 10.1016/j.radonc.2014.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/07/2014] [Accepted: 02/11/2014] [Indexed: 10/25/2022]
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Tumor burden in Hodgkin's lymphoma: Much more than the best prognostic factor. Crit Rev Oncol Hematol 2014; 90:17-23. [DOI: 10.1016/j.critrevonc.2013.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/09/2013] [Accepted: 11/07/2013] [Indexed: 11/20/2022] Open
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Rutkowski T. The role of tumor volume in radiotherapy of patients with head and neck cancer. Radiat Oncol 2014; 9:23. [PMID: 24423415 PMCID: PMC3903043 DOI: 10.1186/1748-717x-9-23] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/09/2014] [Indexed: 12/23/2022] Open
Abstract
The assumption that the larger tumor contains a higher number of clonogenic cells what may deteriorate prognosis of patients treated with RT has been confirmed in many clinical studies. Significant prognostic influence of tumor volume (TV) on radiotherapy (RT) outcome has been found for tumors of different localizations including patients with head and neck cancer (HNC). Although TV usually is a stronger prognostic factor than T stage, commonly used TNM classification system dose not incorporate TV data. The aim of the paper is to refresh clinical data regarding the role of TV in RT of patients with HNC. At present somehow new meaning of TV could be employed in the aspect of modern RT techniques and combined treatment strategies. For larger TV more aggressive treatment options may be considered. In modern RT techniques escalated dose could be provided highly conformal or RT can be combined with systemic treatment increasing therapeutic ratio. In the study several reports estimating prognostic value of TV for patients with HNC treated with RT has been reviewed.Due to substantially various reported groups of patients as to tumor site, stage of disease or treatment strategies, precise cut-off value could not be establish in general, but the significant association between TV and treatment outcome had been found in almost all studies. There is a strong suggestion that TV should supplement clinical decision in the choice of optimal treatment strategy for patients with HNC.
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Affiliation(s)
- Tomasz Rutkowski
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center and the Institute of Oncology, Gliwice Branch, Poland.
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Park G, Jung J, Roh JL, Lee J, Cho KJ, Choi SH, Nam S, Kim S. Prognostic Value of Metastatic Nodal Volume and Lymph Node Ratio in Patients with Cervical Lymph Node Metastases from an Unknown Primary Tumor. Oncology 2014; 86:170-6. [DOI: 10.1159/000358177] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 12/12/2013] [Indexed: 11/19/2022]
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Jung JH, Roh JL, Lee JH, Kim SB, Lee SW, Choi SH, Nam SY, Kim SY. Prognostic factors in patients with head and neck squamous cell carcinoma with cN3 neck disease: a retrospective case-control study. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 117:178-85. [PMID: 24268799 DOI: 10.1016/j.oooo.2013.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/04/2013] [Accepted: 09/16/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study examined prognostic factors in patients with head and neck squamous cell carcinoma with advanced neck disease. STUDY DESIGN The records of 191 patients with previously untreated head and neck squamous cell carcinoma and metastatic cervical lymph node (LN) >6 cm (cN, n = 70) and 3.01 to 6 cm (control, n = 121) in the greatest dimension were reviewed. Univariate and multivariate analyses were used to identify factors associated with disease-free survival (DFS) and locoregional control (LRC). RESULTS In the cN3 group, independent variables for DFS were age, active drinking, LN size, and extranodal extension (P < .05), and that for LRC was age (P = .025). In the control group, independent variables for DFS were tumor location and differentiation and LN bilaterality (P < .05), and that for LRC was LN bilaterality (P = .011). CONCLUSIONS The survival of cN3 patients is affected by host and nodal characteristics including age, drinking, nodal size, and extranodal extension.
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Affiliation(s)
- Jae Hoon Jung
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Jeong Hyun Lee
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Bae Kim
- Department of Internal Medicine (Oncology), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang-Wook Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Korea Institute of Science and Technology, Seoul, Republic of Korea
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Studer G, Glanzmann C. Volumetric stratification of cT4 stage head and neck cancer. Strahlenther Onkol 2013; 189:867-73. [PMID: 24002381 PMCID: PMC3825283 DOI: 10.1007/s00066-013-0413-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 06/17/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND Locoregionally advanced stage head and neck cancer (HNC) is known for unfavorable outcome with only ~ 40-50% 3-year overall survival (OS). Clinical T4 stage includes a wide range of tumor burden. The lack of further nonsurgical subgrouping of cT4 stage makes intercenter outcome of irradiated cohorts difficult. Aim of this analysis was to further stratify cT4 stage HNC using volumetric staging. MATERIAL AND METHODS Between January 2002 and January 2013, a total of 201 cT4 stage squamous cell cancer (SCC) HNC patients referred to our center for curative definitive radiation were consecutively irradiated. Radiation was performed using modulated techniques. Total gross tumor volumes (tGTV: primary+nodal tumor volume) of all patients have retrospectively been stratified using a prospectively evaluated volumetric staging system which bases on 3 cut-offs (15/70/130 ml), translating into 4 prognostic subgroups [V1: 1-15 ml (n=15), V2: 16-70 ml (108), V3: 71-130 ml (62), V4: >130 ml (16)]. OS, disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) rates were calculated. RESULTS The mean/median follow-up was 31/23 months (range 1-116 months). The 3-year OS, DFS, LRC, and DMFS rates of the entire cohort were 63, 44, 48, and 77%, respectively. Volumetric staging revealed its potential to prognostically statistically significantly divide the cT4 cohort into 4 volume subgroups (V1/2/3/4): OS: 90%/72%/58%/18%; DFS: 83%/50%/39%/10%; LRC: 81%/53%/47%/15%; DMFS: 93%/90%/70%/41%, all p<0.0001. CONCLUSION Volumetric staging allowed a highly statistically significant stratification of cT4 HNC stages into prognostic subgroups, which offers the chance of better intercenter comparability of irradiated advanced stage HNC cohorts.
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Affiliation(s)
- G Studer
- Department of Radiation Oncology, University Hospital Zurich, Raemistr. 100, 8091, Zurich, Switzerland,
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Martens K, Meyners T, Rades D, Tronnier V, Bonsanto MM, Petersen D, Dunst J, Dellas K. The prognostic value of tumor necrosis in patients undergoing stereotactic radiosurgery of brain metastases. Radiat Oncol 2013; 8:162. [PMID: 23822663 PMCID: PMC3707781 DOI: 10.1186/1748-717x-8-162] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 07/01/2013] [Indexed: 11/10/2022] Open
Abstract
Background This retrospective study investigated the outcome of patients with brain metastases after radiosurgery with special emphasis on prognostic impact of visible intratumoral necrosis on survival and local control. Methods From 1998 through 2008, 149 patients with brain metastases from solid tumors were treated with stereotactic radiotherapy at Luebeck University. Median age was 58.4 years with 11%, 78%, 10% in recursive partitioning analysis (RPA) classes I, II, III, respectively. 70% had 1 metastasis, 29% 2-3 metastases, 2 patients more than 3 metastases, 71% active extracranial disease. Median volume of metastatic lesions was 4.7 cm3, median radiosurgery dose 22 Gy (single fraction). 71% of patients received additional whole-brain irradiation (WBI). All patients were analyzed regarding survival, local, distant failure and prognostic factors, side effects and changes in neurologic symptoms after radiotherapy. The type of contrast-enhancement in MR imaging was also analyzed; metastatic lesions were classified as containing necrosis if they appeared as ring-enhancing with central areas of no or minimal contrast enhancement. Results Median survival was 7.0 months with 1-year and 5-year survival rates of 33% and 0.4%, respectively. Tumor necrosis (ring-enhancement) was visible on pretreatment MRI scans in 56% of all lesions and lesions with necrosis were larger than non-necrotic lesions (6.7 cm3 vs. 3.2 cm3, p = 0.01). Patients with tumor necrosis had a median survival of 5.4 months, patients without tumor necrosis 7.2 months. Local control rate in the irradiated volume was 70%, median survival without local failure 17.8 months. Control in the brain outside the irradiated volume was 60%, median survival without distant failure 14.0 months. Significant prognostic factors for overall survival were KPS (p = 0.001), presence of tumor necrosis on pretreatment MRI (p = 0.001) with RPA-class and WBI reaching marginal significance (each p = 0.05). Prognostic impact of tumor necrosis remained significant if only smaller tumors with a volume below 3.5 cm3 (p = 0.03). Side effects were rare, only one patient suffered from serious acute side effects. Conclusions Results of this retrospective study support that stereotactic radiotherapy is an effective treatment option for patients with metastatic brain lesions. The prognostic impact of visible tumor necrosis (ring-enhancement) on pretreatment MRI scans should be further investigated.
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Lodder WL, Gilhuijs KGA, Lange CAH, Pameijer FA, Balm AJM, van den Brekel MWM. Semi-automated primary tumor volume measurements by dynamic contrast-enhanced MRI in patients with head and neck cancer. Head Neck 2012; 35:521-6. [DOI: 10.1002/hed.22988] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2012] [Indexed: 11/09/2022] Open
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Definitive Radiotherapy versus Postoperative Radiotherapy of Patients with Oro- and Hypopharyngeal Cancer: Impact of Prognostic Factors. JOURNAL OF ONCOLOGY 2012; 2012:391917. [PMID: 22315594 PMCID: PMC3270431 DOI: 10.1155/2012/391917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Accepted: 10/09/2011] [Indexed: 12/14/2022]
Abstract
Purpose. To compare the impact of prognostic factors of patients treated with definitive radio(chemo)therapy versus patients treated with surgery and postoperative radiotherapy for squamous cell carcinoma of the oro- and hypopharynx. Patients and Methods. 162 patients treated with definitive radiotherapy and 126 patients treated with postoperative radiotherapy were retrospectively analysed. The impact of the prognostic factors gender, age, total tumor volume (TTV), pre-radiotherapy hemoglobin level (Hb-level), tumor site, T- and N-classification, radiotherapy interruptions >5 days, radiotherapy versus simultaneous radiochemotherapy, R-status and time interval between surgery and radiotherapy were investigated. Results. The median follow-up time for the censored patients treated with definitive radio(chemo)therapy was 28.5 months and for postoperative radiotherapy 36.5 months. On univariate analysis, the TTV, Hb-level, and simultaneous radiochemotherapy had a significant impact on the survival of patients treated with definitive radio(chemo)therapy. For patients treated with postoperative radiotherapy, only the TTV showed a statistical trend for the survival (P = 0.13). On multivariate analysis, the TTV and simultaneous radiochemotherapy maintained their statistical significance for patients treated with definitive raditherapy, and the TTV, the statistical trend for patients treated with postoperative radiotherapy (P = 0.19). Conclusions. The TTV was the predominant prognostic factor for both, patients treated with definitive or postoperative radiotherapy.
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Paximadis PA, Christensen ME, Dyson G, Kamdar DP, Sukari A, Lin HS, Yoo GH, Kim HE. Up-front neck dissection followed by concurrent chemoradiation in patients with regionally advanced head and neck cancer. Head Neck 2012; 34:1798-803. [PMID: 22307819 DOI: 10.1002/hed.22011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2011] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The appropriate management of the neck in patients with regionally advanced head and neck cancer remains controversial. The purpose of this study was to retrospectively analyze our institutional experience with up-front neck dissection followed by definitive chemoradiotherapy. METHODS Fifty-five patients with radiographic evidence of large or necrotic lymph nodes underwent up-front neck dissection followed by definitive chemoradiation. RESULTS The 5-year overall survival (OS) and progression-free survival (PFS) rates were estimated at 71.3% and 64.7%, respectively. There were 2 failures in the dissected neck, for a control rate of 96.7%. There were 7 locoregional failures and 12 distant failures, for locoregional and distant control rates of 87.3% and 78.2%, respectively. CONCLUSION Up-front neck dissection followed by chemoradiotherapy resulted in excellent locoregional control, OS, and PFS. Utilization of this strategy should be considered in carefully selected patients with regionally advanced head and neck cancer. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
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Affiliation(s)
- Peter A Paximadis
- Department of Radiation Oncology, Wayne State University/Detroit Medical Center, Detroit, Michigan, USA.
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Lodder WL, Pameijer FA, Rasch CRN, van den Brekel MWM, Balm AJM. Prognostic significance of radiologically determined neck node volume in head and neck cancer: a systematic review. Oral Oncol 2011; 48:298-302. [PMID: 22112442 DOI: 10.1016/j.oraloncology.2011.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022]
Abstract
This systematic review addresses the prognostic significance of neck node volume in head and neck cancer. Primary tumor volume evolved as an independent significant factor for survival in head and neck cancer patients. Besides primary tumor volume, multiple prognostic features related to the regional lymph nodes were studied in literature. In literature, some authors showed the significance of total tumor volume/nodal volume for survival and loco-regional control. Articles reporting prognosis and survival in nodal tumor volumes were collected by systematically reviewing publications listed in the Pubmed and Embase databases. Publications were included when they at least reported on total tumor volume (TTV) or nodal volume and survival. In this systematic review we studied 21 articles. For measurement of nodal volume different formulas were used. Until now, there's no clear statistical evidence for the use of either TTV or nodal volume versus primary tumor volume to predict the individual loco-regional control or survival after treatment. There is wide variety of tumor measuring systems in the literature. The cut-off value for local tumor response also shows large variation. Firstly consensus should be accomplished on standardization of volume measurements, preferably automatic, and secondly large study groups are needed with identical treatment modalities to further unravel the role of neck node volume as separate staging tool.
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Affiliation(s)
- W L Lodder
- Department of Head & Neck Oncology and Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Deron P, Mertens K, Goethals I, Rottey S, Duprez F, De Neve W, Vermeersch H, Van de Wiele C. Metabolic tumour volume. Prognostic value in locally advanced squamous cell carcinoma of the head and neck. Nuklearmedizin 2011; 50:141-6. [PMID: 21594304 DOI: 10.3413/nukmed-0367-10-11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2010] [Accepted: 03/01/2011] [Indexed: 11/20/2022]
Abstract
PURPOSE Evaluate the predictive and prognostic value of semi-quantitative FDG-PET variables derived from pretreatment FDG-PET images in patients suffering from locally advanced squamous cell carcinoma of the head and neck (SCCHN), treated by means of concomitant radiochemotherapy. PATIENTS, METHODS 40 patients with newly diagnosed SCCHN that were treated with concomitant radiochemotherapy underwent FDG-PET/CT for treatment planning; 18 patients had neck dissection prior to their baseline scan and to receiving radiochemotherapy. FDG-PET images were used to calculate metabolic tumour volumes using region growing and a threshold of 50% (MTV50) of primary lesions and involved lymph nodes as well as the mean and maximum standard uptake value (SUVmean and SUVmax) of the primary tumours. RESULTS Neither SUVmean nor SUVmax values of the primary tumour were significantly different between responders and non-responders whereas MTV50 values of the primary tumour proved significantly higher in non-responders. SUVmean, SUVmax and MTV50 of the primary tumour were not predictive for overall or disease free survival. Contrariwise, dichotomized summed MTV50 values (cut-off≥31 cm3) of the primary tumour and involved lymph nodes in patients that didn't have neck dissection prior to radiochemotherapy were predictive for disease free and overall survival in both univariate and multivariate analysis (p≤0.05). CONCLUSION Summed MTV50 values of both the primary tumour and involved lymph nodes provided independent prognostic information on disease free and overall survival.
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Affiliation(s)
- P Deron
- Ghent University Hospital, Department of Head and Neck Surgery, Gent, Belgium.
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Tselis N, Ratka M, Vogt HG, Kolotas C, Baghi M, Baltas D, Fountzilas G, Georgoulias V, Ackermann H, Zamboglou N. Hypofractionated accelerated CT-guided interstitial 192Ir-HDR-Brachytherapy as re-irradiation in inoperable recurrent cervical lymphadenopathy from head and neck cancer. Radiother Oncol 2011; 98:57-62. [DOI: 10.1016/j.radonc.2010.10.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2009] [Revised: 02/02/2010] [Accepted: 10/28/2010] [Indexed: 11/17/2022]
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Ohnishi K, Shioyama Y, Hatakenaka M, Nakamura K, Abe K, Yoshiura T, Ohga S, Nonoshita T, Yoshitake T, Nakashima T, Honda H. Prediction of local failures with a combination of pretreatment tumor volume and apparent diffusion coefficient in patients treated with definitive radiotherapy for hypopharyngeal or oropharyngeal squamous cell carcinoma. JOURNAL OF RADIATION RESEARCH 2011; 52:522-530. [PMID: 21905311 DOI: 10.1269/jrr.10178] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Kayoko Ohnishi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Maidashi, Higashi-ku, Fukuoka city, Japan
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Yu KH, Yu SCH, Hui EP, Kam MKM, Vlantis AC, Yuen E, Chan ATC. Accelerated fractionation radiotherapy and late intensification with 2 intra-arterial cisplatin infusions for locally advanced head and neck squamous cell carcinoma. Head Neck 2010; 32:913-20. [PMID: 19885925 DOI: 10.1002/hed.21279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND This study was established to determine the maximum tolerated dose of intra-arterial cisplatin (IAC) concurrent with accelerated fractionation radiotherapy for locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS We conducted a phase I study. Treatment consisted of 70 Gy/35 fractions/5.8 weeks and 2 weekly IAC infusions during the last 2 weeks. RESULTS Ten patients were recruited. Two patients had stage III, 1 had stage IVa, and 7 had stage IVb disease. Three patients received IAC at 100 mg/m(2), 3 at 125 mg/m(2), and 4 at 150 mg/m(2). Nine patients received both planned infusions. Dose-limiting toxicity occurred at 150 mg/m(2) as transient grade 4 leukopenia and prolonged grade 3 acute skin reactions. The maximum tolerated dose was 125 mg/m(2). Six patients survived disease-free at 39 to 67 months. CONCLUSIONS It was feasible to give IAC concurrent with accelerated fractionation radiotherapy for locally advanced HNSCC. The maximum tolerated dose of cisplatin was 125 mg/m(2).
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Affiliation(s)
- Kwok Hung Yu
- Department of Clinical Oncology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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Yang SN, Liao CY, Chen SW, Liang JA, Tsai MH, Hua CH, Lin FJ. Clinical implications of the tumor volume reduction rate in head-and-neck cancer during definitive intensity-modulated radiotherapy for organ preservation. Int J Radiat Oncol Biol Phys 2010; 79:1096-103. [PMID: 20605362 DOI: 10.1016/j.ijrobp.2009.12.055] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 11/19/2009] [Accepted: 12/14/2009] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the prognostic value of the volume reduction rate (VRR) in patients with head-and-neck cancer treated with intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS Seventy-six patients with oropharyngeal cancer (OPC) and another 76 with hypopharyngeal cancer (HPC) were enrolled in volumetric analysis. All patients received allocated radiotherapy courses. Adaptive computed tomography was done 4 to 5 weeks after the start of IMRT. Primary tumor volume measurement was derived using separate images for the pretreatment gross tumor volume (pGTV) and the interval gross tumor volume. RESULTS In the OPC group, the pGTV ranged from 6.6 to 242.6 mL (mean, 49.9 mL), whereas the value of the VRR ranged from 0.014 to 0.74 (mean, 0.43). In HPC patients, the pGTV ranged from 4.1 to 152.4 mL (mean, 35.6 mL), whereas the VRR ranged from -1.15 to 0.79 (mean, 0.33). Multivariate analysis of the primary tumor relapse-free survival for OPC revealed three prognostic factors: T4 tumor (p = 0.0001, hazard ratio 7.38), pGTV ≥20 mL (p = 0.01, hazard ratio 10.61), and VRR <0.5 (p = 0.001, hazard ratio 6.49). Multivariate analysis of the primary tumor relapse-free survival for HPC showed two prognostic factors: pGTV ≥30 mL (p = 0.001, hazard ratio 2.87) and VRR <0.5 (p = 0.03, hazard ratio 2.25). CONCLUSION The VRR is an outcome predictor for local control in OPC and HPC patients treated with IMRT. Those with large tumor volumes or a VRR <0.5 should be considered for a salvage operation or a dose-escalation scheme.
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Affiliation(s)
- Shih-Neng Yang
- Department of Radiation Oncology, China Medical University, Taichung, Taiwan
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Evaluation of Spatially Fractionated Radiotherapy (GRID) and Definitive Chemoradiotherapy With Curative Intent for Locally Advanced Squamous Cell Carcinoma of the Head and Neck: Initial Response Rates and Toxicity. Int J Radiat Oncol Biol Phys 2010; 76:1369-75. [DOI: 10.1016/j.ijrobp.2009.03.030] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/18/2009] [Accepted: 03/23/2009] [Indexed: 11/21/2022]
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Pretreatment prognostic factors of survival in patients with locally advanced nonmetastatic squamous cell carcinoma of the head and neck treated with radiation therapy with or without concurrent chemotherapy. Am J Clin Oncol 2009; 32:163-8. [PMID: 19307954 DOI: 10.1097/coc.0b013e31818254cc] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identification of pretreatment prognostic factors influencing overall survival (OS) in locally advanced squamous cell carcinoma of the head and neck is an important issue in head and neck oncology. METHODS A total of 289 patients were treated with standard fraction or hyperfractionated radiation therapy with or without concurrent low-dose daily chemotherapy. RESULTS Gender (P = 0.43) and age (P = 0.26) did not influence OS whereas Karnofsky Performance Status (KPS) (P < 0.0001), T stage (P < 0.0001), and N stage (P < 0.0001) did. Stage grouping was another factor that influenced OS (P < 0.001). Patients with larynx and nasopharynx fared better than those with other primaries (P = 0.0153). Finally, treatment significantly influenced OS. Multivariate analysis showed that KPS, T and N stage, and treatment were independent prognosticators of OS. CONCLUSIONS KPS, T and N stage, and treatment are independent prognosticators of OS in patients with locally advanced squamous cell carcinoma of the head and neck treated with radiation therapy with or without concurrent low-dose daily chemotherapy.
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Studer G, Lütolf UM, El-Bassiouni M, Rousson V, Glanzmann C. Volumetric staging (VS) is superior to TNM and AJCC staging in predicting outcome of head and neck cancer treated with IMRT. Acta Oncol 2009; 46:386-94. [PMID: 17450476 DOI: 10.1080/02841860600815407] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The UICC classification (TNM) represents the validated standard tool to describe tumor extent and includes prognostic information on the probability of disease control. The American Joint Committee on Cancer (AJCC) stage grouping is based on the evaluation of treatment and outcome. Gross tumor volume (GTV) might be more relevant than pure description (TNM) or stage grouping as prognostic factor for local control in head and neck cancer (HNC). Based on the observation of GTV-correlated outcome in our initial HNC patient cohort treated with IMRT, we tested the hypothesis that the GTV is the most reliable predictive tool in HNC outcome. A GTV based volumetric staging system (VS) was introduced, using two volumetric cut-off values (15 and 70 cm3). VS, TNM, and AJCC stages were assessed and correlated with outcome following primary radiation in 172 HNC patients. Analyses were based on Kaplan-Meier survival curves. VS proved to be superior to the TNM/AJCC in predicting outcome. In addition, VS enabled to stratify high- and low-risk patients in advanced TN stages. GTV represented the most important prognostic indicator in HNC treated with IMRT and is recommended to be considered for therapeutic decisions and estimation of outcome.
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Affiliation(s)
- G Studer
- Department of Radiation Oncology, University Hospital, Zurich, Switzerland.
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Chen SW, Yang SN, Liang JA, Lin FJ, Tsai MH. Prognostic impact of tumor volume in patients with stage III-IVA hypopharyngeal cancer without bulky lymph nodes treated with definitive concurrent chemoradiotherapy. Head Neck 2009; 31:709-16. [DOI: 10.1002/hed.21011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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El Naqa I, Grigsby P, Apte A, Kidd E, Donnelly E, Khullar D, Chaudhari S, Yang D, Schmitt M, Laforest R, Thorstad W, Deasy JO. Exploring feature-based approaches in PET images for predicting cancer treatment outcomes. PATTERN RECOGNITION 2009; 42:1162-1171. [PMID: 20161266 PMCID: PMC2701316 DOI: 10.1016/j.patcog.2008.08.011] [Citation(s) in RCA: 351] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Accumulating evidence suggests that characteristics of pre-treatment FDG-PET could be used as prognostic factors to predict outcomes in different cancer sites. Current risk analyses are limited to visual assessment or direct uptake value measurements. We are investigating intensity-volume histogram metrics and shape and texture features extracted from PET images to predict patient's response to treatment. These approaches were demonstrated using datasets from cervix and head and neck cancers, where AUC of 0.76 and 1.0 were achieved, respectively. The preliminary results suggest that the proposed approaches could potentially provide better tools and discriminant power for utilizing functional imaging in clinical prognosis.
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Affiliation(s)
- I El Naqa
- Department of Radiation Oncology, Washington University School of Medicine St. Louis, MO, USA
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Abstract
Oral tongue squamous cell carcinoma (OTSCC) is an aggressive cancer associated with poor prognosis. Methods for determining the aggressiveness of OTSCC from analysis of the primary tumour specimen are thus highly desirable. We investigated whether genomic instability and proliferative activity (by means of Ki-67 activity) could be of clinical use for prediction of locoregional recurrence in 76 pretreatment OTSCC paraffin samples (stage I, n=22; stage II, n=33; stage III, n=8; stage IV, n=13). Eleven surgical tumour specimens were also analysed for remnants of proliferative activity after preoperative radiotherapy. Ninety-seven percent of cases (n=72) were characterised as being aneuploid as measured by means of image cytometry. Preoperative radiotherapy (50–68 Gy) resulted in significant reduction of proliferative activity in all patients for which post-treatment biopsies were available (P-value=0.001). Proliferative activity was not associated with response to radiation in stage II patients. However, we report a significant correlation between high proliferation rates and locoregional recurrences in stage I OTSCC patients (P-value=0.028). High-proliferative activity is thus related to an elevated risk of recurrence after surgery alone. We therefore conclude that Ki-67 expression level is a potentially useful clinical marker for predicting recurrence in surgically treated stage I OTSCC.
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Pretreatment Prognostic Factors of Local Recurrence-Free Survival in Locally Advanced Squamous Cell Carcinoma of the Head and Neck Treated With Radiation Therapy With or Without Concurrent Chemotherapy. Am J Clin Oncol 2008; 31:213-8. [DOI: 10.1097/coc.0b013e318161dbef] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chufal KS, Rastogi M, Srivastava M, Pant MC, Bhatt MLB, Srivastava K. Analysis of Prognostic Variables among Patients with Locally Advanced Head and Neck Cancer Treated with Late Chemo-Intensification Protocol: Impact of Nodal Density and Total Tumor Volume. Jpn J Clin Oncol 2006; 36:537-46. [PMID: 16905755 DOI: 10.1093/jjco/hyl081] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of the present study was to define the prognostic impact of nodal density (ND) and total tumor volume along with many other tumor, treatment and patient related variables using the late chemo-intensification treatment regimen with conventionally fractionated radiotherapy (70 Gy/7 weeks). METHODS A total of 74 patients with Stage III and IV biopsy proven squamous cell carcinoma of oropharynx, hypopharynx and larynx were treated with this regimen. ND and total tumor volume was measured on high resolution CT scans for all the patients. Chemotherapy consisted of continuous infusion of 5 FU at 350 mg/m(2)/day and cisplatin as 1 h infusion at 10 mg/m(2)/day on days 1-5 of week 6 and 7 of radiotherapy. RESULTS Grade III mucositis was present in 48 (64.9%) patients. Overall complete response rate was 77%. At 28 months, locoregional relapse-free survival (LRFS), overall survival (OS) and distant metastases-free survival (DMFS) was 70.8%, 66.9% and 81.9%, respectively. In the final multivariate Cox-regression model tumor stage, ND, primary site and nodal stage were independent variables predicting for LRFS. Similarly AJCC group staging, ND and total treatment volume were found to have significant impact, independently over LRFS. CONCLUSIONS There is tremendous variation in terms of ND and total tumor volume within AJCC nodal staging and tumor staging, respectively. ND had significant impact over LRFS and OS. Future phase III trial may need stratification on the basis of these variables.
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Affiliation(s)
- Kundan S Chufal
- Department of Oncology, Batra Hospital and Medical Research Centre, New Delhi 110062, India.
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van den Brekel MWM, Castelijns JA. What the clinician wants to know: surgical perspective and ultrasound for lymph node imaging of the neck. Cancer Imaging 2005; 5 Spec No A:S41-9. [PMID: 16361135 PMCID: PMC1665300 DOI: 10.1102/1470-7330.2005.0028] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Imaging of lymph node metastases in the neck can have two major indications: (1) prognosis and assisting with choice of treatment; (2) staging and detection of clinically occult metastases in different levels of the neck. Both indications are discussed. The role and limitations of US and US-guided fine-needle aspiration cytology are also reviewed.
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Affiliation(s)
- Michiel W M van den Brekel
- Department of Otolaryngology, Head and Neck Surgery, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Kuhnt T, Mueller AC, Pelz T, Haensgen G, Bloching M, Koesling S, Schubert J, Dunst J. Impact of tumor control and presence of visible necrosis in head and neck cancer patients treated with radiotherapy or radiochemotherapy. J Cancer Res Clin Oncol 2005; 131:758-64. [PMID: 16088405 DOI: 10.1007/s00432-005-0018-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2005] [Accepted: 06/07/2005] [Indexed: 11/24/2022]
Abstract
PURPOSE Tumor volume after the lymph node involvement is one of the most important single prognostic factor in patients of head and neck cancers treated with radiotherapy. We have recently demonstrated that the hypoxic subvolume is more important than the total tumor volume. We therefore propose the hypothesis that the presence of visible necrosis might be an important factor for cure by radiotherapy in squamous cell cancers of the head and neck. METHODS A total of 51 patients with locally advanced inoperable (T3-4 or N2-3) squamous cell cancers of the head and neck (mean age 57 years, range 41-75 years) were prospectively investigated with regard to a possible impact of tumor volume. All patients received CT examination of the head and neck according to a standardized protocol (spiral CT, contrast enhancement after automatic injection), and the total tumor volume was calculated as the sum of volumes of all visible macroscopic tumor sites. Poorly perfused and necrotic areas (no contrast enhancement) within macroscopic tumor sites were also calculated. Patients were then treated with accelerated-hyperfractionated radiotherapy in about 6 weeks. Seventeen patients were treated with only radiation. Patients without contraindications to cisplatin chemotherapy received cisplatin chemotherapy or a combination of cisplatin and paclitaxel (N=34). The allocation of patients to certain treatment regimens was based on individual decisions in each case and not randomized. RESULTS In patients treated with radiation alone, 12/17 (71%) got recurrence whereas in patients treated with radiation plus cisplatin, only 14/34 (41%) recurred (P=0.05). The 2-year overall survival was for radiation alone versus radiation plus cisplatin 0% vs. 62% (P<0.0008). Tumors with smaller amount of necrosis (necrosis volume<4 cm3) had a good prognosis irrespective of type of treatment (radiation alone or radiation plus cisplatin). However, patients with tumors with a larger amount of necrosis (necrosis volume> or =4 cm3) had a significantly better outcome if they were treated with radiation plus cisplatin as compared to patients treated with radiation alone. In a multi-variate analysis using a Cox-regression model the type of treatment (radiotherapy plus versus without cisplatin) was the only independent prognostic factor for event-free survival (P<0.03) in the whole group. CONCLUSIONS In this non-randomized retrospective investigation with limited sample size, radiation plus cisplatin was superior to radiation alone. This resulted mainly from a higher efficacy of the radiochemotherapy regimen in patients with large and especially necrotic tumors. The prognostic and predictive impact of visible necrosis should be further evaluated.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Squamous Cell/diagnostic imaging
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/therapy
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- Dose Fractionation, Radiation
- Female
- Head and Neck Neoplasms/diagnostic imaging
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/therapy
- Humans
- Male
- Multivariate Analysis
- Necrosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Staging
- Paclitaxel/administration & dosage
- Proportional Hazards Models
- Prospective Studies
- Radiotherapy, Adjuvant
- Retrospective Studies
- Survival Analysis
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Thomas Kuhnt
- Clinic of Radiotherapy, Martin Luther University Halle Wittenberg, Dryanderstrasse 4, 06097, Halle/Saale, Germany.
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Plataniotis GA, Theofanopoulou ME, Kalogera-Fountzila A, Haritanti A, Ciuleanou E, Ghilezan N, Zamboglou N, Dimitriadis A, Sofroniadis I, Fountzilas G. Prognostic impact of tumor volumetry in patients with locally advanced head-and-neck carcinoma (non-nasopharyngeal) treated by radiotherapy alone or combined radiochemotherapy in a randomized trial. Int J Radiat Oncol Biol Phys 2004; 59:1018-26. [PMID: 15234035 DOI: 10.1016/j.ijrobp.2004.01.021] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2003] [Revised: 01/06/2004] [Accepted: 01/07/2004] [Indexed: 11/26/2022]
Abstract
PURPOSE Tumor volume (TV) is one of the main reported factors determining the outcome of treatment in head-and-neck carcinomas. In this study, the prognostic impact of TV was explored in the context of a randomized trial with the patients assigned to receive standard radiotherapy (RT) alone or RT plus platinum compounds (RT alone, RT plus cisplatin, or RT plus carboplatin). METHODS AND MATERIALS The tumor outlines were traced and digitized on each pretreatment CT slice for each of the 101 patients studied. Taking into account the magnification factor of the scan and CT slice thickness, a computer with specifically designed software calculated the TV in cubic centimeters. RESULTS The median overall survival for the whole group of patients was 21.6 months (95% confidence interval, 13.0-30.2) and the 3-year survival rate was 40%. The addition of platinum compounds to RT (Groups 2 and 3) significantly improved the survival rate (RT alone vs. RT plus cisplatin, hazard ratio 0.36, p = 0.002; RT alone vs. RT plus carboplatin, hazard ratio 0.53, p = 0.029). In univariate analysis, the most significant parameters for survival were treatment group, total gross tumor volume (TGTV), complete response, nodal GTV, primary GTV, and performance status. In multivariate analysis, treatment group, TGTV, gender, and primary site were independent prognostic factors for survival. A prognostic threshold of 22.8 cm(3) was detected for TGTV. Patients with a TGTV of <22.8 cm(3) were more likely to achieve a complete response and had a median survival of 45.3 months, and those with a TGTV >22.8 cm(3) had a median survival of 12.3 months (log-rank test, p = 0.0102). CONCLUSION The prognostic significance of the TGTV was confirmed and a cutoff value of 22.8 cm(3) derived. Our data indicated that locally advanced head-and-neck carcinomas should not be treated by standard (once-daily) RT alone. Tumor size and disease subsite should be taken into account in future randomized trials to increase their statistical power.
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Grabenbauer GG, Suckorada O, Niedobitek G, Rödel F, Iro H, Sauer R, Rödel C, Schultze-Mosgau S, Distel L. Imbalance between proliferation and apoptosis may be responsible for treatment failure after postoperative radiotherapy in squamous cell carcinoma of the oropharynx. Oral Oncol 2003; 39:459-69. [PMID: 12747970 DOI: 10.1016/s1368-8375(03)00005-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
To assess the prognostic value of apoptosis, proliferation and clinical factors in squamous cell carcinoma of the oropharynx after radical surgery and postoperative radiotherapy (RT). Between 1985 and 1995, a total of 82 patients with 84 tumors were entered onto the study. Forty-two primary tumors (50%) involved the tonsils, 23 (27%) the soft palate, and 19 (23%) the base of the tongue. Median age was 52 years (range, 36-73 years). The pT- and pN-categories (UICC 1997) were: T1 (24), T2 (36), T3 (18), T4 (6), N0 (31), N1 (12), N2 (38), NX (8). Histologically clear margins were achieved in all patients by initial surgery. Postoperative RT to the primary and regional lymphatics was given with 60 Gy in 6 weeks and single daily fractions of 2 Gy. The expression of the nuclear Ki-67 labeling index (LI) was investigated by immunostaining using the monoclonal antibody MIB 1 and apoptotic carcinoma cells were identified using the terminal deoxynucleotidyltransferase-(TdT)-mediated dUTP nick end labeling (TUNEL) technique. Median follow-up was 43 months (range, 14-132 months). Overall survival, disease-free survival, and locoregional tumor control rates were 59, 70 and 76% at 5 years. Median values for apoptotic index and Ki-67 labeling were 1.6% (range 0-4.7%), and 20% (range, 0-79%), respectively. Apoptotic index <or=1.6% had a profound negative impact when associated with higher proliferation rates (5-year disease-free survival: 26%) as compared to all other patients with a balance between apoptosis and proliferation (5-year disease-free survival: 66-86%, P=0.003). Additional significant prognostic factors for disease-free survival were: tumor site (tonsils: 83% vs soft palate: 66% vs base of tongue: 49%, P=0.02), duration of RT (<or=47 days: 83% vs >47 days: 55%, P=0.03), Ki-67 LI (<or=20%: 84% vs >20%: 56%, P=0.006). A significant prognostic impact on locoregional control was noted for the duration of RT (P=0.01), tumor site (P=0.02), and the Ki-67 LI (P=0.02). A low apoptotic index together with higher proliferation rates led to unfavourable local control as low as 25% compared to the patients with higher apoptotic index (70-80%, P=0.009). An imbalance between apoptotic index and proliferation may identify patients with squamous cell carcinoma at high risk for local recurrence after surgery and postoperative RT. Prospective observation of these factors in clinical trials is warranted to further elucidate this phenomenon.
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Affiliation(s)
- Gerhard G Grabenbauer
- Department of Radiation Oncology, University of Erlangen, Universitätstrasse 27, 91054 Erlangen, Germany.
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Waaijer A, Terhaard CHJ, Dehnad H, Hordijk GJ, van Leeuwen MS, Raaymakers CPJ, Lagendijk JJW. Waiting times for radiotherapy: consequences of volume increase for the TCP in oropharyngeal carcinoma. Radiother Oncol 2003; 66:271-6. [PMID: 12742266 DOI: 10.1016/s0167-8140(03)00036-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Waiting lists for radiotherapy have become longer over the past years. Apart from the psychological distress for the patient we are concerned about tumour growth during this waiting time, which may worsen prognosis. The purpose of this pilot study was to investigate tumour growth in the waiting time and to obtain an indication of its clinical consequences for patients with oropharyngeal carcinoma. A tumour control probability (TCP) model was applied to evaluate consequences for outcome. METHODS AND MATERIALS Increase in tumour volume was measured for 13 patients with oropharyngeal carcinoma by outlining the tumour on the diagnostic as well as on the treatment planning CT scan. Waiting time was defined as time between histopathological diagnosis and start of radiotherapy. For each tumour we calculated the increase in tumour volume and the tumour doubling time. The potential increase in TCP was calculated for each tumour for the situation without treatment delay. RESULTS The mean increase in tumour volume was 70%. The mean waiting time was 56 days. Expected TCP with incorporation of delay was 47%, without delay it might have been 63-66%. CONCLUSION This study shows tumour progression during the time between the diagnostic CT scan and the treatment planning CT scan in oropharyngeal cancer. As a consequence of waiting time, which allows tumour volume increase, there may be an average control loss of 16-19 % for these tumours during the total waiting time before radiotherapy.
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Affiliation(s)
- Annet Waaijer
- Department of Pediatric Surgery of the UMC Utrecht, Lundlaan 6, 3583 CX Utrecht, The Netherlands
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Grabenbauer GG, Rödel C, Ernst-Stecken A, Brunner T, Hornung J, Kittel K, Steinhart H, Iro H, Sauer R, Schultze-Mosgau S. Neck dissection following radiochemotherapy of advanced head and neck cancer--for selected cases only? Radiother Oncol 2003; 66:57-63. [PMID: 12559521 DOI: 10.1016/s0167-8140(02)00193-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To address the value of neck dissection (ND) in patients with advanced head and neck cancer following primary radiochemotherapy and to specifically analyse its impact on locoregional tumour control, survival and toxicity. PATIENTS AND METHODS Between 1987 and 1997 (9,335), a total of 142 patients (pts) were treated by primary radiochemotherapy (RCT) according to prospective protocols. There were 64 pts with involvement of the hypopharynx, 57 pts with oropharyngeal and 21 with oral cavity carcinoma. UICC (1997) stages included: 16 pts in stage III, 113 pts in stage IV A, 13 pts in stage IV B. All pts received platin-based RCT up to a median total dose of 70 Gy (range, 60-72 Gy). Six weeks after RCT, pts with complete response of the primary tumour (N=97) were offered a uni- or bilateral ND depending on the initially diagnosed nodal disease as part of a strict institutional policy. Fifty-six pts consented to ND and 41 refused. These two groups were analysed in terms of characteristics, local and regional tumour control, survival and long-term side effects. Median follow-up was 37 months (range, 22-124 months). RESULTS Among the 56 pts receiving ND, a total of 13 (23%) was found to have residual tumour in the neck specimen. The rates of positive histology according to clinical N category after RCT were: yN0 (2/22[9%]), yN1 (2/10[20%]), yN2a-b (2/10[20%), yN2c-3 (7/14[54%]). Five-year overall survival and disease-specific survival rates for pts with ND were 44 and 55%, for pts without ND 42 and 47%, respectively (P=0.9). No difference was seen for long-term local and regional control between the two patient groups. Comparing the group of patients with and without ND, a trend towards higher subjective morbidity of grade 3 and 4 (LENT-SOMA), i.e. pain recording (24% vs. 17%), dysphagia (48% vs. 35%) and hoarseness (20% vs. 9%) was evident in patients with ND. CONCLUSION No clear evidence for routine clinical use of ND after RCT in advanced head and neck tumours can be derived from these data. ND may be contemplated in selected cases with multiple residual nodes only.
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Affiliation(s)
- Gerhard G Grabenbauer
- Department of Radiation Therapy, University Hospitals of Erlangen, Universitätsstrasse 27, 91054 Erlangen, Germany
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Monnerat C, Faivre S, Temam S, Bourhis J, Raymond E. End points for new agents in induction chemotherapy for locally advanced head and neck cancers. Ann Oncol 2002; 13:995-1006. [PMID: 12176777 DOI: 10.1093/annonc/mdf172] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
More than 60% of patients diagnosed with squamous cell carcinoma of the head and neck present at a locally advanced stage. Although multimodality therapy has improved locoregional control, the 5-year survival rate of this population rarely exceeds 30%. In this review, we analyzed the impact of chemotherapy in the management of locally advanced head and neck cancer and we underline the potential benefit of induction chemotherapy. The Meta-Analysis of Chemotherapy in Head and Neck Cancer collaborative group has suggested a survival advantage of 5% at 5 years for platin-5-fluorouracil induction chemotherapy. We have analyzed cofactors that may affect the survival of head and neck patients and propose new end points for assessment of the efficacy of induction chemotherapy. The detrimental effect of second primary tumors on long-term results is stressed and we have suggested the use of overall 2-year survival as a surrogate end point for induction chemotherapy efficacy. Finally, we have examined the impact of new cytotoxic agents and present the promising results of new taxane-based combinations.
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Affiliation(s)
- C Monnerat
- Departments of Medicine, Head and Neck Surgery and Radiotherapy, Institut Gustave-Roussy, Villejuif, France
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Hermans R. Tumour oxygenation measurements using computed tomography and magnetic resonance imaging. Cancer Imaging 2002. [PMCID: PMC4448600 DOI: 10.1102/1470-7330.2002.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Robert Hermans
- Department of Radiology, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium
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Magné N, Pivot X, Bensadoun RJ, Guardiola E, Poissonnet G, Dassonville O, Francoual M, Formento JL, Demard F, Schneider M, Milano G. The relationship of epidermal growth factor receptor levels to the prognosis of unresectable pharyngeal cancer patients treated by chemo-radiotherapy. Eur J Cancer 2001; 37:2169-77. [PMID: 11677103 DOI: 10.1016/s0959-8049(01)00280-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to analyse prognostic factors for time to treatment failure (TTF) and overall survival (OS) in patients with unresectable cancer of the pharynx. A twice daily (b.i.d.) radiotherapy with concomitant cisplatin-5-fluorouracil chemotherapy was administered to 77 consecutive patients (68 males, 9 females; median age: 56 years). The studied factors were: age, gender, tumour differentiation, tumour volume, initial hemoglobin level, karnofsky index (KI), primary tumour location, T, N, epidermal growth factor receptor (EGFR) level in the tumour (fmol/mg protein). KI and EGFR level were significant predictors in a multivariate analysis for TTF (P=0.004 and P=0.0001) and OS (P=0.004 and P=0.0001). In order to select subgroups with different outcomes, a stratification of patients was performed based on the EGFR value: patients with tumour EGFR levels <35 fmol/mg protein, between 35 and 275 fmol/mg protein and >275 fmol/mg protein had 95%, 51% and 16% 3 year OS rates, respectively (log rank test; P=0.0001). Interestingly, for patients exhibiting a complete response (CR) after concomitant b.i.d. chemo-radiotherapy, patients with EGFR levels <35 fmol/mg protein were all alive at 3 years; in contrast, there was only 70 and 13% 3 year survival rates for patients with EGFR tumour levels between 35 and 275 fmol/mg protein and above 275 fmol/mg protein, respectively. EGFR determination appears to be a powerful prognostic parameter in unresectable pharyngeal cancer patients treated by concomitant chemo-radiotherapy.
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Affiliation(s)
- N Magné
- Department of Radiotherapy, Centre Antoine Lacassagne, 33 Avenue de Valombrose, 06189 Nice Cedex 2, France
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Hermans R, Op de beeck K, Van den Bogaert W, Rijnders A, Staelens L, Feron M, Bellon E. The relation of CT-determined tumor parameters and local and regional outcome of tonsillar cancer after definitive radiation treatment. Int J Radiat Oncol Biol Phys 2001; 50:37-45. [PMID: 11316544 DOI: 10.1016/s0360-3016(00)01559-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To investigate the value of CT-derived tumor parameters as predictor of local and regional outcome of tonsillar squamous cell carcinoma treated by definitive radiation therapy. METHODS AND MATERIALS The pretreatment CT studies of 112 patients with tonsillar squamous cell carcinoma were reviewed. After redigitizing the films, primary and nodal tumor volume was calculated with the summation-of-areas technique. The nodal CT aspect was graded using a 3-point scale (homogenous, inhomogeneous, and necrotic). Mean follow-up time was 33 months. Actuarial statistical analysis of local and regional outcome was done for each of the covariates; multivariate analysis was performed using Cox's proportional hazards model. RESULTS In the actuarial analysis, CT-determined primary tumor volume was significantly correlated with local recurrence rate (p < 0.05) when all patients were considered, but primary tumor volume did not predict local control within the T2, T3, and T4 category. CT-determined nodal volume was significantly related to regional outcome (p < 0.01), but nodal density was not. Total tumor volume was not significantly related to locoregional outcome (p = 0.1). In the multivariate analysis, the T and N categories were the independent predictors of local and regional outcomes, respectively. CONCLUSION Compared to other head-and-neck sites, primary and nodal tumor volume have only marginal predictive value regarding local and regional outcome after radiation therapy in tonsillar cancer.
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Affiliation(s)
- R Hermans
- Department of Radiology, University Hospitals, Katholieke Universiteit, Herestraat 49, B-3000 Leuven, Belgium.
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49
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Gobbi PG, Ghirardelli ML, Solcia M, Di Giulio G, Merli F, Tavecchia L, Bertè R, Davini O, Levis A, Broglia C, Maffè GC, Ilariucci F, Dore R, Ascari E. Image-aided estimate of tumor burden in Hodgkin's disease: evidence of its primary prognostic importance. J Clin Oncol 2001; 19:1388-94. [PMID: 11230483 DOI: 10.1200/jco.2001.19.5.1388] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To explore a more direct method for evaluating tumor burden (TB) in Hodgkin's disease (HD) and to verify its prognostic importance. PATIENTS AND METHODS The volume of TB at diagnosis was directly and retrospectively measured in 121 HD patients through images of the lesions recorded by computed tomographic (CT) scan of the thorax, abdomen, and pelvis for all deep sites of involvement and many superficial ones, and by ultrasonography (US) for the remaining superficial lesions. RESULTS The TB, which was obtained from the sum of the volumes of all the lesions measured on CT scans and US and normalized to body-surface area (relative TB [rTB]), showed a median value of 102.6 cm(3)/m(2) (range, 2.2 to 582.8). At multivariate analysis for prognostic value, rTB was the parameter that statistically correlated best with time to treatment failure (P = 2.2 x 10(-6)), followed by erythrocyte sedimentation rate (ESR) (P =.0003), and serum fibrinogen (P =.0112). The prognostic discrimination allowed by rTB alone proved to be clearly superior to that obtained with the score of the International Prognostic Factor Project. The rTB was found to be correlated with many clinical staging parameters (bulky disease, number of involved lymph node regions, serum lactate dehydrogenase, ESR, hemoglobin, Karnofsky index), but its predictability from these variables was low (R(2) =.668). CONCLUSION Relative TB is emerging as a strong prognostic factor in HD, more powerful than and largely independent of those hitherto known and used. Further studies are needed to confirm these results and exploit their clinical value, particularly the relationship among rTB, drug doses, and response.
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Affiliation(s)
- P G Gobbi
- Medicina Interna e Oncologia Medica, Università di Pavia, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico S. Matteo, Pavia.
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Rudat V, Wannenmacher M. Role of multimodal treatment in oropharynx, larynx, and hypopharynx cancer. SEMINARS IN SURGICAL ONCOLOGY 2001; 20:66-74. [PMID: 11291134 DOI: 10.1002/ssu.1018] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Due to recent advances in radiation fractionation, radiochemotherapy, and conservative surgical techniques, the concept of multimodal therapy in head and neck cancer is currently changing. The recently published RTOG Phase III trial 9003, with 1,113 patients accrued, showed that hyperfractionation and accelerated fractionation with concomitant boost are more efficacious than standard fractionation for locally-advanced head and neck cancer. Acute, but not late, toxicity was also increased. Three meta-analyses have suggested that the impact of chemotherapy in head and neck cancer is small but is highly associated with the timing of therapy. Concomitant administration of radiation therapy and chemotherapy led to an absolute benefit in 5-year survival of about 10%. This finding has been further supported by recently published randomized prospective trials comparing concomitant radiochemotherapy with radiotherapy alone in advanced head and neck cancer. There is now clear evidence that radiochemotherapy provides a substantial and statistically significant improvement in survival and local-regional control, as compared to radiotherapy alone. Radiochemotherapy should be considered an accepted standard of care in cancers of the oropharynx, particularly for patients with locally-advanced disease who have a good performance status. Two randomized studies conducted by the Department of Veterans' Affairs and the EORTC, with a total of 534 patients accrued, showed that induction chemotherapy followed by radiotherapy of responders yields survival rates equal to those of total laryngectomy with postoperative radiotherapy. After 4 years, one-half to two-thirds of survivors of the chemotherapy arm retained a functional larynx. Larynx preservation using induction chemotherapy can now be regarded as feasible but still investigational. Current phase II studies show excellent larynx preservation rates using a primary concomitant radiochemotherapy with an altered fractionation regimen. More clinical and laboratory research is required to further evaluate the different treatment options of the multimodality concept, and to develop prognostic models that will allow individualization of the therapy.
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Affiliation(s)
- V Rudat
- Department of Radiation Oncology, University of Heidelberg, Germany.
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