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Nikkilä R, Haapaniemi A, Carpén T, Pukkala E, Mäkitie A. Laryngeal cancer relative survival trends from 1972 to 2021 in the Nordic countries. Acta Oncol 2024; 63:612-619. [PMID: 39099322 DOI: 10.2340/1651-226x.2024.40823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/04/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND AND PURPOSE Changes in treatment approaches, characterised by the shift from laryngectomy to a focus on organ-preserving methods may have potentially resulted in lower survival. We aim to identify differences in survival trends for laryngeal cancer (LC) in the Nordic countries over a period of 50 years, and discuss the potential impact of factors such as changes in treatment protocols. MATERIALS AND METHODS Five-year relative survival (RS) data from 1972 to 2021 were obtained from the NORDCAN database 2.0 which included 33,692 LC cases, of which 85% were diagnosed among men. In the NORDCAN database, the age-standardised RS is calculated using the Pohar Perme estimator with individual International Cancer Survival Standards weights. Joinpoint regression models were used to assess potential shifts in trend over the years in RS. RESULTS While Denmark and Norway demonstrated an increasing trend in 5-year RS from 1972 to 2021, in Finland and Sweden, the 5-year RS among men remained static, without any discernible significant trend. Over the 30-year period from 1992-1996 to 2017-2021, RS improved by 9, 4, 13, and 2 percentage points in Denmark, Finland, Norway, and Sweden, respectively. Among women in Sweden, a linear negative trend was observed, noticeable as a 16 percentage-point decline in 5-year RS from the earliest to the latest period. INTERPRETATION The underlying causes for the differences in survival trends remain unclear. Besides differences in treatment protocols, several other factors can affect RS making the interpretation of RS trends challenging.
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Affiliation(s)
- Rayan Nikkilä
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, Helsinki, Finland; Department of Oral and Maxillofacial Surgery, Lahti Central Hospital, Päijät-Häme Joint Authority for Health and Wellbeing, Lahti, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Timo Carpén
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Palliative Care Unit, Comprehensive Cancer Center, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Eero Pukkala
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer and Research, Helsinki, Finland; Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden.
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Brooks FMD, Glenn MC, Hernandez V, Saez J, Mehrens H, Pollard‐Larkin JM, Howell RM, Peterson CB, Nelson CL, Clark CH, Kry SF. A radiotherapy community data-driven approach to determine which complexity metrics best predict the impact of atypical TPS beam modeling on clinical dose calculation accuracy. J Appl Clin Med Phys 2024; 25:e14318. [PMID: 38427776 PMCID: PMC11087168 DOI: 10.1002/acm2.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/20/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024] Open
Abstract
PURPOSE To quantify the impact of treatment planning system beam model parameters, based on the actual spread in radiotherapy community data, on clinical treatment plans and determine which complexity metrics best describe the impact beam modeling errors have on dose accuracy. METHODS Ten beam modeling parameters for a Varian accelerator were modified in RayStation to match radiotherapy community data at the 2.5, 25, 50, 75, and 97.5 percentile levels. These modifications were evaluated on 25 patient cases, including prostate, non-small cell lung, H&N, brain, and mesothelioma, generating 1,000 plan perturbations. Differences in the mean planned dose to clinical target volumes (CTV) and organs at risk (OAR) were evaluated with respect to the planned dose using the reference (50th-percentile) parameter values. Correlation between CTV dose differences, and 18 different complexity metrics were evaluated using linear regression; R-squared values were used to determine the best metric. RESULTS Perturbations to MLC offset and transmission parameters demonstrated the greatest changes in dose: up to 5.7% in CTVs and 16.7% for OARs. More complex clinical plans showed greater dose perturbation with atypical beam model parameters. The mean MLC Gap and Tongue & Groove index (TGi) complexity metrics best described the impact of TPS beam modeling variations on clinical dose delivery across all anatomical sites; similar, though not identical, trends between complexity and dose perturbation were observed among all sites. CONCLUSION Extreme values for MLC offset and MLC transmission beam modeling parameters were found to most substantially impact the dose distribution of clinical plans and careful attention should be given to these beam modeling parameters. The mean MLC Gap and TGi complexity metrics were best suited to identifying clinical plans most sensitive to beam modeling errors; this could help provide focus for clinical QA in identifying unacceptable plans.
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Affiliation(s)
- Fre'Etta Mae Dayo Brooks
- University of Texas MD Anderson UTHealth Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Mallory Carson Glenn
- University of Texas MD Anderson UTHealth Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Victor Hernandez
- Department of Medical PhysicsHospital Sant Joan de Reus, IISPVTarragonaSpain
| | - Jordi Saez
- Department of Radiation OncologyHospital Clinic de BarcelonaBarcelonaSpain
| | - Hunter Mehrens
- University of Texas MD Anderson UTHealth Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Julianne Marie Pollard‐Larkin
- University of Texas MD Anderson UTHealth Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Rebecca Maureen Howell
- University of Texas MD Anderson UTHealth Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Christine Burns Peterson
- University of Texas MD Anderson UTHealth Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Christopher Lee Nelson
- University of Texas MD Anderson UTHealth Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Catharine Helen Clark
- Department of Radiotherapy PhysicsUniversity College London Hospital LondonLondonUK
- Department of Medical Physics and BioengineeringUniversity College LondonLondonUK
- Medical Physics DepartmentNational Physical LaboratoryTeddingtonUK
| | - Stephen Frasier Kry
- University of Texas MD Anderson UTHealth Graduate School of Biomedical SciencesHoustonTexasUSA
- Department of Radiation PhysicsUniversity of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Shih YJ, Huang JY, Lai YC, Lin HM, Kuo TJ. Tooth extraction within 2 weeks before radiotherapy and osteoradionecrosis: A nationwide cohort study. Oral Dis 2024; 30:575-585. [PMID: 35951468 DOI: 10.1111/odi.14349] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/05/2022] [Accepted: 08/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The theory of at least 2-week waiting period between tooth extraction and head and neck radiotherapy could reduce osteoradionecrosis remains controversial. Thus, this study examined the theory and associated factors. MATERIALS AND METHODS Data were retrieved from the National Health Insurance Research Database, Taiwan Cancer Registry Database, and Cause of Death Statistics. We included 24,353 patients with head and neck cancer who received radiotherapy from 2011 to 2017 and were followed up until 2019. The patients were divided into three groups: those undergoing tooth removal 2-8 weeks before radiotherapy, those undergoing tooth removal within 2 weeks before radiotherapy, and others. Confounding factors were clinical information, physical conditions, and risky habits. We used the Cox regression model to assess osteoradionecrosis risk. RESULTS No significant difference in osteoradionecrosis risk was observed between those undergoing tooth extraction within 2 weeks before radiotherapy and the other groups. An irradiation dose of ≥60 Gy, chemotherapy, tumor excision, post-radiotherapy tooth extraction, mandibulectomy, hyperlipidemia, and oral cavity as the tumor subsite were significantly positively associated with osteoradionecrosis risk. CONCLUSION A waiting period of ≥2 weeks between tooth extraction and radiotherapy did not significantly reduce osteoradionecrosis risk.
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Affiliation(s)
- Yin-Ju Shih
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Oral and Maxillofacial Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Cheng Lai
- Department of Orthopedics, Asia University Hospital, Taichung, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hsin-Mei Lin
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsu-Jen Kuo
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Marine Biotechnology and Resources, National Sun Yat-Sen University, Kaohsiung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
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4
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Lu C, Sun Q, Guo Y, Han X, Zhang M, Liu J, Wang Y, Mou Y, Li Y, Song X. Construction and validation of a prognostic nine-gene signature associated with radiosensitivity in head and neck squamous cell carcinoma. Clin Transl Radiat Oncol 2023; 43:100686. [PMID: 37854672 PMCID: PMC10579965 DOI: 10.1016/j.ctro.2023.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/20/2023] Open
Abstract
Background Radiotherapy is an effective treatment for head and neck squamous cell carcinoma (HNSCC), however how to predict the prognosis is not clear. Methods Here we collected 262 radiosensitivity-associated genes, screened and constructed a prognostic nine-gene risk model through univariate COX, lasso regression, stepwise regression and multivariate COX analysis for transcriptome and clinical information of HNSCC patients obtained from the cancer genome atlas (TCGA) and gene expression omnibus (GEO) databases. Results The reliability and robustness of the risk model were verified by receiver operating characteristic (ROC) curves, risk maps, and Kaplan-Meier (KM) curves analysis. Differences in immune cell infiltration and immune-related pathway enrichment between high-risk and low-risk subgroups were determined by multiple immune infiltration analyses. Meanwhile, the mutation map and the responses to immunotherapy were also differentiated by the prognostic nine-gene signature associated with radiosensitivity. These nine genes expression in HNSCC was verified in the Human Protein Atlas (HPA) database. After that, these nine genes expression was verified to be related to radiation resistance through in-vitro cell experiments. Conclusions All results showed that the nine-gene signature associated with radiosensitivity is a potential prognostic indicator for HNSCC patients after radiotherapy and provides potential gene targets for enhancing the efficacy of radiotherapy.
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Affiliation(s)
- Congxian Lu
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Qi Sun
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Ying Guo
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Xiao Han
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Mingjun Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Jiahui Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Yaqi Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Yakui Mou
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Yumei Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
| | - Xicheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai 264000, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, China
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Cheng J, Jiang J, He B, Lin WJ, Li Y, Duan J, Li H, Huang X, Cai J, Xie J, Zhang Z, Yang Y, Xu Y, Hu X, Wu M, Zhuo X, Liu Q, Shi Z, Yu P, Rong X, Ye X, Saw PE, Wu LJ, Simone CB, Chua MLK, Mai HQ, Tang Y. A phase 2 study of thalidomide for the treatment of radiation-induced blood-brain barrier injury. Sci Transl Med 2023; 15:eabm6543. [PMID: 36812346 DOI: 10.1126/scitranslmed.abm6543] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Radiation-induced brain injury (RIBI) is a debilitating sequela after radiotherapy to treat head and neck cancer, and 20 to 30% of patients with RIBI fail to respond to or have contraindications to the first-line treatments of bevacizumab and corticosteroids. Here, we reported a Simon's minmax two-stage, single-arm, phase 2 clinical trial (NCT03208413) to assess the efficacy of thalidomide in patients with RIBI who were unresponsive to or had contraindications to bevacizumab and corticosteroid therapies. The trial met its primary endpoint, with 27 of 58 patients enrolled showing ≥25% reduction in the volume of cerebral edema on fluid-attenuated inversion recovery-magnetic resonance imaging (FLAIR-MRI) after treatment (overall response rate, 46.6%; 95% CI, 33.3 to 60.1%). Twenty-five (43.1%) patients demonstrated a clinical improvement based on the Late Effects Normal Tissues-Subjective, Objective, Management, Analytic (LENT/SOMA) scale, and 36 (62.1%) experienced cognitive improvement based on the Montreal Cognitive Assessment (MoCA) scores. In a mouse model of RIBI, thalidomide restored the blood-brain barrier and cerebral perfusion, which were attributed to the functional rescue of pericytes secondary to elevation of platelet-derived growth factor receptor β (PDGFRβ) expression by thalidomide. Our data thus demonstrate the therapeutic potential of thalidomide for the treatment of radiation-induced cerebral vasculature impairment.
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Affiliation(s)
- Jinping Cheng
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jingru Jiang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Baixuan He
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Wei-Jye Lin
- Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.,Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-sen Memorial Hospital, Foshan 528200, China
| | - Yi Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jingjing Duan
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China
| | - Honghong Li
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiaolong Huang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jinhua Cai
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Jiatian Xie
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhan Zhang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yuhua Yang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yongteng Xu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xia Hu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Minyi Wu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiaohuang Zhuo
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Qiang Liu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Zhongshan Shi
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Pei Yu
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xiaojing Ye
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.,Faculty of Forensic Medicine, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.,Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-sen University, Guangzhou 510080, China
| | - Phei Er Saw
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.,Department of Neuroscience, Mayo Clinic, Jacksonville, FL 32224, USA.,Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY 10035, USA
| | - Melvin L K Chua
- Department of Head and Neck and Thoracic Cancers, Division of Radiation Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore.,Division of Medical Sciences, National Cancer Centre Singapore, Singapore 169610, Singapore.,Oncology Academic Programme, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Hai-Qiang Mai
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou 510060, China
| | - Yamei Tang
- Department of Neurology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Brain Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Medical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.,Nanhai Translational Innovation Center of Precision Immunology, Sun Yat-sen Memorial Hospital, Foshan 528200, China
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Bin-Manie M, Choi Y, Roh JL, Choi SH, Nam SY, Kim SY. Risk Factors for Feeding Tube Dependency in Patients Undergoing Function Preservation Surgery for Advanced-Stage Laryngohypopharyngeal Cancer. Dysphagia 2023; 38:466-473. [PMID: 35779157 DOI: 10.1007/s00455-022-10488-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/17/2022] [Indexed: 01/27/2023]
Abstract
Dysphagia and feeding tube dependency commonly occur in patients with laryngeal or hypopharyngeal cancer (LHC) during and after treatment, often leading to poor functional outcomes. Therefore, we examined the factors related to feeding tube dependency among advanced-stage LHC patients undergoing curative surgery. This study included 69 consecutive patients who underwent conservative surgery for previously untreated, advanced-stage LHC (squamous cell carcinoma) between 2006 and 2016. Persistent feeding tube dependency was defined as 1 year or more after treatment completion. Binary logistic regression analysis was used to determine the factors associated with reactive prolonged and persistent feeding tube dependency. Cox proportional hazard regression analysis was used to determine the association between feeding tube dependency and survival. None of the study patients had a prophylactic feeding tube, but 15 (21.7%) patients had reactive feeding tube placement for 3 months or more. A total of 9 (13.0%) patients had persistent feeding tube dependency. Univariate analysis showed that age, tracheostomy, and common terminology criteria for adverse events (CTCAE) ≥ 3 were significantly associated with reactive prolonged and persistent feeding tube dependency (all P < 0.05). In the multivariate analysis, advanced age and CTCAE ≥ 3 remained the independent factors of reactive prolonged and persistent feeding tube dependency (all P < 0.05). Feeding tube dependency was not associated with overall survival or disease-free survival (P > 0.1). Feeding tube dependency might be related to clinical factors, such as age and severe adverse events, in the patients undergoing function-preserving surgery for advanced-stage LHC.
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Affiliation(s)
- Manal Bin-Manie
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Otolaryngology-Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Yeonjoo Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Gyeonggi-do 13496, Seongnam, 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
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Sato A, Kraynak J, Marciscano AE, Galluzzi L. Radiation therapy: An old dog learning new tricks. Methods Cell Biol 2023; 174:xv-xxv. [PMID: 37039770 DOI: 10.1016/s0091-679x(23)00036-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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8
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Sato A, Kraynak J, Marciscano AE, Galluzzi L. Radiation therapy: An old dog learning new tricks. Methods Cell Biol 2023; 180:xv-xxv. [PMID: 37890936 DOI: 10.1016/s0091-679x(23)00166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Affiliation(s)
- Ai Sato
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Jeffrey Kraynak
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Ariel E Marciscano
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States
| | - Lorenzo Galluzzi
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, United States; Sandra and Edward Meyer Cancer Center, New York, NY, United States; Caryl and Israel Englander Institute for Precision Medicine, New York, NY, United States.
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9
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Investigation of the Effect of Radiotherapy Dose on Chewing and Swallowing Structures in Head and Neck Cancer Patients Treated with Concomitant Chemoradiotherapy. Dysphagia 2022; 37:1400-1413. [PMID: 35075541 DOI: 10.1007/s00455-021-10398-x] [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: 04/28/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
Abstract
Intensity-modulated radiotherapy (IMRT) is a treatment method that is used in the treatment of head and neck cancers. Impairment of chewing and swallowing functions in the early and late periods of radiotherapy is frequent. Therefore, revealing the dose-effect relationship is important. The main purpose of this study is to investigate the dose-effect relationship between chewing and swallowing structures objectively via a standardized videofluoroscopy protocol. The study included 35 participants treated with chemo-IMRT. A videofluoroscopic swallowing study (VFSS) was performed before IMRT, and 3 and 6 months after IMRT. VFSS results were scored according to the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Maximum interincisor mouth opening, body mass index (BMI), and Functional Oral Intake Scale levels were determined in these cases. The quality of life of participants was evaluated. There was a significant increase in PAS and MBSImP scores and a significant decrease in BMI scores of the patients after treatment. Xerotomy and sticky saliva complaints increased after treatment. The dose to the mastication muscles (> 40 Gy) and the temporomandibular joint (> 46 Gy) were found to be associated with a decrease in BMI; the dose to the superior pharyngeal constructor muscle (> 58 Gy) was found to be associated with pharyngeal stripping wave. The presence of aspiration was associated with the inferior pharyngeal constructor muscle, glottic larynx, supraglottic larynx, and upper esophageal sphincter. Important findings to emerge from this study include detected toxic dose limits. These findings may guide physicians to minimize the side effects of IMRT.
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Lee CT, Litwin S, Yao CMKL, Liu JC, Ridge JA, Galloway TJ. Osteoradionecrosis rate in oropharynx cancer treated with dose volume histogram based constraints. Radiother Oncol 2022; 176:215-221. [PMID: 36252636 DOI: 10.1016/j.radonc.2022.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/22/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Mandibular dose constraints are designed to limit high dose to small volumes to avoid osteoradionecrosis (ORN). Based upon a published experience, intermediate-dose constraints were introduced but have not been independently validated. We hypothesize that these constraints lower ORN rate without compromising other organs at risk (OAR). METHODS Oropharyngeal cancer patients treated with standard fractionation adjuvant/definitive VMAT from 01/2014-08/2020 were included. In 09/2017, mandibular dose constraint was changed from historical constraint (HC) of D 0.1 cc < 70 Gy to modified constraints (MC) of V 44 Gy < 42%, V 58 Gy < 25%, D 0.5 cc < 70 Gy. OAR dosimetric changes and ORN development were evaluated. Regression modelling predicted long-term ORN cases in MC group. RESULTS There were 174 patients, 71 in MC group. Seven cases of ORN in HC group at a median follow up (FU) of 39 months and 1 case of ORN in MC group at a median FU of 11 months were observed. More patients in the MC group met V 44 Gy (87% vs 62%, p < 0.01) and V 58 Gy constraints (92% vs 73%, p < 0.01). Mean doses to OARs did not rise. Mandible V 44 Gy and V 58 Gy were significantly associated with ORN (p < 0.01 and p = 0.03, respectively) across all patients. In the HC group, V 44 Gy was independently associated with ORN (p = 0.01). To account for shorter FU in MC group, logistic regression of ORN based on V 44 Gy in HC patients was performed. This predicts 3.2 ORN cases in the MC group (95% CI: 0.00-6.4). CONCLUSION Achieving V 44 Gy and V 58 Gy was successful in 87% of cases without sacrificing target coverage or OARs and resulted in non-significant ORN decrease.
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Affiliation(s)
- Charles T Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA United States.
| | - Samuel Litwin
- Department of Biostatistics and Bioinformatics, Fox Chase Cancer Center, Philadelphia, PA United States.
| | - Christopher M K L Yao
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Jeffrey C Liu
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States; Department of Otolaryngology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, United States.
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States.
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA United States.
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Contrera KJ, Chinn SB, Weber RS, Roberts D, Myers JN, Lai SY, Lewis CM, Hessel AC, Gillenwater AM, Mulcahy CF, Yu P, Hanasono MM, Fuller CD, Chambers MS, Zafereo ME. Outcomes after definitive surgery for mandibular osteoradionecrosis. Head Neck 2022; 44:1313-1323. [PMID: 35238096 PMCID: PMC9081223 DOI: 10.1002/hed.27024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/07/2022] [Accepted: 02/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). MATERIALS AND METHODS Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. RESULTS Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01-19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19-30.29) and smoking (OR 5.91, 95% CI 1.69-20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16-12.17) and preoperative swallow (OR 3.42, 95% CI 1.23-9.51). Five-year ORN-recurrence-free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43-8.94). CONCLUSIONS Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.
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Affiliation(s)
- Kevin J. Contrera
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
- Department of Plastic and Reconstructive Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven B. Chinn
- Department of Otolaryngology – Head and Neck Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan, USA
| | - Randal S. Weber
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Dianna Roberts
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Jeffery N. Myers
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Carol M. Lewis
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy C. Hessel
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ann M. Gillenwater
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Collin F. Mulcahy
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Peirong Yu
- Department of Plastic and Reconstructive Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Matthew M. Hanasono
- Department of Plastic and Reconstructive Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark S. Chambers
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mark E. Zafereo
- Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
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Utilising radiotherapy dose to guide 3D surgical reconstructions for mandibular osteoradionecrosis. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Introduction:
Following radiotherapy for head and neck cancer, a proportion of patients present with mandibular osteoradionecrosis (ORN). Reported incidence and presentation of ORN vary widely, although often initiated by trauma with radiotherapy being the biggest risk factor. Evolved disease requires surgery, mandibular resection and reconstruction. As ORN is a progressive disease, it can manifest beyond resected volumes, compromising surgery. To minimise surgical failures, we present incorporating radiotherapy dose into the surgical design and decision processes—dose guided surgery (DGS).
Method:
Five mandibular ORN patients, referred for resection and reconstruction, underwent DGS—mandible visualised on diagnostic CT, propagated to radiotherapy planning CT, radiotherapy dose displayed on the mandible, high-risk mandible converted to stl files and incorporated in the surgical design.
Results:
DGS ensures high-dose, high-risk ORN mandible is resected, and fixation devices are located in low-dose, low-risk areas.
Conclusions:
DGS represents a potential new standard of care for patients presenting with mandibular ORN post-radiotherapy. Formal follow-up of this small cohort is ongoing although DSG is anticipated to increase the success rate of this high cost, high burden procedure compared to surgery designed on clinical and radiological assessments alone.
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Sato A, Kraynak J, Marciscano AE, Galluzzi L. Radiation therapy: An old dog learning new tricks. Methods Cell Biol 2022; 172:xiii-xxiii. [PMID: 36064230 PMCID: PMC10087864 DOI: 10.1016/s0091-679x(22)00139-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Álvarez-Abril B, Bloy N, Galassi C, Sato A, Jiménez-Cortegana C, Klapp V, Aretz A, Guilbaud E, Buqué A, Galluzzi L, Yamazaki T. Cytofluorometric assessment of acute cell death responses driven by radiation therapy. Methods Cell Biol 2022; 172:17-36. [DOI: 10.1016/bs.mcb.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Jing Z, Guo S, Li Y, Liang Z. FOXC2/ADAM12-dependent radiosensitivity of head and neck squamous cell carcinoma cells. Head Neck 2021; 44:212-225. [PMID: 34731528 DOI: 10.1002/hed.26918] [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: 04/18/2021] [Revised: 09/21/2021] [Accepted: 10/18/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Radiotherapy greatly benefits patients with tumors, but not all patients show favorable treatment response. This study investigated the impact of forkhead box protein C2 (FOXC2)-mediated a disintegrin and metalloprotease 12 (ADAM12) on the radiosensitivity of head and neck squamous cell carcinoma (HNSCC). METHODS After transfection and ionizing radiation, the biological activities of HNSCC cells were assessed. The relationship between ADAM12 and FOXC2 was verified. A xenograft model was used to evaluate the effect of FOXC2 knockdown on HNSCC growth in the context of radiation therapy. RESULTS FOXC2 and ADAM12 were upregulated in irradiated CAL-27 and HN4 cells. Knockdown of FOXC2 suppressed the malignant behaviors of CAL-27 and HN4 cells and inhibited the growth of transplanted tumors in nude mice. FOXC2 could bind ADAM12 promoter. Overexpression of ADAM12 reversed the promotion of FOXC2 silencing on the radiosensitivity of HNSCC cells. CONCLUSIONS FOXC2 regulates the radiosensitivity of HNSCC by targeting ADAM12.
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Affiliation(s)
- Zhibin Jing
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Sitong Guo
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Yao Li
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
| | - Zheng Liang
- Department of Otorhinolaryngology, Tianjin Medical University General Hospital, Tianjin, China
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16
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Cai R, Xiao L, Liu M, Du F, Wang Z. Recent Advances in Functional Carbon Quantum Dots for Antitumour. Int J Nanomedicine 2021; 16:7195-7229. [PMID: 34720582 PMCID: PMC8550800 DOI: 10.2147/ijn.s334012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/23/2021] [Indexed: 12/20/2022] Open
Abstract
Carbon quantum dots (CQDs) are an emerging class of quasi-zero-dimensional photoluminescent nanomaterials with particle sizes less than 10 nm. Owing to their favourable water dispersion, strong chemical inertia, stable optical performance, and good biocompatibility, CQDs have become prominent in biomedical fields. CQDs can be fabricated by “top-down” and “bottom-up” methods, both of which involve oxidation, carbonization, pyrolysis and polymerization. The functions of CQDs include biological imaging, biosensing, drug delivery, gene carrying, antimicrobial performance, photothermal ablation and so on, which enable them to be utilized in antitumour applications. The purpose of this review is to summarize the research progress of CQDs in antitumour applications from preparation and characterization to application prospects. Furthermore, the challenges and opportunities of CQDs are discussed along with future perspectives for precise individual therapy of tumours.
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Affiliation(s)
- Rong Cai
- Central Laboratory, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, 215600, People's Republic of China
| | - Long Xiao
- Central Laboratory, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, 215600, People's Republic of China
| | - Meixiu Liu
- Central Laboratory, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, 215600, People's Republic of China
| | - Fengyi Du
- School of Medicine, Zhenjiang, Jiangsu, 212013, People's Republic of China
| | - Zhirong Wang
- Central Laboratory, Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, Jiangsu, 215600, People's Republic of China
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Oral pH value predicts the incidence of radiotherapy related caries in nasopharyngeal carcinoma patients. Sci Rep 2021; 11:12283. [PMID: 34112869 PMCID: PMC8192759 DOI: 10.1038/s41598-021-91600-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/12/2021] [Indexed: 11/29/2022] Open
Abstract
Radiotherapy-related caries is a complication of radiotherapy for nasopharyngeal carcinoma; however, factors influencing the occurrence, accurate prediction of onset, and protective factors of radiotherapy-related caries remain unclear. This study analyzed risk factors, disease predictors, and protective factors for radiotherapy-related caries in nasopharyngeal carcinoma. This prospective study included 138 nasopharyngeal carcinoma patients receiving radical radiotherapy at our hospital during June 2012–December 2016 and were followed up for dental caries. Patients’ clinical data on radiotherapy were collected, dynamic monitoring was performed to assess changes in oral pH values, and a questionnaire survey was administered to collect patients’ lifestyle habits. Time-dependent cox regression trees, event-free Kaplan–Meier curve, Mann–Whitely U test were used to analysis the results. The median follow-up time was 30 (12–60) months. Radiotherapy-related caries occurred in 28 cases (20.3%). Univariate analyses showed that radiotherapy-related caries was associated with patient’s age, oral saliva pH value, green tea consumption, and radiation dose to sublingual glands, but not with the radiation dose to the parotid and submandibular glands. Multivariate analysis showed that oral saliva pH value [hazard ratio (HR) = 0.390, 95% confidence interval = 0.204–0.746] was an independent prognostic factor for radiotherapy-related caries. Patients with oral saliva pH values ≤ 5.3 in the 9th month after radiotherapy represented a significantly higher risks for radiotherapy-related caries (p < 0.001). Green tea consumption was associated with the occurrence of radiotherapy-related caries, and oral saliva pH values could predict the occurrence of radiotherapy-related caries. Limiting radiation doses to sublingual glands can reduce the occurrence of radiotherapy-related caries.
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Greco E, Ringash J, Tomlinson G, Huang SH, O'Sullivan B, Waldron J, Martino R. Presence and duration of feeding tube in a 5-year cohort of patients with head and neck cancer treated with curative intensity-modulated radiation therapy. Head Neck 2021; 43:1610-1620. [PMID: 33580567 DOI: 10.1002/hed.26638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Our study assessed post-radiation therapy (RT) G-tube presence, duration, and clinical predictors in patients with head and neck cancer (HNC). METHODS We identified those 1-5-years post-RT with stage III/IV nasopharyngeal, oropharyngeal, hypopharyngeal, laryngeal, or unknown primaries. Logistic regression identified predictors of post-RT G-tube presence, Kaplan-Meier analysis estimated G-tube days, and log-rank test compared by tumor site. RESULTS The 977 patients had mean age 60.6 ± 11.6 years, 804 (82.3%) male, 764 (78.2%) stage IV, and 618 (63.3%) oropharyngeal primaries. All patients received intensity-modulated RT (IMRT), 571 (58.4%) received chemotherapy, and 698 (71.4%) prophylactic G-tube. G-tube prevalence 1- and 5-years post-IMRT was 7.1% and 4.8%, respectively. Median post-IMRT G-tube days were overall 63 (95%CI: 56-70), nasopharynx 119 (95%CI: 109-131), oropharynx 57 (95%CI: 51-68), hypopharynx 126 (95%CI: 77-256), larynx 53 (95%CI: 21-63), unknown 30 (95%CI: 17-55), of which hypopharynx was highest p < 0.001. CONCLUSIONS At an institution offering prophylactic G-tube for patients with advanced HNC, no differences were found in yearly G-tube use 1-5 years post-IMRT. Across all patients, median post-IMRT days with G-tube was 63 day but those with hypopharyngeal tumors registered the most days.
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Affiliation(s)
- Elissa Greco
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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Kubota H, Miyawaki D, Mukumoto N, Ishihara T, Matsumura M, Hasegawa T, Akashi M, Kiyota N, Shinomiya H, Teshima M, Nibu KI, Sasaki R. Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma. Radiat Oncol 2021; 16:1. [PMID: 33402192 PMCID: PMC7786900 DOI: 10.1186/s13014-020-01701-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters. METHODS We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008-2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy-70 Gy [V10-70]) were investigated and compared between patients with and without ORNJ. The Mann-Whitney U test was used to compare RT dose parameters. Univariate and multivariate Cox regression analyses were used to assess factors associated with ORNJ development. Kaplan-Meier analyses were performed for cumulative ORNJ incidence estimation. RESULTS Forty-six patients (7.5%) developed ORNJ. The median follow-up duration was 40 (range 3-145) months. The median time to ORNJ development was 27 (range 2-127) months. DVH analysis revealed that V30-V70 values were significantly higher in patients with than in those without ORNJ. In univariate analyses, primary tumor site, pre-RT mandible surgery, post-RT tooth extraction, and V60 > 14% were identified as important factors. In multivariate analyses, V60 > 14% (p = 0.0065) and primary tumor site (p = 0.0059) remained significant. The 3-year cumulative ORNJ incidence rates were 2.5% and 8.6% in patients with V60 ≤ 14% and > 14%, respectively (p < 0.0001), and 9.3% and 1.4% in patients with oropharyngeal or oral cancer and other cancers, respectively (p < 0.0001). CONCLUSIONS V60 > 14% and oropharyngeal or oral cancer were found to be independent risk factors for ORNJ. These findings might be useful to minimize ORNJ incidence in HNSCC treated with curative RT.
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Affiliation(s)
- Hikaru Kubota
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Daisuke Miyawaki
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Naritoshi Mukumoto
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Takeaki Ishihara
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan
| | - Megumi Matsumura
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naomi Kiyota
- Kobe University Hospital Cancer Center, Kobe, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Teshima
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryohei Sasaki
- Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan.
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20
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Liao Y, Wang D, Gu Z. Research Progress of Nanomaterials for Radioprotection. ACTA CHIMICA SINICA 2021. [DOI: 10.6023/a21070319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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21
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Luitje ME, Israel AK, Cummings MA, Giampoli EJ, Allen PD, Newlands SD, Ovitt CE. Long-Term Maintenance of Acinar Cells in Human Submandibular Glands After Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 109:1028-1039. [PMID: 33181249 DOI: 10.1016/j.ijrobp.2020.10.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE In a combined retrospective and prospective study, human salivary glands were investigated after radiation treatment for head and neck cancers. The aim was to assess acinar cell loss and morphologic changes after radiation therapy and to determine whether irradiated salivary glands have regenerative potential. METHODS AND MATERIALS Irradiated human submandibular and parotid salivary glands were collected from 16 patients at a range of time intervals after completion of radiation therapy (RT). Control samples were collected from 14 patients who had not received radiation treatments. Tissue sections were analyzed using immunohistochemistry to stain for molecular markers. RESULTS Human submandibular and parotid glands isolated less than 1 year after RT showed a near complete loss of acinar cells. However, acinar units expressing functional secretory markers were observed in all samples isolated at later intervals after RT. Significantly lower acinar cell numbers and increased fibrosis were found in glands treated with combined radiation and chemotherapy, in comparison to glands treated with RT alone. Irradiated samples showed increased staining for duct cell keratin markers, as well as many cells coexpressing acinar- and duct cell-specific markers, in comparison to nonirradiated control samples. CONCLUSIONS After RT, acinar cell clusters are maintained in human submandibular glands for years. The surviving acinar cells retain proliferative potential, although significant regeneration does not occur. Persistent DNA damage, increased fibrosis, and altered cell identity suggest mechanisms that may impair regeneration.
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Affiliation(s)
- Martha E Luitje
- Department of Otolaryngology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Anna-Karoline Israel
- Department of Pathology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Michael A Cummings
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Ellen J Giampoli
- Department of Pathology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Paul D Allen
- Department of Otolaryngology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Shawn D Newlands
- Department of Otolaryngology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Catherine E Ovitt
- Center for Oral Biology, Department of Biomedical Genetics, University of Rochester School of Medicine and Dentistry, Rochester, New York.
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Mendenhall WM, Strojan P, Lee AWM, Rinaldo A, Eisbruch A, Ng WT, Smee R, Ferlito A. Radiotherapy in the management of glottic squamous cell carcinoma. Head Neck 2020; 42:3558-3567. [PMID: 32896071 DOI: 10.1002/hed.26419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Our purpose is to review the role radiotherapy (RT) in the treatment of glottic squamous cell carcinoma (SCC). METHODS A concise review of the pertinent literature. RESULTS RT cure rates are Tis- T1N0, 90% to 95%; T2N0, 70% to 80%; low-volume T3-T4a, 65% to 70%. Concomitant cisplatin is given for T3-T4a SCCs. Severe complications occur in 1% to 2% for Tis-T2N0 and 10% for T3-T4a SCCs. Patients with high-volume T3-T4 SCCs undergo total laryngectomy, neck dissection, and postoperative RT. Those with positive margins and/or extranodal extension receive concomitant cisplatin. The likelihood of local-regional control at 5 years is 85% to 90%. Severe complications occur in 5% to 10%. CONCLUSIONS RT is a good treatment option for patients with Tis-T2N0 and low-volume T3-T4a glottic SCCs. Patients with higher volume T3-T4 cancers are best treated with surgery and postoperative RT.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital, University of Hong Kong, Hong Kong, China
| | | | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Wai Tong Ng
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Ahmad P, Slavik M, Trachtova K, Gablo NA, Kazda T, Gurin D, Smilek P, Horakova Z, Gal B, Hermanova M, Slampa P, Sana J, Slaby O. Salivary microRNAs identified by small RNA sequencing as potential predictors of response to intensity-modulated radiotherapy in head and neck cancer patients. Cell Oncol (Dordr) 2020; 43:505-511. [PMID: 32266559 DOI: 10.1007/s13402-020-00507-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Progress in radiation therapy of head and neck squamous cell carcinomas (HNSCCs) is logically linked to the development of molecular predictors that would help to enhance individually tailored treatment. MicroRNA (miRNA) expression profiles in tumors have repeatedly been tested to optimize the molecular diagnostics of HNSCC. In addition to tumor tissues, miRNAs are stably present in body fluids, including saliva, and can thus be collected non-invasively. The aim of our current study was to evaluate whether salivary miRNAs have potential as response predictors in HNSCC patients treated with intensity modulated radiation therapy (IMRT). METHODS In total 48 HNSCC patients treated by definitive IMRT were enrolled in our prospective study. To identify predictive salivary miRNAs, we used small RNA sequencing in 14 saliva samples of HNSCC patients and qRT-PCR validation of selected miRNA candidates in an independent set of 34 patients. RESULTS We found that salivary miR-15a-5p and miR-15b-5p exhibited differential levels between patients with and without complete remission (p = 0.025 and p = 0.028, respectively). Subsequent Kaplan-Meier analysis confirmed that patients with higher levels of miR-15a-5p reached a significantly longer locoregional progression-free survival (LPFS) than those with low levels (p = 0.024). Finally, multivariate Cox regression analysis revealed that miR-15a-5p may serve as an independent predictive biomarker of LPFS in HNSCC patients treated with IMRT (HR 0.104; 95% CI 0.004-0.911; p = 0.04). CONCLUSIONS We conclude that salivary miR-15a-5p may represent a potential biomarker for individualized treatment decision-making in HNSCC patients.
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Affiliation(s)
- Parwez Ahmad
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Marek Slavik
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Karolina Trachtova
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Natalia Anna Gablo
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Tomas Kazda
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Dominik Gurin
- 1st Department of Pathology, Medical Faculty, St. Anne´s University Hospital, Masaryk University, Brno, Czech Republic
| | - Pavel Smilek
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical Faculty, St. Anne´s University Hospital, Masaryk University, Brno, Czech Republic
| | - Zuzana Horakova
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical Faculty, St. Anne´s University Hospital, Masaryk University, Brno, Czech Republic
| | - Bretislav Gal
- Department of Otorhinolaryngology and Head and Neck Surgery, Medical Faculty, St. Anne´s University Hospital, Masaryk University, Brno, Czech Republic
| | - Marketa Hermanova
- 1st Department of Pathology, Medical Faculty, St. Anne´s University Hospital, Masaryk University, Brno, Czech Republic
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Jiri Sana
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic. .,Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic. .,Department of Pathology, University Hospital, Brno, Czech Republic.
| | - Ondrej Slaby
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic. .,Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic. .,Department of Pathology, University Hospital, Brno, Czech Republic.
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Chen G, Li Y, He Y, Zeng B, Yi C, Wang C, Zhang X, Zhao W, Yu D. Upregulation of Circular RNA circATRNL1 to Sensitize Oral Squamous Cell Carcinoma to Irradiation. MOLECULAR THERAPY. NUCLEIC ACIDS 2020; 19:961-973. [PMID: 32032888 PMCID: PMC7005496 DOI: 10.1016/j.omtn.2019.12.031] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/14/2022]
Abstract
Accumulating evidence has demonstrated that circular RNAs (circRNAs) play important roles in regulating gene expression involved in tumor development. However, the role of circRNAs in modulating the radiosensitivity of oral squamous cell carcinoma (OSCC) and its potential mechanisms have not been documented. We performed high-throughput RNA sequencing (RNA-seq) to investigate the circRNA expression profile in OSCC patients and discovered that the circATRNL1 expression was significantly downregulated and closely related to tumor progression. The circATRNL1 was structurally validated via Sanger sequencing, RNase R treatment, and specific convergent and divergent primer amplification. Importantly, the expression levels of circATRNL1 decreased after irradiation treatment, and upregulation of circATRNL1 enhanced the radiosensitivity of OSCC through suppressing proliferation and the colony survival fraction, inducing apoptosis and cell-cycle arrest. Moreover, we observed that circATRNL1 could directly bind to microRNA-23a-3p (miR-23a-3p) and relieve inhibition for the target gene PTEN. In addition, the tumor radiosensitivity-promoting effect of circATRNL1 overexpression was blocked by miR-23a-3p in OSCC. Further experiments also showed that PTEN can reverse the inhibitory effect of OSCC radiosensitivity triggered by miR-23a-3p. We concluded that circANTRL1 may function as the sponge of miR-23a-3p to promote PTEN expression and eventually contributes to OSCC radiosensitivity enhancement. This study indicates that circANTRL1 may be a novel therapeutic target to improve the efficiency of radiotherapy in OSCC.
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Affiliation(s)
- Guanhui Chen
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
| | - Yiming Li
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
| | - Yi He
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
| | - Binghui Zeng
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
| | - Chen Yi
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
| | - Chao Wang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
| | - Xiliu Zhang
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China
| | - Wei Zhao
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China.
| | - Dongsheng Yu
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China; Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong 510055, China.
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Charters EK, Bogaardt H, Freeman-Sanderson AL, Ballard KJ. Systematic review and meta-analysis of the impact of dosimetry to dysphagia and aspiration related structures. Head Neck 2019; 41:1984-1998. [PMID: 30680831 DOI: 10.1002/hed.25631] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 10/21/2018] [Accepted: 12/14/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Technological advances in radiotherapy have allowed investigations into new methods to spare healthy tissue in those treated for head and neck cancer. This systematic review with meta-analysis demonstrates the effect that radiation has on swallowing. METHODS Selection and analysis of studies examining the effect of radiation to swallowing structures. A fixed effects meta-analysis calculated the pooled proportions for select outcomes of dysphagia, common across many studies. RESULTS The majority of the papers found a correlation between radiation dose to the swallowing structures and dysphagia, however a meta-analysis found the studies carried a significant degree of heterogeneity. The appraisal demonstrates the need for large-scale studies using a randomized design and instrumental dysphagia assessments. CONCLUSIONS Radiation dose to dysphagia and aspiration structures is correlated with incidence of dysphagia and aspiration. The variables in this population contribute to the heterogeneity within and cross studies and future studies should consider controlling for this.
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Affiliation(s)
| | - Hans Bogaardt
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | | | - Kirrie J Ballard
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Ant A, Yazici Ö, Atabey P, Aslan FF, Duran A, Ozlugedik S, Kemaloglu YK. Is intensity-modulated radiotherapy superior to conventional techniques to prevent late ear complications of nasopharyngeal cancer? Eur Arch Otorhinolaryngol 2019; 276:977-984. [PMID: 30671602 DOI: 10.1007/s00405-019-05299-7] [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: 11/23/2018] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE This study analyzed the late ear complications of radiotherapy for nasopharyngeal cancer (NPC) and compared the conventional and intensity-modulated radiotherapy (2D-RT and IMRT, respectively). METHODS At 2-21 years after the end of NPC treatment, 104 ears of 52 patients were evaluated with the otoscopic examination, pure tone audiometry test, tympanometry, and subjective complaints by being blinded to the radiotherapy technique. RESULTS There were no differences in terms of the pathology of the external, middle or inner ear, air and bone-conduction hearing thresholds, and the air-bone (A-B) gap at 500, 1000, 2000, and 4000 Hz, and tympanometry types between 2D-RT and IMRT groups (p > 0.05). There were positive correlations between the values of A500 and A1000 thresholds; gap 500, 4000, and mean cochlear RT dose (p < 0.05). There were positive correlations between the values of A500, A1000, and A4000 thresholds; gap 500, 1000, 2000, 4000, and maximum cochlear RT dose (p < 0.05). CONCLUSION IMRT was not found to be superior to 2D-RT to prevent RT-induced ear complications. The solution of the middle ear problems must be the goal of the strategies for complications treatment.
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Affiliation(s)
- Ayca Ant
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Medical Sciences, Ankara A.Y. Oncology Education and Research Hospital, Yenimahalle, 06200, Ankara, Turkey.
| | - Ömer Yazici
- Department of Radiation Oncology, University of Medical Sciences, Ankara A.Y. Oncology Education and Research Hospital, Ankara, Turkey
| | - Pinar Atabey
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Medical Sciences, Ankara A.Y. Oncology Education and Research Hospital, Yenimahalle, 06200, Ankara, Turkey
| | - Ferit Ferhat Aslan
- Department of Medical Oncology, University of Medical Sciences, Ankara A.Y. Oncology Education and Research Hospital, Ankara, Turkey
| | - Arzubetul Duran
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Medical Sciences, Ankara A.Y. Oncology Education and Research Hospital, Yenimahalle, 06200, Ankara, Turkey
| | - Samet Ozlugedik
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Medical Sciences, Ankara A.Y. Oncology Education and Research Hospital, Yenimahalle, 06200, Ankara, Turkey
| | - Yusuf Kemal Kemaloglu
- Department of Otorhinolaryngology, Head and Neck Surgery, Gazi University School of Medicine, Ankara, Turkey
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Radiation therapy for patients with newly diagnosed metastatic head and neck squamous cell carcinoma. Head Neck 2018; 41:130-138. [DOI: 10.1002/hed.25476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/11/2018] [Accepted: 07/05/2018] [Indexed: 11/07/2022] Open
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Ibragimov B, Toesca D, Chang D, Yuan Y, Koong A, Xing L. Development of deep neural network for individualized hepatobiliary toxicity prediction after liver SBRT. Med Phys 2018; 45:4763-4774. [PMID: 30098025 DOI: 10.1002/mp.13122] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Accurate prediction of radiation toxicity of healthy organs-at-risks (OARs) critically determines the radiation therapy (RT) success. The existing dose-volume histogram-based metric may grossly under/overestimate the therapeutic toxicity after 27% in liver RT and 50% in head-and-neck RT. We propose the novel paradigm for toxicity prediction by leveraging the enormous potential of deep learning and go beyond the existing dose/volume histograms. EXPERIMENTAL DESIGN We employed a database of 125 liver stereotactic body RT (SBRT) cases with follow-up data to train deep learning-based toxicity predictor. Convolutional neural networks (CNNs) were applied to discover the consistent patterns in 3D dose plans associated with toxicities. To enhance the predicting power, we first pretrain the CNNs with transfer learning from 3D CT images of 2644 human organs. CNNs were then trained on liver SBRT cases. Furthermore, nondosimetric pretreatment features, such as patients' demographics, underlying liver diseases, liver-directed therapies, were inputted into the fully connected neural network for more comprehensive prediction. The saliency maps of CNNs were used to estimate the toxicity risks associated with irradiation of anatomical regions of specific OARs. In addition, we applied machine learning solutions to map numerical pretreatment features with hepatobiliary toxicity manifestation. RESULTS Among 125 liver SBRT patients, 58 were treated for liver metastases, 36 for hepatocellular carcinoma, 27 for cholangiocarcinoma, and 4 for other histologies. We observed that CNN we able to achieve accurate hepatobiliary toxicity prediction with the AUC of 0.79, whereas combining CNN for 3D dose plan analysis and fully connected neural networks for numerical feature analysis resulted in AUC of 0.85. Deep learning produces almost two times fewer false-positive toxicity predictions in comparison to DVH-based predictions, when the number of false negatives, i.e., missed toxicities, was minimized. The CNN saliency maps automatically estimated the toxicity risks for portal vein (PV) regions. We discovered that irradiation of the proximal portal vein is associated with two times higher toxicity risks (risk score: 0.66) that irradiation of the left portal vein (risk score: 0.31). CONCLUSIONS The framework offers clinically accurate tools for hepatobiliary toxicity prediction and automatic identification of anatomical regions that are critical to spare during SBRT.
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Affiliation(s)
- Bulat Ibragimov
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Diego Toesca
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Daniel Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Yixuan Yuan
- Department of Electronic Engineering, City University of Hong Kong, Hong Kong, China
| | - Albert Koong
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Lei Xing
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
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Chen L, Wen Y, Zhang J, Sun W, Lui VWY, Wei Y, Chen F, Wen W. Prediction of radiotherapy response with a 5-microRNA signature-based nomogram in head and neck squamous cell carcinoma. Cancer Med 2018; 7:726-735. [PMID: 29473326 PMCID: PMC5852342 DOI: 10.1002/cam4.1369] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 12/26/2022] Open
Abstract
Radiotherapy is unlikely to benefit all patients with head and neck squamous cell carcinoma (HNSCC). Therefore, novel method is warranted to predict the radiotherapy response. Our study aimed to construct a microRNA (miRNA)‐based nomogram to predict clinical outcomes of patients with HNSCC receiving radiotherapy. We screened out 56 differential miRNAs by analyzing 44 paired tumor and adjacent normal samples miRNA expression profiles from The Cancer Genome Atlas (TCGA). A total of 307 patients with HNSCC receiving adjuvant radiotherapy were randomly divided into a training set (n = 154) and a validation set (n = 153). In the training set, we combined the differential miRNA profiles with clinical outcomes, and LASSO regression model was applied to establish a 5‐miRNA signature. The prediction accuracy of the 5‐miRNA signature was further validated. In addition, target genes of these miRNAs were predicted, and Gene Ontology (GO) analysis as well as KEGG pathway analysis was executed. A 5‐miRNA signature including miR‐99a, miR‐31, miR‐410, miR‐424, and miR‐495 was identified. With a cutoff value of 1.2201 from Youden's index, the training set was divided into high‐risk and low‐risk groups, and the 5‐year overall survival was significantly different (30% vs. 73%, HR 3.65, CI 2.46–8.16; P < 0.0001). Furthermore, our 5‐miRNA signature revealed that only low‐risk group would benefit from radiotherapy. Then, a nomogram combining 5‐miRNA signature with clinical variables to predict radiotherapy response was constructed. The analysis of 108 target genes of these miRNAs revealed some potential mechanisms in HNSCC radiotherapy response for future investigations. In conclusion, the 5‐miRNA signature‐based nomogram is useful in predicting radiotherapy response in HNSCC and might become a promising tool to optimize radiation strategies.
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Affiliation(s)
- Lin Chen
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, China
| | - Yihui Wen
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, China
| | - Jingwei Zhang
- Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Sun
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, China
| | - Vivian W Y Lui
- Faculty of Medicine, School of Biomedical Sciences, the Chinese University of Hong Kong, Hong Kong SAR
| | - Yi Wei
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, China
| | - Fenghong Chen
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, China
| | - Weiping Wen
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangzhou Key Laboratory of Otorhinolaryngology, Guangzhou, China
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Leibowitz A, Grossman E, Berkovitch A, Levartovski M, Appel S, Sharabi Y, Gluck I. The Effect of Head and Neck Radiotherapy on Blood Pressure and Orthostatic Hypotension in Patients With Head and Neck Tumors. Am J Hypertens 2018; 31:235-239. [PMID: 28985342 DOI: 10.1093/ajh/hpx158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Radiotherapy (RT) plays a key role in the management of head and neck cancer (HNC), especially in locally advanced disease. Patients undergoing head and neck RT, especially elderly ones, are suffering from low and labile blood pressure (BP) during the treatment. They complain of weakness and fatigue and are prone to recurrent falls. The aim of this study was to characterize BP changes during RT period. METHODS Patients with HNC, receiving radiation to the neck, were recruited from Sheba medical center RT unit. Office BP, orthostatic measurements, 24-hour ambulatory BP monitoring, body weight, and metabolic parameters were measured at baseline after 30 days and after 90 days from beginning of therapy. RESULTS Nineteen patients (17 males), 64 ± 12 years old were recruited. Nine hypertensive patients continued their antihypertensive treatment during the study. Office systolic BP and diastolic BP decreased significantly after 30 days (128 ± 4/80 ± 3 to 122 ± 3/74 ± 3 mm Hg; P < 0.05). Average 24-hour BP values after 30 days of RT decreased from 130 ± 3/76 ± 2 to 123 ± 3/71 ± 2 mm Hg; P < 0.05. A similar trend was observed for day and night BP levels. Decrease in office and ambulatory BP was sustained for several months after RT completion. No orthostasis was observed during the study period. Patient lost weight significantly during the study period. However, BP changes were independent of weight loss. CONCLUSION There is a significant and sustained BP reduction after head and neck RT, without orthostatic changes. Clinicians should be aware of this phenomenon and consider treatment adaption accordingly.
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Affiliation(s)
- Avshalom Leibowitz
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Ehud Grossman
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Anat Berkovitch
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Meital Levartovski
- Oncology Department, Radiotherapy Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Sarit Appel
- Oncology Department, Radiotherapy Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Yehonatan Sharabi
- Internal Medicine D and Hypertension Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Iris Gluck
- Oncology Department, Radiotherapy Unit, The Chaim Sheba Medical Center, Tel-Hashomer, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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O'Cathail SM, Karir N, Shah K. Optimising volumetric arc radiotherapy for dental rehabilitation in oropharynx cancer - A retrospective dosimetry review and feasibility planning study. Oral Oncol 2018; 76:16-21. [PMID: 29290281 DOI: 10.1016/j.oraloncology.2017.11.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/17/2017] [Accepted: 11/20/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE To assess the dosimetry to dentally relevant substructures within the mandible/maxilla, establish the predictors of increased mean anterior mandible dose and assess the feasibility of rationale optimisation of dose to the anterior mandible (AM) volume to aid reconstructive dental surgery planning, where the AM is a critical structure. MATERIALS AND METHODS In a cohort of radically treated oropharynx cancer patients we conducted a retrospective dosimetry analysis of mandible/maxilla volumes, created using a published atlas. Comparisons of mean AM dose and clinical parameters between groups were tested using Wilcoxon rank-sum and Kruskal-Wallis tests. A multivariate linear regression model was created to assess independent predictors of increased mean AM dose. Patients with a mean AM dose over 37.5 Gy were included in feasibility planning study to test the hypothesis that it is possible to safely limit the dose whilst maintaining dose tolerances for other organs at risk. RESULTS 57 patients were included. Median AM mean dose was 32.2 Gy (IQR 27.7-38.7). T stage, N stage and inclusion of Level 1B were significantly associated with increased mean AM dose. Only T stage (p = .0132) and Level Ib inclusion (p = .018) remained significant in the linear regression model. 88% of plans, all of which included Level Ib, were successfully re-optimised without breaching accepted constraints. CONCLUSIONS Oropharynx cancer patients with advanced T stage and who require Level Ib treatment receive increased mean AM dose, potentially limiting surgical dental rehabilitation options. The majority of patients can be optimised safely with appropriate AM contouring.
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Affiliation(s)
- Sean M O'Cathail
- Oxford Institute of Radiation Oncology, University of Oxford, Old Road, OX3 7DQ, United Kingdom.
| | - Naveen Karir
- Dept. of Restorative Dentistry, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, OX3 7DQ, United Kingdom
| | - Ketan Shah
- Dept. of Oncology, Churchill Hospital, Oxford University NHS Foundation Trust, OX3 7DQ, United Kingdom
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Dean J, Wong K, Gay H, Welsh L, Jones AB, Schick U, Oh JH, Apte A, Newbold K, Bhide S, Harrington K, Deasy J, Nutting C, Gulliford S. Incorporating spatial dose metrics in machine learning-based normal tissue complication probability (NTCP) models of severe acute dysphagia resulting from head and neck radiotherapy. Clin Transl Radiat Oncol 2018; 8:27-39. [PMID: 29399642 PMCID: PMC5796681 DOI: 10.1016/j.ctro.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/20/2022] Open
Abstract
Severe acute dysphagia commonly results from head and neck radiotherapy (RT). A model enabling prediction of severity of acute dysphagia for individual patients could guide clinical decision-making. Statistical associations between RT dose distributions and dysphagia could inform RT planning protocols aiming to reduce the incidence of severe dysphagia. We aimed to establish such a model and associations incorporating spatial dose metrics. Models of severe acute dysphagia were developed using pharyngeal mucosa (PM) RT dose (dose-volume and spatial dose metrics) and clinical data. Penalized logistic regression (PLR), support vector classification and random forest classification (RFC) models were generated and internally (173 patients) and externally (90 patients) validated. These were compared using area under the receiver operating characteristic curve (AUC) to assess performance. Associations between treatment features and dysphagia were explored using RFC models. The PLR model using dose-volume metrics (PLRstandard) performed as well as the more complex models and had very good discrimination (AUC = 0.82) on external validation. The features with the highest RFC importance values were the volume, length and circumference of PM receiving 1 Gy/fraction and higher. The volumes of PM receiving 1 Gy/fraction or higher should be minimized to reduce the incidence of severe acute dysphagia.
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Key Words
- pm, pharyngeal mucosa
- plr, penalized logistic regression
- svc, support vector classification
- rfc, random forest classification
- auc, area under the receiver operating characteristic curve
- ntcp, normal tissue complication probability
- rt, radiotherapy
- imrt, intensity modulated radiotherapy
- ctcae, common terminology criteria for adverse events
- peg, percutaneous endoscopic gastrostomy
- dvh, dose-volume histogram
- dlh, dose-length histogram
- dch, dose-circumference histogram
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Affiliation(s)
- Jamie Dean
- Joint Department of Physics at the Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Kee Wong
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Liam Welsh
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Ann-Britt Jones
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Ulricke Schick
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aditya Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Shreerang Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Joseph Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Sarah Gulliford
- Joint Department of Physics at the Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
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Wilke CT, Zaid M, Chung C, Fuller CD, Mohamed ASR, Skinner H, Phan J, Gunn GB, Morrison WH, Garden AS, Frank SJ, Rosenthal DI, Chambers MS, Koay EJ. Design and fabrication of a 3D-printed oral stent for head and neck radiotherapy from routine diagnostic imaging. 3D Print Med 2017; 3:12. [PMID: 29782600 PMCID: PMC5954788 DOI: 10.1186/s41205-017-0021-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Oral stents have been shown to reduce the deleterious effects of head and neck radiotherapy through the displacement of normal tissues away from the areas of high dose irradiation. While these stents are commonly used in the treatment of patients with head and neck cancer at many large academic cancer centers, their use is much more limited outside of these institutions due to the time and expertise required for their fabrication. Results In the study, we describe a novel method to design and manufacture oral stents from routine computed tomography (CT) imaging studies through the use of 3D printing technologies. Conclusion Our proposed method may help to greatly expand access to these beneficial devices for patients undergoing radiation treatment at centers without access to dental and oral/maxillofacial specialists.
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Affiliation(s)
- Christopher T Wilke
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN USA.,2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Mohamed Zaid
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Caroline Chung
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Clifton D Fuller
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Abdallah S R Mohamed
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Heath Skinner
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Jack Phan
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - G Brandon Gunn
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - William H Morrison
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Adam S Garden
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Steven J Frank
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - David I Rosenthal
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
| | - Mark S Chambers
- 3Department of Head and Neck Surgery, Section of Oral Oncology, University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Eugene J Koay
- 2Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1220 Holcombe Blvd, MS97, Houston, TX 77030 USA
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Brodin NP, Kabarriti R, Garg MK, Guha C, Tomé WA. Systematic Review of Normal Tissue Complication Models Relevant to Standard Fractionation Radiation Therapy of the Head and Neck Region Published After the QUANTEC Reports. Int J Radiat Oncol Biol Phys 2017; 100:391-407. [PMID: 29353656 DOI: 10.1016/j.ijrobp.2017.09.041] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/02/2017] [Accepted: 09/21/2017] [Indexed: 12/21/2022]
Abstract
There has recently been an increasing interest in model-based evaluation and comparison of different treatment options in radiation oncology studies. This is partly driven by the considerable technical advancements in radiation therapy of the last decade, leaving radiation oncologists with a multitude of options to consider. In lieu of randomized trials comparing all of these different treatment options for varying indications, which is unfeasible, treatment evaluations based on normal tissue complication probability (NTCP) models offer a practical alternative. The Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) effort, culminating in a number of reports published in 2010, provided a basis for many of the since-implemented dose-response models and dose-volume constraints and was a key component for model-based treatment evaluations. Given that 7 years have passed since the QUANTEC publications and that patient-reported outcomes have emerged as an important consideration in recent years, an updated summary of the published radiation dose-response literature, which includes a focus on patient-reported quality of life outcomes, is warranted. Here we provide a systematic review of quantitative dose-response models published after January 1, 2010 for endpoints relevant to radiation therapy for head and neck cancer, because these patients are typically at risk for a variety of treatment-induced normal tissue complications.
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Affiliation(s)
- N Patrik Brodin
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York
| | - Rafi Kabarriti
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York
| | - Madhur K Garg
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Bronx, New York; Department of Urology, Montefiore Medical Center, Bronx, New York
| | - Chandan Guha
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Urology, Montefiore Medical Center, Bronx, New York; Department of Pathology, Albert Einstein College of Medicine, Bronx, New York
| | - Wolfgang A Tomé
- Institute for Onco-Physics, Department of Radiation Oncology, Albert Einstein College of Medicine, Bronx, New York; Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York; Department of Neurology, Albert Einstein College of Medicine, Bronx, New York.
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Durante M, Orecchia R, Loeffler JS. Charged-particle therapy in cancer: clinical uses and future perspectives. Nat Rev Clin Oncol 2017; 14:483-495. [DOI: 10.1038/nrclinonc.2017.30] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Espenel S, Garcia MA, Guy JB, Vallard A, Ben Mrad M, Langrand-Escure J, El Meddeb Hamrouni A, Trone JC, Xia Y, Rancoule C, Magné N. Ototoxicité radio-induite et chimio-induite dans les cancers ORL : de la prévention primaire à la prévention tertiaire. Cancer Radiother 2017; 21:77-83. [DOI: 10.1016/j.canrad.2016.08.130] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 12/21/2022]
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Wong ATT, Lai SY, Gunn GB, Beadle BM, Fuller CD, Barrow MP, Hofstede TM, Chambers MS, Sturgis EM, Mohamed ASR, Lewin JS, Hutcheson KA. Symptom burden and dysphagia associated with osteoradionecrosis in long-term oropharynx cancer survivors: A cohort analysis. Oral Oncol 2017; 66:75-80. [PMID: 28249651 DOI: 10.1016/j.oraloncology.2017.01.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 01/04/2017] [Accepted: 01/07/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose is to examine the relationship between mandibular osteoradionecrosis (ORN) and chronic dysphagia in long-term oropharynx cancer (OPC) survivors, and to determine the perceived symptom burden associated with ORN. MATERIALS AND METHODS Medical records of 349 OPC patients treated with bilateral IMRT and systemic therapy were reviewed. ORN was graded using a published 4-point classification schema. Patients were considered to have chronic dysphagia if they had aspiration pneumonia, stricture or aspiration detected by fluoroscopy or endoscopy, and/or feeding tube dependence in long-term follow-up ⩾1year following radiotherapy. MD Anderson Symptom Inventory - Head and Neck Module (MDASI-HN) scores were analyzed in a nested cross-sectional survey sample of 118 patients. RESULTS 34 (9.7%, 95% CI: 6.8-13.3%) patients developed ORN and 45 (12.9%, 95% CI: 9.6-16.9%) patients developed chronic dysphagia. Prevalence of chronic dysphagia was significantly higher in ORN cases (12/34, 35%) compared to those who did not develop ORN (33/315, 11%, p<0.001). ORN grade was also significantly associated with prevalence of dysphagia (p<0.001); the majority of patients with grade 4 ORN requiring major surgery (6 patients, 75%) were found to have chronic dysphagia. Summary MDASI-HN symptom scores did not significantly differ by ORN grade. Significantly higher symptom burden was reported, however, among ORN cases compared to those without ORN for MDASI-HN swallowing (p=0.033), problems with teeth and/or gums (p=0.016) and change in activity (p=0.015) item scores. CONCLUSIONS ORN is associated with excess burden of chronic dysphagia and higher symptom severity related to swallowing, dentition and activity limitations.
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Affiliation(s)
- Angela T T Wong
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Martha P Barrow
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Theresa M Hofstede
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark S Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Yamamoto VN, Thylur DS, Bauschard M, Schmale I, Sinha UK. Overcoming radioresistance in head and neck squamous cell carcinoma. Oral Oncol 2016; 63:44-51. [PMID: 27938999 DOI: 10.1016/j.oraloncology.2016.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 08/29/2016] [Accepted: 11/06/2016] [Indexed: 12/28/2022]
Abstract
Radiation therapy plays an essential role in the treatment of head and neck squamous cell carcinoma (HNSCC), yet therapeutic efficacy is hindered by treatment-associated toxicity and tumor recurrence. In comparison to other cancers, innovation has proved challenging, with the epidermal growth factor receptor (EGFR) antibody cetuximab being the only new radiosensitizing agent approved by the FDA in over half a century. This review examines the physiological mechanisms that contribute to radioresistance in HNSCC as well as preclinical and clinical data regarding novel radiosensitizing agents, with an emphasis on those with highest translational promise.
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Affiliation(s)
- Vicky N Yamamoto
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
| | - David S Thylur
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Michael Bauschard
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Isaac Schmale
- Department of Otolaryngology-Head & Neck Surgery, University of Rochester Medical Center, Rochester, NY, United States
| | - Uttam K Sinha
- USC Tina and Rick Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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Kierkels RGJ, Wopken K, Visser R, Korevaar EW, van der Schaaf A, Bijl HP, Langendijk JA. Multivariable normal tissue complication probability model-based treatment plan optimization for grade 2-4 dysphagia and tube feeding dependence in head and neck radiotherapy. Radiother Oncol 2016; 121:374-380. [PMID: 27614681 DOI: 10.1016/j.radonc.2016.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/15/2016] [Accepted: 08/19/2016] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy of the head and neck is challenged by the relatively large number of organs-at-risk close to the tumor. Biologically-oriented objective functions (OF) could optimally distribute the dose among the organs-at-risk. We aimed to explore OFs based on multivariable normal tissue complication probability (NTCP) models for grade 2-4 dysphagia (DYS) and tube feeding dependence (TFD). MATERIALS AND METHODS One hundred head and neck cancer patients were studied. Additional to the clinical plan, two more plans (an OFDYS and OFTFD-plan) were optimized per patient. The NTCP models included up to four dose-volume parameters and other non-dosimetric factors. A fully automatic plan optimization framework was used to optimize the OFNTCP-based plans. RESULTS All OFNTCP-based plans were reviewed and classified as clinically acceptable. On average, the Δdose and ΔNTCP were small comparing the OFDYS-plan, OFTFD-plan, and clinical plan. For 5% of patients NTCPTFD reduced >5% using OFTFD-based planning compared to the OFDYS-plans. CONCLUSIONS Plan optimization using NTCPDYS- and NTCPTFD-based objective functions resulted in clinically acceptable plans. For patients with considerable risk factors of TFD, the OFTFD steered the optimizer to dose distributions which directly led to slightly lower predicted NTCPTFD values as compared to the other studied plans.
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Affiliation(s)
- Roel G J Kierkels
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands.
| | - Kim Wopken
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Ruurd Visser
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands; Department of Medical Imaging and Radiation Therapy, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Erik W Korevaar
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Arjen van der Schaaf
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Hendrik P Bijl
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
| | - Johannes A Langendijk
- University of Groningen, University Medical Center Groningen, Department of Radiation Oncology, The Netherlands
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De Felice F, Musio D, Tombolini V. Osteoradionecrosis and intensity modulated radiation therapy: An overview. Crit Rev Oncol Hematol 2016; 107:39-43. [PMID: 27823650 DOI: 10.1016/j.critrevonc.2016.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 07/12/2016] [Accepted: 08/31/2016] [Indexed: 10/21/2022] Open
Abstract
Osteoradionecrosis (ORN) is an ongoing topic, especially about its definition, pathogenesis, staging system and management algorithm. But what about its real incidence in intensity modulated radiotherapy (IMRT) era? This paper discusses the mandible in radiation therapy planning as organ at risk and reviews the literature for evidence of radiation damage, discussing likely dose constraints and the use of IMRT to reduce radiation dose to this structure. PubMed search was performed.
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Affiliation(s)
- Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Viale Regina Elena 326, 00161 Rome, Italy.
| | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Viale Regina Elena 326, 00161 Rome, Italy
| | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Viale Regina Elena 326, 00161 Rome, Italy; Spencer-Lorillard Foundation, Viale Regina Elena 262, Rome, Italy
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Galvão-Moreira LV, Santana T, da Cruz MCFN. A closer look at strategies for preserving salivary gland function after radiotherapy in the head and neck region. Oral Oncol 2016; 60:137-41. [DOI: 10.1016/j.oraloncology.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/30/2016] [Accepted: 07/09/2016] [Indexed: 11/26/2022]
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Treatment outcome of ion beam therapy in eight patients with head and neck cancers. Eur Arch Otorhinolaryngol 2016; 273:4397-4402. [PMID: 27168403 DOI: 10.1007/s00405-016-4086-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/05/2016] [Indexed: 12/24/2022]
Abstract
Ion beam therapy has enabled us to treat formerly untreatable malignant tumors. The aim of the present study was to investigate the long-term follow-up course of patients with head and neck cancers who received ion beam therapy. The subjects were 8 patients (3 men and 5 women aged 43-78 years) with head and neck cancers who visited our department from 2006 to 2015 and received ion beam therapy. Six patients received carbon ion beam therapy, and the other two patients received proton beam therapy. The medical records of the patients were retrospectively analyzed. The primary site was the nasal and paranasal sinuses in six cases, nasopharynx in one case, and external auditory canal in one case. The histological type was olfactory neuroblastoma, malignant melanoma, and adenoid cystic carcinoma in two cases each, and chondrosarcoma and squamous cell carcinoma in one case each. The exposure dose ranged from 64 to 70.4 GyE. The average follow-up period was 42.0 months. Early adverse events were generally mild, and complete therapeutic response was obtained in all cases. However, five patients developed severe late complications including craniospinal dissemination, osteoradionecrosis of the maxilla and skull base, brain necrosis, and loss of eyesight. Three patients died of distant metastasis, local recurrence and/or brain necrosis within 2 years, and four patients have been surviving with distant metastasis or severe late complications. Ion beam therapy exhibits outstanding antitumor effects, but the severe late complications of the therapy must also be recognized.
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Kang HS, Roh JL, Kim SB, Choi SH, Nam SY, Kim SY. Noncancer-Related Health Events and Mortality in Head and Neck Cancer Patients After Definitive Radiotherapy: A Prospective Study. Medicine (Baltimore) 2016; 95:e3403. [PMID: 27175640 PMCID: PMC4902482 DOI: 10.1097/md.0000000000003403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The survival of patients with head and neck squamous cell carcinoma (HNSCC) can be affected not only by progression of the original cancer or occurrence of a second cancer but also by noncancer health event (NCHE). In this study, we evaluated the prognostic significance of early NCHEs in HNSCC patients after definitive radiotherapy (RT) or chemoradiotherapy (CRT).The prospective study cohort comprised 190 HNSCC patients who underwent definitive RT (n = 75) or CRT (n = 115). An early NCHE was defined as an event requiring hospital readmission of the patient within 12 months after treatment. Univariate and multivariate analyses were performed to identify clinicopathologic factors associated with early NCHEs, and competing and all-cause mortalities.Thirty-three patients suffered an NCHE (17.3%) and 8 succumbed to a competing cause of mortality (4.2%). Twenty-two (11.6%) patients had an early NCHE: respiratory (22.8%), cerebrovascular (13.7%), gastrointestinal (13.7%), and others (50.0%). In multivariate analysis, hypoalbuminemia (P = 0.022, hazard ratio [HR] = 3.66, 95% confidence interval [CI] = 1.21-11.1), chemotherapy (P = 0.047, HR = 3.02, 95% CI = 1.01-8.98), and tumor recurrence (P = 0.024, HR = 2.66, 95% CI = 1.14-6.22) were independent predictors of an early NCHE. Patients with early NCHEs were at high risk of competing mortality (P < 0.001, HR = 22.6, 95% CI = 4.21-121.00) and all-cause mortality (P = 0.002, HR = 4.44, 95% CI = 1.76-11.2).Early NCHEs are a major contributor to competing and all-cause mortality in HNSCC patients receiving RT or CRT. The risk factors identified could be used to predict early NCHEs.
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Affiliation(s)
- Ho-Seob Kang
- From the Departments of Otolaryngology (H-SK, J-LR, S-HC, SYN, SYK); Radiation Oncology; and Internal Medicine (Oncology) (S-BK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement. Crit Rev Oncol Hematol 2016; 102:47-54. [PMID: 27061883 DOI: 10.1016/j.critrevonc.2016.03.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 03/09/2016] [Indexed: 01/28/2023] Open
Abstract
Radiotherapy alone or in combination with chemotherapy and/or surgery is a well-known radical treatment for head and neck cancer patients. Nevertheless acute side effects (such as moist desquamation, skin erythema, loss of taste, mucositis etc.) and in particular late toxicities (osteoradionecrosis, xerostomia, trismus, radiation caries etc.) are often debilitating and underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met in Milan with the aim of reaching a consensus on a clinical definition and management of these toxicities. The Delphi Appropriateness method was used for this consensus and external experts evaluated the conclusions. The paper contains 20 clusters of statements about the clinical definition and management of stomatological issues that reached consensus, and offers a review of the literature about these topics. The review was split into two parts: the first part dealt with dental pathologies and osteo-radionecrosis (10 clusters of statements), whereas this second part deals with trismus and xerostomia (10 clusters of statements).
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Buglione M, Cavagnini R, Di Rosario F, Sottocornola L, Maddalo M, Vassalli L, Grisanti S, Salgarello S, Orlandi E, Paganelli C, Majorana A, Gastaldi G, Bossi P, Berruti A, Pavanato G, Nicolai P, Maroldi R, Barasch A, Russi EG, Raber-Durlacher J, Murphy B, Magrini SM. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement. Crit Rev Oncol Hematol 2016; 97:131-42. [DOI: 10.1016/j.critrevonc.2015.08.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022] Open
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Hermans BCM, Persoon LCGG, Podesta M, Hoebers FJP, Verhaegen F, Troost EGC. Weekly kilovoltage cone-beam computed tomography for detection of dose discrepancies during (chemo)radiotherapy for head and neck cancer. Acta Oncol 2015. [PMID: 26219958 DOI: 10.3109/0284186x.2015.1061210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Use of highly conformal radiotherapy in patients with head and neck carcinoma may lead to under-/overdosage of gross target volume (GTV) and organs at risk (OAR) due to changes in patients' anatomy. A method to achieve more effective radiation treatment combined with less toxicity is dose-guided radiotherapy (DGRT). The aim of this study was to evaluate discrepancies between planned and actually delivered radiation dose in head and neck patients and to identify predictive factors. METHODS In this retrospective analysis, 20 patients with cT2-4 N0-3 M0 carcinoma originating from oropharynx, oral cavity, larynx and hypopharynx (Cohort 1), and seven patients with cT1-4 N0-3 M0 nasopharyngeal carcinoma (Cohort 2) treated with primary (chemo)radiotherapy and undergoing weekly kV-CBCT scans were included. Radiation dose was recalculated on 184 kV-CBCT images, which was quantified by D95% (GTV), Dmean (parotid and submandibular glands) and D2% (spinal cord). Predictive factors investigated for changes in these dose metrics were: gender, age, cT/N-stage, tumor grade, HPV-status, systemic therapy, body mass index at start of treatment, weight loss and volume change over the duration of the radiotherapy. RESULTS There was no significant difference between the planned and delivered dose for GTV and OARs of Week 1 to subsequent weeks for Cohort 1. In Cohort 2, actually delivered Dmean to parotid glands was significant higher than planned dose (1.1 Gy, p = 0.002). No clinically relevant correlations between dose changes and predictive factors were found. CONCLUSION Weekly dose calculations do not seem to improve dose delivery for patients with tumors of the oral cavity, oropharynx, larynx and hypopharynx. In patients with nasopharyngeal carcinoma, however, mid-treatment imaging may facilitate DGRT.
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Affiliation(s)
- Bregtje C M Hermans
- a Department of Radiation Oncology (MAASTRO clinic) , Maastricht University Medical Centre , Maastricht , the Netherlands
| | - Lucas C G G Persoon
- a Department of Radiation Oncology (MAASTRO clinic) , Maastricht University Medical Centre , Maastricht , the Netherlands
| | - Mark Podesta
- a Department of Radiation Oncology (MAASTRO clinic) , Maastricht University Medical Centre , Maastricht , the Netherlands
| | - Frank J P Hoebers
- a Department of Radiation Oncology (MAASTRO clinic) , Maastricht University Medical Centre , Maastricht , the Netherlands
| | - Frank Verhaegen
- a Department of Radiation Oncology (MAASTRO clinic) , Maastricht University Medical Centre , Maastricht , the Netherlands
| | - Esther G C Troost
- a Department of Radiation Oncology (MAASTRO clinic) , Maastricht University Medical Centre , Maastricht , the Netherlands
- b Helmholtz Zentrum Dresden-Rossendorf , Germany
- c OncoRay, National Center for Radiation Research in Oncology , Dresden , Germany
- d Department of Radiation Oncology , Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden , Dresden , Germany
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Ow TJ, Pitts CE, Kabarriti R, Garg MK. Effective Biomarkers and Radiation Treatment in Head and Neck Cancer. Arch Pathol Lab Med 2015; 139:1379-88. [PMID: 26046489 DOI: 10.5858/arpa.2014-0574-ra] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Radiation is a key arm in the multidisciplinary treatment of patients with head and neck squamous cell carcinoma. During the past 2 decades, significant changes in the way radiation therapy is planned and delivered have improved efficacy and decreased toxicity. Refined approaches in the application of radiation and chemoradiation have led to organ-sparing treatment regimens for laryngeal and pharyngeal cancers and have improved local and regional control rates in the postoperative, adjuvant setting. The molecular and genetic determinants of tumor cell response to radiation have been studied, and several potential biomarkers are emerging that could further improve application and efficacy of radiation treatment in head and neck squamous cell carcinoma. OBJECTIVE To discuss the current understanding of potential biomarkers related to radiation response in head and neck squamous cell carcinoma. DATA SOURCES Existing published literature. CONCLUSIONS Several potential biomarkers are actively being studied as predictors and targets to improve the use and efficacy of radiation therapy to treat head and neck squamous cell carcinoma. Several promising candidates have been defined, and new markers are on the horizon.
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Affiliation(s)
| | | | | | - Madhur K Garg
- From the Departments of Otorhinolaryngology-Head and Neck Surgery (Drs Ow and Garg), Pathology (Dr Ow), Radiation Oncology (Drs Kabarriti and Garg), and Urology (Dr Garg) Montefiore Medical Center, Bronx, New York; and the Albert Einstein College of Medicine (Drs Ow, Kabarriti, and Garg, and Ms Pitts), Bronx
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Jacobi I, Navran A, van der Molen L, Heemsbergen WD, Hilgers FJM, van den Brekel MWM. Radiation dose to the tongue and velopharynx predicts acoustic-articulatory changes after chemo-IMRT treatment for advanced head and neck cancer. Eur Arch Otorhinolaryngol 2015; 273:487-94. [DOI: 10.1007/s00405-015-3526-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/22/2015] [Indexed: 10/24/2022]
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Haapaniemi A, Koivunen P, Saarilahti K, Kinnunen I, Laranne J, Aaltonen LM, Närkiö M, Lindholm P, Grénman R, Mäkitie A, Atula T. Laryngeal cancer in Finland: A 5-year follow-up study of 366 patients. Head Neck 2015; 38:36-43. [PMID: 24996171 DOI: 10.1002/hed.23834] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The purpose of this study was to acquire nationwide data on the management and outcome of laryngeal squamous cell carcinoma (SCC) in Finnish university hospitals over a 5-year posttreatment follow-up. METHODS All records of patients diagnosed and treated for primary laryngeal SCC during 2001 to 2005 were reviewed. RESULTS Three hundred sixty-six patients with laryngeal cancer were identified, 360 of whom had laryngeal SCC. Three hundred forty-two patients with laryngeal SCC (95%) were treated with curative intent. Five-year disease-specific survival (DSS) for T1a, T1b, T2, T3, and T4 glottic SCC was 100%, 95%, 78%, 79%, and 53%, respectively. The corresponding figures for T1 to T4 supraglottic SCC were 68%, 54%, 72%, and 59%. CONCLUSION Results of this nationwide study give a general overview of the outcome of unselected patients treated with unified guidelines. Patients with T2 tumors, usually treated with radiotherapy (RT), had a worse prognosis than expected. This patient group warrants further investigation and possibly treatment intensification.
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Affiliation(s)
- Aaro Haapaniemi
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Petri Koivunen
- Department of Otorhinolaryngology, Head and Neck Surgery, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kauko Saarilahti
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Ilpo Kinnunen
- Department of Otorhinolaryngology, Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finlan
| | - Jussi Laranne
- Department of Otorhinolaryngology, Head and Neck Surgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Mervi Närkiö
- Department of Otorhinolaryngology, Head and Neck Surgery, Kuopio University Hospital and University of Kuopio, Kuopio, Finland
| | - Paula Lindholm
- Department of Oncology, Turku University Hospital and University of Turku, Turku, Finland
| | - Reidar Grénman
- Department of Otorhinolaryngology, Head and Neck Surgery, Turku University Hospital and University of Turku, Turku, Finlan
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
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