51
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Lee DY, Abraham J, Ross E, Ridge JA, Lango MN, Liu JC, Bauman JR, Avkshtol V, Galloway TJ. Rapid recurrence in head and neck cancer: Underappreciated problem with poor outcome. Head Neck 2020; 43:212-222. [PMID: 32989878 DOI: 10.1002/hed.26479] [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: 02/17/2020] [Revised: 07/21/2020] [Accepted: 09/09/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Rapid recurrence, defined as gross tumor recurrence after primary operation but prior to initiating postoperative radiation therapy (PORT), is underappreciated in head and neck cancer (HNC). METHODS CT simulation images in patients with HNC managed surgically with adjuvant therapy at a single center between 2010 and 2017 were retrospectively reviewed. RESULTS A total of 194 patients with HNC were included. Rapid recurrence occurred in 39 patients (20%) with a median time from operation to CT simulation of 37 days. On multivariable analysis (MVA), extranodal extension (ENE) was the only predictor of rapid recurrence (P = .03). While rapid recurrence, ENE, and perineural invasion were all associated with poor overall survival (OS) on MVA, rapid recurrence was the strongest predictor (hazard ratio [HR] 5.47). CONCLUSION Rapid recurrence occurs at an underappreciated rate and is associated with poor survival outcomes. Patients with ENE are at highest risk and may benefit from diagnostic imaging evaluations immediately prior to PORT.
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Affiliation(s)
- Douglas Y Lee
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jesty Abraham
- Department of Diagnostic Radiology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Eric Ross
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Miriam N Lango
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jeffrey C Liu
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jessica R Bauman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Vladimir Avkshtol
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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52
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Induction chemotherapy in nonlaryngeal human papilloma virus-negative high-risk head and neck cancer: a real-world experience. Anticancer Drugs 2020; 31:1074-1083. [PMID: 32932276 DOI: 10.1097/cad.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The role of induction chemotherapy in the multidisciplinary treatment of locally advanced, nonlaryngeal high-risk human papilloma virus (HPV)-negative head and neck squamous cells carcinoma (HNSCC) is uncertain in terms of overall survival (OS). The primary objective of this study was to identify possible predictive factors of survival and outcome in patients with HNSCC who were treated with induction chemotherapy. Fifty-nine patients with stage IVa/b HPV-negative non-laryngeal HNSCC (mostly originating from the oral cavity) who underwent induction chemotherapy at Policlinico Umberto I were reviewed. Treatment outcomes in term of objective response rate (ORR), progression-free survival (PFS), OS and toxicities were analyzed. A significant association between nodal status, ORR, ongoing smoking use, toxicities and OS was demonstrated. ORR (obtained in 61% of patients) was associated with a reduction in mortality of 80% (P< 0.0001). Early discontinuation after just one cycle of induction chemotherapy was associated to a significantly shorter OS. In oral cavity radical surgery with negative margins was obtained in 15/16 patients. In 42% of patients G3-G4 toxicity occurred. Toxicity requiring hospitalization occurred in 42% and 21% of patients with oropharyngeal and oral cavity carcinoma, respectively. Five patients died of treatment-related causes. No treatment-related mortality occurred in oral cavity patients. G5 toxicities were different according to the sub-sites of disease (P = 0.05). Induction chemotherapy in non-laryngeal high-risk HNSCC is an active strategy, most importantly in oral cavity cancer, even though burdened with a high (G ≥ 3) toxicity and early discontinuation rate. These data will however need to be confirmed in further and larger studies.
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53
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Chiang YY, Chou YC, Chang KP, Liao CT, Wu YY, Yap WK, Pai PC, Chang JTC, Lin CY, Fan KH, Huang BS, Hung TM, Tsang NM. Missed radiation therapy sessions in first three weeks predict distant metastasis and less favorable outcomes in surgically treated patients with oral cavity squamous cell carcinoma. Radiat Oncol 2020; 15:194. [PMID: 32795324 PMCID: PMC7427928 DOI: 10.1186/s13014-020-01632-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
Background We sought to investigate the prognostic impact of missed RT sessions in patients who had undergone surgery for oral cavity squamous cell carcinoma (OCSCC). Methods The study sample consisted of 905 patients with surgically treated OCSCC who fulfilled criteria of RT course ≤8 weeks. The study participants were divided into three groups based on the characteristics of missed RT, as follows: 1) early missed RT, 2) late missed RT, and 3) RT as scheduled. Results The 5-year overall survival (OS) rates in the early missed RT, late missed RT, and RT as scheduled groups were 53.0, 58.1, and 64.5%, respectively (p = 0.046). In multivariate analysis, early missed RT was independently associated with both OS (hazard ratio (HR) = 1.486; 95% confidence interval (CI): 1.122–1.966; p = 0.006) and the occurrence of distant metastasis (HR = 1.644; 95% CI: 1.047–2.583; p = 0.031). Conclusion Early missed RT was independently associated with a higher occurrence of distant metastasis and less favorable OS in patients who had undergone surgery for OCSCC.
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Affiliation(s)
- Yin-Yin Chiang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Yung-Chih Chou
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.,College of Medicine Chang Gung University, Taoyuan, Taiwan.,Department of Head and Neck Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.,College of Medicine Chang Gung University, Taoyuan, Taiwan.,Department of Head and Neck Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yao-Yu Wu
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Wing-Keen Yap
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Ping-Ching Pai
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Tsung-Min Hung
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan. .,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Radiation Oncology, Fangliao General Hospital, No. 139, Zhongshan Rd., Fangliao Township, Pingtung County, 940, Taiwan. .,Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, School of Traditional Chinese Medicine, Chang Gung University, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, 333, Taiwan.
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54
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Takes RP, Halmos GB, Ridge JA, Bossi P, Merkx MAW, Rinaldo A, Sanabria A, Smeele LE, Mäkitie AA, Ferlito A. Value and Quality of Care in Head and Neck Oncology. Curr Oncol Rep 2020; 22:92. [PMID: 32651680 PMCID: PMC7351804 DOI: 10.1007/s11912-020-00952-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW The concept of value-based health care (VBHC) was articulated more than a decade ago. However, its clinical implementation remains an on-going process and a particularly demanding one for the domain of head and neck cancer (HNC). These cancers often present with fast growing tumors in functionally and cosmetically sensitive sites and afflict patients with differing circumstances and comorbidity. Moreover, the various treatment modalities and protocols have different effects on functional outcomes. Hence, the interpretation of what constitutes VBHC in head and neck oncology remains challenging. RECENT FINDINGS This monograph reviews developments in specific aspects of VBHC for HNC patients, including establishment of registries and quality indices (such as infrastructure, process, and outcome indicators). It emphasizes the importance of the multidisciplinary team, "time to treatment intervals," and adherence to guidelines. The discussion addresses major indicators including survival, quality of life and functional outcomes, and adverse events. Also, strengths and weaknesses of nomograms, prognostic and decision models, and variation of care warrant attention. Health care professionals, together with patients, must properly define quality and relevant outcomes, both for the individual patient as well as the HNC population. It is essential to capture and organize the relevant data so that they can be analyzed and the results used to improve both outcomes and value.
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Affiliation(s)
- Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology - Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili, Brescia, Italy
| | - Matthias A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Hospital Universitario San Vicente Fundacion. CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Universidad de Antioquia, Medellín, Colombia
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni Van Leeuwenhoek Hospital, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Oral and Maxillofacial Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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55
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Rutland JW, Gill CM, Ladner T, Goldrich D, Villavisanis DF, Devarajan A, Pai A, Banihashemi A, Miles BA, Sharma S, Balchandani P, Bederson JB, Iloreta AM, Shrivastava RK. Surgical outcomes in patients with endoscopic versus transcranial approach for skull base malignancies: a 10-year institutional experience. Br J Neurosurg 2020; 36:79-85. [PMID: 32538686 DOI: 10.1080/02688697.2020.1779659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Object: The authors performed an extensive comparison between patients treated with open versus an endoscopic approach for skull base malignancy with emphasis on surgical outcomes.Methods: A single-institution retrospective review of 60 patients who underwent surgery for skull base malignancy between 2009 and 2018 was performed. Disease features, surgical resection, post-operative morbidities, adjuvant treatment, recurrence, and survival rates were compared between 30 patients who received purely open surgery and 30 patients who underwent purely endoscopic resection for a skull base malignancy.Results: Of the 60 patients with skull base malignancy, 30 underwent open resection and 30 underwent endoscopic resection. The most common hisotype for endoscopic resection was squamous cell carcinoma (26.7%), olfactory neuroblastoma (16.7%), and sarcoma (10.0%), and 43.3%, 13.3%, and 10.0% for the open resection cohort, respectively. There were no statistical differences in gross total resection, surgical-associated cranial neuropathy, or ability to achieve negative margins between the groups (p > 0.1, all comparisons). Patients who underwent endoscopic resection had shorter surgeries (320.3 ± 158.5 minutes vs. 495.3 ± 187.6 minutes (p = 0.0003), less intraoperative blood loss (282.2 ± 333.6 ml vs. 696.7 ± 500.2 ml (p < 0.0001), and shorter length of stay (3.5 ± 3.7 days vs. 8.8 ± 6.0 days (p < 0.0001). Additionally, patients treated endoscopically initiated adjuvant radiation treatment more quickly (48.0 ± 20.3 days vs. 72.0 ± 20.5 days (p = 0.01).Conclusions: An endoscopic endonasal approach facilitates a clinically meaningful improvement in surgical outcomes for skull base malignancies.
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Affiliation(s)
- John W Rutland
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Corey M Gill
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Travis Ladner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Goldrich
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dillan F Villavisanis
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex Devarajan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Akila Pai
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Amir Banihashemi
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brett A Miles
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Priti Balchandani
- Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua B Bederson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raj K Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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56
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Nägeli MC, Ramelyte E, Dummer R. Cutaneous squamous cell carcinomas on special locations: perioral, periocular and genital area. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:21-24. [PMID: 31833605 DOI: 10.1111/jdv.15901] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 08/08/2019] [Indexed: 12/20/2022]
Abstract
If tumours arise in special locations such as around the eyes, mouth or in the genital area, patients and physicians are challenged by the need for complete removal of the tumour with safety margins and high demands on function and aesthetic aspects. Treatment should be performed by specialized physicians including ophthalmologists, head and neck surgeons, surgical, medical and radiation oncologists. The first-line treatment for most cutaneous malignancies is surgical excision; however, in several situations, such as well-differentiated cutaneous squamous cell carcinomas (cSCC) in the periocular or anal region, radiotherapy is a very reasonable and sometimes treatment of first choice, especially in patients with advanced age. In periocular SCC, radiotherapy with superficial x-ray combined with eye shielding, while in anal SCC, radiotherapy combined with chemotherapy is recommended. However, after failure of local treatment options including surgery and radiotherapy, systemic medications are indicated in order to achieve tumour control or cure. Systemic therapies include immunotherapy, targeted therapy or chemotherapy. Preventive strategies are based on UV protection in facial, and vaccination in HPV associated anogenital SCCs.
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Affiliation(s)
- M C Nägeli
- Faculty of Medicine, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - E Ramelyte
- Faculty of Medicine, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - R Dummer
- Faculty of Medicine, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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57
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Nagar H, Formenti SC. Cancer and COVID-19 - potentially deleterious effects of delaying radiotherapy. Nat Rev Clin Oncol 2020; 17:332-334. [PMID: 32341524 PMCID: PMC7184542 DOI: 10.1038/s41571-020-0375-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Radiotherapy can be safely delivered during the coronavirus disease 2019 (COVID-19) pandemic, often through use of hypofractionated regimens, which minimize the number of visits to treatment centres while also avoiding potentially detrimental delays in the delivery of cancer care.
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Affiliation(s)
- Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA.
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58
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Jin MC, Harris JP, Sabolch AN, Gensheimer M, Le QT, Beadle BM, Pollom EL. Proton radiotherapy and treatment delay in head and neck squamous cell carcinoma. Laryngoscope 2019; 130:E598-E604. [PMID: 31837165 DOI: 10.1002/lary.28458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/12/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE For patients with head and neck squamous cell carcinoma (HNSCC), delays in the initiation of radiotherapy (RT) have been closely associated with worse outcomes. We sought to investigate whether RT modality (proton vs. photon) is associated with differences in the time to initiation of RT. METHODS The National Cancer Database was queried for patients diagnosed with nonmetastatic HNSCC between 2004 and 2015 who received either proton or photon RT as part of their initial treatment. Wilcoxon rank-sum and chi-square tests were used to compare continuous and categorical variables, respectively. Multivariable logistic regression was used to determine the association between use of proton RT and delayed RT initiation. RESULTS A total of 175,088 patients with HNSCC receiving either photon or proton RT were identified. Patients receiving proton RT were more likely to be white, reside in higher income areas, and have private insurance. Proton RT was associated with delayed RT initiation compared to photon RT (median 59 days vs. 45, P < 0.001). Receipt of proton therapy was independently associated with RT initiation beyond 6 weeks after diagnosis (adjusted OR [aOR, definitive RT] = 1.69; 95% confidence interval [CI] 1.26-2.30) or surgery (aOR [adjuvant RT] = 4.08; 95% CI 2.64-6.62). In the context of adjuvant proton RT, increases in treatment delay were associated with worse overall survival (weeks, adjusted hazard ratio = 1.099, 95% CI 1.011-1.194). CONCLUSION Use of proton therapy is associated with delayed RT in both the definitive and adjuvant settings for patients with HNSCC and could be associated with poorer outcomes. LEVEL OF EVIDENCE 2b Laryngoscope, 122:0000-0000, 2019 Laryngoscope, 130:E598-E604, 2020.
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Affiliation(s)
- Michael C Jin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Jeremy P Harris
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
| | - Aaron N Sabolch
- The Center for Health Research and the Department of Radiation Oncology, Kaiser Permanente, Portland, Oregon, U.S.A
| | - Michael Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Beth M Beadle
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford
| | - Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford.,Palo Alto Veterans Affairs Health Care System, Palo Alto, California
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59
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McDowell L, Yom SS. Locally advanced non-melanomatous skin cancer: Contemporary radiotherapeutic management. Oral Oncol 2019; 99:104443. [DOI: 10.1016/j.oraloncology.2019.104443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 09/23/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022]
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60
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Itamura K, Kokot N, Sinha U, Swanson M. Association of insurance type with time course of care in head and neck cancer management. Laryngoscope 2019; 130:E587-E592. [PMID: 31756005 DOI: 10.1002/lary.28423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 10/13/2019] [Accepted: 10/30/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine differences in time course of care based on major insurance types for patients with head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN Retrospective cohort study. METHODS Retrospective study of Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Medicare patients with biopsy-proven diagnosis of HNSCC referred to an academic tertiary center for tumor resection and adjuvant therapy. In addition to patient demographic information and tumor characteristics, duration of chief complaint and the following time points were collected: biopsy by referring physician, first specialty surgeon clinic appointment, surgery, and adjuvant radiation start and stop dates. RESULTS There was a statistically significant increase in time interval for HMO (n = 32) patients from chief complaint to biopsy (P = .003), biopsy to first specialty surgeon clinic appointment (P < .001), and surgery to start of adjuvant radiation (P < .001) compared to that of Medicare (n = 31) and PPO (n = 41) patients. Adjuvant radiation was initiated ≤6 weeks after surgery in 22% of HMO (mean duration of 59 ± 17 days), 48% of Medicare (44 ± 13 days), and 61% of PPO (41 ± 12 days) patients. CONCLUSIONS Compared to PPO and Medicare patients, HMO patients begin adjuvant radiation after surgery later and experience treatment delays in transitions of care between provider types and with referrals to specialists. Delaying radiation after 6 weeks of surgery is a known prognostic factor, with insurance type playing a possible role. Further investigation is required to identify insurance type as an independent risk factor of delayed access to care for HNSCC. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E587-E592, 2020.
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Affiliation(s)
- Kyohei Itamura
- Caruso Department of Otolaryngology- Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Niels Kokot
- Caruso Department of Otolaryngology- Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Uttam Sinha
- Caruso Department of Otolaryngology- Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Mark Swanson
- Caruso Department of Otolaryngology- Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
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61
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Roldan CS, Chen JJ, Fareed MM, Hameed MY, Churilla TM, Lango MN, Galloway TJ. Impact of primary tumor-specific growth rate on treatment failure for nonoropharyngeal head and neck cancers. Laryngoscope 2019; 130:2378-2384. [PMID: 31714626 DOI: 10.1002/lary.28393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the prognostic impact of primary tumor-specific growth rate (TSGR) on treatment outcomes after definitive radiation therapy (RT) for nonoropharyngeal squamous cell carcinoma (non-OPSCC). METHODS The diagnostic tumor and nodal volumes of 39 non-OPSCC patients were contoured and compared to corresponding RT planning scan volumes to determine TSGR. Overall survival (OS), disease-free survival (DFS), and local recurrence-free survival were evaluated according to the Kaplan-Meier method; and hazard ratios (HR) were estimated using Cox regression. Based on the 75th percentile TSGR of 2.18%, we stratified patients into a high TSGR group (≥ 2.18% per day) and low TSGR group (< 2.18% per day). RESULTS The median follow-up was 22 months (range: 1-86 months) and median time between diagnostic and simulation computed tomography scans was 22 days (range: 7-170 days). Median RT dose was 70 Gy (range: 60-79.2 Gy). Based on the 75th percentile TSGR, OS at median follow-up was 50.0% for the high TSGR group compared to 92.5% for the low TSGR group (HR [95% confidence interval (CI)] = 2.12[1.16-11.42], P = 0.018). There was a trend toward worse DFS at median follow-up for the high versus low TSGR groups, at 55.6% and 82.3%, respectively (HR [95% CI] = 2.29[0.82-6.38], P = 0.103). CONCLUSION Our study contributes to growing literature on TSGR as a temporal biomarker in patients with non-OPSCC. Patients with high TSGR ≥2.18% per day have significantly worse OS compared to those with TSGR below this threshold. Efforts to address treatment initiation delays may benefit patients with particularly aggressive and rapidly growing tumors. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2378-2384, 2020.
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Affiliation(s)
| | - Jie Jane Chen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - M Mohsin Fareed
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | | | - Thomas M Churilla
- the Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
| | - Miriam N Lango
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
| | - Thomas J Galloway
- the Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
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62
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Santos M, Monteiro E. Is Increased Time From Diagnosis to Treatment in Advanced Hypopharynx Cancer Associated With Poorer Outcomes: A Single-Centre Analysis. EAR, NOSE & THROAT JOURNAL 2019; 100:454-459. [PMID: 31569981 DOI: 10.1177/0145561319878926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the potential influence of increased time from diagnosis to treatment on survival outcomes in patients with locoregionally advanced hypopharyngeal squamous cell carcinoma (HSCC). METHODS Retrospective study of patients with a primary diagnosis of HSCC proposed for primary surgical treatment. RESULTS The study population included a total of 121 Caucasian patients (121 males) with HSCC. Mean age at diagnosis was 60.4 years (range: 43-83 years). All patients had cT3 or cT4 hypopharyngeal tumors. The sample presented a 5-year overall survival (OS) of 59.6% and a disease-specific survival of 74.9%. Considering univariable analysis (unadjusted), duration of adjuvant treatment (T5), pN, margins, and extracapsular spread (ECS) are factors associated with poorer survival outcomes. An increase in T5 was associated with lower OS. Results revealed that T5 higher than 43 days, pN1, pN2, pN3, no free margins, and presence of ECS were associated with lower OS. These patients have 7.465 higher hazard of death. CONCLUSION This study suggests that duration of adjuvant therapy may be more important than other timing metrics from diagnosis to treatment. For locoregionally advanced HSCC, duration of adjuvant therapy after primary surgery higher than 6 weeks is an important feature for worse survival outcome. Preventing strategies in order to avoid radiotherapy or chemoradiotherapy breaks should be developed and optimized.
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Affiliation(s)
- Mariline Santos
- Department of Otolaryngology, Head and Neck Surgery, 112085Centro Hospitalar Universitário do Porto, Portugal
| | - Eurico Monteiro
- Department of Otolaryngology, Head and Neck Surgery, 59035Portuguese Institute of Oncology, Porto, Portugal
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Bonomo P, Paderno A, Mattavelli D, Zenda S, Cavalieri S, Bossi P. Quality Assessment in Supportive Care in Head and Neck Cancer. Front Oncol 2019; 9:926. [PMID: 31620372 PMCID: PMC6759470 DOI: 10.3389/fonc.2019.00926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/04/2019] [Indexed: 01/03/2023] Open
Abstract
Quality assessment is a key issue in every clinical intervention, to be periodically performed so to measure the adherence to standard and to possibly implement strategies to improve its performance. This topic is rarely discussed for what concerns supportive care; however, it is necessary to verify the quality of the supportive measures; “supportive care makes excellent cancer care possible,” as stated by the Multinational Association of Supportive Care in Cancer (MASCC). In this regard, the quality of supportive care in head and neck cancer patients is a crucial topic, both to allow administration of treatments according to planned dose intensity or surgical indications and to maintain or improve patients' quality of life. This paper aims to provide insight on state of the art supportive care and its future developments for locally advanced and recurrent/metastatic head and neck cancer, with a focus on quality assessment in relation to surgery, radiotherapy, and systemic therapy.
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Affiliation(s)
- Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Alberto Paderno
- Unit of Otorhinolaryngology, Department of Surgical Specialties, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Davide Mattavelli
- Unit of Otorhinolaryngology, Department of Surgical Specialties, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Stefano Cavalieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Department of Medical Oncology, ASST Spedali Civili di Brescia, Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Vimawala S, Topf MC, Savard C, Zhan T, Keane W, Luginbuhl A, Goldman R, Cognetti DM, Curry JM. Risk factors for unplanned readmission in total laryngectomy patients. Laryngoscope 2019; 130:1725-1732. [DOI: 10.1002/lary.28255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Swar Vimawala
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | | | - Corey Savard
- Sidney Kimmel Medical CollegeThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Tingting Zhan
- Division of Biostatistics, Department of Pharmacology and Experimental TherapeuticsThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - William Keane
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Adam Luginbuhl
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Richard Goldman
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - David M. Cognetti
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
| | - Joseph M. Curry
- Department of Otolaryngology—Head and Neck SurgeryThomas Jefferson University Philadelphia Pennsylvania U.S.A
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65
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Ma SJ, Oladeru OT, Miccio JA, Iovoli AJ, Hermann GM, Singh AK. Association of Timing of Adjuvant Therapy With Survival in Patients With Resected Stage I to II Pancreatic Cancer. JAMA Netw Open 2019; 2:e199126. [PMID: 31411712 PMCID: PMC6694394 DOI: 10.1001/jamanetworkopen.2019.9126] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Surgery followed by adjuvant chemotherapy or chemoradiation is widely used to treat resectable pancreatic cancer. Although studies suggest initiation of adjuvant therapy within 12 weeks of surgery, there is no clear time interval associated with better survival. OBJECTIVE To evaluate the ideal timing of adjuvant therapy for patients with stage I to II resected pancreatic cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 7548 patients with stage I to II resected pancreatic cancer (5453 with adjuvant therapy; 2095 without adjuvant therapy) from the National Cancer Database from 2004 to 2015. Data were collected from January 2014 to December 2015 and analyzed from December 2018 to May 2019. EXPOSURES Adjuvant chemotherapy or chemoradiation at various time intervals. MAIN OUTCOMES AND MEASURES Overall survival (OS). RESULTS A total of 7548 patients (3770 male [49.9%]; median [interquartile range] age, 67 [59-74] years) were identified from the National Cancer Database. Among 5453 patients with adjuvant therapy, a Cox model with restricted cubic splines identified the lowest mortality risk when adjuvant therapy was started 28 to 59 days after surgery. Patients were divided into early (n = 269, adjuvant therapy initiated within <28 days), reference (n = 3048, adjuvant therapy initiated within 28-59 days), and late (n = 2136, adjuvant therapy initiated after >59 days) interval cohorts. Median (interquartile range) overall follow-up was 38.6 (24.6-62.0) months. Compared with the reference interval cohort on multivariable analysis, both the early cohort (hazard ratio, 1.17; 95% CI, 1.02-1.35; P = .03) and the late cohort (hazard ratio, 1.09; 95% CI, 1.02-1.17; P = .008) were associated with worse mortality. Similarly, the reference interval cohort had improved OS compared with the early cohort in 268 propensity-matched pairs (2-year OS, 52.5% [95% CI, 46.7%-59.0%] vs 45.1% [95% CI, 39.5%-51.6%]; P = .02) and compared with the late cohort in 2042 propensity-matched pairs (2-year OS, 51.3% [95% CI, 49.1%-53.6%] vs 45.4% [95% CI, 43.3%-47.7%]; P = .01). Patients who received adjuvant therapy more than 12 weeks after surgery (n = 683) had improved OS compared with surgery alone in both multivariable analysis (hazard ratio, 0.75; 95% CI, 0.66-0.85; P < .001) and 655 propensity-matched pairs (2-year OS, 47.2% [95% CI, 43.5%-51.3%] vs 38.0% [95% CI, 34.4%-42.0%]; P < .001). CONCLUSIONS AND RELEVANCE Patients with stage I to II pancreatic cancer who commenced adjuvant therapy within 28 to 59 days after primary surgical resection had improved survival outcomes compared with those with adjuvant therapy before 28 days or after 59 days. Patients who recovered slowly from surgery still benefited from delayed adjuvant therapy initiated more than 12 weeks after surgery compared with patients who underwent surgery only.
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Affiliation(s)
- Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Joseph A. Miccio
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Austin J. Iovoli
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo-State University of New York (SUNY), Buffalo
| | - Gregory M. Hermann
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Xiao R, Joshi RR, Husain Q, Cracchiolo JR, Lee N, Tsai J, Yu Y, Chen L, Kang JJ, McBride S, Riaz N, Roman BR, Ganly I, Tabar V, Gray ST, Cohen MA. Timing of surgery and adjuvant radiation therapy for sinonasal malignancies: Effect of surgical approach. Head Neck 2019; 41:3551-3563. [PMID: 31294897 DOI: 10.1002/hed.25873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/03/2019] [Accepted: 06/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Timely postoperative radiation therapy (RT) within 50 days of surgery for head and neck cancers provides a survival advantage. METHODS Using the National Cancer Database, we performed a propensity score-matched analysis comparing patients undergoing open or endoscopic surgery for squamous cell carcinoma (SCC) of the nasal cavity and paranasal sinuses from 2010 to 2015. RESULTS Among 168 pairs, patients undergoing endoscopic surgery had shorter time to surgery (24.2 vs 36.7 days, P < .001) and shorter postoperative time to RT (PTTR, 51.2 vs 58.4 days, P = .02). On multivariable linear regression, endoscopic surgery predicted shorter PTTR (β = -7.6, P = .01). Using the Kaplan-Meier method, patients in the longest PTTR quartile had decreased overall survival (OS; Q1 vs Q4, 3-year OS 76.5% vs 53.3%, P = .007), a durable finding when adjusted for covariates (Q1 vs Q4, HR 0.50, P = .008). CONCLUSIONS Patients undergoing endoscopic surgery for sinonasal SCC experience shorter PTTR. Shorter PTTR is associated with extended OS.
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Affiliation(s)
- Roy Xiao
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Rohan R Joshi
- Department of Otolaryngology - Head and Neck Surgery, Case Western Reserve University, Cleveland, Ohio
| | - Qasim Husain
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Jennifer R Cracchiolo
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jung J Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin R Roman
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ian Ganly
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stacey T Gray
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard University, Boston, Massachusetts
| | - Marc A Cohen
- Department of Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Townsend M, DeWees T, Gross J, Daly M, Gay H, Thorstad W, Jackson RS. Timing of Postoperative Radiotherapy in Surgically Treated HPV-Positive Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2019; 161:297-306. [PMID: 31159646 DOI: 10.1177/0194599819847144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Optimal timing of postoperative radiotherapy (PORT) remains understudied in human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma. Objectives are to determine if delays between surgery and radiotherapy, breaks during radiotherapy, disease, or patient factors are associated with recurrence or survival decrements in HPV-related disease. DESIGN Retrospective review. SETTING Academic medical center. SUBJECTS A total of 240 cases of HPV-positive oropharyngeal squamous cell carcinoma from 2000 to 2016. METHODS Patient and tumor characteristics (American Joint Committee on Cancer, eighth edition), delays to radiation initiation, and breaks during radiation were recorded. Overall survival (OS) and recurrence-free survival (RFS) were analyzed. RESULTS RFS and OS were not significantly affected by delays to PORT >6 weeks or by treatment intervals >100 days (surgery to PORT completion). Breaks during PORT significantly imparted an OS detriment (hazard ratio [HR], 2.4; 95% CI, 1.2-4.8). Advanced-stage disease was significantly associated with reduced RFS and OS. Subgroup analysis of stage I versus stage II/III disease found that >6 weeks to PORT initiation and treatment intervals >100 days did not significantly decrease RFS or OS in either stage group. Advanced-stage disease was significantly associated with worsened OS (HR, 6.6; 95% CI, 2.3-19.1) and RFS (HR, 5.3; 95% CI, 1.5-18.4). Breaks during PORT significantly reduced RFS (HR, 3.6; 95% CI, 1.2-10.8) and OS (HR, 3.2; 95% CI, 1.2-9.0) in the stage II/III subset. CONCLUSION Delays to radiotherapy initiation and prolonged treatment time did not affect recurrence or survival in HPV-related oropharyngeal disease. Locoregionally advanced disease was consistently associated with worse outcomes. Breaks during PORT may affect recurrence and survival, although larger studies are needed to confirm this finding.
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Affiliation(s)
| | | | - Jennifer Gross
- 3 Washington University in St Louis, St Louis, Missouri, USA
| | - Mackenzie Daly
- 3 Washington University in St Louis, St Louis, Missouri, USA
| | - Hiram Gay
- 3 Washington University in St Louis, St Louis, Missouri, USA
| | - Wade Thorstad
- 3 Washington University in St Louis, St Louis, Missouri, USA
| | - Ryan S Jackson
- 3 Washington University in St Louis, St Louis, Missouri, USA
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Fareed MM, Galloway TJ. Time abides long enough for those who make use of it. CANCERS OF THE HEAD & NECK 2019; 3:11. [PMID: 31093364 PMCID: PMC6460542 DOI: 10.1186/s41199-018-0038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/09/2018] [Indexed: 01/29/2023]
Abstract
Increased treatment package time is an independent poor prognostic factor for outcomes in head and neck squamous cell carcinoma (HNSCC). Similarly the timeliness of treatment initiation is a risk factor for disease recurrence. Despite these well-known issues, the timeliness of treatment initiation is actually worsening in the United States and the expeditious completion of radiation treatments continues to be difficult secondary to a number of patients and treatment related issues. This analysis evaluates the current data on treatment intervals in the management of head and neck cancer. Rapid staging/diagnosis of head and neck cancer, appropriate referrals to providers qualified to treat said cancer, and expeditious treatment completion remains the most cost-effective, widely applicable method to improve outcomes in head and neck cancer.
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Affiliation(s)
- Muhammad M Fareed
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
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Garbutcheon‐Singh KB, Veness MJ. The role of radiotherapy in the management of non‐melanoma skin cancer. Australas J Dermatol 2019; 60:265-272. [DOI: 10.1111/ajd.13025] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/28/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Kieran B Garbutcheon‐Singh
- Department of Radiation Oncology Crown Princess Mary Cancer Centre Westmead Hospital Sydney New South Wales Australia
| | - Michael J Veness
- Department of Radiation Oncology Crown Princess Mary Cancer Centre Westmead Hospital Sydney New South Wales Australia
- University of Sydney Sydney New South Wales Australia
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70
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Goel AN, Lee JT, Wang MB, Suh JD. Treatment delays in surgically managed sinonasal cancer and association with survival. Laryngoscope 2019; 130:2-11. [DOI: 10.1002/lary.27892] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Alexander N. Goel
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los Angeles Los Angeles California U.S.A
| | - Jivianne T. Lee
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los Angeles Los Angeles California U.S.A
| | - Marilene B. Wang
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los Angeles Los Angeles California U.S.A
| | - Jeffrey D. Suh
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California, Los Angeles Los Angeles California U.S.A
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Shew M, New J, Bur AM. Machine Learning to Predict Delays in Adjuvant Radiation following Surgery for Head and Neck Cancer. Otolaryngol Head Neck Surg 2019; 160:1058-1064. [PMID: 30691352 DOI: 10.1177/0194599818823200] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To apply a novel methodology with machine learning (ML) to a large national cancer registry to help identify patients who are high risk for delayed adjuvant radiation. STUDY DESIGN Observational cohort study. SETTING National Cancer Database (NCDB). SUBJECTS AND METHODS A total of 76,573 patients were identified from the NCDB who had invasive head and neck cancer and underwent surgery, followed by radiation. The model was constructed from 80% of the patient data and subsequently evaluated and scored with the remaining 20%. Permutation feature importance analysis was used to understand the weighted model construction. RESULTS A total of 76,573 patients met inclusion and exclusion criteria. Our ML model was able to predict whether patients would start adjuvant therapy beyond 50 days after surgery with an overall accuracy of 64.41% and a precision of 58.5%. The 2 most important variables used to build the model were treating facility and urban versus rural demographics. CONCLUSION Statistics can provide inferences within an overall system, while ML is a novel methodology that can make predictions. We can identify patients who are "high risk" for delayed radiation using information from >75,000 patient experiences, which has the potential for a direct impact on clinical care. Our inability to achieve greater accuracy is due to limitations of the data captured by the NCDB, and we need to continue to identify new variables that are correlated with delayed radiation therapy. ML will prove to be a valuable clinical tool in years to come, but its utility is limited by available data.
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Affiliation(s)
- Matthew Shew
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Jacob New
- 2 School of Medicine, University of Kansas, Kansas City, Kansas, USA
| | - Andrés M Bur
- 1 Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of Kansas, Kansas City, Kansas, USA
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Ghanem AI, Schymick M, Bachiri S, Mannari A, Sheqwara J, Burmeister C, Chang S, Ghanem T, Siddiqui F. The effect of treatment package time in head and neck cancer patients treated with adjuvant radiotherapy and concurrent systemic therapy. World J Otorhinolaryngol Head Neck Surg 2019; 5:160-167. [PMID: 31750429 PMCID: PMC6849356 DOI: 10.1016/j.wjorl.2018.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 01/13/2023] Open
Abstract
Objectives In patients with head and neck carcinoma, “treatment package time” (TPT) was proven to impact outcomes in cases receiving adjuvant radiotherapy alone. Its impact in patients receiving radiotherapy with concurrent systemic therapy has not been studied previously. The TPT influence on survival endpoints for patients treated with surgery followed by radiation and concurrent systemic therapy was analyzed. Methods Institutional database to identify head and neck carcinoma cases treated with definitive surgery followed by concomitant chemo(bio) radiotherapy (CRT) was used. TPT was the number of days elapsed between surgery and the last day of radiation. %FINDCUT SAS macro tool was used to search for the cutoff TPT that was associated with significant survival benefit. Kaplan–Meier curves, log-rank tests as well as univariate and multivariate analyses were used to assess overall survival (OS) and recurrence free survival (RFS). Results One hundred and three cases with a median follow up of 37 months were included in the study. Oropharyngeal tumors were 43%, oral cavity 40% and laryngeal 17% of cases. Concurrent systemic therapy included platinum and cetuximab in 72% and 28%, respectively. Optimal TPT was found to be < 100 days with significantly better OS (P = 0.002) and RFS (P = 0.043) compared to TPT ≥100 days. On multivariate analysis; TPT<100 days, extracapsular nodal extension, high-risk score, lymphovascular space and perineural invasion were independent predictors for worse OS (P < 0.05). T4, extracapsular nodal extension and high-risk score were all significantly detrimental to RFS (P < 0.05). Conclusions Addition of concomitant systemic therapy to adjuvant radiotherapy did not compensate for longer TPT in head and neck squamous cell carcinoma. Multidisciplinary coordinated care must be provided to ensure the early start of CRT with minimal treatment breaks.
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Affiliation(s)
- Ahmed I Ghanem
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA.,Alexandria Clinical Oncology Department, Alexandria University, Qasm Bab Sharqi, Alexandria Governate, 00302, Egypt
| | - Matthew Schymick
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Souheyla Bachiri
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Aniruddh Mannari
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Jawad Sheqwara
- Department of Medical Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Charlotte Burmeister
- Department of Public Health Science, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Steven Chang
- Department of Otolaryngology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Tamer Ghanem
- Department of Otolaryngology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202, USA
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Goel AN, Frangos M, Raghavan G, Sangar S, Lazaro S, Wang MB, Long JL, St. John MA. Survival impact of treatment delays in surgically managed oropharyngeal cancer and the role of human papillomavirus status. Head Neck 2019; 41:1756-1769. [DOI: 10.1002/hed.25643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/13/2018] [Accepted: 12/10/2018] [Indexed: 01/03/2023] Open
Affiliation(s)
- Alexander N. Goel
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Mariana Frangos
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Govind Raghavan
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Sophia Sangar
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Stephanie Lazaro
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
| | - Marilene B. Wang
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
- Jonsson Comprehensive Cancer CenterUCLA Medical Center Los Angeles California
- UCLA Head and Neck Cancer ProgramUCLA Medical Center Los Angeles California
| | - Jennifer L. Long
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
- Research ServiceDepartment of Veterans Affairs Los Angeles California
| | - Maie A. St. John
- Department of Head and Neck SurgeryDavid Geffen School of Medicine at University of California Los Angeles Los Angeles California
- Jonsson Comprehensive Cancer CenterUCLA Medical Center Los Angeles California
- UCLA Head and Neck Cancer ProgramUCLA Medical Center Los Angeles California
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74
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Goel AN, Frangos MI, Raghavan G, Lazaro SL, Tang B, Chhetri DK, Long JL, St John MA. The impact of treatment package time on survival in surgically managed head and neck cancer in the United States. Oral Oncol 2018; 88:39-48. [PMID: 30616795 DOI: 10.1016/j.oraloncology.2018.11.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/11/2018] [Accepted: 11/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Delays in the initiation of postoperative radiation have been associated with worse outcomes; however, the effect of the overall treatment package time (interval from surgery through the completion of radiation) remains undefined. The purpose of this study was to determine the impact of package time on survival and to evaluate this effect among different subgroups of head and neck cancer patients. PATIENTS AND METHODS In this observational cohort study, the National Cancer Database was used to identify 35,167 patients with resected nonmetastatic head and neck cancer who underwent adjuvant radiation from 2004 to 2014. Kaplan-Meier survival estimates and multivariate Cox regression analyses were performed to determine the effect of treatment package time on overall survival. RESULTS Median package time was 96 days (interquartile range, 85-112 days). After adjusting for covariates, package times of 11 weeks or less were associated with improved survival (adjusted hazard ratio (aHR), 0.90; 95% confidence interval, 0.83-0.97) compared to an interval of 12-13 weeks, whereas package times of more than 14 weeks were associated with worse survival (aHR, 1.14, 1.14, and 1.22 for 14-15, 15-17, and >17 weeks, respectively). A significant interaction was identified between package time and disease site, nodal status, and stage. Specifically, patients with oropharyngeal tumors, advanced stage (III or IV) disease, or nodal involvement experienced more pronounced increases in mortality risk with delays in treatment time. CONCLUSIONS Treatment package time independently impacts survival. This effect may be strongest for patients with oropharyngeal tumors or advanced stage disease.
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Affiliation(s)
- Alexander N Goel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA.
| | - Mariana I Frangos
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Govind Raghavan
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Stephanie L Lazaro
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Belicia Tang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Dinesh K Chhetri
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA
| | - Jennifer L Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA; Research Service, Department of Veterans Affairs, Los Angeles, CA, USA
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, CA, USA; UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, CA, USA
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