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Voora RS, Stramiello JA, Sumner WA, Finegersh A, Mohammadzadeh A, Fouania J, Ramsey C, Blumenfeld L, Sacco AG, Mell LK, Califano JA, Orosco RK. Quality improvement intervention to reduce time to postoperative radiation in head and neck free flap patients. Head Neck 2021; 43:3530-3539. [PMID: 34492135 DOI: 10.1002/hed.26852] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/07/2021] [Accepted: 08/18/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Best-practice guidelines for head and neck cancer patients advise postoperative radiation therapy (PORT) initiation within 6 weeks of surgery. We report our institutional experience improving timeliness of adjuvant radiation in free-flap patients. METHODS Thirty-nine patients met inclusion criteria in the 2017-2019 study period. We divided into "Early" (n = 19) and "Late" (n = 20) time-period groups to compare performance over time. The primary endpoint was time to PORT initiation, with success defined as <6 weeks. RESULTS The number of patients achieving timely PORT improved from 10.5% in the Early group to 50.0% in the Late group (p = 0.014). Patients undergoing concurrent adjuvant chemoradiation were more likely to meet the PORT target in the Late group (p = 0.012). CONCLUSIONS We ascribe this quality improvement in free-flap patients to increased communication among multidisciplinary care teams, proactive consultation referrals, and a targeted patient-navigator intervention. Though work is needed to further improve performance, insight gained from our experience may benefit other teams.
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Affiliation(s)
- Rohith S Voora
- University of California, San Diego School of Medicine, La Jolla, California, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Joshua A Stramiello
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego School of Medicine, La Jolla, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Whitney A Sumner
- Moores Cancer Center, La Jolla, California, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Andrey Finegersh
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego School of Medicine, La Jolla, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Amir Mohammadzadeh
- University of California, San Diego School of Medicine, La Jolla, California, USA.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego School of Medicine, La Jolla, California, USA
| | | | | | | | - Assuntina G Sacco
- Moores Cancer Center, La Jolla, California, USA.,Division of Hematology-Oncology University, Department of Medicine, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Loren K Mell
- Moores Cancer Center, La Jolla, California, USA.,Department of Radiation Medicine and Applied Sciences, University of California San Diego School of Medicine, La Jolla, California, USA
| | - Joseph A Califano
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego School of Medicine, La Jolla, California, USA.,Moores Cancer Center, La Jolla, California, USA
| | - Ryan K Orosco
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego School of Medicine, La Jolla, California, USA.,Moores Cancer Center, La Jolla, California, USA
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Sahovaler A, Gualtieri T, Lee JJW, Eskander A, Deutsch K, Rashid S, Orsini M, Deganello A, Davies J, Enepekides D, Higgins K. Applications of intraoperative angiography in head and neck reconstruction. ACTA ACUST UNITED AC 2021; 41:215-220. [PMID: 34264914 PMCID: PMC8283404 DOI: 10.14639/0392-100x-n1161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022]
Abstract
Objective Laser-assisted angiography with indocyanine green (LAIG) allows objective intraoperative evaluation of tissue vascularity. We endeavored to describe our experience with this technique in the head and neck region. Methods A retrospective review from February 2016 till October 2018 was conducted. We included patients who underwent head and neck procedures in which LAIG was employed. The main outcome was postoperative wound complications. We analysed the influence of LAIG results in intraoperative decision-making process. Results Nineteen patients were included, and follow-up was for at least 6 months. LAIG was employed in 11 local flaps, 9 free flaps and 6 cases of pharyngeal closure during total laryngectomies. Wound complications occurred in two cases with distal tip flap necrosis. LAIG findings resulted in changes in decision making intraoperatively in 84% of procedures, which consisted in trimming poorly perfused tissues. There were no pharyngocutaneous fistulas. Conclusions This represents a descriptive report on the use of LAIG on diverse head and neck reconstruction cases, with important impact on the decision-making process. A low number of postoperative wound complications were observed.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Tommaso Gualtieri
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada.,Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - John J W Lee
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Rashid
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mario Orsini
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alberto Deganello
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Joel Davies
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology - Head and Neck Surgery and Surgical Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Santos A, Santos IC, Dos Reis PF, Rodrigues VD, Peres WAF. Impact of Nutritional Status on Survival in Head and Neck Cancer Patients After Total Laryngectomy. Nutr Cancer 2021; 74:1252-1260. [PMID: 34278898 DOI: 10.1080/01635581.2021.1952446] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Malnutrition is an important prognostic indicator of laryngeal squamous cell carcinoma. Retrospective study with head and neck cancer patients who underwent total laryngectomy. 243 patients of both sex were evaluated. The univariate analyses demonstrated an increased risk of death for the patients with greater weight loss, hypoalbuminemia, radiotherapy as an initial treatment, salvage surgery, and radical neck dissection. In a Multivariate Cox regression, older age (p = 0.03, 95% confidence interval [CI] 1.003-1.06, hazard ratio [HR] 1.029), Nutritional Risk Index ≤100 (p = 0.008, 95% CI 1.18-3.12, HR 1.921) and adjuvant radiotherapy (p = 0.029, 95% CI 0.31-3.12, HR 0.544) demonstrated prognostic significance in survival. Nutritional status is a modifiable variable and these findings highlight the need to adoption of simple nutritional assessment methods routinely during the treatment of head and neck cancer patients, in order to help improve prognosis after surgery.
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Affiliation(s)
- Adriana Santos
- Nutrition and Dietetic Section, Cancer Hospital Unit 1, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Izabella Costa Santos
- Head and Neck Surgery Section, Cancer Hospital Unit 1, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Patrícia Fonseca Dos Reis
- Nutrition and Dietetic Section, Cancer Hospital Unit 1, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Viviane Dias Rodrigues
- Nutrition and Dietetic Section, Cancer Hospital Unit 1, National Cancer Institute José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wilza Arantes Ferreira Peres
- Department of Nutrition and Dietetics, Institute of Nutrition Josué de Castro, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Klausner G, Troussier I, Kreps S, Fabiano E, Laccourreye O, Giraud P. [Impact of neck dissection in N2-3 oropharyngeal squamous cell carcinomas treated with definitive chemoradiotherapy: An observational real-life study]. Cancer Radiother 2021; 25:771-778. [PMID: 34175226 DOI: 10.1016/j.canrad.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the efficacy in terms of neck failure of an initial neck dissection before definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinomas, as well as the dosimetric impact and the acute and delayed morbidity of this approach. MATERIALS AND METHODS All patients consecutively treated between 2009 and 2018 with definitive chemoradiotherapy using intensity-modulated conformal radiotherapy (IMRT) for a histologically proven N2-3 oropharyngeal squamous cell carcinomas were retrospectively included. The therapeutic approach consisted of induction chemotherapy, followed by cisplatine-based chemoradiotherapy preceded or not by neck dissection. Neck dissection was discussed on a case-by-case basis in a dedicated multidisciplinary tumour board for patients with a dissociated response to induction chemotherapy, defined as a better response on the primary than on the node. Chemoradiotherapy without neck dissection was systematically performed in case of a major lymph node response to induction chemotherapy (decrease in size of 90% or more). Intensity-modulated radiotherapy using a simultaneous-integrated boost delivered 70Gy in 35 fractions on macroscopic tumour volumes, 63Gy on intermediate-risk levels or extra-nodal extension and 54Gy on prophylactic lymph node areas. RESULTS Two groups were constituted: 47 patients without an initial neck dissection (62.7%), and 28 patients with a neck dissection prior to definitive chemoradiotherapy (37.3%). Initial patient characteristics were not statistically different between the two groups. The median follow-up was 60.1months (range: 3.2-119months). Incidence of neck failure was higher in patients without neck dissection (P=0.015). The neck failure rate at 5years was 19.8% (95% confidence interval: 7.4-30.6%; P=0.015) without neck dissection versus 0% following neck dissection. All lymph node failures occurred in the planned target volume at 70Gy. Upfront neck dissection suggested a decrease in the mean dose received by the homolateral parotid gland (P=0.01), mandible (P=0.02), and thyroid gland (P=0.02). Acute toxicity of chemoradiotherapy after neck dissection suggested a reduction in grade≥3 adverse events (P=0.04), early discontinuation of concomitant chemotherapy (P=0.009) and feeding tube-dependence (P=0.008) in univariate analysis. During follow-up, there was no difference between the two groups in terms of xerostomia, dysgeusia, dysphagia or gastrostomy dependence in univariate analysis. CONCLUSION Neck dissection prior to definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinoma was associated with high neck control without additional mid and long-term morbidity.
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Affiliation(s)
- G Klausner
- Université Pierre-et-Marie-Curie, Paris Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - I Troussier
- Oncologie-radiothérapie, centre de haute énergie, 06000 Nice, France; Département de radio-oncologie, hôpitaux universitaires de Genève, 1205 Genève, Suisse
| | - S Kreps
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - E Fabiano
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - O Laccourreye
- Service d'ORL et de chirurgie cervicofaciale, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75015 Paris, France
| | - P Giraud
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75015 Paris, France.
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55
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Use of the O-Z flap as an alternative to free tissue transfer for reconstruction of large scalp defects. World J Otorhinolaryngol Head Neck Surg 2021; 8:355-360. [DOI: 10.1016/j.wjorl.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/12/2021] [Indexed: 11/21/2022] Open
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56
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Beitler JJ. We have met the Enemy and (S)He is Us. Head Neck 2021; 43:2685-2687. [PMID: 33998092 DOI: 10.1002/hed.26737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
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Pang J, Faraji F, Risa E, Mell LK, Houlton JJ, Califano JA. High rates of postoperative radiotherapy delay in head and neck cancer before and after Medicaid expansion. Head Neck 2021; 43:2672-2684. [PMID: 33998088 DOI: 10.1002/hed.26736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 04/22/2021] [Accepted: 04/29/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The objective is to study the effect of Medicaid expansion on postoperative radiation therapy (PORT) delay in patients with head and neck squamous cell carcinoma (HNSCC). METHODS Patients from the National Cancer Database with HNSCC undergoing curative-intent surgery in the 2 years before and after Medicaid expansion were analyzed (n = 11 717) using the difference-in-differences technique to study the effect on PORT delay. RESULTS The rate of PORT delay before and after expansion was 66.0% and 66.9%, respectively. Medicaid patients had more frequent PORT delay than privately insured patients (pre-expansion 77.2% vs. 59.4%, p < 0.001; post-expansion 76.5% vs. 60.9%, p < 0.001). Medicaid expansion had no effect on PORT delay [hazard ratio 0.95, 95% confidence interval 0.81-1.12]. Supplemental analyses revealed that pathologic stage, number of treating facilities, and comorbidities were among several factors associated with PORT delay in the cohort. CONCLUSION PORT delay is unacceptably frequent. Improvement in timely adjuvant therapy requires more than Medicaid expansion.
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Affiliation(s)
- John Pang
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, California, USA
| | - Farhoud Faraji
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, California, USA
| | - Erik Risa
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Loren K Mell
- Department of Radiation Medicine, UC San Diego School of Medicine, San Diego, California, USA
| | - Jeffrey J Houlton
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Joseph A Califano
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, California, USA.,Department of Surgery, Division of Otolaryngology Head and Neck Surgery, Moores Cancer Center, UC San Diego School of Medicine, La Jolla, San Diego, California, USA
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58
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Pannu JS, Simpson MC, Adjei Boakye E, Massa ST, Cass LM, Challapalli SD, Rohde RL, Osazuwa-Peters N. Survival outcomes for head and neck patients with Medicaid: A health insurance paradox. Head Neck 2021; 43:2136-2147. [PMID: 33780066 DOI: 10.1002/hed.26682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/11/2021] [Accepted: 03/12/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid. METHODS A cohort of 18-64-year-old adults (n = 57 920) with index HNC from the Surveillance, Epidemiology, and End Results 18 database (2007-2015) was analyzed using Fine and Gray multivariable competing risks proportional hazards models for HNC-specific mortality. RESULTS Medicaid (sdHR = 1.65, 95% CI 1.58, 1.72) and uninsured patients (sdHR = 1.55, 95% CI 1.46, 1.65) had significantly greater mortality hazard than non-Medicaid patients. Medicaid patients had increased HNC mortality hazard than those uninsured. CONCLUSION Compared with those uninsured, HNC patients on Medicaid did not have superior survival, suggesting that there may be underlying mechanisms/factors inherent in this patient population that could undermine access to care benefits from being on Medicaid.
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Affiliation(s)
- Jaibir S Pannu
- Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, Illinois, USA.,Simmons Cancer Center, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Sean T Massa
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Lauren M Cass
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Sai D Challapalli
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, USA
| | - Rebecca L Rohde
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nosayaba Osazuwa-Peters
- Department of Head and Neck Surgery & Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Duke Cancer Center, Duke University School of Medicine, Durham, North Carolina, USA
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Fagan JJ, Noronha V, Graboyes EM. Making the Best of Limited Resources: Improving Outcomes in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2021; 41:1-11. [PMID: 33793315 PMCID: PMC8059263 DOI: 10.1200/edbk_320923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The overwhelming majority of head and neck cancers and related deaths occur in low- and middle-income countries, which have challenges related to burden of disease versus access to care. Yet the additional health care burden of the COVID-19 pandemic has also impacted access to care for patients with head and neck cancer in the United States. This article focuses on challenges and innovation in prioritizing head and neck cancer care in Sub-Saharan Africa, the Indian experience of value-added head and neck cancer care in busy and densely populated regions, and strategies to optimize the management of head and neck cancer in the United States during the COVID-19 pandemic.
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Affiliation(s)
- Johannes J. Fagan
- Division of Otorhinolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Evan Michael Graboyes
- Departments of Otolaryngology-Head and Neck Surgery and Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Langer C, Wittekindt C, Jensen AD. [The role of chemoradiotherapy in curative treatment of head and neck cancer]. Laryngorhinootologie 2021; 101:22-34. [PMID: 33506441 DOI: 10.1055/a-1351-0417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Radiotherapy and chemotherapy are integral parts of definitive and adjuvant therapy in the treatment of head and neck squamous cell carcinoma (HNSCC). The outcome of therapy is essentially dependent on selection and dosage of chemotherapeutical substances and on the other hand on the radiotherapeutical setting concerning fractionation, time of therapy and technical aspects. Immunotherapeutical substances have an increasing role in the therapy of HNSCC as well as particle therapy is investigated as part of radiotherapy in actual studies. Further challenges relate to treatment of HPV-induced tumors with regard to their differences in tumor biology and consecutively better prognosis.
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Affiliation(s)
- Christine Langer
- HNO, Universitätsklinikum Gießen und Marburg Standort Gießen, Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Halschirurgie und plastische Operationen, Gießen, Germany
| | | | - Alexandra Désirée Jensen
- Klinik für Strahlentherapie, Universitätsklinikum Gießen und Marburg GmbH Standort Gießen, Gießen, Germany
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Graboyes EM, Halbert CH, Li H, Warren GW, Alberg AJ, Calhoun EA, Nussenbaum B, Marsh CH, McCay J, Day TA, Kaczmar JM, Sharma AK, Neskey DM, Sterba KR. Barriers to the Delivery of Timely, Guideline-Adherent Adjuvant Therapy Among Patients With Head and Neck Cancer. JCO Oncol Pract 2020; 16:e1417-e1432. [PMID: 32853120 PMCID: PMC7735037 DOI: 10.1200/op.20.00271] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival. However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown. This study aims to identify the multilevel barriers to timely, guideline-adherent PORT and organize them into a conceptual model. MATERIALS AND METHODS Semi-structured interviews with key informants were conducted with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45). Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model. RESULTS In all, 27 patients with HNSCC undergoing surgery and PORT were included, of whom 41% were African American, and 37% had surgery and PORT at different facilities. Eighteen clinicians representing a diverse mix of provider types from 7 oncology practices participated in key informant interviews. Five key themes representing barriers to timely PORT were identified across 5 health care delivery levels: (1) inadequate education about timely PORT, (2) postsurgical sequelae that interrupt the tight treatment timeline (both intrapersonal level), (3) insufficient coordination and communication during care transitions (interpersonal and health care team levels), (4) fragmentation of care across health care organizations (organizational level), and (5) travel burden for socioeconomically disadvantaged patients (community level). CONCLUSION This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC.
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Affiliation(s)
- Evan M. Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Chanita Hughes Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Graham W. Warren
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston, SC
| | - Anthony J. Alberg
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Elizabeth A. Calhoun
- Center for Population Science and Discovery, University of Arizona Health Sciences, Tucson, AZ
| | - Brian Nussenbaum
- American Board of Otolaryngology-Head and Neck Surgery, Houston, TX
| | - Courtney H. Marsh
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Jessica McCay
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - Terry A. Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - John M. Kaczmar
- Department of Medicine, Division of Medical Oncology, Medical University of South Carolina, Charleston, SC
| | - Anand K. Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC
| | - David M. Neskey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
| | - Katherine R. Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
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Lin MQ, Li JL, Zhang ZK, Chen XH, Ma JY, Dai YQ, Huang SY, Hu YB, Li JC. Delayed postoperative radiotherapy might improve the long-term prognosis of locally advanced esophageal squamous cell carcinoma. Transl Oncol 2020; 14:100956. [PMID: 33227662 PMCID: PMC7689552 DOI: 10.1016/j.tranon.2020.100956] [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: 08/18/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Postoperative radiotherapy timing for esophageal cancer remains to be determined. Delayed postoperative radiotherapy (>48 days) provides better survival benefit. Postoperative radiotherapy following 2–4 chemotherapy cycles achieved best survival.
Objective There is no consensus on the optimal timing of postoperative radiotherapy (PORT) for locally advanced esophageal squamous cell carcinoma (ESCC). We aimed to determine whether the timing of PORT affects the long-term prognosis of ESCC, and plotted nomograms to predict survival. Methods We retrospectively analyzed 351 ESCC patients who underwent radical surgery and PORT. Receiver operating characteristic curves were used to estimate the optimal cutoff point of the time interval between surgery and PORT. Cox proportional hazards regression was used to identify prognostic predictors. Overall survival (OS) and progression-free survival (PFS) were predicted using nomograms. Results The median follow-up was 53 months (range: 3–179 months). Compared to early PORT, PORT at >48 days after surgery was associated with better OS (adjusted hazard ratio [HR]: 1.406, p = 0.037) and PFS (adjusted HR: 1.475, p = 0.018). In the chemotherapy subgroup, incorporation of chemotherapy timing into the analysis suggested that 2–4 chemotherapy cycles followed by PORT was the optimal treatment schedule as compared to 0–1 chemotherapy cycle followed by PORT and concurrent chemoradiotherapy (5-year PFS: 65.9% vs. 51.0% vs. 50.1%; p = 0.049). The nomograms for OS and PFS were superior to the TNM classification (concordance indices: 0.721 vs. 0.626 and 0.716 vs. 0.610, respectively). Conclusions Delayed PORT (>48 days) provides better survival benefit than early PORT among ESCC patients. PORT following 2–4 chemotherapy cycles might lead to the best survival rate. The nomogram plotted in this study effectively predicted survival and may help guide treatment.
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Affiliation(s)
- Ming-Qiang Lin
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jin-Luan Li
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Zong-Kai Zhang
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen 361003, China.
| | - Xiao-Hui Chen
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jia-Yu Ma
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Ya-Qing Dai
- Department of Radiation Oncology, Xiamen Cancer Center, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen 361003, China.
| | - Shu-Yun Huang
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Yi-Bin Hu
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
| | - Jian-Cheng Li
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, 420 Fuma Rd, Jin'an District, Fuzhou, Fujian 350014, China.
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Rygalski CJ, Zhao S, Eskander A, Zhan KY, Mroz EA, Brock G, Silverman DA, Blakaj D, Bonomi MR, Carrau RL, Old MO, Rocco JW, Seim NB, Puram SV, Kang SY. Time to Surgery and Survival in Head and Neck Cancer. Ann Surg Oncol 2020; 28:877-885. [PMID: 33188461 PMCID: PMC7664584 DOI: 10.1245/s10434-020-09326-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/16/2020] [Indexed: 02/06/2023]
Abstract
Background The COVID-19 pandemic has required triage and delays in surgical care throughout the world. The impact of these surgical delays on survival for patients with head and neck squamous cell carcinoma (HNSCC) remains unknown. Methods A retrospective cohort study of 37 730 patients in the National Cancer Database with HNSCC who underwent primary surgical management from 2004 to 2016 was performed. Uni- and multivariate analyses were used to identify predictors of overall survival. Bootstrapping methods were used to identify optimal time-to-surgery (TTS) thresholds at which overall survival differences were greatest. Cox proportional hazard models with or without restricted cubic splines were used to determine the association between TTS and survival. Results The study identified TTS as an independent predictor of overall survival (OS). Bootstrapping the data to dichotomize the cohort identified the largest rise in hazard ratio (HR) at day 67, which was used as the optimal TTS cut-point in survival analysis. The patients who underwent surgical treatment longer than 67 days after diagnosis had a significantly increased risk of death (HR, 1.189; 95% confidence interval [CI], 1.122–1.261; P < 0.0001). For every 30-day delay in TTS, the hazard of death increased by 4.6%. Subsite analysis showed that the oropharynx subsite was most affected by surgical delays, followed by the oral cavity. Conclusions Increasing TTS is an independent predictor of survival for patients with HNSCC and should be performed within 67 days after diagnosis to achieve optimal survival outcomes. Electronic supplementary material The online version of this article (10.1245/s10434-020-09326-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chandler J Rygalski
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, ON, Toronto, Canada
| | - Kevin Y Zhan
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Edmund A Mroz
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Guy Brock
- Department of Biomedical Informatics and Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Dustin A Silverman
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Dukagjin Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Marcelo R Bonomi
- Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ricardo L Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Matthew O Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Nolan B Seim
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sidharth V Puram
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine, Ear, Nose & Throat Center, St. Louis, MO, USA
| | - Stephen Y Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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64
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Jurica JM, Rubio F, Hernandez DJ, Sandulache VC. Institutional financial toxicity of failure to adhere to treatment guidelines for head and neck squamous cell carcinoma. Head Neck 2020; 43:816-824. [PMID: 33166016 DOI: 10.1002/hed.26539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/04/2020] [Accepted: 10/29/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Delays in treatment of head and neck squamous cell carcinoma (HNSCC) are known to increase disease recurrence, generating the need for additional salvage treatment, often with immunotherapy. METHODS Three treatment metrics were identified: time from diagnosis to treatment initiation (TTI), time from surgery to postoperative radiotherapy (surg → PORT), and total treatment package time (TPT). Financial toxicity was calculated using hazard ratios, pembrolizumab cost, and dosing data for a Veterans Health Administration (VHA) institutional cohort (n = 338) and a standardized cohort (n = 100). RESULTS Estimated financial toxicity for the VHA cohort was $2 047 407, $316 545, and $1 114 101 for TTI, surg → PORT, and TPT, respectively. Estimated financial toxicity for the standardized patient cohort was $454 028, $544 576, and $1 879 628 for TTI, surg → PORT, and TPT, respectively. CONCLUSIONS Failure to meet established HNSCC treatment metrics generates significant, yet avoidable, institutional financial toxicity which is particularly relevant to integrated single-payer systems such as the VHA in the modern immunotherapy era.
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Affiliation(s)
- James M Jurica
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Felixnando Rubio
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David J Hernandez
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Vlad C Sandulache
- ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, USA.,Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
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65
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Zhu S, Khalil R, Altairy O, Burmeister C, Dimitrova I, Elshaikh M. Increased risk of recurrence in early-stage endometrial carcinoma after delays in adjuvant radiation treatment. Int J Gynecol Cancer 2020; 31:73-77. [PMID: 33087415 DOI: 10.1136/ijgc-2020-001937] [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] [Received: 08/11/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The benefits of adjuvant radiation treatment after hysterectomy have been confirmed in select patients with early-stage endometrial carcinoma. The goal of this study was to evaluate the prognostic impact of the time interval between hysterectomy and starting adjuvant radiation treatment in patients with early-stage endometrial carcinoma. METHODS Our database was searched for women with early-stage endometrioid endometrial cancer who received adjuvant radiation therapy after hysterectomy. The patients were classified into two groups based on the time interval to adjuvant radiation therapy (≤8 weeks or >8 weeks) after hysterectomy. Recurrence-free survival, disease-specific survival, and overall survival were compared between the two groups. RESULTS Four hundred and sixty patients were identified. Median follow-up was 70.5 months (range 1-360). One hundred and seventy-six patients (38%) were 2009 International Federation of Gynecology and Obstetrics stage IA, 207 (45%) stage IB, and 77 (17%) stage II. Three hundred and fifty-four women (77%) received adjuvant radiation therapy within 8 weeks after hysterectomy. There was no statistically significant difference between the two groups in baseline demographics, disease and treatment characteristics, except for the modality of adjuvant radiation therapy. Patients who received adjuvant radiation therapy within 8 weeks experienced significantly less disease recurrence (9% vs 18%; p=0.01) and particularly less isolated vaginal recurrence (0% vs 6%, p=0.04). Five-year recurrence-free survival was 89% versus 80% (p=0.04), 5-year disease-specific survival was 93% for both groups, and 5-year overall survival was 86% versus 85% for patients who received adjuvant radiation therapy ≤8 and >8 weeks, respectively (p=0.88). CONCLUSION Our study suggests that delaying adjuvant radiation therapy beyond 8 weeks after hysterectomy is associated with significantly more cancer recurrences for women with early-stage endometrial carcinoma.
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Affiliation(s)
- Simeng Zhu
- Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Remonda Khalil
- Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Osama Altairy
- Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | | | - Irina Dimitrova
- Gynecologic Oncology, Henry Ford Hospital, Detroit, Michigan, USA
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Andruska N, Mahapatra L, Brenneman RJ, Rich JT, Baumann BC, Compton L, Thorstad WL, Daly MD. Reduced Wide Local Excision Margins are Associated with Increased Risk of Relapse and Death from Merkel Cell Carcinoma. Ann Surg Oncol 2020; 28:3312-3319. [PMID: 33073342 DOI: 10.1245/s10434-020-09145-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/03/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Current recommendations regarding the size of wide local excision (WLE) margins for Merkel cell carcinoma (MCC) are not well established. METHODS WLE and pathologic margins were respectively reviewed from 79 patients with stage I or II MCC, who underwent WLE at Washington University in St Louis from 2005 to 2019. Outcomes included local recurrence-free survival (LRFS), regional recurrence-free survival (RRFS), distant recurrence-free survival (DRFS), disease-free survival (DFS), and disease-specific survival (DSS). RESULTS Thirty-two percent of patients received adjuvant radiotherapy (aRT). At 1 year, DFS was 51.3%, 71.4%, and 87.8% for patients with WLE margins < 1 cm, 1-1.9 cm, and ≥ 2 cm, respectively (p = 0.02). At 3 years, the DSS was 57.7%, 82.6%, and 100% for patients with WLE margins < 1 cm, 1-1.9 cm, and ≥ 2 cm, respectively (p = 0.02). Multivariable Cox analysis demonstrated that every 1-cm increase in WLE margins was associated with improved RRFS [hazard ratio (HR) = 0.28, 95% confidence interval (CI): 0.11-0.75], DRFS (HR 0.30, CI 0.08-0.99), DFS (HR 0.42, CI 0.21-0.86), and DSS (HR 0.16, CI 0.04-0.61). WLE and pathologic margin size were moderately-to-strongly correlated (r = 0.66). Close or positive pathologic margins (< 3 mm) were associated with reduced DRFS (HR 6.83, CI 1.80-25.9), DFS (HR 2.98, CI 1.31-6.75), and DSS (HR 3.52, CI 1.14-10.9). CONCLUSION Reduced WLE and pathologic margins were associated with higher risk of relapse and death from MCC. Larger WLE margins are important in populations with lower rates of adjuvant radiation.
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Affiliation(s)
- Neal Andruska
- Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Lily Mahapatra
- Department of Pathology and Immunology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Randall J Brenneman
- Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jason T Rich
- Department of Otolaryngology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Brian C Baumann
- Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Leigh Compton
- Department of Pathology and Immunology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.,Division of Dermatology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Wade L Thorstad
- Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA
| | - Mackenzie D Daly
- Department of Radiation Oncology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.
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Boukovalas S, Goepfert RP, Smith JM, Mecham E, Liu J, Zafereo ME, Chang EI, Hessel AC, Hanasono MM, Gross ND, Yu P, Lewin JS, Lewis CM, Diaz EM, Weber RS, Myers JN, Offodile AC. Association between postoperative complications and long-term oncologic outcomes following total laryngectomy: 10-year experience at MD Anderson Cancer Center. Cancer 2020; 126:4905-4916. [PMID: 32931057 DOI: 10.1002/cncr.33185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/23/2020] [Accepted: 07/24/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Postoperative complications are an independent predictor of poor survival across several tumors. However, there is limited literature on the association between postoperative morbidity and long-term survival following total laryngectomy (TL) for cancer. METHODS We conducted a retrospective review of all TL patients at a single institution from 2008 to 2013. Demographic and clinical data were collected and analyzed, including postsurgical outcomes, which were classified using the Clavien-Dindo system. Multivariable Cox regression analyses were performed to identify factors associated with overall survival (OS) and disease-free survival (DFS). RESULTS A total of 362 patients were identified. The mean age was 64 years, and the majority of patients were male (81%). The median follow-up interval was 21 months. Fifty-seven percent of patients had received preoperative radiation, and 40% had received preoperative chemotherapy. Fifty-seven percent of patients underwent salvage TL, and 60% underwent advanced reconstruction (45% free flap and 15% pedicled flap). A total of 136 patients (37.6%) developed postoperative complications, 92 (25.4%) of which were major. Multivariable modeling demonstrated that postoperative complications independently predicted shorter OS (hazard ratio [HR], 1.50; 95% CI, 1.16-1.96; P = .002) and DFS (HR, 1.36; 95% CI, 1.05-1.76; P = .021). Other independent negative predictors of OS and DFS included positive lymph node status, preoperative chemotherapy, comorbidity grade, and delayed adjuvant therapy. Severity of complication and reason for TL (salvage vs primary) were not shown to be predictive of OS or DFS. CONCLUSION Postoperative complications are associated with worse long-term OS and DFS relative to uncomplicated cases. Patient optimization and timely management of postoperative complications may play a critical role in long-term survival.
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Affiliation(s)
- Stefanos Boukovalas
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Michael Smith
- Division of Plastic Surgery, The University of Texas Medical Branch, Galveston, Texas
| | | | - Jun Liu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Edward I Chang
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew M Hanasono
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peirong Yu
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jan S Lewin
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Carol M Lewis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo M Diaz
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anaeze C Offodile
- Department of Plastic and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
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68
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Sullivan CB, Al-Qurayshi Z, Anderson CM, Seaman AT, Pagedar NA. Factors Associated With the Choice of Radiation Therapy Treatment Facility in Head and Neck Cancer. Laryngoscope 2020; 131:1019-1025. [PMID: 32846018 DOI: 10.1002/lary.29033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To analyze the clinicodemographic characteristics and treatment outcomes of patients receiving postoperative radiation therapy (PORT) at a different treatment facility rather than the initial surgical facility for head and neck cancer. STUDY DESIGN Retrospective cohort analysis. METHODS Utilizing the National Cancer Data Base, 2004 to 2015, patients with a diagnosis of oral cavity/oropharyngeal, hypopharyngeal, and laryngeal squamous cell carcinoma were studied. Multivariate analysis was completed with multivariate regression and Cox proportional hazard model, and survival outcomes were examined using Kaplan-Meier analysis. RESULTS A total of 15,181 patients who had surgery for a head and neck cancer at an academic/research center were included in the study population. Of the study population, 4,890 (32.2%) patients completed PORT at a different treatment facility. Treatment at a different facility was more common among patients who were ≥65 years old, white, Medicare recipients, those with a greater distance between residence and surgical treatment facility, and with lower income within area of residence (each P < .05). Overall survival was worse in patients completing PORT at a different treatment facility versus at the institution where surgery was completed (61.9% vs. 66.4%; P = .002). CONCLUSIONS PORT at a different facility was more common in older individuals, Medicare recipients, those with greater distance to travel, and lower-income individuals. Completing PORT outside the hospital where surgery was performed was associated with inferior survival outcomes among head and neck cancer patients. LEVEL OF EVIDENCE 3 Laryngoscope, 131:1019-1025, 2021.
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Affiliation(s)
- Christopher B Sullivan
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Zaid Al-Qurayshi
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Aaron T Seaman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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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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Silverman DA, Zhan KY, Puram SV, Eskander A, Teknos TN, Rocco JW, Old MO, Kang SY. Predictors of Postoperative Radiation Following Laser Resection in Early-Stage Glottic Cancer. Otolaryngol Head Neck Surg 2020; 163:1218-1225. [PMID: 32631147 DOI: 10.1177/0194599820933183] [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] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Guideline recommendations for the treatment of early-stage glottic cancer are limited to single-modality therapy with surgery or radiation alone. We sought to investigate the clinicopathologic and treatment factors associated with the use of postoperative radiation therapy (PORT) following laser excision for patients with T1-T2N0 glottic squamous cell carcinoma (SCC). STUDY DESIGN Retrospective observational study of the National Cancer Database. SETTING National Cancer Database review from 2004 to 2014. PATIENTS AND METHODS A total of 1338 patients with primary cT1-T2N0M0 glottic SCC undergoing primary laser excision were included. Hospitals were divided into quartiles based on yearly volume of laryngeal laser cases performed. Multivariate logistic regression was performed to identify independent predictors of PORT. RESULTS The overall rate of PORT was 30.0%. Predictors of PORT included treatment at lower-volume hospitals (adjusted odds ratio [aOR] for quartiles 2-4, 1.32-4.84), positive margins (aOR, 3.83 [95% CI, 2.54-5.78]), and T2 tumors (aOR, 3.58 [95% CI, 2.24-5.74]). PORT utilization demonstrated a strong inverse correlation with hospital volume. Among top-quartile hospitals, the rate of PORT was 11.2%, while rates of PORT at second-, third-, and fourth-quartile institutions were 19.2%, 32.2%, and 37.4%, respectively. CONCLUSIONS Predictors of PORT in multivariable analysis included treatment at lower-volume facilities, positive margins, and T2 disease. This study highlights the importance of treating early-stage glottic carcinoma at high-volume institutions. In addition, there is a need to reevaluate the use of PORT and reduce the rate of dual-modality therapy for patients with early-stage glottic SCC.
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Affiliation(s)
- Dustin A Silverman
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Kevin Y Zhan
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Sidharth V Puram
- Division of Head and Neck Surgery, Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, Siteman Cancer Center, Saint Louis, Missouri, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Theodoros N Teknos
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - James W Rocco
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Matthew O Old
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
| | - Stephen Y Kang
- Division of Head and Neck Oncology, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, James Cancer Center and Solove Research Institute, Columbus, Ohio, USA
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Sykes KJ, Morrow E, Smith JB, Holcomb AJ, TenNapel M, Lominska CE, Bur AM, Kakarala K. What is the hold up?—Mixed‐methods analysis of postoperative radiotherapy delay in head and neck cancer. Head Neck 2020; 42:2948-2957. [DOI: 10.1002/hed.26355] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/25/2020] [Accepted: 06/09/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Kevin J. Sykes
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
| | - Emily Morrow
- Department of Sociology University of Kansas Lawrence Kansas USA
- Department of Social and Behavioral Sciences and Public Services Kansas City Kansas Community College Kansas City Kansas USA
| | - Joshua B. Smith
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
| | - Andrew J. Holcomb
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
| | - Mindi TenNapel
- Department of Radiation Oncology University of Kansas Medical Center Kansas City Kansas USA
| | | | - Andrés M. Bur
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
| | - Kiran Kakarala
- Department of Otolaryngology—Head and Neck Surgery University of Kansas Medical Center Kansas City Kansas USA
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Graboyes E, Cramer J, Balakrishnan K, Cognetti DM, López-Cevallos D, de Almeida JR, Megwalu UC, Moore CE, Nathan CA, Spector ME, Lewis CM, Brenner MJ. COVID-19 pandemic and health care disparities in head and neck cancer: Scanning the horizon. Head Neck 2020; 42:1555-1559. [PMID: 32562325 PMCID: PMC7323088 DOI: 10.1002/hed.26345] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 12/30/2022] Open
Abstract
The COVID-19 pandemic has profoundly disrupted head and neck cancer (HNC) care delivery in ways that will likely persist long term. As we scan the horizon, this crisis has the potential to amplify preexisting racial/ethnic disparities for patients with HNC. Potential drivers of disparate HNC survival resulting from the pandemic include (a) differential access to telemedicine, timely diagnosis, and treatment; (b) implicit bias in initiatives to triage, prioritize, and schedule HNC-directed therapy; and (c) the marked changes in employment, health insurance, and dependent care. We present four strategies to mitigate these disparities: (a) collect detailed data on access to care by race/ethnicity, income, education, and community; (b) raise awareness of HNC disparities; (c) engage stakeholders in developing culturally appropriate solutions; and (d) ensure that surgical prioritization protocols minimize risk of racial/ethnic bias. Collectively, these measures address social determinants of health and the moral imperative to provide equitable, high-quality HNC care.
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Affiliation(s)
- Evan Graboyes
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - John Cramer
- Department of Otolaryngology-Head & Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - David M Cognetti
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel López-Cevallos
- School of Language, Culture & Society, Oregon State University, Corvallis, Oregon, USA
| | - John R de Almeida
- University Health Network/ Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, USA
| | - Uchechukwu C Megwalu
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - Charles E Moore
- Department of Otolaryngology-Head & Neck Surgery, Emory University, Atlanta, Georgia, USA
| | - Cherie-Ann Nathan
- Department of Otolaryngology-Head & Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Matthew E Spector
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol M Lewis
- Head & Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
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73
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Mazul AL, Stepan KO, Barrett TF, Thorstad WL, Massa S, Adkins DR, Daly MD, Rich JT, Paniello RC, Pipkorn P, Zevallos JP, Jackson RS, Kang SY, Puram SV. Duration of radiation therapy is associated with worse survival in head and neck cancer. Oral Oncol 2020; 108:104819. [PMID: 32485609 DOI: 10.1016/j.oraloncology.2020.104819] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/22/2020] [Accepted: 05/22/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Delays in radiation are multifactorial, frequent, and associated with poor outcomes. This study investigates the effect of both primary and adjuvant radiation therapy duration and their interaction with other measures of treatment delay on survival in head and neck squamous cell carcinoma (HNSCC). METHODS We built a retrospective cohort using the National Cancer Database, consisting of primary oral cavity, hypopharynx, larynx and oropharynx squamous cell carcinoma without distant metastasis and with at least six weeks of radiation. The primary exposure was the duration of radiation therapy (DRT), and the primary outcome was death. We estimated the association between DRT and 5-year overall survival (OS) using Kaplan-Meier curves and hazard ratios (HRs) with Cox proportional hazard regression. RESULTS In both primary (definitive) and adjuvant (post-surgical) radiation settings, increased DRT results in decreased survival. In the primary radiation cohort, 5-year OS was 59.7% [59.1%-60.3%] among those with 47-53 days DRT, which decreased significantly with each subsequent week to completion (81+ days: 38.4% [36.2%-40.7%]). In the surgical cohort, survival decreased 16.5% when DRT extended beyond 75 days (40-46 days: 68.2% [67.3%-69.1%] vs. 75+ days: 53.3% [50.1%-56.7%]). Multivariate analyses showed increased hazard of death with increased DRT (primary radiation: 81+ days HR: 1.69 [1.58-1.81]); surgical: 75+ days HR: 1.61 [1.37-1.88]), with effects intensifying when restricting to those receiving full-dose radiation. CONCLUSION A prolonged DRT was associated with worse OS in head and neck cancer. Radiation treatment delays of even a week lead to a significant survival disadvantage. DRT had a stronger association with survival than time to initiation of postoperative adjuvant radiotherapy.
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Affiliation(s)
- Angela L Mazul
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States; Division of Public Health Sciences, Department of Surgery, Washington University, St Louis, MO, United States
| | - Katelyn O Stepan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Thomas F Barrett
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, United States
| | - Sean Massa
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Douglas R Adkins
- Division of Oncology, Department of Medicine, Washington University School of Medicine, St Louis, MO, United States
| | - Mackenzie D Daly
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, MO, United States
| | - Jason T Rich
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Randal C Paniello
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Jose P Zevallos
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States
| | - Stephen Y Kang
- Department of Otolaryngology - Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH, United States
| | - Sidharth V Puram
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, United States; Department of Genetics, Washington University School of Medicine, St Louis, MO, United States.
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Routine feasibility of postoperative chemoradiotherapy in head and neck squamous cell carcinoma at high risk of recurrence. Eur Ann Otorhinolaryngol Head Neck Dis 2020; 137:371-375. [PMID: 32291205 DOI: 10.1016/j.anorl.2020.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the feasibility in routine practice of postoperative chemoradiotherapy in head and neck squamous cell carcinoma (HNSCC) at high risk of recurrence. METHOD A single-center retrospective study recruited all patients receiving postoperative cisplatin chemoradiotherapy for HNSCC at high risk of recurrence. The main endpoints were the rate of complete postoperative chemoradiotherapy and the impact of various clinical factors. Secondary endpoints comprised the impact of completion of therapy on survival and on acute and late toxicity. RESULTS One hundred and six patients were included. 24.5% showed severe comorbidity. Chemoradiotherapy was complete in 61 patients (57.5%). Radiation therapy was interrupted for >3 days in 16 patients (15.1%). The 3rd concomitant cisplatin course could not be implemented in 34 patients (32.1%). Low pre-treatment glomerular filtration rate was significantly associated (p=0.003) with treatment interruption; >5% weight-loss during treatment showed suggestive association (p=0.026). Completion of treatment was not associated with any significant difference in overall survival (p=0.441) or progression-free survival (p=0.81). 14.9% of patients showed post-treatment kidney failure; there were 10 cases of osteoradionecrosis (9.4%). CONCLUSION The rate of complete postoperative chemoradiotherapy was comparable to that reported in clinical trials, despite frequent comorbidity and poor nutritional status. Early nutritional support is a key factor for treatment under optimal conditions.
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75
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Kato MG, Baek CH, Chaturvedi P, Gallagher R, Kowalski LP, Leemans CR, Warnakulasuriya S, Nguyen SA, Day TA. Update on oral and oropharyngeal cancer staging - International perspectives. World J Otorhinolaryngol Head Neck Surg 2020; 6:66-75. [PMID: 32426706 PMCID: PMC7221211 DOI: 10.1016/j.wjorl.2019.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022] Open
Abstract
Squamous cell carcinoma of the oral cavity and oropharynx have been used synonymously and interchangeably in the world literature in the context of head and neck cancers. As the 21st century progresses, divergence between the two have become more evident, particularly due to evidence related to human papillomavirus-associated oropharyngeal squamous cell carcinoma. As such, the American Joint Committee on Cancer recently published the 8th edition Cancer Staging Manual, serving as a continued global resource to clinicians and researchers. Through changes in staging related to T and N clinical and pathologic classifications, the new system is expected to influence current management guidelines of these cancers that have distinct anatomic and etiopathogenic characteristics. This article aims to review such impactful changes in a time of critical transition of the staging of head and neck cancer and how these changes may affect clinicians and researchers worldwide.
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Affiliation(s)
- Masanari G Kato
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Chung-Hwan Baek
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Pankaj Chaturvedi
- Department of Head and Neck Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Richard Gallagher
- Department of Otolaryngology, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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Graboyes EM, Kompelli AR, Neskey DM, Brennan E, Nguyen S, Sterba KR, Warren GW, Hughes-Halbert C, Nussenbaum B, Day TA. Association of Treatment Delays With Survival for Patients With Head and Neck Cancer: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2020; 145:166-177. [PMID: 30383146 DOI: 10.1001/jamaoto.2018.2716] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Delays in the delivery of care for head and neck cancer (HNC) are a key driver of poor oncologic outcomes and thus represent an important therapeutic target. Objective To synthesize information about the association between delays in the delivery of care for HNC and oncologic outcomes. Evidence Review A systematic review of the English-language literature in PubMed/MEDLINE and Scopus published between January 1, 2007, and February 28, 2018, was performed to identify articles addressing the association between treatment delays and oncologic outcomes for patients with HNC. Articles that were included (1) addressed cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) discussed patients treated in 2004 or later; (3) analyzed time of diagnosis to treatment initiation (DTI), time from surgery to the initiation of postoperative radiotherapy, and/or treatment package time (TPT; the time from surgery through the completion of postoperative radiotherapy); (4) included a clear definition of treatment delay; and (5) analyzed the association between the treatment time interval and an oncologic outcome measure. Quality assessment was performed using the Institute of Health Economics Quality Appraisal Checklist for Case Series Studies. Findings A total of 18 studies met inclusion criteria and formed the basis of the systematic review. Nine studies used the National Cancer Database and 6 studies were single-institution retrospective reviews. Of the 13 studies assessing DTI, 9 found an association between longer DTI and poorer overall survival; proposed DTI delay thresholds ranged from more than 20 days to 120 days or more. Four of the 5 studies assessing time from surgery to the initiation of postoperative radiotherapy (and all 4 studies assessing guideline-adherent time to postoperative radiotherapy) found an association between a timely progression from surgery to the initiation of postoperative radiotherapy and improved overall or recurrence-free survival. Of the 5 studies examining TPT, 4 found that prolonged TPT correlated with poorer overall survival; proposed thresholds for prolonged TPT ranged from 77 days or more to more than 100 days. Conclusions and Relevance Timely care regarding initiation of treatment, postoperative radiotherapy, and TPT is associated with survival for patients with HNC, although significant heterogeneity exists for defining delayed DTI and TPT. Further research is required to standardize optimal time goals, identify barriers to timely care for each interval, and design interventions to minimize delays.
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Affiliation(s)
- Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston
| | - Anvesh R Kompelli
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - David M Neskey
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston.,Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston
| | - Emily Brennan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Shaun Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Katherine R Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Graham W Warren
- Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston.,Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Chanita Hughes-Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston.,Department of Psychiatry, Medical University of South Carolina, Charleston
| | | | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
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Franco R, de Matos LL, Kulcsar MAV, de Castro-Júnior G, Marta GN. Influence of time between surgery and postoperative radiation therapy and total treatment time in locoregional control of patients with head and neck cancer: a single center experience. Clinics (Sao Paulo) 2020; 75:e1615. [PMID: 32725072 PMCID: PMC7362720 DOI: 10.6061/clinics/2020/e1615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the effect of the delay to initiate postoperative radiation therapy (RT) on locoregional control to head and neck squamous cell carcinoma patients. METHODS Retrospective cohort study that included patients submitted to surgery followed by adjuvant RT (with/without chemotherapy). The time interval between surgery and RT was dichotomized by the receiver operating characteristics curve method at 92 days. Other possible sources of heterogeneity with potential impact on locoregional control were explored by regressive analysis. RESULTS A total of 168 patients were evaluated. The median time for locoregional recurrence (LRR) was 29.7 months. The relapse-free survival rates were 66.4% and 75.4% for patients who initiated RT more than and within 92 postoperative days (p=0.377), respectively. Doses lower than 60Gy were associated with worse rates of locoregional control (HR=6.523; 95%CI:2.266-18.777, p=0.001). Patients whose total treatment time (TTT) was longer than 150 days had LRR rate of 41.8%; no patient with TTT inferior to 150 days had relapses (p=0.001). CONCLUSIONS The interval between surgery and RT did not show influence on locoregional control rates. However, doses <60Gy and the total treatment time >150 days were associated with lower locoregional control rates.
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Affiliation(s)
- Rejane Franco
- Programa de Pos-Graduacao, Departamento de Radiologia e Oncologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital de Clinicas, Universidade Federal do Parana, Curitiba, PR, BR
| | - Leandro Luongo de Matos
- Departamento de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marco Aurélio Vamondes Kulcsar
- Departamento de Cirurgia de Cabeca e Pescoco, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gilberto de Castro-Júnior
- Unidade Clinica de Oncologia, Departamento de Radiologia e Oncologia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Oncologia Clinica, Hospital Sirio-Libanes, Sao Paulo, SP, BR
| | - Gustavo Nader Marta
- Departamento de Radiologia e Oncologia, Servico de Radioterapia, Instituto do Cancer do Estado de Sao Paulo (ICESP), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Departamento de Radioterapia, Hospital Sirio-Libanes, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
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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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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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Girkar F, Thiagarajan S, Malik A, Sawhney S, Deshmukh A, Chaukar D, D'Cruz A. Factors predisposing to the development of orocutaneous fistula following surgery for oral cancer: Experience from a tertiary cancer center. Head Neck 2019; 41:4121-4127. [PMID: 31497921 DOI: 10.1002/hed.25951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/24/2019] [Accepted: 08/26/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Orocutaneous fistula (OCF) is one of the frequently encountered postoperative complications following surgery for oral cancer, leading to prolonged hospital stay and delay in the initiation of adjuvant therapy. METHODS We included all patients with oral cancer operated between January 2016 to December 2017 and at risk to develop an OCF. We assessed the incidence of OCF, its management, and factors predisposing to its development. RESULTS Of 587 eligible patients, 9% developed OCF. On univariate and multivariate analysis, patients undergoing bilateral neck dissection or with surgical site infection (SSI) (P < .001) were at maximum risk. On univariate analysis, the incidence was higher following resections for tongue-floor of mouth sub site (P = .002), irrespective of the type of flap used for reconstruction. Majority (57%) required surgical intervention for management. CONCLUSION The presence of SSI and performing bilateral neck dissection posed the maximum risk for developing OCF in patients undergoing surgery for oral cancer.
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Affiliation(s)
- Farhana Girkar
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | | | - Akshat Malik
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Shikhar Sawhney
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anuja Deshmukh
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Devendra Chaukar
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
| | - Anil D'Cruz
- Department of Head & Neck Oncology, Tata Memorial Hospital, Mumbai, India
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81
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Chao H, Schonewolf CA, Tan EX, Swisher‐McClure S, Ghiam AF, Weinstein GS, O'Malley BW, Chalian AA, Rassekh CH, Newman JG, Cohen RB, Bauml JM, Aggarwal C, Lin A, Lukens JN. The impact of treatment package time on locoregional control for HPV+ oropharyngeal squamous cell carcinoma treated with surgery and postoperative (chemo)radiation. Head Neck 2019; 41:3858-3868. [DOI: 10.1002/hed.25914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/25/2019] [Accepted: 07/30/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hann‐Hsiang Chao
- Department of Radiation Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Caitlin A. Schonewolf
- Department of Radiation Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Erik X. Tan
- Department of Radiation Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Samuel Swisher‐McClure
- Department of Radiation Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Alireza F. Ghiam
- Department of Radiation Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Gregory S. Weinstein
- Department of Otorhinolaryngology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Bert W. O'Malley
- Department of Otorhinolaryngology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Ara A. Chalian
- Department of Otorhinolaryngology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Christopher H. Rassekh
- Department of Otorhinolaryngology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Jason G. Newman
- Department of Otorhinolaryngology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Roger B. Cohen
- Department of Internal Medicine, Division of Medical Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Joshua M. Bauml
- Department of Internal Medicine, Division of Medical Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Charu Aggarwal
- Department of Internal Medicine, Division of Medical Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
| | - John N. Lukens
- Department of Radiation Oncology, Perelman School of MedicineUniversity of Pennsylvania Philadelphia Pennsylvania
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82
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Amini A, Stokes WA, Jones BL, Sampath S, Kang RS, Gernon TJ, Maghami EG, Massarelli E, Bradley CJ, Karam SD. Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma. Head Neck 2019; 41:2299-2308. [PMID: 30737961 PMCID: PMC6886367 DOI: 10.1002/hed.25697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 12/10/2018] [Accepted: 01/24/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility. METHODS Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery. RESULTS A total of 10 832 patients were selected. Five-year overall survival (OS) was higher in patients undergoing PORT at the same facility: 52.5% vs 48.4% (P < 0.001). PORT performed at the same facility was associated with improved OS under multivariate (HR, 0.92; P = 0.01) and propensity score matched (hazard ratio, 0.90; P = 0.004) analyses. CONCLUSIONS OS was better among patients with head and neck cancer who received PORT at the same facility as surgery.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - William A. Stokes
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Bernard L. Jones
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Robert S. Kang
- Division of Head and Neck Surgery, City of Hope National Cancer Center, Duarte, California
| | - Thomas J. Gernon
- Division of Head and Neck Surgery, City of Hope National Cancer Center, Duarte, California
| | - Ellie G. Maghami
- Division of Head and Neck Surgery, City of Hope National Cancer Center, Duarte, California
| | - Erminia Massarelli
- Department of Medical Oncology & Therapeutics Research, City of Hope National Cancer Center, Duarte, California
| | - Cathy J. Bradley
- Department of Health Systems Management and Policy, Colorado Comprehensive Cancer Center, University of Colorado, Aurora, Colorado
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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83
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Osmolak AM, Klatt-Cromwell CN, Price AM, Sanclement JA, Krempl GA. Does perioperative oxandrolone improve nutritional status in patients with cachexia related to head and neck carcinoma? Laryngoscope Investig Otolaryngol 2019; 4:314-318. [PMID: 31236465 PMCID: PMC6580053 DOI: 10.1002/lio2.268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/28/2019] [Accepted: 03/30/2019] [Indexed: 01/06/2023] Open
Abstract
Background Cancer cachexia affects up to over 50% of advanced head and neck cancer (HNC) patients. To date, the potential utility of anabolic steroids in perioperative cachectic HNC patients has not been determined. Methods Retrospective review of pre- and post-oxandrolone administration prealbumin levels in 18 perioperative HNC patients between October 2007 and October 2014 at a tertiary academic medical center. Results The median pretreatment prealbumin was 88.5 mg/L. The median post-treatment prealbumin was 227 mg/L. The median interval improvement of the prealbumin level was 131.5 mg/L. The median differences between the pretreatment and post-treatment prealbumin levels were found to be statistically significant (P < .001). Subjective improvement in wound healing was also observed. Conclusions Perioperative administration of oxandrolone resulted in objective improvements in prealbumin levels and subjective improvements in surgical wounds. Oxandrolone administered 10 mg twice daily (BID) for 10 days may be a useful adjunct in the perioperative care of nutritionally deficient HNC patients who are at risk for or have demonstrated impaired wound healing. Level of Evidence 3.
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Affiliation(s)
- Angela M Osmolak
- Department of Otorhinolaryngology-Head and Neck Surgery University of Oklahoma Oklahoma City Oklahoma U.S.A
| | - Cristine N Klatt-Cromwell
- Department of Otorhinolaryngology-Head and Neck Surgery University of Oklahoma Oklahoma City Oklahoma U.S.A.,Department of Otolaryngology Head and Neck Surgery Washington University in St. Louis St. Louis Missouri U.S.A
| | - Amber M Price
- Department of Otorhinolaryngology-Head and Neck Surgery University of Oklahoma Oklahoma City Oklahoma U.S.A
| | - Jose A Sanclement
- Department of Otorhinolaryngology-Head and Neck Surgery University of Oklahoma Oklahoma City Oklahoma U.S.A
| | - Greg A Krempl
- Department of Otorhinolaryngology-Head and Neck Surgery University of Oklahoma Oklahoma City Oklahoma U.S.A
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84
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Strohl MP, Chen JP, Ha PK, Seth R, Yom SS, Heaton CM. Can Early Dental Extractions Reduce Delays in Postoperative Radiation for Patients With Advanced Oral Cavity Carcinoma? J Oral Maxillofac Surg 2019; 77:2215-2220. [PMID: 31228426 DOI: 10.1016/j.joms.2019.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE This study sought to evaluate the effect of early extractions on the timing of postoperative radiation (PORT) for patients with advanced oral cavity squamous cell carcinoma. MATERIALS AND METHODS All patients with oral cavity squamous cell carcinoma who required resection, free flap reconstruction, and dental extractions in a 10-year period were retrospectively reviewed. The study included patients who preoperatively had advanced disease that indicated the need for adjuvant radiation as defined by an advanced clinical T category (T3 or T4a) or clinical N category (N2a or above). Multivariate logistic regression models were created to estimate the risk factors for initiation of PORT greater than 6 weeks after surgery. RESULTS Thirty-four patients were included. Thirteen patients underwent early extractions (before or at the time of surgery). Twenty-one patients underwent extractions after surgery. Extractions included all teeth with periodontal disease within the expected field of radiation. Most patients underwent full-mouth extractions (91.1%). PORT was initiated at greater than 6 weeks in 30.8% of patients in the early cohort, whereas 72.4% of patients in the late group experienced a delay (P = .02). Early extractions were significantly associated with a decreased risk of PORT delay. No increase in operating room time occurred for patients who underwent same-day extractions. CONCLUSIONS Early involvement of the dental oncology department and oral-maxillofacial surgeons can aid in the timely delivery of care for patients with advanced oral cavity cancer.
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Affiliation(s)
- Madeleine P Strohl
- Resident physician, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA.
| | - Jennifer Perkins Chen
- Associate professor, Department of Oral-Maxillofacial Surgery, University of California, San Francisco, San Francisco, CA
| | - Patrick K Ha
- Professor, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Rahul Seth
- Associate professor, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
| | - Sue S Yom
- Professor, Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA
| | - Chase M Heaton
- Assistant professor, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA
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85
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Ahmad P, Sana J, Slavik M, Gurin D, Radova L, Gablo NA, Kazda T, Smilek P, Horakova Z, Gal B, Hermanova M, Slampa P, Slaby O. MicroRNA-15b-5p Predicts Locoregional Relapse in Head and Neck Carcinoma Patients Treated With Intensity-modulated Radiotherapy. Cancer Genomics Proteomics 2019; 16:139-146. [PMID: 30850365 DOI: 10.21873/cgp.20119] [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: 12/04/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/AIM Head and neck cancers are a heterogenous group of epithelial tumors represented mainly by squamous cell carcinomas (HNSCC), which are the sixth most common type of cancer worldwide. Surgery together with radiotherapy (RT) is among the basic treatment modalities for most HNSCC patients. Various biomarkers aiming to predict patients' response to RT are currently investigated. The reason behind this effort is, on one hand, to distinguish radioresistant patients that show weak benefit from RT and, on the other hand, reduce the ionizing radiation dose in less aggressive radiosensitive HNSCC with possibly less acute or late toxicity. MATERIALS AND METHODS A total of 94 HNSCC patients treated by definitive intensity-modulated radiotherapy were included in our retrospective study. We used a global expression analysis of microRNAs (miRNAs) in 43 tumor samples and validated a series of selected miRNAs in an independent set of 51 tumors. RESULTS We identified miR-15b-5p to be differentially expressed between patients with short and long time of locoregional control (LRC). Kaplan-Meier analysis confirmed that HNSCC patients with higher expression of miR-15b-5p reach a significantly longer locoregional relapse-free survival compared to patients expressing low levels. Finally, multivariable Cox regression analysis revealed that miR-15b-5p is an independent predictive biomarker of LRC in HNSCC patients (HR=0.25; 95% CI=0.05-0.78; p<0.016). CONCLUSION miR-15b-5p represents a potentially helpful biomarker for individualized treatment decisions concerning the management of HNSCC patients.
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Affiliation(s)
- Parwez Ahmad
- Central European Institute of Technology, 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
| | - Marek Slavik
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Dominik Gurin
- 1st Department of Pathology, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Lenka Radova
- 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
| | - Pavel Smilek
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Zuzana Horakova
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Bretislav Gal
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Marketa Hermanova
- 1st Department of Pathology, St. Anne's University Hospital and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Pavel Slampa
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute and Medical Faculty, Masaryk University, 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
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86
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Rao AD, Figueiredo MLS, Yegya-Raman N, Sehgal S, Chen Q, Alcorn SR, Chen MJ, Ladra M, Villar R, Terezakis SA. Clinical practice and outcomes of palliative radiation therapy in pediatric oncology patients: An international comparison of experiences from two distinct countries and health care systems. Radiother Oncol 2019; 140:1-5. [PMID: 31174104 DOI: 10.1016/j.radonc.2019.05.017] [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: 12/19/2018] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE This study describes clinical outcomes of palliative radiation therapy (RT) for children treated in distinct health-care environments-the US where there is advanced integration of palliative resources and Brazil, a country in the process of developing provisions for pediatric palliative care. METHODS AND MATERIALS Palliative RT cases of pediatric oncology patients aged ≤21-years from 2010 to 2016 in two Brazil-based and one US-based (Johns Hopkins Hospital, JHH) academic centers were reviewed in this study. RESULTS Eighty-eight pediatric patients were treated to 131 lesions with palliative RT. Forty-nine patients from the JHH cohort comprised 84 cases and 39 patients from the Brazil cohort comprised 46 cases. The most common indication for palliative RT was pain (55% overall, 39% Brazil, 63% JHH). Sixty-seven percent of patients experienced a complete (CR) or partial response (PR) to palliative RT, 12% reported stable symptoms (SS), and 22% reported progressive symptoms (PS). The median survival from the end of palliative RT was 3.6 months (95% confidence interval (CI), 2.3-4.8 months). When treated with palliative RT for pain, 83% of patients experience CR/PR, facilitating reduction or discontinuation of opiates in 46% of these patients. CONCLUSION Despite different practices, the clinical results using palliative RT for pediatric patients treated in two unique healthcare environments demonstrated it is an effective tool for pediatric oncology patients across systems.
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Affiliation(s)
- Avani Dholakia Rao
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, USA
| | | | | | - Shuchi Sehgal
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, USA
| | - Qinyu Chen
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, USA
| | - Sara R Alcorn
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, USA
| | - Michael J Chen
- Department of Radiation Oncology, Grupo de Apoio ao Adolescente e à Criança com Câncer, Brazil
| | - Matthew Ladra
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, USA
| | - Rosangela Villar
- Department of Radiation Oncology, Centro Infantil Boldrini, São Paulo e Região, Brazil
| | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, USA.
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87
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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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88
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Goel AN, Sangar S, Mukdad L, Heaton CM, Ryan WR, Wang MB, Long JL, St John MA. Patterns of care and survival impact of adjuvant chemoradiotherapy for oropharyngeal cancer with intermediate-risk features. Head Neck 2019; 41:3177-3186. [PMID: 31107584 DOI: 10.1002/hed.25808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Survival outcomes for adjuvant chemoradiotherapy (aCRT) and adjuvant radiotherapy (aRT) were compared in patients with oropharyngeal squamous cell carcinoma (OPSCC) with intermediate-risk features. METHODS We identified 2164 patients with OPSCC in the National Cancer Database without positive margins or extracapsular extension and with at least one intermediate-risk feature: pT3-T4 disease, ≥two positive lymph nodes, level IV/V nodal disease, and/or lymphovascular invasion. We assessed predictors of aCRT use and covariables impacting overall survival. RESULTS aCRT was commonly used for both human papillomavirus (HPV)-positive (62.0%) and HPV-negative (64.3%) patients with OPSCC. Higher N stage, level IV/V neck disease, and younger age strongly predicted aCRT utilization. There was no significant survival benefit associated with aCRT vs aRT in HPV-positive (hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.62-1.38; P = .71) or HPV-negative (HR, 0.75; 95% CI, 0.51-1.10; P = .15) disease. CONCLUSIONS Despite high rates of utilization, aCRT is not associated with better survival vs aRT for OPSCC with intermediate-risk features, including HPV-negative tumors.
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Affiliation(s)
- Alexander N Goel
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sophia Sangar
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Laith Mukdad
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Chase M Heaton
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California
| | - William R Ryan
- Division of Head and Neck Oncologic and Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California
| | - Marilene B Wang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California.,Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California.,UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California
| | - Jennifer L Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California.,Research Service, Department of Veterans Affairs, Los Angeles, California
| | - Maie A St John
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, California.,Jonsson Comprehensive Cancer Center, UCLA Medical Center, Los Angeles, California.,UCLA Head and Neck Cancer Program, UCLA Medical Center, Los Angeles, California
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89
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Neck management in head and neck squamous cell carcinomas: where do we stand? Med Oncol 2019; 36:40. [DOI: 10.1007/s12032-019-1265-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 03/19/2019] [Indexed: 01/06/2023]
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90
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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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91
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Pang J, Ching HH, Sobel RH, Orosco RK, Califano JA, Wang RC, Sanghvi P, Coffey CS. Implementation of submandibular gland transfer: A multi‐institutional study of feasibility and time to treatment. Head Neck 2019; 41:2182-2189. [DOI: 10.1002/hed.25685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 12/14/2022] Open
Affiliation(s)
- John Pang
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUC San Diego School of Medicine San Diego California
| | - Harry H. Ching
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Nevada, Las Vegas School of Medicine Las Vegas Nevada
| | - Ryan H. Sobel
- Johns Hopkins Head and Neck Surgery at Greater Baltimore Medical CenterMilton J. Dance Jr. Head and Neck Center Baltimore Maryland
| | - Ryan K. Orosco
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUC San Diego School of Medicine San Diego California
| | - Joseph A. Califano
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUC San Diego School of Medicine San Diego California
| | - Robert C. Wang
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of Nevada, Las Vegas School of Medicine Las Vegas Nevada
| | - Parag Sanghvi
- Department of Radiation Medicine and Applied SciencesUC San Diego School of Medicine San Diego California
| | - Charles S. Coffey
- Department of Surgery, Division of Otolaryngology‐Head and Neck SurgeryUC San Diego School of Medicine San Diego California
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92
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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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93
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Kirtane K, Rodriguez CP. Postoperative Combined Modality Treatment in High Risk Resected Locally Advanced Squamous Cell Carcinomas of the Head and Neck (HNSCC). Front Oncol 2018; 8:588. [PMID: 30564559 PMCID: PMC6288294 DOI: 10.3389/fonc.2018.00588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022] Open
Abstract
Patients who undergo upfront curative intent resection for locally advanced squamous cell carcinomas and who have adverse pathologic features benefit from adjuvant therapy. Concurrent cisplatin based chemoradiation is an established standard of care endorsed by national guidelines. Controversy now exists on the applicability of this strategy to the good risk human papilloma virus (HPV) related oropharynx cancer (OPC) patient. Ongoing clinical studies are exploring therapeutic de-escalation in the postoperative setting for this distinct patient population. The introduction of immune checkpoint inhibitors to the therapeutic armamentarium for recurrent/metastatic head and neck cancer patients has led to clinical investigation of incorporation of PD-1 inhibition in the postoperative setting.
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Affiliation(s)
| | - Cristina P Rodriguez
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
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94
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Janz TA, Kim J, Hill EG, Sterba K, Warren G, Sharma AK, Day TA, Hughes-Halbert C, Graboyes EM. Association of Care Processes With Timely, Equitable Postoperative Radiotherapy in Patients With Surgically Treated Head and Neck Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2018; 144:1105-1114. [PMID: 30347012 PMCID: PMC6472989 DOI: 10.1001/jamaoto.2018.2225] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Delays in initiation of postoperative radiotherapy (PORT) after surgery for head and neck squamous cell carcinoma (HNSCC) are common, predominantly affect racial minorities, and are associated with decreased survival. Details regarding the care processes that contribute to timely, equitable PORT remain unknown. Objective To determine care processes associated with timely, equitable PORT. Design, Setting, and Participants This retrospective cohort study included patients 18 years or older undergoing surgery for HNSCC at the Medical University of South Carolina (MUSC), Charleston, followed by PORT (at MUSC or elsewhere) with or without chemotherapy from January 1, 2014, through December 31, 2016. Data were analyzed from September 15, 2017, through June 28, 2018. Main Outcomes and Measures The main outcome measure was the proportion of timely, guideline-adherent initiation of PORT (≤6 weeks postoperatively). Secondary outcome measures included care processes associated with timely PORT. The association between process variables with timely PORT was explored using multivariable logistic regression analysis. Effect modification of the association between receipt of care processes and timely PORT by race was explored using interaction effects. Results A total of 197 patients were included in the analysis; they were predominantly white (157 [79.7%]) and male (136 [69.0%]) with a mean age of 59 years (range, 28-89 years). Overall, 89 patients (45.2%) experienced a delay initiating PORT. African American patients had a 13.5% absolute increase in the rate of delayed PORT relative to white patients (21 of 37 [56.8%] vs 68 of 157 [43.3%]). The adjusted multivariable regression showed that the following care processes were associated with timely PORT: preoperative radiotherapy consultation (odds ratio [OR], 8.94; 95% CI, 1.64-65.53), PORT at MUSC (OR, 6.21; 95% CI, 1.85-24.75), pathology report within 7 postoperative days (OR, 4.14; 95% CI, 1.21-15.86), time from surgery to PORT referral of no longer than 10 days (OR, 12.14; 95% CI, 3.14-63.00), time from PORT referral to consultation of no longer than 10 days (OR, 10.76; 95% CI, 3.01-49.70), and time from PORT consultation to its start of no longer than 21 days (OR, 4.80; 95% CI 1.41-18.44). Analysis of interactions revealed no statistically significant differences between African American and white patients in receipt of key processes associated with timely PORT. Conclusions and Relevance Specific care processes are associated with guideline-adherent initiation of PORT. Novel strategies appear to be needed to ensure that these processes are performed for all patients with HNSCC, thereby facilitating timely, equitable PORT.
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Affiliation(s)
- Tyler A Janz
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Joanne Kim
- Hollings Cancer Center, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Elizabeth G Hill
- Hollings Cancer Center, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Katherine Sterba
- Hollings Cancer Center, Medical University of South Carolina, Charleston
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Graham Warren
- Department of Radiation Oncology, Medical University of South Carolina, Charleston
- Department of Cell and Molecular Pharmacology, Medical University of South Carolina, Charleston
| | - Anand K Sharma
- Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Terry A Day
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Chanita Hughes-Halbert
- Hollings Cancer Center, Medical University of South Carolina, Charleston
- Department of Psychiatry, Medical University of South Carolina, Charleston
| | - Evan M Graboyes
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
- Hollings Cancer Center, Medical University of South Carolina, Charleston
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95
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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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96
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Janz TA, Graboyes EM, Nguyen SA, Ellis MA, Neskey DM, Harruff EE, Lentsch EJ. A Comparison of the NCDB and SEER Database for Research Involving Head and Neck Cancer. Otolaryngol Head Neck Surg 2018; 160:284-294. [DOI: 10.1177/0194599818792205] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To determine whether structural differences in data sampling between the National Cancer Database (NCDB), a non-population-based cancer registry, and Surveillance, Epidemiology, and End Results (SEER), a population-based cancer registry, result in differences in patient characteristics or oncologic outcomes. Study Design Retrospective cohort study. Setting NCDB and SEER database. Subjects and Methods Patients with head and neck cancer (HNC) were included from 2004 to 2014. The primary outcome, weighted differences in characteristics between the databases, was evaluated for each head and neck subsite (oral cavity [OC], oropharynx [OP], hypopharynx [HP], and larynx [LX]). The secondary outcome measure, overall survival (OS), was evaluated using Kaplan-Meier (KM) estimates of survival and Cox proportional hazards (PH) regression modeling. Results In total, 112,007 and 340,420 HNC cases were registered in SEER and the NCDB, respectively. The mean age at diagnosis for the 4 head and neck subsites differed by no more than 1.1 years between the 2 databases. The largest difference in patient or tumor characteristics was the frequency of OC subsite lip cancer (weighted proportional difference, 6.9%; 95% confidence interval, 6.5%-7.3%). Unadjusted KM estimates of 5-year OS differed by no more than 2% (OP, HP, and LX subsites). On Cox PH modeling, adjusted hazard ratios ranged from 0.89 to 0.91 for patients of different head and neck subsites in the NCDB relative to SEER. Conclusions Patients with HNC in the SEER database and NCDB do not greatly differ in terms of demographics, treatment, and survival. Decisions to use either database should be driven by the data fields, which vary between the registries.
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Affiliation(s)
- Tyler A. Janz
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Evan M. Graboyes
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
| | - Shaun A. Nguyen
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Mark A. Ellis
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David M. Neskey
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
| | - E. Emily Harruff
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eric J. Lentsch
- Department of Otolaryngology–Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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97
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Brenner M, Cramer J, Cohen S, Balakrishnan K. Leveraging Quality Improvement and Patient Safety Initiatives to Enhance Value and Patient-Centered Care in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0209-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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98
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Cheng YJ, Tsai MH, Chiang CJ, Tsai ST, Liu TW, Lou PJ, Liao CT, Lin JC, Chang JTC, Tsai MH, Chu PY, Leu YS, Tsai KY, Terng SD, Chien CY, Yang MH, Hao SP, Wang CC, Tsai MH, Chen HHW, Kuo C, Wu YH. Adjuvant radiotherapy after curative surgery for oral cavity squamous cell carcinoma and treatment effect of timing and duration on outcome-A Taiwan Cancer Registry national database analysis. Cancer Med 2018; 7:3073-3083. [PMID: 29905028 PMCID: PMC6051157 DOI: 10.1002/cam4.1611] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 11/05/2022] Open
Abstract
Conduct an accurate risk assessment of resected oral cavity squamous cell carcinoma (OSCC) patients by accessing a nationwide systemic investigation is pivotal to improve treatment outcomes. In this article, we tried to determine the impact of different prognostic factors for OSCC patients who received adjuvant radiotherapy (RT) after curative surgery, using Taiwan's national cancer registry database (TCR). A nationwide, large population‐based study was conducted using TCR with patients identified from 2007 to 2015. The study variables included age, gender, cancer subsites, stage, histology grade, margin and extra‐nodal extension (ENE) status, treatment type, surgery to RT interval (ORI), total RT treatment time (RTT), and RT dose. Univariate and multivariate analysis were performed to identify predictors of the variables associated with overall survival (OS), cause‐specific survival (CSS), local‐regional relapse‐free survival (LRFS), and distant metastasis‐free survival (DMFS). 8986 OSCC patients treated with surgery and adjuvant RT were analyzed. In multivariate analysis, worse outcomes were associated with males, older age, subsite in the oral tongue, advanced stage, higher histologic grade, involved margin, and positive ENE. ORI only showed an adverse trend in LRFS, when exceeding 7 weeks (P = .06). RTT >8 weeks was a significant poor predictor in OS, CSS and LRFS (P < .001). Extreme RT dose (>70 Gy or ≤50 Gy) also demonstrated an adverse impact on the outcomes. Prolonged RT treatment time and extreme RT doses were identified as significantly poor prognostic predictors in OSCC patients who received adjuvant RT after curative surgery.
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Affiliation(s)
- Yung-Jen Cheng
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mu-Hung Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Sen-Tien Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Ching Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Head and Neck Oncology Group, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Hsui Tsai
- Department of Otorhinolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Shing Leu
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Yang Tsai
- Department of Oral and Maxillofacial Surgery, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Shyuang-Der Terng
- Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Po Hao
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chuan-Cheng Wang
- Division of Medical Oncology in the Hematology-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Hsun Tsai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Helen H W Chen
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin Kuo
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Hua Wu
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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99
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Ho AS, Kim S, Tighiouart M, Mita A, Scher KS, Epstein JB, Laury A, Prasad R, Ali N, Patio C, Clair JMS, Zumsteg ZS. Quantitative survival impact of composite treatment delays in head and neck cancer. Cancer 2018; 124:3154-3162. [PMID: 29742280 DOI: 10.1002/cncr.31533] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Multidisciplinary management of head and neck cancer (HNC) must reconcile increasingly sophisticated subspecialty care with timeliness of care. Prior studies examined the individual effects of delays in diagnosis-to-treatment interval, postoperative interval, and radiation interval but did not consider them collectively. The objective of the current study was to investigate the combined impact of these interwoven intervals on patients with HNC. METHODS Patients with HNC who underwent curative-intent surgery with radiation were identified in the National Cancer Database between 2004 and 2013. Multivariable models were constructed using restricted cubic splines to determine nonlinear relations with overall survival. RESULTS Overall, 15,064 patients were evaluated. After adjustment for covariates, only prolonged postoperative interval (P < .001) and radiation interval (P < .001) independently predicted for worse outcomes, whereas the association of diagnosis-to-treatment interval with survival disappeared. By using multivariable restricted cubic spline functions, increasing postoperative interval did not affect mortality until 40 days after surgery, and each day of delay beyond this increased the risk of mortality until 70 days after surgery (hazard ratio, 1.14; 95% confidence interval, 1.01-1.28; P = .029). For radiation interval, mortality escalated continuously with each additional day of delay, plateauing at 55 days (hazard ratio, 1.25; 95% confidence interval, 1.11-1.41; P < .001). Delays beyond these change points were not associated with further survival decrements. CONCLUSIONS Increasing delays in postoperative and radiation intervals are associated independently with an escalating risk of mortality that plateaus beyond certain thresholds. Delays in initiating therapy, conversely, are eclipsed in importance when appraised in conjunction with the entire treatment course. Such findings may redirect focus to streamlining those intervals that are most sensitive to delays when considering survival burden. Cancer 2018. © 2018 American Cancer Society.
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Affiliation(s)
- Allen S Ho
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sungjin Kim
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Biostatistics and Bioinformatics Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Biostatistics and Bioinformatics Research Center, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Alain Mita
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kevin S Scher
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Division of Medical Oncology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joel B Epstein
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Anna Laury
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ravi Prasad
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nabilah Ali
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Chrysanta Patio
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jon Mallen-St Clair
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.,Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
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100
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Divi V, Chen MM, Hara W, Shah D, Narvasa K, Segura Smith A, Kelley J, Rosenthal EL, Porter J. Reducing the Time from Surgery to Adjuvant Radiation Therapy: An Institutional Quality Improvement Project. Otolaryngol Head Neck Surg 2018; 159:158-165. [PMID: 29631478 DOI: 10.1177/0194599818768254] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective The National Comprehensive Cancer Network guidelines recommend an interval between surgery and adjuvant radiation therapy of less than 6 weeks, but only 44% of patients meet this metric nationally. We sought to identify key components of an improvement process focused on starting adjuvant radiation therapy within 6 weeks of surgery. Methods This project used an A3 model to improve a defined process measure. We studied a consecutive sample of 56 patients with oral cavity carcinoma who were treated at our institution with upfront surgical resection followed by adjuvant radiation therapy. Twelve proposed interventions tested during the study period focused on 3 key drivers of delays: delayed dental evaluation and teeth extraction, delayed radiation oncology consults, and inadequate patient engagement. The primary outcome measure was the number of days from surgery to the start of radiation therapy. Results Prior to the intervention, 62% of patients received adjuvant radiation within 6 weeks of surgery. Following the intervention, 73% of patients achieved this metric. The percentage of patients with avoidable delays decreased from 24% to 9%. The percentage of patients with unavoidable delays was relatively constant before and after the intervention (15% and 18%, respectively). Discussion Defining disease-specific metrics is critical to improving care in our head and neck cancer patient population. We demonstrate several key components to develop and improve self-defined metrics. Implications for Practice As we transition to a system of value-based care, structured quality improvement projects can have a measurable impact on cancer patient process measures.
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Affiliation(s)
- Vasu Divi
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.,2 Stanford Health Care, Stanford University, Stanford, California, USA
| | - Michelle M Chen
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA
| | - Wendy Hara
- 3 Department of Radiation Oncology, Stanford Cancer Center, Stanford University, Stanford, California, USA
| | - Deepa Shah
- 2 Stanford Health Care, Stanford University, Stanford, California, USA
| | - Kristina Narvasa
- 2 Stanford Health Care, Stanford University, Stanford, California, USA
| | | | - Jennifer Kelley
- 2 Stanford Health Care, Stanford University, Stanford, California, USA
| | - Eben L Rosenthal
- 1 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Stanford, California, USA.,2 Stanford Health Care, Stanford University, Stanford, California, USA
| | - Julie Porter
- 2 Stanford Health Care, Stanford University, Stanford, California, USA
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