51
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Predictors of weight loss during and after radiotherapy in patients with head and neck cancer: A longitudinal study. Eur J Oncol Nurs 2019; 39:98-104. [DOI: 10.1016/j.ejon.2019.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 01/22/2019] [Accepted: 02/14/2019] [Indexed: 12/24/2022]
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52
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Simon SR, Florie M, Pilz W, Winkens B, Winter N, Kremer B, Baijens LWJ. Association Between Pharyngeal Pooling and Aspiration Using Fiberoptic Endoscopic Evaluation of Swallowing in Head and Neck Cancer Patients with Dysphagia. Dysphagia 2019; 35:42-51. [PMID: 30868301 PMCID: PMC6987057 DOI: 10.1007/s00455-019-09992-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/23/2019] [Indexed: 11/29/2022]
Abstract
Postswallow pharyngeal pooling may be a risk factor for tracheal aspiration. However, limited literature shows the potential association between pharyngeal pooling and aspiration in head and neck cancer (HNC) patients. This study investigates the relationship between postswallow pharyngeal pooling and aspiration in HNC patients with oropharyngeal dysphagia. Furthermore, the effects of tumor stage, tumor location, and cancer treatment on aspiration were examined. Ninety dysphagic HNC patients underwent a standardized fiberoptic endoscopic evaluation of swallowing (FEES) using thin and thick liquid boluses. For each swallow, three visuoperceptual ordinal variables were scored: postswallow vallecular pooling, postswallow pyriform sinus pooling, and aspiration. Logistic regression analyses with correction for the location of pooling, tumor stage, tumor location, and cancer treatment were performed to explore the association between pooling and aspiration. No significant association was found between postswallow vallecular pooling and aspiration for thin liquid. However, severe versus mild-to-moderate postswallow vallecular pooling of thick liquid was significantly associated to aspiration. Similar results were seen after correction for the presence of pyriform sinus pooling, tumor stage, tumor location, or type of cancer treatment. This study showed a significant association between severe postswallow pyriform sinus pooling of thick liquid and aspiration, independent of the presence of vallecular pooling, tumor stage, tumor location, or cancer treatment. Concluding, location (valleculae versus pyriform sinuses), liquid bolus consistency (thin versus thick liquid), and amount of postswallow pharyngeal pooling (no pooling, mild/moderate pooling, severe pooling) have an influence on the probability of aspiration in dysphagic HNC patients, and they should be carefully considered during FEES, even in the absence of aspiration during the examination.
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Affiliation(s)
- Sorina R Simon
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Michelle Florie
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,School for Oncology and Developmental Biology - GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands.,Care and Public Health Research Institute - CAPHRI, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Naomi Winter
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,School for Oncology and Developmental Biology - GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.,School for Oncology and Developmental Biology - GROW, Maastricht University Medical Center, Maastricht, The Netherlands
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53
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Barnhart MK, Cartmill B, Ward EC, Brown E, Sim J, Saade G, Rayner S, Robinson RA, Simms VA, Smee RI. Optimising Radiation Therapy Dose to the Swallowing Organs at Risk: An In Silico Study of feasibility for Patients with Oropharyngeal Tumours. Dysphagia 2019; 34:869-878. [PMID: 30741335 DOI: 10.1007/s00455-019-09983-y] [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: 08/19/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
Recent evidence suggests that reducing radiotherapy dose delivered to specific anatomical swallowing structures [Swallowing Organs at Risk (SWOARs)] may improve swallowing outcomes post-treatment for patients with head and neck cancer. However, for those patients with tumours of the oropharynx, which typically directly overlap the SWOARs, reducing dose to these structures may be unachievable without compromising on the treatment of the disease. To assess the feasibility of dose reduction in this cohort, standard IMRT plans (ST-IMRT) and plans with reduced dose to the SWOARs (SW-IMRT) were generated for 25 oropharyngeal cancer patients (Brouwer et al. in Radiother Oncol 117(1):83-90, https://doi.org/10.1016/j.radonc.2015.07.041 , 2015; Christianen et al. in Radiother Oncol 101(3):394-402, https://doi.org/10.1016/j.radonc.2011.05.015 , 2011). ST-IMRT and SW-IMRT plans were compared for: mean dose to the SWOARs, volume of pharynx and larynx receiving 50 Gy and 60 Gy (V50 and V60 respectively) and overlap between the tumour volume and the SWOARs. Additionally, two different SWOARs delineation guidelines (Brouwer et al. in Radiother Oncol 117(1):83-90, https://doi.org/10.1016/j.radonc.2015.07.041 , 2015; Christianen et al. in Radiother Oncol 101(3):394-402, https://doi.org/10.1016/j.radonc.2011.05.015 , 2011) were used to highlight differences in calculated volumes between existing contouring guidelines. Agreement in SWOARs volumes between the two guidelines was calculated using a concordance index (CI). Despite a large overlap between the tumour and SWOARs, significant (p < 0.05) reductions in mean dose to 4 of the 5 SWOARs, and V50/V60 for the pharynx and larynx were achieved with SW-IMRT plans. Low CIs per structure (0.15-0.45) were found between the two guidelines highlighting issues comparing data between studies when different guidelines have been used (Hawkins et al. in Semin Radiat Oncol 28(1):46-52, https://doi.org/10.1016/j.semradonc.2017.08.002 , 2018; Brodin et al. in Int J Radiat Oncol Biol Phys 100(2):391-407, https://doi.org/10.1016/j.ijrobp.2017.09.041 , 2018). This study found reducing dose to the SWOARs is a feasible practice for patients with oropharyngeal cancer. However, future prospective research is needed to determine if the extent of dose reduction achieved equates to clinical benefits.
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Affiliation(s)
- Molly K Barnhart
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia. .,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Bena Cartmill
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, QLD, 4102, Australia.,Speech Pathology, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Woolloongabba, QLD, 4102, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, QLD, 4102, Australia
| | - Elizabeth Brown
- Radiation Oncology, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Woolloongabba, QLD, 4102, Australia
| | - Jonathon Sim
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - George Saade
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - Sandra Rayner
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - Rachelle A Robinson
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia
| | - Virginia A Simms
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia
| | - Robert I Smee
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia.,The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia
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54
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Radiotherapy-induced dysphagia and its impact on quality of life in patients with nasopharyngeal carcinoma. Strahlenther Onkol 2019; 195:457-467. [DOI: 10.1007/s00066-018-01421-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 12/22/2018] [Indexed: 12/13/2022]
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55
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External validation of a multifactorial normal tissue complication probability model for tube feeding dependence at 6 months after definitive radiotherapy for head and neck cancer. Radiother Oncol 2018; 129:403-408. [DOI: 10.1016/j.radonc.2018.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 08/12/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
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56
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Khan MS, Roberts MS. Challenges and innovations of drug delivery in older age. Adv Drug Deliv Rev 2018; 135:3-38. [PMID: 30217519 DOI: 10.1016/j.addr.2018.09.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Both drug delivery performance and various age-related physical, mental and physiological changes can affect drug effectiveness and safety in elderly patients. The many drug delivery systems developed over the years include recent novel transdermal, nasal, pulmonary and orally disintegrating tablets that provide consistent, precise, timely and more targeted drug delivery. Certain drug delivery systems may be associated with suboptimal outcomes in the elderly because of the nature of drug present, a lack of appreciation of the impact of age-related changes in drug absorption, distribution and clearance, the limited availability of pharmacokinetic, safety and clinical data. Polypharmacy, patient morbidity and poor adherence can also contribute to sub-optimal drug delivery systems outcomes in the elderly. The development of drug delivery systems for the elderly is a poorly realised opportunity, with each system having specific advantages and limitations. A key challenge is to provide the innovation that best meets the specific physiological, psychological and multiple drug requirements of individual elderly patients.
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57
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Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of a mono-institutional prospective study. Strahlenther Onkol 2018; 194:1114-1123. [DOI: 10.1007/s00066-018-1328-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
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58
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Messing BP, Ward EC, Lazarus C, Ryniak K, Kim M, Silinonte J, Gold D, Thompson CB, Pitman KT, Blanco R, Sobel R, Harrer K, Ulmer K, Neuner G, Patel K, Tang M, Lee G. Establishing a Multidisciplinary Head and Neck Clinical Pathway: An Implementation Evaluation and Audit of Dysphagia-Related Services and Outcomes. Dysphagia 2018; 34:89-104. [PMID: 29922848 PMCID: PMC6349813 DOI: 10.1007/s00455-018-9917-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/02/2018] [Indexed: 11/28/2022]
Abstract
Head and neck cancer (HNC) guidelines recommend regular multidisciplinary team (MDT) monitoring and early intervention to optimize dysphagia outcomes; however, many factors affect the ability to achieve these goals. The aims of this study were to explore the barriers/facilitators to establishing and sustaining a MDT HNC care pathway and to examine the dysphagia-related speech-language pathology (SLP) and dietetic components of the pathway. Using the Consolidated Framework for Implementation Research (CFIR), a mixed methods study design was used to evaluate an established MDT HNC pathway. Ten MDT members provided perceptions of facilitators/barriers to implementing and sustaining the pathway. Patients attending the SLP and dietetic components of the pathway who commenced treatment between 2013 and 2014 (n = 63) were audited for attendance, outcome data collected per visit, and swallowing outcomes to 24-month post-treatment. Dysphagia outcomes were compared to a published cohort who had received intensive prophylactic dysphagia management. Multiple CFIR constructs were identified as critical to implementing and sustaining the pathway. Complexity was a barrier. Patient attendance was excellent during treatment, with low rates of non-compliance (< 15%) to 24 months. Collection of clinician/patient outcome tools was good during treatment, but lower post-treatment. Dysphagia outcomes were good and comparable to prior published data. The pathway provided patients with access to regular supportive care and provided staff opportunities to provide early and ongoing dysphagia monitoring and management. However, implementing and sustaining a HNC pathway is complex, requiring significant staff resources, financial investment, and perseverance. Regular audits are necessary to monitor the quality of the pathway.
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Affiliation(s)
- Barbara Pisano Messing
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA. .,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia. .,Greater Baltimore Medical Center, The Milton J. Dance, Jr. Head & Neck Center, 6569 N. Charles Street, PPW Suite 401, Baltimore, MD, 21204, USA.
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Government, Brisbane, QLD, Australia
| | - Cathy Lazarus
- Department of Otolaryngology-Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, Thyroid Head and Neck Research Center, Thyroid Head and Neck Cancer (THANC) Foundation, Mount Sinai Beth Israel, New York, NY, USA
| | - Keri Ryniak
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Melissa Kim
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Jessica Silinonte
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Dorothy Gold
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Carol B Thompson
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen T Pitman
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Ray Blanco
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Ryan Sobel
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Karen Harrer
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Karen Ulmer
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Geoffrey Neuner
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Kruti Patel
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Mei Tang
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
| | - Gregory Lee
- Greater Baltimore Medical Center, The Milton J Dance, Jr. Head and Neck Center, Johns Hopkins Head & Neck Surgery, Johns Hopkins Voice Center, Baltimore, MD, USA
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59
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Iqbal MS, Dua D, Kelly C, Bossi P. Managing older patients with head and neck cancer: The non-surgical curative approach. J Geriatr Oncol 2018; 9:411-417. [PMID: 29685382 DOI: 10.1016/j.jgo.2018.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/27/2018] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
Managing older patients with head and neck cancers poses a challenge due to the often reduced levels of physiological reserve, the frequent comorbidities and treatment related toxicity. These factors have implications on speech, breathing and swallowing functions. Treatment management plans in these patients may result in de-intensification strategies and as a result of this, use of non-standard treatments is increasing. There have been published reports that indicate the addition of concurrent systemic therapy to radiation in selected older patients is feasible, and produces outcomes comparable with younger patients. However, some other studies including meta-analyses suggest a lack of real survival benefit with the addition of chemotherapy. So, the key point appears to be the optimal patient selection. Appropriate geriatric and frailty assessments are required to help determine the optimal treatment for older patients with head and neck cancer. Treatment for this population still needs to be well defined and optimized in both modality and intensity. Qualitative studies are also required to address short and long-term post-treatment quality-of-life and survivorship issues in this specific patient population. This review summarizes the evidence available regarding the non-surgical management of older patients with head and neck cancers.
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Affiliation(s)
- Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Divyanshu Dua
- Department of Medical Oncology, The Canberra Hospital, Garran ACT 2605, Australia
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Paolo Bossi
- Department of Medical Oncology, Fondazione IRCCS Instituto Nazionale Tumori, Milan, Italy
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60
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Orlandi E, Miceli R, Infante G, Mirabile A, Alterio D, Cossu Rocca M, Denaro N, Vigna-Taglianti R, Merlotti A, Schindler A, Pizzorni N, Fallai C, Licitra L, Bossi P. Predictors of Patient-Reported Dysphagia Following IMRT Plus Chemotherapy in Oropharyngeal Cancer. Dysphagia 2018; 34:52-62. [PMID: 29948260 DOI: 10.1007/s00455-018-9913-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 05/29/2018] [Indexed: 10/14/2022]
Abstract
The aim of this cross-sectional study is to evaluate the factors associated with patient-reported dysphagia in patients affected by locally advanced oropharyngeal cancer (OPC) treated with definitive intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy (CHT), with or without induction CHT. We evaluated 148 OPC patients treated with IMRT and concurrent CHT, without evidence of disease and who had completed their treatment since at least 6 months. At their planned follow-up visit, patients underwent clinical evaluation and completed the M.D. Anderson dysphagia inventory (MDADI) questionnaire. The association between questionnaire composite score (MDADI-CS) and different patients' and tumor's characteristics and treatments (covariates) was investigated by univariable and multivariable analyses, the latter including only covariates significant at univariable analysis. With a median time from treatment end of 30 months [range 6-74 months, interquartile range (IQR) 16-50 months], the median (IQR) MDADI-CS was 72 (63-84). The majority of patients (82.4%) had a MDADI-CS ≥ 60. At multivariable analysis, female gender, human papilloma virus (HPV)-negative status, and moderate and severe clinician-rated xerostomia were significantly associated with lower MDADI-CS. Patient-perceived dysphagia was satisfactory or acceptable in the majority of patients. HPV status and xerostomia were confirmed as important predictive factors for swallowing dysfunction after radiochemotherapy. Data regarding female gender are new and deserve further investigation.
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Affiliation(s)
- Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, MI, Italy.
| | - Rosalba Miceli
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gabriele Infante
- Unit of Medical Statistics, Biometry and Bioinformatics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aurora Mirabile
- Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Daniela Alterio
- Department of Radiotherapy, Advanced Radiotherapy Center, European Institute of Oncology, Milan, Italy
| | - Maria Cossu Rocca
- Medical Oncology Division of Urogenital and Head and Neck Tumours, European Institute of Oncology, Milan, Italy
| | - Nerina Denaro
- Department of Oncology, Azienda Ospedaliera Santa Croce e Carle, Cuneo, Italy
| | | | - Annamaria Merlotti
- Department of Radiation Oncology, Azienda Ospedaliera Santa Croce and Carle, Cuneo, Italy
| | - Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Sciences, Ospedale Sacco, University of Milan, Milan, Italy
| | - Nicole Pizzorni
- Phoniatric Unit, Department of Biomedical and Clinical Sciences, Ospedale Sacco, University of Milan, Milan, Italy
| | - Carlo Fallai
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, MI, Italy
| | - Lisa Licitra
- Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
| | - Paolo Bossi
- Medical Oncology 3 Department, Fondazione IRCCS Istituto Nazionale dei Tumori, University of Milan, Milan, Italy
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61
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Abstract
Head and neck cancers account for approximately 3% of all cancers in the United States with 62,000 new cases diagnosed annually. The global incidence is approximately 700,000 new cases a year. There has also been a recent increase in human papilloma virus-related oropharyngeal cancers. External beam radiation therapy (RT) is commonly used as an effective therapy for head and neck (H&N) cancers. This is used as a definitive treatment (alone or in combination with chemotherapy) or as an adjuvant treatment after surgical resection of the tumors. Because of the complex anatomy of the H&N region, several critical structures in and around the area receive radiation treatment. This includes the neural structures (brainstem, spinal cord, and brachial plexus), salivary glands, mucosa, major blood vessels, and swallowing musculature. Careful RT planning is necessary to avoid or mitigate the side effects of treatment. This review discusses some of the major acute and late side effects of RT for H&N cancers and provides evidence-based guidelines for their management. Patient-reported outcomes and quality-of-life implications are also discussed.
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Affiliation(s)
- Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI.
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI
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62
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Dean J, Wong K, Gay H, Welsh L, Jones AB, Schick U, Oh JH, Apte A, Newbold K, Bhide S, Harrington K, Deasy J, Nutting C, Gulliford S. Incorporating spatial dose metrics in machine learning-based normal tissue complication probability (NTCP) models of severe acute dysphagia resulting from head and neck radiotherapy. Clin Transl Radiat Oncol 2018; 8:27-39. [PMID: 29399642 PMCID: PMC5796681 DOI: 10.1016/j.ctro.2017.11.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 12/20/2022] Open
Abstract
Severe acute dysphagia commonly results from head and neck radiotherapy (RT). A model enabling prediction of severity of acute dysphagia for individual patients could guide clinical decision-making. Statistical associations between RT dose distributions and dysphagia could inform RT planning protocols aiming to reduce the incidence of severe dysphagia. We aimed to establish such a model and associations incorporating spatial dose metrics. Models of severe acute dysphagia were developed using pharyngeal mucosa (PM) RT dose (dose-volume and spatial dose metrics) and clinical data. Penalized logistic regression (PLR), support vector classification and random forest classification (RFC) models were generated and internally (173 patients) and externally (90 patients) validated. These were compared using area under the receiver operating characteristic curve (AUC) to assess performance. Associations between treatment features and dysphagia were explored using RFC models. The PLR model using dose-volume metrics (PLRstandard) performed as well as the more complex models and had very good discrimination (AUC = 0.82) on external validation. The features with the highest RFC importance values were the volume, length and circumference of PM receiving 1 Gy/fraction and higher. The volumes of PM receiving 1 Gy/fraction or higher should be minimized to reduce the incidence of severe acute dysphagia.
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Key Words
- pm, pharyngeal mucosa
- plr, penalized logistic regression
- svc, support vector classification
- rfc, random forest classification
- auc, area under the receiver operating characteristic curve
- ntcp, normal tissue complication probability
- rt, radiotherapy
- imrt, intensity modulated radiotherapy
- ctcae, common terminology criteria for adverse events
- peg, percutaneous endoscopic gastrostomy
- dvh, dose-volume histogram
- dlh, dose-length histogram
- dch, dose-circumference histogram
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Affiliation(s)
- Jamie Dean
- Joint Department of Physics at the Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
| | - Kee Wong
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Hiram Gay
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Liam Welsh
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Ann-Britt Jones
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Ulricke Schick
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Aditya Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kate Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Shreerang Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Joseph Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Fulham Road, London SW3 6JJ, UK
| | - Sarah Gulliford
- Joint Department of Physics at the Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG, UK
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Dysphagia Evaluation and Treatment After Head and Neck Surgery and/or Chemoradiotherapy of Head and Neck Malignancy. Dysphagia 2018. [DOI: 10.1007/174_2018_179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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64
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Al Barmawi M, Al Hadid LA, Alqudah HN, Al Hadid WA, Shamoun SA. Measuring the Quality of Life among Head-and/or-Neck Cancer Patients with Oral Mucositis Using the Functional Assessment of Cancer Therapy-General in Jordan. Asia Pac J Oncol Nurs 2018; 5:320-326. [PMID: 29963595 PMCID: PMC5996588 DOI: 10.4103/apjon.apjon_14_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Quality of life (QOL) in cancer patients can be influenced by the presence of medical conditions, such as oral mucositis (OM). There is still limited knowledge about this issue among patients in Jordan, and this could be related to the absence of research instruments testing QOL among cancer patients with OM. This study measured the QOL among cancer patients using the Functional Assessment of Cancer Therapy-General (FACT-G), Arabic version. Methods: This was a cross-sectional study on 118 head-and/or-neck cancer patients with OM in Jordan. Data were submitted to measures of normality, reliability, and validity using exploratory factor analysis. The study also measured QOL among the study sample. Results: FACT-G demonstrated good internal consistency reliability and validity. Factor analysis indicated the presence of four factors explained by 24 items representing a valid FACT-G, Arabic version. Scores reflected low QOL compared to reported normative values in the literature. The values used to compare findings from this study were extracted from international literature; no similar values were present in published literature. Conclusions: FACT-G, Arabic version, is valid and reliable when applied to this study population. Further testing is recommended, which would include the establishment of normative values.
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Affiliation(s)
- Marwa Al Barmawi
- Department of Nursing, Faculty of Nursing, Alzaytoonah University of Jordan (ZUJ), Ma'an, Jordan
| | - Lourance A Al Hadid
- Department of Nursing, Aisha Bint Al Hussein College of Nursing and Health Sciences, Al Hussein Bin Talal University, Ma'an, Jordan
| | - Hani Nawaf Alqudah
- Nursing Department, Al-Bashir Hospital, Ministry of Health, Amman, Jordan
| | - Wasfi A Al Hadid
- Department of Dentistry Al Zarqa Hospital, Ministry of Health, Amman, Jordan
| | - Shaimaa A Shamoun
- Department of Clinical Oncology and Radiation Therapy, Al-Bashir Hospital, Ministry of Health, Amman, Jordan
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Giusti R, Bossi P, Mazzotta M, Filetti M, Iacono D, Marchetti P. The use of fentanyl in pain management in head and neck cancer patients: a narrative review. Br J Pain 2017; 12:155-162. [PMID: 30057760 DOI: 10.1177/2049463717736787] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Head and neck (H&N) cancers account for about 5% of all malignant tumours. Pain is one of the most feared consequences of H&N neoplasms and is experienced by up to 80% of patients and worsens their quality of life inhibiting speaking, eating, drinking or swallowing. Nevertheless, pain is still often underestimated and undertreated. Objectives The role of opioids in cancer pain has been well established but evidences about the role and the relative effectiveness of opioids such as fentanyl in the context of H&N cancer pain remains unclear. Methods A literature review based on the guidance of the Centre for Reviews and Dissemination was conducted. An iterative approach was used starting with an electronic search in the MEDLINE database. The search terms (('Neoplasms'[Mesh]) AND 'Head and Neck Neoplasms'[Mesh]) AND 'Fentanyl'[Mesh] were used. Results A total of 18 publications were found by the first performed search on PubMed. Other publications concordant with our aim were found by cross-reference. Considering inclusion and exclusion criteria for our review, eight papers resulted eligible for analysis. Conclusion Fentanyl transdermal therapeutic system (TTS) seems to be an important option, thanks to the way of administration, the good safety and tolerability profiles to control baseline pain. For breakthrough cancer pain (BTcP), several formulations of transmucosal fentanyl are available. All the formulations seem to be active and safety but we lack head-to-head studies of fentanyl versus other strong opioids, as well as with different formulation of fentanyl, particularly for BTcP where H&N cancer population is very poorly represented.
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Affiliation(s)
- Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Paolo Bossi
- Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Marco Mazzotta
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Marco Filetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
| | - Daniela Iacono
- Pulmonary Oncology Unit, San Camillo Forlanini Hospital, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology Unit, Sant'Andrea Hospital of Rome, Rome, Italy
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Bossi P, Cossu Rocca M, Corvò R, Depenni R, Guardamagna V, Marinangeli F, Miccichè F, Trippa F. The vicious circle of treatment-induced toxicities in locally advanced head and neck cancer and the impact on treatment intensity. Crit Rev Oncol Hematol 2017; 116:82-88. [DOI: 10.1016/j.critrevonc.2017.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/22/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022] Open
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Ursino S, D’Angelo E, Mazzola R, Merlotti A, Morganti R, Cristaudo A, Paiar F, Musio D, Alterio D, Bacigalupo A, Russi EG, Lohr F. A comparison of swallowing dysfunction after three-dimensional conformal and intensity-modulated radiotherapy. Strahlenther Onkol 2017; 193:877-889. [DOI: 10.1007/s00066-017-1160-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 05/23/2017] [Indexed: 11/28/2022]
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Van den Steen L, Vanderveken O, Vanderwegen J, Van Gestel D, Daisne JF, Allouche J, Delacroix L, Van Rompaey D, Beauvois S, Cvilic S, Mariën S, Desuter G, Vermorken JB, Van den Weyngaert D, Specenier P, Van Laer C, Peeters M, Van de Heyning P, Chantrain G, Lawson G, Lazarus C, De Bodt M, Van Nuffelen G. Feasibility of tongue strength measurements during (chemo)radiotherapy in head and neck cancer patients. Support Care Cancer 2017; 25:3417-3423. [PMID: 28573486 DOI: 10.1007/s00520-017-3761-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/22/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to investigate the feasibility of tongue strength measures (TSMs) and the influence of bulb location, sex, and self-perceived pain and mucositis in head and neck cancer (HNC) patients during chemoradiotherapy (CRT). METHODS Twenty-six newly diagnosed HNC patients treated with CRT performed anterior and posterior maximal isometric tongue pressures by means of the Iowa Oral Performance Instrument (IOPI). The Oral Mucositis Weekly Questionnaire (OMWQ) and a Visual Analogue Scale (VAS) for pain during swallowing were completed weekly from baseline to 1 week post CRT. RESULTS Feasibility of TSMs during CRT declines significantly from 96 to 100% at baseline to 46% after 6 weeks of CRT. But post-hoc analyses reveal only significant differences in feasibility between baseline and measurements after 4 weeks of treatment. No effect of gender or bulb location was established, but feasibility is influenced by pain and mucositis. CONCLUSIONS Feasibility of TSMs declines during CRT and is influenced by mucositis and pain. For the majority of subjects, TSMs were feasible within the first 4 weeks, which provides a window of scientific and clinical opportunities in this patient population.
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Affiliation(s)
- Leen Van den Steen
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.
| | - Olivier Vanderveken
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Jan Vanderwegen
- University College Thomas More, Antwerp, Belgium.,CHU Saint-Pierre, Brussels, Belgium
| | - Dirk Van Gestel
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-François Daisne
- Université Catholique de Louvain, CHU-UCL-Namur, Site Sainte-Elisabeth, Namur, Belgium
| | | | - Laurence Delacroix
- Université Catholique de Louvain, CHU-UCL-Namur, Site Godinne, Yvoir, Belgium
| | - Diane Van Rompaey
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Sylvie Beauvois
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium
| | - Gauthier Desuter
- Cliniques Universitaires St-Luc, Universite Catholique de Louvain, Brussels, Belgium
| | - Jan Baptist Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | | | - Pol Specenier
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Carl Van Laer
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium
| | - Marc Peeters
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Multi-disciplinary Oncological Center Antwerp, Antwerp, Belgium.,Department Medical Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Paul Van de Heyning
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Georges Lawson
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Cathy Lazarus
- Department of Otolaryngology Head & Neck Surgery, Mount Sinai Beth Israel, New York, NY, USA.,Department of Otorhinolaryngology of the Albert Einstein College of Medicine, Department of Otorhinolaryngology, New York, NY, USA
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Speech, Pathology and Audiology, Ghent University, Ghent, Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Faculty of Speech, Pathology and Audiology, Ghent University, Ghent, Belgium
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Reyes-Gibby CC, Melkonian SC, Hanna EY, Yeung SCJ, Lu C, Chambers MS, Banala SR, Gunn GB, Shete SS. Cohort study of oncologic emergencies in patients with head and neck cancer. Head Neck 2017; 39:1195-1204. [PMID: 28346771 PMCID: PMC5429871 DOI: 10.1002/hed.24748] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 12/12/2016] [Accepted: 01/03/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Treatments for head and neck squamous cell carcinoma (HNSCC) are associated with toxicities that lead to emergency department presentation. METHODS We utilized data from an ongoing prospective cohort of newly diagnosed, previously untreated patients (N = 298) with HNSCC to evaluate the association between clinical and epidemiologic factors and risk for and frequency of emergency department presentation. Time to event was calculated from the date of treatment initiation to emergency department presentation, date of death, or current date. Frequency of emergency department presentation was the sum of emergency department visits during the follow-up time. RESULTS History of hypertension, normal/underweight body mass index (BMI), and probable depression predicted increased risk for emergency department presentation. BMI and severe pain were associated with higher frequency of emergency department presentations. CONCLUSION Clinical and epidemiologic factors can help predict patients with HNSCC who will present to the emergency department. Such knowledge may improve treatment-related patient outcomes and quality of life. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1195-1204, 2017.
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Affiliation(s)
- Cielito C. Reyes-Gibby
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephanie C. Melkonian
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sai-ching J. Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Charles Lu
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mark S. Chambers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Srinivas R. Banala
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary B. Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sanjay S. Shete
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
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Diagnostic accuracy of magnetic resonance imaging techniques for treatment response evaluation in patients with head and neck tumors, a systematic review and meta-analysis. PLoS One 2017; 12:e0177986. [PMID: 28542474 PMCID: PMC5443521 DOI: 10.1371/journal.pone.0177986] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/06/2017] [Indexed: 12/30/2022] Open
Abstract
Background Novel advanced MRI techniques are investigated in patients treated for head and neck tumors as conventional anatomical MRI is unreliable to differentiate tumor from treatment related imaging changes. Purpose As the diagnostic accuracy of MRI techniques to detect tumor residual or recurrence during or after treatment is variable reported in the literature, we performed a systematic meta-analysis. Data sources Pubmed, EMBASE and Web of Science were searched from their first record to September 23th 2014. Study selection Studies reporting diagnostic accuracy of anatomical, ADC, perfusion or spectroscopy to identify tumor response confirmed by histology or follow-up in treated patients for head and neck tumors were selected by two authors independently. Data analysis Two authors independently performed data extraction including true positives, false positives, true negatives, false negatives and general study characteristics. Meta-analysis was performed using bivariate random effect models when ≥5 studies per test were included. Data synthesis We identified 16 relevant studies with anatomical MRI and ADC. No perfusion or spectroscopy studies were identified. Pooled analysis of anatomical MRI of the primary site (11 studies, N = 854) displayed a sensitivity of 84% (95%CI 72–92) and specificity of 82% (71–89). ADC of the primary site (6 studies, N = 287) showed a pooled sensitivity of 89% (74–96) and specificity of 86% (69–94). Limitations Main limitation are the low, but comparable quality of the included studies and the variability between the studies. Conclusions The higher diagnostic accuracy of ADC values over anatomical MRI for the primary tumor location emphases the relevance to include DWI with ADC for response evaluation of treated head and neck tumor patients.
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71
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Prophylactic Swallow Therapy for Patients with Head and Neck Cancer Undergoing Chemoradiotherapy: A Randomized Trial. Dysphagia 2017; 32:487-500. [PMID: 28444488 PMCID: PMC5515964 DOI: 10.1007/s00455-017-9790-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/15/2017] [Indexed: 11/14/2022]
Abstract
Evidence supporting prophylactic swallow exercises for patients with head and neck cancer (HNC) has not been universally demonstrated. This RCT examined diet level, feeding tube use, swallow function, and quality of life (QOL) of patients undergoing chemoradiotherapy who performed prophylactic swallowing exercises. Sixty HNC patients were randomized into exercise versus control groups. Swallowing, oromotor, toxicity, and QOL data were recorded (baseline, 3, 6, 12, 24 months). Physiological swallow function was examined at baseline and 3 months. Swallow exercises were completed twice daily. Oral intake at 3 months was 10% better in the exercise group, which was not statistically significant (p = 0.49). Significant (p < 0.05) differences in secondary outcomes including oromotor function, pharyngeal impairment, oral pharyngeal swallow efficiency, and incisal opening were noted at early time points (3–6 months) in the exercise group. Possible positive early improvements in swallow function are associated with swallowing exercises, although these improvements are not significant longer term.
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72
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Behaviour change technique taxonomy: a method of describing head and neck cancer dysphagia intervention delivery. Curr Opin Otolaryngol Head Neck Surg 2017; 25:182-187. [PMID: 28306585 DOI: 10.1097/moo.0000000000000360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of the review is to examine the current state of the art of dysphagia intervention delivery description and to propose use of a new tool to facilitate this: the behaviour change technique taxonomy version 1 (BCTTv1). RECENT FINDINGS Describing intervention delivery is difficult, and published research in the field of speech and language therapy (SLT) does not include detail on this key aspect of research protocols. Interventions themselves are often poorly delineated, and a way is needed of classifying how these interventions are delivered in practice. SUMMARY Use of the BCTTv1 would facilitate clarity and transparency in intervention delivery description and have positive implications for research, clinical practice and undergraduate teaching if employed by the SLT profession.
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Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, Fearon K, Hütterer E, Isenring E, Kaasa S, Krznaric Z, Laird B, Larsson M, Laviano A, Mühlebach S, Muscaritoli M, Oldervoll L, Ravasco P, Solheim T, Strasser F, de van der Schueren M, Preiser JC. ESPEN guidelines on nutrition in cancer patients. Clin Nutr 2017. [DOI: 10.1016/j.clnu.2016.07.015 10.1016/j.clnu.2016.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hajdú SF, Wessel I, Johansen C, Kristensen CA, Kadkhoda ZT, Plaschke CC, Dalton SO. Swallowing therapy and progressive resistance training in head and neck cancer patients undergoing radiotherapy treatment: randomized control trial protocol and preliminary data. Acta Oncol 2017; 56:354-359. [PMID: 28206871 DOI: 10.1080/0284186x.2016.1269193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Head and neck cancer (HNC) patients are often challenged by treatment induced dysphagia and trismus. Traditionally, rehabilitation is initiated when loss of function has already occurred. There is increasing evidence that it is of benefit to patients to initiate an early rehabilitation process before and during treatment. HNC patients have a unique set of functional challenges such as pre- and post-treatment dysphagia, pain and weight loss. The aim of the trial is to investigate the effects of swallowing and mouth-opening exercises combined with progressive resistance training (PRT) during radiotherapy. This report presents the protocol, interim inclusion and feasibility data. MATERIAL AND METHODS The trial (clinicaltrials.gov NCT02385929) is a multicenter randomized controlled trial (RCT) with a parallel-group randomization (1:1). The planned sample size of 240 HNC patients is randomly assigned to either (1) twice weekly PRT and three times weekly swallowing exercises by physio- and occupational therapists, respectively, as well as daily home exercises throughout radiotherapy or (2) standard care. Inclusion criteria are patients with cancer in the larynx, pharynx, oral cavity, or unknown primary tumor who are referred to radiotherapy with curative intent. Outcomes are measured at end-of-treatment and two, five, and 12 months post-treatment. Interim results: In 16 months, 321 HNC patients were screened for eligibility. Of these, 131 (41%) were eligible according to inclusion criteria. One-hundred-and-fifteen patients were invited to participate of which 69 (60%) were enrolled in the trial and randomized for either intervention or control group with 10 drop-outs (14%). The six pilot patients adhered more than 90% to the program. CONCLUSION Preliminary results show that exercise according to protocol is tolerable and feasible.
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Affiliation(s)
- Sara F. Hajdú
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christoffer Johansen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Unit of Survivorship Research, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Claus A. Kristensen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Zahra T. Kadkhoda
- Department of Oncology, Naestved Hospital, Region Zealand, Naestved, Denmark
| | - Christina C. Plaschke
- Department of Otorhinolaryngology, Head & Neck Surgery and Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanne O. Dalton
- Unit of Survivorship Research, Danish Cancer Society Research Centre, Copenhagen, Denmark
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How to minimize morbidity in radiotherapy of pharyngolaryngeal tumors? Curr Opin Otolaryngol Head Neck Surg 2016; 24:163-9. [PMID: 26959843 DOI: 10.1097/moo.0000000000000235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Radiotherapy is one of the most effective treatment modalities for head and neck cancer. However, because of the intricacy between tumors and normal tissues, it can induce morbidity, such as mucositis, dermatitis, xerostomia, dysphagia, hearing loss, vision impairment, skin fibrosis, and osteoradionecrosis of the jaw, and it can dramatically impact on patient quality of life. RECENT FINDINGS Throughout the last decade, significant improvements have been made in head and neck cancer radiotherapy, especially with the introduction on a routine basis of intensity-modulated radiotherapy. SUMMARY In this context, this review manuscript will focus on how the implementation of intensity-modulated radiotherapy influences treatment morbidity. Specifically, the issues of target volume and organ-at-risk delineation, sparing of organs at risk, tailored treatment intensity, adaptive treatment, and the use of proton therapy will be discussed.
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76
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Mazzola R, Ricchetti F, Fiorentino A, Giaj-Levra N, Fersino S, Tebano U, Albanese S, Gori S, Alongi F. Fentanyl pectin nasal spray for painful mucositis in head and neck cancers during intensity-modulated radiation therapy with or without chemotherapy. Clin Transl Oncol 2016; 19:593-598. [DOI: 10.1007/s12094-016-1570-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/31/2016] [Indexed: 12/14/2022]
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Affiliation(s)
- Rachel Galot
- Department of Medical Oncology, Institut Roi Albert II, Cliniques universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université catholique de Louvain, Brussels, Belgium
| | - Jean-Pascal Machiels
- Department of Medical Oncology, Institut Roi Albert II, Cliniques universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale (Pole MIRO), Université catholique de Louvain, Brussels, Belgium
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Abstract
Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
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Non-surgical organ preservation strategies for locally advanced laryngeal tumors: what is the Italian attitude? Results of a national survey on behalf of AIRO and AIOM. Med Oncol 2016; 33:76. [PMID: 27290695 DOI: 10.1007/s12032-016-0781-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
Abstract
Chemoradiotherapy is the treatment mostly used as organ preservation (OP) strategy worldwide in advanced laryngo-hypopharyngeal cancer. Due to the not homogeneous results of the literature data regarding the pre-treatment assessment and treatment schedule in this setting of patients, the Italian societies of radiation oncology and medical oncology surveyed (by an online survey) their memberships regarding the Italian attitude on larynx preservation in clinical practice. The survey outline addressed different items such as: demographics (11 items), pre-treatment evaluation (12 items), treatment schedules (10 items) and outcomes (3 items). The survey was filled in by 116 clinical oncologists (64 % radiation and 36 % medical oncologists). Results highlighted that pretreatment evaluation was not homogeneous among the respondents. The treatment of choice for the OP program resulted the concurrent chemoradiotherapy (66 %). Induction chemotherapy was proposed mostly in case of aggressive tumors such as advanced stage (T4 or N3) and/or unfavorable primary sites (hypopharynx). Moreover, after induction chemotherapy, for responders patients most participants (46 %) proposed concurrent chemoradiotherapy, while 18 and 19 % proposed radiotherapy alone or radiotherapy and cetuximab, respectively. For patients with stable disease after induction chemotherapy, the respondents declared to suggest surgery, radiotherapy and cetuximab or radiotherapy alone in 38, 32 and 15 % of cases, respectively. Results of the present survey highlighted the variability of therapeutic approaches offered in clinical practice for patients candidate to a larynx OP program. Analysis of abovementioned results may give the chance to modify some clinical attitudes and create the background for future clinical investigation in this field.
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Research into the prevention and rehabilitation of dysphagia in head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2016; 24:208-14. [DOI: 10.1097/moo.0000000000000260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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De Sanctis V, Bossi P, Sanguineti G, Trippa F, Ferrari D, Bacigalupo A, Ripamonti CI, Buglione M, Pergolizzi S, Langendjik JA, Murphy B, Raber-Durlacher J, Russi EG, Lalla RV. Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus statements. Crit Rev Oncol Hematol 2016; 100:147-66. [DOI: 10.1016/j.critrevonc.2016.01.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 11/30/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
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Cilla S, Deodato F, Macchia G, Digesù C, Ianiro A, Piermattei A, Valentini V, Morganti AG. Volumetric modulated arc therapy (VMAT) and simultaneous integrated boost in head-and-neck cancer: is there a place for critical swallowing structures dose sparing? Br J Radiol 2016; 89:20150764. [PMID: 26728543 DOI: 10.1259/bjr.20150764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the potential of volumetric-modulated arc therapy (VMAT) to reduce the risk of swallowing problems after curative chemoradiotherapy. METHODS 20 patients with head and neck cancer who previously underwent radiotherapy were selected. Radiotherapy was prescribed according to simultaneous integrated boost technique with all targets irradiated simultaneously over 30 daily fractions. Doses of 70.5 (67.5), 60.0 and 55.5 Gy were prescribed to primary tumour, high-risk nodal regions and low-risk nodal regions, respectively. Pharyngeal constrictor muscles (PCM) and glottic and supraglottic larynx (SGL) were considered organs at risk related to swallowing dysfunction (SW-OARs). Upper pharyngeal constrictor muscles (uPCM), middle pharyngeal constrictor muscles (mPCM) and lower pharyngeal constrictor muscles (lPCM) part of PCM were also outlined separately. Clinical standard plans (standard-VMAT) and plans aiming to spare SW-OARs (swallowing dysfunction-VMAT) were also created. Normal tissue complication probabilities (NTCP) for physician-rated swallowing dysfunction were calculated using a recently predictive model developed by Christianen et al. RESULTS Planning with two strategies demonstrated comparable planning target volume coverage and no differences in sparing of parotid glands and other non-swallowing organs at risk. SW-VMAT plans provided mean dose reduction for uPCM and SGL by 3.9 and 4.5 Gy, respectively. NTCP values for Radiation Therapy Oncology Group grade 2-4 swallowing dysfunction was decreased by 9.2%. Dose reductions with SW-VMAT depended on tumour location and overlap with SW-OARs. CONCLUSION VMAT plans aiming at sparing swallowing structures are feasible, providing a significant reduction in NTCP swallowing dysfunction with respect to conventional VMAT. ADVANCES IN KNOWLEDGE Dysphagia is today considered one of the dose-limiting toxicities of chemoradiotherapy. The dose sparing of swallowing structures represents a major challenge in radiotherapy. VMAT is a complex new technology having the potential to significantly reduce the risk of dysphagia after curative chemoradiotherapy.
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Affiliation(s)
- Savino Cilla
- 1 Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Universit à Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- 2 Radiotherapy Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- 2 Radiotherapy Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Cinzia Digesù
- 2 Radiotherapy Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Anna Ianiro
- 1 Medical Physics Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Universit à Cattolica del Sacro Cuore, Campobasso, Italy
| | - Angelo Piermattei
- 3 Medical Physics Unit, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Vincenzo Valentini
- 2 Radiotherapy Unit, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del Sacro Cuore, Campobasso, Italy.,4 Radiotherapy Department, Policlinico Agostino Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Alessio G Morganti
- 5 DIMES Università di Bologna-S.Orsola-Malpighi Hospital, Radiation Oncology Center, Bologna, Italy
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