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Dok R, Nuyts S. HPV Positive Head and Neck Cancers: Molecular Pathogenesis and Evolving Treatment Strategies. Cancers (Basel) 2016; 8:cancers8040041. [PMID: 27043631 PMCID: PMC4846850 DOI: 10.3390/cancers8040041] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/09/2016] [Accepted: 03/23/2016] [Indexed: 01/02/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous disease that is the result of tobacco and/or alcohol abuse or infection with high-risk Human papillomaviruses. Despite the fact that HPV positive HNSCC cancers form a distinct clinical entity with better treatment outcome, all HNSCC are currently treated uniformly with the same treatment modality. At present, biologic basis of these different outcomes and their therapeutic influence are areas of intense investigation. In this review, we will summarize the molecular basis for this different outcome, novel treatment opportunities and possible biomarkers for HPV positive HNSCC. In particular, the focus will be on several molecular targeted strategies that can improve the chemoradiation response by influencing DNA repair mechanisms.
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Affiliation(s)
- Rüveyda Dok
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven (KU Leuven), 3000 Leuven, Belgium.
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven (KU Leuven), 3000 Leuven, Belgium.
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium.
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Vuichoud C, Klap J, Loughlin KR. The Emerging Role and Promise of Biomarkers in Penile Cancer. Urol Clin North Am 2016; 43:135-43. [PMID: 26614036 DOI: 10.1016/j.ucl.2015.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Penile cancer is a rare malignancy, which can be a source of devastating psychosexual distress because of its implication on sexual function and self-image. Current penile staging relies on invasive techniques and is often inaccurate. The authors review the promising biomarkers currently under investigation and their application to the staging and prognosis of penile cancer. Further development of such biomarkers provides the potential of improved clinical management of this disease.
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Affiliation(s)
- Camille Vuichoud
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Julia Klap
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA
| | - Kevin R Loughlin
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, 45 Francis Street, Boston, MA 02115, USA.
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Johansen J, Grau Eriksen J. Trends in cancer of the head and neck in the elderly in Denmark, 1980-2012. Acta Oncol 2016; 55 Suppl 1:13-8. [PMID: 26760291 DOI: 10.3109/0284186x.2015.1114672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Squamous cell carcinoma of the head and neck (HNSCC) comprises a variety of malignant tumors. Due to the rarity of each individual malignant entity, knowledge of epidemiological changes and trends over time may be derived from data compiled in regional and national registries. This study analyzed the development in incidence rates and mortality in elderly HNSCC patients in Denmark between 1980 and 2012 with specific attention to compliance to radiotherapy, the main treatment modality of HNSCC in Denmark. MATERIAL AND METHODS HNSCC consisting of more than 25 patients per year over the age of 70 years were analyzed. This included cancer of the oral cavity defined as ICD-codes C00.3-4, C02-04, C05.0, C06; oropharynx as C01, C05.1-9, C09-10; and larynx as C32 recorded in the NORDCAN database. Additional data from the DAHANCA database was added to assess differences in compliance to treatment between younger and older patient groups. RESULTS HNSCC was predominant in younger patients. Only 17% were older than 70 years. The median age was 60 years. Generally, incidence rates rose for cancer of the oral cavity and oropharynx between 1980 and 2012 and stabilized for laryngeal cancer. Mortality rates had a shallower increase, especially in younger age groups, which translated into improved age-specific survival rates. Compliance to radiotherapy was high for all age groups. Failure to receive at least 60 Gy during radical radiation treatment was 2.3% despite a significant increase in patients with poor WHO performance status over time. CONCLUSION HNSCC is a rare disease in patients above 70 years accounting for only 17% of all HNSCC patients. Incidence rates increased over time, but age-specific survival rates improved, especially in younger patients. Failure rates to comply with radiation treatment, however, were low in both young and elderly patients.
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Chirla R, Marcu LG. PET-based quantification of statistical properties of hypoxic tumor subvolumes in head and neck cancer. Phys Med 2016; 32:23-35. [DOI: 10.1016/j.ejmp.2015.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/29/2015] [Accepted: 12/13/2015] [Indexed: 11/30/2022] Open
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Eriksen JG, Lassen P. Human Papilloma Virus as a Biomarker for Personalized Head and Neck Cancer Radiotherapy. Recent Results Cancer Res 2016; 198:143-61. [PMID: 27318685 DOI: 10.1007/978-3-662-49651-0_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A dramatic increase in the incidence of HPV-related oropharyngeal cancer has been reported in some parts of the western world over the past 30 years. They constitute a clinically distinct subgroup of cancers in terms of molecular biology, patient characteristics, and treatment outcome. This chapter describes the molecular characteristics, epidemiology, and demographics of the HPV-related head and neck cancers and discuss available methods to detect HPV-related tumours. The impact of HPV-related biomarkers in clinical studies on radiotherapy only, altered fractionation, modulation of hypoxia, and concurrent chemo- or bio-radiotherapy are reviewed as well as the perspectives of de-escalation and immune-modulation are discussed.
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Affiliation(s)
| | - Pernille Lassen
- Department of Oncology, Department of Clinical Experimental Oncology, Aarhus University Hospital, 8000, Aarhus C, Denmark
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Lønbro S, Petersen GB, Andersen JR, Johansen J. Prediction of critical weight loss during radiation treatment in head and neck cancer patients is dependent on BMI. Support Care Cancer 2015; 24:2101-2109. [PMID: 26553031 DOI: 10.1007/s00520-015-2999-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 10/26/2015] [Indexed: 01/19/2023]
Abstract
PURPOSE The aims of the present study were to explore pre-treatment predictors of weight loss during radiation treatment only in head and neck cancer (HNSCC) patients and investigate the weight loss in patients with or without a feeding tube. METHODS Retrospectively, weight change during curative radiotherapy was investigated in 476 consecutive HNSCC patients. Independent predictors were identified using multivariate regression analysis with weight loss below or above 5 % as the primary dependent variable. RESULTS Baseline BMI, tumor site, and stage predicted weight loss above 5 %. The odds of weight loss above 5 % in patients with BMI >25 were 3.00 ± 0.64 times higher compared with patients with BMI <25 (p < 0.0001). Patients with pharyngeal, oral cavity, or supraglottic tumors had 3.12 ± 0.80 times higher odds of weight loss above 5 % compared with glottic cancer patients (p < 0.0001), and the odds were 1.68 ± 0.40 times higher in stage III-IV patients compared with stage I-II patients (p = 0.03). Seperate analyses revealed that tumor site and stage only predicted weight loss in patients with BMI >25 but not in patients with BMI <25. Patients receiving a feeding tube weighed less than patients without (73.8 vs 78.3 kg) and feeding tube reduced, but did not prevent, weight loss which averaged 6.7 ± 4.7 kg (7.4 ± 4.7 %) compared with 4.7 ± 5.9 kg (5.5 ± 6.0 %) in patients without a feeding tube (P < 0.0001). CONCLUSION Pre-treatment BMI, tumor site and stage predicted weight loss above 5 % in HNSCC patients during radiotherapy. BMI should be considered when analyzing weight loss in HNSCC patients receiving curative radiotherapy.
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Affiliation(s)
- Simon Lønbro
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
- Department of Public Health, Section for Sports Science, Aarhus University, Aarhus, Denmark
| | - Gry Bjerg Petersen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - Jens Rikardt Andersen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000, Odense C, Denmark.
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Mature results from a Swedish comparison study of conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma - The ARTSCAN trial. Radiother Oncol 2015; 117:99-105. [PMID: 26427805 DOI: 10.1016/j.radonc.2015.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE This report contains the mature five-year data from the Swedish ARTSCAN trial including information on the influence of p16 positivity (p16+) for oropharyngeal cancers. MATERIAL AND METHODS Patients with previously untreated squamous cell carcinoma without distant metastases of the oral cavity, oropharynx, larynx (except T1-2, N0 glottic cancers) and hypopharynx were included. Patients were randomised between accelerated fractionation (AF) (1.1Gy+2Gy per day, 5days/week for 4.5weeks, total dose 68Gy) and conventional fractionation (CF) (2Gy per day, 5days/week for 7weeks, total dose 68Gy). Human papillomavirus (HPV)-associated p16-expression was assessed retrospectively in tumour tissues from patients with oropharyngeal carcinoma. RESULTS There was no significant difference in loco-regional control (LRC) between AF and CF (log-rank test p=0.75). LRC at 5years was 65.5% for AF and 64.9% for CF. Overall survival (OS) was similar in both arms (p=0.99). The estimated cancer specific survival (CSS) at 5years was 62.2% (AF) and 63.3% (CF) (p=0.99). 206 specimens were analysed for p16 with 153 specimens (74%) identified as p16+. P16 status did not discriminate for response to AF vs. CF with regard to LRC, OS or CSS. Patients with p16+ tumours had a statistically significant better overall prognosis compared with p16- tumours. CONCLUSION This update confirms the results of the 2-year report. We failed to identify a positive effect resulting from AF with regards to LRC, OS and CSS. The addition of information on the HPV-associated p16 overexpression did not explain this lack of effect.
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Ye A, Bradley KL, Kader H, Wu J, Hay JH. Patterns of Relapse in Squamous Cell Carcinoma of the Tonsil - Unilateral vs. Bilateral Radiation in the HPV-Era. Cureus 2015; 7:e322. [PMID: 26487998 PMCID: PMC4601887 DOI: 10.7759/cureus.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES In the pre-human papillomavirus (HPV) era, unilateral radiation therapy (URT) for tonsil cancer was associated with low contralateral failure rates and had less toxicity than bilateral radiation therapy (BRT). This study explores the validity of URT in HPV-positive tonsil cancers. METHODS Tonsil squamous cell carcinomas (SCC) treated (typically with 70 Gy radiation and Cisplatin-based chemotherapy) between 2001 and 2007 were reviewed. Retrospective p16 immunohistochemistry staining was undertaken. Baseline, treatment, and response data were collected. RESULTS Of 182 patients, 78% were p16-positive, were younger (predominantly male), mostly former or non-smokers, and had a more advanced nodal stage. With a median follow-up of 68 months, contralateral recurrence (CLR) rates were low (3.5% p16-positive versus 2.5% p16-negative, p=0.63). Overall survival (OS) was 74% for p16-positive versus 54% for p16-negative subjects (p=0.01), but all other outcomes were similar. Analysis amongst only p16-positive subjects revealed URT was delivered to 37%, with CLR rates of 7.5% versus 1.1% for those treated with BRT, p=0.05. Of the four p16-positive subjects treated with URT who developed contralateral recurrences, three were managed with neck dissection (two disease-free and one died of lung metastases) and one received palliative radiation to the neck and distant metastatic site. All disease control and survival outcomes were similar between those treated with URT versus BRT. CONCLUSION While CLRs remain rare overall, there appears to be a slightly increased rate among HPV-positive subjects treated with URT. However, overall outcomes do not appear to be impacted, suggesting that URT remains a reasonable approach in HPV-positive subjects.
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Affiliation(s)
- Allison Ye
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Cancer Centre
| | | | - Hosam Kader
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Cancer Centre
| | - John Wu
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Cancer Centre
| | - John H Hay
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Cancer Centre
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Pullos AN, Castilho RM, Squarize CH. HPV Infection of the Head and Neck Region and Its Stem Cells. J Dent Res 2015; 94:1532-43. [PMID: 26353884 DOI: 10.1177/0022034515605456] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The human papillomavirus (HPV) is an etiologic agent associated with the development of head and neck squamous carcinoma (HNSCC)-in particular, oropharyngeal squamous cell carcinoma. The HPV-positive HNSCC is characterized by genetic alterations, clinical progression, and therapeutic response, which are distinct from HPV-negative head and neck cancers, suggesting that virus-associated tumors constitute a unique entity among head and neck cancers. Malignant stem cells, or cancer stem cells, are a subpopulation of tumor cells that self-renew, initiate new tumors upon transplantation, and are resistant to therapy, and their discovery has revealed novel effects of oncovirus infection in cancer. In this review, we provide a virus-centric view and novel insights into HPV-positive head and neck pathogenesis. We discuss the influence of cancer stem cells, HPV oncoproteins, altered molecular pathways, and mutations in cancer initiation and cancer progression. We compiled a catalogue of the mutations associated with HPV-positive HNSCC, which may be a useful resource for genomic-based studies aiming to develop personalized therapies. We also explain recent changes in mass vaccination campaigns against HPV and the potential long-term impact of vaccinations on the prevention and treatment of HPV-positive head and neck cancers.
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Affiliation(s)
- A N Pullos
- Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - R M Castilho
- Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - C H Squarize
- Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
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Swick AD, Chatterjee A, De Costa AMA, Kimple RJ. Modulation of therapeutic sensitivity by human papillomavirus. Radiother Oncol 2015; 116:342-5. [PMID: 26364887 PMCID: PMC4609293 DOI: 10.1016/j.radonc.2015.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 12/12/2022]
Abstract
Human papillomaviruses (HPVs) are small double-stranded DNA viruses that pose significant public health concerns as the causative agent of approximately 5% of worldwide cancers. The HPV oncogenes E6 and E7 play key roles in carcinogenesis. In the last 15years there has been a significant increase in the incidence of HPV-related head and neck cancers arising primarily in the oropharynx. Patients with HPV-positive head and neck cancers (HNCs) have a significantly improved prognosis compared to those with HPV-negative disease. In this review we will discuss data suggesting how HPV oncogenes modulate both the intrinsic radiation sensitivity of HNCs and also have important effects upon the tumor microenvironment. Together, these findings contribute to the improved outcomes seen in patients with HPV-positive HNC.
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Affiliation(s)
- Adam D Swick
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Anirban Chatterjee
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Anna-Maria A De Costa
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, USA
| | - Randall J Kimple
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, USA; University of Wisconsin Carbone Comprehensive Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, USA.
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Morris ZS, Weichert JP, Saker J, Armstrong EA, Besemer A, Bednarz B, Kimple RJ, Harari PM. Therapeutic combination of radiolabeled CLR1404 with external beam radiation in head and neck cancer model systems. Radiother Oncol 2015; 116:504-9. [PMID: 26123834 PMCID: PMC4609259 DOI: 10.1016/j.radonc.2015.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/10/2015] [Accepted: 06/13/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE CLR1404 is a phospholipid ether that exhibits selective uptake and retention in malignant tissues. Radiolabeled CLR1404 enables tumor-specific positron-emission tomography (PET) imaging ((124)I) and targeted delivery of ionizing radiation ((131)I). Here we describe the first preclinical studies of this diapeutic molecule in head and neck cancer (HNC) models. MATERIAL AND METHODS Tumor-selective distribution of (124)I-CLR1404 and therapeutic efficacy of (131)I-CLR1404 were tested in HNC cell lines and patient-derived xenograft tumor models. Monte Carlo dose calculations and (124)I-CLR1404 PET/CT imaging were used to examine (131)I-CLR1404 dosimetry in preclinical HNC tumor models. RESULTS HNC tumor xenograft studies including patient-derived xenografts demonstrate tumor-selective uptake and retention of (124)I-CLR1404 resulting in a model of highly conformal dose distribution for (131)I-CLR1404. We observe dose-dependent response to (131)I-CLR1404 with respect to HNC tumor xenograft growth inhibition and this effect is maintained together with external beam radiation. CONCLUSIONS We confirm the utility of CLR1404 for tumor imaging and treatment of HNC. This promising agent warrants further investigation in a developing phase I trial combining (131)I-CLR1404 with reduced-dose external beam radiation in patients with loco-regionally recurrent HNC.
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Affiliation(s)
- Zachary S Morris
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Jamey P Weichert
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Jarob Saker
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Eric A Armstrong
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Abigail Besemer
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Bryan Bednarz
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Randall J Kimple
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, United States
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, United States.
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Scheer M, Fuss J, Derman MA, Kreppel M, Neugebauer J, Rothamel D, Drebber U, Zoeller JE. Autofluorescence imaging in recurrent oral squamous cell carcinoma. Oral Maxillofac Surg 2015; 20:27-33. [PMID: 26267490 DOI: 10.1007/s10006-015-0520-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
The survival of patients with oral cancer is decreased by locoregional recurrence after an initial multimodal treatment. In order to identify lesions in the oral cavity for a possible recurrence, clinical evaluation as well as MRI or CT scanning is advised. The evaluation of mucosa lesions is hampered by changes related to radio- and chemotherapy as well as reconstruction with tissue flaps. Several techniques for easier identification of tissue abnormalities in the oral cavity have been advocated as adjuncts in order to facilitate identification. Especially methods using altered tissue fluorescence have gained much interest during the last decade. The aim of our prospective study was to evaluate fluorescence properties of undiagnosed mucosa lesions with the VELscope device in patients with multimodal treated oral cancer prior to histological confirmation. In total, 41 patients with a history of oral squamous cell carcinomas (OSCC) (19 females and 22 males) with undiagnosed mucosa lesions where included in the study. After clinical evaluation, examination and documentation using the VELscope® device were performed. Then, an incisional biopsy was performed. An autofluorescence loss indicating a malignant or dysplastic mucosa condition could be detected in six patients (14.6 %); however, only one OSCC and one SIN revealed a complete autofluorescence loss. In four patients, OSCC was present in lesions with retained autofluorescence. Sensitivity and specificity for the VELscope® examination to identify malignant oral lesions by autofluorescence were 33.3 and 88.6 %, respectively. The positive and negative predictive values were 33.3 and 88.6 %, respectively. No statistical correlation between gender and lesion appearance versus autofluorescence loss could be detected. In contrast to mucosa lesions in patients with no prior treatment, the autofluorescence evaluation with the VELscope reveals no additional information in our analysis. Accordingly, invasive biopsies as gold standard are still needed to get sufficient evidence regarding potential malignancy in patients after multimodal treatment for oral cancer.
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Affiliation(s)
- Martin Scheer
- Department for Oral and Craniomaxillo and Facial Plastic Surgery, Johannes Wesling Klinikum Minden, Hans-Nolte-Str. 1, 32429, Minden, Germany.
| | - Juliana Fuss
- Department for Oral and Craniomaxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Mehmet Ali Derman
- Department for Oral and Craniomaxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Matthias Kreppel
- Department for Oral and Craniomaxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Jörg Neugebauer
- Dental Private Practice, Bayer, Kistler, Elbertzhagen and Colleagues, Landsberg am Lech, Germany
| | - Daniel Rothamel
- Department for Oral and Craniomaxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
| | - Uta Drebber
- Department of Pathology, University of Cologne, Cologne, Germany
| | - Joachim E Zoeller
- Department for Oral and Craniomaxillo and Facial Plastic Surgery, University of Cologne, Cologne, Germany
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Lilja-Fischer JK, Jensen K, Eskildsen HW, Fink-Jensen V, Nielsen VE. Response evaluation of the neck in oropharyngeal cancer: Value of magnetic resonance imaging and influence of p16 in selecting patients for post-radiotherapy neck dissection. Acta Oncol 2015. [PMID: 26198649 DOI: 10.3109/0284186x.2015.1063781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Residual neck disease after radiotherapy in advanced oropharyngeal squamous cell carcinoma (OPSCC) is associated with increased mortality, and some patients may benefit from post-radiotherapy neck dissection (PRND). The aim of the present study was to assess the value of magnetic resonance imaging (MRI) and other clinical characteristics in selecting patients for PRND. MATERIALS AND METHODS Retrospective cohort study. Consecutive patients with N+ OPSCC were included. Medical records, pathology reports and imaging reports were reviewed. Pre- and post-therapeutic imaging was re-evaluated. RESULTS A total of 100 consecutive patients from a three-year period were included. Neck response was evaluated with MRI two months after treatment. Sixty patients were suspicious for residual neck disease, and were offered surgery; seven of these patients had histologic evidence of carcinoma. Cumulative neck failure after three years was 14% (8.4-24%), and did not differ significantly among patients with positive compared to negative MRI (radiologist's initial description; p = 0.47, log-rank test). Applying neck failure as gold standard, sensitivity and specificity of MRI was 69% and 41%, respectively; positive and negative predictive value was 15% and 90%. Patients with p16 + disease had significantly larger lymph nodes after treatment, and imaging based on lymph node size resulted in many false positives. Analysis of receiver operating characteristic curves in 191 individual lymph nodes showed that a short axis ≥ 10 mm should be classified as suspicious. Furthermore, T-stage and p16-status were associated with increased risk of neck recurrence. Salvage was successful in four patients with early detected nodal recurrence. CONCLUSION These results suggest that lymph node size, T-stage and p16 status could be used in selecting patients for PRND in OPSCC. Yet, early anatomical imaging may be inappropriate for evaluating neck response in patients with p16 + disease as enlarged lymph nodes often do not indicate residual neck disease.
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Affiliation(s)
- Jacob K Lilja-Fischer
- a Department of Experimental Clinical Oncology , Aarhus University Hospital , Aarhus , Denmark
- b Department of Otorhinolaryngology-Head & Neck Surgery , Aarhus University Hospital , Aarhus , Denmark
| | - Kenneth Jensen
- c Department of Oncology , Aarhus University Hospital , Aarhus , Denmark
| | - Helle W Eskildsen
- d Department of Neuroradiology , Aarhus University Hospital , Aarhus , Denmark
| | - Vibeke Fink-Jensen
- e Department of Radiology , Aalborg University Hospital , Aarhus , Denmark
| | - Viveque E Nielsen
- b Department of Otorhinolaryngology-Head & Neck Surgery , Aarhus University Hospital , Aarhus , Denmark
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Bentzen J, Toustrup K, Eriksen JG, Primdahl H, Andersen LJ, Overgaard J. Locally advanced head and neck cancer treated with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. Results from the DAHANCA 18 phase II study. Acta Oncol 2015; 54:1001-7. [PMID: 25629651 DOI: 10.3109/0284186x.2014.992547] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE/OBJECTIVE A phase II clinical trial evaluating the feasibility and outcome of treating locally advanced head and neck squamous cell carcinoma (HNSCC) with accelerated radiotherapy, the hypoxic modifier nimorazole and weekly cisplatin. MATERIAL AND METHODS A total of 227 patients with stage III or IV HNSCC of the larynx, oropharynx, hypopharynx, or oral cavity where included between January 2007 and December 2010. The prescribed radiotherapy (RT) dose was 66-68 Gy in 2 Gy fractions, 6 F/W. The hypoxic radiosensitiser nimorazole was given orally at a dose of 1200 mg/m(2) before each fraction. Concomitant cisplatin (40 mg/m(2)) i.v. was given once a week for a maximum of six cycles. Outcome data were evaluated in terms of loco-regional tumour control (LRC), event-free survival (EFS) and overall survival (OS). Morbidity data were evaluated based on the DAHANCA routine registration. Human papillomavirus (HPV)-status was estimated by immunohistochemical staining of p16. RESULTS Included were 178 (78%) men and 49 (22%) women with a median age of 57 years. All except five patients received RT as prescribed. At least five series of cisplatin was given to 164 (72%) of the patients, and 149 patients (66%) received the full dose of nimorazole. The five-year actuarial LRC, EFS and OS rates were 80%, 67% and 72%, respectively. The LRC rates according to site were: oropharynx: 88%, larynx: 77%, hypopharynx 72% and oral cavity 49%, respectively. HPV/p16 staining was obtained in 141 of the 150 oropharyngeal cancers. Of these, 112 (79%) were p16 pos and 29 (21%) were p16 neg. LRC for the p16 neg oropharyngeal cancers was poorer than for the p16 pos (74% vs. 91%; p = 0.02). Tube feeding during treatment was necessary for 146 (64%) patients. At 12 months this number was reduced to 6%. CONCLUSION The treatment was tolerable in this cohort of locally advanced HNSCC patients. Acute and late toxicity was comparable to similar studies of chemoradiotherapy, and the outcome superior to the data reported in the literature. This strongly indicates that RT of advanced head and neck cancer must include as well hypoxic modification, accelerated fractionation as chemoradiotherapy to yield optimal outcome.
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Affiliation(s)
- Jens Bentzen
- Department of Oncology, Herlev Hospital, Herlev, Denmark
| | - Kasper Toustrup
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark, on behalf of the Danish Head and Neck Cancer Group
| | | | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark, on behalf of the Danish Head and Neck Cancer Group
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Brown E, Owen R, Harden F, Mengersen K, Oestreich K, Houghton W, Poulsen M, Harris S, Lin C, Porceddu S. Predicting the need for adaptive radiotherapy in head and neck cancer. Radiother Oncol 2015; 116:57-63. [PMID: 26142268 DOI: 10.1016/j.radonc.2015.06.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Revised: 06/12/2015] [Accepted: 06/22/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Adaptive radiotherapy (ART) can account for the dosimetric impact of anatomical change in head and neck cancer patients; however it can be resource intensive. Consequently, it is imperative that patients likely to require ART are identified. The purpose of this study was to find predictive factors that identify oropharyngeal squamous cell carcinoma (OPC) and nasopharyngeal carcinoma (NPC) patients more likely to need ART. MATERIALS AND METHODS One hundred and ten patients with OPC or NPC were analysed. Patient demographics and tumour characteristics were compared between patients who were replanned and those that were not. Factors found to be significant were included in logistic regression models. Risk profiles were developed from these models. A dosimetric analysis was performed. RESULTS Nodal disease stage, pre-treatment largest involved node size, diagnosis and initial weight (categorised in 2 groups) were identified as significant for inclusion in the model. Two models were found to be significant (p=0.001), correctly classifying 98.2% and 96.1% of patients respectively. Three ART risk profiles were developed. CONCLUSION Predictive factors identifying OPC or NPC patients more likely to require ART were reported. A risk profile approach could facilitate the effective implementation of ART into radiotherapy departments through forward planning and appropriate resource allocation.
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Affiliation(s)
- Elizabeth Brown
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Australia; Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia.
| | - Rebecca Owen
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Australia
| | - Fiona Harden
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia
| | - Kerrie Mengersen
- Queensland University of Technology, Institute of Health and Biomedical Innovation, Brisbane, Australia
| | - Kimberley Oestreich
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Australia
| | - Whitney Houghton
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Australia
| | - Michael Poulsen
- Radiation Oncology Department, Radiation Oncology Mater Centre, Brisbane, Australia
| | - Selina Harris
- Radiation Oncology Department, Royal Brisbane and Women's Hospital, Australia
| | - Charles Lin
- Radiation Oncology Department, Royal Brisbane and Women's Hospital, Australia
| | - Sandro Porceddu
- Radiation Oncology Department, Princess Alexandra Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
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Biau J, Chautard E, Miroir J, Lapeyre M. [Radioresistance parameters in head and neck cancers and methods to radiosensitize]. Cancer Radiother 2015; 19:337-46; quiz 360-1, 363. [PMID: 26119219 DOI: 10.1016/j.canrad.2015.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/06/2015] [Accepted: 02/12/2015] [Indexed: 12/24/2022]
Abstract
Head and neck cancers have been widely studied concerning their sensitivity to radiation therapy. Several parameters affect tumour response to radiation therapy. Some parameters are linked to the tumour. Large or invasive tumours, localization, such as oral cavity or adenopathy, are factors of radioresistance. Others parameters are linked to the patients themselves. Tobacco intoxication during radiotherapy and a low hemoglobin level contribute to radioresistance. More recently, a positive human papilloma virus (HPV) status has been reported to positively affect radiosensitivity. Finally, other parameters are related to tumour biology. Hypoxia, intrinsic radiosensitivity of tumour cells, tumour differentiation and repopulation (provided by Ki-67 index or EGFR level) are components of radiosensitivity. Currently, concurrent chemoradiotherapy is one of the gold standard treatments to overcome clinical outcome of locally advanced head and neck cancer. This combination increases locoregional control and survival. Taxane-based induction chemotherapy can also be an alternative. Another validated approach is the association of radiotherapy with cetuximab (EGFR targeting) but only one randomized study has been published. Fractionation modifications, especially hyperfractionation, have given positive results on both tumour control and survival. Strategies targeting hypoxia improve locoregional control but have less clinical impact.
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Affiliation(s)
- J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France; EA7283 Cancer Resistance Exploring and Targeting (CREAT), Clermont université, université d'Auvergne, 49, boulevard François-Mitterrand, CS 60032, 63001 Clermont-Ferrand cedex 1, France; Équipe recombinaison, réparation et cancer, UMR 3347, CNRS, centre universitaire, 91405 Orsay cedex, France; Inserm U1021, centre universitaire, 91405 Orsay cedex, France; Institut Curie, 26, rue d'Ulm, 75005 Paris, France.
| | - E Chautard
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France; EA7283 Cancer Resistance Exploring and Targeting (CREAT), Clermont université, université d'Auvergne, 49, boulevard François-Mitterrand, CS 60032, 63001 Clermont-Ferrand cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
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Regional recurrence of oropharyngeal cancer after definitive radiotherapy: a case control study. Radiat Oncol 2015; 10:117. [PMID: 26014350 PMCID: PMC4490759 DOI: 10.1186/s13014-015-0422-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/15/2015] [Indexed: 11/24/2022] Open
Abstract
Background Elective treatment of lymph nodes in oropharyngeal cancer (OPC) has impact on both regional recurrences (RR) and risk of late side effects. This study was performed to quantify the dose-dependent impact on RR and overall survival (OS) in a prospectively collected cohort of OPC from the ARTSCAN study with emphasis on elective treatment. Methods ARTSCAN is a previously published prospective, randomized, multicentre study of altered radiotherapy (RT) fractionation in head and neck cancer. In ARTSCAN the elective treatment volume for node positive OPC varied significantly between centres due to local treatment principles. All patients with OPC in complete response after primary treatment were eligible for the present case–control study. Cases were patients with RR during five years follow-up. Patients with no recurrence were eligible as controls. Four controls per case were matched according to T- and N-stage. Mean (Dmean) and median (D50%) dose for the lymph node level (LNL) of RR in the cases and the corresponding LNL in the controls were analysed with conditional logistic regression. OS was estimated with the Kaplan-Meier method and evaluated by multivariate Cox regression analysis. Results There was a dose-dependent risk reduction for D50% in the interval that represented elective treatment (40–50 Gy) (OR = 0.18, p < 0.05) and a trend in the same dose interval for Dmean (OR = 0.19, p = 0.07). OS rates at five years were 0.39 (0.24-0.65) for cases and 0.70 (0.62–0.81) for controls (p < 0.001). The Kaplan-Meier and the Cox regression analysis for cases categorised by delivered dose showed an inverse relationship between dose and survival. The cases with RR in a LNL outside planning target volume (PTV) (Dmean < 40 Gy) had an OS rate comparable to that of all patients, and those with RR in a LNL in PTVelective (Dmean 40–60 Gy) or PTVtumour (Dmean >60 Gy) did significantly worse (p < 0.05). The same inverse relationship was also shown for a small subset of patient with known HPV-status, defined by over expression of p16 (p < 0.05). Conclusions There was a significant risk reduction for RR of elective treatment. However the OS for patients with RR outside target volumes was not affected, with similar results for patients with HPV-positive OPC. This could be an argument for a prospective randomized study on limited elective target volumes in OPC.
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Datta NR, Singh S, Kumar P, Gupta D. Human papillomavirus confers radiosensitivity in cancer cervix: a hypothesis toward a possible restoration of apoptotic pathways based on clinical outcomes. Future Oncol 2015; 11:1363-71. [DOI: 10.2217/fon.15.53] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
ABSTRACT Aim: To evaluate if high baseline local human papillomavirus (HPV) titer confers radiosensitivity in cancer cervix. A hypothesis is proposed to explain the clinical outcomes. Materials & methods: 121 serial HPV titers from cervical smears of 21 patients were estimated during radiotherapy (RT) and correlated with RT dose–response curves, local response and local disease-free survival (LDFS). Results: Local response (p = 0.04) and LDFS (p = 0.06) were better in high HPV than low HPV baseline group. On multivariate analysis, RT doses for 50% tumor regression and baseline HPV titer were the only predictors for LDFS. Conclusion: Serial reductions of HPV titers following RT could restore the HPV induced temporarily downregulated p53 and pRb apoptotic pathways resulting in radiosensitivity of these tumors.
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Affiliation(s)
- Niloy Ranjan Datta
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
- Presently at, Centre for Radiation Oncology, KSA-KSB, Cantonal Hospital of Aarau, Switzerland
| | - Shalini Singh
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Piyush Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
- Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, India
| | - Dinesh Gupta
- National Clinical Reference Laboratory, Delhi, India
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Mondini M, Nizard M, Tran T, Mauge L, Loi M, Clémenson C, Dugue D, Maroun P, Louvet E, Adam J, Badoual C, Helley D, Dransart E, Johannes L, Vozenin MC, Perfettini JL, Tartour E, Deutsch E. Synergy of Radiotherapy and a Cancer Vaccine for the Treatment of HPV-Associated Head and Neck Cancer. Mol Cancer Ther 2015; 14:1336-45. [PMID: 25833837 DOI: 10.1158/1535-7163.mct-14-1015] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
Abstract
There is growing interest in the association of radiotherapy and immunotherapy for the treatment of solid tumors. Here, we report an extremely effective combination of local irradiation (IR) and Shiga Toxin B (STxB)-based human papillomavirus (HPV) vaccination for the treatment of HPV-associated head and neck squamous cell carcinoma (HNSCC). The efficacy of the irradiation and vaccine association was tested using a model of HNSCC obtained by grafting TC-1/luciferase cells at a submucosal site of the inner lip of immunocompetent mice. Irradiation and the STxB-E7 vaccine acted synergistically with both single and fractionated irradiation schemes, resulting in complete tumor clearance in the majority of the treated mice. A dose threshold of 7.5 Gy was required to elicit the dramatic antitumor response. The combined treatment induced high levels of tumor-infiltrating, antigen-specific CD8(+) T cells, which were required to trigger the antitumor activity. Treatment with STxB-E7 and irradiation induced CD8(+) T-cell memory, which was sufficient to exert complete antitumor responses in both local recurrences and distant metastases. We also report for the first time that a combination therapy based on local irradiation and vaccination induces an increased pericyte coverage (as shown by αSMA and NG2 staining) and ICAM-1 expression on vessels. This was associated with enhanced intratumor vascular permeability that correlated with the antitumor response, suggesting that the combination therapy could also act through an increased accessibility for immune cells. The combination strategy proposed here offers a promising approach that could potentially be transferred into early-phase clinical trials.
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Affiliation(s)
- Michele Mondini
- INSERM U1030 «Radiothérapie Moléculaire», Gustave Roussy Cancer Campus Grand Paris, Villejuif, France and Labex LERMIT
| | - Mevyn Nizard
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Thi Tran
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris Descartes, Sorbonne Paris-Cité, Paris, France
| | - Laetitia Mauge
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris Descartes, Sorbonne Paris-Cité, Paris, France. Service d'Hématologie Biologique, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Mauro Loi
- INSERM U1030 «Radiothérapie Moléculaire», Gustave Roussy Cancer Campus Grand Paris, Villejuif, France and Labex LERMIT. Radioterapia, Università di Firenze, Florence, Italy
| | - Céline Clémenson
- INSERM U1030 «Radiothérapie Moléculaire», Gustave Roussy Cancer Campus Grand Paris, Villejuif, France and Labex LERMIT
| | - Delphine Dugue
- INSERM U1030 «Radiothérapie Moléculaire», Gustave Roussy Cancer Campus Grand Paris, Villejuif, France and Labex LERMIT
| | - Pierre Maroun
- INSERM U1030 «Radiothérapie Moléculaire», Gustave Roussy Cancer Campus Grand Paris, Villejuif, France and Labex LERMIT. Département de Radiothérapie, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France. Université Paris Sud, Faculté de Médecine du Kremlin-Bicêtre, France
| | - Emilie Louvet
- INSERM U981, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France. SIRIC SOCRATE, Villejuif Cedex, France
| | - Julien Adam
- INSERM U981, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France. SIRIC SOCRATE, Villejuif Cedex, France
| | - Cécile Badoual
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris Descartes, Sorbonne Paris-Cité, Paris, France. Service d'Anatomie Pathologique, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Dominique Helley
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris Descartes, Sorbonne Paris-Cité, Paris, France. Service d'Hématologie Biologique, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Estelle Dransart
- Institut Curie, U1143 INSERM, UMR3666 CNRS, Endocytic Trafficking and Intracellular Delivery Group, Paris, France
| | - Ludger Johannes
- Institut Curie, U1143 INSERM, UMR3666 CNRS, Endocytic Trafficking and Intracellular Delivery Group, Paris, France
| | - Marie-Catherine Vozenin
- INSERM U1030 «Radiothérapie Moléculaire», Gustave Roussy Cancer Campus Grand Paris, Villejuif, France and Labex LERMIT. Université Paris Sud, Faculté de Médecine du Kremlin-Bicêtre, France. Laboratoire de Recherche en Radio-Oncologie, CHUV, Lausanne, Switzerland
| | - Jean-Luc Perfettini
- INSERM U1030 «Radiothérapie Moléculaire», Gustave Roussy Cancer Campus Grand Paris, Villejuif, France and Labex LERMIT. Université Paris Sud, Faculté de Médecine du Kremlin-Bicêtre, France. SIRIC SOCRATE, Villejuif Cedex, France
| | - Eric Tartour
- INSERM U970, PARCC (Paris Cardiovascular Research Center), Université Paris Descartes, Sorbonne Paris-Cité, Paris, France. Service d'Immunologie Biologique, Hôpital Européen Georges-Pompidou, AP-HP, Paris, France
| | - Eric Deutsch
- INSERM U1030 «Radiothérapie Moléculaire», Gustave Roussy Cancer Campus Grand Paris, Villejuif, France and Labex LERMIT. Département de Radiothérapie, Gustave Roussy Cancer Campus Grand Paris, Villejuif, France. Université Paris Sud, Faculté de Médecine du Kremlin-Bicêtre, France. SIRIC SOCRATE, Villejuif Cedex, France.
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Horn D, Hess J, Freier K, Hoffmann J, Freudlsperger C. Targeting EGFR-PI3K-AKT-mTOR signaling enhances radiosensitivity in head and neck squamous cell carcinoma. Expert Opin Ther Targets 2015; 19:795-805. [PMID: 25652792 DOI: 10.1517/14728222.2015.1012157] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Head and neck squamous cell carcinoma (HNSCC) is frequently characterized by high resistance to radiotherapy, which critically depends on both altered signaling pathways within tumor cells and their dynamic interaction with the tumor microenvironment. AREAS COVERED This review covers EGFR-phosphoinositide 3-kinase (PI3K)-protein kinase B (AKT)-mechanistic target of rapamycin (mTOR) signaling in HNSCC. The role of each pathway node in radioresistance is discussed. Preclinical and clinical innovative aspects of targeting EGFR-PI3K-AKT and mTOR are demonstrated. Ongoing clinical trials and future perspectives are presented. EXPERT OPINION Different cellular signaling pathways seem to mediate radioresistance in advanced HNSCC and various molecular targeted therapies are currently being investigated to sensitize tumor cells to radiotherapy. Recently, new insights in the mutational landscape of HNSCC unraveled critical alterations in putative oncogenes and tumor suppressor genes and have emphasized the importance of PI3K and the corresponding upstream and downstream signaling pathways in pathogenesis and treatment response. The frequent activation of the EGFR-PI3K-AKT-mTOR pathway in HNSCC and its implication in the context of radiosensitivity make this pathway one of the most promising targets in the therapy of HNSCC patients. Clinical studies targeting EGFR and mTOR in combination with radiotherapy are under investigation.
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Affiliation(s)
- Dominik Horn
- University Hospital Heidelberg, Department of Oral and Maxillofacial Surgery , Im Neuenheimer Feld 400, 69120 Heidelberg , Germany +49 0 6221 56 38462 ; +49 0 6221 56 4222 ;
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Morbini P, Alberizzi P, Tinelli C, Paglino C, Bertino G, Comoli P, Pedrazzoli P, Benazzo M. Identification of transcriptionally active HPV infection in formalin-fixed, paraffin-embedded biopsies of oropharyngeal carcinoma. Hum Pathol 2015; 46:681-9. [PMID: 25708613 DOI: 10.1016/j.humpath.2014.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/04/2014] [Accepted: 12/25/2014] [Indexed: 11/24/2022]
Abstract
Human papillomavirus (HPV) oncogenic activity is the result of viral oncogene E6 and E7 expression in infected cells. Oncogene expression analysis is, however, not part of the routine diagnostic evaluation of HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) since it requires fresh tumor tissue. We compared the diagnostic accuracy of several methods commonly employed for HPV characterization in OPSCC with the results of the newly available HPV E6/E7 mRNA in situ hybridization (ISH) on formalin-fixed, paraffin-embedded biopsy samples, in order to establish if the latter should be introduced in the diagnostic routine to increase accuracy when fresh tissue is not available. p16 immunostain, DNA ISH for high-risk HPV genotypes, SPF LiPA amplification and genotyping, and HPV16 E6 amplification were performed on 41 consecutive OPSCC samples. Twenty (48.7%) cases were positive by mRNA ISH; sensitivity and specificity were 100% and 90% for p16, 90% and 100% for DNA ISH, 70% and 76% for SPF10 LiPA, 90% and 76% for E6 amplification. A diagnostic algorithm considering p16 immunostain as first step followed by either high-risk HPV DNA ISH or HPV16 E6 amplification in p16-positive cases correctly characterized 90% of mRNA-positive and all mRNA-negative cases; combining the 3 tests correctly identified all cases. While no stand-alone test was sufficiently accurate for classifying HPV-associated OPSCC, the high sensitivity and specificity of the established combination of p16 immunostain, DNA ISH, and HPV16 DNA amplification suggests that the introduction of labour- and cost-intensive mRNA ISH, is not necessary in the diagnostic routine of oropharyngeal tumors.
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Affiliation(s)
- Patrizia Morbini
- Department of Molecular Medicine, Unit of Pathology, University of Pavia, via Forlanini 16, 27100 Pavia, Italy; Department of Pathology IRCCS Policlinico S. Matteo Foundation, via Forlanini 16, 27100 Pavia, Italy.
| | - Paola Alberizzi
- Department of Pathology IRCCS Policlinico S. Matteo Foundation, via Forlanini 16, 27100 Pavia, Italy.
| | - Carmine Tinelli
- Clinical Epidemiology and Biometric Unit, IRCCS Policlinico S. Matteo Foundation, P.le Golgi 5, 27100 Pavia, Italy.
| | - Chiara Paglino
- Department of Oncology, IRCCS Policlinico S. Matteo Foundation, P.le Golgi 5, 27100 Pavia, Italy.
| | - Giulia Bertino
- Department of Otolaryngology, University of Pavia and IRCCS Policlinico S. Matteo Foundation, P.le Golgi 5, 27100 Pavia, Italy.
| | - Patrizia Comoli
- Pediatric Hematology/Oncology, IRCCS Policlinico S. Matteo Foundation, P.le Golgi 5, 27100 Pavia, Italy.
| | - Paolo Pedrazzoli
- Department of Oncology, IRCCS Policlinico S. Matteo Foundation, P.le Golgi 5, 27100 Pavia, Italy.
| | - Marco Benazzo
- Department of Otolaryngology, University of Pavia and IRCCS Policlinico S. Matteo Foundation, P.le Golgi 5, 27100 Pavia, Italy.
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Lassen P, Primdahl H, Johansen J, Kristensen CA, Andersen E, Andersen LJ, Evensen JF, Eriksen JG, Overgaard J. Impact of HPV-associated p16-expression on radiotherapy outcome in advanced oropharynx and non-oropharynx cancer. Radiother Oncol 2014; 113:310-6. [DOI: 10.1016/j.radonc.2014.11.032] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 12/18/2022]
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Güster JD, Weissleder SV, Busch CJ, Kriegs M, Petersen C, Knecht R, Dikomey E, Rieckmann T. The inhibition of PARP but not EGFR results in the radiosensitization of HPV/p16-positive HNSCC cell lines. Radiother Oncol 2014; 113:345-51. [PMID: 25467050 DOI: 10.1016/j.radonc.2014.10.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE HPV-negative and HPV-positive HNSCC comprise distinct tumor entities with different biological characteristics. Specific regimens for the comparably well curable HPV-positive entity that reduce side effects without compromising outcome have yet to be established. Therefore, we tested here whether the inhibition of EGFR or PARP may be used to specifically enhance the radiosensitivity of HPV-positive HNSCC cells. MATERIALS AND METHODS Experiments were performed with five HPV/p16-positive HNSCC cell lines. Inhibitors used were cetuximab, olaparib and PF-00477736. The respective inhibition of EGFR, PARP and Chk1 was evaluated by Western blot, immunofluorescence analysis and assessment of cell cycle distribution. Cell survival was assessed by colony formation assay. RESULTS Inhibition of EGFR by cetuximab failed to radiosensitize any of the HPV-positive HNSCC cell lines tested. In contrast, PARP-inhibition resulted in a substantial radiosensitization of all strains, with the sensitization being further enhanced by the additional inhibition of Chk1. CONCLUSIONS PARP-inhibition effectively radiosensitizes HPV-positive HNSCC cells and may therefore represent a viable alternative to chemotherapy possibly even allowing for a reduction in radiation dose. For the latter, PARP-inhibition may be combined with the inhibition of Chk1. In contrast, the inhibition of EGFR cannot be expected to radiosensitize HPV-positive HNSCC through the modulation of cellular radiosensitivity.
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Affiliation(s)
- Julian David Güster
- Laboratory of Radiobiology & Experimental Radiooncology, University Medical Center Hamburg-Eppendorf, Germany
| | | | - Chia-Jung Busch
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Malte Kriegs
- Laboratory of Radiobiology & Experimental Radiooncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiooncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Rainald Knecht
- Department of Otolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Germany
| | - Ekkehard Dikomey
- Laboratory of Radiobiology & Experimental Radiooncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Thorsten Rieckmann
- Laboratory of Radiobiology & Experimental Radiooncology, University Medical Center Hamburg-Eppendorf, Germany; Department of Otolaryngology and Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Germany.
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Garnaes E, Kiss K, Andersen L, Therkildsen MH, Franzmann MB, Filtenborg-Barnkob B, Hoegdall E, Krenk L, Josiassen M, Lajer CB, Specht L, Frederiksen K, Friis-Hansen L, Nielsen FC, Kjaer SK, Norrild B, von Buchwald C. A high and increasing HPV prevalence in tonsillar cancers in Eastern Denmark, 2000-2010: The largest registry-based study to date. Int J Cancer 2014; 136:2196-203. [DOI: 10.1002/ijc.29254] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/15/2014] [Accepted: 09/09/2014] [Indexed: 12/25/2022]
Affiliation(s)
- Emilie Garnaes
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Katalin Kiss
- Department of Pathology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Luise Andersen
- Department of Pathology; Roskilde Hospital; Roskilde Denmark
| | | | | | | | | | - Lene Krenk
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Michael Josiassen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Christel B. Lajer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Lena Specht
- Department of Oncology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Kirsten Frederiksen
- Department of Statistics, Bioinformatics and Registry; Danish Cancer Society Research Center; Copenhagen Denmark
| | - Lennart Friis-Hansen
- Center for Genomic Medicine, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Finn C. Nielsen
- Center for Genomic Medicine, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Susanne K. Kjaer
- Department of Virus, Lifestyle and Genes; Danish Cancer Society Research Center and Department of Gynecology, Rigshospitalet, University of Copenhagen; Copenhagen Denmark
| | - Bodil Norrild
- Institute of Cellular and Molecular Medicine, Panum Institute, University of Copenhagen; Copenhagen Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology; Rigshospitalet, University of Copenhagen; Copenhagen Denmark
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Rohde M, Dyrvig AK, Johansen J, Sørensen JA, Gerke O, Nielsen AL, Høilund-Carlsen PF, Godballe C. 18F-fluoro-deoxy-glucose-positron emission tomography/computed tomography in diagnosis of head and neck squamous cell carcinoma: A systematic review and meta-analysis. Eur J Cancer 2014; 50:2271-9. [DOI: 10.1016/j.ejca.2014.05.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/18/2014] [Indexed: 11/16/2022]
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76
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Davis KS, Vargo JA, Ferris RL, Burton SA, Ohr JP, Clump DA, Heron DE. Stereotactic body radiotherapy for recurrent oropharyngeal cancer - influence of HPV status and smoking history. Oral Oncol 2014; 50:1104-8. [PMID: 25175942 DOI: 10.1016/j.oraloncology.2014.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE HPV status and smoking history stratifies patients into 3 distinct risk groups for survival following definitive chemoradiotherapy. Local-regional recurrences are common patterns of failure across all 3 risk-groups. SBRT±cetuximab has emerged as a promising salvage strategy for unresectable locally-recurrent, previously-irradiated head-and-neck cancer (rHNC) relative to conventional re-irradiation±chemotherapy. However the influence of HPV and smoking remains unknown in the setting of re-irradiation. METHODS/MATERIALS Patients (n=30) with rHNC of the oropharynx salvaged with SBRT±cetuximab from August 2002 through August 2013 were retrospectively reviewed; HPV status was determined based on p16 staining of primary pathology. RESULTS At a median follow-up of 10months for surviving patients, the mean overall survival for all patients was 12.6 months. HPV positivity was a significant predictor of overall survival (13.6 vs. 6.88 months, p=0.024), while smoking status did not significantly impact overall survival (p=0.707). CONCLUSION HPV status remains a significant predictor of overall survival in the re-irradiation setting with HPV positive rHNC demonstrating superior overall survival following salvage SBRT±cetuximab.
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Affiliation(s)
- Kara S Davis
- University of Pittsburgh Medical Center, Department of Otolaryngology - Head and Neck Surgery, Pittsburgh, PA, USA.
| | - John A Vargo
- University of Pittsburgh Medical Center, Department of Radiation Oncology, Pittsburgh, PA, USA
| | - Robert L Ferris
- University of Pittsburgh Medical Center, Department of Otolaryngology - Head and Neck Surgery, Pittsburgh, PA, USA
| | - Steven A Burton
- University of Pittsburgh Medical Center, Department of Radiation Oncology, Pittsburgh, PA, USA
| | - James P Ohr
- UPMC Cancer Center, Medical Oncology, Pittsburgh, PA, USA
| | - David A Clump
- University of Pittsburgh Medical Center, Department of Radiation Oncology, Pittsburgh, PA, USA
| | - Dwight E Heron
- University of Pittsburgh Medical Center, Department of Radiation Oncology, Pittsburgh, PA, USA
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77
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Murakami N, Mori T, Yoshimoto S, Ito Y, Kobayashi K, Ken H, Kitaguchi M, Sekii S, Takahashi K, Yoshio K, Inaba K, Morota M, Sumi M, Itami J. Expression of EpCAM and prognosis in early-stage glottic cancer treated by radiotherapy. Laryngoscope 2014; 124:E431-6. [PMID: 25043563 DOI: 10.1002/lary.24839] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/03/2014] [Accepted: 06/25/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS Treatment of head and neck squamous cell carcinoma (HNSCC) often requires radiotherapy, but relapse can occur. There is, therefore, an urgent need for the identification of a predictive novel biomarker for radiosensitivity. The epithelial cell adhesion molecule (EpCAM) has been shown to promote the transformation of malignant tumors, and EpCAM may have prognostic significance, but it is not known if EpCAM determines prognosis, especially with respect to radiotherapy. Therefore, we determined the incidence of the expression of EpCAM in HNSCC and analyzed the prognostic value in patients with early-stage glottic cancer treated with radiotherapy. STUDY DESIGN Retrospective analysis. METHODS All patients with HNSCCs examined in our hospital between January 2012 and February 2013 were analyzed prospectively for the expression of EpCAM. T1-2N0 glottic cancer patients who were primarily treated by radiation therapy between 1995 and 2008 were retrospectively investigated. Patients with or without local recurrence after radical radiation therapy were extracted. The relationship between local recurrence and histopathologic EpCAM expression was compared within these two groups. RESULTS One hundred eighteen patients with HNSCCs from the nasopharynx, oropharynx, hypopharynx, larynx, oral cavity, paranasal cavity, unknown primary, and other sites were analyzed. Positive expression of EpCAM was noted in the oropharynx, hypopharynx, and larynx (72%, 90%, and 58%, respectively). Seventeen and 22 patients with or without local recurrence were extracted, respectively. There was no difference between two groups, with the exception of EpCAM expression. CONCLUSIONS The expression of EpCAM in HNSCC was investigated. Patients with strong EpCAM expression were associated with local recurrence after primary radiation therapy. LEVEL OF EVIDENCE NA
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Affiliation(s)
- Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, Japan
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78
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Kimple RJ, Harari PM. Is radiation dose reduction the right answer for HPV-positive head and neck cancer? Oral Oncol 2014; 50:560-4. [PMID: 24134946 PMCID: PMC3986346 DOI: 10.1016/j.oraloncology.2013.09.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 09/17/2013] [Accepted: 09/26/2013] [Indexed: 01/29/2023]
Abstract
Patients with head and neck squamous cell carcinoma (HNC) related to human papillomavirus (HPV) represent a growing and distinct patient cohort with unique molecular and epidemiologic characteristics. These patients have markedly improved survival outcomes compared to those with traditional HNC, leading some to advocate for treatment dose reduction. In this article, we review ongoing clinical trials investigating several ways to reduce therapeutic intensity for patients with HPV-positive HNC, discuss the risks and benefits associated with these trials, and summarize the data underlying the advancement of dose reduction trials for patients with HPV-positive HNC.
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Affiliation(s)
- Randall J Kimple
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA.
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79
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Davis KS, Byrd JK, Mehta V, Chiosea SI, Kim S, Ferris RL, Johnson JT, Duvvuri U. Occult Primary Head and Neck Squamous Cell Carcinoma: Utility of Discovering Primary Lesions. Otolaryngol Head Neck Surg 2014; 151:272-8. [PMID: 24812081 DOI: 10.1177/0194599814533494] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 04/08/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Cancer of an unknown primary (CUP) squamous cell carcinoma metastatic to cervical lymph nodes is a challenging problem for the treating physician. Our aim is to determine if identification of the primary tumor is associated with improved oncologic outcomes and/or tumor characteristics including human papilloma virus (HPV) status. STUDY DESIGN Retrospective, matched-pairs analysis contrasting 2 cohorts based upon discovery of primary lesion. SETTING Tertiary teaching hospital. SUBJECTS AND METHODS Records of 136 patients initially diagnosed as carcinoma of unknown primary were retrospectively reviewed (1980-2010) and divided into 2 cohorts based on discovery of the primary lesion. Primary outcome measures were overall survival and time to recurrence according to Kaplan-Meier analysis. A nested subset of 22 patients in which the primary was discovered were matched to 22 patients remaining undiscovered according to nodal stage and age. RESULTS Discovered lesions were more likely to exhibit HPV positivity (P < .001). Matched-pairs analyses demonstrated that discovery of the primary was associated with better overall survival (HR = 0.125; 95% confidence interval [CI], 0.019-0.822; P = .030). Discovery of the primary was associated with improved cause-specific survival (HR = 0.142; 95% CI, 0.021-0.93; P = .0418) and disease-free survival (HR = 0.25; 95% CI, 0.069-0.91; P = .03). CONCLUSION HPV positivity is associated with discovery of the primary tumor. Discovery of the primary lesion is associated with improved overall survival, cause-specific survival, and disease-free survival in patients initially presenting as CUP in matched-pair and cohort comparison analyses.
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Affiliation(s)
- Kara S Davis
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - J Kenneth Byrd
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vikas Mehta
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Simon I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonas T Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA VA Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
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80
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Blitzer GC, Smith MA, Harris SL, Kimple RJ. Review of the clinical and biologic aspects of human papillomavirus-positive squamous cell carcinomas of the head and neck. Int J Radiat Oncol Biol Phys 2014; 88:761-70. [PMID: 24606845 PMCID: PMC3990872 DOI: 10.1016/j.ijrobp.2013.08.029] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/22/2013] [Accepted: 08/23/2013] [Indexed: 02/07/2023]
Abstract
Human papillomavirus (HPV), a known etiology of a subset of head-and-neck squamous cell carcinomas (HNCs), causes numerous alterations in normal cellular functions. This article reviews the biology, detection, and treatment of HPV-positive HNC. The role of HPV oncoproteins in tumor development, the natural history of HPV infection, and risk factors for and prevention of transmission of oral HPV are considered. Commonly used methods for detecting HPV infection, including limitations of these methods, are discussed to aid the practicing clinician in using these tests in their clinical practice. Clinical characteristics of HPV-positive HNC, including potential explanations for the improved outcomes seen in patients with HPV-positive HNC, are assessed. Ongoing clinical trials specific for patients with HPV-positive HNC are described, and areas in need of additional research are summarized. Until the results of ongoing trials are known, treatment of HPV-positive HNC should not differ in clinical practice from treatment of similar non-HPV related cancers.
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Affiliation(s)
- Grace C Blitzer
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Molly A Smith
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | | | - Randall J Kimple
- Department of Human Oncology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin; University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin.
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81
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Dok R, Kalev P, Van Limbergen EJ, Asbagh LA, Vázquez I, Hauben E, Sablina A, Nuyts S. p16INK4a impairs homologous recombination-mediated DNA repair in human papillomavirus-positive head and neck tumors. Cancer Res 2014; 74:1739-51. [PMID: 24473065 DOI: 10.1158/0008-5472.can-13-2479] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The p16INK4a protein is a principal cyclin-dependent kinase inhibitor that decelerates the cell cycle. Abnormally high levels of p16INK4a are commonly observed in human papillomavirus (HPV)-positive head and neck squamous cell carcinomas (HNSCC). We and others found that p16INK4a overexpression is associated with improved therapy response and survival of patients with HNSCC treated with radiotherapy. However, the functional role of p16INK4a in HNSCC remains unexplored. Our results implicate p16INK4a in regulation of homologous recombination-mediated DNA damage response independently from its role in control of the cell cycle. We found that expression of p16INK4a dramatically affects radiation sensitivity of HNSCC cells. p16INK4a overexpression impairs the recruitment of RAD51 to the site of DNA damage in HPV-positive cells by downregulating of cyclin D1 protein expression. Consistent with the in vitro findings, immunostaining of HNSCC patient samples revealed that high levels p16INK4a expression significantly correlated with decreased cyclin D1 expression. In summary, these findings reveal an unexpected function of p16INK4a in homologous recombination-mediated DNA repair response and imply p16INK4a status as an independent marker to predict response of patients with HNSCC to radiotherapy.
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Affiliation(s)
- Rüveyda Dok
- Authors' Affiliations: Department of Oncology, Laboratory of Experimental Radiotherapy; Department of Human Genetics, Laboratory for Mechanisms of Cell Transformation; Department of Oncology, Molecular and Digestive Oncology; Department of Imaging and Pathology, Translational Cell and Tissue Research, KU Leuven, University of Leuven; VIB Center for the Biology of Disease; Departments of Radiation Oncology; and Pathology, UZ Leuven, Leuven, Belgium
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82
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Bøje CR, Dalton SO, Primdahl H, Kristensen CA, Andersen E, Johansen J, Andersen LJ, Overgaard J. Evaluation of comorbidity in 9388 head and neck cancer patients: A national cohort study from the DAHANCA database. Radiother Oncol 2014; 110:91-7. [DOI: 10.1016/j.radonc.2013.11.009] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Revised: 11/27/2013] [Accepted: 11/27/2013] [Indexed: 11/15/2022]
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83
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Bøje CR. Impact of comorbidity on treatment outcome in head and neck squamous cell carcinoma – A systematic review. Radiother Oncol 2014; 110:81-90. [DOI: 10.1016/j.radonc.2013.07.005] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/14/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
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84
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Brown E, Owen R, Mengersen K, Harden F, Porceddu S. Evaluating the dosimetric effect of treatment‐induced changes in virally mediated head and neck cancer patients. J Med Radiat Sci 2013; 60:139-44. [PMID: 26229622 PMCID: PMC4175821 DOI: 10.1002/jmrs.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/24/2013] [Accepted: 10/15/2013] [Indexed: 11/11/2022] Open
Abstract
Introduction Patients with virally mediated head and neck cancer (VMHNC) often present with advanced nodal disease that is highly radioresponsive as demonstrated by tumour and nodal regression during treatment. The resultant changes may impact on the planned dose distribution and so adversely affect the therapeutic ratio. The aim of this study was to evaluate the dosimetric effect of treatment-induced anatomical changes in VMHNC patients who had undergone a replan. Methods Thirteen patients with virally mediated oropharyngeal or nasopharyngeal cancer who presented for definitive radiotherapy between 2005 and 2010 and who had a replan generated were investigated. The dosimetric effect of anatomical changes was quantified by comparing dose–volume histograms (DVH) of primary and nodal gross target volumes and organs at risk (OAR), including spinal cord and parotid glands, from the original plan and a comparison plan. Results Eleven three-dimensional conformal radiation therapy (3DCRT) and two intensity modulated radiation therapy (IMRT) plans were evaluated. Dose to the spinal cord and brainstem increased by 4.1% and 2.6%, respectively. Mean dose to the parotid glands also increased by 3.5%. In contrast, the dose received by 98% of the primary and nodal gross tumour volumes decreased by 0.15% and 0.3%, respectively, when comparing the initial treatment plan to the comparison plan. Conclusion In this study, treatment-induced anatomical changes had the greatest impact on OAR dose with negligible effect on the dose to nodal gross tumour volumes. In the era of IMRT, accounting for treatment-induced anatomical changes is important as focus is placed on minimizing the acute and long-term side effects of treatment.
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Affiliation(s)
- Elizabeth Brown
- Radiation Oncology Department Princess Alexandra Hospital Brisbane Queensland Australia
- Queensland University of Technology Brisbane Queensland Australia
| | - Rebecca Owen
- Radiation Oncology Department Radiation Oncology Mater Centre Brisbane Queensland Australia
| | - Kerrie Mengersen
- Queensland University of Technology Brisbane Queensland Australia
| | - Fiona Harden
- Queensland University of Technology Brisbane Queensland Australia
| | - Sandro Porceddu
- Radiation Oncology Department Princess Alexandra Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
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85
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Wang H, Sun R, Lin H, Hu WH. P16INK4A as a surrogate biomarker for human papillomavirus-associated oropharyngeal carcinoma: consideration of some aspects. Cancer Sci 2013; 104:1553-9. [PMID: 24344719 DOI: 10.1111/cas.12287] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/03/2013] [Accepted: 09/11/2013] [Indexed: 12/21/2022] Open
Abstract
Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinomas (OPSCCs) frequently show different clinical and pathological features, which tend to be younger age, better performance status, less tobacco and alcohol consumption, more poorly differentiated histopathology, but usually with better treatment response and prognosis compared with HPV-negative OPSCCs. In tumor tissue, HPV infection is closely correlated with p16(INK4A) expression, which has been suggested to be a surrogate biomarker of HPV infection. However, there is diversity of sensitivity and specificity about p16(INK4A) in surrogate detection of HPV status. Herein, we summarize the current knowledge and note some aspects for consideration concerning p16(INK4A) as a surrogate biomarker for HPV-associated OPSCC.
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Affiliation(s)
- Hongzhi Wang
- Sun Yat-sen University Cancer Center, Guangdong, China; State Key Laboratory of Oncology in South China, Guangdong, China; Collaborative Innovation Center for Cancer Medicine, Guangdong, China
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86
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Lassen P, Overgaard J, Eriksen JG. Expression of EGFR and HPV-associated p16 in oropharyngeal carcinoma: correlation and influence on prognosis after radiotherapy in the randomized DAHANCA 5 and 7 trials. Radiother Oncol 2013; 108:489-94. [PMID: 24060179 DOI: 10.1016/j.radonc.2013.08.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 08/25/2013] [Accepted: 08/25/2013] [Indexed: 02/05/2023]
Abstract
AIM EGFR and HPV-associated p16 are among the most investigated biomarkers in head and neck cancer. The aim was to investigate the correlation and interaction between these two markers and to evaluate their potential prognostic significance when combined. MATERIALS AND METHODS 336 Oropharyngeal carcinomas treated with primary radiotherapy (66-68 Gy, 2fx/day, 10-12 Gy/week) and with known EGFR/p16-status estimated semiquantitatively by immunohistochemistry were included in the study. Data were evaluated by EGFR-expression (high/low) and p16-status (positive/negative) consequently dividing tumours into four groups by combination of the biomarkers. Patient/tumour characteristics and complete 5-year follow-up were available. RESULTS Low EGFR-expression was significantly more common in p16-positive tumours compared to p16-negative, p < 0.0001. p16 positivity showed a strong prognostic impact (p < 0.0001, HR = 0.22 [0.13-0.38]), whereas EGFR was a weak prognostic marker when local control was used as endpoint (p = 0.03, HR = 0.53 [0.29-0.94]). Combination of EGFR/p16 did not add significant information to p16 alone and by multivariable analysis only p16 showed significant prognostic information for all evaluated endpoints. CONCLUSIONS Both EGFR and p16 bear prognostic information in oropharyngeal cancer, although p16 is, by far, the strongest prognostic factor. The markers seem to be correlated and this might have influence when evaluating the effect of EGFR inhibition in oropharyngeal tumours.
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Affiliation(s)
- Pernille Lassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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87
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Developing an Adaptive Radiotherapy Technique for Virally Mediated Head and Neck Cancer. J Med Imaging Radiat Sci 2013; 44:134-140. [DOI: 10.1016/j.jmir.2013.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 01/23/2013] [Accepted: 04/02/2013] [Indexed: 11/21/2022]
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88
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Radiosensitivity and effect of hypoxia in HPV positive head and neck cancer cells. Radiother Oncol 2013; 108:500-5. [DOI: 10.1016/j.radonc.2013.06.011] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 11/18/2022]
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89
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Affiliation(s)
- Pernille Lassen
- Aarhus University Hospital, Department of Experimental Clinical Oncology, Aarhus C, Denmark
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90
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Ampil F, Chaudhery S, Devarakonda S, Mills G. Extended survival after chemotherapy and conservative radiotherapy for HPV-16 positive stage IVB oropharyngeal carcinoma. Acta Oncol 2013; 52:1236-7. [PMID: 23421928 DOI: 10.3109/0284186x.2013.770922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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91
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Wang JL, Fang CL, Wang M, Yu MC, Bai KJ, Lu PC, Liu HE. Human papillomavirus infections as a marker to predict overall survival in lung adenocarcinoma. Int J Cancer 2013; 134:65-71. [DOI: 10.1002/ijc.28349] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 06/07/2013] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Ming-Chih Yu
- Department of Internal Medicine, Wan Fang Hospital; Taipei Medical University; Taipei; Taiwan
| | - Kuan-Jen Bai
- Department of Internal Medicine, Wan Fang Hospital; Taipei Medical University; Taipei; Taiwan
| | - Pei-Chih Lu
- Department of Internal Medicine, Wan Fang Hospital; Taipei Medical University; Taipei; Taiwan
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92
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Näsman A, Nordfors C, Grün N, Munck-Wikland E, Ramqvist T, Marklund L, Lindquist D, Dalianis T. Absent/weak CD44 intensity and positive human papillomavirus (HPV) status in oropharyngeal squamous cell carcinoma indicates a very high survival. Cancer Med 2013; 2:507-18. [PMID: 24156023 PMCID: PMC3799285 DOI: 10.1002/cam4.90] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 12/11/2022] Open
Abstract
Patients with human papillomavirus DNA positive (HPVDNA+) oropharyngeal squamous cell carcinoma (OSCC) have better clinical outcome than those with HPV DNA negative (HPVDNA−) OSCC upon intensive oncological treatment. All HPVDNA+ OSCC patients may not require intensive treatment, however, but before potentially deintensifying treatment, additional predictive markers are needed. Here, we examined HPV, p16INK4a, and CD44 in OSCC in correlation to clinical outcome. Pretreatment tumors from 290 OSCC patients, the majority not receiving chemotherapy, were analyzed for HPV DNA by Luminex and for p16INK4a and CD44 by immunohistochemistry. 225/290 (78%) tumors were HPVDNA+ and 211/290 (73%) overexpressed p16INK4a, which correlated to presence of HPV (P < 0.0001). Presence of HPV DNA, absent/weak CD44 intensity staining correlated to favorable 3-year disease-free survival (DFS) and overall survival (OS) by univariate and multivariate analysis, and likewise for p16INK4a by univariate analysis. Upon stratification for HPV, HPVDNA+ OSCC with absent/weak CD44 intensity presented the significantly best 3-year DFS and OS, with >95% 3-year DFS and OS. Furthermore, in HPVDNA+ OSCC, p16INK4a+ overexpression correlated to a favorable 3-year OS. In conclusion, patients with HPVDNA+ and absent/weak CD44 intensity OSCC presented the best survival and this marker combination could possibly be used for selecting patients for tailored deintensified treatment in prospective clinical trials. Absence of/weak CD44 or presence of human papillomavirus (HPV) DNA was shown as a favorable prognostic factors in tonsillar and tongue base cancer. Moreover, patients with the combination of absence of/weak CD44 and presence of HPV DNA presented a very favorable outcome. Therefore, we suggest that this marker combination could potentially be used to single out patients with a high survival that could benefit from a de-escalated oncological treatment.
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Affiliation(s)
- Anders Näsman
- Department of Oncology-Pathology, Karolinska Institutet Stockholm, Sweden
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93
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Rademakers SE, Hoogsteen IJ, Rijken PF, Oosterwijk E, Terhaard CH, Doornaert PA, Langendijk JA, van den Ende P, Takes R, De Bree R, van der Kogel AJ, Bussink J, Kaanders JH. Pattern of CAIX expression is prognostic for outcome and predicts response to ARCON in patients with laryngeal cancer treated in a phase III randomized trial. Radiother Oncol 2013; 108:517-22. [PMID: 23719582 DOI: 10.1016/j.radonc.2013.04.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 04/22/2013] [Accepted: 04/26/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE In a phase III trial in patients with advanced stage laryngeal carcinoma comparing ARCON (accelerated radiotherapy with carbogen breathing and nicotinamide) to accelerated radiotherapy alone (AR) the prognostic and predictive value of CAIX, a hypoxia-associated protein, was investigated. MATERIAL AND METHODS 261 Paraffin embedded tumor biopsies and 79 fresh frozen biopsies from patients entered in the trial were immunohistochemically stained for CAIX. CAIX-fraction and CAIX expression pattern were related to tumor control and patient survival. RESULTS Low CAIX-fraction was prognostic for worse regional control and overall survival in patients treated with AR. Patients with a low CAIX-fraction treated with ARCON had better regional control and metastasis-free survival compared to AR (RC 97% vs 71%, p < 0.01 and MFS 92% vs 69%, p = 0.06). Patients with a perinecrotic CAIX staining pattern had a significantly worse local control, metastasis-free and overall survival compared to patients with a diffuse pattern (65% vs 84%, p = 0.01, 70% vs 96%, p < 0.01 and 42% vs 71%, p < 0.01 respectively), and this could not be improved with ARCON. After multivariate analysis CAIX pattern and N-stage emerged as significant predictors for metastasis-free survival and overall survival. CONCLUSIONS ARCON improves regional control and metastasis-free survival only in patients with low CAIX expression. The different patterns of CAIX expression suggest different mechanisms of upregulation and have important prognostic value.
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Affiliation(s)
- Saskia E Rademakers
- Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, The Netherlands.
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94
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Farnebo L, Tiefenböck K, Ansell A, Thunell LK, Garvin S, Roberg K. Strong expression of survivin is associated with positive response to radiotherapy and improved overall survival in head and neck squamous cell carcinoma patients. Int J Cancer 2013; 133:1994-2003. [PMID: 23564498 DOI: 10.1002/ijc.28200] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 03/22/2013] [Indexed: 02/06/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a malignancy that is associated with severe mortality despite advances in therapy. Today's standard treatment most commonly includes radiotherapy, often combined with chemotherapy or surgery. There are so far no established biomarkers to predict response to radiation, and thus the aim of this study was to investigate a series of markers that could potentially identify HNSCC patients who would benefit from radiotherapy. The selected markers, both proteins (epidermal growth factor receptor, survivin and p53), and single nucleotide polymorphisms (SNPs) in the genes of XRCC3, XRCC1, XPC, XPD, MDM2, p53 and FGFR4 were correlated to the response to radiotherapy and overall survival. Investigations were performed on pretreatment tumor biopsies from patients classified as responders or nonresponders to radiotherapy. Protein expression was examined using immunohistochemistry and the genotyping of specific SNPs was analyzed using PCR-RFLP or pyrosequencing. We found that survivin expression was significantly stronger in the responder group (p = 0.003) and that patients with a strong survivin expression had a significantly better overall survival (p < 0.001). Moreover, downregulation of survivin by siRNA in two HNSCC cell lines significantly decreased their sensitivity to radiation. Among the SNPs analyzed, patients with the XPD Lys751Gln SNP had a significantly shorter overall survival (p = 0.048), and patients with the FGFR4 Gly388Arg SNP had a significantly longer overall survival (p = 0.010). In conclusion, our results suggest that survivin plays an important role in the response to radiotherapy and may be a useful marker for predicting radiotherapy response in patients with HNSCC.
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Affiliation(s)
- Lovisa Farnebo
- Department of ENT-Head and Neck Surgery, UHL, County Council of Östergötland, Linköping, Sweden
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95
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Cun B, Song X, Jia R, Wang H, Zhao X, Liu B, Ge S, Fan X. Cell growth inhibition in HPV 18 positive uveal melanoma cells by E6/E7 siRNA. Tumour Biol 2013; 34:1801-6. [PMID: 23494180 DOI: 10.1007/s13277-013-0719-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 02/24/2013] [Indexed: 12/12/2022] Open
Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. However, the molecular development of UM is not fully understood and current therapeutic modalities result in poor outcomes. Increasingly, data have shown that human papillomaviruses (HPVs) contribute to the development of cervical cancer and other malignancies, and the key viral oncoprotein E6/E7 has become the target of gene therapy in HPV-related cancers. In this study, we identified HPV 18 infection in the UM cell line, VUP, for the first time and silenced HPV 18 E6/E7 expression using siRNA. Our results demonstrated that down regulation of HPV 18E6/E7 led to growth inhibition and cell cycle block in VUP cells by activation of the p53 and Rb pathways. We propose that HPV is possibly involved in the development of UM, and provide a novel target for the development of therapeutic strategies for UM.
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Affiliation(s)
- Biyun Cun
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China
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96
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Tao Y, Bardet E, Rosine D, Rolland F, Bompas E, Daly-Schveitzer N, Lusinchi A, Bourhis J. Phase I trial of oral etoposide in combination with radiotherapy in head and neck squamous cell carcinoma - GORTEC 2004-02. Radiat Oncol 2013; 8:40. [PMID: 23445779 PMCID: PMC3606353 DOI: 10.1186/1748-717x-8-40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 01/27/2013] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study sought to determine the maximum tolerated dose (MTD) of oral etoposide in combination with radiotherapy in head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS Phase I, multicenter, open-labelled, non-comparative and dose escalating trial. Patients with locally advanced HNSCC were enrolled onto cohorts of escalating dose of etoposide. Oral etoposide was administered on five consecutive days every week for 7 weeks (7 treatment cycles) in combination with daily radiotherapy (70 Gy /35 fractions). Two dose levels (25 mg/day and 50 mg/day) of etoposide were planned and three to six patients were to be enrolled at each level according to the potential DLTs. RESULTS Fourteen patients were allocated to two dose levels: 25 mg/day (3) and 50 mg/day (11). Cisplatin was contra-indicated in all the patients included. Only one patient (50 mg/day) presents a grade 4 neutropenia (DLT), no other DLTs were observed. The most frequently adverse events (AEs) were radiomucositis. Two deaths before 3 months of end of treatment were not related to treatment. Seven patients were still alive with a median follow-up of 30 months (12-58 months). Nine patients had a complete response (CR) at 3 months after the radiotherapy; Among the 9 patients, 3 patients had a local relapse; one patient with local and distant relapse. CONCLUSION Due to only one DLT experienced, it is possible to a dose of 50 mg/day for phase II studies, however this should be considered with caution.
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Affiliation(s)
- Yungan Tao
- Institute Gustave-Roussy, Villejuif, France
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97
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Lønbro S, Dalgas U, Primdahl H, Overgaard J, Overgaard K. Feasibility and efficacy of progressive resistance training and dietary supplements in radiotherapy treated head and neck cancer patients--the DAHANCA 25A study. Acta Oncol 2013. [PMID: 23190359 DOI: 10.3109/0284186x.2012.741325] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Patients with head and neck squamous cell carcinoma (HNSCC) often lose a considerable amount of muscle mass following the disease and treatment. This is an independent mortality predictor, lowering muscle strength and functional performance. Progressive resistance training (PRT) increases muscle mass among healthy individuals and groups of cancer patients, but it has not been investigated in HNSCC patients. Furthermore, studies in healthy subjects show an additive effect of protein and creatine supplementation following PRT. OBJECTIVES Firstly, to investigate the feasibility of 12 weeks of PRT ± protein and creatine supplementation among HNSCC patients. Secondly, to investigate group changes over time and group differences regarding lean body mass (LBM), muscle strength and functional performance following PRT ± dietary supplementation. MATERIAL AND METHODS Thirty patients were randomized into two groups: a PROCR group undergoing a seven-day pre-trial creatine loading protocol followed by 12 weeks of PRT with creatine and protein supplementation and a PLA group undergoing a seven-day pre-trial placebo ingestion protocol followed by an identical PRT protocol with placebo supplementation. Before the pre-trial and pre- and post-PRT evaluation of LBM, maximal isometric and isokinetic muscle strength and functional performance were performed. RESULTS Seventy percent of the patients completed the intervention and the PRT adherence rate was 97%. No significant group differences were found in any endpoints. From pre- to post-PRT, LBM increased significantly in the PROCR group by 2.6 ± 2.2 kg (p < 0.0001) and increased in the PLA group (1.3 ± 1.1 kg, p = 0.07). Maximal isometric and isokinetic muscle strength as well as functional performance increased significantly in both groups. CONCLUSION PRT is feasible in radiotherapy treated HNSCC patients. Following PRT, lean body mass, muscle strength and functional performance increased significantly in both groups (LBM only borderline significant in PLA group) with no significant group difference in any endpoint.
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Affiliation(s)
- Simon Lønbro
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
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98
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Bøje CR, Dalton SO, Grønborg TK, Primdahl H, Kristensen CA, Andersen E, Johansen J, Andersen LJ, Overgaard J. The impact of comorbidity on outcome in 12 623 Danish head and neck cancer patients: a population based study from the DAHANCA database. Acta Oncol 2013; 52:285-93. [PMID: 23320773 DOI: 10.3109/0284186x.2012.742964] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is primarily caused by smoking and alcohol. Besides having a carcinogenic effect, smoking also leads to other diseases and thus contributes to a high prevalence of comorbidities among HNSCC patients. Furthermore, the world population is becoming older resulting in more elderly patients with HNSCC. The aim of this study was to investigate the prevalence and impact of comorbidity in a retrospective nationwide population-based study of all Danish HNSCC patients diagnosed from 1992 to 2008. MATERIAL AND METHODS A total of 12 623 patients diagnosed with HNSCC in the period from 1992 to 2008 were identified through the Danish Head and Neck Cancer group (DAHANCA) database. By linking to the Danish registers, information on somatic comorbidity present prior to the HNSCC diagnosis was obtained and adapted to the Charlson Comorbidity Index (CCI). The influence of comorbidity on overall survival and cancer specific death was evaluated and the type and prevalence of comorbidity described. RESULTS In total, 36% of patients had comorbidity according to CCI. Increasing age was significantly associated with increasing CCI. In multivariate analyses, the CCI score remained a strong independent prognostic factor for overall survival, the HR being 1.16 (95% CI 1.08; 1.25), 1.34 (1.22; 1.46), 1.63 (1.51; 1.80) for patients with CCI score 1, 2, and 3+, respectively. The CCI score did not influence cancer specific death. CONCLUSION Comorbidity is common among HNSCC patients and has a negative prognostic impact on overall survival. Cancer specific death was not affected by comorbidity suggesting that patients die from their comorbidities rather than their cancer. In the future, more elderly patients with comorbidity will require treatment which will demand a change in the healthcare system with a multidisciplinary approach required in order to take care of both their cancer and their comorbidities.
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99
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Recommendations for the diagnosis of human papilloma virus (HPV) high and low risk in the prevention and treatment of diseases of the oral cavity, pharynx and larynx. Guide of experts PTORL and KIDL. Otolaryngol Pol 2013; 67:113-34. [PMID: 23719268 DOI: 10.1016/j.otpol.2013.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 01/09/2013] [Indexed: 11/20/2022]
Abstract
The role of human papilloma viruses (HPV) in malignant and nonmalignant ENT diseases and the corresponding epidemiological burden has been widely described. International head and neck oncology community discussed growing evidence that oral HPV infection contributes to the risk of oro-pharyngeal carcinoma (OPC) and recommended HPV testing as a part of the work up for patients with OPC. Polish Society of ENT Head Neck Surgery and National Chamber of Laboratory Diagnosticians have worked together to define the minimum requirements for assigning a diagnosis of HPV-related conditions and testing strategy that include HPV specific tests in our country. This paper briefly frames the literature information concerning low risk (LR) and high risk (HR) HPV, reviews the epidemiology, general guidance on the most appropriate biomarkers for clinical assessment of HPV. The definition of HPV-related cancer was presented. The article is aiming to highlight some of major issues for the clinician dealing with patients with HPV-related morbidities and to introduce the diagnostic algorithm in Poland.
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100
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Abstract
Epigenetic modifications constitute the next frontier in tumor biology research. Post-translation modification of histones dynamically influences gene expression independent of alterations to the DNA sequence. These mechanisms are often mediated by histone linkers or by proteins associated with the recruitment of DNA-binding proteins, HDAC I and II interacting proteins and transcriptional activators, coactivators or corepressors. Early evidence suggested that histones and their modifiers are involved in sophisticated processes that modulate tumor behavior and cellular phenotype. In this review, we discuss how recent discoveries about chromatin modifications, particularly histone acetylation, are shaping our knowledge of cell biology and our understanding of the molecular circuitry governing tumor progression and consider whether recent insights may extend to novel therapeutic approaches. Furthermore, we discuss the latest oncogenomic findings in Head and Neck Squamous Cell Carcinoma (HNSCC) from studies using Next Generation Sequencing (NGS) technology and highlight the impact of mutations identified in histones and their modifiers.
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Affiliation(s)
- Manoela D Martins
- Department of Oral Pathology, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rogerio M Castilho
- Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
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