101
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SEOM clinical guidelines for the treatment of head and neck cancer (2017). Clin Transl Oncol 2017; 20:75-83. [PMID: 29159792 PMCID: PMC5785598 DOI: 10.1007/s12094-017-1776-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 01/04/2023]
Abstract
Head and neck cancer (HNC) is defined as malignant tumours located in the upper aerodigestive tract and represents 5% of oncologic cases in adults in Spain. More than 90% of these tumours have squamous histology. In an effort to incorporate evidence obtained since 2013 publication, Spanish Society of Medical Oncology (SEOM) presents an update of HNC diagnosis and treatment guideline. The eighth edition of TNM classification, published in January 2017, introduces important changes for p16-positive oropharyngeal tumours, for lip and oral cavity cancer and for N3 category. In addition, there are new data about induction chemotherapy and the role of immunotherapy in HNC.
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102
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Goyal U, Prabhakar NK, Davuluri R, Morrison CM, Yi SK. Role of Concurrent Systemic Therapy with Adjuvant Radiation Therapy for Locally Advanced Cutaneous Head and Neck Squamous Cell Carcinoma. Cureus 2017; 9:e1784. [PMID: 29279810 PMCID: PMC5736240 DOI: 10.7759/cureus.1784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Objective To evaluate the role of concurrent systemic therapy to postoperative radiation therapy (RT) for locally advanced cutaneous head and neck squamous cell carcinoma (LA-cHNSCC). Materials and methods A retrospective study of 32 patients with LA-cHNSCC receiving postoperative RT with and without systemic therapy was conducted. Patients with LA-cHNSCC after surgical resection with one or more high risk features were evaluated. Local regional control (LRC), distant control (DC), and acute and late toxicities were evaluated with Fisher exact tests. Progression-free survival (PFS) and overall survival (OS) were evaluated utilizing Kaplan Meier and log-rank analyses. Univariate Cox proportional hazard analyses were used to examine patient, disease, and treatment-related factors with OS and PFS. Results While comparing patients receiving RT with systemic therapy (n = 14) vs RT alone (n = 18), LRC was 92.9% vs 72.2% (p = 0.20), DC 92.9% vs 94.4% (p = 1.0), median PFS 17.7 months vs 34.4 months (p = 0.48), and median OS 20.9 months vs 34.4 months (p = 0.03), respectively. On univariate analyses, use of concurrent systemic therapy was associated with an increased risk of death with an HR of 3.5 [95% confidence interval (CI): 1.04 - 11.6] (p = 0.04), while patients treated for recurrent disease who had previously treated superficial primaries had improved OS with an HR of 0.10 [95% CI: 0.01-0.80] (p = 0.03). There were no significant differences in acute or chronic toxicities between groups. Conclusions Patients receiving postoperative RT alone for LA-cHNSCC had better OS than patients receiving concurrent systemic therapy. There were no differences in any other endpoints evaluated.
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Affiliation(s)
- Uma Goyal
- Radiation Oncology, University of Arizona Cancer Center
| | - Nitin K Prabhakar
- College of Medicine, University of Arizona College of Medicine-Tucson
| | | | | | - Sun K Yi
- Radiation Oncology, University of Arizona Cancer Center
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103
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Garinis AC, Cornell A, Allada G, Fennelly KP, Maggiore RJ, Konrad-Martin D. Ototoxicity monitoring through the eyes of the treating physician: Perspectives from pulmonology and medical oncology. Int J Audiol 2017; 57:S19-S24. [PMID: 28978238 DOI: 10.1080/14992027.2017.1381769] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Integrating audiological management into the care pathways of clinical specialties that prescribe ototoxic medications for essential, often life-preserving medical care that is critical for early hearing loss identification and remediation. Research shows that successful implementation of a new health service or intervention requires alignment of goals among provider groups, institutional leadership and patients. Thoughtful consideration of the physician's viewpoints about ototoxicity and its implications for treatment planning is, therefore, important for the implementation and enduring success of an ototoxicity monitoring programme (OMP). DESIGN This discussion paper uses qualitative methods to explore the perspectives of four physicians on OMP provision in their patient populations. STUDY SAMPLE Three pulmonologists and one oncologist completed the written survey or survey-based interview described in this report. RESULTS Each physician indicated that (i) ototoxicity is a potential problem for their patients; (ii) monitoring hearing is important to ensure good quality of life among their patients and (iii) treatment modification would be considered if an alternative treatment option were available. The physicians differed in their approaches to ototoxicity monitoring, from routine referrals to audiology, to relying on patient self-referral. CONCLUSION Physician provider input is needed to optimise monitoring schedules and OMP care coordination with audiology.
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Affiliation(s)
- Angela C Garinis
- a Department of Otolaryngology - Head and Neck Surgery , Oregon Health & Science University , Portland , OR , USA.,b VA Portland Health Care System , VA RR&D Center of Excellence, National Center for Rehabilitative Auditory Research , Portland , OR , USA
| | - Alexandra Cornell
- c Division of Pulmonary and Critical Care Medicine Adult Cystic Fibrosis Program , Oregon Health & Science University , Portland , OR , USA
| | - Gopal Allada
- d Department of Pediatrics Pulmonary Medicine , Oregon Health & Science University , Portland , OR , USA
| | - Kevin P Fennelly
- e National Heart, Lung and Blood Institute , National Institutes of Health , Bethesda , MD , USA
| | - Ronald J Maggiore
- b VA Portland Health Care System , VA RR&D Center of Excellence, National Center for Rehabilitative Auditory Research , Portland , OR , USA.,f Department of Medicine, Hematology & Oncology , Oregon Health & Science University , Portland , OR , USA , and.,g Department of Medicine, Hematology & Oncology , University of Rochester , Rochester , NY , USA
| | - Dawn Konrad-Martin
- a Department of Otolaryngology - Head and Neck Surgery , Oregon Health & Science University , Portland , OR , USA.,b VA Portland Health Care System , VA RR&D Center of Excellence, National Center for Rehabilitative Auditory Research , Portland , OR , USA
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104
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Baine M, Dorius T, Bennion N, Alam M, Smith L, Zhen W, Ganti A. Chemoradiotherapy for locally advanced squamous cell carcinoma of the oropharynx: Does completion of systemic therapy affect outcomes? Oral Oncol 2017; 73:105-110. [DOI: 10.1016/j.oraloncology.2017.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/31/2017] [Accepted: 08/27/2017] [Indexed: 10/18/2022]
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105
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Al-Mamgani A, de Ridder M, Navran A, Klop WM, de Boer JP, Tesselaar ME. The impact of cumulative dose of cisplatin on outcome of patients with head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2017; 274:3757-3765. [DOI: 10.1007/s00405-017-4687-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 07/21/2017] [Indexed: 11/24/2022]
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106
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Szturz P, Wouters K, Kiyota N, Tahara M, Prabhash K, Noronha V, Castro A, Licitra L, Adelstein D, Vermorken JB. Weekly Low-Dose Versus Three-Weekly High-Dose Cisplatin for Concurrent Chemoradiation in Locoregionally Advanced Non-Nasopharyngeal Head and Neck Cancer: A Systematic Review and Meta-Analysis of Aggregate Data. Oncologist 2017; 22:1056-1066. [PMID: 28533474 DOI: 10.1634/theoncologist.2017-0015] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Three-weekly high-dose cisplatin (100 mg/m2) is considered the standard systemic regimen given concurrently with postoperative or definitive radiotherapy in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, due to unsatisfactory patient tolerance, various weekly low-dose schedules have been increasingly used in clinical practice. The aim of this meta-analysis was to compare the efficacy, safety, and compliance between these two approaches. MATERIALS AND METHODS We systematically searched literature for prospective trials of patients with LA-SCCHN who received postoperative or definitive conventionally fractionated concurrent chemoradiation. Radiation doses were usually 60-66 gray (Gy) in the postoperative setting and 66-70 Gy in the definitive setting. Standard, three-weekly high-dose cisplatin (100 mg/m2, 3 doses) was compared with the weekly low-dose protocol (≤50 mg/m2, ≥6 doses). The primary endpoint was overall survival. Secondary outcomes comprised response rate, acute and late adverse events, and treatment compliance. RESULTS Fifty-two studies with 4,209 patients were included in two separate meta-analyses according to the two clinical settings. There was no difference in treatment efficacy as measured by overall survival or response rate between the chemoradiation settings with low-dose weekly and high-dose three-weekly cisplatin regimens. In the definitive treatment setting, the weekly regimen was more compliant and significantly less toxic with respect to severe (grade 3-4) myelosuppression (leukopenia p = .0083; neutropenia p = .0024), severe nausea and/or vomiting (p < .0001), and severe nephrotoxicity (p = .0099). Although in the postoperative setting the two approaches were more equal in compliance and with clearly less differences in the cisplatin-induced toxicities, the weekly approach induced more grade 3-4 dysphagia (p = .0026) and weight loss (p < .0001). CONCLUSION In LA-SCCHN, current evidence is insufficient to demonstrate a meaningful survival difference between the two dosing regimens. Prior to its adoption into routine clinical practice, the low-dose weekly approach needs to be prospectively compared with the standard three-weekly high-dose schedule. IMPLICATIONS FOR PRACTICE Given concurrently with conventional radiotherapy in locally advanced head and neck cancer, high-dose three-weekly cisplatin has often been replaced with weekly low-dose infusions to increase compliance and decrease toxicity. The present meta-analysis suggests that both approaches might be equal in efficacy, both in the definitive and postoperative settings, but differ in toxicity. However, some toxicity data can be influenced by unbalanced representation, and the conclusions are not based on adequately sized prospective randomized studies. Therefore, low-dose weekly cisplatin should not be used outside clinical trials but first prospectively studied in adequately sized phase III trials versus the high-dose three-weekly approach.
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Affiliation(s)
- Petr Szturz
- Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno, Czech Republic
- School of Medicine, Masaryk University, Brno, Czech Republic
| | - Kristien Wouters
- Scientific Coordination and Biostatistics, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Naomi Kiyota
- Kobe University Hospital Cancer Center, Hyogo, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Ana Castro
- Medical Oncology, Centro Hospitalar do Porto, Porto, Portugal
| | - Lisa Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan and University of Milan, Milan, Italy
| | - David Adelstein
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jan B Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
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107
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Specenier P, Vermorken JB. CONCERT-1, an additional piece in the puzzle of (bio)-(chemo)-radiation. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:432. [PMID: 27942523 PMCID: PMC5124631 DOI: 10.21037/atm.2016.11.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 10/17/2016] [Indexed: 08/30/2023]
Affiliation(s)
- Pol Specenier
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Jan B. Vermorken
- Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
- Department of Oncology, Antwerp University Hospital, Edegem, Belgium
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108
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Rades D, Seidl D, Janssen S, Strojan P, Karner K, Bajrovic A, Hakim SG, Wollenberg B, Schild SE. Comparing two lower-dose cisplatin programs for radio-chemotherapy of locally advanced head-and-neck cancers. Eur Arch Otorhinolaryngol 2016; 274:1021-1027. [PMID: 27687678 DOI: 10.1007/s00405-016-4326-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/26/2016] [Indexed: 12/14/2022]
Abstract
Radio-chemotherapy is a common treatment for locally advanced squamous cell head-and-neck cancers (LA-SCCHN). Cisplatin (100 mg/m2) every 3 weeks is very common but associated with considerable toxicity. Therefore, cisplatin programs with lower daily doses were introduced. There is a lack of studies comparing lower-dose programs. In this study, 85 patients receiving radio-chemotherapy with 20 mg/m2 cisplatin on 5 days every 4 weeks (group A) were retrospectively compared to 85 patients receiving radio-chemotherapy with 30-40 mg/m2 cisplatin weekly (group B). Groups were matched for nine factors including age, gender, performance score, tumor site, T-/N-category, surgery, hemoglobin before radio-chemotherapy, and radiation technique. One- and 3-year loco-regional control rates were 83 and 69 % in group A versus 74 and 63 % in group B (p = 0.12). One- and 3-year survival rates were 93 % and 73 % in group A versus 91 and 49 % in group B (p = 0.011). On multivariate analysis, survival was significantly better for group A (HR 1.17; p = 0.002). In groups A and B, 12 and 28 % of patients, respectively, did not receive a cumulative cisplatin dose ≥180 mg/m2 (p = 0.016). Toxicity rates were not significantly different. On subgroup analyses, group A patients had better loco-regional control (p = 0.040) and survival (p = 0.005) than group B patients after definitive radio-chemotherapy. In patients receiving adjuvant radio-chemotherapy, outcomes were not significantly different. Thus, 20 mg/m2 cisplatin on 5 days every 4 weeks resulted in better loco-regional control and survival in patients receiving definitive radio-chemotherapy and may be preferable for these patients. Confirmation of these results in a randomized trial is warranted.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
| | - Daniel Seidl
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.,Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
| | - Primoz Strojan
- Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia
| | - Katarina Karner
- Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia
| | - Amira Bajrovic
- Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany
| | - Samer G Hakim
- Department of Oral and Maxillofacial Surgery, University of Lübeck, Lübeck, Germany
| | - Barbara Wollenberg
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
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109
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Impact of cisplatin dose intensity on human papillomavirus-related and -unrelated locally advanced head and neck squamous cell carcinoma. Eur J Cancer 2016; 67:174-182. [PMID: 27669504 DOI: 10.1016/j.ejca.2016.08.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/16/2016] [Accepted: 08/21/2016] [Indexed: 10/21/2022]
Abstract
AIM The aim is to evaluate the impact of cisplatin dose modification on outcomes of human papillomavirus (HPV)-related (HPV+) and HPV-unrelated (HPV-) locally advanced head and neck cancer (LAHNC) treated with chemoradiotherapy (CRT). PATIENTS AND METHODS A pooled analysis was conducted of stage III/IV oropharyngeal cancer (OPC), carcinoma of unknown primary (CUP) and laryngo-hypopharyngeal cancer (LHC) patients treated with single-agent cisplatin CRT in 2000-2012 from two tertiary academic cancer centres. HPV status was determined by p16 staining and/or in situ hybridisation. LHC was assumed to be HPV-. Unknown HPV status OPC/CUPs were excluded. Overall survival (OS) was calculated. Multivariable analysis (MVA) evaluated the impact of cisplatin dose intensity on survival for HPV+ and HPV- cohorts separately. RESULTS A total of 404 HPV+ and 255 HPV- LAHNC (481 OPC, 18 CUP, 160 LHC) patients were included. Median follow-up was 4.3 (0.5-11.9) years. Three-year OS for cisplatin <200, =200, and >200 mg/m2 subgroups were 52%, 60%, and 72% (P = 0.001) for the HPV- and 91%, 90%, and 91% (P = 0.30) for the HPV+ patients. MVA confirmed a survival benefit with cisplatin >200 mg/m2 for the HPV- (hazard ratio [HR] 0.5, 95% confidence interval [CI]: 0.3-0.7, P < 0.001) but not for HPV+ (HR 0.6, 95% CI: 0.4-1.1, P = 0.104). There was a superior OS trend in the HPV+ T4 or N3 high-risk subset (N = 107) with cisplatin >200 mg/m2 (HR 0.5, 95% CI: 0.2-1.1, P = 0.07). CONCLUSIONS A survival benefit of cisplatin dose >200 mg/m2 is evident for HPV- LAHNC patients, but not for HPV+ cohort overall, although the T4 or N3 subset may benefit from a higher cumulative cisplatin dose.
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110
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Hartmann S, Grandis JR. Treatment of head and neck cancer in the elderly. Expert Opin Pharmacother 2016; 17:1903-21. [DOI: 10.1080/14656566.2016.1220540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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111
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Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI. Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/- chemotherapy) for head and neck cancer. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF OTO-RHINO-LARYNGOLOGICAL SOCIETIES (EUFOS) : AFFILIATED WITH THE GERMAN SOCIETY FOR OTO-RHINO-LARYNGOLOGY - HEAD AND NECK SURGERY 2016. [PMID: 27498203 DOI: 10.1007/s00405-016-4241-9.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
A proportion of patients with head and neck cancer (HNC) experience significant swallowing difficulty during and post-radiotherapy/chemoradiotherapy (RT/CRT). Identifying patients during the pretreatment period who are anticipated to have compromised oral intake would allow for early and accurate patient education, and prioritisation of their management. Ascertaining a clear set of pretreatment predictors from the literature is challenging due to heterogeneity in study designs and patient cohorts, with minimal prospective data available (especially at 1-month post-treatment). The objectives of this study were to investigate which pretreatment factors predicted compromised oral intake and feeding tube use at 1 and 6 months post-RT/CRT. Prospective data were collected on 80 consecutive HNC patients receiving RT/CRT from 2011 to 2014. The primary outcome was to identify predictors of a modified diet at 1 and 6 months post-RT/CRT. Secondary outcomes were to identify predictors of feeding tube use at these time intervals, and <6 vs. >6 week duration of feeding tube use. Multivariate analysis revealed bilateral neck radiotherapy treatment was a strong predictor of modified diets at 1 month (p < 0.001), and T-stages T3/T4 a predictor of modified diets at 6 months (p = 0.03). Patients treated with concurrent CRT (p = 0.02) and bilateral neck treatment (p = 0.02) predicted feeding tube use at 1 month, and concurrent CRT predicted feeding tube use for >6 weeks (p = 0.04). Therefore, patients receiving bilateral neck treatment and/or CRT are at greatest risk of requiring modified diets and feeding tube use early post-treatment, and should be prioritised for intervention and ongoing support.
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Affiliation(s)
- Molly K Barnhart
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia. .,The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia.,Speech Pathology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Rachelle A Robinson
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Virginia A Simms
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Sophie J Chandler
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Elea T Wurth
- Simba Analytics, Melbourne, VIC, 3000, Australia
| | - Robert I Smee
- Comprehensive Cancer Centre, POWH, Randwick, NSW, 2031, Australia.,The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia.,Acting Dir, Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, 2340, Australia
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112
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Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI. Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/− chemotherapy) for head and neck cancer. Eur Arch Otorhinolaryngol 2016; 274:507-516. [DOI: 10.1007/s00405-016-4241-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
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113
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Peng H, Chen L, Zhang Y, Li WF, Mao YP, Zhang F, Guo R, Liu LZ, Lin AH, Sun Y, Ma J. Prognostic Value of the Cumulative Cisplatin Dose During Concurrent Chemoradiotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma: A Secondary Analysis of a Prospective Phase III Clinical Trial. Oncologist 2016; 21:1369-1376. [PMID: 27496040 DOI: 10.1634/theoncologist.2016-0105] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/12/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the prognostic value of the cumulative cisplatin dose (CCD) for long-term survival outcomes after concurrent chemoradiotherapy (CCRT) in locoregionally advanced nasopharyngeal carcinoma (NPC). METHODS Patients were included in an open-label phase III multicenter randomized controlled trial performed at seven institutions in China, and the 298 patients receiving CCRT only were assessed. Patient survival between different CCD groups were compared. RESULTS Median CCD for the 298 patients was 240 mg/m2 (range, 40-320 mg/m2); 113 (37.9%) patients received a CCD of <240 (≤200) mg/m2, and 185 (62.1%) received a CCD of ≥240 mg/m2. For CCD of ≥240 mg/m2 vs. <240 mg/m2, the estimated 5-year overall survival, disease-free survival, locoregional relapse-free survival, and distant metastasis-free survival rates were 83.2% vs. 76.2% (p = .403), 73.5% vs. 67.8% (p = .461), 90.4% vs. 86.8% (p = .551), and 82.6% vs. 79.7% (p = .632), respectively. Multivariate analysis demonstrated that CCD (240 mg/m2) was not an independent prognostic factor in either the entire cohort or stage III/IV subgroup. CONCLUSION A CCD of ≥240 mg/m2 was not an independent prognostic factor in patients with locoregionally advanced NPC at high risk of distant metastasis, and 200 mg/m2 cisplatin may be adequate to achieve a survival benefit. IMPLICATIONS FOR PRACTICE The current standard treatment for locoregionally advanced nasopharyngeal carcinoma (NPC) is cisplatin-based concurrent chemoradiotherapy (CCRT), and the cisplatin is delivered every 3 weeks (100 mg/m2) for three cycles. However, the prognostic value of cumulative cisplatin dose (CCD) delivered during CCRT is controversial. The present study investigated the prognostic value of CCD and demonstrated that a CCD of 200 mg/m2 during CCRT is adequate to achieve satisfactory survival outcomes for patients with locoregionally advanced NPC. This finding is of great importance to clinicians because it could allow patients to avoid excessive treatment and toxicities.
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Affiliation(s)
- Hao Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yuan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Wen-Fei Li
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Fan Zhang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Rui Guo
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Li-Zhi Liu
- Imaging Diagnosis and Interventional Center, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Ai-Hua Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China
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114
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The Cumulative Cisplatin Dose Affects the Long-Term Survival Outcomes of Patients with Nasopharyngeal Carcinoma Receiving Concurrent Chemoradiotherapy. Sci Rep 2016; 6:24332. [PMID: 27071833 PMCID: PMC4829825 DOI: 10.1038/srep24332] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 03/24/2016] [Indexed: 11/16/2022] Open
Abstract
The prognostic value of the cumulative cisplatin dose (CCD) remains controversial for patients with nasopharyngeal carcinoma (NPC) receiving only concurrent chemoradiotherapy (CCRT). We retrospectively reviewed 549 consecutive patients with non-metastatic, histologically-proven NPC treated using intensity-modulated radiotherapy (IMRT) at Sun Yat-sen university cancer center. Patient survival between different CCD groups were compared. The cut-off value of pre-treatment plasma EBV DNA (pre-DNA) and CCD based on disease-free survival (DFS) were 1460 copies/ml (AUC, 0.691; sensitivity, 0.717; specificity, 0.635) and 240 mg/m2 (AUC, 0.506; sensitivity, 0.526; specificity, 0.538), respectively. Of the entire cohort, 92/549 (16.8%) patients received a CCD ≥ 240 mg/m2 and 457 (83.2%) patients, <240 mg/m2. For CCD ≥ 240 mg/m2 vs. < 240 mg/m2, the estimated 4-year DFS, overall survival (OS), locoregional-free survival (LRFFS) and distant metastasis-free survival (DMFS) rates were 89.1% vs. 81.3% (P = 0.097), 92.4% vs. 90.0% (P = 0.369), 95.6% vs. 91.2% (P = 0.156), and 91.3% vs. 88.4% (P = 0.375), respectively. For the whole cohort, multivariate analysis identified the CCD was an independent prognostic factor for DFS (HR, 0.515; 95% CI, 0.267–0.995; P = 0.048). However, CCD (≥240 mg/m2) had no prognostic value in subgroup analysis with stratification by the cut-off value of pre-DNA (P > 0.05 for all rates).
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de Miguel-Luken MJ, Chaves-Conde M, Carnero A. A genetic view of laryngeal cancer heterogeneity. Cell Cycle 2016; 15:1202-12. [PMID: 26940775 DOI: 10.1080/15384101.2016.1156275] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
During the recent decades significant improvements in the understanding of laryngeal molecular biology allowed a better characterization of the tumor. However, despite increased molecular knowledge and clinical efforts, survival of patients with laryngeal cancer remains the same as 30 years ago. Although this result may not make major conclusions as preservation approaches were not broadly used until the time of database collection, it seems to be clear that there is still window for improvement. Although the cornerstone for laryngeal cancer eradication is to implement smoking cessation programs, survival progresses will be hopefully seen in the future. Introducing molecular biomarkers as predictive factors to determine which patients will benefit of preservation treatments may become one of the next steps to improve survival. Furthermore, the development of new therapeutic modalities joint to biomarkers to selectively apply such new therapy in these patients may help to define new modalities with improved survival. New inhibitors against Notch pathway, EGFR, VRK1 or DNA damage repair may become gold standard if we are able to identify patients that may benefit from them, either on survival or functional larynx preservation. It is the moment for an inflexion point on the way laryngeal cancer is clinically managed.
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Affiliation(s)
- María José de Miguel-Luken
- a Instituto de Biomedicina de Sevilla, IBIS/Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas , Seville , Spain.,b Department of Medical Oncology , Virgen del Rocío University Hospital , Seville , Spain
| | - Manuel Chaves-Conde
- a Instituto de Biomedicina de Sevilla, IBIS/Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas , Seville , Spain.,b Department of Medical Oncology , Virgen del Rocío University Hospital , Seville , Spain
| | - Amancio Carnero
- a Instituto de Biomedicina de Sevilla, IBIS/Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas , Seville , Spain
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Hoek J, Bloemendal KM, van der Velden LAA, van Diessen JNA, van Werkhoven E, Klop WMC, Tesselaar MET. Nephrotoxicity as a Dose-Limiting Factor in a High-Dose Cisplatin-Based Chemoradiotherapy Regimen for Head and Neck Carcinomas. Cancers (Basel) 2016; 8:E21. [PMID: 26891330 PMCID: PMC4773744 DOI: 10.3390/cancers8020021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/18/2016] [Accepted: 02/03/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Loco-regional control and organ preservation are significantly improved with concomitant cisplatin/radiotherapy and are compromised with less than 5% grade 3 nephrotoxicity (creatinine clearance 15-29 mL/min). However, although clinically important, in none of the randomized trials is grade 2 nephrotoxicity (defined as creatinine clearance 59-30 mL/min) mentioned. In this study, we assessed nephrotoxicity in daily practice among patients treated with high-dose cisplatin (100 mg/m² on days 1, 22, and 43), concurrently with chemoradiotherapy (CCRT) and the impact on treatment modifications. METHODS 208 patients with advanced-stage malignancies of the head and neck region were evaluated. All patients were treated with high-dose cisplatin CCRT. The main outcome parameters were nephrotoxicity (defined as creatinine clearance grade 2 or more) and cumulative doses of cisplatin and radiation. RESULTS 133 patients (64%) completed all pre-planned courses of cisplatin. Nephrotoxicity was the main reason to discontinue the chemotherapy. Grade 3 nephrotoxicity was seen in 16 patients (8%) while grade 2 nephrotoxicity was seen in 53 patients (25%). Thirty six patients (17%) could not complete the pre-planned chemotherapy due to nephrotoxicity. CONCLUSIONS In head and neck cancer patients, nephrotoxicity grade 2 is under-reported but is the major factor for discontinuing cisplatin during CCRT.
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Affiliation(s)
- Jantien Hoek
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
| | - Karen M Bloemendal
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
| | - Lilly-Ann A van der Velden
- Department of Otolaryngology and Head & Neck Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
| | - Judi N A van Diessen
- Department of Radiotherapy, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
| | - Erik van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
| | - Willem M C Klop
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
| | - Margot E T Tesselaar
- Department of Medical Oncology, Netherlands Cancer Institute, 1066 CX Amsterdam, The Netherlands.
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Swiecicki PL, Malloy KM, Worden FP. Advanced oropharyngeal squamous cell carcinoma: Pathogenesis, treatment, and novel therapeutic approaches. World J Clin Oncol 2016; 7:15-26. [PMID: 26862488 PMCID: PMC4734935 DOI: 10.5306/wjco.v7.i1.15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/07/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
Oropharyngeal cancer accounts for approximately 2.8% of newly cancer cases. Although classically a tobacco related disease, most cases today are related to infection with human papilloma virus (HPV) and present with locally advanced tumors. HPV related tumors have been recognized as a molecularly distinct entity with higher response rates to therapy, lower rates of relapse, and improved overall survival. Treatment of oropharyngeal cancer entails a multi-disciplinary approach with concomitant chemoradiation. The role of induction chemotherapy in locally advanced tumors continues to be controversial however large studies have demonstrated no difference in survival or time to treatment failure. Surgical approaches may be employed with low volume oropharyngeal cancers and with development new endoscopic tools, more tumors are able to be resected via an endoscopic approach. Given advances in the understanding of HPV related oropharyngeal cancer, ongoing research is looking at ways to minimize toxicities via de-intensification of therapy. Unfortunately, some patients develop recurrent or metastatic disease. Novel therapeutics are currently being investigated for this patient population including immunotherapeutics. This review discusses the current understanding of the pathogenesis of oropharyngeal cancer and treatment. We also discuss emerging areas of research as it pertains to de-intensification as well novel therapeutics for the management of metastatic disease.
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