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Lalla RV, Treister N, Sollecito T, Schmidt B, Patton LL, Mohammadi K, Hodges JS, Brennan MT. Oral complications at 6 months after radiation therapy for head and neck cancer. Oral Dis 2017; 23:1134-1143. [PMID: 28675770 DOI: 10.1111/odi.12710] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/25/2017] [Accepted: 06/19/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine oral complications 6 months after modern radiation therapy (RT) for head and neck cancer (HNC). METHODS Prospective multicenter cohort study of patients with HNC receiving intensity-modulated radiation therapy or more advanced RT. Stimulated whole salivary flow, maximal mouth opening, oral mucositis, oral pain, oral health-related quality of life (OH-QOL), and oral hygiene practices were measured in 372 subjects pre-RT and 216 subjects at 6 months from the start of RT. RESULTS Mean stimulated whole salivary flow declined from 1.09 to 0.47 ml/min at 6 months (p < .0001). Mean maximal mouth opening reduced from 45.58 to 42.53 mm at 6 months (p < .0001). 8.1% of subjects had some oral mucositis at 6 months, including 3.8% with oral ulceration. Mean overall pain score was unchanged. OH-QOL was reduced at 6 months, with changes related to dry mouth, sticky saliva, swallowing solid foods, and sense of taste (p ≤ .0001). At 6 months, there was greater frequency of using dental floss and greater proportion using supplemental fluoride (p < .0001). CONCLUSIONS Despite advances in RT techniques, patients with HNC experience oral complications 6 months after RT, with resulting negative impacts on oral function and quality of life.
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Affiliation(s)
- R V Lalla
- Section of Oral Medicine, MC1605, University of Connecticut Health, Farmington, CT, USA
| | - N Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, MA, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - T Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, Philadelphia, PA, USA.,Division of Oral Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - B Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, New York, NY, USA
| | - L L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - K Mohammadi
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - J S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - M T Brennan
- Department of Oral Medicine, Carolinas Medical Center, Charlotte, NC, USA
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Uchibori M, Aoyama KI, Ota Y, Kajiwara K, Tanaka M, Kimura M. A mutation in NOTCH1 ligand binding region detected in patients with oral squamous cell carcinoma reduces NOTCH1 oncogenic effect. Oncol Rep 2017; 38:2237-2242. [DOI: 10.3892/or.2017.5870] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/11/2017] [Indexed: 11/06/2022] Open
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A comparison of concurrent cisplatin versus cetuximab with radiotherapy in locally-advanced head and neck cancer: A bi-institutional analysis. Rep Pract Oncol Radiother 2017; 22:389-395. [PMID: 28808428 DOI: 10.1016/j.rpor.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/06/2017] [Accepted: 07/11/2017] [Indexed: 12/30/2022] Open
Abstract
AIM To present our experience comparing cisplatin- and cetuximab-based radiotherapy for locally-advanced head and neck squamous cell carcinoma. BACKGROUND The comparative effectiveness of cisplatin-based chemoradiotherapy (CRT) versus cetuximab-based bioradiotherapy (BRT) for locally-advanced head and neck squamous cell carcinoma (LAHNSCC) continues to be explored. MATERIALS AND METHODS Outcomes of LAHNSCC patients treated with CRT (125) or BRT (34) at two institutions were compared retrospectively, with attention to overall survival (OS), cancer-specific survival (CSS), locoregional control (LRC), and distant control (DC). Univariate analysis (UVA) using Cox regression was performed to explore the association of intervention with survival and disease control, and multivariate (MVA) Cox regression was then performed to assess the association of intervention with survival. RESULTS There were significant baseline differences between the CRT and BRT groups with respect to age, race, performance status, N-classification, tobacco history, and human papillomavirus status. UVA demonstrated inferiority of BRT versus CRT with respect to both OS (hazard ratio [HR] 2.19, 95% confidence interval [95%CI] 1.03-4.63, p = 0.04) and CSS (HR 3.33, 95%CI 1.42-7.78, p < 0.01), but non-significantly different outcomes in LRC (HR 0.99, 95%CI 0.37-2.61, p = 0.98) and DC (HR 2.01, 95%CI 0.78-5.37, p = 0.14). On MVA, there was no significant OS difference between interventions (HR 1.19, 95%CI 0.42-3.35, p = 0.74); there were too few events for the other outcomes to draw meaningful conclusions with MVA. CONCLUSIONS In our retrospective analysis, patients undergoing CRT experienced improved OS and CSS over those receiving BRT; however, disease control did not significantly differ. These findings may inform management of LAHNSCC patients.
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Zhai TT, van Dijk LV, Huang BT, Lin ZX, Ribeiro CO, Brouwer CL, Oosting SF, Halmos GB, Witjes MJH, Langendijk JA, Steenbakkers RJHM, Sijtsema NM. Improving the prediction of overall survival for head and neck cancer patients using image biomarkers in combination with clinical parameters. Radiother Oncol 2017; 124:256-262. [PMID: 28764926 DOI: 10.1016/j.radonc.2017.07.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/25/2017] [Accepted: 07/13/2017] [Indexed: 02/05/2023]
Abstract
PURPOSE To develop and validate prediction models of overall survival (OS) for head and neck cancer (HNC) patients based on image biomarkers (IBMs) of the primary tumor and positive lymph nodes (Ln) in combination with clinical parameters. MATERIAL AND METHODS The study cohort was composed of 289 nasopharyngeal cancer (NPC) patients from China and 298 HNC patients from the Netherlands. Multivariable Cox-regression analysis was performed to select clinical parameters from the NPC and HNC datasets, and IBMs from the NPC dataset. Final prediction models were based on both IBMs and clinical parameters. RESULTS Multivariable Cox-regression analysis identified three independent IBMs (tumor Volume-density, Run Length Non-uniformity and Ln Major-axis-length). This IBM model showed a concordance(c)-index of 0.72 (95%CI: 0.65-0.79) for the NPC dataset, which performed reasonably with a c-index of 0.67 (95%CI: 0.62-0.72) in the external validation HNC dataset. When IBMs were added in clinical models, the c-index of the NPC and HNC datasets improved to 0.75 (95%CI: 0.68-0.82; p=0.019) and 0.75 (95%CI: 0.70-0.81; p<0.001), respectively. CONCLUSION The addition of IBMs from the primary tumor and Ln improved the prognostic performance of the models containing clinical factors only. These combined models may improve pre-treatment individualized prediction of OS for HNC patients.
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Affiliation(s)
- Tian-Tian Zhai
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands; Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, China.
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Bao-Tian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, China
| | - Zhi-Xiong Lin
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, China.
| | - Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Charlotte L Brouwer
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otolaryngology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Max J H Witjes
- Department of Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
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Lv JW, Zhou GQ, Chen YP, Tang LL, Mao YP, Chen L, Li WF, Lin AH, Ma J, Sun Y. Refining the Role of Lymph Node Biopsy in Survival for Patients with Nasopharyngeal Carcinoma: Population-Based Study from the Surveillance Epidemiology and End-Results Registry. Ann Surg Oncol 2017; 24:2580-2587. [DOI: 10.1245/s10434-017-5966-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Indexed: 01/18/2023]
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Abstract
Oral leukoplakia is defined as a white oral lesion not related to another disease process. These lesions are largely asymptomatic, and the clinical relevance of oral leukoplakia is primarily tied to its association with oral cavity squamous cell carcinoma. Timely workup and effective management of these lesions can reduce the risk of malignant transformation and promote early diagnosis of invasive tumors. A biopsy should be performed promptly of any persistent or suspicious leukoplakia with subsequent management dictated by histologic findings. Benign lesions can be observed or treated with topical therapy, and dysplastic lesions should be excised. Some risk of malignant transformation remains even after treatment, and close follow-up is required. Oral cavity squamous cell carcinoma is an aggressive malignancy that can result from malignant conversion of oral leukoplakia or occur de novo. These tumors are primarily treated with surgical resection and adjuvant radiation or chemoradiation as dictated by histopathologic findings.
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Affiliation(s)
- Arnaud F Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, CA.
| | - D Gregory Farwell
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis School of Medicine, Sacramento, CA
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David JM, Ho AS, Luu M, Yoshida EJ, Kim S, Mita AC, Scher KS, Shiao SL, Tighiouart M, Zumsteg ZS. Treatment at high-volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer. Cancer 2017. [DOI: 10.1002/cncr.30843] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- John M. David
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Department of Surgery; Cedars-Sinai Medical Center; Los Angeles California
| | - Michael Luu
- Biostatistics and Bioinformatics Research Center; Cedars-Sinai Medical Center; Los Angeles California
| | - Emi J. Yoshida
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Sungjin Kim
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Biostatistics and Bioinformatics Research Center; Cedars-Sinai Medical Center; Los Angeles California
| | - Alain C. Mita
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Kevin S. Scher
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Stephen L. Shiao
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Biostatistics and Bioinformatics Research Center; Cedars-Sinai Medical Center; Los Angeles California
| | - Zachary S. Zumsteg
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
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Chang H, Kim JS, Choi YJ, Cho JG, Woo JS, Kim A, Kim JS, Kang EJ. Overexpression of PD-L2 is associated with shorter relapse-free survival in patients with malignant salivary gland tumors. Onco Targets Ther 2017; 10:2983-2992. [PMID: 28652780 PMCID: PMC5476710 DOI: 10.2147/ott.s134589] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives PD-1/PD-L1 and CTLA-4 have been investigated and are thought to play an important role in tumor evasion. This study aimed to investigate expression patterns of immune-related molecules, and their clinical impacts in malignant salivary gland tumors. Patients and methods We performed immunohistochemical staining for PD-L1, PD-L2, CTLA-4, PD-1, and CD8+ tumor-infiltrating lymphocytes in 70 malignant salivary gland tumors. Protein expression was assessed by H-score by multiplying the staining intensity by the percentage of cells with positive staining. Results The tumors comprised mucoepidermoid carcinomas (38.6%), adenoid cystic carcinomas (21.4%), salivary duct carcinomas (15.7%), and others. In malignant salivary gland tumors, PD-L2 expression was high, while expression of PD-L1 was relatively low in terms of the percentage of positively stained cells and the staining intensity. In univariate analysis, PD-L2 expression (H-score <1 vs ≥1), PD-1 (H-score <1 vs ≥1), and CD8+ tumor-infiltrating lymphocytes (H-score <1 vs ≥1) were significant prognostic factors. In multivariate analysis, low PD-L2 expression (H-score <1) was independently associated with shorter relapse-free survival (hazard ratio =6.514; 95% confidence interval, 1.2–36.2; P=0.032). Conclusion In summary, PD-L2 is potentially an important biomarker in malignant salivary gland tumors, especially in regard to relapse.
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Affiliation(s)
- Hyeyoon Chang
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jung Sun Kim
- Division of Oncology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon Ji Choi
- Division of Oncology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jeong-Soo Woo
- Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Aeree Kim
- Department of Pathology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jun Suk Kim
- Division of Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eun Joo Kang
- Division of Oncology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
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Broglie MA, Jochum W, Michel A, Waterboer T, Foerbs D, Schoenegg R, Stoeckli SJ, Pawlita M, Holzinger D. Evaluation of type-specific antibodies to high risk-human papillomavirus (HPV) proteins in patients with oropharyngeal cancer. Oral Oncol 2017. [PMID: 28622890 DOI: 10.1016/j.oraloncology.2017.05.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES High risk human papillomavirus (HR-HPV) infection leads to a subgroup of oropharyngeal cancer (OPSCC) characterized by improved treatment response. However an universally accepted definition of an HR-HPV-attributable cancer is lacking. METHODS Detailed, type-specific HPV antibody responses were analyzed by multiplex serology in HR-HPV-attributable OPSCC patients, defined by p16INK4A overexpression and HR-HPV DNA detection by PCR amplification and sequencing. RESULTS Fifty patients were prospectively enrolled. 26/50 (52%) tumor samples were positive for both p16INK4A expression and HR-HPV DNA (22 HPV16, 4 HPV33). Seropositivity was present in 26/26 HPV-attributable OPSCC and one p16INK4A-positive/HPV DNA-negative case. The sensitivity and specificity to diagnose an HR-HPV-attributable tumor was 100% and 96%, respectively for anti-E6 reactivity, 82% and 100%, respectively for anti-E2 reactivity, and clearly lower for anti-E7, anti-E1, anti-E4 and anti-L1-reactivity. 3yr-overall (OS) and disease specific survival (DSS) was higher in patients with HR-HPV-attributable tumors (OS 88% vs 64%, p=0.02; DSS 90% vs 80%, p=0.07) and seropositive patients (OS 88% vs 62%, p=0.01; DSS 92% vs 78%, p=0.05) than HR-HPV-negative or seronegative patients. CONCLUSIONS Detection of HR-HPV type-specific antibodies highly correlated with HPV-attributable OPSCC and was associated with better survival. HR-HPV antibodies are promising diagnostic, prognostic and potentially screening markers in HR-HPV-attributable OPSCC.
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Affiliation(s)
- Martina A Broglie
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland.
| | - Wolfram Jochum
- Institute of Pathology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Angelika Michel
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infections, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Tim Waterboer
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infections, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Diana Foerbs
- Institute of Pathology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - René Schoenegg
- Institute of Pathology, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Sandro J Stoeckli
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital St. Gallen, 9007 St. Gallen, Switzerland
| | - Michael Pawlita
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infections, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Dana Holzinger
- Division of Molecular Diagnostics of Oncogenic Infections, Research Program Infections, Inflammation and Cancer, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
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Sukegawa S, Kanno T, Shibata A, Matsumoto K, Sukegawa-Takahashi Y, Sakaida K, Furuki Y. Use of the bioactive resorbable plate system for zygoma and zygomatic arch replacement and fixation with modified Crockett's method for maxillectomy: A technical note. Mol Clin Oncol 2017; 7:47-50. [PMID: 28685074 DOI: 10.3892/mco.2017.1269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/24/2017] [Indexed: 11/06/2022] Open
Abstract
As a surgical approach targeting the pterygopalatine fossa following maxillary cancer due to tumor invasion, Crockett's method is conventional and useful. However, if the tumor is confined to the area between the maxilla and pterygopalatine fossa, it is not necessary to include the zygomatico-orbital in the access osteotomy, and the orbital floor may be preserved. Depending on the range of tumor invasion, the current study reports a more minimally invasive, modified Crockett's surgery that may be considered, which includes resection with modified osteotomy lines and repositioning with fixation of the zygoma and zygomatic arch following maxillary cancer ablation. In addition, the majority of patients with advanced maxillary cancer may require postoperative radiotherapy or chemoradiotherapy following maxillectomy according to several guidelines. Therefore, using a low-profile bioactive resorbable plate system as a method of repositioning and fixing the resected and preserved zygoma and zygomatic arch may be more effective in this modified Crockett's method for maxillectomy.
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Affiliation(s)
- Shintaro Sukegawa
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Takahiro Kanno
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan.,Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, Shimane 693-8501, Japan
| | - Akane Shibata
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Kenichi Matsumoto
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Yuka Sukegawa-Takahashi
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Kyousuke Sakaida
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
| | - Yoshihiko Furuki
- Division of Oral and Maxillofacial Surgery, Kagawa Prefectural Central Hospital, Takamatsu, Kagawa 760-8557, Japan
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Lu J, Ma H, Lian S, Huang D, Lian M, Zhang Y, Huang J, Feng X. Clinical Significance and Prognostic Value of the Expression of LAMP3 in Oral Squamous Cell Carcinoma. DISEASE MARKERS 2017; 2017:1218254. [PMID: 28607528 PMCID: PMC5451762 DOI: 10.1155/2017/1218254] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/05/2017] [Accepted: 04/30/2017] [Indexed: 01/27/2023]
Abstract
Recent studies demonstrated high expression of lysosome-associated membrane protein 3 (LAMP3) in a variety of malignancies including esophageal squamous cell carcinoma, gastrointestinal cancer, breast cancer, and cervical cancer and its involvement in several biological activities of tumor cells. However, the expression of LAMP3 and its value in oral squamous cell carcinoma (OSCC) remain unclear. In this study, we examined the expression of LAMP3 in OSCC tissue samples and investigated the relationship between LAMP3 and clinical characteristics of patients with OSCC. We examined mRNA and protein levels of LAMP3 in OSCC tissues and neighboring normal tissues using quantitative real-time polymerase chain reaction and immunohistochemistry analyses, respectively. Both the mRNA and protein levels of LAMP3 were significantly higher in OSCC tissues than in adjacent normal tissues. Chi-square analysis showed that the high LAMP3 expression was notably linked to the degree of tumor differentiation and advanced TNM stage. Univariate and multivariate analyses showed that the high LAMP3 expression was an independent prognostic marker in OSCC. Our results suggest that LAMP3 might act as a potential anticancer target and a prognostic marker in patients with OSCC.
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Affiliation(s)
- Jun Lu
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Hengcheng Ma
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Shuijin Lian
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Dan Huang
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Min Lian
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Ye Zhang
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jianfei Huang
- Department of Pathology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Xingmei Feng
- Department of Stomatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Martell K, Mackenzie J, Kerney W, Lau HY. Management delays in patients with squamous cell cancer of neck node(s) and unknown primary site: a retrospective cohort study. J Otolaryngol Head Neck Surg 2017; 46:39. [PMID: 28482917 PMCID: PMC5422917 DOI: 10.1186/s40463-017-0217-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We aim to characterize the workup received by and identify any delays to diagnosis or treatment in patients referred to a tertiary cancer centre with the diagnosis of squamous cell carcinoma in neck node(s) and no identifiable primary (SCCNIP). METHODS Over 1 year, 68 patients were initially referred to the Head and Neck clinic with a label of "primary unknown". After extensive workup, 29 of the 68 patients were found to have pathologically confirmed SCCNIP. For these 29 patients, imaging tests, biopsies, examinations and times to treatment were reviewed and compared to 145 patients referred for known primaries. RESULTS In 21/29 (72%) patients, ultrasound was ordered prior to biopsy or referral. After referral, the first imaging test used was CT neck in 28 patients and PET/CT in 1 patient. Median time from referral to primary identification (n = 23) or workup completion (n = 6) were 16 (range: 0-48) and 36 (17-82) days respectively. Median time from referral to treatment was 55 (27-90; n = 26) days and was longer than those referred for known primaries (48 days; 20-162; p < 0.001). Across all patients, median time between first diagnostic imaging test and pathologic diagnosis were 20.5 and -8.0 days (p < 0.0001) in patients receiving ultrasound and CT, respectively. CONCLUSIONS In our cohort, delays to management were linked to community use of ultrasound and scheduling of both CT and PET/CT after thorough head and neck examination in patients with SCCNIP.
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Affiliation(s)
- Kevin Martell
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
- Department of Oncology, University of Calgary, 1331 29 Street Northwest, Calgary, AB, T2N 4 N2, Canada.
| | - Joanna Mackenzie
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, UK
| | - Warren Kerney
- Calgary Zone, Alberta Health Services, Calgary, AB, Canada
| | - Harold Yeehau Lau
- Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
- Department of Oncology, University of Calgary, 1331 29 Street Northwest, Calgary, AB, T2N 4 N2, Canada
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Spiotto MT, Koshy M. Impact of fraction size on locally advanced oropharyngeal and nasopharyngeal cancers treated with chemoradiation. Oral Oncol 2017; 68:27-35. [DOI: 10.1016/j.oraloncology.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 02/28/2017] [Accepted: 03/04/2017] [Indexed: 11/16/2022]
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Busch CJ, Girke J, Tribius S, Bussmann L, Knecht R, Schafhausen P, Lörincz BB, Münscher A. Induction chemotherapy followed by radiochemotherapy for locally advanced head and neck cancer as an individual treatment approach-Feasibility, safety and retrospective survival analysis in twenty-three patients. Clin Otolaryngol 2017; 42:1392-1396. [PMID: 28429525 DOI: 10.1111/coa.12890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 11/27/2022]
Affiliation(s)
- C-J Busch
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Girke
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Tribius
- Hermann-Holthusen Institute for Radiotherapy, Asklepios St. Georg Hospital, Hamburg, Germany
| | - L Bussmann
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - R Knecht
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Schafhausen
- Department of Medical Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - B B Lörincz
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Otorhinolaryngology and Head & Neck Surgery, Asklepios Altona Hospital, Hamburg, Germany
| | - A Münscher
- Department of Otorhinolaryngology, Head and Neck Surgery and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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115
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Leone A, Diorio GJ, Pettaway C, Master V, Spiess PE. Contemporary management of patients with penile cancer and lymph node metastasis. Nat Rev Urol 2017; 14:335-347. [PMID: 28401957 DOI: 10.1038/nrurol.2017.47] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Penile cancer is a rare disease that causes considerable physical and psychological patient morbidity, especially at advanced stages. Patients with low-stage nodal metastasis can achieve durable survival with surgery alone, but those with extensive locoregional metastasis have overall low survival. Contemporary management strategies for lymph node involvement in penile cancer aim to minimize the morbidity associated with traditional radical inguinal lymphadenectomy through appropriate risk stratification while optimizing oncological outcomes. Modified (or superficial) inguinal lymph node dissection and dynamic sentinel lymph node biopsy are diagnostic modalities that have been recommended in patients with high-risk primary penile tumours and nonpalpable inguinal lymph nodes. In addition, advances in minimally invasive and robot-assisted lymphadenectomy techniques are being investigated in patients with penile cancer and might further decrease lymphadenectomy-related adverse effects. The management of patients with advanced disease has evolved to include multimodal treatment with systemic chemotherapy before surgical intervention and can include adjuvant chemotherapy after pelvic lymphadenectomy. The role of radiotherapy in the neoadjuvant or adjuvant setting remains largely unclear, owing to a lack of high-level evidence of possible benefits. New targeted therapies have shown efficacy in squamous cell carcinomas of other sites and might also prove effective in patients with penile cancer.
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Affiliation(s)
- Andrew Leone
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
| | - Gregory J Diorio
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
| | - Curtis Pettaway
- The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit Number: 1373, Houston, Texas 77030, USA
| | - Viraj Master
- Emory University School of Medicine, 1365 Clifton Road NE, Building B, Room 1485, Atlanta, Georgia 30030, USA
| | - Philippe E Spiess
- H. Lee Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, Florida 33602, USA
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116
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Stokes WA, Abbott D, Phan A, Raben D, Lanning RM, Karam SD. Patterns of Care for Patients With Early-Stage Glottic Cancer Undergoing Definitive Radiation Therapy: A National Cancer Database Analysis. Int J Radiat Oncol Biol Phys 2017; 98:1014-1021. [PMID: 28721883 DOI: 10.1016/j.ijrobp.2017.03.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/16/2016] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE To characterize practice patterns, including temporal trends, in fractionation schedules among patients in the United States undergoing definitive radiation therapy for early-stage glottic cancer and to compare overall survival outcomes between fractionation schedules. METHODS AND MATERIALS We queried the National Cancer Database for patients with TisN0M0, T1N0M0, or T2N0M0 squamous cell carcinoma of the glottic larynx diagnosed between 2004 and 2012 and undergoing definitive radiation therapy. Dose per fraction was calculated to define cohorts undergoing conventional fractionation (CFxn) and hypofractionation (HFxn). Logistic regression was performed to identify predictors of receiving HFxn, and Cox regression was used to determine predictors of death. One-to-one propensity score matching was then used to compare survival between fractionation schedules. RESULTS The study included 10,539 patients, with 6576 undergoing CFxn and 3963 undergoing HFxn. Patients with T1 disease comprised a majority of each cohort. Use of HFxn increased significantly over the period studied (P<.001), but even in the final year, nearly one-half of patients continued to receive CFxn. Receipt of HFxn was also independently associated with higher income and facility types other than community cancer programs on logistic regression. On multivariate Cox regression, HFxn was associated with improved survival (hazard ratio [HR] for death, 0.90; 95% confidence interval [CI], 0.83-0.97; P=.008), a finding redemonstrated on univariate Cox regression among a well-matched cohort after propensity score matching (HR, 0.88; 95% CI, 0.80-0.96; P=.003). Subgroup Cox multivariate analysis demonstrated a significant survival advantage with HFxn among patients with T1 disease (HR, 0.90; 95% CI, 0.81-0.99; P=.042) but a nonsignificant benefit among those with Tis (HR, 0.86; 95% CI, 0.57-1.30; P=.472) or T2 (HR, 0.88; 95% CI, 0.76-1.02; P=.099) disease. CONCLUSIONS Use of HFxn is increasing and is associated with improved survival over CFxn. Our findings support the broadened use of HFxn for patients with early-stage glottic cancer undergoing definitive radiation therapy.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Diana Abbott
- Colorado Biostatistics Consortium, Colorado School of Public Health, Aurora, Colorado
| | - Andy Phan
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ryan M Lanning
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
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117
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Harris BN, Bayoumi A, Rao S, Moore MG, Farwell DG, Bewley AF. Factors Associated with Recurrence and Regional Adenopathy for Head and Neck Cutaneous Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 156:863-869. [DOI: 10.1177/0194599817697053] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignancies worldwide. With advanced CSCC of the head and neck, there is conflicting evidence on what constitutes high-risk disease. Our objective is to evaluate which factors are predictive of recurrence and nodal spread and survival. Study Design Case series with chart review. Setting Tertiary academic institution. Subjects and Methods Patients with advanced head and neck CSCC treated with primary resection identified by chart review. Results A total of 212 patients met inclusion criteria, with a mean age of 70.4 years; 87.3% were men. Mean tumor diameter was 3.65 cm, with an average depth of invasion of 1.38 cm. The mean follow-up time was 35 months (median, 21.5), and over that period 67 recurrences were recorded, 49 of which were local. The 5-year Kaplan-Meier estimate of disease-free survival for the cohort was 53.2%. On Cox multivariate analysis, recurrent disease, perineural invasion (PNI), and poorly differentiated histology were independent predictors of recurrence. On multinomial logistic regression, patients with primary tumors on the ear, cheek, temple, or lip, as well as those with PNI, were more likely to present with nodal metastasis. Conclusion For advanced CSCCs of the head and neck, patients with recurrent disease, PNI, and poorly differentiated tumors are at highest risk for local recurrence. Patients with tumors or the ear, cheek, temple, or lip, as well as those with PNI, are at increased risk of harboring nodal disease.
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Affiliation(s)
- Brianna N. Harris
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Ahmed Bayoumi
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Shyam Rao
- Department of Radiation Oncology, University of California–Davis, Sacramento, California, USA
| | - Michael G. Moore
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - D. Gregory Farwell
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology, University of California–Davis, Sacramento, California, USA
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Leal SM, Gulley ML. Current and Emerging Molecular Tests for Human Papillomavirus-Related Neoplasia in the Genomic Era. J Mol Diagn 2017; 19:366-377. [PMID: 28325688 DOI: 10.1016/j.jmoldx.2017.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 01/30/2017] [Indexed: 12/14/2022] Open
Abstract
Laboratory tests have a key role in preventing human papillomavirus (HPV)-driven carcinomas and in guiding therapeutic interventions. An understanding of the virology, immunology, and carcinogenesis of HPV is essential for choosing appropriate diagnostic test modalities and developing new and even more effective cancer prevention strategies. HPV infects basal epithelial cells on multiple surfaces and induces carcinoma primarily in the cervix and the oropharynx. HPV types are stratified as high risk or low risk based on their carcinogenic potential. During oncogenesis, HPV interferes with cell cycle regulation and incites DNA damage responses that thwart apoptosis and enable mutations to accumulate. Such mutations are an adverse effect of innate and adaptive antiviral immune responses that up-regulate DNA-editing enzymes, with natural selection of cells having a chromosomally integrated viral genome lacking expression of viral proteins targeted by the immune system. Infected cancers share a similar mutation signature, reflecting the effect of apolipoprotein B mRNA-editing catalytic polypeptide enzyme DNA-editing enzymes. It is feasible that genomic tests for characteristic mutations or methylation signatures, along with tests for dysregulated HPV gene expression, add value in predicting behavior of premalignant lesions. Furthermore, these tumor markers in cell-free DNA of plasma or body fluids may one day assist in early detection or monitoring cancer burden during treatment.
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Affiliation(s)
- Sixto M Leal
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Margaret L Gulley
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
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Stokes WA, Amini A, Jones BL, McDermott JD, Raben D, Ghosh D, Goddard JA, Bowles DW, Karam SD. Survival impact of induction chemotherapy in advanced head and neck cancer: A National Cancer Database analysis. Head Neck 2017; 39:1113-1121. [PMID: 28301079 DOI: 10.1002/hed.24739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/20/2016] [Accepted: 12/29/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adding induction chemotherapy to concurrent chemotherapy and radiotherapy (RT) has generally not improved the overall survival (OS) in randomized trials of patients with head and neck cancer. This failure may stem from inadequate power or inappropriate patient selection, prompting this National Cancer Data Base analysis. METHODS 8031 patients with T4 or N2b to N3 disease undergoing RT and chemotherapy were divided into induction chemotherapy and concurrent chemotherapy cohorts. Multivariate analysis was used to explore the association of treatment with survival and to identify predictors of radiation dose. RESULTS On multivariate analysis incorporating sociodemographic and clinical variables, survival of the induction chemotherapy cohort was not significantly different from that of the concurrent cohort (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.88-1.05; p = .35), nor on subgroup analyses of advanced disease. Multivariate analysis demonstrated increased odds of receiving <66 Gy among the patients in the induction chemotherapy cohort (p < .01). CONCLUSION Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1113-1121, 2017.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Julie A Goddard
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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Hajek M, Sewell A, Kaech S, Burtness B, Yarbrough WG, Issaeva N. TRAF3/CYLD mutations identify a distinct subset of human papillomavirus-associated head and neck squamous cell carcinoma. Cancer 2017; 123:1778-1790. [PMID: 28295222 PMCID: PMC5419871 DOI: 10.1002/cncr.30570] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 12/18/2016] [Accepted: 12/21/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The incidence of human papillomavirus (HPV)‐associated (HPV‐positive) head and neck squamous cell carcinoma (HNSCC) of the oropharynx has dramatically increased over the last decade and continues to rise. Newly diagnosed HPV‐positive HNSCCs in the United States currently outnumber any other HPV‐associated cancers, including cervical cancer. Despite introduction of the HPV vaccine, the epidemic of HPV‐positive HNSCC is expected to continue for approximately 60 years. Compared with patients who have tobacco‐associated HNSCC, those who have HPV‐positive HNSCC have better overall survival and response to treatment. Current treatment, including chemotherapy and radiation therapy, is associated with lifelong morbidity, and there are limited treatments and no curative options for patients who develop recurrent metastatic disease. Therapeutic de‐escalation (decreased radiation dose) is being tested through clinical trials; however, those studies select patients based solely on tumor and patient smoking characteristics. Mechanisms of HPV‐driven carcinogenesis in HNSCC are not well understood, which limits new therapeutic strategies and hinders the appropriate selection of patients for de‐escalation therapy. METHODS The authors analyzed HNSCC data from The Cancer Genome Atlas to identify molecular characteristics that correlate with outcomes and integration status of the HPV genome. RESULTS The current investigations identified a subset of HPV‐positive HNSCCs with mutations in the genes TRAF3 (tumor necrosis factor receptor‐associated factor 3) and CYLD (cylindromatosis lysine 63 deubiquitinase). Defects in TRAF3 and CYLD correlated with the activation of transcriptional factor nuclear factor κB, episomal HPV status of tumors, and improved patient survival. CONCLUSIONS Defects in TRAF3/CYLD were accompanied with the activation of nuclear factor κB signaling and maintenance of episomal HPV in tumors, suggesting that these mutations may support an alternative mechanism of HPV tumorigenesis in head and neck tumors. Cancer 2017;123:1778–1790. © 2017 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. This is an open access article under the terms of the Creative Commons Attribution NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. Human papillomavirus‐associated head and neck cancer tends to respond better to treatment compared with tobacco‐associated tumors; however, patients suffer severe and long‐lasting side effects. Somatic mutations in the genes TRAF3 and CYLD identified in The Cancer Genome Atlas data set are correlated with the activation of nuclear factor‐κB, define a distinct etiologic subset of head and neck cancers, and will be useful as biomarkers for predicting improved prognosis and selecting patients with human papillomavirus‐positive head and neck cancer who may be successfully treated with de‐escalating therapy. See also pages 1695‐98.
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Affiliation(s)
- Michael Hajek
- Division of Otolaryngology, Department of Surgery, Yale University, New Haven, Connecticut
| | - Andrew Sewell
- Division of Otolaryngology, Department of Surgery, Yale University, New Haven, Connecticut
| | - Susan Kaech
- Department of Immunobiology, Yale University, New Haven, Connecticut
| | - Barbara Burtness
- Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
| | - Wendell G Yarbrough
- Division of Otolaryngology, Department of Surgery, Yale University, New Haven, Connecticut.,Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut.,Department of Pathology, Yale School of Medicine, New Haven, Connecticut
| | - Natalia Issaeva
- Division of Otolaryngology, Department of Surgery, Yale University, New Haven, Connecticut.,Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut
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Guo T, Goldenberg D, Fakhry C. AHNS series: Do you know your guidelines? Management of head and neck cancer in the era of human papillomavirus: Educating our patients on human papillomavirus. Head Neck 2017; 39:833-839. [PMID: 28263449 DOI: 10.1002/hed.24693] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 11/30/2016] [Indexed: 12/16/2022] Open
Abstract
Human papillomavirus (HPV) has changed the face of head and neck cancer over the past 2 decades. No longer is this solely a disease of older patients with a history of heavy tobacco and alcohol use. Patients with HPV-related head and neck cancers tend to be younger, healthier, and have an improved prognosis, compared with those with HPV-negative tumors. As more patients are diagnosed with HPV-related head and neck cancer, physicians have important topics to consider. These include prevalence, transmission, and natural history of HPV, the role of screening, vaccines, and HPV testing in head and neck cancer. This article continues a series developed by the American Head and Neck Society's Education Committee entitled "Do you know your guidelines?" and is intended to provide guidance for navigating common questions and concerns patients may have about HPV infection and HPV-related head and neck cancer. © 2017 Wiley Periodicals, Inc. Head Neck 39: 833-839, 2017.
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Affiliation(s)
- Theresa Guo
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology - Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Carole Fakhry
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Lalla RV, Long-Simpson L, Hodges JS, Treister N, Sollecito T, Schmidt B, Patton LL, Brennan MT. Clinical registry of dental outcomes in head and neck cancer patients (OraRad): rationale, methods, and recruitment considerations. BMC Oral Health 2017; 17:59. [PMID: 28241807 PMCID: PMC5327511 DOI: 10.1186/s12903-017-0344-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/08/2017] [Indexed: 01/25/2023] Open
Abstract
Background Most head and neck (H&N) cancer patients receive high-dose external beam radiation therapy (RT), often in combination with surgery and/or chemotherapy. Unfortunately, high-dose RT has significant adverse effects on the oral and maxillofacial tissues, some of which persist for the life of the patient. However, dental management of these patients is based largely on individual and expert opinion, as few studies have followed patients prospectively to determine factors that predict adverse oral sequelae. In addition, many previous studies were conducted before wide-spread adoption of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy. The objective of this multi-center study is to systematically evaluate the oral health of subjects for 2 years after commencement of RT, with the goal of identifying risk factors that predict adverse oral outcomes post-RT. Methods This is a prospective multi-center longitudinal cohort study of H&N cancer patients who receive high-dose RT with curative intent. Planned enrollment is 756 subjects at 6 primary clinical sites (and their affiliated sites) in the USA. A baseline visit is conducted prior to the beginning of RT. Follow-up visits are conducted at 6, 12, 18 and 24 months from the start of RT. The primary outcome measure is the 2-year rate of tooth loss in patients who have received at least one session of external beam RT for H&N cancer. Secondary outcome measures include the incidence of exposed intraoral bone; incidence of post-extraction complications; change in Decayed Missing and Filled Surfaces (DMFS); change in periodontal measures; change in stimulated whole salivary flow rates; change in mouth opening; topical fluoride utilization; chronic oral mucositis incidence; changes in RT-specific quality of life measures; and change in oral pain scores. Discussion This study will contribute to a better understanding of the dental complications experienced by these patients. It will also enable identification of risk factors associated with adverse outcomes such as tooth loss and osteoradionecrosis. These findings will support the development of evidence-based guidelines and inform the planning of future interventional studies, with the goal of advancing improvements in patient care and outcomes. Trial registration ClinicalTrials.gov Identifier NCT02057510, registered 5 February 2014.
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Affiliation(s)
- Rajesh V Lalla
- Section of Oral Medicine, MC1605, University of Connecticut Health, 263, Farmington Avenue, Farmington, CT, 06030-1605, USA.
| | - Leslie Long-Simpson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE Suite 200, Minneapolis, MN, 55414, USA
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, 1620 Tremont Street, 3rd Floor, Boston, MA, 02120, USA.,Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Thomas Sollecito
- Department of Oral Medicine, University of Pennsylvania School of Dental Medicine, 240 South 40th Street, Philadelphia, PA, 19104, USA
| | - Brian Schmidt
- Department of Oral & Maxillofacial Surgery and Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, New York, NY, 10010, USA
| | - Lauren L Patton
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, CB 7450, USA
| | - Michael T Brennan
- Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
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Lee YG, Oh S, Kimm H, Koo DH, Kim DY, Kim BS, Lee SS. Practice Patterns Regarding Multidisciplinary Cancer Management and Suggestions for Further Refinement: Results from a National Survey in Korea. Cancer Res Treat 2017; 49:1164-1169. [PMID: 28231425 PMCID: PMC5654152 DOI: 10.4143/crt.2016.517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 02/05/2017] [Indexed: 01/10/2023] Open
Abstract
Purpose This study was conducted to explore the process and operation of a cancer multidisciplinary team (MDT) after the reimbursement decision in Korea, and to identify ways to overcome the major barriers to effective and sustainable MDTs. Materials and Methods Approximately 1,000 cancer specialists, including medical oncologists, surgical oncologists, radiation oncologists, pathologists, and radiologists in general hospitals in Koreawere invited to complete the survey. The questionnaire covered the following topics: organizational structure of MDTs, candidates for consulting, the clinical decision-making initiative, and responsibility for dealing with legal disputes. Results We collected a total of 179 responses (18%) from physicians at institutions where an MDT approach was active. A surgical oncologist (91%), internist (90%),radiologist (89%),radiation oncologist (86%), pathologist (71%), and trainees (20%) regularly participated in MDT operations. Approximately 55% of respondents stated that MDTs met regularly. In cases of a split opinion, the physician in charge (69%) or chairperson (17%) made the final decision, and most (86%) stated they followed the final decision. About 15% and 32% of respondents were “very satisfied” and “satisfied,” respectively, with the current MDT’s operations. Among 38 institutional representatives, 34% responded that the MDT operation became more active and 18% stated an MDT was newly implemented after the reimbursement decision. Conclusion The reimbursement decision invigorated MDT operations in almost half of eligible hospitals. Dissatisfaction regarding current MDTs was over 50%, and the high discordance rates regarding risk sharing suggest that it is necessary to revise the current system of MDTs.
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Affiliation(s)
- Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sukjoong Oh
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heejin Kimm
- Institute for Health Promotion and Department of Epidemiology and Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Dong-Hoe Koo
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Yeun Kim
- Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Bong-Seog Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung-Sei Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Ooi ASH, Teven CM, Inbal A, Chang DW. The utility of the musculocutaneous anterolateral thigh flap in pharyngolaryngeal reconstruction in the high-risk patient. J Surg Oncol 2017; 115:842-847. [PMID: 28194796 DOI: 10.1002/jso.24577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/02/2017] [Accepted: 01/15/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Prior radiotherapy leads to increased wound complication rates for microsurgical reconstruction of pharyngolaryngeal (PL) defects. Incorporating vastus lateralis muscle together with anterolateral thigh flap (ALT) skin in defect reconstruction is useful in protecting vital structures and reinforcing irradiated neck skin and suture lines. This study shows the utility of the musculocutaneous ALT (MC ALT) in PL reconstruction in previously irradiated patients. METHODS A single-surgeon, retrospective chart review of all patients with defects of the PL region where an MC ALT was used for reconstruction from February 2014 to May 2016. The harvest of the MC ALT is described. RESULTS Thirteen consecutive patients underwent reconstruction with a MC ALT flap. All 13 patients had received previous radiotherapy. PL defects included five partial, five subtotal, and three total. There was a 100% flap survival rate with five early recipient site complications including three fistulas, one neck abscess, and one partial muscle necrosis. Three patients (23%) developed strictures requiring dilatation, two of whom had received post-reconstruction radiotherapy. CONCLUSIONS The use of the MC ALT for reconstruction of PL defects should be considered to mitigate the negative effects of prior irradiation and provide a back-up plan in instances where complications occur.
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Affiliation(s)
- Adrian S H Ooi
- Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Chicago, Illinois.,Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore
| | - Chad M Teven
- Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - Amir Inbal
- Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Chicago, Illinois
| | - David W Chang
- Section of Plastic and Reconstructive Surgery, University of Chicago Medical Center, Chicago, Illinois
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Ouyang DQ, Liang LZ, Zheng GS, Ke ZF, Weng DS, Yang WF, Su YX, Liao GQ. Risk factors and prognosis for salivary gland adenoid cystic carcinoma in southern china: A 25-year retrospective study. Medicine (Baltimore) 2017; 96:e5964. [PMID: 28151884 PMCID: PMC5293447 DOI: 10.1097/md.0000000000005964] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Adenoid cystic carcinoma (ACC) is characterized by slow growth, frequent local recurrences, and high incidence of distant metastasis (DM). The aim of this study was to evaluate predictive factors for local-regional (LR) recurrence, DM, and survival in ACC.A retrospective review of the medical records for patients with salivary glands ACC from 1990 to 2015 was performed. The clinical parameters were assessed to identify correlations with the development of LR recurrence, DM, and survival of these patients.Among 228 patients who underwent surgery as definitive treatment, 210 (92.1%) were followed up in the study. DM was detected in 64 (30.5%) patients, LR recurrence was detected in 58 (27.6%) patients. The estimated 5, 10, and 15-year overall survival rates were 84.7%, 70.8%, and 34.0%, respectively. Multivariate analysis revealed that the presence of lymphovascular invasion and a high T classification were very strong adverse factors, which independently influenced LR recurrence, DM, and survival of ACC patients. Positive/close margin and N+ status were independent risk factors for DM and LR recurrence, respectively. Survival of ACC patents was also affected by tumor location.Presence of lymphovascular invasion and a high T classification were very strong adverse factors and independent predictors for ACC patients' prognosis, which influenced LR control, DM control, and survival.
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Affiliation(s)
- Dai-qiao Ouyang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou
| | - Li-zhong Liang
- Department of Oral and Maxillofacial Surgery, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai
| | - Guang-sen Zheng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou
| | - Zun-fu Ke
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University
| | - De-sheng Weng
- Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong
| | - Wei-fa Yang
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Yu-xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Gui-qing Liao
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou
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126
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Keller A, Harvey ME, Kameh DS, Haughey B, Ho H, Magnuson S, Akhtar A, Mekhail T, Zehngebot L, Rao NG. De-escalation of radiotherapy for the treatment of HPV-associated head and neck cancer: A case report and a word of caution. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2017.1292399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Andrew Keller
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Mark E. Harvey
- Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Darian S. Kameh
- Department of Pathology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Bruce Haughey
- Department of Head and Neck Surgery, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Henry Ho
- Department of Head and Neck Surgery, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Scott Magnuson
- Department of Head and Neck Surgery, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Adnan Akhtar
- Department of Medical Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Tarek Mekhail
- Department of Medical Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Lee Zehngebot
- Department of Medical Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
| | - Nikhil G. Rao
- College of Medicine, University of Central Florida, Orlando, FL, USA
- Department of Radiation Oncology, Florida Hospital Cancer Institute, Orlando, FL, USA
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127
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Turri-Zanoni M, Salzano G, Lambertoni A, Giovannardi M, Karligkiotis A, Battaglia P, Castelnuovo P. Prognostic value of pretreatment peripheral blood markers in paranasal sinus cancer: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio. Head Neck 2016; 39:730-736. [DOI: 10.1002/hed.24681] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/10/2016] [Accepted: 11/08/2016] [Indexed: 12/12/2022] Open
Affiliation(s)
- Mario Turri-Zanoni
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria; Varese Italy
| | - Giovanni Salzano
- Division of Maxillofacial Surgery; Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples “Federico II”; Naples Italy
| | - Alessia Lambertoni
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Marta Giovannardi
- Unit of Biostatistics, Department of Statistics, Monzino Hospital IRCCS; Milan Italy
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
| | - Paolo Battaglia
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria; Varese Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology; Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi; Varese Italy
- Head and Neck Surgery & Forensic Dissection Research Center (HNS & FDRC), Department of Biotechnology and Life Sciences, University of Insubria; Varese Italy
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128
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Zumsteg ZS, Kim S, David JM, Yoshida EJ, Tighiouart M, Shiao SL, Scher K, Mita A, Sherman EJ, Lee NY, Ho AS. Impact of concomitant chemoradiation on survival for patients with T1-2N1 head and neck cancer. Cancer 2016; 123:1555-1565. [DOI: 10.1002/cncr.30508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/17/2016] [Accepted: 11/28/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Zachary S. Zumsteg
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Sungjin Kim
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Department of Biostatistics and Bioinformatics; Cedars-Sinai Medical Center; Los Angeles California
| | - John M. David
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Emi J. Yoshida
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Mourad Tighiouart
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Department of Biostatistics and Bioinformatics; Cedars-Sinai Medical Center; Los Angeles California
| | - Stephen L. Shiao
- Department of Radiation Oncology; Cedars-Sinai Medical Center; Los Angeles California
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Kevin Scher
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Alain Mita
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
| | - Eric J. Sherman
- Department of Medical Oncology; Memorial Sloan Kettering Cancer Center; New York New York
| | - Nancy Y. Lee
- Department of Radiation Oncology; Memorial Sloan Kettering Cancer Center; New York New York
| | - Allen S. Ho
- Samuel Oschin Comprehensive Cancer Institute; Cedars-Sinai Medical Center; Los Angeles California
- Department of Surgery; Cedars-Sinai Medical Center; Los Angeles California
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129
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Arosio AD, Pignataro L, Gaini RM, Garavello W. Neck lymph node metastases from unknown primary. Cancer Treat Rev 2016; 53:1-9. [PMID: 28027480 DOI: 10.1016/j.ctrv.2016.11.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/18/2022]
Abstract
Metastatic cervical carcinoma from unknown primary is a metastatic disease in the lymph nodes of the neck without any evidence of a primary tumour after appropriate investigation. The condition is rare and definite evidence is lacking for both diagnosis and treatment. In this review of the literature, we tried to draw some clinical indications based on the few available studies. We ultimately came to the following conclusions: (1) a thorough and accurate diagnostic work-up should be systematically offered. It includes accurate inspection with fibroscopy, CT or MRI, fine needle aspiration, panendoscopy and positron emission tomography, (2) Patients with low-volume neck disease, N1 and N2a stage and without extracapsular extension on histopathological examination should receive single modality treatment. Radiotherapy and surgery may be similarly effective but, if possible, surgery (excisional biopsy, neck dissection and tonsillectomy) should be favoured because it consents a more precise staging, (3) patients with more advanced conditions require combined treatment in the form of either resection followed by adjuvant radiation (±chemotherapy) or primary chemoradiation (±post-therapy neck dissection).
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Affiliation(s)
- Alberto Daniele Arosio
- Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Lorenzo Pignataro
- Department of Otorhinolaryngology, Department of Clinical Sciences and Community Health, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Renato Maria Gaini
- Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Werner Garavello
- Department of Otorhinolaryngology, School of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
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130
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Schiffman M, Doorbar J, Wentzensen N, de Sanjosé S, Fakhry C, Monk BJ, Stanley MA, Franceschi S. Carcinogenic human papillomavirus infection. Nat Rev Dis Primers 2016; 2:16086. [PMID: 27905473 DOI: 10.1038/nrdp.2016.86] [Citation(s) in RCA: 528] [Impact Index Per Article: 66.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Infections with human papillomavirus (HPV) are common and transmitted by direct contact. Although the great majority of infections resolve within 2 years, 13 phylogenetically related, sexually transmitted HPV genotypes, notably HPV16, cause - if not controlled immunologically or by screening - virtually all cervical cancers worldwide, a large fraction of other anogenital cancers and an increasing proportion of oropharyngeal cancers. The carcinogenicity of these HPV types results primarily from the activity of the oncoproteins E6 and E7, which impair growth regulatory pathways. Persistent high-risk HPVs can transition from a productive (virion-producing) to an abortive or transforming infection, after which cancer can result after typically slow accumulation of host genetic mutations. However, which precancerous lesions progress and which do not is unclear; the majority of screening-detected precancers are treated, leading to overtreatment. The discovery of HPV as a carcinogen led to the development of effective preventive vaccines and sensitive HPV DNA and RNA tests. Together, vaccination programmes (the ultimate long-term preventive strategy) and screening using HPV tests could dramatically alter the landscape of HPV-related cancers. HPV testing will probably replace cytology-based cervical screening owing to greater reassurance when the test is negative. However, the effective implementation of HPV vaccination and screening globally remains a challenge.
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Affiliation(s)
- Mark Schiffman
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Room 6E544, 9609 Medical Center Drive, Rockville, Maryland 20850, USA
| | - John Doorbar
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Nicolas Wentzensen
- National Cancer Institute, Division of Cancer Epidemiology and Genetics, Room 6E544, 9609 Medical Center Drive, Rockville, Maryland 20850, USA
| | - Silvia de Sanjosé
- Catalan Institute of Oncology, IDIBELL, Cancer Epidemiology Research Programme and CIBER Epidemiologia Y Salud Publica, Barcelona, Spain
| | - Carole Fakhry
- Department of Otolaryngology, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Bradley J Monk
- Division of Gynecologic Oncology, US Oncology Network, University of Arizona-Phoenix, Phoenix, Arizona, USA
| | | | - Silvia Franceschi
- International Agency for Research on Cancer, Infections and Cancer Epidemiology Group, Lyon, France
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131
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Gooi Z, Richmon J, Agrawal N, Blair E, Portugal L, Vokes E, Seiwert T, de Souza J, Saloura V, Haraf D, Goldenberg D, Chan J. AHNS Series - Do you know your guidelines? Principles of treatment for nasopharyngeal cancer: A review of the National Comprehensive Cancer Network guidelines. Head Neck 2016; 39:201-205. [DOI: 10.1002/hed.24635] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/10/2016] [Indexed: 01/27/2023] Open
Affiliation(s)
- Zhen Gooi
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Chicago; Chicago Illinois
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Nishant Agrawal
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Chicago; Chicago Illinois
| | - Elizabeth Blair
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Chicago; Chicago Illinois
| | - Louis Portugal
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery; University of Chicago; Chicago Illinois
| | - Everett Vokes
- Section of Hematology/Oncology, Department of Medicine; University of Chicago; Chicago Illinois
| | - Tanguy Seiwert
- Section of Hematology/Oncology, Department of Medicine; University of Chicago; Chicago Illinois
| | - Jonas de Souza
- Section of Hematology/Oncology, Department of Medicine; University of Chicago; Chicago Illinois
| | - Vassiliki Saloura
- Section of Hematology/Oncology, Department of Medicine; University of Chicago; Chicago Illinois
| | - Daniel Haraf
- Department of Radiation and Cellular Oncology; University of Chicago; Chicago Illinois
| | - David Goldenberg
- Division of Otolaryngology-Head and Neck Surgery; Penn State University College of Medicine and Penn State Health; Hershey Pennsylvania
| | - Jason Chan
- Department of Otorhinolaryngology-Head and Neck Surgery; The Chinese University of Hong Kong, Prince of Wales Hospital; Shatin Hong Kong SAR
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132
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Massive internal jugular vein tumor thrombus derived from squamous cell carcinoma of the head and neck: two case reports. Oral Maxillofac Surg 2016; 21:69-74. [PMID: 27885568 DOI: 10.1007/s10006-016-0600-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/18/2016] [Indexed: 12/14/2022]
Abstract
PURPOSE Tumor thrombosis of the internal jugular vein (IJV) is an extremely rare disease, and the reported cases have been exclusively associated with differentiated thyroid cancer. In the present study, we describe two cases of IJV tumor thrombosis originated from squamous cell carcinoma (SCC), which is the first case report. METHODS Case 1 was a 67-year-old man diagnosed with advanced supraglottic SCC with a massive tumor thrombus in the IJV. He was treated with bio-radiotherapy followed by radical surgery. Case 2 was a 65-year-old woman who underwent radical surgery for SCC of thyroid with tumor thrombosis in the IJV. RESULTS These cases rapidly developed local recurrences and distant metastases and died within 10 months after surgery. CONCLUSIONS IJV tumor thrombosis originated from SCC apparently reflects extremely aggressive state of the tumor. Recognition and precaution to this condition is essential for the development of a clinically effective treatment strategy.
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133
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Leeman JE, Gutiontov S, Romesser P, McBride S, Riaz N, Lee N, Tsai CJ. Sparing of high retropharyngeal nodal basins in patients with unilateral oropharyngeal carcinoma treated with intensity modulated radiation therapy. Pract Radiat Oncol 2016; 7:254-259. [PMID: 28094212 DOI: 10.1016/j.prro.2016.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE The introduction of intensity modulated radiotherapy (IMRT) has facilitated dose painting and sparing of uninvolved/low-risk nodal basins in head and neck cancers. In oropharynx cancer (OPC), the need for elective coverage of uninvolved high contralateral retropharyngeal (RP) nodes and the risk associated with sparing this region remain unclear. We examined outcomes of OPC patients treated with IMRT and omission of contralateral high RP coverage. METHODS AND MATERIALS We identified 102 OPC patients with cN0-N2b disease treated with definitive IMRT with or without concurrent chemotherapy between 2010 and 2013. The contralateral RP nodal basins superior to the vertebral level of C1 were omitted from the elective IMRT field for all patients. Of the 67 patients (66%) with p16 status available, 63 (94%) were p16+. We used the Kaplan-Meier method to estimate overall survival, as well as freedom from local failure, regional failure, distant failure, and retropharyngeal failure. RESULTS The median follow-up was 26.9 months (range, 3.0-59.9 months). There were no failures in the treated ipsilateral RP nodes or the spared contralateral high RP nodes in the entire cohort. In the p16+ cohort and the entire cohort, the 2-year rates of overall survival and freedom from local, regional, distant, and retropharyngeal failure were 98.0% and 95.1%, 98.1% and 97.7%, 96.4% and 96.7%, 98.1% and 95.1%, and 100% and 100%, respectively. CONCLUSIONS Omission of contralateral high RP nodes in patients with p16+ OPC with unilateral disease is safe.
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Affiliation(s)
- Jonathan E Leeman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stanley Gutiontov
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Romesser
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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134
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Beck TN, Smith CH, Flieder DB, Galloway TJ, Ridge JA, Golemis EA, Mehra R. Head and neck squamous cell carcinoma: Ambiguous human papillomavirus status, elevated p16, and deleted retinoblastoma 1. Head Neck 2016; 39:E34-E39. [PMID: 27859938 DOI: 10.1002/hed.24604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is potentially curable, but treatment planning remains a challenge. Oncogenic human papillomavirus (HPV)-positive disease is often associated with a good prognosis compared with HPV-negative disease. However, some HPV-positive HNSCC recurs, often with distant metastases and significant treatment resistance. METHODS AND RESULTS We performed p16 immunohistochemistry (IHC), in situ hybridization (ISH) for high-risk HPV, and comprehensive genomic profiling on oropharyngeal HNSCC with basaloid features and particularly aggressive disease course, noting a rare genetic event: a deleting mutation (exons 5-17) of the tumor suppressor and dominant cell cycle regulator retinoblastoma 1 (RB1). Genomic and transcriptomic data available through FoundationOne and The Cancer Genome Atlas (TCGA) were reviewed for additional HNSCC cases with RB1 alterations. CONCLUSION RB1 alterations may have important prognostic implications, particularly in the context of high p16 expression, in both HPV-positive and HPV-negative HNSCC. © 2016 Wiley Periodicals, Inc. Head Neck 39: E34-E39, 2017.
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Affiliation(s)
- Tim N Beck
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Molecular and Cell Biology & Genetics Program, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Chad H Smith
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Douglas B Flieder
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - John A Ridge
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Erica A Golemis
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Molecular and Cell Biology & Genetics Program, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ranee Mehra
- Program in Molecular Therapeutics, Fox Chase Cancer Center, Philadelphia, Pennsylvania.,Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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135
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Haughey BH, Sinha P, Kallogjeri D, Goldberg RL, Lewis JS, Piccirillo JF, Jackson RS, Moore EJ, Brandwein-Gensler M, Magnuson SJ, Carroll WR, Jones TM, Wilkie MD, Lau A, Upile NS, Sheard J, Lancaster J, Tandon S, Robinson M, Husband D, Ganly I, Shah JP, Brizel DM, O'Sullivan B, Ridge JA, Lydiatt WM. Pathology-based staging for HPV-positive squamous carcinoma of the oropharynx. Oral Oncol 2016; 62:11-19. [PMID: 27865363 PMCID: PMC5523818 DOI: 10.1016/j.oraloncology.2016.09.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 09/06/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The rapid worldwide rise in incidence of human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) has generated studies confirming this disease as an entity distinct from traditional OPSCC. Based on pathology, surgical studies have revealed prognosticators specific to HPV-positive OPSCC. The current AJCC/UICC staging and pathologic nodal (pN)-classification do not differentiate for survival, demonstrating the need for new, HPV-specific OPSCC staging. The objective of this study was to define a pathologic staging system specific to HPV-positive OPSCC. METHODS Data were assembled from a surgically-managed, p16-positive OPSCC cohort (any T, any N, M0) of 704 patients from five cancer centers. Analysis was performed for (a) the AJCC/UICC pathologic staging, (b) newly published clinical staging for non-surgically managed HPV-positive OPSCC, and (c) a novel, pathology-based, "HPVpath" staging system that combines features of the primary tumor and nodal metastases. RESULTS A combination of AJCC/UICC pT-classification and pathology-confirmed metastatic node count (⩽4 versus ⩾5) yielded three groups: stages I (pT1-T2, ⩽4 nodes), II (pT1-T2, ⩾5 nodes; pT3-T4, ⩽4 nodes), and III (pT3-T4, ⩾5 nodes), with incrementally worse prognosis (Kaplan-Meier overall survival of 90%, 84% and 48% respectively). Existing AJCC/UICC pathologic staging lacked prognostic definition. Newly published HPV-specific clinical stagings from non-surgically managed patients, although prognostic, showed lower precision for this surgically managed cohort. CONCLUSIONS Three loco-regional "HPVpath" stages are identifiable for HPV-positive OPSCC, based on a combination of AJCC/UICC primary tumor pT-classification and metastatic node count. A workable, pathologic staging system is feasible to establish prognosis and guide adjuvant therapy decisions in surgically-managed HPV-positive OPSCC.
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Affiliation(s)
- B H Haughey
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA; Department of Surgery, University of Auckland Faculty of Medicine and Health Sciences, Auckland, New Zealand.
| | - P Sinha
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - D Kallogjeri
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R L Goldberg
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - J S Lewis
- Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J F Piccirillo
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - R S Jackson
- Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - E J Moore
- Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN, USA
| | - M Brandwein-Gensler
- Pathology and Anatomical Sciences, SUNY at the University at Buffalo, Buffalo, NY, USA
| | - S J Magnuson
- Head and Neck Surgery, Florida Hospital Celebration Health, Celebration, FL, USA
| | - W R Carroll
- Otolaryngology-Head and Neck Surgery, University of Alabama, Birmingham, AL, USA
| | - T M Jones
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M D Wilkie
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - A Lau
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N S Upile
- Otolaryngology-Head and Neck Surgery, University of Liverpool, UK; Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jon Sheard
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK; Pathology, University of Liverpool, UK
| | - J Lancaster
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S Tandon
- Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - M Robinson
- Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK
| | - D Husband
- Clatterbridge Cancer Centre, Wirral, UK
| | - I Ganly
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - J P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - D M Brizel
- Radiation Oncology, Duke University Medical Center, Durham, NC, USA
| | - B O'Sullivan
- Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - J A Ridge
- Head and Neck Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - W M Lydiatt
- Clinical Professor, Creighton Department of Surgery, Omaha, NE, USA
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Wakasaki T, Kubota M, Nakashima Y, Tomonobe E, Mihara T, Fukushima J. Invasive myoepithelial carcinoma ex pleomorphic adenoma of the major salivary gland: two case reports. BMC Cancer 2016; 16:827. [PMID: 27793123 PMCID: PMC5084397 DOI: 10.1186/s12885-016-2871-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/21/2016] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Myoepithelial carcinoma (MEC) is a rare salivary gland tumor. Its long-term prognosis remains unknown because of the paucity of reported cases with long-term follow-up. Although some case series exist, the clinical features of MEC vary considerably depending on the site of origin. Therefore, accumulation of these rare cases is important. CASE PRESENTATION Case 1: An 89-year-old man presented with a 10-year history of a mass originating from the right parotid gland and involving the neck. The mass grew rapidly for 3 months, reaching approximately 8 cm. There was no facial paralysis. MEC ex pleomorphic adenoma (PA) was suspected. Superficial parotid gland resection was performed in 2013; the tumor grade was pT3N0M0, and the resection margins were free of carcinoma. Because of several high-risk factors for metastasis (i.e., invasive carcinoma ex PA, high MIB1 index, and mutant p53 protein positivity), radiotherapy and chemotherapy were recommended as adjuvant therapy. Although the patient refused adjuvant therapy, he was recurrence-free at 36 months after surgery. Case 2: A 54-year-old woman presented with a >10-year history of a right submandibular mass, which grew rapidly for 1 year, reaching approximately 6 cm. Preoperative diagnosis was PA of the right submandibular gland. Submandibular gland resection was performed in 2013. Pathological analysis revealed invasive MEC ex PA, pT3N0M0; in addition, the carcinoma portion had an extra capsule and had invaded the platysma muscle close to the margin. An MIB1 index of 40 % and mutant p53 protein positivity indicated a high risk for metastasis. Additional resection and right neck dissection revealed no residual carcinoma. The patient refused adjuvant chemotherapy. One year after surgery, metastasis to the right pulmonary hilar node and both lungs were detected. Chemotherapy prevented recurrent growth of the lesion and extended survival. The patient was alive with cancer 30 months after the first surgery. CONCLUSIONS High expression of the Ki67 labeling index might reflect prognosis of these cases. Chemotherapy for distant metastasis was effective, as expected. Further accumulation of cases and long follow-up data are needed to elucidate the pathophysiology and prognosis of MEC ex PA.
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Affiliation(s)
- Takahiro Wakasaki
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan. .,Department of Head and Neck Surgery, National Hospital Organization, Kyushu Cancer Center, 3-1-1 Notame, Miniami-ku, Fukuoka, 811-1395, Japan.
| | - Marie Kubota
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
| | - Yutaka Nakashima
- Department of Pathology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
| | - Eri Tomonobe
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
| | - Takenao Mihara
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
| | - Junichi Fukushima
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, 3-1-1 Okusu, Miniami-ku, Fukuoka, 815-8555, Japan
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A case of peritoneal metastasis during treatment for hypopharyngeal squamous cell carcinoma. World J Surg Oncol 2016; 14:265. [PMID: 27756320 PMCID: PMC5070098 DOI: 10.1186/s12957-016-1025-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/12/2016] [Indexed: 01/12/2023] Open
Abstract
Background Advanced head and neck squamous cell carcinomas frequently develop distant metastases to limited organs, including the lungs, bone, mediastinal lymph nodes, brain, and liver. Peritoneal carcinomatosis as an initial distant metastasis from hypopharyngeal squamous cell carcinoma is quite rare. Case presentation A 75-year-old man diagnosed with hypopharyngeal squamous cell carcinoma and his clinical stage was determined as T2N2cM0. Notably, the right retropharyngeal lymph node surrounded more than half of the right internal carotid artery. Concomitant conformal radiation therapy was administered for the primary hypopharyngeal lesion, and the whole neck and tumor response was evaluated at this point according to our algorithm-based chemoradioselection protocol. As the tumor responses at both the primary and lymph nodes were poor, with the right retropharyngeal lymph node in particular demonstrating mild enlargement, we performed a radical surgery: pharyngolaryngectomy, bilateral neck dissection, and reconstruction of the cervical esophagus with a free jejunal flap. Then, postoperative CRT was performed. During these therapies, the patient developed a fever and mild abdominal pain, which was associated with an increased C-reactive protein level. Contrast-enhanced computed tomography from the neck to the pelvis demonstrated mild peritoneal hypertrophy and ascites with no evidence of recurrent and/or metastatic tumor formation. We initially diagnosed acute abdomen symptoms as postoperative ileus. However, cytological examination of the refractory ascites resulted in a diagnosis of peritoneal carcinomatosis. Owing to rapid disease progress, the patient died 1.5 months after abdominal symptom onset. Conclusions The present case is the second reported case of head and neck squamous cell carcinoma with peritoneal carcinomatosis as an incipient distant metastasis. Therefore, peritoneal carcinomatosis should be considered a differential diagnosis when acute abdomen is noted during treatment for head and neck cancers.
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Stokes WA, Jones BL, Bhatia S, Oweida AJ, Bowles DW, Raben D, Goddard JA, McDermott JD, Karam SD. A comparison of overall survival for patients with T4 larynx cancer treated with surgical versus organ-preservation approaches: A National Cancer Data Base analysis. Cancer 2016; 123:600-608. [PMID: 27727461 DOI: 10.1002/cncr.30382] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/18/2016] [Accepted: 09/12/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although laryngectomy is the treatment of choice for patients with T4 larynx cancer, many patients are unable or unwilling to undergo laryngectomy and instead pursue larynx-preservation strategies combining radiotherapy (RT) and chemotherapy. Herein, the authors analyzed the National Cancer Data Base to evaluate overall survival (OS) between patients treated with surgical and organ-preserving modalities. METHODS The National Cancer Data Base was queried for patients diagnosed from 2004 through 2012 with T4M0 laryngeal cancer who underwent either laryngectomy (surgery) with adjuvant RT (SRT), chemotherapy starting concurrently within 7 days of RT (CCRT), or multiagent induction chemotherapy starting 43 to 98 days before RT (ICRT). Multivariate analysis and propensity score matching were used to explore the association between the intervention and OS. Recursive partitioning analysis was performed to identify groups benefiting from particular modalities. RESULTS A total of 1559 patients who underwent SRT, 1597 patients who underwent CCRT, and 386 patients who underwent ICRT were included. Adjusting for covariates, CCRT was found to be associated with inferior OS compared with SRT (hazard ratio [HR], 1.55; 95% confidence interval [95% CI], 1.41-1.70 [P<.01]) and with ICRT (HR, 1.25; 95% CI, 1.07-1.45 [P<.01]). OS among the patients treated with SRT did not appear to differ significantly from that of the ICRT cohort (HR, 0.87; 95% CI, 0.73-1.03 [P = 0.10]), a finding confirmed with propensity score matching. Recursive partitioning analysis identified no subset of patients that derived an OS benefit from either approach over the other. CONCLUSIONS OS among patients undergoing SRT was found to be superior to that of patients treated with CCRT but did not significantly differ from that of those undergoing ICRT. Because these intriguing findings require validation, SRT should remain the standard of care for patients with this disease. However, organ preservation with ICRT may be a reasonable alternative in certain patients. Cancer 2017;123:600-608. © 2016 American Cancer Society.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Ayman J Oweida
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Julie A Goddard
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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Dunn LA, Ho AL, Laurie SA, Pfister DG. Unmet needs for patients with salivary gland cancer. Oral Oncol 2016; 60:142-145. [PMID: 27377424 DOI: 10.1016/j.oraloncology.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Lara A Dunn
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY, USA
| | - Alan L Ho
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY, USA
| | - Scott A Laurie
- Ottawa Hospital Cancer Centre, The University of Ottawa, Ottawa, Canada
| | - David G Pfister
- Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, NY, USA.
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Pearson AT, Jackson TL, Nör JE. Modeling head and neck cancer stem cell-mediated tumorigenesis. Cell Mol Life Sci 2016; 73:3279-89. [PMID: 27151511 PMCID: PMC5312795 DOI: 10.1007/s00018-016-2226-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 03/29/2016] [Accepted: 04/12/2016] [Indexed: 12/22/2022]
Abstract
A large body of literature has emerged supporting the importance of cancer stem cells (CSCs) in the pathogenesis of head and neck cancers. CSCs are a subpopulation of cells within a tumor that share the properties of self-renewal and multipotency with stem cells from normal tissue. Their functional relevance to the pathobiology of cancer arises from the unique properties of tumorigenicity, chemotherapy resistance, and their ability to metastasize and invade distant tissues. Several molecular profiles have been used to discriminate a stem cell from a non-stem cell. CSCs can be grown for study and further enriched using a number of in vitro techniques. An evolving option for translational research is the use of mathematical and computational models to describe the role of CSCs in complex tumor environments. This review is focused discussing the evidence emerging from modeling approaches that have clarified the impact of CSCs to the biology of cancer.
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Affiliation(s)
- Alexander T Pearson
- Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan School of Medicine, 1500 E. Medical Center Dr., SPC 5848, Ann Arbor, MI, 48109-5848, USA.
| | - Trachette L Jackson
- Department of Mathematics, University of Michigan School of Literature, Sciences, and the Arts, Ann Arbor, MI, USA
| | - Jacques E Nör
- Department of Restorative Sciences, University of Michigan School of Dentistry, 1011 N. University Rm. 2309, Ann Arbor, MI, 48109-1078, USA.
- Department of Otolaryngology, University of Michigan School of Medicine, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan College of Engineering, Ann Arbor, MI, USA.
- Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA.
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141
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Détection et évaluation de la dénutrition en oncologie : quels sont les outils, pour quel type de cancer et dans quels buts ? Bull Cancer 2016; 103:776-85. [DOI: 10.1016/j.bulcan.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/15/2016] [Accepted: 06/18/2016] [Indexed: 01/06/2023]
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142
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Brotherton JML, Jit M, Gravitt PE, Brisson M, Kreimer AR, Pai SI, Fakhry C, Monsonego J, Franceschi S. Eurogin Roadmap 2015: How has HPV knowledge changed our practice: Vaccines. Int J Cancer 2016; 139:510-7. [PMID: 26916230 PMCID: PMC7388730 DOI: 10.1002/ijc.30063] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/02/2016] [Accepted: 02/11/2016] [Indexed: 12/18/2022]
Abstract
This review is one of two complementary reviews that have been prepared in the framework of the Eurogin Roadmap 2015 to evaluate how knowledge about HPV is changing practices in HPV infection and disease control through vaccination and screening. In this review of HPV vaccine knowledge, we present the most significant findings of the past year which have contributed to our knowledge of the two HPV prophylactic vaccines currently in widespread use and about the recently licensed nonavalent HPV vaccine. Whereas anal cancer is dealt with in the companion mini-review on screening, we also review here the rapidly evolving evidence regarding HPV-associated head and neck cancer and priority research areas.
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Affiliation(s)
- Julia M L Brotherton
- National HPV Vaccination Program Register, VCS Registries, East Melbourne, Vic, Australia
- School of Population and Global Health, University of Melbourne, Vic, Australia
| | - Mark Jit
- Modelling and Economics Unit, Public Health England, London, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patti E Gravitt
- Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Marc Brisson
- Département de Médecine Sociale et Préventive, Université Laval, Québec, QC, Canada
| | - Aimée R Kreimer
- Infections & Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, MD
| | - Sara I Pai
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA
| | - Carole Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins School of Medicine, Johns Hopkins Outpatient Center, Baltimore, MD
| | | | - Silvia Franceschi
- International Agency for Research on Cancer, 69372 Lyon cedex 08, France
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Abstract
: The overall incidence of head and neck cancer-which includes laryngeal, hypopharyngeal, nasal cavity, paranasal sinus, nasopharyngeal, oral, oropharyngeal, and salivary gland cancers-has declined in the United States over the past 30 years with the concomitant reduction in tobacco use. Over that same period, however, the worldwide incidence of oropharyngeal cancer has escalated significantly, most notably among men and women under age 60 who live in developed countries. This epidemic rise in oropharyngeal cancer is largely attributed to certain genotypes of the human papillomavirus (HPV). In the United States, HPV prevalence in oropharyngeal tumors increased dramatically, from roughly 16% between 1984 and 1989 to nearly 73% between 2000 and 2004, and the annual incidence of HPV-positive oropharyngeal cancer is expected to surpass that of HPV-related cervical cancer by 2020.This article provides an overview of head and neck cancer-its incidence, risk factors, treatment, and posttreatment sequelae-with a focus on HPV-related oropharyngeal cancer. Unlike other forms of head and neck cancer, HPV-related oropharyngeal cancer tends to affect younger patients with few or none of the traditional risk factors and has a distinctive presentation, histology, and natural course. In order to provide appropriate patient education and to help these patients monitor and manage late and long-term treatment effects, it is important for nurses to be aware of this disease and its treatment, and of the unique survivorship issues that arise for affected patients.
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144
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Kim JH, Shin SY, Paek J, Lee JH, Kwon HB. Analysis of maxillofacial prosthetics at university dental hospitals in the capital region of Korea. J Adv Prosthodont 2016; 8:229-34. [PMID: 27350859 PMCID: PMC4919495 DOI: 10.4047/jap.2016.8.3.229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the demographic patterns of maxillofacial prosthetic treatment to identify the characteristics and geographic distribution of patients with maxillofacial prosthetics in the capital region of Korea. MATERIALS AND METHODS This retrospective analytical multicenter study was performed by chart reviews. This study included patients who visited the department of prosthodontics at four university dental hospitals for maxillofacial prosthetic rehabilitation. Patients with facial and congenital defects or with insufficient medical data were excluded. The patients were classified into three categories based on the location of the defect. Patients' sex, age, and residential area were analyzed. Pearson's chi-square test with a significance level of 0.05 was used to analyze the variables. RESULTS Among 540 patients with maxillofacial prosthetics, there were 284 (52.59%) male patients and 256 (47.41%) female patients. The number of the patients varied greatly by hospital. Most patients were older than 70, and the most common defect was a hard palate defect. Chi-square analysis did not identify any significant differences in sex, age, and distance to hospital for any defect group (P>.05). CONCLUSION The results of this study indicated that there was imbalance in the distribution of patients with maxillofacial prosthetic among the hospitals in the capital region of Korea. Considerations on specialists and insurance policies for the improvement of maxillofacial prosthetics in Korea are required.
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Affiliation(s)
- Jee-Hwan Kim
- Department of Prosthodontics, Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Soo-Yeon Shin
- Department of Prosthodontics, College of Dentistry, Dankook University, Cheonan, Republic of Korea
| | - Janghyun Paek
- Department of Prosthodontics, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Jong-Ho Lee
- Oral Cancer Center and Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Ho-Beom Kwon
- Dental Research Institute and Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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145
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Wakasaki T, Gotoh S, Tomonobe E, Mihara T, Fukushima J. Posterior Reversible Encephalopathy Syndrome During Combined Modality Therapy for Head and Neck Squamous Cell Carcinoma. Ann Otol Rhinol Laryngol 2016; 125:844-9. [PMID: 27317313 DOI: 10.1177/0003489416654710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Posterior reversible encephalopathy syndrome (PRES) is a rare and acute disease with central nervous system symptoms. Without appropriate therapy, patients may exhibit a poor prognosis. PRES should be recognized as a possible problem during therapy for head and neck squamous cell carcinoma (HNSCC). METHODS A 56-year-old female developed PRES during combined modality therapy for HNSCC. On the fourth day after surgery and following chemoradiotherapy, PRES developed with a sudden visual disorder, followed by headache located at the back of the head and convulsions accompanied by impaired consciousness. We diagnosed PRES based on the clinical manifestations and magnetic resonance imaging data. RESULTS The patient recovered from PRES by appropriate treatment. CONCLUSION This is the first case report of PRES developed during treatment for HNSCC. Masked by other cerebrovascular disorders, more cases of PRES could exist than usually expected; therefore, we should consider PRES as a differential diagnosis for central nervous system disorders developing during high-intensity therapy.
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Affiliation(s)
- Takahiro Wakasaki
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Seiji Gotoh
- Department of Cerebrovascular Medicine, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Eri Tomonobe
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Takenao Mihara
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Junichi Fukushima
- Department of Otorhinolaryngology, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
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146
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Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide and is frequently impervious to curative treatment efforts. Similar to other cancers associated with prolonged exposure to carcinogens, HNSCCs often have a high burden of mutations, contributing to substantial inter- and intra-tumor heterogeneity. The heterogeneity of this malignancy is further increased by the rising rate of human papillomavirus (HPV)-associated (HPV+) HNSCC, which defines an etiological subtype significantly different from the more common tobacco and alcohol associated HPV-negative (HPV-) HNSCC. Since 2011, application of large scale genome sequencing projects by The Cancer Genome Atlas (TCGA) network and other groups have established extensive datasets to characterize HPV- and HPV+ HNSCC, providing a foundation for advanced molecular diagnoses, identification of potential biomarkers, and therapeutic insights. Some genomic lesions are now appreciated as widely dispersed. For example, HPV- HNSCC characteristically inactivates the cell cycle suppressors TP53 (p53) and CDKN2A (p16), and often amplifies CCND1 (cyclin D), which phosphorylates RB1 to promote cell cycle progression from G1 to S. By contrast, HPV+ HNSCC expresses viral oncogenes E6 and E7, which inhibit TP53 and RB1, and activates the cell cycle regulator E2F1. Frequent activating mutations in PIK3CA and inactivating mutations in NOTCH1 are seen in both subtypes of HNSCC, emphasizing the importance of these pathways. Studies of large patient cohorts have also begun to identify less common genetic alterations, predominantly found in HPV- tumors, which suggest new mechanisms relevant to disease pathogenesis. Targets of these alterations including AJUBA and FAT1, both involved in the regulation of NOTCH/CTNNB1 signaling. Genes involved in oxidative stress, particularly CUL3, KEAP1 and NFE2L2, strongly associated with smoking, have also been identified, and are less well understood mechanistically. Application of sophisticated data-mining approaches, integrating genomic information with profiles of tumor methylation and gene expression, have helped to further yield insights, and in some cases suggest additional approaches to stratify patients for clinical treatment. We here discuss some recent insights built on TCGA and other genomic foundations.
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Affiliation(s)
- Tim N Beck
- Program in Molecular Therapeutics, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA.,Program in Molecular and Cell Biology and Genetics, Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Erica A Golemis
- Program in Molecular Therapeutics, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA.,Program in Molecular and Cell Biology and Genetics, Drexel University College of Medicine, Philadelphia, PA 19129, USA
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147
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Gooi Z, Fakhry C, Goldenberg D, Richmon J, Kiess AP. AHNS Series: Do you know your guidelines?Principles of radiation therapy for head and neck cancer: A review of the National Comprehensive Cancer Network guidelines. Head Neck 2016; 38:987-92. [DOI: 10.1002/hed.24448] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 01/02/2023] Open
Affiliation(s)
- Zhen Gooi
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins University; Baltimore Maryland
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Breik O, Sim F, Wong T, Nastri A, Iseli TA, Wiesenfeld D. Survival Outcomes of Mucosal Melanoma in the Head and Neck: Case Series and Review of Current Treatment Guidelines. J Oral Maxillofac Surg 2016; 74:1859-71. [PMID: 27063590 DOI: 10.1016/j.joms.2016.03.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/10/2016] [Accepted: 03/10/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Malignant mucosal melanoma of the head and neck (MMHN) is an aggressive and rare neoplasm with poor long-term outcomes. The aim of this study is to evaluate the outcomes of patients treated by a single-institution head and neck multidisciplinary team. MATERIALS AND METHODS In this retrospective case series, all MMHN cases treated at the Royal Melbourne Hospital from 1990-2015 were retrospectively reviewed. Patient demographic characteristics (eg, age), treatment offered, pathology, and outcomes were collected, tabulated, and correlated with outcomes. Survival outcomes were calculated by the Kaplan-Meier method. Comparison was made between oral and sinonasal melanomas. RESULTS A total of 16 cases were identified. Two were excluded because of inaccessible data. Of the 14 remaining cases, 8 were sinonasal melanomas and 6 were oral cavity melanomas. Sinonasal tumor patients presented with epistaxis or visual impairment. Oral melanoma patients presented with pigmented lesions or ulceration. Follow-up ranged from 4 months to 11 years. In 2 patients, locoregional recurrences developed that were successfully re-excised. Six patients died of distant metastases despite clear surgical margins. Two patients with sinonasal melanomas died of extensive local disease with intracranial invasion. One patient died 4 years after diagnosis without disease. There were no failures in the neck. The 2- and 5-year overall survival rates were 63.3% and 31.7%, respectively, by the Kaplan-Meier method. The difference in survival between oral and sinonasal melanomas was not statistically significant. CONCLUSIONS Despite clear surgical margins, MMHN has a poor prognosis and most deaths are due to distant metastases. Systemic therapies such as those used in cutaneous melanoma treatment might be used in the future for MMHN.
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Affiliation(s)
- Omar Breik
- Registrar, Department of Oral and Maxillofacial Surgery, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Felix Sim
- Head and Neck Fellow, Head and Neck Tumour Stream, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim Wong
- Consultant Oral and Maxillofacial Surgeon, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alf Nastri
- Head of Unit, Department of Oral and Maxillofacial Surgery, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim A Iseli
- Head of Unit, Department of Otorhinolaryngology, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Wiesenfeld
- Head, Head and Neck Tumour Stream, Head and Neck Oncology Tumour Stream, Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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149
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Amini A, Jones BL, McDermott JD, Serracino HS, Jimeno A, Raben D, Ghosh D, Bowles DW, Karam SD. Survival outcomes with concurrent chemoradiation for elderly patients with locally advanced head and neck cancer according to the National Cancer Data Base. Cancer 2016; 122:1533-43. [PMID: 26969811 DOI: 10.1002/cncr.29956] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 01/19/2016] [Accepted: 01/27/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND The overall survival (OS) benefit of concurrent chemoradiotherapy (CRT) for head and neck squamous cell carcinoma patients older than 70 years is debated. This study examines the outcomes of elderly patients receiving CRT versus radiotherapy (RT) alone. METHODS The National Cancer Data Base was queried for patients older than 70 years with nonmetastatic oropharyngeal, laryngeal, or hypopharyngeal cancer (T3-4 or N(+)). CRT was defined as chemotherapy started within 14 days of the initiation of RT. Univariate analysis, multivariate analysis (MVA), propensity score matching (PSM), and recursive partitioning analysis (RPA) were performed. RESULTS The study included 4042 patients: 2538 (63%) received CRT. The median follow-up was 19 months. The unadjusted median OS was longer with the addition of CRT (P < .001). OS was superior with CRT in the MVA (hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.58-0.68; P < .001) and PSM analyses (HR, 0.73; 95% CI, 0.66-0.80; P < .001) in comparison with RT alone. According to RPA, CRT was associated with longer OS for patients 81 years or younger with low comorbidity scores and either T1-2/N2-3 disease or T3-4/N0-3 disease. The survival benefit with CRT disappeared for 2 subgroups in the 71- to 81-year age range: those with T1-2, N1, and Charlson-Deyo 0-1 (CD0-1) disease and those with T3-4, N1+, and CD1+ disease. Patients who were older than 81 years did not have increased survival with CRT. The receipt of CRT was associated with a longer duration of RT (odds ratio, 1.74; 95% CI, 1.50-2.01; P < .001). CONCLUSIONS Patients older than 70 years should not be denied concurrent chemotherapy solely on the basis of age; additional factors, including the performance status and the tumor stage, should be taken into account. Cancer 2016;122:1533-43. © 2016 American Cancer Society.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, Colorado
| | - Hilary S Serracino
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Antonio Jimeno
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Debashis Ghosh
- Department of Biostatistics, University of Colorado School of Public Health, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.,Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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150
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Chin SC, Lin CY, Huang BS, Tsang NM, Fan KH, Ku YK, Hsu CL, Chan SC, Huang SF, Li CH, Tseng HJ, Liao CT, Liu HL, Sung K. Pretreatment Dynamic Contrast-Enhanced MRI Improves Prediction of Early Distant Metastases in Patients With Nasopharyngeal Carcinoma. Medicine (Baltimore) 2016; 95:e2567. [PMID: 26871776 PMCID: PMC4753871 DOI: 10.1097/md.0000000000002567] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The identification of early distant metastases (DM) in patients with newly diagnosed, previously untreated nasopharyngeal carcinoma (NPC) plays an important role in selecting the most appropriate treatment approach. Here, we sought to investigate the predictive value of distinct MRI parameters for the detection of early DM.Between November 2010 and June 2011, a total of 51 newly diagnosed NPC patients were included. All of the study participants were followed until December 2014 at a single institution after completion of therapy. DM was defined as early when they were detected on pretreatment FDG-PET scans or within 6 months after initial diagnosis. The following parameters were tested for their ability to predict early DM: pretreatment FDG-PET standardized uptake value (SUV), MRI-derived AJCC tumor staging, tumor volume, and dynamic contrast-enhanced (DCE) values. The DCE-derived ve was defined as the volume fraction of the extravascular, extracellular space.Compared with patients without early DM, patients with early DM had higher SUV, tumor volume, DCE mean (median) ve, ve skewness, ve kurtosis, and the largest mean ve selected among sequential slices (P < 0.05). No differences were identified when early DM were defined only according to the results of pretreatment FDG-PET. Among different quantitative DCE parameters, the mean ve had the highest area under curve (AUC, 0.765). However, the AUCs of SUV, tumor volume, mean ve, ve skewness, ve kurtosis, or the largest mean ve selected among the sequential slices did not differ significantly from one another (P = 0.82).Taken together, our results suggest that DCE-derived ve may be a useful parameter in combination with SUV and tumor volume for predicting early DM. Dynamic contrast-enhanced MRI may be complementary to FDG-PET for selecting the most appropriate treatment approach in NPC patients.
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Affiliation(s)
- Shy-Chyi Chin
- From the Department of Medical Imaging and Intervention (C-SC, K-YK); Department of Radiation Oncology (L-CY, H-BS, T-NM, F-KH); Division of Medical Oncology, Department of Internal Medicine (H-CL); Molecular Imaging Center and Department of Nuclear Medicine (C-SC); Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University (H-SF, L-CT), Taoyuan; Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University (L-CH), Hsinchu; Biostatistical Center for Clinical Research, Linkou Chang Gung Memorial Hospital and Chang Gung University (T-HJ), Taoyuan, Taiwan, ROC; Department of Imaging Physics, University of Texas MD Anderson Cancer Center (L-HL), Houston, TX; and Department of Radiological Sciences, University of California (S-K), Los Angeles, CA
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