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León X, Farré N, Montezuma L, Holgado A, Vásquez R, Neumann E, Quer M. Resultados de la radioterapia en los carcinomas de orofaringe. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022. [DOI: 10.1016/j.otorri.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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2
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Transoral robotic surgery and intensity-modulated radiotherapy in the treatment of the oropharyngeal carcinoma: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 278:1321-1335. [DOI: 10.1007/s00405-020-06224-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/16/2020] [Indexed: 01/18/2023]
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3
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Dougherty MI, Dougherty W, Kain JJ, Hughley BB, Shonka DC, Fedder KL, Jameson MJ. Non-HPV-Related Head and Neck Squamous Cell Carcinoma in a Young Patient Cohort. EAR, NOSE & THROAT JOURNAL 2020; 100:1101S-1106S. [PMID: 32584613 DOI: 10.1177/0145561320935839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Head and neck squamous cell carcinoma (HNSCC) is rare in patients younger than 40 years. Many practitioners suspect HNSCC is a more aggressive disease in this age group, and perhaps increasing in incidence; however, there are scant and conflicting data to support this assertion. We sought to compare outcomes for young patients with non-human papillomavirus (HPV)-related HNSCC to those of older patients. METHODS A retrospective chart review of patients with HNSCC treated from 2004 to 2016 at 2 tertiary referral centers. Patients aged 18 to 40 with p16-negative HNSCC were included in the young patient cohort (n = 59). A randomly selected stage- and subsite-matched cohort aged 55 to 65 was analyzed for comparison (n = 114). RESULTS When considering all patients with HNSCC, patients younger than 40 were more likely to have oral tongue cancer (62.7%) compared to patients age 55 to 65 (16.9%). When an older patient cohort was stage- and subsite-matched to the young patient cohort, there were more never smokers (49.2% vs 17.5% of older patients, P < .01) and females (40.7% vs 24.6% of older patients, P = .028) in the young patient group. The young patient cohort had better average overall survival than the older group (14.4 vs 8.1 years, respectively, P = .02), but similar average disease-free survival (6.2 years vs 6.6 years, respectively, P = .67); 50.9% of young patients had tumors with adverse histologic features versus 42.0% of older patients (P = .28). The young patients demonstrated a superior average conditional survival after recurrence (9.8 years vs 3.2 years for older patients, P < .01). CONCLUSIONS Despite the limitations of study design, these data suggest that young patients who develop non-HPV-related HNSCC tend to have similarly aggressive disease, but longer overall survival and better survival after recurrence. These findings may be attributable to better overall health as evidenced by fewer comorbidities.
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Affiliation(s)
- Michael I Dougherty
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - William Dougherty
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Joshua J Kain
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian B Hughley
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David C Shonka
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Katherine L Fedder
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Mark J Jameson
- Department of Otolaryngology-Head and Neck Surgery, University of Virginia Health System, Charlottesville, VA, USA
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4
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Ben Elhadj M, Fourati A, El Amine O, Goucha A, El May A, El May MV, Mokni Baizig N. Prevalence and Prognostic Value of HPV among Tunisian Patients with Laryngeal Cancer and Relationship between DNA HPV and p16, IGF-1R, Survivin, p53 Expressions. Ann Otol Rhinol Laryngol 2020; 129:863-871. [PMID: 32364419 DOI: 10.1177/0003489420918280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Tobacco and alcohol are the main etiological factors common to laryngeal cancers. However, the Human Papilloma Virus (HPV) constitutes an alternative risk factor according to several studies. In Tunisia, despite the annual increasing incidence of laryngeal squamous cell carcinoma (LSCC), the prevalence and prognostic significance of HPV have never been explored.In this study, we sought to highlight HPV DNA in 70 biopsies of laryngeal cancer, and to analyze the status of HPV infection in association with p53, p16, survivin, and IGF-1R expressions. METHODS HPV high risk (HPV HR) DNA was detected in tumors by in situ hybridization. However, the expression of p53, p16, survivin and IGF-1R were stained by immunohistochemistry test. The correlations of HPV status with clinicopathological parameters, overall survival, disease-free survival and proteins expressions were statistically evaluated. RESULTS HPV HR DNA was detected in 39 out of 70 (55.71%) laryngeal tumors. HPV+ patients have a better overall survival (P = .081) and long disease-free-survival (P = .016) with a low rate of recurrence (P = .006) than HPV- patients. No significant correlations were found between HPV HR status and clinicopathological parameters (all P > .005). Moreover, HPV+ tumors were not associated with expression of p53, p16 and survivin. However, HPV HR status correlates with weak to moderate IGF-1R expression (P = .043). CONCLUSION The substantial detection of HPV HR in LSCC tumors suggest that this virus plays an important part in laryngeal cancer in Tunisia. It is a good prognostic factor. In addition, HPV infection could act to block the pathway of IGF-1R expression.
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Affiliation(s)
- Mariem Ben Elhadj
- Departement of Immuno-Histo-Cytology, Salah Azaiez Cancer Institute, Tunis, Tunisia.,Research unit 17/ES/13 Faculty of Medicine, Tunis, Tunisia, University of Tunis El Manar, Tunisia
| | - Asma Fourati
- Departement of Immuno-Histo-Cytology, Salah Azaiez Cancer Institute, Tunis, Tunisia.,Research unit 17/ES/13 Faculty of Medicine, Tunis, Tunisia, University of Tunis El Manar, Tunisia
| | - Olfa El Amine
- Departement of Immuno-Histo-Cytology, Salah Azaiez Cancer Institute, Tunis, Tunisia
| | - Aida Goucha
- Departement of Immuno-Histo-Cytology, Salah Azaiez Cancer Institute, Tunis, Tunisia
| | - Ahmed El May
- Departement of Immuno-Histo-Cytology, Salah Azaiez Cancer Institute, Tunis, Tunisia
| | - Michèle-Veronique El May
- Research unit 17/ES/13 Faculty of Medicine, Tunis, Tunisia, University of Tunis El Manar, Tunisia
| | - Nehla Mokni Baizig
- Departement of Immuno-Histo-Cytology, Salah Azaiez Cancer Institute, Tunis, Tunisia.,Research unit 17/ES/13 Faculty of Medicine, Tunis, Tunisia, University of Tunis El Manar, Tunisia
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5
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Stepp WH, Farquhar D, Sheth S, Mazul A, Mamdani M, Hackman TG, Hayes DN, Zevallos JP. RNA Oncoimmune Phenotyping of HPV-Positive p16-Positive Oropharyngeal Squamous Cell Carcinomas by Nodal Status. JAMA Otolaryngol Head Neck Surg 2019; 144:967-975. [PMID: 29710215 DOI: 10.1001/jamaoto.2018.0602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Clinical trials that deintensify treatment for patients with suspected human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC) use p16 expression to identify HPV-mediated tumors and guide treatment. While p16 staining has a strong correlation with good outcomes, approximately 12% of p16-positive patients have recurrent disease. Biomarkers that reveal tumor-specific characteristics, such as nodal involvement, may change therapy decisions. Objective To assess whether if a tumor-specific genetic signature exists for node-negative vs node-positive HPV 16-positive/p16-positive OPSCCs. Design, Setting, and Participants This was a retrospective cohort study with randomized case selection for p16 OPSCCs undertaken at a university-based, tertiary care cancer center. Samples were collected from patients with p16-positive OPSCC. A total of 21 HPV 16/p16-positive tumors were used in this study. Main Outcomes and Measures Gene expression profiles of node-negative vs node-positive tumor samples were evaluated using a differential expression analysis approach and the sensitivity and specificity of a molecular signature was determined. Results Among the 21 patients in the study (3 women, 18 men; mean [SD] age, 54.6 [9.6] years), 6 had node-negative disease and 15 had node-positive disease. Using differential expression analysis, we found 146 genes that were significantly different in patients with node-negative disease vs those with node-positive disease, of which 15 genes were used to create a genetic signature that could distinguish node-negative-like from node-positive-like disease. The resultant molecular signature has a sensitivity of 88.2% (95% CI, 63.6%-98.5%) and specificity of 85.7% (95% CI, 42.1%-99.6%). The positive likelihood ratio of this signature was 6.1 (95% CI, 1.0-38.2) and the negative likelihood ratio was 0.1 (95% CI, 0.04-0.5). Given this population's prevalence of node-positive disease of 70.8%, the positive- and negative-predicative values for this gene signature were 93.7% (95% CI, 70.8%-98.9%) and 75.0% (95% CI, 44.1%-92.0%), respectively. In addition, we developed a gene signature using agnostic, machine learning software that identified a 40-gene profile that predicts node-negative disease from node-positive disease (area under the curve, 0.93; 95% CI, 0.63-1.00). Conclusions and Relevance Many HPV-16 and p16-positive tumors are treated as "lower-risk," but they do not have similar genetic compositions at the biological level. The identification of subgroups with unique expression patterns, such as those with nodal metastases, may guide physicians toward alternative or more aggressive therapies. In our study, unguided clustering suggested that that the larger biological characteristics of a tumor could be a better prognostic biomarker.
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Affiliation(s)
- Wesley H Stepp
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill
| | - Douglas Farquhar
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill
| | - Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill
| | - Angela Mazul
- Department of Epidemiology, University of North Carolina, Gillings School of Public Health, Chapel Hill.,now at Division of Hematology-Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Mohammed Mamdani
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill
| | - Trevor G Hackman
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill
| | - D Neil Hayes
- Division of Medical Oncology, Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill.,now at Division of Hematology-Oncology, Department of Medicine, University of Tennessee Health Science Center, Memphis
| | - Jose P Zevallos
- Department of Epidemiology, University of North Carolina, Gillings School of Public Health, Chapel Hill.,now at Department of Otolaryngology, Washington University in St Louis, School of Medicine, St Louis, Missouri
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Badoual C, Pavie J, Ménard M, Pernot S, Cochand-Priollet B, Hurel S, Péré H, Bats AS. [Multidisciplinary consultation for patients with HPV-related invasive carcinoma or precancerous lesions]. Cancer Radiother 2018; 22:487-491. [PMID: 30197024 DOI: 10.1016/j.canrad.2018.07.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 10/28/2022]
Abstract
Given the recent increase in the number of human papillomavirus (HPV)-induced cancers in other locations than gynaecological, the number of patients with two cancers at distinct sites, and because of the lack of exhaustive data, we decided to create a multidisciplinary network around an HPV consultation at the Georges-Pompidou European Hospital (HEGP). This network aims to set up the best tools for detecting HPV-associated "multisite" precancerous lesions in order to determine the possible impact of dedicated care for this at-risk population. This monthly consultation was created at the HEGP in June 2014. It is currently organized around five consultations: gynaecological, ENT, urological, digestive and immunological. Every patient who has been diagnosed with HPV-related cancer and whose care is provided at the HEGP is offered this particular follow-up: systematically, once the initial lesion has been treated, the patient is convened annually for a day during which it benefits from the consultations mentioned above. A consultation with a psychologist is systematically proposed. Local samples are taken at each site: a cytological examination, the analysis of known predictive and prognostic virological markers are carried out. This study fits more broadly in a theme of clinical and fundamental research around cancers related to HPV.
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Affiliation(s)
- C Badoual
- Service d'anatomie pathologique, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France; Inserm U 970, équipe 10, PARCC, France.
| | - J Pavie
- Service d'immunologie clinique, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - M Ménard
- Service d'ORL et chirurgie cervico-faciale, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - S Pernot
- Service de hépato-gastro-entérologie et oncologie digestive, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - B Cochand-Priollet
- Service d'anatomie pathologique, faculté Paris-Descartes, hôpital Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - S Hurel
- Service d'urologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - H Péré
- Laboratoire de virologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
| | - A-S Bats
- Service de gynécologie, faculté Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20-40, rue Leblanc, 75015 Paris, France
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Maqsood S, Jameson MB, De Groot C, Hartopeanu C, Yasin NABHM, Thotathil Z. Outcomes after primary intensity-modulated radiation therapy for oropharyngeal squamous cell carcinoma at a New Zealand regional cancer centre: Impact of p16 status. Cancer Rep (Hoboken) 2018; 1:e1001. [PMID: 32729235 DOI: 10.1002/cnr2.1001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The rising incidence of oropharyngeal squamous cell carcinoma (OPSCC) in New Zealand is due to an increase in the numbers of human papilloma virus (HPV)-associated OPSCC. We evaluated the impact of positive p16 immunohistochemistry, as a surrogate for HPV positivity, on OPSCC outcomes after primary intensity-modulated radiotherapy (IMRT) with or without concurrent chemotherapy. METHODS Retrospective review was undertaken of electronic medical records of 90 patients with OPSCC who received primary IMRT with or without chemotherapy between 2008 and mid-2015 at the Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand. RESULTS Median age was 57.5 years. Immunohistochemistry for p16 was positive in 53 (59%) OPSCC while 37 (41%) had negative or unknown p16 status. Median radiotherapy dose was 70 Gy. Chemotherapy was administered to 78 (87%) patients, most receiving high-dose cisplatin. Nine patients had residual disease following treatment completion. Seven patients relapsed, and 26 died during the study period. Five patients with p16-positive OPSCC had persistent or recurrent disease. Actuarial 3-year locoregional control, disease-free survival, and overall survival for all patients were 80.7%, 74.7%, and 77.1%, respectively. Among p16-positive OPSCC patients, 3-year locoregional control, disease-free survival, and overall survival were 89.5%, 80.8%, and 90.9%, respectively. CONCLUSION Outcomes after IMRT for OPSCC at Waikato Hospital are in line with the reported literature. Human papilloma virus-related OPSCC has better outcomes compared with patients with unknown or HPV-unrelated OPSCC. Trials are underway evaluating reduced intensity of treatment for HPV-related OPSCC.
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Affiliation(s)
- Saad Maqsood
- Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand
| | - Michael B Jameson
- Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand.,Waikato Clinical Campus, Faculty of Medical and Health Sciences, University of Auckland, Hamilton, New Zealand
| | | | | | | | - Ziad Thotathil
- Regional Cancer Centre, Waikato Hospital, Hamilton, New Zealand
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8
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Sims JR, Moore EJ. Primary surgical management with radial forearm free flap reconstruction in T4 oropharyngeal cancer: Complications and functional outcomes. Am J Otolaryngol 2018; 39:116-121. [PMID: 29279248 DOI: 10.1016/j.amjoto.2017.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 12/18/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Functional outcomes and complication rates after open surgery for advanced-stage oropharyngeal cancers are rarely reported. These measures are critical for choice of treatment modality and patient counseling. We describe the long term functional outcomes and associated complications of primary surgical management of T4 oropharyngeal cancers reconstructed with radial forearm free flaps. MATERIALS AND METHODS A retrospective review was performed of 40 patients with T4 oropharyngeal cancers treated between 2005 and 2015 at a tertiary care center. RESULTS Forty patients with T4 oropharyngeal cancers underwent open surgical resection and radial forearm free flap reconstruction at the time of surgery. Mandibulotomy was required in 33 (82.5%) cases. Thirty-five (87.5%) patients received adjuvant radiation or combined chemotherapy and radiation. Tracheostomy was performed in all patients, but every patient was eventually decannulated. Twenty (57.1%) patients required gastrostomy tube placement at some point during treatment; however, 91.4% were on a completely oral diet with a mean FOSS score of 1.6 by 1year after completion of treatment. The addition of adjuvant treatment was the only factor significantly associated with poorer FOSS scores. The overall rates of short and long-term complications were 60.0% and 57.1% respectively. The most common short and long-term complications were infection (30.0%) and velopharyngeal insufficiency (25.7%) respectively. CONCLUSIONS Traditional open surgical approaches to large tumors of the oropharynx carry higher complication rates than more recent advanced transoral approaches. However, they can still be utilized with excellent long-term functional results in certain cases of advance oropharyngeal cancers not amenable to transoral approaches. With careful reconstruction of oropharyngeal defects, over 90% of patients can achieve a completely oral diet.
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Affiliation(s)
- John R Sims
- Mayo Clinic, Department of Otorhinolaryngology, Rochester, MN, United States
| | - Eric J Moore
- Mayo Clinic, Department of Otorhinolaryngology, Rochester, MN, United States.
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9
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Vanderdys V, Allak A, Guessous F, Benamar M, Read PW, Jameson MJ, Abbas T. The Neddylation Inhibitor Pevonedistat (MLN4924) Suppresses and Radiosensitizes Head and Neck Squamous Carcinoma Cells and Tumors. Mol Cancer Ther 2018; 17:368-380. [PMID: 28838998 PMCID: PMC5805645 DOI: 10.1158/1535-7163.mct-17-0083] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 07/06/2017] [Accepted: 08/17/2017] [Indexed: 11/16/2022]
Abstract
The cullin RING E3 ubiquitin ligase 4 (CRL4) with its substrate receptor CDT2 (CRL4-CDT2) is emerging as a critical regulator of DNA replication through targeting CDT1, SET8, and p21 for ubiquitin-dependent proteolysis. The aberrant increased stability of these proteins in cells with inactivated CRL4-CDT2 results in DNA rereplication, which is deleterious to cells due to the accumulation of replication intermediates and stalled replication forks. Here, we demonstrate that CDT2 is overexpressed in head and neck squamous cell carcinoma (HNSCC), and its depletion by siRNA inhibits the proliferation of human papilloma virus-negative (HPV-ve) HNSCC cells primarily through the induction of rereplication. Treatment of HNSCC with the NEDD8-activating enzyme inhibitor pevonedistat (MLN4924), which inhibits all cullin-based ligases, induces significant rereplication and inhibits HNSCC cell proliferation in culture and HNSCC xenografts in mice. Pevonedistat additionally sensitizes HNSCC cells to ionizing radiation (IR) and enhances IR-induced suppression of xenografts in mice. Induction of rereplication via CDT2 depletion, or via the stabilization or activation of CDT1, also radiosensitizes HNSCC cells. Collectively, these results demonstrate that induction of rereplication represents a novel approach to treating radioresistant HNSCC tumors and suggest that pevonedistat may be considered as an adjuvant for IR-based treatments. Mol Cancer Ther; 17(2); 368-80. ©2017 AACRSee all articles in this MCT Focus section, "Developmental Therapeutics in Radiation Oncology."
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Affiliation(s)
- Vanessa Vanderdys
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Amir Allak
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - Fadila Guessous
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Mouadh Benamar
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, Virginia
| | - Paul W Read
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia
| | - Mark J Jameson
- Department of Otolaryngology, Head and Neck Surgery, University of Virginia, Charlottesville, Virginia
| | - Tarek Abbas
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia.
- Department of Biochemistry and Molecular Genetics, University of Virginia, Charlottesville, Virginia
- Center for Cell Signaling, University of Virginia, Charlottesville, Virginia
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10
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Sims JR, Van Abel K, Martin EJ, Lohse CM, Price DL, Olsen KD, Moore EJ. Management of Recurrent and Metastatic HPV-Positive Oropharyngeal Squamous Cell Carcinoma after Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2017; 157:69-76. [DOI: 10.1177/0194599817696304] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC). Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods A total of 286 patients with HPV-positive OPSCC who underwent transoral robotic surgery–based treatment from May 2007 to May 2015. Results Of 286 patients (12.2%), 35 met inclusion criteria. Of these, 19 experienced an LRR and 16 developed a DM; 2 patients with LRR subsequently developed DM. In those patients with an LRR, 79% had T1/T2 tumors, and 47% had N0/N1 nodal disease, compared with 75% and 6% in the DM group, respectively. The median time to LRR or DM was 0.6 years (interquartile range [IQR], 0.4-1.0) and 1.8 years (IQR, 1.0-2.1), respectively. Salvage treatment with intent to cure was attempted in 23 patients (16 LRR, 7 DM). The median time from LRR or DM to last follow-up for the 18 patients who were still alive after salvage was 1.9 years (IQR, 0.4-3.8; range, 7 days–6.2 years). Estimated cancer-specific survival rates at 3 years following intent-to-cure treatment were 63% (95% CI, 39-100; number still at risk, 5) in the LRR group and 100% (95% CI, 100-100; number still at risk, 2) in the DM group. Conclusion Overall, LRR and DM for HPV-positive OPSCC following transoral robotic surgery–based therapy are infrequent. In our subset of patients who underwent intent-to-cure treatment, cancer-specific survival rates were favorable. Therefore, aggressive salvage treatment for LRR and DM for HPV-positive OPSCC should be recommended for appropriate candidates.
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Affiliation(s)
- John R. Sims
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eliot J. Martin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M. Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L. Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D. Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Bird T, De Felice F, Michaelidou A, Thavaraj S, Jeannon JP, Lyons A, Oakley R, Simo R, Lei M, Guerrero Urbano T. Outcomes of intensity-modulated radiotherapy as primary treatment for oropharyngeal squamous cell carcinoma - a European singleinstitution analysis. Clin Otolaryngol 2016; 42:115-122. [DOI: 10.1111/coa.12674] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/12/2022]
Affiliation(s)
- T. Bird
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - F. De Felice
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - A. Michaelidou
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - S. Thavaraj
- Department of Pathology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - J.-P. Jeannon
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - A. Lyons
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - R. Oakley
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - R. Simo
- Department of Head & Neck Surgery; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - M. Lei
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
| | - T. Guerrero Urbano
- Department of Clinical Oncology; Guy's & St Thomas’ NHS Foundation Trust; London UK
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12
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Fusco N, Guerini-Rocco E, Del Gobbo A, Franco R, Zito-Marino F, Vaira V, Bulfamante G, Ercoli G, Nosotti M, Palleschi A, Bosari S, Ferrero S. The Contrasting Role of p16Ink4A Patterns of Expression in Neuroendocrine and Non-Neuroendocrine Lung Tumors: A Comprehensive Analysis with Clinicopathologic and Molecular Correlations. PLoS One 2015; 10:e0144923. [PMID: 26674347 PMCID: PMC4684221 DOI: 10.1371/journal.pone.0144923] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 11/26/2015] [Indexed: 11/24/2022] Open
Abstract
Lung cancer encompasses a constellation of malignancies with no validated prognostic markers. p16Ink4A expression has been reported in different subtypes of lung cancers; however, its prognostic value is controversial. Here, we sought to investigate the clinical significance of p16Ink4A immunoexpression according to specific staining patterns and its operational implications. A total of 502 tumors, including 277 adenocarcinomas, 84 squamous cell carcinomas, 22 large cell carcinomas, 47 typical carcinoids, 12 atypical carcinoids, 28 large cell neuroendocrine carcinomas, and 32 small cell carcinomas were reviewed and subjected to immunohistochemical analysis for p16Ink4A and Ki67. The spectrum of p16Ink4A expression was annotated for each case as negative, sporadic, focal, or diffuse. Expression at immunohistochemical level showed intra-tumor homogeneity, regardless tumor histotype. Enrichments in cells expressing p16Ink4A were observed from lower- to higher-grade neuroendocrine malignancies, whereas a decrease was seen in poorly and undifferentiated non-neuroendocrine carcinomas. Tumor proliferation indices were higher in neuroendocrine tumors expressing p16Ink4A while non-neuroendocrine malignancies immunoreactive for p16Ink4A showed a decrease in Ki67-positive cells. Quantitative statistical analyses including each histotype and the p16Ink4A status confirmed the independent prognostic role of p16Ink4A expression, being a high-risk indicator in neuroendocrine tumors and a marker of good prognosis in non-neuroendocrine lung malignancies. In this study, we provide circumstantial evidence to suggest that the routinary assessment of p16Ink4A expression using a three-tiered scoring algorithm, even in a small biopsy, may constitute a reliable, reproducible, and cost-effective substrate for a more accurate risk stratification of each individual patient.
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Affiliation(s)
- Nicola Fusco
- Division of Pathology, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Guerini-Rocco
- Division of Pathology, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Del Gobbo
- Division of Pathology, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Renato Franco
- Department of Pathology, Istituto Nazionale Tumori—IRCCS Fondazione Pascale, Naples, Italy
| | - Federica Zito-Marino
- Department of Pathology, Istituto Nazionale Tumori—IRCCS Fondazione Pascale, Naples, Italy
| | - Valentina Vaira
- Istituto Nazionale Genetica Molecolare “Romeo ed Enrica Invernizzi”, Milan, Italy
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
| | - Gaetano Bulfamante
- Division of Pathology, San Paolo Hospital; Department of Health Sciences, University of Milan, Milan, Italy
| | - Giulia Ercoli
- Division of Pathology, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
| | - Mario Nosotti
- Division of Thoracic Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Division of Thoracic Surgery, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvano Bosari
- Division of Pathology, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
| | - Stefano Ferrero
- Division of Pathology, Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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Yeh DH, Tam S, Fung K, MacNeil SD, Yoo J, Winquist E, Palma DA, Nichols AC. Transoral robotic surgery vs. radiotherapy for management of oropharyngeal squamous cell carcinoma - A systematic review of the literature. Eur J Surg Oncol 2015; 41:1603-14. [PMID: 26461255 DOI: 10.1016/j.ejso.2015.09.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) with or without concurrent chemotherapy is widely utilized for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). However, due to significant acute and late toxicities there has been increasing interest in minimally invasive surgical approaches, particularly transoral robotic surgery (TORS) in an attempt to preserve patient quality of life while maintaining oncologic outcomes. The aim of this study was to review the current literature in order to compare primary IMRT versus TORS in the management of OPSCC. METHODS A MEDLINE search was conducted to identify studies reporting on the outcomes of TORS or IMRT in the treatment of OPSCC. Reference lists were also reviewed for relevant articles. Oncologic, functional, and quality of life data is summarized and discussed. RESULTS One hundred-ninety papers were identified through the MEDLINE search. An additional 52 papers were retrieved by hand searching the reference lists. Ultimately, 44 papers were identified that discussed outcomes after IMRT or TORS for OPSCC. No outcomes from randomized trials were identified. CONCLUSION No randomized trials comparing TORS versus IMRT to each other were identified. Uncontrolled reports from the current literature suggest comparable oncologic outcomes with TORS compared to IMRT and functional outcomes may be superior. However, the median follow-up was relatively short and the TORS studies included patients with earlier stage OPSCC on average compared to IMRT studies. Prospective, randomized controlled trials and direct, well-matched comparisons are needed to further elucidate the role for TORS in the treatment of oropharyngeal squamous cell carcinoma.
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Affiliation(s)
- D H Yeh
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada
| | - S Tam
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada
| | - K Fung
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - S D MacNeil
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - J Yoo
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - E Winquist
- London Health Sciences Centre, London, Ontario, Canada; Division of Medical Oncology, Western University, London, Ontario Canada
| | - D A Palma
- London Health Sciences Centre, London, Ontario, Canada; Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - A C Nichols
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
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14
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Ye A, Bradley KL, Kader H, Wu J, Hay JH. Patterns of Relapse in Squamous Cell Carcinoma of the Tonsil - Unilateral vs. Bilateral Radiation in the HPV-Era. Cureus 2015; 7:e322. [PMID: 26487998 PMCID: PMC4601887 DOI: 10.7759/cureus.322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES In the pre-human papillomavirus (HPV) era, unilateral radiation therapy (URT) for tonsil cancer was associated with low contralateral failure rates and had less toxicity than bilateral radiation therapy (BRT). This study explores the validity of URT in HPV-positive tonsil cancers. METHODS Tonsil squamous cell carcinomas (SCC) treated (typically with 70 Gy radiation and Cisplatin-based chemotherapy) between 2001 and 2007 were reviewed. Retrospective p16 immunohistochemistry staining was undertaken. Baseline, treatment, and response data were collected. RESULTS Of 182 patients, 78% were p16-positive, were younger (predominantly male), mostly former or non-smokers, and had a more advanced nodal stage. With a median follow-up of 68 months, contralateral recurrence (CLR) rates were low (3.5% p16-positive versus 2.5% p16-negative, p=0.63). Overall survival (OS) was 74% for p16-positive versus 54% for p16-negative subjects (p=0.01), but all other outcomes were similar. Analysis amongst only p16-positive subjects revealed URT was delivered to 37%, with CLR rates of 7.5% versus 1.1% for those treated with BRT, p=0.05. Of the four p16-positive subjects treated with URT who developed contralateral recurrences, three were managed with neck dissection (two disease-free and one died of lung metastases) and one received palliative radiation to the neck and distant metastatic site. All disease control and survival outcomes were similar between those treated with URT versus BRT. CONCLUSION While CLRs remain rare overall, there appears to be a slightly increased rate among HPV-positive subjects treated with URT. However, overall outcomes do not appear to be impacted, suggesting that URT remains a reasonable approach in HPV-positive subjects.
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Affiliation(s)
- Allison Ye
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Cancer Centre
| | | | - Hosam Kader
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Cancer Centre
| | - John Wu
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Cancer Centre
| | - John H Hay
- Department of Radiation Oncology, British Columbia Cancer Agency - Vancouver Cancer Centre
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p16 status and interval neck dissection findings after a ‘clinically complete response’ to chemoradiotherapy in oropharyngeal squamous cell carcinoma. The Journal of Laryngology & Otology 2015; 129:801-6. [DOI: 10.1017/s0022215115001139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectives:To evaluate the histopathological findings from post-treatment neck dissection of p16 positive and negative oropharyngeal carcinoma cases, after completion of chemoradiotherapy, and to question the role of neck dissection after a ‘clinically complete response’ to chemoradiotherapy.Methods:Data were collected retrospectively from a cohort of patients treated with curative intent using chemoradiotherapy and post-treatment neck dissection. Primary tumours underwent p16 immunohistochemistry. Neck dissection specimens were examined for viable cancer cells.Results:A total of 76 cases were assessed. Viable cancer cells were detected from neck dissection in 29 per cent of p16 negative cases. Locoregional recurrence occurred in 12.9 per cent of p16 negative cases. The association between p16 positivity in the primary tumour and histopathologically negative neck dissection was significant (p < 0.05).Conclusion:p16 status appeared to be an independent marker of disease control for the cohort in this study. The data raise questions about the role of post-treatment neck dissection in p16 positive cases with a ‘clinically complete response’ to chemoradiotherapy.
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16
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Barry B, Ortholan C. [Human papilloma virus in head and neck cancer]. Cancer Radiother 2014; 18:430-3. [PMID: 25151649 DOI: 10.1016/j.canrad.2014.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 06/19/2014] [Indexed: 01/27/2023]
Abstract
Head and neck cancer is frequently associated with alcohol and tobacco consumption but there is an increasing incidence of oropharyngeal carcinoma associated with oncogenic type-16 human papillomavirus (HPV). The clinical profile of these patients is distinct from that of other patients, with an earlier onset, 1/1 male to female sex ratio, cystic cervical nodes. Detection of intratumoral viral DNA is essential to confirm the role of HPV. According to several reports, the prognosis in terms of survival and locoregional control is better in HPV-positive oropharyngeal carcinoma than in HPV-negative oropharyngeal carcinoma or associated with tobacco consumption. The future lies in vaccination of women against cervical cancer but vaccination of boys will be certainly necessary.
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Affiliation(s)
- B Barry
- Service ORL, hôpital Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75877 Paris cedex 18, France
| | - C Ortholan
- Service de radiothérapie, centre hospitalier Princesse-Grace, avenue Pasteur, 98000 Monaco, Monaco.
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17
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Petrelli F, Sarti E, Barni S. Predictive value of human papillomavirus in oropharyngeal carcinoma treated with radiotherapy: An updated systematic review and meta-analysis of 30 trials. Head Neck 2013; 36:750-9. [DOI: 10.1002/hed.23351] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/27/2013] [Accepted: 04/09/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Fausto Petrelli
- Medical Oncology Unit; Oncology Department; Azienda Ospedaliera Treviglio, Piazzale Ospedale 1 24047 Treviglio (BG) Italy
| | - Enrico Sarti
- Radiotherapy Unit; Oncology Department; Azienda Ospedaliera Treviglio, Piazzale Ospedale 1 24047 Treviglio (BG) Italy
| | - Sandro Barni
- Medical Oncology Unit; Oncology Department; Azienda Ospedaliera Treviglio, Piazzale Ospedale 1 24047 Treviglio (BG) Italy
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18
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May JT, Rao N, Sabater RD, Boutrid H, Caudell JJ, Merchant F, Han G, Padhya TA, McCaffrey JC, Tanvetyanon T, Deconti R, Kish J, McCaffrey TV, Trotti A. Intensity-modulated radiation therapy as primary treatment for oropharyngeal squamous cell carcinoma. Head Neck 2013; 35:1796-800. [PMID: 23468387 DOI: 10.1002/hed.23245] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2012] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Over the past decade, intensity-modulated radiation therapy (IMRT) has gained widespread use in the treatment of head and neck cancer. METHODS All patients with squamous cell carcinoma of the oropharynx treated with primary IMRT with or without chemotherapy over a 5-year period were reviewed. Outcomes and morbidity were analyzed and compared with previously published data. RESULTS In all, 170 patients were included in the analysis. The 3-year local control, locoregional control, disease-free survival, and overall survival rates were 92%, 91%, 80%, and 87%, respectively. Feeding tubes were present in 55% of patients during treatment, but remained in only 1% 2 years following treatment. CONCLUSIONS This study confirms that IMRT yields excellent treatment outcomes for oropharyngeal carcinoma. Although acute toxicity remains a problem, late toxicity rates are low and long-term feeding tube dependence is rare compared with conventional radiation therapy.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Humanized/therapeutic use
- Antineoplastic Agents/therapeutic use
- Carboplatin/therapeutic use
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Cetuximab
- Chemotherapy, Adjuvant
- Cisplatin/therapeutic use
- Disease-Free Survival
- Enteral Nutrition
- Female
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Oropharyngeal Neoplasms/drug therapy
- Oropharyngeal Neoplasms/mortality
- Oropharyngeal Neoplasms/pathology
- Oropharyngeal Neoplasms/radiotherapy
- Radiotherapy Planning, Computer-Assisted
- Radiotherapy, Intensity-Modulated/adverse effects
- Retrospective Studies
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Affiliation(s)
- James T May
- Head and Neck Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Psychogios G, Mantsopoulos K, Agaimy A, Koch M, Zenk J, Waldfahrer F, Iro H. Prognostic factors in limited (T1-2, N0-1) oropharyngeal carcinoma treated with surgery ± adjuvant therapy. Head Neck 2013; 35:1752-8. [DOI: 10.1002/hed.23229] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2012] [Indexed: 11/08/2022] Open
Affiliation(s)
- Georgios Psychogios
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Konstantinos Mantsopoulos
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Abbas Agaimy
- Institute of Pathology; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Michael Koch
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Johannes Zenk
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Frank Waldfahrer
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology; Head and Neck Surgery; Friedrich Alexander University of Erlangen-Nuremberg; Erlangen Germany
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20
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Volumetric staging in oropharyngeal cancer patients treated with definitive IMRT. Oral Oncol 2013; 49:269-76. [DOI: 10.1016/j.oraloncology.2012.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 09/22/2012] [Accepted: 09/26/2012] [Indexed: 11/21/2022]
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21
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Badoual C, Righini C, Barry B, Bertolus C, Nadéri S, Morinière S, de Raucourt D. Pre-therapeutic histological and cytological assessment in head and neck squamous cell carcinomas. French Society of Otorhinolaryngology Guidelines – 2012. Eur Ann Otorhinolaryngol Head Neck Dis 2012. [DOI: 10.1016/j.anorl.2012.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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22
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Sandulache VC, Ow TJ, Daram SP, Hamilton J, Skinner H, Bell D, Rosenthal DI, Beadle BM, Ang KK, Kies MS, Johnson FM, El-Naggar AK, Myers JN. Residual nodal disease in patients with advanced-stage oropharyngeal squamous cell carcinoma treated with definitive radiation therapy and posttreatment neck dissection: Association with locoregional recurrence, distant metastasis, and decreased survival. Head Neck 2012; 35:1454-60. [DOI: 10.1002/hed.23173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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23
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Rahimi AS, Wilson DD, Saylor DK, Stelow EB, Thomas CY, Reibel JF, Levine PA, Shonka DC, Jameson MJ, Read PW. p16, Cyclin D1, and HIF-1α Predict Outcomes of Patients with Oropharyngeal Squamous Cell Carcinoma Treated with Definitive Intensity-Modulated Radiation Therapy. Int J Otolaryngol 2012; 2012:685951. [PMID: 22888357 PMCID: PMC3409529 DOI: 10.1155/2012/685951] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 05/30/2012] [Accepted: 05/31/2012] [Indexed: 12/28/2022] Open
Abstract
We evaluated a panel of 8 immunohistochemical biomarkers as predictors of clinical response to definitive intensity-modulated radiotherapy in patients with oropharyngeal squamous cell carcinoma (OPSCC). 106 patients with OPSCC were treated to a total dose of 66-70 Gy and retrospectively analyzed for locoregional control (LRC), disease-free survival (DFS), and overall survival (OS). All tumors had p16 immunohistochemical staining, and 101 tumors also had epidermal growth factor receptor (EGFR) staining. 53% of the patients had sufficient archived pathologic specimens for incorporation into a tissue microarray for immunohistochemical analysis for cyclophilin B, cyclin D1, p21, hypoxia-inducible factor-1α (HIF-1α), carbonic anhydrase, and major vault protein. Median followup was 27.2 months. 66% of the tumors were p16 positive, and 34% were p16 negative. On univariate analysis, the following correlations were statistically significant: p16 positive staining with higher LRC (P = 0.005) and longer DFS (P < 0.001); cyclin D1 positive staining with lower LRC (P = 0.033) and shorter DFS (P = 0.002); HIF-1α positive staining with shorter DFS (P = 0.039). On multivariate analysis, p16 was the only significant independent predictor of DFS (P = 0.023). After immunohistochemical examination of a panel of 8 biomarkers, our study could only verify p16 as an independent prognostic factor in OPSCC.
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Affiliation(s)
- Asal S. Rahimi
- Department of Radiation Oncology, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - David D. Wilson
- Department of Radiation Oncology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
| | - Drew K. Saylor
- Department of Radiation Oncology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
| | - Edward B. Stelow
- Department of Pathology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
| | - Christopher Y. Thomas
- Division of Hematology and Oncology, School of Medicine, Wake Forest University, Watlington 1, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - James F. Reibel
- Department of Otolaryngology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
| | - Paul A. Levine
- Department of Otolaryngology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
| | - David C. Shonka
- Department of Otolaryngology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
| | - Mark J. Jameson
- Department of Otolaryngology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
| | - Paul W. Read
- Department of Radiation Oncology, University of Virginia, P.O. Box 800383, Charlottesville, VA 22908, USA
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Thariat J, Hamoir M, Garrel R, Cosmidis A, Dassonville O, Janot, Righini CA, Vedrine PO, Prades JM, Lacau-Saint-Guily J, Jegoux F, Malard O, De Mones E, Benlyazid A, Bensadoun RJ, Baujat B, Merol JC, Ferron C, Scavennec C, Salvan D, Mallet Y, Moriniere S, Vergez S, Choussy O, Dollivet G, Guevara N, Ceruse P, De Raucourt D, Lallemant B, Lawson G, Lindas P, Poupart M, Duflo S, Dufour X. Management of the Neck in the Setting of Definitive Chemoradiation: Is There a Consensus? A GETTEC Study. Ann Surg Oncol 2012; 19:2311-9. [DOI: 10.1245/s10434-012-2275-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Indexed: 11/18/2022]
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25
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Postradiotherapy Neck Dissection: An Obsolete Treatment Paradigm? Int J Radiat Oncol Biol Phys 2012; 82:502-4. [DOI: 10.1016/j.ijrobp.2011.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 07/27/2011] [Indexed: 11/24/2022]
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26
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Loss of heterozygosity of D9S162: Molecular predictor for treatment response in oral carcinoma. Oral Oncol 2011; 47:571-6. [DOI: 10.1016/j.oraloncology.2011.04.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 03/30/2011] [Accepted: 04/18/2011] [Indexed: 11/23/2022]
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27
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Outcomes of patients with head-and-neck cancer of unknown primary origin treated with intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2011; 81:e83-91. [PMID: 21377283 DOI: 10.1016/j.ijrobp.2011.01.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 01/16/2011] [Accepted: 02/22/2011] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyze survival, failure patterns, and toxicity in patients with head-and-neck carcinoma of unknown primary origin (HNCUP) treated with intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS Records from 27 patients with HNCUP treated during the period 2002-2008 with IMRT were reviewed retrospectively. Nodal staging ranged from N1 to N3. The mean preoperative dose to gross or suspected disease, Waldeyer's ring, and uninvolved bilateral cervical nodes was 59.4, 53.5, and 51.0 Gy, respectively. Sixteen patients underwent neck dissection after radiation and 4 patients before radiation. Eight patients with advanced nodal disease (N2b-c, N3) or extracapsular extension received chemotherapy. RESULTS With a median follow-up of 41.9 months (range, 25.3-93.9 months) for non deceased patients, the 5-year actuarial overall survival, disease-free survival, and nodal control rates were 70.9%, 85.2%, and 88.5%, respectively. Actuarial disease-free survival rates for N1, N2, and N3 disease were 100%, 94.1%, and 50.0%, respectively, at 5 years. When stratified by non advanced (N1, N2a nodal disease without extracapsular spread) vs. advanced nodal disease (N2b, N2c, N3), the 5-year actuarial disease-free survival rate for the non advanced nodal disease group was 100%, whereas for the advanced nodal disease group it was significantly lower at 66.7% (p = 0.017). Three nodal recurrences were observed: in 1 patient with bulky N2b disease and 2 in patients with N3 disease. No nodal failures occurred in patients with N1 or N2a disease who received only radiation and surgery. CONCLUSION Definitive IMRT to 50-56 Gy followed by neck dissection results in excellent nodal control and overall and disease-free survival, with acceptable toxicity for patients with T0N1 or non bulky T0N2a disease without extracapsular spread. Patients with extracapsular spread, advanced N2 disease, or N3 disease may benefit from concurrent chemotherapy, targeted therapeutic agents, or accelerated radiation regimens in addition to surgery.
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