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Are we ready for deintensification in human papillomavirus-positive oropharyngeal carcinomas? Curr Opin Otolaryngol Head Neck Surg 2023; 31:118-128. [PMID: 36912224 DOI: 10.1097/moo.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW Excellent outcomes following contemporary treatment of human papillomavirus (HPV)-positive oropharyngeal carcinoma (HPV+ OPC) have prompted the exploration of deintensification approaches to minimize treatment-related toxicities. This review describes the landscape of deintensification to date (up to November 2022). RECENT FINDINGS Although several deintensification trials have been published, none are practice changing. Three phase III randomized-controlled trials studying cetuximab and radiation therapy vs. standard chemoradiotherapy all showed inferior outcomes. Although some phase II trials reported favourable outcomes, they are often single-arm trials without an adequate control arm, thereby limiting the ability to modify practice. SUMMARY Substantial effort has been expended to explore deintensification options for selected HPV+ OPC patients aiming to avoid unnecessary toxicity. Strategies have included replacing cisplatin with cetuximab, reduced chemotherapy or radiotherapy intensity, reduction of radiotherapy volumes and risk stratification after trans-oral surgery or following induction chemotherapy. Challenges remain in the current deintensification landscape, including identifying the most suitable candidates along with a choice of most appropriate deintensification strategies. Promising selection criteria included either static baseline features or kinetic characteristics of clinical-biological parameters. Practice-changing trials remain elusive, and the search continues to attempt optimization of the therapeutic ratio for these patients.
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Meccariello G, Catalano A, Cammaroto G, Iannella G, Vicini C, Hao SP, De Vito A. Treatment Options in Early Stage (Stage I and II) of Oropharyngeal Cancer: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58081050. [PMID: 36013517 PMCID: PMC9415053 DOI: 10.3390/medicina58081050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: to show an overview on the treatments’ options for stage I and II oropharyngeal carcinomasquamous cell carcinoma (OPSCC). Background: The traditional primary treatment modality of OPSCC at early stages is intensity modulated radiation therapy (IMRT). Trans-oral robotic surgery (TORS) has offered as an alternative, less invasive surgical option. Patients with human papilloma virus (HPV)-positive OPSCC have distinct staging with better overall survival in comparison with HPV-negative OPSCC patients. Methods: a comprehensive review of the English language literature was performed using PubMed, EMBASE, the Cochrane Library, and CENTRAL electronic databases. Conclusions: Many trials started examining the role of TORS in de-escalating treatment to optimize functional consequences while maintaining oncologic outcome. The head–neck surgeon has to know the current role of TORS in HPV-positive and negative OPSCC and the ongoing trials that will influence its future implementation. The feasibility of this treatment, the outcomes ensured, and the side effects are key factors to consider for each patient. The variables reported in this narrative review are pieces of a bigger puzzle called tailored, evidence-based driven medicine. Future evidence will help in the construction of robust and adaptive algorithms in order to ensure the adequate treatment for the OPSCC at early stages.
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Affiliation(s)
- Giuseppe Meccariello
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Andrea Catalano
- Otolaryngology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanni Cammaroto
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Giannicola Iannella
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Claudio Vicini
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Sheng-Po Hao
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, School of Medicine, Fu-Jen University, Taipei 111, Taiwan
| | - Andrea De Vito
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Santa Maria delle Croci Hospital, Health Local Agency of Romagna, 48121 Ravenna, Italy
- Correspondence:
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Level IV neck dissection in cN0 HPV-negative oropharyngeal squamous cell carcinoma: a retrospective cohort study. BMC Cancer 2022; 22:535. [PMID: 35549914 PMCID: PMC9097444 DOI: 10.1186/s12885-022-09609-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As opposed to observation of the neck, elective neck dissection has a survival benefit for cN0 oropharyngeal squamous cell carcinoma (OPSCC). However, there are limited date on level IV neck dissection in human papillomavirus (HPV)-negative OPSCC because most earlier studies did not stratify by P16 or HPV status. Thus, whether to exclude level IV from selective dissection (SND) of cN0 HPV-negative OPSCC remains controversial. METHODS In this single-center retrospective cohort study, disease-free survival (DFS) was estimated as the primary endpoint for 124 cN0 HPV-negative OPSCC patients who received SND of levels I-III (Group A) and I-IV (Group B). Overall survival (OS) and disease-specific survival (DSS) were considered secondary endpoints. RESULTS For the entire cohort, the 5-year DFS rates of Groups A and B were 55.0% and 60.1%, respectively. Five-year OS rates were 58.9% and 61.5%, and 5-year DSS rates were 74.0% and 64.8%, respectively. Group B did not show higher 5-year DFS, OS, or DSS than Group A. CONCLUSIONS This retrospective cohort study validated that in cN0 HPV-negative OPSCC, SND including level IV does not have substantial benefits regarding DFS, OS or DSS.
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Petrelli F, Luciani A, Ghidini A, Cherri S, Gamba P, Maddalo M, Bossi P, Zaniboni A. Treatment de-escalation for HPV+ oropharyngeal cancer: A systematic review and meta-analysis. Head Neck 2022; 44:1255-1266. [PMID: 35238114 DOI: 10.1002/hed.27019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022] Open
Abstract
Human Papillomavirus (HPV) related oropharyngeal carcinoma (OPC) carries a better prognosis compared with HPV-counterparts, thereby pushing the adoption of de-intensification treatment approaches as new strategies to preserve superior oncologic outcomes while minimizing toxicity. We evaluated the effect of treatment de-intensification in terms of overall survival (OS), progression-free survival (PFS), locoregional and distant control (LRC and DM) by selecting prospective or retrospective studies, providing outcome data with reduced intensification versus standard curative treatment in HPV+ OPC patients, with a systematic analysis till September 2020. The primary outcome of interest was OS. Secondary endpoints were PFS, LRC, and DM expressed as HR. A total of 55 studies (from 1393 screened references) were employed for quantitative synthesis for 38 929 patients. Among n = 48 studies with data available, de-intensified treatments reduced OS in HPV+ OPCs (HR = 1.33, 95% CI 1.17-1.52; p < 0.01). In de-escalated treatments, PFS was also decreased (HR = 2.11, 95% CI 1.65-2.69; p < 0.01). Compared with standard treatments, reduced intensity approaches were associated with reduced locoregional and distant disease control (HR = 2.51, 95% CI 1.75-3.59; p < 0.01; and HR = 1.9, 95% CI 1.25-2.9; p < 0.01). Chemoradiation improved survival in a definitive curative setting compared with radiotherapy alone (HR = 1.42, 95% CI 1.16-1.75; p < 0.01). When adjuvant treatments were compared, standard and de-escalation strategies provided similar OS. In conclusion, in patients with HPV+ OPC, de-escalation treatments should not be widely and agnostically adopted in clinical practice, as therein lies a concrete risk of offering a sub-optimal treatment to patients.
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Affiliation(s)
| | | | | | - Sara Cherri
- Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Gamba
- Otolaryngology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Marta Maddalo
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, Public Health, University of Brescia, Brescia, Italy
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Högmo A, Holmberg E, Haugen Cange H, Reizenstein J, Wennerberg J, Beran M, Söderkvist K, Hammerlid E, Sjödin H, Farnebo L, Sandström K, Hammarstedt-Nordenvall L, Zborayova K, Brun E. Base of tongue squamous cell carcinomas, outcome depending on treatment strategy and p16 status. A population-based study from the Swedish Head and Neck Cancer Register. Acta Oncol 2022; 61:433-440. [PMID: 35081863 DOI: 10.1080/0284186x.2022.2027516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The base of tongue squamous cell carcinoma (BOTSCC) is mainly an HPV-related tumor. Radiotherapy (EBRT) ± concomitant chemotherapy (CT) is the backbone of the curatively intended treatment, with brachytherapy (BT) boost as an option. With four different treatment strategies in Sweden, a retrospective study based on the population-based Swedish Head and Neck Cancer Register (SweHNCR) was initiated. MATERIAL AND METHODS Data on tumors, treatment and outcomes in patients with BOTSCC treated between 2008 and 2014 were validated through medical records and updated as needed. Data on p16 status were updated or completed with immunohistochemical analysis of archived tumor material. Tumors were reclassified according to the UICC 8th edition. RESULTS Treatment was EBRT, EBRT + CT, EBRT + BT or EBRT + CT + BT in 151, 145, 82 and 167 patients respectively (n = 545). A p16 analysis was available in 414 cases; 338 were p16+ and 76 p16-. 5-year overall survival (OS) was 68% (95% CI: 64-72%), with76% and 37% for p16+ patients and p16- patients, respectively. An increase in OS was found with the addition of CT to EBRT for patients with p16+ tumors, stages II-III, but for patients with tumor stage I, p16+ (UICC 8) none of the treatment strategies was superior to EBRT alone. CONCLUSION In the present retrospective population-based study of BOTSCC brachytherapy was found to be of no beneficial value in curatively intended treatment. An increase in survival was found for EBRT + CT compared to EBRT alone in patients with advanced cases, stages II and III (UICC 8), but none of the regimes was significantly superior to EBRT as a single treatment modality for stage I (UICC 8), provided there was p16 positivity in the tumor. In the small group of patients with p16- tumors, a poorer prognosis was found, but the small sample size did not allow any comparisons between different treatment strategies.
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Affiliation(s)
- Anders Högmo
- Regional Cancer Centre West, Region Västra Götaland, Gothenburg, Sweden
| | - Erik Holmberg
- Regional Cancer Centre West, Region Västra Götaland, Gothenburg, Sweden
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden
| | - Hedda Haugen Cange
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Johan Wennerberg
- Otolaryngology/H&N Surgery, Department of Clinical Sciences, Lund University and University Hospital of Scania, Lund, Sweden
| | - Martin Beran
- Department of ENT and Maxillofacial Surgery, NAL Medical Center Hospital, Trollhättan, Sweden
| | - Karin Söderkvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå and Cancercentre, Umeå University Hospital, Umeå, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Sjödin
- Department of Oncology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Lovisa Farnebo
- Department of Otorhinolaryngology – Head and Neck Surgery in Östergötland, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Karl Sandström
- Otolaryngology, Department of Surgical Sciences, Uppsala University and University Hospital, Uppsala, Sweden
| | - Lalle Hammarstedt-Nordenvall
- Division of Ear, Nose, and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Katarina Zborayova
- Department of Clinical Sciences, Division of Otorhinolaryngology, Umeå University and University Hospital, Umeå, Sweden
| | - Eva Brun
- Oncology, Department of Clinical Sciences, Lund University and University Hospital of Scania, Lund, Sweden
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Vijayvargiya P, Trivedi S, Rupji M, Song H, Liu Y, Jiang R, Kaka AS, Chen GZ, Stokes W, Steuer C, Shin DM, Beitler JJ, Patel MR, Aiken A, Saba NF. Comparison of the Seventh and Eighth Edition of American Joint Committee on Cancer (AJCC) Staging for Selected and Nonselected Oropharyngeal Squamous Cell Carcinomas. Oncologist 2022; 27:48-56. [PMID: 35305095 PMCID: PMC8842371 DOI: 10.1093/oncolo/oyab001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The eighth edition American Joint Committee on Cancer (AJCC) Staging incorporates significant changes to the seventh edition in the staging of oropharyngeal squamous cell carcinomas (OPSCC). An important change was the inclusion of OPSCC associated with the human papilloma virus (HPV). Our goal is to compare the performance of both staging systems for patients with HPV-selected and unselected clinical characteristics for OPSCC. METHODS Using the Surveillance, Epidemiology, and End Results (SEER) database, 2004-2016, we identified patients with likely HPV-associated OPSCC based on surrogate markers (white males aged <65 years old with squamous cell carcinomas of the tonsil and base of tongue), excluding those who underwent surgery. We re-classified these patients using seventh and eighth edition staging for HPV-selected OPSCC and compared the prediction performance of both staging editions for overall survival (OS) and disease-specific survival (DSS). We performed the same analysis for clinically unselected patients with OPSCC. RESULTS Our analysis included 9554 patients with a median follow-up of 67 months. Comparing the eighth versus seventh edition for our HPV-selected cohort, clinical staging changed for 92.3% of patients and 10-year OS was 62.2%, 61.2%, 35.3%, and 15.5% for Stage I, II, III, and IV, versus 52.9%, 59.2%, 61.6%, 55.1%, 38.3%, and 15.5% for stage I, II, III, IVA, IVB, and IVC, respectively. A similar pattern was observed for 10-year DSS. The concordance statistics for our HPV-selected cohort were improved for both AJCC 7 (0.6260) and AJCC 8 (0.6846) compared with the unselected cohort, 0.5860 and 0.6457 for AJCC 7 and 8, respectively. CONCLUSION The overall performance of discrimination improved from AJCC 7 to AJCC 8 for both clinically selected and unselected patients, but more notably for our HPV-selected cohort. Despite the lack of statistically significant differentiation between Stages I and II in AJCC 8 in either groups, markedly improved discrimination was observed between Stages I/II, III, and IV in the HPV-selected cohort.
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Affiliation(s)
- Pooja Vijayvargiya
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Sumita Trivedi
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Manali Rupji
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Haocan Song
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Renjian Jiang
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Azeem S Kaka
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Georgia Z Chen
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - William Stokes
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Jonathan J Beitler
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Mihir R Patel
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
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7
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Golusinski P, Corry J, Poorten VV, Simo R, Sjögren E, Mäkitie A, Kowalski LP, Langendijk J, Braakhuis BJM, Takes RP, Coca-Pelaz A, Rodrigo JP, Willems SM, Forastiere AA, De Bree R, Saba NF, Teng Y, Sanabria A, Di Maio P, Szewczyk M, Ferlito A. De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed? Oral Oncol 2021; 123:105620. [PMID: 34798575 DOI: 10.1016/j.oraloncology.2021.105620] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 12/26/2022]
Abstract
Human papilloma virus (HPV) is a well-established causative factor in a subset of squamous cell carcinomas of the head and neck (HNSCC). Although HPV can be detected in various anatomical subsites, HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) is the most common HPV-related malignancy of the head and neck, and its worldwide incidence is constantly rising. Patients with OPSCC are generally younger, have less co-morbidities and generally have better prognosis due to different biological mechanisms of carcinogenesis. These facts have generated hypotheses on potential treatment modifications, aiming to minimize treatment-related toxicities without compromising therapy efficacy. Numerous randomized clinical trials have been designed to verify this strategy and increasingly real-world evidence data from retrospective, observational studies is becoming available. Until now, the data do not support any modification in contemporary treatment protocols. In this narrative review, we outline recent data provided by both randomized controlled trials and real-world evidence of HPV-positive OPSCC in terms of clinical value. We critically analyze the potential value and drawbacks of the available data and highlight future research directions. This article was written by members and invitees of the International Head and Neck Scientific Group.(www.IHNSG.com).
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Affiliation(s)
- Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora; Department of Maxillofacial Surgery Poznan University of Medical Sciences, Poland.
| | - June Corry
- Department Radiation Oncology, GenesisCare St Vincent's Hospital, Melbourne, Australia
| | - Vincent Vander Poorten
- Surgery and Department of Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Ricard Simo
- Head & Neck Surgery, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Elisabeth Sjögren
- Otolaryngology, Head and Neck Surgery Department, Leidse Universitaire Medisch Centrum (LUMC), University of Leiden, Leiden, The Netherlands
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Finland; Division of Ear, Nose, Finland
| | - Luis Paulo Kowalski
- Head and Neck Surgery Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - Johannes Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain, Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Stefan M Willems
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Remco De Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yong Teng
- Department of Hematology and Medical Oncology Emory University School of Medicine; Winship Cancer Institute of Emory University, Georgia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - Pasquale Di Maio
- Department of Otolaryngology-Head and Neck Surgery, Giovanni Borea Civil Hospital, San Remo, Italy
| | - Mateusz Szewczyk
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Center, Poznan, Poland
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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8
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Molteni G, Comini L, Le Pera B, Bassani S, Ghirelli M, Martone A, Mattioli F, Nocini R, Santoro R, Spinelli G, Presutti L, Marchioni D, Mannelli G. Salvage neck dissection for isolated neck recurrences in head and neck tumors: Intra and postoperative complications. J Surg Oncol 2021; 124:740-750. [PMID: 34152604 DOI: 10.1002/jso.26576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/04/2021] [Accepted: 05/27/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The current evidence regarding complications after salvage neck dissection (ND) for isolated regional recurrences (IRRs) in head and neck cancers is poor. The aim of this study is to evaluate the incidence and differences in complication rates of salvage ND after primary surgery, radiotherapy, chemoradiotherapy, or combined treatments. METHODS This was a multicentric retrospective study on 64 patients who underwent salvage ND for IRR in three Italian institutes between 2008 and May 2020. RESULTS Complications were detected in 7 of the 34 patients (20.8%) and surgeons described difficult dissection in 20 patients (58.82%). Accidental vascular ligations or nervous injury during surgery were never detected. None of the variables analyzed were statistically significant in predicting the risk of complications, disease-free survival, or overall survival. CONCLUSIONS IRR represents a rare entity among total relapses. The incidence of complications after salvage ND for IRR is higher than after primary surgery but at an acceptable rate in experienced hands. However, an adequate balance between functional and oncological outcomes is mandatory.
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Affiliation(s)
- Gabriele Molteni
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Lara Comini
- Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Beatrice Le Pera
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Sara Bassani
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Michael Ghirelli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Andrea Martone
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Francesco Mattioli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Riccardo Nocini
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Roberto Santoro
- Department of Experimental and Clinical Medicine, University of Florence, AOU-Careggi, Florence, Italy
| | - Giuseppe Spinelli
- Department of Maxillo Facial Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Livio Presutti
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Daniele Marchioni
- Department of Surgery, Dentistry, Gynecology, and Pediatrics, Division of Otorhinolaryngology, University of Verona, University Hospital of Verona, Borgo Trento, Piazzale Aristide Stefani, Verona, Italy
| | - Giuditta Mannelli
- Head and Neck Oncology and Robotic Surgery, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Saito Y, Hayashi R, Iida Y, Mizumachi T, Fujii T, Matsumoto F, Beppu T, Yoshida M, Shinomiya H, Kamiyama R, Kitano M, Yokoshima K, Fujimoto Y, Hama T, Yamashita T, Okami K, Miura K, Fujisawa T, Sano D, Kato H, Minami S, Sugasawa M, Masuda M, Ota I, Iwae S, Kawata R, Monden N, Imai T, Asakage T, Okada M, Yoshikawa T, Tanioka K, Kitayama M, Doi M, Fujii S, Fujii M, Oridate N, Nakamizo M, Yoshimoto S, Homma A, Nibu KI, Yane K. Optimization of therapeutic strategy for p16-positive oropharyngeal squamous cell carcinoma: Multi-institutional observational study based on the national Head and Neck Cancer Registry of Japan. Cancer 2020; 126:4177-4187. [PMID: 32648953 DOI: 10.1002/cncr.33062] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Although the American Joint Committee on Cancer TNM classification has been amended to include human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC) as an independent entity, to the authors' knowledge the optimized de-escalating treatment modality has not been established to date. METHODS The authors conducted a retrospective, nationwide, observational study in patients with HPV-related OPSCC who were treated from 2011 to 2014 in Japan to determine the best treatment modality. RESULTS A total of 688 patients who were newly diagnosed with HPV-related OPSCC who were treated with curative intent at 35 institutions and had coherent clinical information and follow-up data available were included in the current study. In patients with T1-T2N0 disease (79 patients), both the 3-year recurrence-free survival and overall survival (OS) rates were 100% in the group treated with radiotherapy (RT) as well as the group receiving concurrent chemoradiotherapy (CCRT). The 3-year OS rates were 94.4% (for patients with T1N0 disease) and 92.9% (for patients with T2N0 disease) among the patients treated with upfront surgery. In patients with stage I to stage II HPV-related OPSCC, the 5-year recurrence-free survival and OS rates were 91.4% and 92%, respectively, in the patients treated with CCRT with relatively high-dose cisplatin (≥160 mg/m2 ; 114 patients) and 74.3% and 69.5%, respectively, in the patients treated with low-dose cisplatin (<160 mg/m2 ; 17 patients). CONCLUSIONS Despite it being a retrospective observational trial with a lack of information regarding toxicity and morbidity, the results of the current study demonstrated that patients with T1-T2N0 HPV-related OPSCC could be treated with RT alone because of the equivalent outcomes of RT and CCRT, and patients with stage I to stage II HPV-related OPSCC other than those with T1-T2N0 disease could be treated with CCRT with cisplatin at a dose of ≥160 mg/m2 .
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Affiliation(s)
- Yuki Saito
- Department of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yoshiyuki Iida
- Department of Head and Neck Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Takatsugu Mizumachi
- Department of Otorhinolaryngology, Hokkaido University Hospital, Hokkaido, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Fumihiko Matsumoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Beppu
- Department of Head and Neck Surgery, Saitama Cancer Center, Saitama, Japan
| | - Masafumi Yoshida
- Department of Otolaryngology, Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University School of Medicine, Hyogo, Japan
| | - Ryosuke Kamiyama
- Department of Head and Neck Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Mutsukazu Kitano
- Department of Otolaryngology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuhiko Yokoshima
- Department of Otorhinolaryngology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takanori Hama
- Department of Otolaryngology, Jikei University Hospital, Tokyo, Japan
| | - Taku Yamashita
- Department of Otolaryngology-Head and Neck Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kenji Okami
- Department of Otolaryngology, Tokai University Hospital, Kanagawa, Japan
| | - Kouki Miura
- Department of Head and Neck Surgery, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Takuo Fujisawa
- Department of Otolaryngology, Kansai Medical University, Osaka, Japan
| | - Daisuke Sano
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, School of Medicine, Kanagawa, Japan
| | - Hisayuki Kato
- Department of Otolaryngology & Head and Neck Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Shujiro Minami
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Masashi Sugasawa
- Department of Head and Neck Surgery, Saitama Medical University International Medical Center, Saitama, Japan
| | - Muneyuki Masuda
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Ichiro Ota
- Department of Otolaryngology, Nara Medical University Hospital, Nara, Japan
| | - Shigemichi Iwae
- Department of Head and Neck Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Ryo Kawata
- Department of Otolaryngology, Osaka Medical College Hospital, Osaka, Japan
| | - Nobuya Monden
- Department of Head and Neck Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Takayuki Imai
- Department of Head and Neck Surgery, Miyagi Cancer Center, Miyagi, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Masafumi Okada
- University Hospital Medical Information Network, Tokyo, Japan
| | - Takanori Yoshikawa
- Data Center Department, Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan
| | - Kensuke Tanioka
- Faculty of life and biomedical sciences, Doshisha Univeristy, Kyoto, Japan
| | - Megumi Kitayama
- Data Center Department, Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan
| | - Mariko Doi
- Department of Health Policy and Technology Assessment, National Institute of Public Health, Saitama, Japan
| | - Satoshi Fujii
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Chiba, Japan.,Department of Molecular Pathology, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Masato Fujii
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Nobuhiko Oridate
- Department of Otolaryngology-Head and Neck Surgery, Yokohama City University, School of Medicine, Kanagawa, Japan
| | - Munenaga Nakamizo
- Department of Otorhinolaryngology, Nippon Medical School Hospital, Tokyo, Japan
| | - Seiichi Yoshimoto
- Department of Head and Neck Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Akihiro Homma
- Department of Otorhinolaryngology, Hokkaido University Hospital, Hokkaido, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University School of Medicine, Hyogo, Japan
| | - Katsunari Yane
- Department of Otorhinolaryngology, Kindai University Nara Hospital, Nara, Japan
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