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Dequanter D, Dok R, Koolen L, Vander Poorten V, Nuyts S. Prognostic Significance of Glutathione Peroxidase Levels (GPx1) in Head and Neck Cancers. Front Oncol 2017; 7:84. [PMID: 28536671 PMCID: PMC5423422 DOI: 10.3389/fonc.2017.00084] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 04/18/2017] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION To date, no reliable prognostic biological marker for all squamous cell carcinoma located in different subsites of the head and neck region has been identified and used in daily routine. In line with our previous studies, in which we showed a role of glutathione and associated enzymes as potential biological markers, we investigated the relationship between GPx1 and prognosis of head and neck squamous cell carcinoma. METHODS The association between GPx1 and patient and tumor related factors were investigated in 87 pretreatment biopsies from head and neck cancer patients treated by (chemo)radiation. Moreover, the influence of GPx1 expression on outcome parameters was assessed. RESULTS A significant difference was found in the T-stage between the low and high-expressing GPx1 groups. About 75% of the T3-T4 tumors were considered GPx1 low-expressing tumors, while low GPx1 expression was only seen in 25% of the T1-T2 tumors. There was also a significant difference found between the groups when looking at the different tumor sites. Local control, locoregional control, disease-free survival, and overall survival were the same in both groups. All these results indicate that GPx1 expression does not influence the radiotherapy response nor survival.
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Affiliation(s)
- Didier Dequanter
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Belgium.,Department of Head and Neck Surgery, CHU Saint Pierre, Brussels, Belgium
| | - Ruveyda Dok
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Belgium
| | - Louet Koolen
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, Department of Oncology, Section Head and Neck Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven, Belgium.,Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
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Nevens D, Vantomme O, Laenen A, Hermans R, Nuyts S. The prognostic value of location and size change of pathological lymph nodes evaluated on CT-scan following radiotherapy in head and neck cancer. Cancer Imaging 2017; 17:8. [PMID: 28241854 PMCID: PMC5330029 DOI: 10.1186/s40644-017-0111-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/22/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Overall survival after chemo-radiotherapy (CRT) for head and neck cancer ranges between 50 and 60% after 5 year of follow-up. Local and/or regional recurrence is the most frequent form of therapy failure. The aim of this study is to investigate whether the initial location and size change of pathological lymph nodes as evaluated on Computed Tomography (CT) studies can help predict outcome. METHODS One hundred eighty-three patients with lymph node-positive head and neck cancer were treated with radiotherapy (RT) or CRT. CT studies pre- and post-treatment were reviewed for lymph node size and location. Data were correlated with local control, regional control, metastasis free survival, disease free survival and overall survival. RESULTS Regarding the risk for distant metastasis, a significant influence was seen for the location of the pathological lymph nodes. The metastatic risk increases when levels IV-V are affected rather than levels I-III. A similar observation is seen for levels VI-VII. Regional control improves with decreasing lymph node diameter and volume as evaluated on CT. CONCLUSIONS Both location and size change of pathological lymph nodes are of prognostic value after CRT for head and neck cancer.
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Affiliation(s)
- Daan Nevens
- Department of Radiation Oncology, University Hospitals of Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Olivier Vantomme
- Department of Radiation Oncology, University Hospitals of Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre, University of Leuven, Leuven, Belgium
| | - Robert Hermans
- Radiology Department, University Hospitals of Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Department of Radiation Oncology, University Hospitals of Leuven, Herestraat 49, 3000, Leuven, Belgium
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Nevens D, Vantomme O, Laenen A, Hermans R, Nuyts S. CT-based follow-up following radiotherapy or radiochemotherapy for locally advanced head and neck cancer; outcome and development of a prognostic model for regional control. Br J Radiol 2016; 89:20160492. [PMID: 27710014 DOI: 10.1259/bjr.20160492] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The purpose of this study was to make a prognostic model for regional relapse in head and neck cancer using clinical and CT parameters. METHODS 183 patients with lymph node-positive head and neck cancer were treated between 2002 and 2012 with radiotherapy or concurrent chemoradiotherapy. CT studies pre- and post-treatment were reviewed for lymph node size and the presence of necrosis, extracapsular spread (ECS) and calcifications. For every patient, correlations with 3-year regional control (RC), metastasis-free survival (MFS), disease-free survival (DFS) and overall survival (OS) were made. RESULTS 3-year outcome rates were as follows: local control of 84%, RC of 80%, MFS of 74%, DFS of 61% and OS of 63%. Pre-treatment nodal size and the presence of necrosis were associated with a poorer outcome. This was also the case for post-treatment lymph node size, the presence of necrosis and ECS. We developed a CT-based prognostic model for RC with an area under the curve of 0.78 (95% confidence interval 0.63; 0.85). CONCLUSION We reached a good outcome in our patient cohort using a CT-based follow-up approach. A CT-based model was developed, which can aid in predicting RC. Advances in knowledge: A prognostic model is proposed, which can aid in predicting RC and the necessity for post-radiotherapy neck dissection using clinical parameters and parameters derived from the post-treatment CT study. This is the first article to propose a prognostic model for regional relapse in head and neck cancer based on these parameters.
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Affiliation(s)
- Daan Nevens
- 1 Department of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Vantomme
- 1 Department of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- 2 Leuven Biostatistics and Statistical Bioinformatics Centre, University of Leuven, Leuven, Belgium
| | - Robert Hermans
- 3 Department of Radiology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Sandra Nuyts
- 1 Department of Radiation Oncology, KU Leuven-University of Leuven, University Hospitals Leuven, Leuven, Belgium
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Smet S, Lambrecht M, Vanstraelen B, Nuyts S. Clinical and dosimetric evaluation of RapidArc versus standard sliding window IMRT in the treatment of head and neck cancer. Strahlenther Onkol 2014; 191:43-50. [PMID: 25168752 DOI: 10.1007/s00066-014-0742-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/07/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND Several planning studies have already proven the substantial dosimetric advantages of RapidArc (RA) over standard intensity-modulated radiotherapy. We retrospectively compared RapidArc and standard sliding window IMRT (swIMRT) in locally advanced head and neck cancer, looking both at dosimetrics as well as toxicity and outcome. METHODS CT datasets of 78 patients treated with swIMRT and 79 patients treated with RA were included. To compare the resulting dose distributions, the dose-volume parameters were evaluated for the planning target volumes (PTVs), clinical target volumes (CTVs), and organs at risk (OARs), and the number of MU were calculated. Acute toxicity was assessed by the Common Toxicity Criteria version 3.0. RESULTS PTV coverage with the 95% isodose was slightly better for RA. Dose distribution has proven to be significantly more homogenous with RA and led to a reduction of 62% in MU with better OAR sparing. As for toxicity, more grade 3 mucositis and dysphagia was observed for swIMRT, though we observed more grade 3 dermatitis for RA. CONCLUSION In our retrospective analysis, RA had better target coverage and better sparing of the OAR. Overall, the grade of acute toxicity was lower for RA than for swIMRT for the same types of tumor locations, except for the grade of dermatitis.
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Affiliation(s)
- Stéphanie Smet
- Department of Radiation Oncology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium,
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Dirix P, Lambrecht M, Nuyts S. Radiotherapy for laryngeal squamous cell carcinoma: current standards. Expert Rev Anticancer Ther 2014; 10:1461-9. [DOI: 10.1586/era.10.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Platteaux N, Dirix P, Vanstraelen B, Nuyts S. Outcome after re-irradiation of head and neck cancer patients. Strahlenther Onkol 2010; 187:23-31. [PMID: 21234530 DOI: 10.1007/s00066-010-2139-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 08/26/2010] [Indexed: 02/01/2023]
Abstract
PURPOSE To retrospectively report the outcome of head and neck cancer patients following re-irradiation. PATIENTS AND METHODS A total of 51 patients with recurrent or second primary head and neck cancer received re-irradiation at Leuven University Hospital. Survival and locoregional control were calculated. Doses to organs at risk were retrieved from dose-volume histograms. Radiation-related toxicities were reported. RESULTS The 2-year actuarial overall survival rate was 30%. On univariate analysis, surgery before re-irradiation and high radiation dose were associated with superior survival. Grade 3 acute and grade 3 or more late toxicity occurred in respectively 29.4% and 35.3% of the patients. CONCLUSION Re-irradiation in head and neck cancer patients is feasible with acceptable late toxicity, although the survival remains poor.
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Affiliation(s)
- Nele Platteaux
- Department of Radiation Oncology, Leuvens Kankerinstituut, University Hospitals Leuven, Campus Gasthuisberg, Leuven, Belgium.
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Value of Intensity-Modulated Radiotherapy in Stage IV Head-and-Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2010; 78:1373-80. [DOI: 10.1016/j.ijrobp.2009.10.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 09/29/2009] [Accepted: 10/06/2009] [Indexed: 01/23/2023]
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Incidence of isolated regional recurrence after definitive (chemo-) radiotherapy for head and neck squamous cell carcinoma. Radiother Oncol 2009; 93:498-502. [DOI: 10.1016/j.radonc.2009.08.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 08/14/2009] [Accepted: 08/27/2009] [Indexed: 11/20/2022]
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Ford EC, Herman J, Yorke E, Wahl RL. 18F-FDG PET/CT for image-guided and intensity-modulated radiotherapy. J Nucl Med 2009; 50:1655-65. [PMID: 19759099 PMCID: PMC2899678 DOI: 10.2967/jnumed.108.055780] [Citation(s) in RCA: 112] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Advances in technology have allowed extremely precise control of radiation dose delivery and localization within a patient. The ability to confidently delineate target tumor boundaries, however, has lagged behind. (18)F-FDG PET/CT, with its ability to distinguish metabolically active disease from normal tissue, may provide a partial solution to this problem. Here we review the current applications of (18)F-FDG PET/CT in a variety of disease sites, including non-small cell lung cancer, head and neck cancer, and pancreatic adenocarcinoma. This review focuses on the use of (18)F-FDG PET/CT to aid in planning radiotherapy and the associated benefits and challenges. We also briefly consider novel radiopharmaceuticals that are beginning to be used in the context of radiotherapy planning.
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Affiliation(s)
- Eric C Ford
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231, USA.
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Dysphagia After Chemoradiotherapy for Head-and-Neck Squamous Cell Carcinoma: Dose–Effect Relationships for the Swallowing Structures. Int J Radiat Oncol Biol Phys 2009; 75:385-92. [DOI: 10.1016/j.ijrobp.2008.11.041] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 10/24/2008] [Accepted: 11/05/2008] [Indexed: 11/17/2022]
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Dysphagia in Head and Neck Cancer Patients Treated with Chemoradiotherapy. Dysphagia 2009; 25:139-52. [DOI: 10.1007/s00455-009-9247-7] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 07/31/2009] [Indexed: 11/25/2022]
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Nuyts S, Dirix P, Clement PMJ, Poorten VV, Delaere P, Schoenaers J, Hermans R, Van den Bogaert W. Impact of adding concomitant chemotherapy to hyperfractionated accelerated radiotherapy for advanced head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2008; 73:1088-95. [PMID: 18707823 DOI: 10.1016/j.ijrobp.2008.05.042] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 05/23/2008] [Accepted: 05/23/2008] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the feasibility and efficacy of a hyperfractionated accelerated radiotherapy (RT) schedule combined with concomitant chemotherapy (Cx) in patients with locally advanced head-and-neck squamous cell carcinoma. METHODS AND MATERIALS Between 2004 and 2007, a total of 90 patients with locoregionally advanced head-and-neck squamous cell carcinoma underwent irradiation according to a hybrid fractionation schedule consisting of 20 fractions of 2 Gy (once daily) followed by 20 fractions of 1.6 Gy (twice daily) to a total dose of 72 Gy. Concomitant Cx (cisplatinum 100 mg/m(2)) was administered at the start of Weeks 1 and 4. Treatment outcome and toxicity were retrospectively compared with a previous patient group (n = 73) treated with the same schedule, but without concomitant Cx, between 2001 and 2004. RESULTS The locoregional control (LRC) rate was 70% after 2 years. Two-year overall and 2-year disease-free survival rates were 74% and 60%, respectively. In comparison with the RT-only group, an improvement of 15% in both LRC (p = 0.03) and overall survival (p = 0.09) was observed. All patients were treated to full radiation dose according to protocol, although the Cx schedule had to be adjusted in 12 patients. No acute Grade 4 or 5 toxicity was seen, but incidences of Grade 3 acute mucositis (74.5% vs. 50.7%; p = 0.002) and dysphagia (82.2% vs. 47.9%; p < 0.001) were significantly higher in the chemoradiotherapy group compared with patients treated with RT alone. CONCLUSION With this chemoradiotherapy regimen, excellent LRC and survival rates were achieved, with acceptable acute toxicity.
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Affiliation(s)
- Sandra Nuyts
- Department of Radiation Oncology, Leuvens Kankerinstituut, University Hospitals Leuven, campus Gasthuisberg, Leuven, Belgium.
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Diffusion-Weighted Magnetic Resonance Imaging to Evaluate Major Salivary Gland Function Before and After Radiotherapy. Int J Radiat Oncol Biol Phys 2008; 71:1365-71. [DOI: 10.1016/j.ijrobp.2007.12.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2007] [Revised: 11/05/2007] [Accepted: 12/04/2007] [Indexed: 11/20/2022]
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Current World Literature. Curr Opin Otolaryngol Head Neck Surg 2008; 16:175-82. [DOI: 10.1097/moo.0b013e3282fd9415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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