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Koutroumpakis E, Naser MA, Mohamed ASR, Eraj SA, Jarre A, Shiao JC, Kamal M, Perni S, Phan JP, Morrison WH, Frank SJ, Gunn GB, Garden AS, Deswal A, Abe JI, Rosenthal DI, Mouhayar E, Fuller CD. Detection of Alteration in Carotid Artery Volumetry Using Standard-of-care Computed Tomography Surveillance Scans Following Unilateral Radiation Therapy for Early-stage Tonsillar Squamous Cell Carcinoma Survivors: A Cross-Sectional Internally-Matched Carotid Isodose Analysis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.03.24302288. [PMID: 38798400 PMCID: PMC11118557 DOI: 10.1101/2024.02.03.24302288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Purpose Radiation induced carotid artery disease (RICAD) is a major cause of morbidity and mortality among survivors of oropharyngeal cancer. This study leveraged standard-of-care CT scans to detect volumetric changes in the carotid arteries of patients receiving unilateral radiotherapy (RT) for early tonsillar cancer, and to determine dose-response relationship between RT and carotid volume changes, which could serve as an early imaging marker of RICAD. Methods and Materials Disease-free cancer survivors (>3 months since therapy and age >18 years) treated with intensity modulated RT for early (T1-2, N0-2b) tonsillar cancer with pre- and post-therapy contrast-enhanced CT scans available were included. Patients treated with definitive surgery, bilateral RT, or additional RT before the post-RT CT scan were excluded. Pre- and post-treatment CTs were registered to the planning CT and dose grid. Isodose lines from treatment plans were projected onto both scans, facilitating the delineation of carotid artery subvolumes in 5 Gy increments (i.e. received 50-55 Gy, 55-60 Gy, etc.). The percent-change in sub-volumes across each dose range was statistically examined using the Wilcoxon rank-sum test. Results Among 46 patients analyzed, 72% received RT alone, 24% induction chemotherapy followed by RT, and 4% concurrent chemoradiation. The median interval from RT completion to the latest, post-RT CT scan was 43 months (IQR 32-57). A decrease in the volume of the irradiated carotid artery was observed in 78% of patients, while there was a statistically significant difference in mean %-change (±SD) between the total irradiated and spared carotid volumes (7.0±9.0 vs. +3.5±7.2, respectively, p<.0001). However, no significant dose-response trend was observed in the carotid artery volume change withing 5 Gy ranges (mean %-changes (±SD) for the 50-55, 55-60, 60-65, and 65-70+ Gy ranges [irradiated minus spared]: -13.1±14.7, -9.8±14.9, -6.9±16.2, -11.7±11.1, respectively). Notably, two patients (4%) had a cerebrovascular accident (CVA), both occurring in patients with a greater decrease in carotid artery volume in the irradiated vs the spared side. Conclusions Our data show that standard-of-care oncologic surveillance CT scans can effectively detect reductions in carotid volume following RT for oropharyngeal cancer. Changes were equivalent between studied dose ranges, denoting no further dose-response effect beyond 50 Gy. The clinical utility of carotid volume changes for risk stratification and CVA prediction warrants further evaluation.
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Van Hoe S, Hermans R. Post-treatment surveillance imaging in head and neck cancer: a systematic review. Insights Imaging 2024; 15:32. [PMID: 38315325 PMCID: PMC10844183 DOI: 10.1186/s13244-023-01578-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/29/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND In patients treated for head and neck cancer, imaging studies are usually obtained within 3-6 months after treatment for assessment of treatment response. After 6 months, most guidelines advocate clinical follow-up, with imaging reserved for patients with clinically suspect or equivocal findings. However, some guidelines do recommend systematic imaging surveillance, and many clinicians tend to include some type of imaging in their follow-up schemes. OBJECTIVES This systematic review focuses on the usefulness of routine (systematic) post-treatment imaging surveillance of head and neck cancer beyond the first 3-6-month baseline imaging study. METHODS A systematic literature search was conducted using PubMed and Google Scholar. Additional studies were identified by reviewing reference lists. Only original studies and review papers were considered. Results obtained with systematic post-treatment surveillance imaging were compared to symptom-directed imaging and/or clinical finding-directed imaging. RESULTS Five hundred twenty-one records were identified through the database search, and 44 additional records were identified through other sources. Forty-eight articles were selected for the final review. Analysis of these records showed that almost half of cases of locoregional recurrences and/or metastases were only detected by imaging (40.9%), and the mean time of detection of recurrent or metastatic disease (11.5 months) was well beyond the period of the first post-treatment scan. Most authors reported superior results with PET-CT when compared to other imaging techniques. CONCLUSION Strong arguments were found in favor of systematic imaging surveillance in locoregional advanced head and neck cancer during at least one and preferably 2 years after treatment. CRITICAL RELEVANCE STATEMENT Analysis of the selected records showed that almost half of cases of locoregional recurrences and/or metastases were only detected by imaging. This systematic review suggests that imaging may currently be underused in the post-treatment surveillance of patients with head and neck cancer. KEY POINTS • This systematic review focuses on the usefulness of long-term systematic imaging surveillance in patients treated for head and neck cancer. • Analysis of 521 articles revealed that systematic imaging allowed the initial detection of locoregional recurrences and/or metastases in more than 40% of patients. • Imaging may currently be underused in the post-treatment surveillance of patients with advanced head and neck cancer.
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Affiliation(s)
| | - Robert Hermans
- Department of Radiology, University Hospitals Leuven, Herestraat 49, Leuven, 3000, Belgium.
- Department of Imaging and Pathology, KU Leuven-University of Leuven, Leuven, Belgium.
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3
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Lin ME, Castellanos CX, Acevedo JR, Yu JC, Kokot NC. Cost-Effectiveness Analysis of PET-CT Surveillance After Treatment of Human Papillomavirus-Positive Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2024; 170:122-131. [PMID: 37622527 DOI: 10.1002/ohn.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE To determine the cost-effectiveness of surveillance imaging with PET/CT scan among patients with human papillomavirus-positive oropharyngeal squamous cell carcinoma. STUDY DESIGN Cost-effectiveness analysis. SETTING Oncologic care centers in the United States with head and neck oncologic surgeons and physicians. METHODS We compared the cost-effectiveness of 2 posttreatment surveillance strategies: clinical surveillance with the addition of PET/CT scan versus clinical surveillance alone in human papillomavirus-positive oropharyngeal squamous cell carcinoma patients. We constructed a Markov decision model which was analyzed from a third-party payer's perspective using 1-year Markov cycles and a 30-year time horizon. Values for transition probabilities, costs, health care utilities, and their studied ranges were derived from the literature. RESULTS The incremental cost-effectiveness ratio for PET/CT with clinical surveillance versus clinical surveillance alone was $89,850 per quality-adjusted life year gained. Flexible fiberoptic scope exams during clinical surveillance would have to be over 51% sensitive or PET/CT scan cost would have to exceed $1678 for clinical surveillance alone to be more cost-effective. The willingness-to-pay threshold at which imaging surveillance was equally cost-effective to clinical surveillance was approximately $80,000/QALY. CONCLUSION Despite lower recurrence rates of human papillomavirus-positive oropharyngeal cancer, a single PET/CT scan within 6 months after primary treatment remains a cost-effective tool for routine surveillance when its cost does not exceed $1678. The cost-effectiveness of this strategy is also dependent on the clinical surveillance sensitivity (flexible fiberoptic pharyngoscopy), and willingness-to-pay thresholds which vary by country.
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Affiliation(s)
- Matthew E Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Carlos X Castellanos
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Joseph R Acevedo
- Department of Otolaryngology-Head & Neck Surgery, Kaiser Permanente Medical Center, Panorama City, California, USA
| | - Jeffrey C Yu
- School of Pharmacy, University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Niels C Kokot
- Caruso Department of Otolaryngology-Head & Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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Farquhar DR, Masood MM, Lenze NR, Tasoulas J, Sheth S, Lumley C, Blumberg J, Yarbrough WG, Zevallos J, Weissler MC, Zanation AM, Hackman TG, Olshan AF. Effect of distance of treatment center on survival for HPV-negative head and neck cancer patients. Head Neck 2023; 45:2981-2989. [PMID: 37767817 DOI: 10.1002/hed.27522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/20/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In rural states, travel burden for complex cancer care required for head and neck squamous cell carcinoma (HNSCC) may affect patient survival, but its impact is unknown. METHODS Patients with HPV-negative HNSCC were retrospectively identified from a statewide, population-based study. Euclidian distance from the home address to the treatment center was calculated for radiation therapy, surgery, and chemotherapy. Multivariable Cox proportional hazards models were used to examine the risk of 5-year mortality with increasing travel quartiles. RESULTS There were 936 patients with HPV-negative HNSCC with a mean age of 60. Patients traveled a median distance of 10.2, 11.1, and 10.9 miles to receive radiation therapy, surgery, and chemotherapy, respectively. Patients in the fourth distance quartile were more likely to live in a rural location (p < 0.001) and receive treatment at an academic hospital (p < 0.001). Adjusted overall survival (OS) improved proportionally to distance traveled, with improved OS remaining significant for patients who traveled the furthest for care (third and fourth quartile by distance). Relative to patients in the first quartile, patients in the fourth had a reduced risk of mortality with radiation (HR 0.59, 95% CI 0.42-0.83; p = 0.002), surgery (HR 0.47, 95% CI 0.30-0.75; p = 0.001), and chemotherapy (HR 0.56, 95% CI 0.35-0.91; p = 0.020). CONCLUSION For patients in this population-based cohort, those traveling greater distances for treatment of HPV-negative HNSCC had improved OS. This analysis suggests that the benefits of coordinated, multidisciplinary care may outweigh the barriers of travel burden for these patients.
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Affiliation(s)
- Douglas R Farquhar
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Maheer M Masood
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Nicholas R Lenze
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jason Tasoulas
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Siddharth Sheth
- Department of Hematology/Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Catherine Lumley
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Jeffrey Blumberg
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jose Zevallos
- Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark C Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Adam M Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Trevor G Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Otolaryngology/Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Avery EW, Joshi K, Mehra S, Mahajan A. Role of PET/CT in Oropharyngeal Cancers. Cancers (Basel) 2023; 15:2651. [PMID: 37174116 PMCID: PMC10177278 DOI: 10.3390/cancers15092651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/03/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) comprises cancers of the tonsils, tongue base, soft palate, and uvula. The staging of oropharyngeal cancers varies depending upon the presence or absence of human papillomavirus (HPV)-directed pathogenesis. The incidence of HPV-associated oropharyngeal cancer (HPV + OPSCC) is expected to continue to rise over the coming decades. PET/CT is a useful modality for the diagnosis, staging, and follow up of patients with oropharyngeal cancers undergoing treatment and surveillance.
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Affiliation(s)
- Emily W. Avery
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Kavita Joshi
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Saral Mehra
- Department of Otolaryngology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
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Mariani C, Carta F, Bontempi M, Marrosu V, Tatti M, Pinto V, Gerosa C, Puxeddu R. Management and Oncologic Outcomes of Close and Positive Margins after Transoral CO 2 Laser Microsurgery for Early Glottic Carcinoma. Cancers (Basel) 2023; 15:cancers15051490. [PMID: 36900281 PMCID: PMC10000552 DOI: 10.3390/cancers15051490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND The present study analyzed the impact of margin status on local control and survival, and the management of close/positive margins after transoral CO2 laser microsurgery for early glottic carcinoma. METHODS 351 patients (328 males, 23 females, mean age 65.6 years) underwent surgery. We identified the following margin statuses: negative, close superficial (CS), close deep (CD), positive single superficial (SS), positive multiple superficial (MS), and positive deep (DEEP). RESULTS A total of 286 patients (81.5%) had negative margins, 23 (6.5%) had close margins (8 CS, 15 CD) and 42 (12%) had positive margins (16 SS, 9 MS, 17 DEEP). Among the 65 patients with close/positive margins, 44 patients underwent enlargement, 6 radiotherapy and 15 follow-up. Twenty-two patients (6.3%) recurred. Patients with DEEP or CD margins showed a higher risk of recurrence (hazard ratios of 2.863 and 2.537, respectively), compared to patients with negative margins. Local control with laser alone, overall laryngeal preservation and disease-specific survival decreased significantly in patients with DEEP margins (57.5%, 86.9% and 92.9%, p < 0.05). CONCLUSIONS Patients with CS or SS margins could be safely submitted to follow-up. In the case of CD and MS margins, any additional treatment should be discussed with the patient. In the case of DEEP margin, additional treatment is always recommended.
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Affiliation(s)
- Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
- Correspondence:
| | - Mauro Bontempi
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Melania Tatti
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Valeria Pinto
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Clara Gerosa
- Unit of Pathology, Department of Medical Sciences and Public Health, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, 09100 Cagliari, Italy
- ENT Department, King’s College Hospital London-Dubai, Dubai P.O. Box 340901, United Arab Emirates
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7
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Janopaul-Naylor JR, Aiken AH, Saba NF, El-Deiry M, Kaka A, Stokes WA. To scan or not to scan: the dilemma of post-treatment imaging surveillance of head and neck cancer. Pract Radiat Oncol 2022; 12:210-214. [PMID: 35150898 DOI: 10.1016/j.prro.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/24/2022] [Accepted: 01/31/2022] [Indexed: 11/15/2022]
Abstract
Locoregional recurrence remains common after treatment of head and neck cancer, warranting careful surveillance in follow-up. While randomized data support an initial PET/CT several months after treatment, evidence supporting subsequent imaging is limited, and most recurrences ultimately manifest clinically. Cooperative group studies and consensus guidelines vary widely in their recommendations regarding surveillance imaging. Patients with indeterminate findings, new symptoms, or areas difficult to examine in clinic may avoid invasive and potentially morbid interventions with judicious use of subsequent imaging. For any patient undergoing post-treatment imaging, standardized reporting criteria provide a framework for risk-stratification that can enhance communication and potentially guide management.
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Affiliation(s)
| | - Ashley H Aiken
- Department of Radiology and Imaging Services, Winship Cancer Institute at Emory University; Department of Otolaryngology, Winship Cancer Institute at Emory University
| | - Nabil F Saba
- Department of Otolaryngology, Winship Cancer Institute at Emory University; Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University
| | - Mark El-Deiry
- Department of Otolaryngology, Winship Cancer Institute at Emory University
| | - Azeem Kaka
- Department of Otolaryngology, Winship Cancer Institute at Emory University
| | - William A Stokes
- Department of Radiation Oncology, Winship Cancer Institute at Emory University.
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Arrazubi V, Cajaraville G, Cantero D, Giralt J, Mesia R, Monje F, Rueda A, Sistiaga A, Suarez J, Mut A, Comellas M, Lizán L. Defining a Standard Set of Health Outcomes for Patients With Squamous Cell Carcinoma of the Head and Neck in Spain. Front Oncol 2022; 11:747520. [PMID: 35141139 PMCID: PMC8819151 DOI: 10.3389/fonc.2021.747520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose A systematic, standardized collection of health outcomes during patient treatment and follow-up, relevant from the perspective of all stakeholders, is a crucial step toward effective and efficient disease management. This project aimed to define a standard set of health outcomes for patients with squamous cell carcinoma of the head and neck (SCCHN). Methods The project was led and coordinated by a scientific committee (SC). It comprised: (1) a literature review (to identify variables used during SCCHN management); (2) 1st-SC meeting (to select the variables for presentation during nominal groups-NG); (3) five NG (n=42 experts) and four interviews with patients (to reach consensus on the variables for inclusion); and (4) final-SC meeting (to review the results of NG ensuring consensus on the variables where consensus was not reached). Results Experts agreed to include the following variables in the standard set: treatment-related (treatment intent and type, response to treatment, treatment toxicity/complication, treatment completion), degree of health (performance status, patient-reported health status, pain, dysphonia, feeding and speech limitations, body image alteration, tracheotomy), survival (overall and progression-free survival, cause of death), nutritional (weight, nutritional intervention), other variables (smoking status, alcohol consumption, patient satisfaction with aftermath care, employment status), and case-mix variables (demographic, tumor-related, clinical and nutritional factors). Conclusions This project may pave the way to standardizing the collection of health outcomes in SCCHN and promote the incorporation of patients’ perspective in its management. The information provided through the systematic compilation of this standard set may define strategies to achieve high-quality, patient-centered care.
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Affiliation(s)
| | | | - David Cantero
- Quality and Innovation, Organización Sanitaria Integrada (Integrated Health Organisation) (OSI) Barrualde Galdakao, Galdakao, Spain
| | - Jordi Giralt
- Radiation Oncology, Hospital Universitari Vall d´Hebrón, Barcelona, Spain
| | - Ricard Mesia
- Medical Oncology, Institut Català d’Oncología, Group Badalona Applied Research Group in Oncology (B-ARGO) Group, Institut d'Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Florencio Monje
- Oral and Maxillofacial Surgery, Hospital Universitario de Badajoz, Badajoz, Spain
| | - Antonio Rueda
- Oncology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | | | | | - Luis Lizán
- Outcomes’10, Castellón de la Plana, Spain
- Medicine Department, Jaume I University, Castellón de la Plana, Spain
- *Correspondence: Luis Lizán,
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Panvongsa W, Siripoon T, Worakitchanon W, Arsa L, Trachu N, Jinawath N, Ngamphaiboon N, Chairoungdua A. Plasma extracellular vesicle microRNA-491-5p as diagnostic and prognostic marker for head and neck squamous cell carcinoma. Cancer Sci 2021; 112:4257-4269. [PMID: 34273216 PMCID: PMC8486186 DOI: 10.1111/cas.15067] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/09/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023] Open
Abstract
Poor survival of patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) is partly due to early diagnosis difficulties and the lack of reliable biomarkers for predicting treatment outcomes. In the discovery cohort, plasma-derived extracellular vesicles (EVs) from LA-HNSCC patients (n = 48) and healthy volunteers (n = 12) were used for profiling for microRNA (miRNA) expression by NanoString analysis. Ten EV-associated miRNAs were differentially expressed between LA-HNSCC patients and healthy volunteers. Subsequently, the results were validated in the individual discovery and additional cases (HNSCC, n = 73; control, n = 20) by quantitative RT-PCR. Among 10 EV-miRNAs, four (miR-27b-3p, miR-491-5p, miR-1910-5p, and miR-630) were significantly dysregulated in LA-HNSCC patients (n = 73) compared with healthy volunteers (n = 20). The miRNA prediction models were developed to discriminate HNSCC patients from healthy volunteers. The model using miR-491-5p was selected as a diagnostic biomarker for LA-HNSCC with a sensitivity and specificity of 46.6% and 100%, respectively (P < .001). The dynamic changes of miRNA model score (ΔmiRNAs) were determined using scores pre- and postdefinitive treatment to further investigate the prognostic value of miRNA prediction models. The univariate and multivariate analyses indicated that ΔmiR-491-5p was the most powerful and independent prognostic indicator for overall survival (hazard ratio [HR] 5.66, 95% confidence interval, 1.77-18.01; P = .003) and disease-free survival (HR 2.82, 95% CI, 1.13-7.05; P = .027) of HNSCC patients. In summary, the miR-491-5p prediction model could serve as a blood-based diagnostic marker for LA-HNSCC. Moreover, ΔmiR-491-5p could be a potential monitoring prognostic marker to reflect the survival of HNSCC patients.
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Affiliation(s)
- Wittaya Panvongsa
- Toxicology Graduate ProgramFaculty of ScienceMahidol UniversityBangkokThailand
- Excellent Center for Drug Discovery (ECDD)Mahidol UniversityBangkokThailand
| | - Teerada Siripoon
- Division of Medical OncologyDepartment of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Wittawin Worakitchanon
- Excellent Center for Drug Discovery (ECDD)Mahidol UniversityBangkokThailand
- Department of PhysiologyFaculty of ScienceMahidol UniversityBangkokThailand
| | - Lalida Arsa
- Molecular Histopathology LaboratoryDepartment of PathologyFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Narumol Trachu
- Research CenterFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Natini Jinawath
- Program in Translational MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
- Integrative Computational BioScience Center (ICBS)Mahidol UniversityNakhon PathomThailand
| | - Nuttapong Ngamphaiboon
- Excellent Center for Drug Discovery (ECDD)Mahidol UniversityBangkokThailand
- Division of Medical OncologyDepartment of MedicineFaculty of Medicine Ramathibodi HospitalMahidol UniversityBangkokThailand
| | - Arthit Chairoungdua
- Toxicology Graduate ProgramFaculty of ScienceMahidol UniversityBangkokThailand
- Excellent Center for Drug Discovery (ECDD)Mahidol UniversityBangkokThailand
- Department of PhysiologyFaculty of ScienceMahidol UniversityBangkokThailand
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Wu CF, Lin L, Mao YP, Deng B, Lv JW, Zheng WH, Wen DW, Kou J, Chen FP, Yang XL, Xu SS, Ma J, Zhou GQ, Sun Y. Liquid biopsy posttreatment surveillance in endemic nasopharyngeal carcinoma: a cost-effective strategy to integrate circulating cell-free Epstein-Barr virus DNA. BMC Med 2021; 19:193. [PMID: 34433440 PMCID: PMC8390246 DOI: 10.1186/s12916-021-02076-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The optimal posttreatment surveillance strategy for nasopharyngeal carcinoma (NPC) remains unclear. Circulating cell-free Epstein-Barr virus (cfEBV) DNA has been recognized as a promising biomarker to facilitate early detection of NPC recurrence. Therefore, we aim to determine whether integrating circulating cfEBV DNA into NPC follow-up is cost-effective. METHODS For each stage of asymptomatic nonmetastatic NPC patients after complete remission to primary NPC treatment, we developed a Markov model to compare the cost-effectiveness of the following surveillance strategies: routine follow-up strategy, i.e., (1) routine clinical physical examination; routine imaging strategies, including (2) routine magnetic resonance imaging plus computed tomography plus bone scintigraphy (MRI + CT + BS); and (3) routine 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT); cfEBV DNA-guided imaging strategies, including (4) cfEBV DNA-guided MRI + CT + BS and (5) cfEBV DNA-guided PET/CT. Clinical probabilities, utilities, and costs were derived from published studies or databases. Sensitivity analyses were performed. RESULTS For all disease stages, cfEBV DNA-guided imaging strategies demonstrated similar survival benefits but were considerably more economical than routine imaging strategies. They only required approximately one quarter of the number of imaging studies compared with routine imaging strategies to detect one recurrence. Specifically, cfEBV DNA-guided MRI + CT + BS was most cost-effective for stage II (incremental cost-effectiveness ratio [ICER] $57,308/quality-adjusted life-year [QALY]) and stage III ($46,860/QALY) patients, while cfEBV DNA-guided PET/CT was most cost-effective for stage IV patients ($62,269/QALY). However, routine follow-up was adequate for stage I patients due to their low recurrence risk. CONCLUSIONS The cfEBV DNA-guided imaging strategies are effective and cost-effective follow-up methods in NPC. These liquid biopsy-based strategies offer evidence-based, stage-specific surveillance modalities for clinicians and reduce disease burden for patients.
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Affiliation(s)
- Chen-Fei Wu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Li Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Yan-Ping Mao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Bin Deng
- Department of Radiation Oncology, Wuzhou Red Cross Hospital, Wuzhou, 543002, Guangxi, People's Republic of China
| | - Jia-Wei Lv
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Wei-Hong Zheng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Dan-Wan Wen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jia Kou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Fo-Ping Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Xing-Li Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Si-Si Xu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Jun Ma
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China
| | - Guan-Qun Zhou
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, People's Republic of China.
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11
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Abstract
Lip and oral cavity squamous cell carcinoma (SCC) develop from progressive dysplasia of these mucosal structures. The cancers are often preceded by premalignant lesions, and any nonhealing ulcers of the lip or oral cavity should be biopsied. Some risk factors for these 2 subsites overlap and include tobacco use, alcohol use, and an immunocompromised state. Lip and oral cavity SCC are clinically staged based on physical examination and imaging. The 5-year overall survival for early-stage lip and oral cavity SCC is around 70% to 90% but decreases to about 50% for late-stage disease.
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12
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Borsetto D, Sethi M, Polesel J, Tomasoni M, Deganello A, Nicolai P, Bossi P, Fabbris C, Molteni G, Marchioni D, Tofanelli M, Cragnolini F, Tirelli G, Ciorba A, Pelucchi S, Corazzi V, Canzi P, Benazzo M, Lupato V, Giacomarra V, Cazzador D, Bandolin L, Menegaldo A, Spinato G, Obholzer R, Fussey J, Boscolo-Rizzo P. The risk of recurrence in surgically treated head and neck squamous cell carcinomas: a conditional probability approach. Acta Oncol 2021; 60:942-947. [PMID: 34013838 DOI: 10.1080/0284186x.2021.1925343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Over 50% of patients with head-and-neck squamous cell carcinoma (HNSCC) experience locoregional recurrence, which is associated with poor outcome. In the course of follow-up for patients surviving primary surgery for HNSCC, one might ask: What is the probability of recurrence in one year considering that the cancer has not yet recurred to date? MATERIALS AND METHODS To answer this question, 979 patients surgically treated for HNSCC (i.e. cancer of the oral cavity, oropharynx, hypopharynx or larynx) between March 2004 and June 2018 were enrolled in a multicenter retrospective cohort study, followed up for death and recurrence over a 5 year period. The conditional probability of recurrence in 12 months - i.e. the probability of recurrence in the next 12 months given that, to date, the patient has not recurred - was derived from the cumulative incidence function (Aalen-Johansen method). RESULTS Overall, the probability of recurrence was the highest during the first (17.3%) and the second years (9.6%) after surgery, declining thereafter to less than 5.0% a year thereafter. The probability of recurrence was significantly higher for stage III-IV HNSCCs than for stage I-II HNSCCs in the first year after surgery (20.4% versus 10.0%; p < 0.01), but not thereafter. This difference was most pronounced for oral cavity cancers. No significant differences were observed across different tumor sites. CONCLUSION This dynamic evaluation of recurrence risk in patients surgically treated for HNSCC provides helpful and clinically meaningful information, which can be useful to patients in planning their future life, and to clinicians in tailoring post-treatment surveillance according to a more personalized risk stratification.
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Affiliation(s)
- Daniele Borsetto
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Mantegh Sethi
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jerry Polesel
- Unit of Cancer Epidemiology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michele Tomasoni
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Paolo Bossi
- Department of Medical Oncology, Medical Oncology Unit, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Cristoforo Fabbris
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Section of Ear Nose and Throat (ENT), University of Verona, Verona, Italy
| | - Gabriele Molteni
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Section of Ear Nose and Throat (ENT), University of Verona, Verona, Italy
| | - Daniele Marchioni
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, Section of Ear Nose and Throat (ENT), University of Verona, Verona, Italy
| | - Margherita Tofanelli
- Department of Medical Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Fiordaliso Cragnolini
- Department of Medical Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Giancarlo Tirelli
- Department of Medical Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
| | - Andrea Ciorba
- ENT Department, University Hospital of Ferrara, Ferrara, Italy
| | | | | | - Pietro Canzi
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico ‘San Matteo’ Foundation, Pavia, Italy
| | - Marco Benazzo
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico ‘San Matteo’ Foundation, Pavia, Italy
| | - Valentina Lupato
- Unit of Otolaryngology, Azienda Ospedaliera ‘S. Maria degli Angeli’, Pordenone, Italy
| | - Vittorio Giacomarra
- Unit of Otolaryngology, Azienda Ospedaliera ‘S. Maria degli Angeli’, Pordenone, Italy
| | - Diego Cazzador
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Luigia Bandolin
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Padova, Italy
| | - Anna Menegaldo
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | - Giacomo Spinato
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
| | - Rupert Obholzer
- Department of ENT, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Paolo Boscolo-Rizzo
- Department of Medical Surgical and Health Sciences, Section of Otolaryngology, University of Trieste, Trieste, Italy
- Department of Neurosciences, Section of Otolaryngology, University of Padova, Treviso, Italy
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13
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Best Practices: Application of NI-RADS for Posttreatment Surveillance Imaging of Head and Neck Cancer. AJR Am J Roentgenol 2021; 216:1438-1451. [PMID: 32876470 DOI: 10.2214/ajr.20.23841] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Imaging surveillance is an important component of posttreatment management of head and neck cancers. There is variability in the surveillance regimen used by various practitioners and institutions, with no official National Comprehensive Cancer Network guidelines for patients showing no symptoms beyond 6 months posttreatment. Moreover, imaging of the neck after treatment is a complex examination with significant interreader heterogeneity, particularly in terms of the manner in which degree of suspicion for disease recurrence is expressed. The Neck Imaging Reporting and Data System (NI-RADS) was introduced by the American College of Radiology (ACR) in 2018 as a practical guide for the interpreting radiologist. NI-RADS is a proposed interpretive framework that can be applied to any standardized or institutional surveillance imaging protocol. NI-RADS simplifies communication between radiologists and referring clinicians and provides management guidance linked to specific levels of suspicion. The ACR NI-RADS Committee also provided general best practice recommendations for imaging surveillance modality and timing in the 2018 white paper. This article will review existing literature regarding choice of modality and timeline for surveillance in treated cancer of the head and neck. NI-RADS will then be presented as an approach to imaging reporting, interpretation, and design of next steps in management.
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14
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Riechelmann H, Steinbichler TB, Sprung S, Santer M, Runge A, Ganswindt U, Gamerith G, Dudas J. The Epithelial-Mesenchymal Transcription Factor Slug Predicts Survival Benefit of Up-Front Surgery in Head and Neck Cancer. Cancers (Basel) 2021; 13:cancers13040772. [PMID: 33673269 PMCID: PMC7918715 DOI: 10.3390/cancers13040772] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary In preclinical studies, the epithelial-to-mesenchymal transition (EMT)-related transcription factor Slug indicated radio- and chemoresistance in head and neck squamous cell carcinoma (HNSCC). Here we show that Slug is a biomarker associated with treatment failure in HNSCC patients treated with primary radio- or radiochemotherapy, but not in patients undergoing upfront surgery and postoperative radio- or chemoradiotherapy. Slug may thus serve as a predictive biomarker to identify HNSCC patients who will benefit from upfront surgery. Slug status is an immunohistochemical (IHC) parameter that is easy to determine. If the predictive value observed here can be confirmed in validation studies with independent data, Slug immunohistochemistry may have significant clinical relevance in treatment planning for HNSCC patients. Abstract EMT promotes radio- and chemotherapy resistance in HNSCC in vitro. As EMT has been correlated to the transcription factor Slug in tumor specimens from HNSCC patients, we assessed whether Slug overexpression predicts radio- and chemotherapy resistance and favors upfront surgery in HNSCC patients. Slug expression was determined by IHC scoring in tumor specimens from patients with incident HNSCC. Patients were treated with either definitive radiotherapy or chemoradiotherapy (primary RT/CRT) or upfront surgery with or without postoperative RT or CRT (upfront surgery/PORT). Treatment failure rates and overall survival (OS) were compared between RT/CRT and upfront surgery/PORT in Slug-positive and Slug-negative patients. Slug IHC was positive in 91/354 HNSCC patients. Primary RT/CRT showed inferior response rates (univariate odds ratio (OR) for treatment failure, 3.6; 95% CI, 1.7 to 7.9; p = 0.001) and inferior 5-year OS (univariate, p < 0.001) in Slug-positive patients. The independent predictive value of Slug expression status was confirmed in a multivariable Cox model (p = 0.017). Slug-positive patients had a 3.3 times better chance of survival when treated with upfront surgery/PORT versus primary RT/CRT. For HNSCC patients, Slug IHC represents a novel and feasible predictive biomarker to support upfront surgery.
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Affiliation(s)
- Herbert Riechelmann
- Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (M.S.); (A.R.); (J.D.)
| | - Teresa Bernadette Steinbichler
- Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (M.S.); (A.R.); (J.D.)
- Correspondence:
| | - Susanne Sprung
- Institute of Pathology, Neuropathology and Molecular Pathology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Matthias Santer
- Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (M.S.); (A.R.); (J.D.)
| | - Annette Runge
- Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (M.S.); (A.R.); (J.D.)
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Gabriele Gamerith
- Department of Hematology and Oncology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - Jozsef Dudas
- Department for Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (M.S.); (A.R.); (J.D.)
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15
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Yao CMKL, Fu S, Tam S, Kiong KL, Guo T, Zhao H, Giordano SH, Sturgis EM, Lewis CM. Impact of provider type and number of providers on surveillance testing among survivors of head and neck cancers. Cancer 2021; 127:1699-1711. [PMID: 33471396 DOI: 10.1002/cncr.33402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/10/2020] [Accepted: 11/30/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Guidelines for follow-up after head and neck cancer (HNC) treatment recommend frequent clinical examinations and surveillance testing. Here, the authors describe real-world follow-up care for HNC survivors and variations in surveillance testing. METHODS Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, this study examined a population-based cohort of HNC survivors between 2001 and 2011 Usage of cross-sectional head and neck imaging (CHNI), chest imaging (CI), positron emission tomography (PET), fiberoptic nasopharyngolaryngoscopy (FNPL), and, in irradiated patients, thyroid function testing (TFT) was captured over 2 consecutive surveillance years. Multivariate modeling with logistic regression analyses was used to assess variations by clinical factors, nonclinical factors, number and types of providers seen and their evolution over time. RESULTS Among 13,836 HNC survivors, the majority saw a medical, radiation, or surgical oncologist and a primary care provider (PCP; 81.7%) in their first year of surveillance. However, only 58.1% underwent either PET or CHNI, 47.8% underwent CHNI, 64.1% underwent CI, 32.5% underwent PET scans, 55.0% underwent FNPL, and 55.9% underwent TFT. In multivariate analyses, patients who followed up with more providers and those who followed up with both a PCP and an oncologist were more likely to undergo surveillance testing (P < .007). However, adjusting for providers seen did not explain the variations in surveillance testing rates based on age, race, education, income level, and place of residence. Over time, there was a gradual increase in the use of PET scans and TFT during surveillance years. CONCLUSIONS In this large SEER-Medicare data study, only half of HNC survivors received the recommended testing, and greater compliance was seen in those who followed up with both an oncologist and a PCP. More attention is needed to minimize variations in surveillance testing across sociodemographic groups.
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Affiliation(s)
- Christopher M K L Yao
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shuangshuang Fu
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Samantha Tam
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberley L Kiong
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Theresa Guo
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hui Zhao
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Carol M Lewis
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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16
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Lenze NR, Farquhar DR, Dorismond C, Sheth S, Zevallos JP, Blumberg J, Lumley C, Patel S, Hackman T, Weissler MC, Yarbrough WG, Olshan AF, Zanation AM. Age and risk of recurrence in oral tongue squamous cell carcinoma: Systematic review. Head Neck 2020; 42:3755-3768. [PMID: 32914472 DOI: 10.1002/hed.26464] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/19/2020] [Accepted: 08/26/2020] [Indexed: 12/29/2022] Open
Abstract
The incidence of oral tongue squamous cell carcinoma has been increasing in young patients (≤45 years) without a clear etiologic driver. It is unknown if younger patients have an increased risk of recurrence compared to older patients. A literature search was conducted through January 2020 using PubMed/MEDLINE, Embase, Cochrane, Scopus, Science Direct, and clinicaltrials.gov. This review was registered with PROSPERO (ID: CRD42020167498) and the PRISMA statement was followed. Studies were eligible for inclusion if they assessed risk of recurrence by age using a time-to-event analysis, used an age cutoff of ≤45 years or less for the younger cohort, and limited the analysis to the oral tongue subsite. Data were extracted independently by two reviewers using a form with a prespecified list of variables. There were 13 articles that met criteria for the qualitative synthesis (n = 1763 patients). The reported 5-year rates of disease-free survival ranged from 30% to 72% for the younger cohorts and 42% to 81% for the older cohorts. Three studies reported a statistically significant increased risk of recurrence in younger patients, three studies reported a nonsignificant increased risk in younger patients, and seven studies reported a similar risk in younger patients based on the time-to-event analyses. There may be an increased risk of recurrence for younger patients with oral tongue cancer. A definitive conclusion is precluded by limitations among individual studies, and additional research is warranted to examine this question.
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Affiliation(s)
- Nicholas R Lenze
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Douglas R Farquhar
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Christina Dorismond
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Siddharth Sheth
- Division of Hematology and Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jose P Zevallos
- Department of Otolaryngology - Head and Neck Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Jeffrey Blumberg
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Catherine Lumley
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Samip Patel
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Trevor Hackman
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Mark C Weissler
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Wendell G Yarbrough
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.,Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam M Zanation
- Department of Otolaryngology - Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Carta F, Quartu D, Mariani C, Tatti M, Marrosu V, Gioia E, Gerosa C, Zanda JSA, Chuchueva N, Figus A, Puxeddu R. Compartmental Surgery With Microvascular Free Flap Reconstruction in Patients With T1-T4 Squamous Cell Carcinoma of the Tongue: Analysis of Risk Factors, and Prognostic Value of the 8th Edition AJCC TNM Staging System. Front Oncol 2020; 10:984. [PMID: 32760667 PMCID: PMC7372302 DOI: 10.3389/fonc.2020.00984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/19/2020] [Indexed: 11/13/2022] Open
Abstract
Compartmental surgery and primary reconstruction with microvascular free flaps represent the gold-standard in the treatment of oral tongue squamous cell carcinoma (OTSCC). However, there are still unclear clinical features that negatively affect the outcomes. This retrospective study included 80 consecutive patients with OTSCC who underwent compartmental surgery and primary reconstruction by free flap. The oncologic outcomes, the reliability of the 8th edition American Joint Committee on Cancer (AJCC) staging system and the prognostic factors were evaluated. Fifty-nine males and 21 females (mean age 57.8 years, range 27-81 years) were treated between November 2010 and March 2018 (one patient had two metachronous primaries). Seventy-one patients (88.75%, 52 males, 19 females, mean age of 57.9 years, range of 27-81 years) had no clinical history of previous head and neck radiotherapy and were considered as naive. Histology showed radical surgery on 80/81 lesions (98.8%), with excision margins >0.5 cm, while in 1 case (1.2%), a close posterior margin was found. According to the 8th AJCC classification, 37 patients (45.7%) were upstaged shifting from the clinical to the pathological stage, and 39 (48.1%) showed an upstaging while shifting from the 7th to the 8th AJCC staging system (no tumors were downstaged). Nodal involvement was confirmed in 33 patients (40.7%). Perineural and lymphovascular invasion were present in 9 (11.1%) and 11 (13.6%) cases, respectively. Twenty-two patients (27.1%) underwent adjuvant therapy. The 5-years disease-specific, overall, overall relapse-free, locoregional relapse-free and distant metastasis-free survival rates were 73.2, 66.8, 62.6, 67.4, and 86%, respectively. Patients with a lymph node ratio >0.09 experienced significantly worse outcomes. Univariate analysis showed that patients with previous radiotherapy, stage IV disease, nodal involvement, and lymphovascular invasion had significantly worse outcomes. Multivariate analysis focused naive patients and showed that lymphovascular invasion, advanced stage of disease, and node involvement resulted reliable prognostic factors, and patients with the same tumor stage and histological risk factors who did not undergo adjuvant therapy experienced significantly worse outcomes. In our series, surgery played a major role in the treatment of local extension; adjuvant therapy resulted strictly indicated in patients with advanced-stage disease associated with risk factors.
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Affiliation(s)
- Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Daniela Quartu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Melania Tatti
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Valeria Marrosu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Edoardo Gioia
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Clara Gerosa
- Unit of Pathology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Jacopo S A Zanda
- Unit of Pathology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Natalia Chuchueva
- ENT Department, I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Andrea Figus
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
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18
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Kumar D, Dey T. Treatment delays in oncology patients during COVID-19 pandemic: A perspective. J Glob Health 2020; 10:010367. [PMID: 32566158 PMCID: PMC7296208 DOI: 10.7189/jogh.10.010367] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Divyesh Kumar
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
| | - Treshita Dey
- Department of Radiotherapy and Oncology, PGIMER, Chandigarh, India
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19
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Szturz P, Van Laer C, Simon C, Van Gestel D, Bourhis J, Vermorken JB. Follow-Up of Head and Neck Cancer Survivors: Tipping the Balance of Intensity. Front Oncol 2020; 10:688. [PMID: 32435619 PMCID: PMC7218054 DOI: 10.3389/fonc.2020.00688] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/14/2020] [Indexed: 01/17/2023] Open
Abstract
The traditional concept of post-treatment surveillance in head and neck cancer patients relies on examinations directed at early detection of disease recurrence and/or second primary tumors. They are usually provided by ear, nose and throat specialists with complementary input from radiation oncologists and medical oncologists. Emerging evidence underscores the importance of monitoring and effective management of late adverse events. One of the major drawbacks is a lack of prospective controlled data. As a result, local institutional policies differ, and practice recommendations are subject to continuing debate. Due to the economic burden and impact on emotional comfort of patients, intensity and content of follow-up visits are a particularly conflicting topic. According to the current evidence-based medicine, follow-up of head and neck cancer patients does not prolong survival but can improve quality of life. Therefore, an approach giving priority to a multidisciplinary care involving a speech and swallowing expert, dietician, dentist, and psychologist may indeed be more relevant. Moreover, on a case-by-case basis, some patients need more frequent consultations supplemented by imaging modalities. Human papillomavirus positive oropharyngeal cancer tends to develop late failures at distant sites, and asymptomatic oligometastatic disease, especially in the lungs, can be successfully salvaged by local ablation, either surgically or by radiation. The deep structures of the skull base related to the nasopharynx are inaccessible to routine clinical examination, advocating periodic imaging supplemented by nasofibroscopy as indicated. Anamnesis of heavy smoking justifies annual low-dose computed tomography screening of the thorax and intensive smoking cessation counseling. Finally, some cancer survivors feel more comfortable with regular imaging, and their voice should be taken into consideration. Future development of surveillance strategies will depend on several variables including identification of reliable predictive factors to select those who could derive the most benefit from follow-up visits, the availability of long-term follow-up data, the results of the first randomized trials, resource allocation patterns, infrastructure density, and the therapeutic landscape of locally advanced and recurrent and/or metastatic disease, which is rapidly changing with the advent of immune checkpoint inhibitors and better utilization of local approaches.
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Affiliation(s)
- Petr Szturz
- Medical Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Carl Van Laer
- Department of Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Dirk Van Gestel
- Department of Radiotherapy, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Bourhis
- Radiation Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jan B Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
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20
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Dawson C, Roe J, Starmer H, Brady G, Nund R, Coffey M, Govender R, Patterson JM, Nankivell P, Topping A, Sharma N, Parmar S, Elkington C, Merrit M, Stanbury D, Pracy P. Patient advocacy in head and neck cancer: Realities, challenges and the role of the multi‐disciplinary team. Clin Otolaryngol 2020; 45:437-444. [DOI: 10.1111/coa.13508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/12/2020] [Indexed: 12/17/2022]
Affiliation(s)
| | - Justin Roe
- Department of Speech & Language Therapy The Royal Marsden NHS Foundation Trust London UK
- Department of Surgery and Cancer Imperial College Healthcare NHS Trust London UK
- National Centre for Airway ReconstructionImperial College Healthcare Trust London UK
| | - Heather Starmer
- Department of Otolaryngology and Head and Neck Cancer Speech and Swallowing Rehabilitation Stanford Cancer Center CA USA
| | - Grainne Brady
- Department of Speech and Language Therapy The Royal Marsden NHS Foundation Trust London UK
| | - Rebecca Nund
- School of Health and Rehabilitation Sciences The University of Queensland Brisbane Qld. Australia
| | | | - Roganie Govender
- University College London Hospital NHS Foundation Trust London UK
| | | | | | | | - Neil Sharma
- Queen Elizabeth Hospital Birmingham Birmingham UK
| | - Sat Parmar
- Queen Elizabeth Hospital Birmingham Birmingham UK
| | | | | | | | - Paul Pracy
- Queen Elizabeth Hospital Birmingham Birmingham UK
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21
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Cognetti DM, Villaflor VM, Fakhry C, Miller MC, Malloy KM. Survivorship support in head and neck cancer: American Head and Neck Society survey. Head Neck 2020; 42:939-944. [DOI: 10.1002/hed.26066] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/24/2019] [Accepted: 12/17/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- David M. Cognetti
- Department of Otolaryngology, Sydney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania
| | - Victoria M. Villaflor
- Department of Medical Oncology, Robert H Lurie Comprehensive Cancer Center of Northwestern University Chicago Illinois
| | - Carole Fakhry
- Department of Otolaryngology, Johns Hopkins University School of Medicine Baltimore Maryland
| | - Matthew C. Miller
- Department of Otolaryngology, University of Rochester School of Medicine Rochester New York
| | - Kelly M. Malloy
- Department of Otolaryngology, University of Michigan Medical School Ann Arbor Michigan
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22
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Zocchi J, Pietrobon G, Campomagnani I, Riggi E, Veronesi G, Borchini R, Pellini R, Volpi L, Bignami M, Castelnuovo P. The role of a post therapeutic surveillance program for sinonasal malignancies: Analysis of 417 patients. Head Neck 2019; 42:963-973. [PMID: 31889395 DOI: 10.1002/hed.26069] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 10/08/2019] [Accepted: 12/19/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Post therapeutic surveillance of head and neck neoplasms is a still debated issue in the current literature: although different works tried to establish frequency, modality, and efficacy of a routine follow-up, little evidence has been produced, in particular considering only sinonasal malignancies. METHODS A retrospective review of patients treated for sinonasal malignancies in a single tertiary center and followed through a regular program of follow-up was carried out. Rate of recurrence, location, timing, diagnosis, and salvage treatment were the main data analyzed. RESULTS Of note, 417 patients were included in the study and 117 experienced at least one relapse. Staging, histological type, and previous treatment represent the main clinical factors to be considered to stratify patient's risk of recurrence. CONCLUSION A regular post therapeutic surveillance can provide an early recurrence detection for patients treated for sinonasal malignancies, offering opportunity for salvage treatment in a high percentage of patients.
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Affiliation(s)
- Jacopo Zocchi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Giacomo Pietrobon
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Isotta Campomagnani
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Emilia Riggi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria.,SSD Epidemiology and Screening-CPO, University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Giovanni Veronesi
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria
| | - Rossana Borchini
- Research Center in Epidemiology and Preventive Medicine (EPIMED), Department of Medicine and Surgery, University of Insubria
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, Regina Elena National Cancer Institute IRCCS, Rome, Italy
| | - Luca Volpi
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Maurizio Bignami
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Paolo Castelnuovo
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.,Head and Neck Surgery & Forensic Dissection Research Center (HNS&FDRc), Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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23
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Wang M, Sharma A, Osazuwa-Peters N, Simpson MC, Schootman M, Piccirillo JF, Huh WK, Adjei Boakye E. Risk of subsequent malignant neoplasms after an index potentially-human papillomavirus (HPV)-associated cancers. Cancer Epidemiol 2019; 64:101649. [PMID: 31816512 DOI: 10.1016/j.canep.2019.101649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/12/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Since the number of cancer survivors is increasing, it is imperative that we better understand the long-term consequences of these survivors. We assessed the risk of developing a second primary malignant neoplasm (SPMN) after an index potentially-HPV-associated cancers (P-HPV-AC). METHODS We constructed a population-based cohort of patients with P-HPV-AC using Surveillance, Epidemiology, and End Results registry data (2000-2015). We limited patients to those with invasive P-HPV-AC [cervical, vagina, vulva, penile, anal, and oropharynx] based on the International Classification of Diseases for Oncology, 3rd edition. Excess SPMN risks were calculated based on standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). RESULTS A total of 105,644 patients with an index P-HPV-AC were identified, and 7.8 % developed a SPMN. In all P-HPV-AC patients, the overall SIR was 1.73 (95 % CI: 1.69-1.77) and EAR of 70.72 per 10,000 PYR. All index P-HPV-AC sites showed statistically significant increases in the risk of SPMN, except for anal cancer among men, compared with the general population. The greatest increase in risk of SPMN was observed among patients diagnosed with an index P-HPV-oropharyngeal cancer (SIR = 1.83; 95 % CI, 1.70-1.82 and SIR = 2.29; 95 % CI, 2.12-2.47 for men and women, respectively). Men developed SPMN mostly in aero-digestive tract whiles women developed SPMN both in aero-digestive tract and other HPV-associated cancer sites. CONCLUSIONS P-HPV-AC survivors experienced excess risk of SPMN. These findings have the potential to affect future surveillance practices and improve preventive healthcare for survivors of P-HPV-ACs.
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Affiliation(s)
- Maggie Wang
- Saint Louis University School of Medicine, 1402 S Grand Blvd, St. Louis, MO 63104, USA.
| | - Arun Sharma
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, 720 N. Bond Street, Springfield, IL 62702, USA.
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3660 Vista Ave, St. Louis, MO 63110, USA; Saint Louis University Cancer Center, 3685 Vista Ave, St. Louis, MO 63110, USA.
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, 3660 Vista Ave, St. Louis, MO 63110, USA.
| | - Mario Schootman
- Center for Clinical Excellence, SSM Health, 10101 Woodfield Ln., St. Louis, MO 63132, USA.
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
| | - Warner K Huh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 1201 11th Ave S, Birmingham, AL 35205, USA.
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, 201 E. Madison Street, P. O. Box 19664, Springfield, IL 62794-9664, USA; Department of Internal Medicine, Southern Illinois University School of Medicine, 751 N Rutledge St, Springfield, IL 62702, USA; Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, 315 W Carpenter St, Springfield, IL 62702, USA.
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24
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Coca-Pelaz A, Rodrigo JP, Suárez C, Nixon IJ, Mäkitie A, Sanabria A, Quer M, Strojan P, Bradford CR, Kowalski LP, Shaha AR, de Bree R, Hartl DM, Rinaldo A, Takes RP, Ferlito A. The risk of second primary tumors in head and neck cancer: A systematic review. Head Neck 2019; 42:456-466. [PMID: 31750595 DOI: 10.1002/hed.26016] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/22/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Second primary tumors (SPTs) are a common cause of reduced life expectancy in patients treated for head and neck cancer (HNC). This phenomenon forms an area to be addressed during posttreatment follow-up. METHODS We conducted a systematic review of literature following PRISMA guidelines, from 1979 to 2019, to investigate incidence of SPTs, synchronous, and metachronous, in HNC population. RESULTS Our review includes data of 456 130 patients from 61 articles. With a minimum follow-up of 22 months, mean incidence of SPTs was 13.2% (95% CI: 11.56-14.84): 5.3% (95% CI: 4.24-6.36) for synchronous SPTs and 9.4% (95% CI: 7.9-10.9) for metachronous SPTs. The most frequent site for SPTs was head and neck area, followed by the lungs and esophagus. CONCLUSION Although with wide variations between studies, the rate of SPTs in HNC patients is high. Given the impact in the prognosis, we must develop strategies for the early diagnosis of SPTs.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Iain J Nixon
- Ear, Nose and Throat Department, NHS Lothian, University of Edinburgh, Edinburgh, UK
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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25
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Hall SF, Owen T, Griffiths RJ, Brennan K. Does the frequency of routine follow-up after curative treatment for head-and-neck cancer affect survival? ACTA ACUST UNITED AC 2019; 26:295-306. [PMID: 31708648 DOI: 10.3747/co.26.4949] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Routine follow-up is a cornerstone of oncology practice, but evidence to support most aspects of follow-up is lacking. Our objective was to investigate the relationship between frequency of routine follow-up and survival. Methods This population-based study used electronic health care data relating to 5310 patients from Ontario diagnosed with squamous-cell head-and-neck cancer during 2007-2012. Treatments included surgery (24.6%), radiotherapy with or without chemotherapy (52.4%), and combined surgery and radiotherapy (23%). We determined the oncologist who was following each patient after treatment; calculated the average follow-up visits to the oncologist during the subsequent 2.5 years for all patients who were doing well; and used Kaplan-Meier and multiple variable regression analysis to compare, by treatment, overall survival for patients in the high, typical, and low follow-up oncologist groups. Results Many oncologists saw patients 40%-80% more often than other oncologists did. No relationship of appointment frequency with survival was observed for patients in any treatment group. Conclusions The practice of routine follow-up varies and is costly both to a health care system and to patients. Without evidence about the effectiveness of current policies, further research is required to investigate new or optimal practices.
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Affiliation(s)
- S F Hall
- Department of Otolaryngology and Division of Cancer Care and Epidemiology of the Queen's Cancer Research Institute, Queen's University, Kingston, ON
| | - T Owen
- Department of Oncology, Division of Radiation Oncology, Queen's University, Kingston, ON
| | | | - K Brennan
- Clinical Research Centre, Dalhousie University, Halifax, NS
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26
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Critical review of the follow-up protocol for head and neck cancer patients. The Journal of Laryngology & Otology 2019; 133:424-429. [PMID: 31006389 DOI: 10.1017/s0022215119000811] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Head and neck cancer follow-up length, interval and content are controversial. Therefore, this study aimed to evaluate the efficacy of the follow-up protocol after curative treatment in head and neck cancer patients. METHOD Clinical data of 456 patients with new malignancy of the head and neck from a tertiary care centre district from 1999 to 2008 were analysed. Time from treatment, symptoms and second-line treatment outcomes of patients with recurrent disease were evaluated. RESULTS A total of 94 (22 per cent) patients relapsed during the 5-year follow-up period; 90 per cent of recurrences were found within 3 years. Fifty-six per cent of the patients had subjective symptoms indicating a recurrence of the tumour. All recurrent tumours found during routine follow-up visits without symptoms were found within 34 months after completion of treatment. CONCLUSION Routine follow up after three years is questionable; recurrent disease beyond this point was detected in only 2 per cent of patients. In this study, all late tumour recurrences had symptoms of the disease. Easy access to extra follow-up visits when symptoms occur could cover the need for late follow up.
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27
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Value of patient-reported symptoms in the follow up of patients potentially cured of laryngeal carcinoma. The Journal of Laryngology & Otology 2019; 133:508-514. [PMID: 31006407 DOI: 10.1017/s0022215119000677] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate the significance of patients' ability to recognise symptoms that signify recurrence. METHODS A retrospective analysis was conducted in Norway of demographic, clinical and follow-up data for patients with laryngeal carcinoma considered free of disease following treatment. The study included clinical data from 732 patients with glottic tumours and 249 patients with supraglottic tumours who were considered cured of disease. Data on the site, time and type of recurrence (symptomatic or asymptomatic) were retrieved. RESULTS Recurrence was observed in 127 patients with glottic tumours and 71 with supraglottic tumours. A total of 103 glottic recurrences and 53 supraglottic recurrences were symptomatic. For patients with glottic carcinoma, recurrence detection through symptoms was associated with a favourable post-salvage survival rate compared with asymptomatic recurrences (p = 0.003). CONCLUSION A patient's ability to self-detect 'red flag' symptoms and self-initiate visits represents a previously ignored prognostic factor, and may rationalise follow up and improve survival.
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28
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Ilmarinen T, Keski-Säntti H, Markkanen-Leppänen M, Haapaniemi A, Tapiovaara L, Atula T, Bäck LJJ. De-escalation of post-treatment surveillance in oropharyngeal cancer. Head Neck 2018; 41:1457-1462. [PMID: 30582249 DOI: 10.1002/hed.25593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 09/11/2018] [Accepted: 12/05/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The majority of new oropharyngeal squamous cell carcinoma (OPSCC) cases are associated with human papillomavirus and favorable prognosis. Post-treatment follow-up should be targeted to patients at greatest risk for disease recurrence. METHODS To assess the benefits of routine clinical surveillance in OPSCC, we reviewed all follow-up visits conducted in 2014 at Helsinki University Hospital Department of Otorhinolaryngology. RESULTS Of 366 visits, 26 (7%) were from patients presenting with a new symptom, and disease recurrence was detected in four. The presence of a new symptom was significantly associated with disease recurrence (P < 0.001). Of 366 visits, 340 (93%) were from patients presenting without new symptoms, and not a single recurrence was found during these visits. CONCLUSIONS Based on our findings, and previous studies assessing the prognosis and pattern of recurrent OPSCC, we concluded that the number of routine post-treatment visits can be reduced. Follow-up should rather focus on symptom-directed examinations.
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Affiliation(s)
- Taru Ilmarinen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Harri Keski-Säntti
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mari Markkanen-Leppänen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Laura Tapiovaara
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leif J J Bäck
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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29
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Meerwein CM, Pizzuto DA, Vital D, Morand GB, Stolzmann P, Huber GF, Huellner MW. Use of MRI and FDG-PET/CT to predict fixation of advanced hypopharyngeal squamous cell carcinoma to prevertebral space. Head Neck 2018; 41:503-510. [DOI: 10.1002/hed.25431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/24/2018] [Accepted: 09/21/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Christian M. Meerwein
- Department of Otorhinolaryngology, Head & Neck Surgery; University Hospital Zurich; Zurich Switzerland
| | - Daniele A. Pizzuto
- Department of Nuclear Medicine; University Hospital Zurich/University of Zurich; Zurich Switzerland
- Instituto di Medicina Nucleare, Università Cattolica del Sacro Cuore; Rome Italy
| | - Domenic Vital
- Department of Otorhinolaryngology, Head & Neck Surgery; University Hospital Zurich; Zurich Switzerland
| | - Grégoire B. Morand
- Department of Otorhinolaryngology, Head & Neck Surgery; University Hospital Zurich; Zurich Switzerland
| | - Paul Stolzmann
- Department of Nuclear Medicine; University Hospital Zurich/University of Zurich; Zurich Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology; Kantonsspital St. Gallen; St. Gallen Switzerland
| | - Martin W. Huellner
- Department of Nuclear Medicine; University Hospital Zurich/University of Zurich; Zurich Switzerland
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Rohde RL, Adjei Boakye E, Challapalli SD, Patel SH, Geneus CJ, Tobo BB, Simpson MC, Mohammed KA, Deshields T, Varvares MA, Osazuwa-Peters N. Prevalence and sociodemographic factors associated with depression among hospitalized patients with head and neck cancer-Results from a national study. Psychooncology 2018; 27:2809-2814. [DOI: 10.1002/pon.4893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/04/2018] [Accepted: 09/13/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - Eric Adjei Boakye
- Saint Louis University Center for Health Outcomes Research; St Louis Missouri
| | | | - Shivam H. Patel
- Saint Louis University School of Medicine; St Louis Missouri
| | - Christian J. Geneus
- Department of Biostatistics and Bioinformatics; Tulane University School of Public Health and Tropical Medicine; New Orleans Louisiana
| | - Betelihem B. Tobo
- Department of Epidemiology and Biostatistics; Saint Louis University College for Public Health and Social Justice; St Louis Missouri
| | - Matthew C. Simpson
- Department of Otolaryngology; Harvard Medical School, Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Kahee A. Mohammed
- Department of Internal Medicine; Saint Louis University School of Medicine; St Louis Missouri
| | - Teresa Deshields
- Department of Medicine; Washington University School of Medicine; St Louis Missouri
| | - Mark A. Varvares
- Department of Otolaryngology; Harvard Medical School, Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Nosayaba Osazuwa-Peters
- Department of Epidemiology and Biostatistics; Saint Louis University College for Public Health and Social Justice; St Louis Missouri
- Department of Otolaryngology-Head and Neck Surgery; Saint Louis University School of Medicine; St Louis Missouri
- Saint Louis University Cancer Center; St Louis Missouri
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Polednik KM, Simpson MC, Adjei Boakye E, Mohammed KA, J Dombrowski J, Varvares MA, Osazuwa-Peters N. Radiation and Second Primary Thyroid Cancer Following Index Head and Neck Cancer. Laryngoscope 2018; 129:1014-1020. [PMID: 30208210 DOI: 10.1002/lary.27467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES/HYPOTHESIS Radiation is thought to increase risk of developing second primary thyroid cancer (SPTC). This study estimated the rate of SPTC following index head and neck cancer (HNC) and determined whether radiation treatment among HNC survivors increased SPTC risk. STUDY DESIGN Retrospective data analysis. METHOD The Surveillance, Epidemiology, and End Results database (1975-2014) was queried for cases of index HNC (N = 127,563) that developed SPTC. Adjusted multivariable competing risk proportional hazards model tested risk of developing a SPTC following index HNC. Sensitivity analyses using proportional hazards models were also performed restricting data to patients who 1) received both radiation and chemotherapy and 2) radiation alone. RESULTS Only 0.2% of index HNC survivors (n = 229) developed SPTC, yielding a rate of 26.1 per 100,000 person-years. For every increasing year of age at diagnosis, patients were 3% less likely to develop an SPTC (adjusted hazard ratio [aHR] = 0.97, 95% CI: 0.96-0.98). Males were also less likely to develop an SPTC (aHR = 0.73, 95% CI: 0.55-0.96). Radiation (aHR = 0.92, 95% CI: 0.68-1.25), surgery (aHR = 0.79, 95% CI: 0.56-1.11), and chemotherapy (aHR = 1.13, 95% CI: 0.76-1.69) were not significantly associated with developing SPTC. The sensitivity models also did not find an association between treatment and risk of SPTC. CONCLUSIONS Rate of developing SPTC following index HNC was very low, and previous exposure to radiation did not significantly increase risk in our study population. More studies are needed to understand the increasing incidence of thyroid cancer across the United States. LEVEL OF EVIDENCE NA Laryngoscope, 129:1014-1020, 2019.
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Affiliation(s)
| | - Matthew C Simpson
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Eric Adjei Boakye
- Center for Health Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - Kahee A Mohammed
- Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri.,Center for Health Outcomes Research, Saint Louis University, St. Louis, Missouri
| | - John J Dombrowski
- Department of Radiation Oncology, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Mark A Varvares
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.,Saint Louis University Cancer Center, St. Louis, Missouri.,Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, U.S.A
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Carta F, Mariani C, Sambiagio GB, Chuchueva N, Lecis E, Gerosa C, Puxeddu R. CO 2 Transoral Microsurgery for Supraglottic Squamous Cell Carcinoma. Front Oncol 2018; 8:321. [PMID: 30234007 PMCID: PMC6131582 DOI: 10.3389/fonc.2018.00321] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/27/2018] [Indexed: 02/05/2023] Open
Abstract
The present study analyzed the results of the endoscopic approach to T1, T2 and selected T3 supraglottic carcinoma with the aim of reviewing functional and oncologic outcomes after different types of endoscopic supraglottic laryngectomies. This is a retrospective clinical study of 42 consecutive patients (mean age of 61.8 years, 33 males, 9 females) treated by the senior author for supraglottic squamous cell carcinoma with a transoral CO2 laser approach and reviewed from November 2010 to September 2017. Surgical procedures were classified according to the European Laryngological Society. In addition to the standardized transoral supraglottic laryngectomies, we introduced a modified type IVb by sparing the inferior third of the arytenoid if not directly involved in the tumor. Swallowing was evaluated with the Swallowing Performance Status Scale reported by the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology. Survival probabilities were estimated using Kaplan-Meier curves. Two type I, 2 type IIa, 2 type IIb, 3 type IIIa, 12 type IIIb, 13 type IVa, 3 type modified IVb, and 5 type IVb supraglottic laryngectomies were performed. Twenty-one patients (50%) underwent primary neck dissection. The pathologic TNM classification according to the 8th edition of the American Joint Committee on Cancer system was as follows: 9 pT1cN0, 2 pT1N0, 1 pT1N1, 7 pT2cN0, 1 rypT2cN0, 9 pT2N0, 4 pT2N1, 2 ypT2N1, 2 pT3cN0, 2 rypT3cN0, 1 pT3N1, and 2 pT3N2b. Mean follow-up was 3.4 years (range of 9 months to 6 years). According to the Kaplan-Meier analysis, 5-year disease-specific survival, local-relapse-free survival, nodal-relapse-free survival, overall laryngeal preservation and overall survival of patients without previous head and neck radiotherapy/open surgery were 100%, 95.2%, 87.8%, 100%, and 64.6%, respectively. Patients who underwent type I, IIa, and IIb resections (n = 6) started oral feeding the day after surgery, patients who underwent type III-IVb modified resections (n = 31) started oral feeding 3-4 days after surgery, and patients who underwent standard type 4b resections (n = 5) started oral feeding 7 days after surgery. Three months after surgery, patients without a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed significantly better swallowing compared to patients who underwent standard type IVb resection: grade 4-6 impairment of swallowing in 8 and 66.7% of cases, respectively (p = 0.006072); patients with a clinical history of previous head and neck radiotherapy/open surgery who underwent type III, IVa, and modified IVb resections showed not statistically significant better swallowing compared to patients who underwent standard type IVb resection: grade 4-6 impairment of swallowing at 3 months in 16.7% and 50% of cases, respectively (p = 0.23568). Transoral CO2 laser supraglottic laryngectomy is an oncologic sound alternative to traditional open neck surgery and chemo-radiotherapy. Recovery of swallowing is significantly worsened after total resection of the arytenoid. Modified type IVb procedure leaving intact, when possible, the inferior third of the arytenoid and consequently the glottic competence, improves functional outcome.
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Affiliation(s)
- Filippo Carta
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Cinzia Mariani
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | | | | | - Elisa Lecis
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Clara Gerosa
- Unit of Pathology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
| | - Roberto Puxeddu
- Unit of Otorhinolaryngology, Department of Surgery, Azienda Ospedaliero-Universitaria di Cagliari, University of Cagliari, Cagliari, Italy
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Schwartz SR, Almosnino G. The Value of Clinical Practice Guidelines in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2018. [DOI: 10.1007/s40136-018-0205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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An assessment of patient burdens from head and neck cancer survivorship care. Oral Oncol 2018; 82:115-121. [DOI: 10.1016/j.oraloncology.2018.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/26/2018] [Accepted: 04/29/2018] [Indexed: 02/06/2023]
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Brennan K, Hall S, Owen T, Griffiths R, Peng Y. Variation in routine follow-up care after curative treatment for head-and-neck cancer: a population-based study in Ontario. Curr Oncol 2018; 25:e120-e131. [PMID: 29719436 PMCID: PMC5927791 DOI: 10.3747/co.25.3892] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background The actual practices of routine follow-up after curative treatment for head-and-neck cancer are unknown, and existing guidelines are not evidence-based. Methods This retrospective population-based study used administrative data to describe 5 years of routine follow-up care in 3975 head-and-neck cancer patients diagnosed between 2007 and 2012 in Ontario. Results The mean number of visits per year declined during the follow-up period (from 7.8 to 1.9, p < 0.001). The proportion of patients receiving visits in concordance with guidelines ranged from 80% to 45% depending on the follow-up year. In at least 50% of patients, 1 head, neck, or chest imaging test was performed in the first follow-up year; that proportion subsequently declined (p < 0.001). Factors associated with follow-up practices included comorbidity, tumour site, treatment, geographic region, and physician specialty (p < 0.05). Conclusions Given current practice variation and the absence of an evidence-based standard, the challenge in identifying a single optimal follow-up strategy might be better addressed with a harmonized approach to providing individualized follow-up care.
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Affiliation(s)
| | - S.F. Hall
- Department of Otolaryngology
- Department of Oncology
| | | | | | - Y. Peng
- Department of Public Health Sciences, Queen’s University, Kingston, ON
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Fulcher CD, Haigentz M, Ow TJ. AHNS Series: Do you know your guidelines? Principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma. Head Neck 2018; 40:676-686. [PMID: 29171929 PMCID: PMC5849482 DOI: 10.1002/hed.25025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/11/2022] Open
Abstract
This article is a continuation of the "Do You Know Your Guidelines" series, initiated by the Education committee of the American Head and Neck Society. Treatment guidelines for advanced head and neck squamous cell carcinoma are reviewed here, including the critical roles of radiotherapy, chemotherapy, and the recent application of immunotherapy agents. We will be limiting this discussion to include cancers of the oral cavity, oropharynx, hypopharynx, and larynx. It should be noted that much of the article pertains to human papillomavirus (HPV)-negative oropharyngeal cancer where applicable, as HPV-positive oropharyngeal squamous cell carcinoma carries a different natural history, different prognosis, and now different staging criteria. Additionally, the article will not include information on nasopharyngeal or sinus cancers, as these latter topics are covered in separate "Do you know your guidelines?" installments and these diagnoses carry somewhat different approaches to diagnosis and management that diverge from the focus of this article.
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Affiliation(s)
- Cory D. Fulcher
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Missak Haigentz
- Department of Medicine (Oncology), Albert Einstein College of Medicine
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine
- Department of Medicine (Oncology), Morristown Medical Center, Morristown, NJ
| | - Thomas J. Ow
- Department of Otorhinolaryngology-Head and Neck Surgery and Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine
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Carta F, Bandino F, Olla AM, Chuchueva N, Gerosa C, Puxeddu R. Prognostic value of age, subglottic, and anterior commissure involvement for early glottic carcinoma treated with CO2 laser transoral microsurgery: a retrospective, single-center cohort study of 261 patients. Eur Arch Otorhinolaryngol 2018; 275:1199-1210. [DOI: 10.1007/s00405-018-4890-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/27/2018] [Indexed: 12/18/2022]
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39
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Gill A, Vasan N, Givi B, Joshi A. AHNS Series: Do you know your guidelines? Evidence-based management of oral cavity cancers. Head Neck 2017; 40:406-416. [PMID: 29206324 DOI: 10.1002/hed.25024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 10/13/2017] [Indexed: 12/22/2022] Open
Abstract
Oral cavity squamous cell carcinoma (OCSCC) is the most common nonmelanoma head and neck cancer in the world, with an estimated 405 000 new cases expected each year. Subsites of the oral cavity include the alveolar ridge, buccal mucosa, anterior tongue, tonsillar pillar, retromolar trigone, hard palate, gingiva, and floor of the mouth. In this issue of the AHNS "Do you know your guidelines?" series, we review the evidence-based approach to the management of oral cavity carcinomas based on the framework provided by the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology.
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Affiliation(s)
- Amarbir Gill
- Division of Otolaryngology - Head and Neck Surgery, The University of California, Davis, Sacramento, California
| | - Nilesh Vasan
- Department of Otorhinolaryngology - University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Babak Givi
- Department of Otolaryngology - New York University Langone Medical Center, New York, New York
| | - Arjun Joshi
- Division of Otolaryngology - Head and Neck Surgery, The George Washington University, Washington, DC
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40
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Moshtaghi O, Haidar YM, Mahmoodi A, Tjoa T, Armstrong WB. The Role of In-Office Ultrasound in the Diagnosis of Neck Masses. Otolaryngol Head Neck Surg 2017; 157:58-61. [PMID: 28669308 DOI: 10.1177/0194599817696288] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To evaluate the efficacy of otolaryngologist-performed in-office ultrasound (US) in the clinical assessment of lateral neck masses, we performed a retrospective review of patients with lateral neck masses who had both a surgeon-performed US and US-guided fine-needle aspiration (USGFNA) at our tertiary academic center from 2012 to 2015. Fifty-nine patients were included. USGFNA results included 32 (54%) malignant lesions, 23 (39%) benign lesions, and 4 (6%) nondiagnostic lesions. USGFNA demonstrated 85% accuracy. In 22 (37%) patients, in-office US revealed additional findings that were not identified on physical examination (eg, nonpalpable lymph nodes or elucidated anatomical structures), which either assisted in surgical planning or altered treatment. In-office US and USGFNA on initial evaluation by the otolaryngologist augment physical examination and have potential value as the primary imaging and diagnostic modality in the workup of lateral neck masses.
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Affiliation(s)
- Omid Moshtaghi
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Yarah M Haidar
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - Amin Mahmoodi
- 2 Department of Biomedical Engineering, University of California, Irvine, Orange, California
| | - Tjoson Tjoa
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
| | - William B Armstrong
- 1 Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine Medical Center, Orange, California, USA
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41
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Dougherty W, Givi B, Jameson MJ. AHNS Series - Do you know your guidelines? Lip cancer. Head Neck 2017; 39:1505-1509. [DOI: 10.1002/hed.24817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 04/04/2017] [Indexed: 11/09/2022] Open
Affiliation(s)
- William Dougherty
- Department of Otolaryngology - Head and Neck Surgery; University of Virginia Health System; Charlottesville Virginia
| | - Babak Givi
- Department of Otolaryngology - Head and Neck Surgery; New York University Langone Medical Center; New York New York
| | - Mark J. Jameson
- Department of Otolaryngology - Head and Neck Surgery; University of Virginia Health System; Charlottesville Virginia
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Sekine T, Barbosa FDG, Delso G, Burger IA, Stolzmann P, Ter Voert EE, Huber GF, Kollias SS, von Schulthess GK, Veit-Haibach P, Huellner MW. Local resectability assessment of head and neck cancer: Positron emission tomography/MRI versus positron emission tomography/CT. Head Neck 2017; 39:1550-1558. [PMID: 28500749 DOI: 10.1002/hed.24783] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/28/2016] [Accepted: 02/08/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare the diagnostic accuracy of positron emission tomography (PET)/MRI with PET/CT for local resectability of head and neck cancer. METHODS Sequential contrast-enhanced PET/CT-MRI was performed in 58 patients referred for the staging or restaging of head and neck cancer. Tumors were assessed with PET/CT and PET/MRI for the presence of resectability-defining factors: T4b status (mediastinal invasion, invasion of the prevertebral space, and vascular encasement), and another 8 findings that would imply obstacles for surgical cure (invasion of the laryngeal cartilage, invasion of the preepiglottic fat pad, perineural spread, orbital invasion, bone infiltration, skull base invasion, dural infiltration, and invasion of the brachial plexus). RESULTS The sensitivity/specificity/accuracy of local resectability-defining factors of PET/CT and PET/MRI was 0.92/0.99/0.98 and 0.98/0.99/0.99 (P = .727), respectively, per lesion, and 0.96/0.87/0.91 and 0.96/0.90/0.93 (P = .687), respectively, per patient. CONCLUSION Both contrast-enhanced PET/MRI and contrast-enhanced PET/CT can serve as reliable examinations for defining local resectability of head and neck cancer.
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Affiliation(s)
- Tetsuro Sekine
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland.,Department of Radiology, Nippon Medical School, Tokyo, Japan
| | - Felipe de Galiza Barbosa
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland
| | - Gaspar Delso
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland.,GE Healthcare, Waukesha, Wisconsin
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland
| | - Paul Stolzmann
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland
| | - Edwin E Ter Voert
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland
| | - Gerhard F Huber
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Zurich / University of Zurich, Zurich, Switzerland
| | - Spyros S Kollias
- Clinic of Neuroradiology, University Hospital Zurich / University of Zurich, Zurich, Switzerland
| | - Gustav K von Schulthess
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland
| | - Patrick Veit-Haibach
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich / University of Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zurich / University of Zurich, Zurich, Switzerland
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Taghipour M, Marcus C, Sheikhbahaei S, Mena E, Prasad S, Jha AK, Solnes L, Subramaniam RM. Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up 18F-FDG PET/CT Scans in Oncology Patients. J Nucl Med 2016; 58:737-743. [PMID: 27811123 DOI: 10.2967/jnumed.116.183111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/04/2016] [Indexed: 12/14/2022] Open
Abstract
The Centers for Medicare and Medicaid Services coverage includes 3 posttherapy 18F-FDG PET/CT scans per patient and per tumor type. Any additional follow-up 18F-FDG PET/CT scans will be reimbursed at the discretion of a local Medicare administrator, if deemed medically necessary. This study aimed to investigate common clinical indications for performing a fourth or additional follow-up 18F-FDG PET/CT scans that could affect the management of patients. Methods: This was a retrospective institutional review of 433 oncology patients (203 men; mean age, 55 y), including a total of 1,659 fourth or subsequent follow-up PET/CT scans after completion of primary treatment. Twelve indications for performing a fourth or subsequent follow-up PET/CT scan were determined, and the impact of each of the 12 indications on patients' management was evaluated. Results: The primary tumors were breast cancer (92 patients, 426 scans), non-Hodgkin lymphoma (77 patients, 208 scans), Hodgkin disease (41 patients, 182 scans), colorectal cancer (70 patients, 286 scans), melanoma (69 patients, 271 scans), and lung cancer (84 patients, 286 scans). The indications were categorized in 4 groups: PET/CT for diagnosis of tumor recurrence (303/1,659, 18.3%), PET/CT before starting therapy for tumor recurrence (64/1,659, 3.9%), PET/CT to assess therapy response for tumor recurrence (507/1,659, 30.6%), and follow-up PET/CT after completion of treatment for tumor recurrence (785/1,659, 47.3%). Overall, fourth and subsequent follow-up 18F-FDG PET/CT scans resulted in change in management in 31.6% of the scans (356 of 1,128) when the scans were obtained for medical necessities (indications 1-11), and in 5.6% of the scans (30/531) when the scans were obtained without any medical necessity (indication 12). Conclusion: The fourth and subsequent PET/CT scans obtained after completion of primary treatment led to a change in management in 31.6% of the scans when acquired for appropriate clinical reasons. Performing follow-up PET/CT without appropriate medical reason had a low impact on patients' management and should be avoided.
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Affiliation(s)
- Mehdi Taghipour
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charles Marcus
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sara Sheikhbahaei
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Esther Mena
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shwetha Prasad
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Abhinav K Jha
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lilja Solnes
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rathan M Subramaniam
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland .,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, Texas; and.,Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
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Takenaka Y, Takemoto N, Yasui T, Yamamoto Y, Uno A, Miyabe H, Ashida N, Shimizu K, Nakahara S, Hanamoto A, Fukusumi T, Michiba T, Cho H, Yamamoto M, Inohara H. Transaminase Activity Predicts Survival in Patients with Head and Neck Cancer. PLoS One 2016; 11:e0164057. [PMID: 27732629 PMCID: PMC5061313 DOI: 10.1371/journal.pone.0164057] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/19/2016] [Indexed: 02/06/2023] Open
Abstract
Various serum biomarkers have been developed for predicting head and neck squamous cell carcinoma (HNSCC) prognosis. However, none of them have been proven to be clinically significant. A recent study reported that the ratio of aspartate aminotransaminase (AST) to alanine aminotransaminase (ALT) had a prognostic effect on non-metastatic cancers. This study aimed to examine the effect of the AST/ALT ratio on the survival of patients with HNSCC. Clinical data of 356 patients with locoregionally advanced HNSCC were collected. The effect of the AST/ALT ratio on overall survival was analyzed using a Cox proportional hazard model. Moreover, recursive partitioning analysis (RPA) was used to divide the patients into groups on the basis of the clinical stage and AST/ALT ratio. The prognostic ability of this grouping was validated using an independent data set (N = 167). The AST/ALT ratio ranged from 0.42 to 4.30 (median, 1.42) and was a prognostic factor for overall survival that was independent of age, primary sites, and tumor stage (hazard ratio: 1.36, confidence interval: 1.08−1.68, P = 0.010). RPA divided patients with stage IVA into the following two subgroups: high AST/ALT (≥2.3) and low AST/ALT (<2.3) subgroups. The 5-year survival rate for patients with stage III, stage IVA with a low AST/ALT ratio, stage IVA with a high AST/ALT ratio, and stage IVB were 64.8%, 49.2%, 28.6%, and 33.3%, respectively (p < 0.001). Compared with the low AST/ALT group, the adjusted hazard ratio for death was 2.17 for high AST/ALT group (confidence interval: 1.02–.22 P = 0.045). The AST/ALT ratio was demonstrated to be a prognostic factor of HNSCC. The ratio subdivided patients with stage IVA into low- and high-risk groups. Moreover, intensified treatment for the high-risk group may be considered.
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Affiliation(s)
- Yukinori Takenaka
- Department of Otorhinolaryngology-Htaead and Neck Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Norihiko Takemoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
- * E-mail:
| | - Toshimichi Yasui
- Department of Otorhinolaryngology-Htaead and Neck Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Yoshifumi Yamamoto
- Department of Otorhinolaryngology-Htaead and Neck Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology-Htaead and Neck Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Haruka Miyabe
- Department of Otorhinolaryngology-Htaead and Neck Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Naoki Ashida
- Department of Otorhinolaryngology-Htaead and Neck Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Kotaro Shimizu
- Department of Otorhinolaryngology-Htaead and Neck Surgery, Osaka General Medical Center, Sumiyoshi, Osaka, Japan
| | - Susumu Nakahara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Atshushi Hanamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takahito Fukusumi
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takahiro Michiba
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hironori Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masashi Yamamoto
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Denaro N, Merlano MC, Russi EG. Follow-up in Head and Neck Cancer: Do More Does It Mean Do Better? A Systematic Review and Our Proposal Based on Our Experience. Clin Exp Otorhinolaryngol 2016; 9:287-297. [PMID: 27337948 PMCID: PMC5115151 DOI: 10.21053/ceo.2015.00976] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 12/02/2015] [Accepted: 12/29/2015] [Indexed: 12/19/2022] Open
Abstract
As the patients population ages, cancer screening increases, and cancer treatments improve, millions more head and neck carcinoma (HNC) patients will be classified as cancer survivors in the future. Change in epidemiology with human papillomavirus related HNC leads to a number of young treated patients. After treatment for HNC intensive surveillance, including ear, nose and throat (ENT) endoscopy, imaging, and serology, confers a survival benefit that became less evident in unresectable recurrence. We performed a comprehensive revision of literature and analyzed the experience of our centre. We revised publications on this topic and added data derived from the interdisciplinary work of experts within medical oncology, ENT, and radiation oncology scientific societies. We retrospectively collected local and distant recurrence of chemoradiation treated patients at Santa Croce and Carle University Hospital. A HNC follow-up program is not already codified and worldwide accepted. There is a need of scheduled follow-up. We suggest adopting a standardized follow-up guideline, although a multidisciplinary approach is frequently requested to tailor surveillance program and treatment on each patient.
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Affiliation(s)
- Nerina Denaro
- Department of Oncology, A.S.O. Santa Croce e Carle, Cuneo, Italy
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