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Qu W, Qin Z, Cui L, Yuan S, Yao N, Ma J, Lu J, Wang J, Wang M, Yao Y. Diagnostic and prognostic nomograms for laryngeal carcinoma patients with lung metastasis: a SEER-based study. Eur Arch Otorhinolaryngol 2024; 281:3071-3082. [PMID: 38584217 DOI: 10.1007/s00405-024-08608-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To establish two nomograms to quantify the risk of lung metastasis (LM) in laryngeal carcinoma (LC) and predict the overall survival of LC patients with LM. METHODS Totally 9515 LC patients diagnosed histologically from 2000 to 2019 were collected from the Surveillance, Epidemiology, and End Results database. The independent diagnostic factors for LM in LC patients and prognostic factors for LC patients with LM were identified by logistic and Cox regression analysis, respectively. Nomograms were established based on regression coefficients and evaluated by receiver operating characteristic curve, calibration curves, and decision curve analysis. RESULTS Patients with supraglottis, higher pathological grade, higher N stage, and distant metastasis (bone, brain, or liver) were more likely to have LM (P < 0.05). Chemotherapy, surgery and radiotherapy were independent factors of the overall survival of LC patients with LM (P < 0.05). The area under curve of diagnostic nomogram were 0.834 and 0.816 in the training and validation cohort respectively. For the prognostic nomogram, the area under curves of 1-, 2-, and 3-years were 0.735, 0.734, and 0.709 in the training cohort and 0.705, 0.803, and 0.809 in the validation cohort. The calibration curves and decision curve analysis indicated good performance of the nomograms. CONCLUSION Distant metastasis (bone, brain, or liver) and N stage should be considered for prediction of LM in LC patients. Chemotherapy is the most significant influencing prognostic factor improving the survival of LC patients with LM. Two nomograms may benefit for providing better precautionary measures and treatment decision.
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Affiliation(s)
- Wanxi Qu
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Zhaohui Qin
- Research Center for Medical and Health Emergency Rescue, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Li Cui
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Shiwang Yuan
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Nan Yao
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Ji Ma
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Jiaying Lu
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Jiang Wang
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Minhan Wang
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Yuanhu Yao
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
- Department of Radiation Oncology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, Jiangsu, China.
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Tham JLM, Ng SP, Khor R, Wada M, Gan H, Thai AA, Corry J, Bahig H, Mäkitie AA, Nuyts S, De Bree R, Strojan P, Ng WT, Eisbruch A, Chow JCH, Ferlito A. Stereotactic Body Radiotherapy in Recurrent and Oligometastatic Head and Neck Tumours. J Clin Med 2024; 13:3020. [PMID: 38892731 PMCID: PMC11173254 DOI: 10.3390/jcm13113020] [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: 02/13/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
The treatment of head and neck cancers (HNCs) encompasses a complex paradigm involving a combination of surgery, radiotherapy, and systemic treatment. Locoregional recurrence is a common cause of treatment failure, and few patients are suitable for salvage surgery. Reirradiation with conventional radiation techniques is challenging due to normal tissue tolerance limits and the risk of significant toxicities. Stereotactic body radiotherapy (SBRT) has emerged as a highly conformal modality that offers the potential for cure while limiting the dose to surrounding tissue. There is also growing research that shows that those with oligometastatic disease can benefit from curative intent local ablative therapies such as SBRT. This review will look at published evidence regarding the use of SBRT in locoregional recurrent and oligometastatic HNCs.
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Affiliation(s)
- Jodie L. M. Tham
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Richard Khor
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Morikatsu Wada
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Hui Gan
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Alesha A. Thai
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - June Corry
- GenesisCare, St Vincent’s Hospital, Melbourne 3065, Australia
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de L’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Research Program in Systems Oncology, Helsinki University Hospital, University of Helsinki, 00100 Helsinki, Finland
| | - Sandra Nuyts
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Remco De Bree
- Department of Otolaryngology—Head and Neck Surgery, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, MI 48109, USA
| | - James C. H. Chow
- Department of Clinical Oncology, Queens Elizabeth Hospital, Hong Kong SAR, China
| | - Alfio Ferlito
- International Head and Neck Scientific Group, 35100 Padua, Italy
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Mohamed AA, Goncalves M, Singh BP, Tometten M, Rashad A, Hölzle F, Hackenberg S, Eble M. Stereotactic radiotherapy in the management of oligometastatic and recurrent head and neck cancer: a single-center experience. Strahlenther Onkol 2024; 200:400-408. [PMID: 38063900 DOI: 10.1007/s00066-023-02180-9] [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: 06/16/2023] [Accepted: 11/01/2023] [Indexed: 04/24/2024]
Abstract
INTRODUCTION Oligometastatic disease (OMD) is a metastatic stage that could benefit maximally from local therapies. Patients in this state have a better prognosis relative to those with disseminated metastases. Stereotactic radiotherapy provides a non-invasive ablative tool for primary malignant tumors and metastases. MATERIALS AND METHODS We searched our register for patients with oligometastatic or recurrent head and neck cancer (OMD/R-HNC) who received stereotactic radiotherapy to manage their OMD/R. We evaluated the survival outcomes and prognostic factors that affected the survival of those patients. RESULTS In all, 31 patients with 48 lesions met the inclusion criteria for the analysis. The lesions comprised various metastatic sites, with the majority being pulmonary (37 lesions). Squamous cell cancer was the most common histology (26 patients). The median overall survival (mOS) was 33 months, with a progression-free survival (PFS) of 9.6 months. Eight patients received subsequent stereotactic radiotherapy after disease progression. The local control (LC) rates were 91.3, 87.7, and 83% at 6, 12, and 36 months. Patients with the de novo OMD who received stereotactic radiotherapy as their initial treatment had a median systemic treatment-free survival of 23.9 months. In univariate analysis, a trend for better OS was observed in patients with p16-positive squamous cell tumors; patients who progressed within 150 days after diagnosis had a significantly lower OS. De novo OMD showed significantly better PFS compared to induced OMD. Multivariate analyses identified p16-positive squamous cell cancer, metachronous OMD and a longer time to progression as positive predictors of OS, while de novo OMD was the only positive predictor for PFS. Treatment-related toxicities were generally mild, with two cases of grade 3 dysphagia reported. CONCLUSION Stereotactic radiotherapy demonstrated favorable outcomes in patients with OMD/R-HNC with limited toxicities. Further studies are warranted to validate these findings and optimize treatment strategies for this patient population.
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Affiliation(s)
- Ahmed Allam Mohamed
- Department of Radiation Oncology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany.
| | - Miguel Goncalves
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Biney Pal Singh
- Department of Radiation Oncology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
| | - Mareike Tometten
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Hematology, Oncology and Stem Cell Transplantation, RWTH Aachen University Hospital, Aachen, Germany
| | - Ashkan Rashad
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Frank Hölzle
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Oral and Maxillofacial Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Stephan Hackenberg
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
- Department of Oto-Rhino-Laryngology-Head and Neck Surgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Michael Eble
- Department of Radiation Oncology, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany
- Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany
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4
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Mutsaers A, Akingbade A, Louie AV, Id Said B, Zhang L, Poon I, Smoragiewicz M, Eskander A, Karam I. Stereotactic Body Radiotherapy for Extracranial Oligometastatic Disease from Head and Neck Primary Cancers: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:851. [PMID: 38473213 DOI: 10.3390/cancers16050851] [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: 12/14/2023] [Revised: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Stereotactic body radiotherapy (SBRT) is increasingly used to treat disease in the oligometastatic (OM) setting due to mounting evidence demonstrating its efficacy and safety. Given the low population representation in prospective studies, we performed a systematic review and meta-analysis of outcomes of HNC patients with extracranial OM disease treated with SBRT. METHODS A systematic review was conducted with Cochrane, Medline, and Embase databases queried from inception to August 2022 for studies with extracranial OM HNC treated with stereotactic radiotherapy. Polymetastatic patients (>five lesions), mixed-primary cohorts failing to report HNC separately, lack of treatment to all lesions, nonquantitative endpoints, and other definitive treatments (surgery, conventional radiotherapy, and radioablation) were excluded. The meta-analysis examined the pooled effects of 12- and 24-month local control (LC) per lesion, progression-free survival (PFS), and overall survival (OS). Weighted random-effects were assessed using the DerSimonian and Laird method, with heterogeneity evaluated using the I2 statistic and Cochran Qtest. Forest plots were generated for each endpoint. RESULTS Fifteen studies met the inclusion criteria (639 patients, 831 lesions), with twelve eligible for quantitative synthesis with common endpoints and sufficient reporting. Fourteen studies were retrospective, with a single prospective trial. Studies were small, with a median of 32 patients (range: 6-81) and 63 lesions (range: 6-126). The OM definition varied, with a maximum of two to five metastases, mixed synchronous and metachronous lesions, and a few studies including oligoprogressive lesions. The most common site of metastasis was the lung. Radiation was delivered in 1-10 fractions (20-70 Gy). The one-year LC (LC1), reported in 12 studies, was 86.9% (95% confidence interval [CI]: 79.3-91.9%). LC2 was 77.9% (95% CI: 66.4-86.3%), with heterogeneity across studies. PFS was reported in five studies, with a PFS1 of 43.0% (95% CI: 35.0-51.4%) and PFS2 of 23.9% (95% CI: 17.8-31.2%), with homogeneity across studies. OS was analyzed in nine studies, demonstrating an OS1 of 80.1% (95% CI: 74.2-85.0%) and OS2 of 60.7% (95% CI: 51.3-69.4%). Treatment was well tolerated with no reported grade 4 or 5 toxicities. Grade 3 toxicity rates were uniformly below 5% when reported. CONCLUSIONS SBRT offers excellent LC and promising OS, with acceptable toxicities in OM HNC. Durable PFS remains rare, highlighting the need for effective local or systemic therapies in this population. Further investigations on concurrent and adjuvant therapies are warranted.
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Affiliation(s)
- Adam Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON M4N 3M5, Canada
- Division of Radiation Oncology, London Health Sciences, Western University, Toronto, ON M4N 3M5, Canada
| | - Aquila Akingbade
- Division of Radiation Oncology, London Health Sciences, Western University, Toronto, ON M4N 3M5, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Badr Id Said
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Liying Zhang
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Martin Smoragiewicz
- Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences, University of Toronto, Toronto, ON M4N 3M5, Canada
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5
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Tonneau M, Nebbache R, Larnaudie A, Thureau S, Pointreau Y, Blanchard P, Thariat J. Management of head and neck carcinomas with synchronous or metachronous oligometastatic disease: Role of locoregional radiotherapy and metastasis-directed radiotherapy. Cancer Radiother 2024; 28:83-92. [PMID: 37620212 DOI: 10.1016/j.canrad.2023.03.004] [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: 12/31/2022] [Revised: 02/19/2023] [Accepted: 03/28/2023] [Indexed: 08/26/2023]
Abstract
Head and neck carcinomas are initially metastatic in about 15% of cases. Radiotherapy is a cornerstone in the multimodal strategy at the locoregional phase. In patients with head and neck cancer, often heavily pretreated and with comorbidities, who relapse locoregionally or at distant sites, radiotherapy has also become increasingly important at the metastatic phase. Data on the optimal sequence of systemic treatments and metastasis-directed treatments including stereotactic irradiation are still lacking. Several randomized head and neck trials have been initiated that should provide important answers, including one recent GORTEC trial.
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Affiliation(s)
- M Tonneau
- Service d'oncologie radiothérapie, CRLCC Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - R Nebbache
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - A Larnaudie
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France
| | - S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France; Unité QuantIF Litis EA 4108, université de Rouen, Rouen, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France
| | - Y Pointreau
- Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, centre de cancérologie de la Sarthe (CCS), 64, rue de Degré, 72000 Le Mans, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, université Paris Saclay, Inserm U1018 Oncostat, Villejuif, France
| | - J Thariat
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France; Laboratoire de physique corpusculaire/IN2P3-CNRS UMR 6534, Unicaen-université de Normandie, 14000 Caen, France.
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Brajkovic D, Kiralj A, Mijatov I, Ilic M. Pathological nodal status as a main predictive factor of survival and treatment outcomes of submandibular salivary gland cancers: A 25-year single center experience. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101462. [PMID: 37003413 DOI: 10.1016/j.jormas.2023.101462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Aim of this study was to explore the survival predictive factors and treatment outcomes in a cohort of SGC patients treated at a single center over a period of 25 years. MATERIALS AND METHODS Patients who had received primary treatment for SGC were enroled. Outcomes evaluated were: overall survival (OS), disease specific survival (DSS), recurrence free survival (RFS), locoregional recurrence free survival (LRFS) and distant metastasis free survival (DFS). RESULTS A total of 40 patients with SGC were enroled in the study. The most common tumor was the adenoid cystic carcinoma (60% of cases). Cumulative OS for 5-and 10-year follow up period was 81% and 60%, respectively. Thirteen patients (32.5%) developed distant metastases during follow-up. Nodal status, high-grade histology, tumor stage and adjuvant radiation-therapy (RT) were significant variables on multivariate analysis for survival and treatment outcomes. CONCLUSIONS Submandibular gland carcinomas represent rare and heterogenous tumor group regarding histological appearance and locoregional and distant metastatic potential. Tumor histological grade, AJCC tumor stage and nodal status were the strongest predictive factors for survival and treatment outcomes. RT improved OS and locoregional treatment outcome, but not DFS. Elective neck dissection (END) could be beneficial for selected cases of SGC. Superselective neck dissection of levels I-IIa may be the level of dissection for END. Distant metastases were the main cause of death and treatment failure. Prognostic factors for poor DMFS were AJCC stage III and IV, high tumor grade and nodal status.
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Affiliation(s)
- Denis Brajkovic
- Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Novi Sad, Serbia; Faculty of Medicine, Department for Dentistry and Maxillofacial Surgery, University of Novi Sad, Novi Sad, Serbia.
| | - Aleksandar Kiralj
- Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Novi Sad, Serbia; Faculty of Medicine, Department for Dentistry and Maxillofacial Surgery, University of Novi Sad, Novi Sad, Serbia
| | - Ivana Mijatov
- Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Novi Sad, Serbia; Faculty of Medicine, Department for Dentistry and Maxillofacial Surgery, University of Novi Sad, Novi Sad, Serbia
| | - Miroslav Ilic
- Clinical Center of Vojvodina, Clinic for Maxillofacial and Oral Surgery, Novi Sad, Serbia; Faculty of Medicine, Department for Dentistry and Maxillofacial Surgery, University of Novi Sad, Novi Sad, Serbia
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7
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Vorbach SM, Mangesius J, Dejaco D, Seppi T, Santer M, Zur Nedden S, Sarcletti MP, Pointner MJ, Hart TJ, Riechelmann H, Ganswindt U, Nevinny-Stickel M. Survival, Treatment Outcome, and Safety of Multiple and Repeated Courses of Stereotactic Body Radiotherapy for Pulmonary Oligometastases of Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:5253. [PMID: 37958426 PMCID: PMC10647772 DOI: 10.3390/cancers15215253] [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: 09/22/2023] [Revised: 10/17/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Current literature regarding survival and treatment outcome of SBRT in patients with pulmonary oligometastatic head and neck squamous cell carcinoma (HNSCC) is limited. Additionally, most of the published studies include metastatic lesions deriving also from primaries with histologies other than SCC when investigating the outcome of SBRT. The aim of the present retrospective study is to explore local control (LC) of treated metastases, progression-free survival (PFS), and overall survival (OS) of exclusively pulmonary oligometastatic HNSCC-patients treated with SBRT. Between 2006 and 2021, a total of 46 patients were treated with SBRT for a maximum of four pulmonary oligometastases (PM) concurrently (mean PM per patient = 2.0; range 1 to 6 PM, total of 92). Of these, 17 patients (37.0%) developed new pulmonary metastases after their first SBRT. Repeated courses of SBRT were required once in 15 patients (88.2%) and twice in 2 patients (11.8%). Median follow-up was 17 months (range, 0-109 months). One year after completion of SBRT, LC rate, PFS, and OS were 98.7%, 37.9%, and 79.5%, respectively. After two years, LC rate, PFS, and OS were 98.7%, 28.7%, and 54.9%; as well as 98.7%, 16.7%, and 31.0% after five years. Radiochemotherapy (HR 2.72, p < 0.001) or radiotherapy as primary treatment (HR 8.60; p = 0.003), as well as reduced patient performance status (HR 48.30, p = 0.002), were associated with lower PFS. Inferior OS correlated with poor performance status (HR 198.51, p < 0.001) and surgery followed by radiochemotherapy (HR 4.18, p = 0.032) as primary treatment, as well as radiotherapy alone (HR 7.11, p = 0.020). Treatment of more than one PM is an independent predictor of impaired OS (HR 3.30, p = 0.016). SBRT of HNSCC-derived PMs results in excellent LC rates and encouraging OS rates of 54.9% at two years along with good tolerability (no more than grade 2 toxicities). Favourable outcome and low toxicity also apply to repeated courses of SBRT of newly emerging PMs.
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Affiliation(s)
- Samuel Moritz Vorbach
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.M.V.); (T.S.); (M.P.S.); (M.J.P.); (T.J.H.); (U.G.); (M.N.-S.)
| | - Julian Mangesius
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.M.V.); (T.S.); (M.P.S.); (M.J.P.); (T.J.H.); (U.G.); (M.N.-S.)
| | - Daniel Dejaco
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (D.D.); (M.S.); (H.R.)
| | - Thomas Seppi
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.M.V.); (T.S.); (M.P.S.); (M.J.P.); (T.J.H.); (U.G.); (M.N.-S.)
| | - Matthias Santer
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (D.D.); (M.S.); (H.R.)
| | - Stephanie Zur Nedden
- CCB-Biocenter, Institute of Neurobiochemistry, Medial University of Innsbruck, 6020 Innsbruck, Austria;
| | - Manuel Paolo Sarcletti
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.M.V.); (T.S.); (M.P.S.); (M.J.P.); (T.J.H.); (U.G.); (M.N.-S.)
| | - Martin Josef Pointner
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.M.V.); (T.S.); (M.P.S.); (M.J.P.); (T.J.H.); (U.G.); (M.N.-S.)
| | - Tilmann Jakob Hart
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.M.V.); (T.S.); (M.P.S.); (M.J.P.); (T.J.H.); (U.G.); (M.N.-S.)
| | - Herbert Riechelmann
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (D.D.); (M.S.); (H.R.)
| | - Ute Ganswindt
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.M.V.); (T.S.); (M.P.S.); (M.J.P.); (T.J.H.); (U.G.); (M.N.-S.)
| | - Meinhard Nevinny-Stickel
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria; (S.M.V.); (T.S.); (M.P.S.); (M.J.P.); (T.J.H.); (U.G.); (M.N.-S.)
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8
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Id Said B, Mutsaers A, Chen H, Husain ZA, Biswas T, Dagan R, Erler D, Foote M, Louie AV, Redmond K, Ricardi U, Sahgal A, Poon I. Outcomes for oligometastatic head and neck cancer treated with stereotactic body radiotherapy: Results from an international multi-institutional consortium. Head Neck 2023; 45:2627-2637. [PMID: 37602655 DOI: 10.1002/hed.27488] [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: 01/30/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND We report the results of an international multi-institutional cohort of oligometastatic (OMD) head and neck cancer (HNC) patients treated with SBRT. METHODS Patients with OMD HNC (≤5 metastases) treated with SBRT between 2008 and 2016 at six institutions were included. Treated metastasis control (TMC), progression-free survival (PFS), and overall survival (OS) were analyzed by multivariable analysis (MVA). RESULTS Forty-two patients with 84 HNC oligometastases were analyzed. The TMC rate at 1 and 2 years were 80% and 66%, with a median time to recurrence of 10.1 months. The median PFS and OS were 4.7 and 23.3 months. MVA identified a PTV point maximum (BED)10 > 100 Gy as a predictor of improved TMC (HR = 0.31, p = 0.034), and a cumulative PTV > 48 cc as having worse PFS (HR = 2.99, p < 0.001). CONCLUSION Favorable TMC and OS was observed in OMD HNCs treated with SBRT.
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Affiliation(s)
- Badr Id Said
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Adam Mutsaers
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Hanbo Chen
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Zain A Husain
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio, USA
| | - Roi Dagan
- University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
| | - Darby Erler
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Matthew Foote
- Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Kristin Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, Toronto, Ontario, Canada
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9
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Denaro N, Succo G, Ostellino O, Airoldi M, Merlano MC, Badellino S, Solinas C, Garrone O, Iorio GC. The oligometastatic setting in HNSCC: A critical review by the Rete Oncologica Piemonte e Valle d'Aosta multidisciplinary team. Crit Rev Oncol Hematol 2023; 185:103968. [PMID: 36965646 DOI: 10.1016/j.critrevonc.2023.103968] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION The oligometastatic disease is a low burden metastatic disease that might still benefit from curable treatment. Squamous cell carcinoma of the head and neck (HNSCC) is a complex group of malignancies, with high rates of loco-regional recurrences. Distant metastases are less frequent, and a single or few deposits are often observed (oligometastatic disease). The optimal management of oligometastatic HNSCC remains to be defined. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of the available evidence on the management of oligometastatic HNSCC patients, with a focus on metastasis-directed therapy (MDT), particularly stereotactic ablative radiotherapy (SABR). CONCLUSIONS in line with literature data, the multidisciplinary evaluation emerged as the key element in the management of oligometastatic HNSCC patients.
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Affiliation(s)
- Nerina Denaro
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Giovanni Succo
- Oncology Department, Head & Neck Surgery, University of Turin, Turin, Italy
| | - Oliviero Ostellino
- Oncology Unit 2, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mario Airoldi
- Oncology Unit 2, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Carlo Merlano
- Scientific Direction, Candiolo Cancer Institute, FPO-IRCCS Candiolo, 10060 Torino, Italy
| | - Serena Badellino
- Department of Oncology, University of Torino, 10125 Torino, Italy
| | - Cinzia Solinas
- Oncology Department AOU Cagliari, Policlinico di Monserrato, Monserrato (CA) Italy
| | - Ornella Garrone
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
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10
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Lee RH, Wai KC, Chan JW, Ha PK, Kang H. Approaches to the Management of Metastatic Adenoid Cystic Carcinoma. Cancers (Basel) 2022; 14:cancers14225698. [PMID: 36428790 PMCID: PMC9688467 DOI: 10.3390/cancers14225698] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
High rates of recurrence and distant metastasis are a foremost challenge in the management of adenoid cystic carcinoma (ACC), occurring in approximately 40% of all ACC patients. Despite the morbidity and mortality resulting from recurrent/metastatic (R/M) disease, there are no FDA-approved systemic agents for these patients. In this review, we summarize pertinent ACC pathophysiology and its implications for different systemic treatment regimens in R/M ACC. We review the evidence for the most widely used systemic agents - cytotoxic chemotherapy and tyrosine kinase inhibitors (TKIs) targeting VEGFR - in addition to immune checkpoint inhibitors and non-TKI biologic agents. Exciting emerging targets for R/M ACC, including inhibitors of Notch signaling, stemness, PRMT5, and Axl, are also discussed. Lastly, we review local therapies for small-volume lung disease in patients with oligometastatic ACC, specifically pulmonary metastasectomy and stereotactic body radiation therapy (SBRT). Future development of targeted molecular agents which exploit the underlying biology of this disease may yield novel therapeutic options to improve clinical outcomes in patients with R/M ACC.
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Affiliation(s)
- Rex H. Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Katherine C. Wai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA 94304, USA
| | - Jason W. Chan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Patrick K. Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Hyunseok Kang
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Correspondence:
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11
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Patients with Pulmonary Metastases from Head and Neck Cancer Benefit from Pulmonary Metastasectomy, A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081000. [PMID: 35893115 PMCID: PMC9332790 DOI: 10.3390/medicina58081000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of distant metastases in patients with head and neck cancer (HNC) is approximately 10%. Pulmonary metastases are the most frequent distant location, with an incidence of 70-85%. The standard treatment options are chemo-, immuno- and radiotherapy. Despite a benefit for long-term survival for patients with isolated pulmonary metastases, pulmonary metastasectomy (PM) is not the treatment of choice. Furthermore, many otorhinolaryngologists are not sufficiently familiar with the concept of PM. This work reviews the recent studies of pulmonary metastatic HNC and the results after pulmonary metastasectomy. Materials and Methods: PubMed, Medline, Embase, and the Cochrane library were checked for the case series' of patients undergoing metastasectomy with pulmonary metastases published since 1 January 2000. Results: We included the data of 15 studies of patients undergoing PM. The 5-year survival rates varied from 21% to 59%, with median survival from 10 to 77 months after PM. We could not identify one specific prognostic factor for long-term survival after surgery. However, at least most studies stated that PM should be planned if a complete (R0) resection is possible. Conclusions: PM showed reliable results and is supposedly the treatment of choice for patients with isolated pulmonary metastases. Patients not suitable for surgery may benefit from other non-surgical therapy. Every HNC patient with pulmonary metastases should be discussed in the multidisciplinary tumor board to optimize the therapy and the outcome.
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12
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Oligometastasis in head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2022; 114:803-811. [DOI: 10.1016/j.ijrobp.2022.06.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/18/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022]
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13
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Borson S, Shuai Y, Branstetter BF, Nilsen ML, Hughes MA, Fenton M, Kubik M, Sridharan S, Clump DA, Skinner HD, Johnson JT, Chiosea SI, Ohr J, Duvvuri U, Kim S, Traylor KS, Ferris R, Zandberg DP. Definitive local therapy to head and neck squamous cell carcinoma with distant metastasis. Laryngoscope Investig Otolaryngol 2022; 7:757-765. [PMID: 35734044 PMCID: PMC9194988 DOI: 10.1002/lio2.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/21/2022] [Accepted: 03/06/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives Data on the efficacy of including definitive local therapy to the primary site for head and neck squamous cell carcinoma (HNSCC) patients with synchronous distant metastasis are lacking. In multiple different solid tumor types, there has been benefit when using systemic therapy followed by local consolidative therapy (stereotactic ablative radiotherapy or surgery) directed at metastases. We proposed to retrospectively evaluate patients at our institution that received definitive treatment to the primary. Methods Single institution retrospective study evaluating 40 patients with metastatic HNSCC treated with definitive surgery (55%) or chemoradiation (45%) to the primary site from 2000 to 2020. The major endpoints were overall survival (OS) and progression‐free survival (PFS) for the total population and multiple sub‐groups. Some variables were evaluated with multiple covariates Cox model. Results The median PFS was 8.6 months (95% CI, 6.4–11.6), and OS was 14.2 months (95% CI, 10.9–27.5). In 28% of patients that received induction therapy, there was a twofold increase in median overall survival to 27.5 months. In the 33% of patients that received anti‐PD‐1 mAb as part of their treatment course, the median OS was significantly increased to 41.7 months (95% CI, 8.7‐NR) versus 12.1 months (95% CI, 8.4–14.4) with a 5‐year OS of 39%. Multivariate analysis for OS showed significance for age at diagnosis, use of IO, and number of metastatic sites. Conclusion We observed impressive survival outcomes in metastatic HNSCC patients treated with definitive local therapy to the primary site in addition to induction and/or immunotherapy. Further study is warranted. Level of Evidence: 3.
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Affiliation(s)
- Steven Borson
- University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania USA
| | - Yongli Shuai
- University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania USA
| | - Barton F. Branstetter
- Department of Radiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
| | - Marci Lee Nilsen
- Department of Acute and Tertiary Care School of Nursing Pittsburgh Pennsylvania USA
| | - Marion A. Hughes
- Department of Radiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
| | - Moon Fenton
- University of Pittsburgh Cancer Institute Pittsburgh Pennsylvania USA
| | - Mark Kubik
- Department of Otolaryngology UPMC Pittsburgh Pennsylvania USA
| | - Shaum Sridharan
- Department of Otolaryngology UPMC Pittsburgh Pennsylvania USA
| | - David A. Clump
- Department of Radiation Oncology UPMC Hillman Cancer Center Pittsburgh Pennsylvania USA
| | - Heath D. Skinner
- Department of Radiation Oncology UPMC Hillman Cancer Center Pittsburgh Pennsylvania USA
| | - Jonas T. Johnson
- Department of Radiation Oncology UPMC Hillman Cancer Center Pittsburgh Pennsylvania USA
| | | | - James Ohr
- Department of Otolaryngology UPMC Pittsburgh Pennsylvania USA
| | | | - Seungwon Kim
- Department of Otolaryngology UPMC Pittsburgh Pennsylvania USA
| | - Katie S. Traylor
- Department of Radiology University of Pittsburgh Medical Center Pittsburgh Pennsylvania USA
| | - Robert Ferris
- Department of Otolaryngology UPMC Pittsburgh Pennsylvania USA
| | - Dan P. Zandberg
- Department of Hematology/Oncology UPMC Hillman Cancer Center Pittsburgh Pennsylvania USA
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14
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Debbi K, Loganadane G, To NH, Kinj R, Husain ZA, Chapet S, Nguyen NP, Barillot I, Benezery K, Belkacemi Y, Calais G. Curative intent Stereotactic Ablative Radiation Therapy (SABR) for treatment of lung oligometastases from head and neck squamous cell carcinoma (HNSCC): a multi-institutional retrospective study. Br J Radiol 2022; 95:20210033. [PMID: 35143326 PMCID: PMC10993965 DOI: 10.1259/bjr.20210033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aim of this retrospective study was to assess outcomes of SABR for metachronous isolated lung oligometastases from HNSCC. METHODS For patients who developed isolated, 1 or 2 lungs lesions (<5cm) consistent with metastases from HNSCC, the indication of SABR was validated in a multidisciplinary tumor board. All patients were monitored by CT or PET CT after SABR (Stereotactic Ablative Body Radiation) for HNSCC. RESULTS Between November 2007 and February 2018, 52 patients were treated with SABR for metachronous lung metastases. The median time from the treatment of the primary HNSCC to the development of lung metastases was 18 months (3-93). The cohort's median age was 65.5 years old (50-83). The vast majority (94.2%) received 60 Gy in three fractions. Forty-one patients (78.5%) presented a solitary lung metastasis, while 11 patients (21.5%) had two lung metastases. With a median follow-up of 45.3 months, crude local and metastatic control rates were 74 and 38%, respectively. 1 year and 2 year Overall Survival (OS) were 85.8 and 65.9%, respectively. The median OS was 46.8 months. About one-fourth of patients were retreated by SABR for distant pulmonary recurrence. The treatment was well tolerated with only one patient who reported ≥ grade 3 toxicity (1.9%). CONCLUSION In selected metastatic HNSCC patients, early detection and treatment of lung metastases with SABR is effective and safe. Prospective studies are required to validate this potential shift. ADVANCES IN KNOWLEDGE Patients with oligometastases and controlled primary HNSCC seem to benefit from metastasis directed therapies.
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Affiliation(s)
- Kamel Debbi
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | | | - Nhu Hanh To
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | - Remy Kinj
- Department of Radiation Oncology, Centre
Antoine-Lacassagne, Nice,
France
| | - Zain A Husain
- Department of Radiation Oncology, Odette Cancer Center,
Sunnybrook Health Sciences Centre, Toronto,
Ontario, Canada
| | - Sophie Chapet
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
| | - Nam P Nguyen
- Department of Radiation Oncology, Howard
University, Washington, DC,
USA
| | - Isabelle Barillot
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
| | - Karen Benezery
- Department of Radiation Oncology, Centre
Antoine-Lacassagne, Nice,
France
| | - Yazid Belkacemi
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | - Gilles Calais
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
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15
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Wise-Draper TM, Bahig H, Karivedu V, Burtness B. Current Therapy for Metastatic Head and Neck Cancer: Evidence, Opportunities, and Challenges. Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35486888 DOI: 10.1200/edbk_350442] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Management of metastatic head and neck squamous cell carcinoma is evolving as new systemic therapies have led to improvements in survival, and as advances in locoregional therapy and the increased numbers of patients with HPV-associated cancers who develop oligometastases raise the possibility of ablation of limited numbers of metastases. We review the data regarding first-line immunotherapy in PD-L1-expressing metastatic head and neck squamous cell carcinoma, the experience with aggressive local management of oligometastases, and promising novel immunotherapies, targeted therapies, and HPV-specific treatments. For patients with metastatic head and neck squamous cell carcinoma that is PD-L1 expressing, first-line systemic therapy is pembrolizumab or pembrolizumab with chemotherapy. Inclusion of chemotherapy is associated with higher objective response proportion in all biomarker subgroups and may have a greater impact on survival in HPV-associated cancers. For patients with oligometastatic disease, particularly when metastases are metachronous, current evidence supporting the role of local ablation is limited to a small number of retrospective studies. Based on retrospective data, patients with a smaller number of metastases, lung metastases, and/or virally associated head and neck squamous cell carcinoma are most likely to benefit from an aggressive ablative approach. Additionally, we review emerging evidence for targeted therapy in metastatic head and neck squamous cell carcinoma, including with agents that inhibit mutant HRAS or NOTCH1, or overexpressed EGFR. Studies of antiangiogenic agents in combination with immune checkpoint blockade, and combination immunotherapy, are also under study.
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Affiliation(s)
| | - Houda Bahig
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Vidhya Karivedu
- Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - Barbara Burtness
- Yale University School of Medicine and Yale Cancer Center, New Haven, CT
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16
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CW. Wong K, Johnson D, Hui EP, CT. Lam R, BY. Ma B, TC. Chan A. Opportunities and Challenges in Combining Immunotherapy and Radiotherapy in Head and Neck Cancers. Cancer Treat Rev 2022; 105:102361. [DOI: 10.1016/j.ctrv.2022.102361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 02/06/2023]
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17
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Singh R, Jenkins J, Davis J, Song S, Sharma S, Vargo JA. A multi-institutional analysis of outcomes following stereotactic body radiation therapy for management of metastases from squamous cell carcinomas of the head and neck. JOURNAL OF RADIOSURGERY AND SBRT 2022; 8:11-19. [PMID: 35387401 PMCID: PMC8930056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023]
Abstract
Background There is limited data on clinical outcomes following SBRT for patients with metastatic head and neck squamous cell carcinoma (mHNC). Method An international SBRT registry was utilized to identify patients. LC and OS were evaluated with the Kaplan-Meier method and a Cox-proportional hazards model for multivariate analysis (MVA) to assess potential prognostic factors. Results We identified 81 patients with 98 lesions treated with SBRT. Areas treated included the lung (53.0%), non-regional lymph nodes (16.0%), and spine (12.3%). OS rates at 1 year and 2 years were 66.4% and 43.1%, respectively. Utilizing KPS, spinal disease, and GTV, 1-year OS estimates were 90.9%, 70.4%, 54.5%, and 25% for patients with 0-3 of these factors, respectively (p = 0.002). One-year and 2-year LC rates were both 93.3%. Roughly 17% of patients reported toxicities (none Grade 3+). Conclusions SBRT resulted in promising LC for mHNC patients. Spinal disease, GTV, and KPS should be considered in selecting patients with mHNC that may benefit from SBRT.
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Affiliation(s)
- Raj Singh
- Virginia Commonwealth University Health System, Department of Radiation Oncology, Richmond, VA, USA
| | - Jan Jenkins
- The Radiosurgery Society, Sunnyvale, CA, USA
| | | | - Shiyu Song
- Virginia Commonwealth University Health System, Department of Radiation Oncology, Richmond, VA, USA
| | - Sanjeev Sharma
- St. Mary’s Medical Center, Department of Radiation Oncology, Huntington, WV, USA
| | - John Austin Vargo
- University of Pittsburgh Hillman Cancer Center, Department of Radiation Oncology, Pittsburgh, PA, USA
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18
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Xing DT, Khor R, Gan H, Wada M, Ermongkonchai T, Ng SP. Recent Research on Combination of Radiotherapy with Targeted Therapy or Immunotherapy in Head and Neck Squamous Cell Carcinoma: A Review for Radiation Oncologists. Cancers (Basel) 2021; 13:5716. [PMID: 34830871 PMCID: PMC8616456 DOI: 10.3390/cancers13225716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy plays an important role of managing head and neck squamous cell carcinoma (HNSCC). Concurrent radiotherapy with radiosensitizing cisplastin chemotherapy is the standard of care (SOC) for non-operable locally advanced HNSCC. Cetuximab, a monoclonal antibody of epidermal growth factor receptor, was the most extensively studied targeted therapy as a chemo-sparing agent that was used concurrently with radiotherapy. Immunotherapy is used in the treatment of metastatic HNSCC. There is evidence to support the synergistic effect when combining radiotherapy with immunotherapy to potentiate anti-tumor immune response. There has been increasing interest to incorporate immune checkpoint inhibitor (ICI) with radiotherapy in the curative setting for HNSCC. In this review, we discuss the latest evidence that supports concurrent radiotherapy with cisplatin which remains the SOC for locally advanced HNSCC (LA-HNSCC). Cetuximab is suitable for patients who are not fit for cisplatin. We then summarize the clinical trials that incorporate ICI with radiotherapy for LA-HNSCC in concurrent, neoadjuvant, and adjuvant settings. We also discuss the potential of combining immunotherapy with radiotherapy as a treatment de-escalating strategy in HPV-associated oropharyngeal carcinoma. Finally, the pre-clinical and clinical evidence of the abscopal effect when combining stereotactic body radiotherapy with ICIs is presented.
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Affiliation(s)
- Daniel Tao Xing
- Oliver Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC 3079, Australia; (D.T.X.); (R.K.); (M.W.)
| | - Richard Khor
- Oliver Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC 3079, Australia; (D.T.X.); (R.K.); (M.W.)
| | - Hui Gan
- Medical Oncology, Austin Hospital, Heidelberg, VIC 3079, Australia;
- La Trobe University School of Cancer Medicine, Heidelberg, VIC 3079, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Morikatsu Wada
- Oliver Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC 3079, Australia; (D.T.X.); (R.K.); (M.W.)
| | - Tai Ermongkonchai
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC 3000, Australia;
| | - Sweet Ping Ng
- Oliver Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC 3079, Australia; (D.T.X.); (R.K.); (M.W.)
- La Trobe University School of Cancer Medicine, Heidelberg, VIC 3079, Australia
- Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC 3000, Australia;
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Shen Z, Tan X, Li S, Tian X, Luo H, Wang Y, Jin F. Correlation between the γ passing rates of IMRT plans and the volumes of air cavities and bony structures in head and neck cancer. Radiat Oncol 2021; 16:134. [PMID: 34289863 PMCID: PMC8296469 DOI: 10.1186/s13014-021-01861-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/15/2021] [Indexed: 12/31/2022] Open
Abstract
Background Both patient-specific dose recalculation and γ passing rate analysis are important for the quality assurance (QA) of intensity modulated radiotherapy (IMRT) plans. The aim of this study was to analyse the correlation between the γ passing rates and the volumes of air cavities (Vair) and bony structures (Vbone) in target volume of head and neck cancer. Methods Twenty nasopharyngeal carcinoma and twenty nasal natural killer T-cell lymphoma patients were enrolled in this study. Nine-field sliding window IMRT plans were produced and the dose distributions were calculated by anisotropic analytical algorithm (AAA), Acuros XB algorithm (AXB) and SciMoCa based on the Monte Carlo (MC) technique. The dose distributions and γ passing rates of the targets, organs at risk, air cavities and bony structures were compared among the different algorithms. Results The γ values obtained with AAA and AXB were 95.6 ± 1.9% and 96.2 ± 1.7%, respectively, with 3%/2 mm criteria (p > 0.05). There were significant differences (p < 0.05) in the γ values between AAA and AXB in the air cavities (86.6 ± 9.4% vs. 98.0 ± 1.7%) and bony structures (82.7 ± 13.5% vs. 99.0 ± 1.7%). Using AAA, the γ values were proportional to the natural logarithm of Vair (R2 = 0.674) and inversely proportional to the natural logarithm of Vbone (R2 = 0.816). When the Vair in the targets was smaller than approximately 80 cc or the Vbone in the targets was larger than approximately 6 cc, the γ values of AAA were below 95%. Using AXB, no significant relationship was found between the γ values and Vair or Vbone. Conclusion In clinical head and neck IMRT QA, greater attention should be paid to the effect of Vair and Vbone in the targets on the γ passing rates when using different dose calculation algorithms.
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Affiliation(s)
- Zhengwen Shen
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Xia Tan
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Shi Li
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Xiumei Tian
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Huanli Luo
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Fu Jin
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China.
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20
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Incurable locoregional disease is a strong poor prognostic factor in recurrent or metastatic squamous cell carcinoma of the head and neck. Int J Clin Oncol 2021; 26:1822-1830. [PMID: 34152533 DOI: 10.1007/s10147-021-01965-1] [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: 04/22/2021] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Distant metastasis is a poor prognostic factor in recurrent/metastatic squamous cell carcinoma of the head and neck. However, limited information on the prognostic impact of locoregional disease is available, despite its life-threatening features. We investigated the prognostic impact of incurable locoregional disease and distant metastasis in recurrent/metastatic squamous cell carcinoma of the head and neck. METHODS We retrospectively analyzed 156 patients with recurrent/metastatic squamous cell carcinoma of the head and neck who received palliative chemotherapy between August 2006 and December 2019. RESULTS The median follow-up time for all censored patients was 12.1 (range 1.9-63.5) months. The median overall survival was 12.4 (95% confidence interval 10.1-15.1) months. Incurable locoregional disease (hazard ratio: 2.31, P = 0.007), liver metastasis (hazard ratio: 2.84, P = 0.006), disease-free interval > 13 months (hazard ratio: 0.51, P = 0.041), cetuximab use (hazard ratio: 0.59, P = 0.007), and immune checkpoint inhibitor use (hazard ratio: 0.56, P = 0.006) were associated with prognosis. The number of distant metastatic sites was not associated with overall survival (1-2: hazard ratio: 0.60, P = 0.16; 3-4: hazard ratio: 1.34, P = 0.50). Patients with incurable locoregional disease had more life-threatening events than those with curable locoregional disease. CONCLUSION The presence of incurable locoregional disease had a significant prognostic impact, whereas the number of distant metastatic sites had no prognostic impact. Liver metastasis was a poor prognostic factor for recurrent/metastatic squamous cell carcinoma of the head and neck.
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21
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Vincent AG, Wang W, Shokri T, Ducic Y. Treatment of Oligometastatic Disease in Squamous Cell Carcinoma of the Head and Neck. Laryngoscope 2021; 131:E1476-E1480. [PMID: 33044014 PMCID: PMC8246782 DOI: 10.1002/lary.29115] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/19/2020] [Accepted: 09/02/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE No surgical or radiotherapeutic treatment guidelines exist for oligometastatic head and neck squamous cell carcinoma (oHNSCC), and only recently have interventions with curative intent been studied. Herein, we sought to elucidate survival rates among patients with oHNSCC to determine if treatment with curative intent is warranted in this population. STUDY DESIGN Retrospective chart review. METHODS We retrospectively reviewed cases of oHNSCC treated between March 1998 and March 2018. Fisher's exact test was used to compare patients treated with radiotherapy (RT) to those who underwent surgical excision and to compare outcomes of patients with oligometastases at the time of initial presentation to those that developed oligometastatic disease after primary treatment. RESULTS Eighty one patients with metastases to the lungs, ribs, pelvis, vertebral column, liver, clavicle, and sternum were included. Overall, 32 patients (40%) were alive 5 years post-treatment. The site of metastasis, the modality of treatment, and the time of development of oligometastatic disease did not significantly affect 5-year survival. CONCLUSION Herein, we demonstrate that multi-modality treatment of oHNSCC is warranted for some patients with an estimated 40% 5-year survival. Aggressive treatment of the primary and regional sites is necessary in addition to treatment of the metastatic site and incurs a survival benefit compared to patients with metastatic HNSCC treated with systemic therapy alone. oHNSCC should be approached separately from polymetastatic disease. Patients should be counseled about the possibility for long-term survival, and aggressive initial treatment with the intention for cure should be considered in this population. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1476-E1480, 2021.
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Affiliation(s)
| | - Weitao Wang
- Facial Plastic Surgery AssociatesFort WorthTexasU.S.A.
| | - Tom Shokri
- Pennsylvania State Hershey Medical Center, Otolaryngology – Head and Neck SurgeryHersheyPennsylvaniaU.S.A.
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22
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Weissmann T, Höfler D, Hecht M, Semrau S, Haderlein M, Filimonova I, Frey B, Bert C, Lettmaier S, Mantsopoulos K, Iro H, Fietkau R, Putz F. Oligometastatic head and neck cancer: Which patients benefit from radical local treatment of all tumour sites? Radiat Oncol 2021; 16:62. [PMID: 33789725 PMCID: PMC8011153 DOI: 10.1186/s13014-021-01790-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background There is a large lack of evidence for optimal treatment in oligometastatic head and neck cancer and it is especially unclear which patients benefit from radical local treatment of all tumour sites. Methods 40 patients with newly diagnosed oligometastatic head and neck cancer received radical local treatment of all tumour sites from 14.02.2008 to 24.08.2018. Primary endpoint was overall survival. Time to occurrence of new distant metastases and local control were evaluated as secondary endpoints as well as prognostic factors in univariate und multivariate Cox’s regression analysis. To investigate the impact of total tumour volume on survival, all tumour sites were segmented on baseline imaging. Results Radical local treatment included radiotherapy in 90% of patients, surgery in 25% and radiofrequency ablation in 3%. Median overall survival from first diagnosis of oligometastatic disease was 23.0 months, 2-year survival was 48%, 3-year survival was 37%, 4-year survival was 24% and 5-year survival was 16%. Median time to occurrence of new distant metastases was 11.6 months with freedom from new metastases showing a tail pattern after 3 years of follow-up (22% at 3, 4- and 5-years post-treatment). In multivariate analysis, better ECOG status, absence of bone and brain metastases and lower total tumour volume were significantly associated with improved survival, whereas the number of metastases and involved organ sites was not. Conclusions Radical local treatment in oligometastatic head and neck cancer shows promising outcomes and needs to be further pursued. Patients with good performance status, absence of brain and bone metastases and low total tumour volume were identified as optimal candidates for radical local treatment in oligometastatic head and neck cancer and should be considered for selection in future prospective trials. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01790-w.
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Affiliation(s)
- Thomas Weissmann
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Daniel Höfler
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Markus Hecht
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Marlen Haderlein
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Irina Filimonova
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Benjamin Frey
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Christoph Bert
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Sebastian Lettmaier
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Konstantinos Mantsopoulos
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Heinrich Iro
- Department of Otolaryngology, Head and Neck Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany
| | - Florian Putz
- Department of Radiotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitaetsstraße 27, 91054, Erlangen, Germany.
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23
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Antonoff MB, Sofocleous CT, Callstrom MR, Nguyen QN. The roles of surgery, stereotactic radiation, and ablation for treatment of pulmonary metastases. J Thorac Cardiovasc Surg 2021; 163:495-502. [PMID: 33838914 DOI: 10.1016/j.jtcvs.2021.01.143] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/16/2020] [Accepted: 01/02/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
| | | | | | - Quynh-Nhu Nguyen
- Department of Thoracic Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex
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24
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Mat Lazim N, Elliott M, Wykes J, Clark J. Oligometastases in head and neck carcinoma and their impact on management. ANZ J Surg 2021; 91:2617-2623. [PMID: 33634950 DOI: 10.1111/ans.16622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Historically, patients with head and neck squamous cell carcinoma (HNSCC) with distant metastases were regarded as palliative. Oligometastasis (OM) refers to patients with a limited number of distant metastatic deposits. Treatment of patients with OMs has been reported in patients with lung, colon, breast, prostate and brain malignancies. Selected patients with oligometastatic HNSCC have a higher probability of durable disease control and cure and these patients should be treated aggressively. Treatment options for patients with HNSCC OMs include single or combinations of the three arms of cancer treatment, that is surgery, radiotherapy and chemotherapy/immunotherapy. To date, there are limited studies reporting the management of OM with head and neck malignancy. This review will give insights into the management of OMs in HNSCC.
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Affiliation(s)
- Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Michael Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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25
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Franzese C, Badalamenti M, Teriaca A, De Virgilio A, Mercante G, Cavina R, Ferrari D, Santoro A, Spriano G, Scorsetti M. Metastasis-directed stereotactic body radiation therapy in the management of oligometastatic head and neck cancer. J Cancer Res Clin Oncol 2021; 147:1307-1313. [PMID: 33471186 DOI: 10.1007/s00432-021-03518-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Recently major efforts have been made to define the oligometastatic setting, but for head and neck cancer (HNC) limited data are available. We aimed to evaluate outcome of oligometastatic HNC treated with Stereotactic body radiotherapy (SBRT) as metastasis-directed therapy. MATERIALS AND METHODS We analyzed patients treated with SBRT on a maximum of five oligometastases from HNC, in up to two organs. Concomitant treatment was allowed. End points were toxicity, local control of treated metastases (LC), progression-free survival (PFS) and overall survival (OS). RESULTS 48 consecutive patients and 71 lesions were treated. With a follow-up of 20.2 months, most common primary tumors were larynx (29.2%) and salivary glands (29.2%), while common site of metastases was lung (59.1%). Median dose was 48 Gy (21-75) in 3-8 fractions. Treatment was well tolerated, with two patients reporting mild pain and nausea. LC rates at 1 and 2 years were 83.1% and 70.2%. Previous local therapy (HR 4.97; p = 0.002), oligoprogression (HR 4.07; p = 0.031) and untreated metastases (HR 4.19; p = 0.027) were associated with worse LC. PFS at 1 and 2 years were 42.2% and 20.0%. Increasing age (HR 1.03; p = 0.010), non-adenoid cystic carcinoma (HR 2.57; p = 0.034) and non-lung metastases (HR 2.20; p = 0.025) were associated with worse PFS. One- and 2-years OS were 81.0% and 67.1%. Worse performance status (HR 2.91; p = 0.049), non-salivary primary (HR 19.9; p = 0.005), non-lung metastases (HR 2.96; p = 0.040) were correlated with inferior OS. CONCLUSIONS SBRT can be considered a safe metastasis-directed therapy in oligometastatic HNC. Efficacy of the treatment seems to be higher when administered upfront in the management of metastatic disease; however, selection of patients need to be improved due to the relevant risk of appearance of new metastatic site after SBRT.
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Affiliation(s)
- Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy. .,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
| | - M Badalamenti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - A Teriaca
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - A De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - G Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - R Cavina
- Department of Medical Oncology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - D Ferrari
- Medical Oncology Unit, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Paolo, Milan, Italy
| | - A Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,Department of Medical Oncology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - G Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - M Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
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26
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Yang W, Mei X, Zhou Y, Su R, Lei W, Zheng S, Zhu R, Guo L, Tao Y, Su Y, Li J, Ding C, Zou S, Li X, Hu H. Risk factors and survival outcomes of laryngeal squamous cell carcinoma patients with lung metastasis: A population-based study. Auris Nasus Larynx 2020; 48:723-730. [PMID: 33358379 DOI: 10.1016/j.anl.2020.11.009] [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: 03/28/2020] [Revised: 11/04/2020] [Accepted: 11/18/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE It remains elusive which factors may influence the morbidity and mortality of lung metastasis (LM) in Laryngeal Squamous Cell Carcinoma (LSCC) patients. The aim of the present study was to investigate factors influencing LM and the survival outcomes of LSCC patients with LM. METHODS We identified 10,935 patients with LSCC from 2010 to 2014 using the Surveillance, Epidemiology and End Results database. Multivariate logistic regression analysis was used to determine the factors associated with the presence of LM. Multivariate cox regression analysis was used to identify covariates associated with increased all-cause mortality in patients with LM. RESULTS Among 10,935 patients with LSCC, 232 (2.12%) patients had LM. The median survival time of patients with LM was 8 months, and 8.37% of patients survived after 3 years. Patients with age ≥ 60 years old, unmarried status, supraglottis, overlapping lesion of larynx, subglottis, pathological grade III, T4 stage, N1 stage, N2 stage, N3 stage and bone, brain or liver metastases were more likely to have LM. Survival analysis showed that chemotherapy and radiotherapy suggested better survival of LSCC patients with LM while pathological grade IV was associated with an increased all-cause mortality. CONCLUSION The incidence of LSCC patients with LM varied by age, married status, and tumor subtypes. LSCC patients with LM had poor survival, and only 8.37% of patients survived after 3 years. However, chemotherapy and radiotherapy were found as independent favorable prognostic factors for survival.
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Affiliation(s)
- Weiqiang Yang
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Xueshuang Mei
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Yaqi Zhou
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Rongfei Su
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Wenbin Lei
- Otorhinolaryngology Hospital, Institute of Otolaryngology, Guangdong Provincial Key Laboratory, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China.
| | - Shixin Zheng
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Rufei Zhu
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Lianrong Guo
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Yuan Tao
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Yongjin Su
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Jianyu Li
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Chuchu Ding
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Songfeng Zou
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
| | - Xiaoling Li
- Community Health Service Management Center, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen 518033, China.
| | - Hongyi Hu
- Department of Otorhinolaryngology, Hearing and Balance Function Medical Engineering Laboratory, Peking University Shenzhen Hospital, Shenzhen 518036, China.
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27
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Szturz P, Nevens D, Vermorken JB. Oligometastatic Disease Management: Finding the Sweet Spot. Front Oncol 2020; 10:617793. [PMID: 33415080 PMCID: PMC7783387 DOI: 10.3389/fonc.2020.617793] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/16/2020] [Indexed: 12/25/2022] Open
Abstract
Hematogenous dissemination represents a common manifestation of squamous cell carcinoma of the head and neck, and the recommended therapeutic options usually consist of systemically administered drugs with palliative intent. However, mounting evidence suggests that patients with few and slowly progressive distant lesions of small size may benefit from various local ablation techniques, which have already been established as standard-of-care modalities for example in colorectal and renal cell carcinomas and in sarcomas. In principle, serving as radical approaches to eradicate cancer, these interventions can be curative. Their impact on local control and overall survival has been shown in numerous retrospective and prospective studies. The term oligometastatic refers to the number of distant lesions which should generally not surpass five in total, ideally in one organ. Currently, surgical resection remains the method of choice supported by the majority of published data. More recently, stereotactic (ablative) body radiotherapy (SABR/SBRT) has emerged as a viable alternative. In cases technically amenable to such local interventions, several other clinical variables need to be taken into account also, including patient-related factors (general health status, patient preferences, socioeconomic background) and disease-related factors (primary tumor site, growth kinetics, synchronous or metachronous metastases). In head and neck cancer, patients presenting with late development of slowly progressive oligometastatic lesions in the lungs secondary to human papillomavirus (HPV)-positive oropharyngeal cancer are the ideal candidates for metastasectomy or other local therapies. However, literature data are still limited to say whether there are other subgroups benefiting from this approach. One of the plausible explanations is that radiological follow-up after primary curative therapy is usually not recommended because its impact on survival has not been unequivocal, which is also due to the rarity of oligometastatic manifestations in this disease. At the same time, aggressive treatment of synchronous metastases early in the disease course should be weighed against the risk of futile interventions in a disease with already multimetastatic microscopic dissemination. Therefore, attentive treatment sequencing, meticulous appraisal of cancer extension, refinement of post-treatment surveillance, and understanding of tumor biology and kinetics are crucial in the management of oligometastases.
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Affiliation(s)
- Petr Szturz
- Medical Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Daan Nevens
- Department of Radiation Oncology, IridiumNetwork, Wilrijk (Antwerp), Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - 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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Oliveira TB, Mesía R, Falco A, Hsieh JCH, Yokota T, Saada-Bouzid E, Schmitz S, Elicin O, Giacomelli L, Bossi P. Defining the needs of patients with recurrent and/or metastatic head and neck cancer: An expert opinion. Crit Rev Oncol Hematol 2020; 157:103200. [PMID: 33321152 DOI: 10.1016/j.critrevonc.2020.103200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/08/2023] Open
Abstract
The clinical and biological heterogeneity of head and neck cancer (HNC) is paralleled by a plethora of different symptoms that affect the patient's quality of life. These symptoms include, for instance, pain, fatigue, nutritional issues, airways obstruction, voice alterations and psychological distress. In addition, patients with HNC are prone to a high risk of infection, and may also suffer from acute complications, such as hypercalcemia, spine compression by bone metastasis or bleeding. Prolonging survival is also an inherent expectation for all patients. Addressing the above needs is crucial in all patients with HNC, and especially in those with recurrent and/or metastatic (RM) disease. However, research on how to address patients' needs in RM-HNC remains scarce. This paper defines patients' needs for RM HNC and presents an Expert Opinion on how to address them, proposing also some lines of research.
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Affiliation(s)
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Barcelona, Spain
| | - Agustin Falco
- Medical Oncology Department, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, 333, Taiwan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Esma Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | - Sandra Schmitz
- Departments of Medical Oncology and Head and Neck Surgery, Institut Roi Albert II, Institut de Recherche Clinique et Expérimentale (Pole MIRO), Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Woluwe-Saint-Lambert, Belgium
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Luca Giacomelli
- Polistudium srl, Milan, Italy; Department of Surgical Sciences and Integrated Diangostics, University of Genoa, Genoa, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, 25123, Brescia, Italy.
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