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Queyrel É, Lapierre A, Pointreau Y, Lapeyre M, Biau J, Ruffier A. Reirradiation of squamous cell carcinoma of the head and neck with external photons: A practical review of the literature. Cancer Radiother 2024:S1278-3218(24)00137-9. [PMID: 39389843 DOI: 10.1016/j.canrad.2024.07.011] [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: 07/14/2024] [Accepted: 07/17/2024] [Indexed: 10/12/2024]
Abstract
The modalities of management by reirradiation for recurrence or a second localization of head and neck squamous cell carcinoma (HNSCC) in previously irradiated terrain is challenging due to the great heterogeneity of data in the literature, mainly retrospective data reporting non-negligible risks of serious late toxicity events. With the recent development of more precise and conformal radiotherapy techniques such as intensity modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), stereotactic radiotherapy (SBRT), the benefit-to-risk ratio of reirradiation has evolved in recent years with encouraging results, but patient selection is crucial. The aim of this review is to discuss the role of HNSCC reirradiation in terms of patient selection and external photon radiotherapy techniques for definitive tumor reirradiation and postoperative reirradiation.
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Affiliation(s)
- Élodie Queyrel
- Radiotherapy Department, centre Jean-Perrin, Clermont-Ferrand, France.
| | - Arianne Lapierre
- Radiotherapy Department, centre hospitalier universitaire Lyon Sud, Pierre-Bénite, France
| | - Yoann Pointreau
- Radiotherapy Department, centre Jean-Bernard, Institut inter-régional de cancérologie (ILC) - CCS, Le Mans, France
| | - Michel Lapeyre
- Radiotherapy Department, centre Jean-Perrin, Clermont-Ferrand, France
| | - Julian Biau
- Radiotherapy Department, centre Jean-Perrin, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm, U1240 IMoST, Clermont-Ferrand, France
| | - Amandine Ruffier
- Radiotherapy Department, centre Jean-Bernard, Institut inter-régional de cancérologie (ILC) - CCS, Le Mans, France
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2
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Verginadis II, Velalopoulou A, Kim MM, Kim K, Paraskevaidis I, Bell B, Oliaei Motlagh SA, Karaj A, Banerjee E, Finesso G, Assenmacher CA, Radaelli E, Lu J, Lin Y, Putt ME, Diffenderfer ES, Guha C, Qin L, Metz JM, Maity A, Cengel KA, Koumenis C, Busch TM. FLASH proton reirradiation, with or without hypofractionation, mitigates chronic toxicity in the normal murine intestine, skin, and bone. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.08.602528. [PMID: 39026805 PMCID: PMC11257476 DOI: 10.1101/2024.07.08.602528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Background and purpose The normal tissue sparing afforded by FLASH radiotherapy (RT) is being intensely investigated for potential clinical translation. Here, we studied the effects of FLASH proton RT (F-PRT) in the reirradiation setting, with or without hypofractionation. Chronic toxicities in three murine models of normal tissue toxicity including the intestine, skin, and bone were investigated. Materials and methods In studies of the intestine, single-dose irradiation was performed with 12 Gy of Standard proton RT (S-PRT), followed by a second dose of 12 Gy of F-PRT or S-PRT. Additionally, a hypofractionation scheme was applied in the reirradiation setting (3 x 6.4 Gy of F-PRT or S-PRT, given every 48 hrs). In studies of skin/bone of the murine leg, 15 Gy of S-PRT was followed by hypofractionated reirradiation with F-PRT or S-PRT (3 x 11 Gy). Results Compared to reirradiation with S-PRT, F-PRT reduced intestinal fibrosis and collagen deposition in the reirradiation setting and significantly increased survival rate, demonstrating its protective effects on intestinal tissues. In previously irradiated leg tissues, reirradiation with hypofractionated F-PRT created transient dermatitis that fully resolved in contrast to reirradiation with hypofractionated S-PRT. Lymphedema was also alleviated after a second course of radiation with F-PRT, along with significant reductions in the accumulation of fibrous connective tissue in the skin compared to mice reirradiated with S-PRT. The delivery of a second course of fractionated S-PRT induced tibial fractures in 83.3% of the mice, whereas only 20% of mice reirradiated with F-PRT presented with fractures. Conclusion These studies provide the first evidence of the sparing effects of F-PRT, in the setting of hypofractionated reirradiation. The results support FLASH as highly relevant to the reirradiation regimen where it exhibits significant potential to minimize chronic complications for patients undergoing RT.
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3
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Alterio D, Zaffaroni M, Bossi P, Dionisi F, Elicin O, Falzone A, Ferrari A, Jereczek-Fossa BA, Sanguineti G, Szturz P, Volpe S, Scricciolo M. Reirradiation of head and neck squamous cell carcinomas: a pragmatic approach-part I: prognostic factors and indications to treatment. LA RADIOLOGIA MEDICA 2024; 129:160-173. [PMID: 37731151 DOI: 10.1007/s11547-023-01713-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Reirradiation (reRT) of locally recurrent/second primary tumors of the head and neck region is a potentially curative treatment for patients not candidate to salvage surgery. Aim of the present study is to summarize available literature on both prognostic factors and indications to curative reRT in this clinical setting. MATERIALS AND METHODS A narrative review of the literature was performed on two topics: (1) patients' selection according to prognostic factors and (2) dosimetric feasibility of reRT. Postoperative reRT and palliative intent treatments were out of the scope of this work. RESULTS Patient-tumor and treatment-related prognostic factors were analyzed, together with dosimetric parameters concerning target volume and organs at risk. Based on available evidence, a stepwise approach has been proposed aiming to provide a useful tool to identify suitable candidates for curative reRT in clinical practice. This was then applied to two clinical cases, proposed at the end of this work. CONCLUSION A second course of RT in head and neck recurrence/second primary tumors is a personalized approach that can be offered to selected patients only in centers with expertise and dedicated equipment following a multidisciplinary team discussion.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Francesco Dionisi
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Andrea Falzone
- Unità Operativa Multizonale di Radiologia Ospedale di Rovereto e Arco, Azienda Sanitaria per i Servizi Provinciali di Trento, Trento, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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4
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Bansal I, Singh R, Bansal K, Bansal A. Delineation of Lingual Artery as an Additional Organ-At-Risk for Stereotactic Body Radiation Therapy of Head and Neck Cancers. Pract Radiat Oncol 2023; 13:517-521. [PMID: 37597614 DOI: 10.1016/j.prro.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/25/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
Lingual artery (LA) stenosis or bleeding can be a potentially fatal consequence of stereotactic body radiation therapy of recurrent head and neck cancer. We aim to provide delineation guidelines for LA contouring during head and neck radiation. Three experienced radiation oncologists and 1 radiologist studied the course of LA and its anatomic relationships. A step-by-step guideline was formulated for its delineation on contrast-enhanced axial computed tomography scans. We recommend that LA should be considered an important organ at risk for stereotactic body radiation therapy of head and neck cancer. Its delineation and dose constraints should be considered on a case-to-case basis.
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Affiliation(s)
| | | | | | - Akash Bansal
- Department of Radiology, Narayana Superspecialty Hospital, Gurugram, Haryana, India
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5
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Alterio D, Zaffaroni M, Bossi P, Dionisi F, Elicin O, Falzone A, Ferrari A, Jereczek-Fossa BA, Sanguineti G, Szturz P, Volpe S, Scricciolo M. Reirradiation of head and neck squamous cell carcinomas: a pragmatic approach, part II: radiation technique and fractionations. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01671-0. [PMID: 37415056 DOI: 10.1007/s11547-023-01671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023]
Abstract
INTRODUCTION Reirradiation (reRT) of local recurrent/second primary tumors of the head and neck represents a potential curative treatment for patients not candidate to a salvage surgery. Aim of the present study is to summarize literature data on modern radiation techniques and fractionations used in this setting of patients. MATERIALS AND METHODS A narrative review of the literature was conducted on three topics: (1) target volume delineation (2) reRT dose and techniques and (3) ongoing studies. Patients treated with postoperative reRT and palliative intent were not considered for the current analysis. RESULTS Recommendations on the target volume contouring have been reported. 3D-Conformal Radiotherapy, Intensity Modulated Radiotherapy, Stereotactic body Radiotherapy Intraoperative Radiotherapy, Brachytherapy and Charged Particles have been analyzed in terms of indication and fractionation in the field of reRT. Ongoing studies on the topic have been reported for IMRT and Charged Particles. Moreover, according to literature data a stepwise approach has been proposed aiming to provide a useful tool to select patients candidate to a curative reRT in daily clinical practice. Two clinical cases were also provided for its application. CONCLUSION Different radiation techniques and fractionations can be used for a second course of radiotherapy in patients with recurrent/second primary tumor of head and neck region. Tumor characteristics as well as radiobiological considerations should be take into account to define the best reRT approach.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST-Spedali Civili, Brescia, Italy
| | - Francesco Dionisi
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Falzone
- Unità Operativa Multizonale di Radiologia Ospedale di Rovereto e Arco, Azienda Sanitaria per i Servizi Provinciali di Trento, Trento, Italy
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Giuseppe Sanguineti
- Radiotherapy Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Dowthwaite S, Jackson J, Dzienis M, Khoo E, Cronin M, Guazzo E. Management of Recurrent HPV-Positive Oropharyngeal Squamous Cell Carcinoma: a Contemporary Review. Curr Oncol Rep 2023; 25:501-510. [PMID: 36881215 DOI: 10.1007/s11912-023-01386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE OF REVIEW To review the impact of contemporary treatment strategies on salvage outcomes in patients with recurrent human papilloma virus-positive oropharyngeal squamous cell carcinoma (HPV + OPSCC). RECENT FINDINGS Secondary to HPV, changes in disease biology have impacted primary treatments and subsequent approaches to patients with recurrence. With treatment strategies more inclusive of upfront surgery, the characteristics of patients with recurrence HPV + OPSCC have been further redefined. Less invasive endoscopic surgical approaches such as transoral robotic surgery (TORS), and the continued refinement of conformal radiotherapy techniques, have improved treatment options for patients with recurrent HPV + OPSCC. Systemic treatment options have continued to expand including potentially effective immune-based therapies. Effective surveillance with systemic and oral biomarkers offers hope of earlier detection of recurrence. Management of patients with recurrent OPSCC remains difficult. Modest improvements in salvage treatment have been observed within the HPV + OPSCC cohort largely reflecting disease biology and improved treatment techniques.
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Affiliation(s)
- Sam Dowthwaite
- Gold Coast University Hospital, Department of Otolaryngology/Head and Neck Surgery, Suite 2B, Ground Floor, AHC House, 14 Carrara St Benowa, Benowa, QLD, 4217, Australia.
| | - James Jackson
- Gold Coast University Hospital, Department of Radiation Oncology, Benowa, Australia.,Icon Cancer Centre, Benowa, Australia
| | - Marcin Dzienis
- Gold Coast University Hospital, Department of Medical Oncology, Benowa, Australia
| | - Eric Khoo
- Gold Coast University Hospital, Department of Radiation Oncology, Benowa, Australia.,Icon Cancer Centre, Benowa, Australia
| | - Mathew Cronin
- Gold Coast University Hospital, Department of Otolaryngology/Head and Neck Surgery, Suite 2B, Ground Floor, AHC House, 14 Carrara St Benowa, Benowa, QLD, 4217, Australia
| | - Emily Guazzo
- Gold Coast University Hospital, Department of Otolaryngology/Head and Neck Surgery, Suite 2B, Ground Floor, AHC House, 14 Carrara St Benowa, Benowa, QLD, 4217, Australia
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7
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Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
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8
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Kreinbrink PJ, Lewis LM, Redmond KP, Takiar V. Reirradiation of Recurrent and Second Primary Cancers of the Head and Neck: a Review of the Contemporary Evidence. Curr Treat Options Oncol 2022; 23:295-310. [PMID: 35226310 DOI: 10.1007/s11864-021-00936-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/07/2023]
Abstract
OPINION STATEMENT Recurrent and second primary head and neck cancers represent a clinical challenge due to frequently unresectable and/or locally advanced disease. Given that many of these patients have received definitive doses of radiation previously, reirradiation is associated with significant morbidity. Use of modern approaches such as conformal photon-based planning and charged particle therapy using protons or carbon ions allows for greater sparing of normal tissues while maintaining or escalating doses to tumor volumes. While the reirradiation data has consistently shown benefits to local control and even survival from escalation of radiotherapy dose, excessive cumulative doses can result in severe toxicities, including fatal carotid blowout syndrome. For all modalities, appropriate patient selection is of utmost importance. Large-scale trials and multi-institutional registry data are needed to standardize treatment modalities, and to determine optimal doses and volumes for reirradiation.
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Affiliation(s)
- Paul J Kreinbrink
- University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA
| | - Luke M Lewis
- University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA
| | - Kevin P Redmond
- University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA
| | - Vinita Takiar
- University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA. .,Cincinnati VA Medical Center, Cincinnati, OH, USA. .,University of Cincinnati Medical Center, 234 Goodman Street, ML 0757, Cincinnati, OH, 45267, USA.
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9
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Woods KE, Ma TM, Cook KA, Morris ED, Gao Y, Sheng K, Kishan AU, Hegde JV, Felix C, Basehart V, Narahara K, Shen Z, Tenn S, Steinberg ML, Chin RK, Cao M. A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes. Cancers (Basel) 2022; 14:cancers14040939. [PMID: 35205686 PMCID: PMC8870161 DOI: 10.3390/cancers14040939] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The delivery of higher radiation doses has been shown to increase local control, and ultimately survival, for head and neck cancer patients, but highly conformal dose distributions are necessary to minimize normal tissue toxicity. Varian’s HyperArc non-coplanar automated treatment planning and delivery technique has been shown to improve dose conformity for intracranial treatment, but its safety and efficacy for head and neck cancer treatment has yet to be verified. This study evaluates the initial results of a prospective clinical trial using HyperArc for recurrent head and neck cancer patients. We demonstrated that HyperArc can enable significant tumor dose escalation compared to conventional volumetric modulated arc therapy (VMAT) planning while minimizing the dose to organs at risk. Treatment delivery was feasible and safe, with minimal treatment-related toxicities and positive patient-reported quality of life measures. Abstract This study reports the initial results for the first 15 patients on a prospective phase II clinical trial exploring the safety, feasibility, and efficacy of the HyperArc technique for recurrent head and neck cancer treatment. Eligible patients were simulated and planned with both conventional VMAT and HyperArc techniques and the plan with superior dosimetry was selected for treatment. Dosimetry, delivery feasibility and safety, treatment-related toxicity, and patient-reported quality of life (QOL) were all evaluated. HyperArc was chosen over conventional VMAT for all 15 patients and enabled statistically significant increases in dose conformity (R50% reduced by 1.2 ± 2.1, p < 0.05) and mean PTV and GTV doses (by 15.7 ± 4.9 Gy, p < 0.01 and 17.1 ± 6.0 Gy, p < 0.01, respectively). The average HyperArc delivery was 2.8 min longer than conventional VMAT (p < 0.01), and the mean intrafraction motion was ≤ 0.5 ± 0.4 mm and ≤0.3 ± 0.1°. With a median follow-up of 12 months, treatment-related toxicity was minimal (only one grade 3 acute toxicity above baseline) and patient-reported QOL metrics were favorable. HyperArc enabled superior dosimetry and significant target dose escalation compared to conventional VMAT planning, and treatment delivery was feasible, safe, and well-tolerated by patients.
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Affiliation(s)
- Kaley E. Woods
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
- Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033, USA
| | - Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Kiri A. Cook
- Department of Radiation Oncology, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Eric D. Morris
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Yu Gao
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Ke Sheng
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - John V. Hegde
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Carol Felix
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Vincent Basehart
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Kelsey Narahara
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Zhouhuizi Shen
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Michael L. Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
| | - Robert K. Chin
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
- Correspondence: (R.K.C.); (M.C.)
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA 90095, USA; (K.E.W.); (T.M.M.); (E.D.M.); (Y.G.); (K.S.); (A.U.K.); (J.V.H.); (C.F.); (V.B.); (K.N.); (Z.S.); (S.T.); (M.L.S.)
- Correspondence: (R.K.C.); (M.C.)
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Pandya S, Thakur A, Saxena S, Jassal N, Patel C, Modi K, Shah P, Joshi R, Gonge S, Kadam K, Kadam P. A Study of the Recent Trends of Immunology: Key Challenges, Domains, Applications, Datasets, and Future Directions. SENSORS (BASEL, SWITZERLAND) 2021; 21:7786. [PMID: 34883787 PMCID: PMC8659723 DOI: 10.3390/s21237786] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/13/2022]
Abstract
The human immune system is very complex. Understanding it traditionally required specialized knowledge and expertise along with years of study. However, in recent times, the introduction of technologies such as AIoMT (Artificial Intelligence of Medical Things), genetic intelligence algorithms, smart immunological methodologies, etc., has made this process easier. These technologies can observe relations and patterns that humans do and recognize patterns that are unobservable by humans. Furthermore, these technologies have also enabled us to understand better the different types of cells in the immune system, their structures, their importance, and their impact on our immunity, particularly in the case of debilitating diseases such as cancer. The undertaken study explores the AI methodologies currently in the field of immunology. The initial part of this study explains the integration of AI in healthcare and how it has changed the face of the medical industry. It also details the current applications of AI in the different healthcare domains and the key challenges faced when trying to integrate AI with healthcare, along with the recent developments and contributions in this field by other researchers. The core part of this study is focused on exploring the most common classifications of health diseases, immunology, and its key subdomains. The later part of the study presents a statistical analysis of the contributions in AI in the different domains of immunology and an in-depth review of the machine learning and deep learning methodologies and algorithms that can and have been applied in the field of immunology. We have also analyzed a list of machine learning and deep learning datasets about the different subdomains of immunology. Finally, in the end, the presented study discusses the future research directions in the field of AI in immunology and provides some possible solutions for the same.
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Affiliation(s)
- Sharnil Pandya
- Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Pune 412115, India; (A.T.); (S.S.); (N.J.); (R.J.); (S.G.); (K.K.); (P.K.)
| | - Aanchal Thakur
- Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Pune 412115, India; (A.T.); (S.S.); (N.J.); (R.J.); (S.G.); (K.K.); (P.K.)
| | - Santosh Saxena
- Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Pune 412115, India; (A.T.); (S.S.); (N.J.); (R.J.); (S.G.); (K.K.); (P.K.)
| | - Nandita Jassal
- Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Pune 412115, India; (A.T.); (S.S.); (N.J.); (R.J.); (S.G.); (K.K.); (P.K.)
| | - Chirag Patel
- Computer Science & Engineering, Devang Patel Institute of Advance Technology and Research, Changa 388421, India;
| | - Kirit Modi
- Sankalchand Patel College of Engineering, Sankalchand Patel University, Visnagar 384315, India;
| | - Pooja Shah
- Information Technology Department, Gandhinagar Institute of Technology, Ahmedabad 382010, India;
| | - Rahul Joshi
- Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Pune 412115, India; (A.T.); (S.S.); (N.J.); (R.J.); (S.G.); (K.K.); (P.K.)
| | - Sudhanshu Gonge
- Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Pune 412115, India; (A.T.); (S.S.); (N.J.); (R.J.); (S.G.); (K.K.); (P.K.)
| | - Kalyani Kadam
- Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Pune 412115, India; (A.T.); (S.S.); (N.J.); (R.J.); (S.G.); (K.K.); (P.K.)
| | - Prachi Kadam
- Symbiosis Institute of Technology, Symbiosis International (Deemed) University, Pune 412115, India; (A.T.); (S.S.); (N.J.); (R.J.); (S.G.); (K.K.); (P.K.)
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11
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Diao K, Nguyen TP, Moreno AC, Reddy JP, Garden AS, Wang CH, Tung S, Wang C, Wang XA, Rosenthal DI, Fuller CD, Gunn GB, Frank SJ, Morrison WH, Shah SJ, Lee A, Spiotto MT, Su SY, Ferrarotto R, Phan J. Stereotactic body ablative radiotherapy for reirradiation of small volume head and neck cancers is associated with prolonged survival: Large, single-institution, modern cohort study. Head Neck 2021; 43:3331-3344. [PMID: 34269492 PMCID: PMC8511054 DOI: 10.1002/hed.26820] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recurrent head and neck cancer has poor prognosis. Stereotactic body radiotherapy (SBRT) may improve outcomes by delivering ablative radiation doses. METHODS We reviewed patients who received definitive-intent SBRT reirradiation at our institution from 2013 to 2020. Patterns of failure, overall survival (OS), and toxicities were analyzed. RESULTS One hundred and thirty-seven patients were evaluated. The median OS was 44.3 months. The median SBRT dose was 45 Gy and median target volume 16.9 cc. The 1-year local, regional, and distant control was 78%, 66%, and 83%, respectively. Systemic therapy improved regional (p = 0.004) and distant control (p = 0.04) in nonmetastatic patients. Grade 3+ toxicities were more common at mucosal sites (p = 0.001) and with concurrent systemic therapy (p = 0.02). CONCLUSIONS In a large cohort of SBRT reirradiation for recurrent, small volume head and neck cancers, a median OS of 44.3 months was observed. Systemic therapy improved regional and distant control. Toxicities were modulated by anatomic site and systemic therapy.
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Affiliation(s)
- Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Theresa P. Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amy C. Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Adam S. Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Catherine H. Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Samuel Tung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Congjun Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xin A. Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David I. Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary B. Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William H. Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shalin J. Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anna Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael T. Spiotto
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shirley Y. Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Renata Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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12
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Bozec A, Culié D, Poissonnet G, Demard F, Dassonville O. Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status. Cancers (Basel) 2021; 13:cancers13215456. [PMID: 34771619 PMCID: PMC8582410 DOI: 10.3390/cancers13215456] [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: 09/28/2021] [Revised: 10/28/2021] [Accepted: 10/28/2021] [Indexed: 01/19/2023] Open
Abstract
Simple Summary Contrary to other head and neck subsites, oropharyngeal squamous cell carcinoma (OPSCC) has shown a considerable increase in incidence over the past 20 years. This growing incidence is largely due to the increasing place of human papillomavirus (HPV)-related tumors. HPV-positive and HPV-negative OPSCC are two distinct entities with considerable differences in terms of treatment response and prognosis. However, there are no specific recommendations yet in the therapeutic management of OPSCC patients according to their tumor HPV-status. The aim of this review is therefore to discuss the therapeutic management of patients with OPSCC and the impact of HPV status on treatment selection. Abstract Since there is no published randomized study comparing surgical and non-surgical therapeutic strategies in patients with oropharyngeal squamous cell carcinoma (OPSCC), the therapeutic management of these patients remains highly controversial. While human papillomavirus (HPV)-positive and HPV-negative OPSCC are now recognized as two distinct diseases with different epidemiological, biological, and clinical characteristics, the impact of HPV status on the management of OPSCC patients is still unclear. In this review, we analyze the current therapeutic options in patients with OPSCC, highlighting the most recent advances in surgical and non-surgical therapies, and we discuss the impact of HPV status on the therapeutic strategy.
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13
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Doyen J, Aloi D, Groulier A, Vidal M, Lesueur P, Calugaru V, Bondiau PY. Role of proton therapy in reirradiation and in the treatment of sarcomas. Cancer Radiother 2021; 25:550-553. [PMID: 34284969 DOI: 10.1016/j.canrad.2021.06.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/11/2021] [Accepted: 06/16/2021] [Indexed: 01/12/2023]
Abstract
Reirradiation and irradiation of sarcoma is often difficult due to the frequent need for a high dose of radiation in order to increase tumor control. This can result in a greater risk of toxicity which can be mitigated with the use of proton therapy. The present review aims to summarize the role of proton therapy in these 2 clinical contexts.
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Affiliation(s)
- J Doyen
- Department of radiation oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, 33, avenue de Valombrose, 06189 Nice, France.
| | - D Aloi
- Department of radiation oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, 33, avenue de Valombrose, 06189 Nice, France
| | - A Groulier
- Department of radiation oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, 33, avenue de Valombrose, 06189 Nice, France
| | - M Vidal
- Department of radiation oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, 33, avenue de Valombrose, 06189 Nice, France
| | - P Lesueur
- Department of radiation oncology, Centre François Baclesse, Centre de Protonthérapie de Normandie, University of Caen Normandie, Caen, France
| | - V Calugaru
- Department of radiation oncology, Institut Curie, Centre de Protonthérapie d'Orsay, Orsay, France
| | - P Y Bondiau
- Department of radiation oncology, Centre Antoine-Lacassagne, University of Côte d'Azur, 33, avenue de Valombrose, 06189 Nice, France
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14
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Gunn GB, Garden AS, Ye R, Ausat N, Dahlstrom KR, Morrison WH, Fuller CD, Phan J, Reddy JP, Shah SJ, Mayo LL, Chun SG, Chronowski GM, Moreno AC, Myers JN, Hanna EY, Esmaeli B, Gillison ML, Ferrarotto R, Hutcheson KA, Chambers MS, Ginsberg LE, El-Naggar AK, Rosenthal DI, Zhu XR, Frank SJ. Proton Therapy for Head and Neck Cancer: A 12-Year, Single-Institution Experience. Int J Part Ther 2021; 8:108-118. [PMID: 34285940 PMCID: PMC8270083 DOI: 10.14338/ijpt-20-00065.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To characterize our experience and the disease control and toxicity of proton therapy (PT) for patients with head and neck cancer (HNC). PATIENTS AND METHODS Clinical outcomes for patients with HNC treated with PT at our institution were prospectively collected in 2 institutional review board-approved prospective studies. Descriptive statistics were used to summarize patient characteristics and outcomes. Overall survival, local-regional control, and disease-free survival were estimated by the Kaplan-Meier method. Treatment-related toxicities were recorded according to the Common Terminology Criteria for Adverse Events (version 4.03) scale. RESULTS The cohort consisted of 573 patients treated from February 2006 to June 2018. Median patient age was 61 years. Oropharynx (33.3%; n = 191), paranasal sinus (11%; n = 63), and periorbital tissues (11%; n = 62) were the most common primary sites. Patients with T3/T4 or recurrent disease comprised 46% (n = 262) of the cohort. The intent of PT was definitive in 53% (n = 303), postoperative in 37% (n = 211), and reirradiation in 10% (n = 59). Median dose was 66 Gy (radiobiological equivalent). Regarding systemic therapy, 43% had received concurrent (n = 244), 3% induction (n = 19), and 15% (n = 86) had both. At a median follow-up of 2.4 years, 88 patients (15%) had died and 127 (22%) developed disease recurrence. The overall survival, local-regional control, and disease-free survival at 2 and 5 years were, respectively, 87% and 75%, 87% and 78%, and 74% and 63%. Maximum toxicity (acute or late) was grade 3 in 293 patients (51%), grade 2 in 234 patients (41%), and grade 1 in 31 patients (5%). There were 381 acute grade 3 and 190 late grade 3 unique toxicities across 212 (37%) and 150 (26%) patients, respectively. There were 3 late-grade 4 events across 2 patients (0.3%), 2 (0.3%) acute-grade 5, and no (0%) late-grade 5 events. CONCLUSIONS The overall results from this prospective study of our initial decade of experience with PT for HNC show favorable disease control and toxicity outcomes in a multidisease-site cohort and provide a reference benchmark for future comparison and study.
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Affiliation(s)
- G. Brandon Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rong Ye
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Noveen Ausat
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristina R. Dahlstrom
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William H. Morrison
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C. David Fuller
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jay P. Reddy
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shalin J. Shah
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren L. Mayo
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen G. Chun
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory M. Chronowski
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C. Moreno
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffery N. Myers
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ehab Y. Hanna
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bita Esmaeli
- Ophthalmic Plastic Surgery, Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maura L. Gillison
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Ferrarotto
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine A. Hutcheson
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark S. Chambers
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lawrence E. Ginsberg
- Department of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adel K. El-Naggar
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I. Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Xiaorong Ronald Zhu
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J. Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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15
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Schindler A, Baijens LWJ, Clave P, Degen B, Duchac S, Dziewas R, Farneti D, Hamdy S, Michou E, Pokieser P, Speyer R, Walshe M, Verin E, Rommel N. ESSD Commentary on Dysphagia Management During COVID Pandemia. Dysphagia 2020; 36:764-767. [PMID: 33111204 PMCID: PMC7592131 DOI: 10.1007/s00455-020-10194-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
Since the World Health Organization declared the COVID-19 pandemic a Global Public Health Emergency, experts in swallowing are seeking guidance on service delivery and clinical procedures. The European Society for Swallowing Disorders provides considerations to support experts in swallowing disorders in clinical practice. During the COVID-19 pandemic, assessment and treatment of patients with oropharyngeal dysphagia should be provided, while at the same time balancing risk of oropharyngeal complications with that of infection of patients and healthcare professionals involved in their management. Elective, non-urgent assessment may be temporarily postponed and patients are triaged to decide whether dysphagia assessment is necessary; instrumental assessment of swallowing is performed only if processing of the instruments can be guaranteed and clinical assessment has not provided enough diagnostic information for treatment prescription. Assessment and management of oropharyngeal dysphagia is a high-risk situation as it must be considered an aerosol-generating procedure. Personal protective equipment (PPE) should be used. Telepractice is encouraged and compensatory treatments are recommended.
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Affiliation(s)
- Antonio Schindler
- Phoniatric Unit, Department of Biomedical and Clinical Science "L. Sacco", University of Milan, Milan, Italy
| | - Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center,, Maastricht, The Netherlands
| | - Pere Clave
- Gastrointestinal Physiology Laboratory. Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| | | | - Stephanie Duchac
- SRH Hochschule für Gesundheit, University of Applied Health Sciences, Campus Karlsruhe Benzstr. 5, Karlsruhe, Germany
| | - Rainer Dziewas
- Department of Neurology, University Hospital Münster, Albert-Schweitzer-Campus 1, Munster, Germany
| | - Daniele Farneti
- Audiology Phoniatric Service - ENT Department, Infermi Hospital of Rimini - AUSL Romagna, Rimini, Italy
| | - Shaheen Hamdy
- GI Sciences, School of Medical Sciences, Clinical Sciences Building, University of Manchester, Salford Royal Hospital, Salford, M6 8HD, UK
| | - Emilia Michou
- Department of Speech Language Therapy, School of Rehabilitation Sciences, University of Patras, Patras, Greece
| | - Peter Pokieser
- Unified Patient Program, Teaching Center, Medical University of Vienna, Vienna, Austria
| | - Renee Speyer
- Department Special Needs Education, University of Oslo, Oslo, Norway
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, The University of Dublin, Dublin 2, Ireland
| | - Eric Verin
- Rouen University Hospital, University of Rouen, 3830, Normandy, EA, France
| | - Nathalie Rommel
- Dept of Neurosciences, ExpORL, Deglutology and University Hospital Leuven, University of Leuven, Leuven, Belgium. .,Dept Gastroenterology (Neurogastroenterology and Motility), University of Leuven, Leuven, Belgium.
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16
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Bandi F, Karligkiotis A, Mellia J, Gallo S, Turri-Zanoni M, Battaglia P, Castelnuovo P. Strategies to overcome limitations in Otolaryngology residency training during the COVID-19 pandemic. Eur Arch Otorhinolaryngol 2020; 277:3503-3506. [PMID: 32705361 PMCID: PMC7377304 DOI: 10.1007/s00405-020-06228-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE The COVID-19 pandemic has produced an unequaled human crisis forcing a radical reorganization in the healthcare system. Otolaryngologists are at high risk of exposure, and changes in medical and surgical activities have reduced the learning opportunity for residents and fellows. We believe that even during COVID-19 crisis it is mandatory to guarantee an optimal training, and here, we propose some strategies, based on our experience, to further increase our trainees' learning curve. METHODS We asked our trainees to fill out an electronic survey about several aspect of their training: a first section focused on the reduction of clinical activities and the perceived impact of the pandemic on residents' skills; the second part outlined the type of attended training activity and the perceived benefit. RESULTS Surgical training has been reported by our residents as the activity perceived to be the most contracted during the pandemic. According to residents' opinion the most useful activities were dissection (n = 8, 53.4% residents) and online journal clubs/webinars (n = 7, 46.6% of residents). Residents' suggestions included actively participating to tracheostomy procedures on SARS-CoV-2 positive patients, attending lessons held by senior consultants on basic ENT topics and promoting collegial discussion of inpatient clinical cases. CONCLUSION Building on this dramatic experience, we must be ready for a global restructuring of the residency program to provide an adequate trainee education for the future surgeons.
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Affiliation(s)
- Francesco Bandi
- Department of Otolaryngology-Head and Neck Surgery, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - Apostolos Karligkiotis
- Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Jessica Mellia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Stefania Gallo
- Division of Otorhinolaryngology, Department of Surgical Specialties, ASST Sette Laghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, 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 Battaglia
- Division of Otorhinolaryngology, Department of Biotechnology and Life Sciences, University of Insubria-Varese, ASST Sette Laghi, 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-Varese, ASST Sette Laghi, 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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