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Yang Z, Mansour J, Sun P, Wei P, Dahlstrom KR, Zafereo M, Li G, Gross ND. Impact of pretreatment body mass index on the survival of head and neck cancer patients. Head Neck 2024; 46:1881-1892. [PMID: 38269627 PMCID: PMC11227405 DOI: 10.1002/hed.27659] [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: 03/06/2023] [Revised: 12/29/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Differences in pretreatment body mass index (BMI) have been associated with survival in squamous cell carcinoma of head and neck (SCCHN). We examined effects of BMI on survival in SCCHN patients after stratifying patients by tumor human papillomavirus (HPV) status and subsite. METHODS Totally 2204 SCCHN patients in a prospective study were included in this secondary analysis. Multivariable Cox models were used to evaluate associations between pretreatment BMI and overall survival, disease-specific survival, and disease-free survival. RESULTS BMI was significantly higher among patients with HPV-positive tumors than HPV-negative tumors. BMI >25 kg/m2 was associated with improved survival, while BMI <18.5 kg/m2 was associated with reduced survival, particularly in patients with HPV-positive oropharyngeal cancer tumors. CONCLUSIONS This exploratory analysis suggests that pretreatment BMI could be an independent prognostic factor of survival outcomes in SCCHN patients, particularly in patients with HPV-positive oropharyngeal cancer tumors. Further prospective investigations are warranted.
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Affiliation(s)
- Zheng Yang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University; Key Laboratory of Otolaryngology Head and Neck Surgery of the Ministry of Education, Beijing 100730, China
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jobran Mansour
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peng Sun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Otolaryngology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Peng Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, TX, USA
| | - Kristina R. Dahlstrom
- Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Guojun Li
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Division of Epidemiology, The University of Texas School of Public Health, Houston, TX, USA
| | - Neil D. Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Schimansky S, Lang S, Beynon R, Penfold C, Davies A, Waylen A, Thomas S, Pring M, Pawlita M, Waterboer T, Ness A. Association between comorbidity and survival in head and neck cancer: Results from Head and Neck 5000. Head Neck 2019; 41:1053-1062. [PMID: 30549147 PMCID: PMC6890487 DOI: 10.1002/hed.25543] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 07/18/2018] [Accepted: 10/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND People with head and neck cancer have higher comorbidity levels but it remains unclear if pretreatment comorbidity is an independent prognosticator in head and neck cancer. METHODS Survival analyses were performed using data from participants in a UK multicentre cohort study with cancers of the oral cavity (n = 668), oropharynx (n = 1074), and larynx (n = 530). Survival analyses were incrementally adjusted for age, sex, marital status, income, education, stage, alcohol, and smoking. RESULTS After adjusting for demographic, clinical, and behavioral confounders, higher baseline comorbidity was associated with reduced overall survival (mild comorbidity HR = 1.4, 95% CI = 1.1, 1.7; moderate comorbidity HR = 1.7, 95% CI = 1.3, 2.2; severe comorbidity HR = 2.8, 95% CI = 1.9, 4.; P-trend<.001). CONCLUSIONS Our findings suggest that comorbidity is an independent prognosticator for overall survival in head and neck cancer. Comorbid illnesses should be considered in the assessment and treatment planning of people with head and neck cancer.
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Affiliation(s)
- Sarah Schimansky
- National Institute of Health (NIHR) Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Upper Maudlin Street, Bristol BS2 8AE, United Kingdom
| | - Samantha Lang
- National Institute of Health (NIHR) Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Upper Maudlin Street, Bristol BS2 8AE, United Kingdom
| | - Rhona Beynon
- Department of Population Health Sciences, University of Bristol Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom
| | - Christopher Penfold
- National Institute of Health (NIHR) Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Upper Maudlin Street, Bristol BS2 8AE, United Kingdom
| | - Amy Davies
- National Institute of Health (NIHR) Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Upper Maudlin Street, Bristol BS2 8AE, United Kingdom
| | - Andrea Waylen
- Department of Oral and Dental Sciences, Bristol Dental School, Lower Maudlin Street, Bristol, BS1 2YL, United Kingdom
| | - Steve Thomas
- Department of Oral and Dental Sciences, Bristol Dental School, Lower Maudlin Street, Bristol, BS1 2YL, United Kingdom
| | - Miranda Pring
- Department of Oral and Dental Sciences, Bristol Dental School, Lower Maudlin Street, Bristol, BS1 2YL, United Kingdom
| | - Michael Pawlita
- Molecular Diagnostics of Oncogenic Infections Division, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Tim Waterboer
- Infections and Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Andy Ness
- National Institute of Health (NIHR) Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Upper Maudlin Street, Bristol BS2 8AE, United Kingdom
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Sundermann BV, Uhlmann L, Hoffmann J, Freier K, Thiele OC. The localization and risk factors of squamous cell carcinoma in the oral cavity: A retrospective study of 1501 cases. J Craniomaxillofac Surg 2017; 46:177-182. [PMID: 29242026 DOI: 10.1016/j.jcms.2017.10.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/20/2017] [Accepted: 10/23/2017] [Indexed: 01/08/2023] Open
Abstract
Head and neck cancer is the tenth leading cause of cancer mortality. Ninety percent of tumours in the oral cavity are squamous cell carcinomas. Information about the exact localisation of OSCC is missing in the literature. In the present study, we retrospectively analysed a total of 1501 OSCC patients, who were treated between 1975 and 2009. The purpose of this study was to examine the localisation of OSCC tumours and to analyse the influence of various parameters on tumour localisation. 71.5% of these patients were male and 28.5% were female. The mean age was 60 years. The most common sites of OSCC occurrence were the floor of the mouth and the anterior base of the mouth. The hard palate was the most affected anatomical area of the maxilla. Descriptive statistical analysis, chi-square testing and a multivariate analysis using a multinomial logistical model showed a significant correlation of younger age and female gender with tumour occurrence in the maxilla and the tongue. We provide a very detailed anatomical mapping of OSCC.
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Affiliation(s)
- Britta V Sundermann
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hoffmann, MD, DDS), University Hospital Heidelberg, Germany.
| | - Lorenz Uhlmann
- Department of Medical Biometry and Informatics (Head: Prof. M. Kieser MD), Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hoffmann, MD, DDS), University Hospital Heidelberg, Germany
| | - Kolja Freier
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hoffmann, MD, DDS), University Hospital Heidelberg, Germany
| | - Oliver C Thiele
- Department of Oral and Maxillofacial Surgery (Head: Prof. J. Hoffmann, MD, DDS), University Hospital Heidelberg, Germany
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4
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[Reasons for the terms "radiosurgery" and "Gamma Knife"]. HNO 2017; 65:775-776. [PMID: 28776076 DOI: 10.1007/s00106-017-0396-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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5
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Gama RR, Song Y, Zhang Q, Brown MC, Wang J, Habbous S, Tong L, Huang SH, O'Sullivan B, Waldron J, Xu W, Goldstein D, Liu G. Body mass index and prognosis in patients with head and neck cancer. Head Neck 2017; 39:1226-1233. [PMID: 28323362 DOI: 10.1002/hed.24760] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/04/2017] [Accepted: 02/01/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Body mass index (BMI) has been associated variably with head and neck cancer outcomes. We evaluated the association between BMI at either diagnosis or at early adulthood head and neck cancer outcomes. METHODS Patients with invasive head and neck squamous cell cancer at Princess Margaret Cancer Centre in Toronto, Canada, were surveyed on tobacco and alcohol exposure, performance status, comorbidities, and BMI at diagnosis. A subset also had data collected for BMI at early adulthood. RESULTS With a median follow-up of 2.5 years, in 1279 analyzed patients, being overweight (hazard ratio [HR], 0.55; 95% confidence interval [CI], 0.4-0.8; p = .001) at diagnosis was associated with improved survival when compared with individuals with normal weight. In contrast, underweight patients at diagnosis were associated with a worse outcome (HR, 1.89; 95% CI, 1.2-3.1; p < .01). CONCLUSION Being underweight at diagnosis was an independent, adverse prognostic factor, whereas being overweight conferred better prognosis. BMI in early adulthood was not associated strongly with head and neck cancer outcomes. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1226-1233, 2017.
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Affiliation(s)
| | - Yuyao Song
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Qihuang Zhang
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - M Catherine Brown
- Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jennifer Wang
- Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Steven Habbous
- Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Li Tong
- Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Wei Xu
- Biostatistics Department, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David Goldstein
- Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Geoffrey Liu
- Department of Medicine, Princess Margaret Cancer Centre and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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van Deudekom FJ, Schimberg AS, Kallenberg MH, Slingerland M, van der Velden LA, Mooijaart SP. Functional and cognitive impairment, social environment, frailty and adverse health outcomes in older patients with head and neck cancer, a systematic review. Oral Oncol 2017; 64:27-36. [DOI: 10.1016/j.oraloncology.2016.11.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/24/2016] [Accepted: 11/24/2016] [Indexed: 12/13/2022]
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7
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Hartmann S, Grandis JR. Treatment of head and neck cancer in the elderly. Expert Opin Pharmacother 2016; 17:1903-21. [DOI: 10.1080/14656566.2016.1220540] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Calderon B, Guerder C, Resbeut M, Fakhry N, Dupuis C, Cowen D. [Observance and results of concurrent chemoradiotherapy after induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil for locally advanced head and neck cancers]. Cancer Radiother 2016; 20:83-90. [PMID: 26969244 DOI: 10.1016/j.canrad.2015.10.001] [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: 05/22/2015] [Revised: 09/07/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Retrospectively evaluate the safety, feasibility and efficacy of concomitant chemoradiotherapy after induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil for locally advanced head and neck cancers. PATIENTS AND METHODS Patients' data from three radiotherapy centres in South of France, with locally advanced head and neck cancers, and treated between December 2007 and July 2013 by concomitant chemoradiotherapy, after induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil, were analysed. Adverse effects were graduated according to CTCAE v3.0 criteria. Overall survival and disease-free survival were calculated according to Kaplan-Meier method. RESULTS One hundred and sixty-eight patients, mostly oropharynx (38%) T4 (46%) N2 (54%) tumors, received, after induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil, a concomitant chemoradiotherapy with platin or cetuximab, which delivered 66 to 70Gy. Grade 3-4 adverse effects were less frequent in the group of patients who received cisplatin (with or withour 5-fluoro-uracil) at 100mg/m(2) each 21 days compared to cetuximab (radiomucositis: 32.5% vs 61%, P=0.018; radioepithelitis: 13% vs 61 %, P<0.0001). Chemopotentiation was incomplete for 21% of patients without impacting survival. Two years overall survival and disease-free survival were respectively of 81% and 64%. Lymph nodes status and WHO status significantly influenced these survivals (overall survival 84% if N<3 vs 56% if N3, P=0.017 and 85 % if WHO status ≤ 1 vs 50% if WHO status>1, P=0.006; disease-free survival 66% if N<3 vs 47% if N3, P=0.046). CONCLUSION The association of induction chemotherapy by docetaxel, cisplatin and 5-fluoro-uracil and concomitant chemoradiotherapy shows satisfying results with an acceptable toxicity. The terms of the chemopotentiation and its superiority to a single concomitant chemoradiotherapy treatment still remain to be clarified.
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Affiliation(s)
- B Calderon
- Service de radiothérapie, centre hospitalier universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - C Guerder
- Centre de radiothérapie Saint-Louis, Croix-Rouge française, quartier Sainte-Musse, rue André-Blondel, 83100 Toulon, France
| | - M Resbeut
- Service de radiothérapie, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13273 Marseille cedex 9, France
| | - N Fakhry
- Service de chirurgie ORL, centre hospitalier universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - C Dupuis
- Service d'oncologie médicale, centre hospitalier universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France
| | - D Cowen
- Service de radiothérapie, centre hospitalier universitaire de la Timone, 264, rue Saint-Pierre, 13005 Marseille, France; Faculté de médecine de Marseille, 27, boulevard Jean-Moulin, 13005 Marseille, France
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9
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Wang JR, Habbous S, Espin-Garcia O, Chen D, Huang SH, Simpson C, Xu W, Liu FF, Brown DH, Gilbert RW, Gullane PJ, Irish JC, Goldstein DP, Liu G. Comorbidity and performance status as independent prognostic factors in patients with head and neck squamous cell carcinoma. Head Neck 2015; 38:736-42. [PMID: 25521753 DOI: 10.1002/hed.23947] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the individual and combined relationship of comorbidity and performance status (PS) on head and neck squamous cell carcinoma (HNSCC) survival. METHODS Six hundred patients with HNSCC were prospectively recruited. Comorbidity and PS were measured using the Charlson Comorbidity Index (CCI) and the Eastern Cooperative Oncology Group (ECOG) Scale. Outcomes were overall survival (OS) and cancer-specific survival (CSS). RESULTS A total of 48.3% of the patients had at least 1 comorbidity, and 42.3% had impaired PS at baseline. There was no correlation between CCI and ECOG (Spearman's ρ = 0.033; p = .42). In multivariate analysis, CCI score was significantly associated with OS (p = .01). ECOG was not associated with OS, but seems to act as an effect modifier in the association between comorbidity and OS. CCI and ECOG were not associated with CSS. CONCLUSION CCI and ECOG scores both provide prognostic information in predicting OS in HNSCC, but a significant association with CSS was not observed.
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Affiliation(s)
- Jennifer R Wang
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Steven Habbous
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Osvaldo Espin-Garcia
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Duoduo Chen
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Colleen Simpson
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Fei-Fei Liu
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Dale H Brown
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Patrick J Gullane
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey Liu
- Ontario Cancer Institute, University Health Network, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.,Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Pandey KC, Revannasiddaiah S, Pant NK. Evaluation of Factors in Relation with the Non-Compliance to Curative Intent Radiotherapy among Patients of Head and Neck Carcinoma: A Study from the Kumaon Region of India. Indian J Palliat Care 2015; 21:21-6. [PMID: 25709180 PMCID: PMC4332121 DOI: 10.4103/0973-1075.150161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Radiotherapy (RT)-based curative regimens for head and neck squamous cell carcinomas (HNSCC) deliver a dose of 66-70 Gray (Gy) over a period of 6-7 weeks, and incomplete treatments are unlikely to result in cure. Non-compliance to RT is major contributory factor to treatment failure. AIMS To assess the proportion of patients who do not complete planned treatment after initiation of curative RT. This study also aims to explore a possible relationship of non-compliance due to socio-economic, disease-related and treatment-related factors. MATERIALS AND METHODS The records of HNSCC patients treated from January 2012-December 2013 were audited. Data from the treatment records were to collect patient-related, disease-related, and social demographic parameters. Of the patients who had not completed treatment, the reasons behind the same were investigated. RESULTS Of the 324 patients of HNSCC who were initiated on radical RT, a total of 76 patients were found to have discontinued treatment without authorization of the treating clinician. There was no significant predilection for treatment non-compliance with regards to patient age, educational status, religion, site of the disease, use of neoadjuvant chemotherapy, or use of concurrent chemotherapy. There tended to be a higher association of treatment non-compliance among patients residing >100 km away from the treatment center, patients hailing from hilly regions, patients without the below poverty line (BPL) card, unemployed patients, and patients with stage IV-A/B disease. Of the 76 patients who did not complete treatment, telephonic questionnaire could be obtained from 54 patients. Causes for non-compliance included preference for traditional healers (22.2%), fear of toxicity (7.4%), logistic reasons (18.5%), financial reasons (24.1%), and lack of interest/faith in RT (5.6%). CONCLUSION There is a high incidence of treatment default among patients of HNSCC during RT in this region. The revelation of the higher propensity for treatment default among patients from distant, hilly regions, unemployed, patients without BPL cards, and stages-IVA/IVB highlights the need for specific interventions for these special populations.
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Affiliation(s)
- Kailash Chandra Pandey
- Department of Radiotherapy, Swami Rama Cancer Hospital and Research Institute, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Swaroop Revannasiddaiah
- Department of Radiotherapy, Swami Rama Cancer Hospital and Research Institute, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Nirdosh Kumar Pant
- Department of Radiotherapy, Swami Rama Cancer Hospital and Research Institute, Government Medical College, Haldwani, Nainital, Uttarakhand, India
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Selzer E, Grah A, Heiduschka G, Kornek G, Thurnher D. Primary radiotherapy or postoperative radiotherapy in patients with head and neck cancer: Comparative analysis of inflammation-based prognostic scoring systems. Strahlenther Onkol 2015; 191:486-94. [PMID: 25583136 DOI: 10.1007/s00066-014-0803-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 12/18/2014] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Inflammation-based scoring systems have potential value in evaluating the prognosis of cancer patients; however, detailed comparative analyses in well-characterized head and neck cancer patient collectives are missing. METHODS We analyzed overall survival (OS) in locally advanced head and neck cancer patients who were treated with curative intent by primary radiotherapy (RT) alone, by RT in combination with cetuximab (RIT) or with cisplatin (RCHT), and by primary surgery followed by postoperative radiotherapy (PORT). The primary RT collective (N = 170) was analyzed separately from the surgery plus RT group (N = 148). OS was estimated using the Kaplan-Meyer method. Cox proportional-hazard regression models were applied to compare the risk of death among patients stratified according to risk factors and the inflammation-based Glasgow Prognostic Score (GPS), the modified GPS (mGPS), the neutrophil-lymphocyte ratio (NLR), the platelet-lymphocyte ratio (PLR), and the prognostic index (PI). RESULTS A prognostic relevance of the scoring systems for OS was observed in the primarily irradiated, but not in the PORT collective. OS was 35.5, 18.8, and 15.4 months, respectively, according to GPS 0, 1, and 2. OS according to mGPS 0-2 was identical. The PLR scoring system was not of prognostic relevance, while OS was 27.3 months in the NLR 0 group and 17.3 months in the NLR 1 group. OS was 35.5 months in PI 0, 16.1 months in PI 1, and 22.6 months in PI 2. CONCLUSION GPS/mGPS scoring systems are able to discriminate between three risk groups in primarily, but not postoperatively irradiated locally advanced head and neck cancer patients.
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Affiliation(s)
- Edgar Selzer
- Department of Radiotherapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria,
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12
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Miszczyk L, Maciejewski B, Tukiendorf A, Woźniak G, Jochymek B, Gawryszuk A, Szweda M. Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients-final results of a randomized clinical trial. Br J Radiol 2014; 87:20140212. [PMID: 25027170 DOI: 10.1259/bjr.20140212] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Evaluation of the efficacy and toxicity of split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck (H&N) cancer patients. METHODS We enrolled 101 patients (39 in CHA-CHA and 37 in conventional (Conv.) arm completed the treatment). The CHA-CHA arm patients were irradiated twice a day, 7 days a week, using a fraction dose (fd) of 1.6 Gy up to 64 Gy with an 8-day gap in midterm. Patients in the control (Conv.) arm group were irradiated with a fd of 2 Gy, five times a week to a total dose of 72-74 Gy in the overall treatment time of 50-53 days. Quality of life (QOL) and acute mucosal reaction were evaluated during radiotherapy (RT). After RT, we followed the effect of treatment, QOL, performance status and adverse effects of radiation. For statistical analysis mainly a hierarchical multilevel modelling was used. RESULTS QOL was most deteriorated in the CHA-CHA arm; the CHA-CHA scheme also caused a relatively stronger acute injury. There were no significant differences in late adverse effects. In the CHA-CHA arm in 35% and in Conv. arm in 30% of patients, disease was controlled during follow-up. Tumour regression 1 year after the treatment was significantly better in the CHA-CHA arm. However, the overall survival rate analysis did not show significant difference between both arms. CONCLUSION Despite differences in treatment results, we cannot conclude that split-course accelerated hyperfractionated irradiation is superior to conventionally fractionated RT as a sole treatment for advanced H&N cancer patients. ADVANCES IN KNOWLEDGE Obtained results in the context of published data support the statement that altered fractionations alone do not give an advantage for advanced H&N cancer patients.
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Affiliation(s)
- L Miszczyk
- 1 Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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Lee YJ, Suh SY, Choi YS, Shim JY, Seo AR, Choi SE, Ahn HY, Yim E. EORTC QLQ-C15-PAL quality of life score as a prognostic indicator of survival in patients with far advanced cancer. Support Care Cancer 2014; 22:1941-8. [PMID: 24577883 DOI: 10.1007/s00520-014-2173-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/17/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Quality of life (QoL) and performance status predict survival in advanced cancer patients; these relationships have not been explored in the hospice palliative care setting. The aim of this study was to examine the survival predictability of patient-reported QoL using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire in far advanced cancer inpatients at the very end of life. METHODS This is a retrospective cohort study. Patients reported QoL using the EORTC QLQ-C15-PAL. One hundred sixty-two inpatients in hospice palliative wards of six hospitals in South Korea were followed until death or the end of the study. Additional symptoms and performance status were assessed by the MD Anderson Symptom Inventory-Korean (MDASI-K), Palliative Performance Scale (PPS) and Eastern Cooperative Oncology Group (ECOG) performance status. Correlations between EORTC QLQ-C15-PAL, MDASI-K, PPS, and ECOG were assessed. Survival analyses were performed using Cox proportional hazard models. RESULTS Patients' median survival was less than 1 month. Physician-reported PPS significantly predicted survival (hazard ratio [HR] 0.493; p<0.001). From the EORTC QLQ-C15-PAL, patient-reported physical functioning predicted survival (HR=0.65; p<0.001). Other six domains of EORTC QLQ-C15-PAL were significantly related to survival after adjustment. Those domains were global health status, emotional functioning, fatigue, nausea/vomiting, appetite loss, and constipation. CONCLUSIONS EORTC QLQ-C15-PAL can be an independent prognostic factor in inpatients with far advanced cancer. Patient-reported physical functioning showed survival predictability as good as physician-reported performance status. It is notable that the QLQ instrument is useful even for patients in their final month of life. Cancer anorexia-cachexia syndrome-related symptoms may be independent prognostic symptoms. Prospective study is warranted.
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Affiliation(s)
- Yong Joo Lee
- College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Balermpas P, Bauer C, Fraunholz I, Ottinger A, Wagenblast J, Stöver T, Seitz O, Fokas E, Rödel C, Weiss C. Concomitant chemoradiotherapy versus induction chemotherapy followed by chemoradiotherapy as definitive, first line treatment of squamous cell carcinoma of the head and neck. A retrospective single center analysis. Strahlenther Onkol 2014; 190:256-62. [PMID: 24413895 DOI: 10.1007/s00066-013-0509-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/08/2013] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite the lack of evidence to support its implementation in the clinical practice, induction chemotherapy (IC) before chemoradiotherapy (CRT) is often used in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). We retrospectively examined the tolerability, feasibility, and clinical outcome of both concepts in a single center analysis. PATIENTS AND METHODS In all, 83 patients were treated between 2007 and 2010 with IC + CRT (n = 42) or CRT alone (n = 41). IC consisted of docetaxel, cisplatin and 5-fluorouracil (TPF), or cisplatin and 5-fluorouracil (PF). All patients were scheduled to receive 2 cycles of PF during concurrent CRT. Adverse events were assessed according to the common toxicity criteria of adverse events (CTCAE v. 3.0). Associations were tested using the χ² test, and survival estimates were calculated according to Kaplan-Meier. RESULTS The median follow-up was 30.35 months (range 2.66-61.25 months). At 2 years, the overall survival rate was significantly higher for primary CRT compared to IC + CRT group (74.8 % vs. 54 %, respectively; p = 0.041). Significantly more treatment-related overall grade 4 toxicities were documented in the IC + CRT group compared to the CRT group (42.9% vs. 9.8%; p = 0.001). Renal toxicity ≥ grade 2 occurred in 52.4 % vs. 7.3 % (p < 0.001), respectively. In all, 93 % of the patients with primary CRT compared to 71 % with IC + CRT received the planned full radiotherapy dose (p = 0.012). CONCLUSION This is, to our knowledge, the largest retrospective study to compare IC + CRT with primary CRT. IC showed high acute toxicity, compromised the feasibility of concurrent CRT, and was associated with reduced overall survival rates compared to primary CRT. The lack of clinical benefit in conjunction with the increased toxicity does not support implementation of IC.
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Affiliation(s)
- P Balermpas
- Department of Radiation Therapy and Oncology, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Budach V, Becker ET, Boehmer D, Badakhshi H, Jahn U, Wernecke KD, Stromberger C. Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer. Strahlenther Onkol 2013; 190:250-5. [DOI: 10.1007/s00066-013-0481-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/26/2013] [Indexed: 12/01/2022]
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Rutkowski T, Wygoda A, Składowski K, Hejduk B, Rutkowski R, Kołosza Z, Maciejewski B. Prognostic role of tumor volume for radiotherapy outcome in patient with T2 laryngeal cancer. Strahlenther Onkol 2013; 189:861-6. [DOI: 10.1007/s00066-013-0411-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 06/17/2013] [Indexed: 11/24/2022]
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High-dose radiotherapy alone for patients with T4-stage laryngeal cancer. Strahlenther Onkol 2013; 189:632-8. [DOI: 10.1007/s00066-013-0396-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
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Brömme J, Schmücking M, Arnold A, Giger R, Rauch D, Leiser D, Plasswilm L, Geretschläger A, Ghadjar P, Aebersold D. Taxane-containing induction chemotherapy followed by definitive chemoradiotherapy. Strahlenther Onkol 2013; 189:618-24. [DOI: 10.1007/s00066-013-0397-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
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