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Haderlein M, von der Grün J, Balermpas P, Rödel C, Hautmann MG, Steger F, Bohr C, Hehr T, Stromberger C, Budach V, Schymalla M, Engenhart-Cabillic R, Kocik L, Geinitz H, Nestle U, Klautke G, Scherl C, Gall C, Frey B, Schubert P, Semrau S, Ott O, Kesting M, Iro H, Mueller SK, Fietkau R. De-intensification of postoperative radiotherapy in head and neck cancer irrespective of human papillomavirus status-results of a prospective multicenter phase II trial (DIREKHT Trial). Front Oncol 2024; 14:1447123. [PMID: 39224800 PMCID: PMC11366634 DOI: 10.3389/fonc.2024.1447123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
Background Current standard treatment concepts in head and neck squamous cell carcinoma (HNSCC) are based on former studies using 2D and 3D treatment plans. However, modern radiation techniques allow for a more precise and individual dose application. Therefore, in a clearly defined patient population, de-intensified risk-adapted radiation is investigated. Methods Patients with newly diagnosed HNSCC after surgery (with resection margins ≥1 mm and cM0) with the following tumor stages (TNM 7th Edition) were eligible for the study: oral cavity, oropharynx, or larynx: pT1-3, pN0-pN2b; hypopharynx: pT1-2, pN1. The patients should have either a low risk of local recurrence [≤pT2, resection margin ≥5 mm, no peritumoral lymphangiosis (L0), and no perineural invasion] or contralateral lymph node metastasis (≤3 ipsilateral lymph node metastases, in case of well-lateralized oropharyngeal or oral cavity cancer contralateral cN0, otherwise pN0). Patients were assigned to three different treatment regimes with reduction of the treated volume, radiation dose, or both, according to tumor stage and results of surgery performed. The primary objective was to show an LRR of <10% after 2 years. Findings A total of 150 patients were enrolled. Tumor localizations were as follows: n = 53 (35.3%), oral cavity; n = 94 (62.7%), oropharynx (82% HPV-positive); n = 2 (1.3%), hypopharynx; and n = 1 (0.7%), larynx. A total of 61 patients (41.0%) were stage IVA, 81 (54.0%) were stage III, and 8 (5.3%) were stage II. Median follow-up was 36 months. Cumulative incidence of 2y-LRR was 5.6% (95% CI: 1.7%-9.2%) in the whole study population and 14.1% (95% CI: 3.8%-23.2%) in patients with oral cavity cancer. Cumulative incidence of 2y-LRR in non-irradiated or dose-reduced regions was 3.5% (95% CI: 0.4%-6.5%). After 2 years, disease-free survival was 92% (95% CI: 87%-96%) and overall survival was 94% (95% CI: 90%-98%) for the complete study cohort. Acute III° toxicity was as follows: dysphagia, 30%; xerostomia, 7%; mucositis, 19%; and dermatitis, 4%. Dysphagia and xerostomia decrease over time. After 27 months, late dysphagia III° and xerostomia II° were 1% and 9%, respectively. Interpretation The study met its primary objective. De-intensification of postoperative radiotherapy irrespective of HPV status in a predefined patient population is associated with a favorable toxicity profile without compromising LRR. In an unplanned subgroup analysis, a significantly increased risk of LRR was observed in patients with oral cavity cancer. In these patients, de-intensified radiotherapy should be applied with caution.
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Affiliation(s)
- Marlen Haderlein
- Department of Radiotherapy and Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Jens von der Grün
- Department of Radiotherapy and Radiation Oncology, University Hospital Frankfurt, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
- Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiotherapy and Radiation Oncology, University Hospital Frankfurt, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
- Department of Radiation Oncology, Zurich University Hospital, Zurich, Switzerland
| | - Claus Rödel
- Department of Radiotherapy and Radiation Oncology, University Hospital Frankfurt, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Germany
| | - Matthias G. Hautmann
- Department of Radiotherapy and Radiation Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Felix Steger
- Department of Radiotherapy and Radiation Oncology, University Hospital of Regensburg, Regensburg, Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Hehr
- Department of Radiotherapy and Radiation Oncology, Marienhospital, Stuttgart, Germany
| | - Carmen Stromberger
- Department of Radiotherapy and Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Volker Budach
- Department of Radiotherapy and Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Markus Schymalla
- Department of Radiotherapy and Radiation Oncology, University Hospital of Marburg, Marburg, Germany
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, University Hospital of Marburg, Marburg, Germany
| | - Lukas Kocik
- Department of Radiation Oncology and Radiotherapy, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Hans Geinitz
- Department of Radiation Oncology and Radiotherapy, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Ursula Nestle
- Department of Radiotherapy and Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
- Department of Radiation Oncology, Freiburg University Medical Center, Freiburg, Germany
| | - Gunter Klautke
- Department of Radiation Oncology, Chemnitz Hospital, Chemnitz, Germany
| | - Claudia Scherl
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Christine Gall
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Benjamin Frey
- Department of Radiotherapy and Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Philipp Schubert
- Department of Radiotherapy and Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sabine Semrau
- Department of Radiotherapy and Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Ott
- Department of Radiotherapy and Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marco Kesting
- Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Erlangen, Germany
| | - Heinrich Iro
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Otolaryngology - Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Sarina K. Mueller
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Department of Otolaryngology - Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiotherapy and Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Bhattacharjee B, Syeda AF, Rynjah D, Hussain SM, Chandra Bora S, Pegu P, Sahu RK, Khan J. Pharmacological impact of microRNAs in head and neck squamous cell carcinoma: Prevailing insights on molecular pathways, diagnosis, and nanomedicine treatment. Front Pharmacol 2023; 14:1174330. [PMID: 37205904 PMCID: PMC10188950 DOI: 10.3389/fphar.2023.1174330] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
Head and neck squamous cell carcinoma is a disease that most commonly produce tumours from the lining of the epithelial cells of the lips, larynx, nasopharynx, mouth, or oro-pharynx. It is one of the most deadly forms of cancer. About one to two percent of all neo-plasm-related deaths are attributed to head and neck squamous cell carcinoma, which is responsible for about six percent of all cancers. MicroRNAs play a critical role in cell proliferation, differentiation, tumorigenesis, stress response, triggering apoptosis, and other physiological process. MicroRNAs regulate gene expression and provide new diagnostic, prognostic, and therapeutic options for head and neck squamous cell carcinoma. In this work, the role of molecular signaling pathways related to head and neck squamous cell carcinoma is emphasized. We also provide an overview of MicroRNA downregulation and overexpression and its role as a diagnostic and prognostic marker in head and neck squamous cell carcinoma. In recent years, MicroRNA nano-based therapies for head and neck squamous cell carcinoma have been explored. In addition, nanotechnology-based alternatives have been discussed as a promising strategy in exploring therapeutic paradigms aimed at improving the efficacy of conventional cytotoxic chemotherapeutic agents against head and neck squamous cell carcinoma and attenuating their cytotoxicity. This article also provides information on ongoing and recently completed clinical trials for therapies based on nanotechnology.
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Affiliation(s)
| | - Ayesha Farhana Syeda
- Department of Pharmaceutics, Unaiza College of Pharmacy, Qassim University, Unaizah, Saudi Arabia
| | | | - Shalam M. Hussain
- Department of Clinical Pharmacy, College of Nursing and Health Sciences, Al-Rayyan Medical College, Madinah, Saudi Arabia
| | | | - Padmanath Pegu
- Girijananda Chowdhury Institute of Pharmaceutical Science, Tezpur, India
| | - Ram Kumar Sahu
- Department of Pharmaceutical Sciences, Hemvati Nandan Bahuguna Garhwal University (A Central University), Chauras Campus, Tehri Garhwal, Uttarakhand, India
| | - Jiyauddin Khan
- School of Pharmacy, Management and Science University, Shah Alam, Malaysia
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Bukovszky B, Fodor J, Székely G, Tóth E, Major T, Oberna F, Takácsi-Nagy Z, Polgár C. Neck Node Squamous Cell Metastasis from Unknown Primary and Mutagen Sensitivity: A Case Series. Case Rep Oncol 2023; 16:1598-1605. [PMID: 38116298 PMCID: PMC10730097 DOI: 10.1159/000533708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 07/25/2023] [Indexed: 12/21/2023] Open
Abstract
Most of the neck node metastases from cancer of unknown primary (CUP) are squamous cell carcinomas (SCCs). The majority of which are human papillomavirus (HPV)-related, frequently show cystic morphology referring to Waldeyer's ring origin. Here, we report four cases of neck node SCCs metastases from CUP. In our institute, 432 patients with head and neck (HN) SCC underwent pretreatment mutagen sensitivity (MS) assay between 1996 and 2006. Among them, 4 patients ≤50 years of age had metastatic cervical nodes from CUP. The primary treatment was cervical node dissection ± radiotherapy. All patients had elevated (>1.0 chromatid break/cell) MS. One male patient died of progressive neck metastasis within 3 years and the 3 female patients are still alive more than 15 years after initial treatment of HPV+ (two) or cystic (one) SCC. Two female patients developed second and third distant site metachronous primary cancers. HPV+ or cystic HNSCC from CUP with elevated MS indicates good outcome. Distant site metachronous cancers of different histologic origins cannot be explained by field cancerization. The clinical significance of elevated MS in neck node SCC metastasis from CUP requires further investigation.
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Affiliation(s)
- Botond Bukovszky
- Department of Oncology, Semmelweis University, Budapest, Hungary
- Department of Oral Diagnostics, Semmelweis University, Budapest, Hungary
- National Institute of Oncology, Budapest, Hungary
| | - János Fodor
- National Institute of Oncology, Budapest, Hungary
| | | | - Erika Tóth
- National Institute of Oncology, Budapest, Hungary
| | - Tibor Major
- Department of Oncology, Semmelweis University, Budapest, Hungary
- National Institute of Oncology, Budapest, Hungary
| | | | - Zoltán Takácsi-Nagy
- Department of Oncology, Semmelweis University, Budapest, Hungary
- National Institute of Oncology, Budapest, Hungary
| | - Csaba Polgár
- Department of Oncology, Semmelweis University, Budapest, Hungary
- National Institute of Oncology, Budapest, Hungary
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Salcedo‐Bellido I, Requena P, Mateos R, Ortega‐Rico C, Olmedo‐Requena R, Lozano‐Lorca M, Arrebola JP, Barrios‐Rodríguez R. Factors associated with the development of second primary tumours in head and neck cancer patients. Eur J Cancer Care (Engl) 2022; 31:e13699. [PMID: 36117311 PMCID: PMC9787413 DOI: 10.1111/ecc.13699] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 07/15/2022] [Accepted: 08/31/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The development of second primary tumours (SPTs) is one of the main causes of low survival in patients with head and neck cancer (HNC). The aim of this study was to review the evidence about factors associated with developing SPTs in patients with HNC. METHODS An updated systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and the search was performed in Pubmed and Scopus. Only original articles with a cohort or case-control design were included. Article quality was assessed with the Newcastle-Ottawa scale. RESULTS Thirty-six and two case-control studies were included, with quality medium (n = 5) to high (n = 33). Tobacco showed a significant association with SPT development, with risks ranging from 1.41 (95%CI: 1.04-1.91) to 5.52 (95%CI: 2.91-10.49). Regarding alcohol, risks ranged from 1.46 (95%CI: 1.12-1.91) to 21.3 (95%CI: 2.9-156). Location of the index tumour in the hypopharynx/oropharynx, absence of human papillomavirus and presence of a premalignant lesion also increased the risk of SPTs. More controversy was found for sex, age and other clinical factors of the tumour. CONCLUSION Toxic lifestyle habits and clinical factors were associated with the risk of SPTs in HNC patients. These findings may improve individualised prevention strategies in its follow-up.
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Affiliation(s)
- Inmaculada Salcedo‐Bellido
- Departamento de Medicina Preventiva y Salud PúblicaUniversidad de GranadaGranadaSpain,Instituto de Investigación Biosanitaria de Granada (ibs.Granada)GranadaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Pilar Requena
- Departamento de Medicina Preventiva y Salud PúblicaUniversidad de GranadaGranadaSpain,Instituto de Investigación Biosanitaria de Granada (ibs.Granada)GranadaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Rocío Mateos
- Departamento de Medicina Preventiva y Salud PúblicaUniversidad de GranadaGranadaSpain
| | - Carmen Ortega‐Rico
- Departamento de Medicina Preventiva y Salud PúblicaUniversidad de GranadaGranadaSpain
| | - Rocío Olmedo‐Requena
- Departamento de Medicina Preventiva y Salud PúblicaUniversidad de GranadaGranadaSpain,Instituto de Investigación Biosanitaria de Granada (ibs.Granada)GranadaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Macarena Lozano‐Lorca
- Departamento de Medicina Preventiva y Salud PúblicaUniversidad de GranadaGranadaSpain,Instituto de Investigación Biosanitaria de Granada (ibs.Granada)GranadaSpain
| | - Juan Pedro Arrebola
- Departamento de Medicina Preventiva y Salud PúblicaUniversidad de GranadaGranadaSpain,Instituto de Investigación Biosanitaria de Granada (ibs.Granada)GranadaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
| | - Rocío Barrios‐Rodríguez
- Departamento de Medicina Preventiva y Salud PúblicaUniversidad de GranadaGranadaSpain,Instituto de Investigación Biosanitaria de Granada (ibs.Granada)GranadaSpain,Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP)MadridSpain
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