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Ansarin M, Pietrobon G, Tagliabue M, Mossinelli C, Ruju F, Maffini F, Rocca MC, Alterio D, Simon C, Zorzi SF. Salvage transoral robotic surgery in recurrent oropharyngeal carcinoma: a single-center retrospective study. Eur Arch Otorhinolaryngol 2024; 281:3167-3177. [PMID: 38546850 DOI: 10.1007/s00405-024-08590-4] [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: 12/01/2023] [Accepted: 02/29/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Salvage surgery is still the best therapeutic option for resectable recurrent oropharyngeal squamous cell carcinoma (rOPSCC). Transoral robotic surgery may potentially reduce the morbidity of standard open approaches. The aim of the study is to present oncological and functional outcomes of a monocentric experience in salvage transoral robotic surgery. METHODS We performed a single-center retrospective analysis of patients submitted to transoral robotic salvage surgery with or without neck dissection for cT1-3 rOPSCC. We investigated complication rate, survival outcomes (Overall Survival, Disease Specific Survival, Loco-Regional Recurrence Free Survival) and functional outcomes (tracheal tube and/or gastrostomy dependence). RESULTS Sixty-one patients were included in the analysis. No major complications or perioperative deaths were recorded. The estimated 2-year OS was 76.7%, DSS 81.8% and LRRFS 50.5%. In multivariable analysis rpT, PNI (perineural infiltration) and HPV-positivity were significantly associated with LRRFS (Hazard Ratios: T3 vs T1 6.43, PNI yes vs no 4.19, HPV+ yes vs no 2.63). At last follow up, 97% of patients were tracheal tube-free, while 93% were gastrostomy-free. CONCLUSION Transoral robotic salvage surgery is a successful treatment in selected patients affected by rOPSCC because it grants good oncologic and functional outcomes.
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Affiliation(s)
- Mohssen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Giacomo Pietrobon
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy.
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Chiara Mossinelli
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
| | - Francesca Ruju
- Division of Radiology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Fausto Maffini
- Division of Pathology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Maria Cossu Rocca
- Division of Medical Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Daniela Alterio
- Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Christian Simon
- Department of Otolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stefano Filippo Zorzi
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Via Giuseppe Ripamonti 435, 20141, Milan, Italy
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León X, Neumann E, Holgado A, Vásquez R, Pujol A, Quer M. Oncological results of salvage treatment in patients with oropharynx carcinoma treated with radiotherapy. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024; 75:8-16. [PMID: 37393035 DOI: 10.1016/j.otoeng.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 01/04/2023] [Accepted: 01/11/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVE To evaluate the possibilities of salvage after local recurrence in patients with oropharyngeal carcinomas treated with radiotherapy, and to analyse the prognostic factors related to the final control of the disease. METHODS Retrospective study of 596 patients with oropharyngeal carcinoma treated with radiotherapy during the period 1991-2018. RESULTS One hundred and eighty-one patients (30.4%) had a local recurrence. Of the patients with a local recurrence, 51 (28.2%) were treated with salvage surgery. Variables that were associated with the patient not receiving salvage surgery were age greater than 75 years, tumour location in the posterior hypopharyngeal wall, an initial tumour extent cT4, and a recurrence-free interval of less than 6 months. Five-year specific survival of patients treated with salvage surgery was 19.1% (95% CI: 7.3%-30.9%). Variables that were related to specific survival were extent of recurrence and status of resection margins. Final tumour control was not achieved in any of the patients with extensive recurrence (rpT3-4, n = 25) or positive resection margins (n = 22). CONCLUSION Patients with oropharyngeal carcinomas treated with radiotherapy with local tumour recurrence have a limited prognosis. Most patients (71.8%) were not considered candidates for salvage surgery. The 5-year specific survival of patients treated with salvage surgery was 19.1%.
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Affiliation(s)
- Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain; UVIC. Universitat Central de Catalunya, Vic, Spain
| | - Eduard Neumann
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Holgado
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rosselin Vásquez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Pujol
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain
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Zhang S, Zeng N, Yang J, He J, Zhu F, Liao W, Xiong M, Li Y. Advancements of radiotherapy for recurrent head and neck cancer in modern era. Radiat Oncol 2023; 18:166. [PMID: 37803477 PMCID: PMC10559506 DOI: 10.1186/s13014-023-02342-0] [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: 05/17/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023] Open
Abstract
Head and neck cancer is a kind of cancer which can be eradicated from radical radiation therapy. However, with best efforts, nearly 40% patients will experience locoregional recurrence. Locoregional recurrence is the main cause of cancer-related death in head and neck cancers, so local treatments play a key role in improving progression free survival. In the last decades, radiation techniques have been tremendously developed, highly conformal radiation techniques such as intensity-modulated radiotherapy, stereotactic body radiation therapy, brachytherapy and proton or heavy ion radiation therapy have their unique radiobiological advances. Although reirradiation is widely used in clinical practice, but little is known when comparing the different techniques. In this review, we will provide a comprehensive overview of the role of reirradiation in recurrent head and neck cancers including radiation techniques, patient selection, overall clinical benefits, and toxicities.
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Affiliation(s)
- Shu Zhang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Ni Zeng
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Jiangping Yang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Jinlan He
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Fubin Zhu
- Department of Oncology, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, China
| | - Wenjun Liao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Sichuan Cancer Hospital& Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Maoqi Xiong
- West China Clinical Skills Training Center, West China School of Medicine, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Yan Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China.
- Lung Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China.
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Beddok A, Maynadier X, Krhili S, Ala Eddine C, Champion L, Chilles A, Goudjil F, Zefkili S, Amessis M, Choussy O, Le Tourneau C, Buvat I, Créhange G, Carton M, Calugaru V. Predictors of toxicity after curative reirradiation with intensity modulated radiotherapy or proton therapy for recurrent head and neck carcinoma: new dose constraints for pharyngeal constrictors muscles and oral cavity. Strahlenther Onkol 2023; 199:901-909. [PMID: 37256301 DOI: 10.1007/s00066-023-02080-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Our study aims to identify predictive factors of moderate to severe (grade ≥ 2) late toxicity after reirradiation (reRT) of recurrent head and neck carcinoma (HNC) and explore the correlations between dose organs at risk (OAR) and grade ≥ 2 toxicity. MATERIAL AND METHODS Between 09/2007 and 09/2019, 55 patients were re-irradiated with IMRT or proton therapy with curative intent for advanced HNC. Our study included all patients for whom data from the first and second irradiations were available. Co-variables, including interval to reRT, size of re-irradiated PTV, and dose to OAR, were analyzed as potential predictors for developing moderate to severe long-term toxicity with death as a competing risk. Receiver-operator characteristics (ROC) analysis assessed the association between dose/volume parameters and the risk of toxicity. RESULTS Twenty-three patients participated in our study. After a median follow-up of 41 months, 65% of the patients experienced grade ≥ 2 late toxicity. The average dose to pharyngeal constrictor muscles (PCM) at the time of reRT showed an association with the risk of grade ≥ 2 dysphagia: AUC = 0.78 (95% CI: 0.53-1), optimal cut-off value = 36.7 Gy (sensitivity 62%/specificity 100%). The average dose to the oral cavity at the time of reRT showed an association with the risk of grade ≥ 2 dysgeusia: AUC = 0.96 (0.89-1), optimal cut-off value = 20.5 Gy (sensitivity 100%/specificity 88%). CONCLUSION Our analysis depicted an association between the dose to OAR and the risk of developing moderate to severe dysphagia and dysgeusia and proposed new dose constraints for PCM (36.7 Gy) and oral cavity (20.5 Gy).
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Affiliation(s)
- Arnaud Beddok
- Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France.
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898, Orsay, France.
| | - Xavier Maynadier
- Biometry Unit, Institut Curie, PSL Research University, Paris, France
| | - Samar Krhili
- Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France
| | | | - Laurence Champion
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898, Orsay, France
- Department of Nuclear Medicine, Institut Curie, Saint-Cloud, France
| | - Anne Chilles
- Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France
| | - Farid Goudjil
- Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France
| | - Sofia Zefkili
- Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France
| | - Malika Amessis
- Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France
| | - Olivier Choussy
- Department of Head and Neck Surgery, Institut Curie, Paris, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), INSERM U900 Research unit, Paris-Saclay University, Institut Curie, Paris, France
| | - Irene Buvat
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898, Orsay, France
| | - Gilles Créhange
- Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898, Orsay, France
| | - Matthieu Carton
- Biometry Unit, Institut Curie, PSL Research University, Paris, France
| | - Valentin Calugaru
- Radiation Oncology Department, Institut Curie, PSL Research University, 25 rue d'Ulm, 75005, Paris/Orsay, France
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Gordon K, Smyk D, Gulidov I, Golubev K, Fatkhudinov T. An Overview of Head and Neck Tumor Reirradiation: What Has Been Achieved So Far? Cancers (Basel) 2023; 15:4409. [PMID: 37686685 PMCID: PMC10486419 DOI: 10.3390/cancers15174409] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
The recurrence rate of head and neck cancers (HNCs) after initial treatment may reach 70%, and poor prognosis is reported in most cases. Curative options for recurrent HNCs mainly depend on the treatment history and the recurrent tumor localization. Reirradiation for HNCs is effective and has been included in most guidelines. However, the option remains clinically challenging due to high incidence of severe toxicity, especially in cases of quick infield recurrence. Recent technical advances in radiation therapy (RT) provide the means for upgrade in reirradiation protocols. While the majority of hospitals stay focused on conventional and widely accessible modulated RTs, the particle therapy options emerge as tolerable and providing further treatment opportunities for recurrent HNCs. Still, the progress is impeded by high heterogeneity of the data and the lack of large-scale prospective studies. This review aimed to summarize the outcomes of reirradiation for HNCs in the clinical perspective.
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Affiliation(s)
- Konstantin Gordon
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation (A. Tsyb MRRC), 4, Korolev Street, 249036 Obninsk, Russia; (D.S.); (I.G.); (K.G.)
- Medical Institute, Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklaya Street 8, 117198 Moscow, Russia;
| | - Daniil Smyk
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation (A. Tsyb MRRC), 4, Korolev Street, 249036 Obninsk, Russia; (D.S.); (I.G.); (K.G.)
- Medical Institute, Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklaya Street 8, 117198 Moscow, Russia;
| | - Igor Gulidov
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation (A. Tsyb MRRC), 4, Korolev Street, 249036 Obninsk, Russia; (D.S.); (I.G.); (K.G.)
| | - Kirill Golubev
- A. Tsyb Medical Radiological Research Center, Branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation (A. Tsyb MRRC), 4, Korolev Street, 249036 Obninsk, Russia; (D.S.); (I.G.); (K.G.)
| | - Timur Fatkhudinov
- Medical Institute, Peoples’ Friendship University of Russia (RUDN University), Miklukho-Maklaya Street 8, 117198 Moscow, Russia;
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Sakai A, Ebisumoto K, Iijima H, Yamauchi M, Teramura T, Yamazaki A, Watanabe T, Inagi T, Maki D, Okami K. Salvage transoral videolaryngoscopic surgery for post-irradiation recurrence of hypopharyngeal carcinoma. Laryngoscope Investig Otolaryngol 2023; 8:667-674. [PMID: 37342106 PMCID: PMC10278106 DOI: 10.1002/lio2.1068] [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: 02/28/2023] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 06/22/2023] Open
Abstract
Background Transoral salvage surgery has the potential to preserve a patient's quality of life. Therefore, we investigated the outcomes, safety, and risk factors for postoperative complications of salvage transoral videolaryngoscopic surgery (TOVS) for recurrent hypopharyngeal carcinoma after radiotherapy (RT) or chemoradiotherapy (CRT). Methods This retrospective analysis enrolled patients with hypopharyngeal cancer who had a history of RT or CRT and underwent TOVS from January 2008 to June 2021. The factors related to postoperative complications, postoperative swallowing functions and survival rates were analyzed. Results Seven patients (36.8%) of the 19 patients developed complications. Severe dysphagia was the primary complication, and post-cricoid resection was a complication risk factor. The FOSS score was significantly lower in the salvage treatment group. The survival rates were: 3-year overall survival: 94.4%; disease-specific survival: 94.4%; 5-year overall survival: 62.3%; and disease-specific survival: 86.6%. Conclusions Salvage TOVS for hypopharyngeal cancer was feasible, and oncologically and functionally reasonable. Level of Evidence: 2b.
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Affiliation(s)
- Akihiro Sakai
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Koji Ebisumoto
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Hiroaki Iijima
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Mayu Yamauchi
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Takanobu Teramura
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Aritomo Yamazaki
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Takane Watanabe
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Toshihide Inagi
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Daisuke Maki
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
| | - Kenji Okami
- Department of Otolaryngology, Head and Neck SurgeryTokai University, School of MedicineIseharaJapan
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Dabas S, Menon NN, Ranjan R, Gurung B, Shukla H, Tiwari S, Sharma A. Transoral Robotic surgery - excision of Tongue base Tumour with the Entire Hyoid bone in a Salvage Setting. Indian J Otolaryngol Head Neck Surg 2023; 75:1071-1075. [PMID: 37275013 PMCID: PMC10235351 DOI: 10.1007/s12070-022-03355-z] [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: 07/20/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives - Transoral robotic surgery (TORS) is an already well established modality of treatment for early stage oropharyngeal cancer. This case report will throw light on the role of TORS as a treatment option for oropharyngeal cancer in a salvage setting. Methods - This is a case of a 69 year old patient who was a follow up case of carcinoma base of tongue, status - post concurrent chemoradiation who presented with residual disease at the primary site. Results - TORS was used as a successful treatment modality for base of tongue carcinoma in a salvage setting. The surgical procedure included removal of the entire hyoid bone in toto along with the tumour which is not reported in literature. The procedure also helped us in achieving an R0 resection. Conclusion - TORS should be considered as an important management modality for tongue base tumours in upfront as well as salvage setting.
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Affiliation(s)
- Surender Dabas
- Department of Surgical Oncology, BLK – MAX Superspeciality hospital, Delhi, India
| | - Nandini N Menon
- Department of Surgical Oncology, BLK – MAX Superspeciality hospital, Delhi, India
| | - Reetesh Ranjan
- Department of Surgical Oncology, BLK – MAX Superspeciality hospital, Delhi, India
| | - Bikas Gurung
- Department of Surgical Oncology, BLK – MAX Superspeciality hospital, Delhi, India
| | - Himanshu Shukla
- Department of Surgical Oncology, BLK – MAX Superspeciality hospital, Delhi, India
| | - Sukirti Tiwari
- Department of Surgical Oncology, BLK – MAX Superspeciality hospital, Delhi, India
| | - Ashwani Sharma
- Department of Surgical Oncology, BLK – MAX Superspeciality hospital, Delhi, India
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Smyk DI, Gulidov IA, Gordon KB, Gogolin DV, Dyuzhenko SS, Semenov AV. Proton beam therapy in repeat irradiation of recurrent head and neck tumors: analysis of short-term results. HEAD AND NECK TUMORS (HNT) 2023. [DOI: 10.17650/2222-1468-2022-12-4-39-47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Introduction. Recurrence of head and neck tumors occurs in 50 % of cases and usually has locoregional character. Due to the characteristics of dose distribution, proton beam therapy is a promising treatment option for patients with recurrences of tumors in this location who previously underwent radiation therapy.Aim. To evaluate the effectiveness and tolerability of repeat irradiation using active scanning proton beam therapy in patients with recurrent head and neck tumors who previously underwent radiation therapy.Materials and methods. Between November of 2015 and December of 2020, 40 patients with locoregional recurrence of head and neck tumors underwent treatment using active scanning proton beam therapy at the A. F . Tsyb Medical Radiological Research Center – branch of the National Medical Research Radiological Center. Median cumulative dose of primary irradiation was 64.5 Gy. Median time between primary and repeat irradiation was 35.7 months, mean irradiated volume of the repeat course was 94.5 cm3. Proton beam therapy was performed using standard mode (2 isoGy) and accelerated hypofractionation (2.4 isoGy / 3 isoGy) with mean equivalent cumulative dose of 56.4 Gy (α / β = 10). Radiation toxicity was evaluated using the Radiation Therapy Oncology Group European (RTOG) / Organization for Research and Treatment of Cancer (EORTC) scale.Results. Treatment response was achieved in 34 (85 %) patients: in 17 (42.5 %) patients, stable disease was observed; in 10 (25 %) patients, partial response was observed; and in 7 (17.5 %) patients, complete response was observed. In 6 (15 %) cases, disease progression was diagnosed at first follow-up examination. One- and two-year locoregional control, progression-free survival and overall survival were 58.4 / 19.8; 44.5 / 19.8 and 82.3 / 38.8 % respectively with median follow-up duration of 14.2 months. Median survival was 19.5 months. Grade III and above early radiation toxicity was observed in 3 (7.5 %) patients. In total, 6 (15 %) cases of grade III complications and 2 (5 %) episodes of carotid artery rupture leading to death were observed. Overall frequency of complications of grade III and higher was 20 %.Conclusion. Repeat irradiation using proton beam therapy can be considered an effective and safe treatment method for patients with recurrent head and neck tumors. Dosimetric and radiobiological benefits of proton beams allow to achieve balance between high doses and radiation exposure in previously irradiated tissues.
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Affiliation(s)
- D. I. Smyk
- A. F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Center of Radiology, Ministry of Health of Russia
| | - I. A. Gulidov
- A. F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Center of Radiology, Ministry of Health of Russia
| | - K. B. Gordon
- A. F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Center of Radiology, Ministry of Health of Russia
| | - D. V. Gogolin
- A. F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Center of Radiology, Ministry of Health of Russia
| | - S. S. Dyuzhenko
- A. F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Center of Radiology, Ministry of Health of Russia
| | - A. V. Semenov
- A. F. Tsyb Medical Radiological Research Center – branch of the National Medical Research Center of Radiology, Ministry of Health of Russia
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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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De Felice F, Bird T, Michaelidou A, Jeannon JP, Simo R, Oakley R, Lyons A, Fry A, Cascarini L, Asit A, Thavaraj S, Reis Ferreira M, Petkar I, Kong A, Lei M, Guerrero Urbano T. Clinical outcomes in relapsed oropharyngeal cancer after definitive (chemo) radiotherapy. Oral Dis 2023; 29:595-603. [PMID: 34338394 DOI: 10.1111/odi.13985] [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: 05/29/2021] [Revised: 07/05/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To report clinical outcomes of relapsed oropharyngeal squamous cell carcinoma (OPSCC) after definitive intensity-modulated (chemo)radiotherapy [(C)RT]. MATERIALS AND METHODS Data for all relapsed patients treated for OPSCC with definitive (C)RT between 2010 and 2016 were collected. Primary end-point was post-failure survival (PFS). RESULTS Overall, 273 OPSCC patients completed definitive (C)RT. Of these, 42 cases (n = 26 human papilloma virus (HPV)-negative; n = 16 HPV-positive) had relapsed (n = 23 persistent disease; n = 19 recurrent disease) and were included in the final analysis. Two-year PFS for the entire population was 30.6%; 20.5% for HPV-negative and 43.8% for HPV-positive patients. Salvage curative surgery was associated with a significantly higher 2 years PFS rate (56.2%) compared with palliative treatment (22.9%) and best supportive care (0%) (p < 0.001). A positive trend in 2 years PFS was recorded in the early complete response cases (49.5%) versus patients who did not achieve a complete response within 3 months of the end of (C)RT (23.0%) (p = 0.11). CONCLUSION A higher PFS rate is achieved when relapsed OPSCC cases are treated with salvage curative intent. HPV-positive disease and early complete response within 3 months from the end of (C)RT may be related to better PFS.
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Affiliation(s)
- Francesca De Felice
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK.,Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Thomas Bird
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | | | - Jean-Pierre Jeannon
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Richard Oakley
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Andrew Lyons
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Alastair Fry
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Luke Cascarini
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Arora Asit
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Selvam Thavaraj
- Department of Head and Neck Pathology, Guy's and St Thomas' NHS Trust, London, UK.,Centre for Oral, Clinical and Translational Science, King's College London, London, UK
| | | | - Imran Petkar
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK
| | - Anthony Kong
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK
| | - Mary Lei
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK
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11
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Beddok A, Orlhac F, Calugaru V, Champion L, Ala Eddine C, Nioche C, Créhange G, Buvat I. [18F]-FDG PET and MRI radiomic signatures to predict the risk and the location of tumor recurrence after re-irradiation in head and neck cancer. Eur J Nucl Med Mol Imaging 2023; 50:559-571. [PMID: 36282298 DOI: 10.1007/s00259-022-06000-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/09/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE To evaluate whether radiomics from [18F]-FDG PET and/or MRI before re-irradiation (reRT) of recurrent head and neck cancer (HNC) could predict the occurrence and the location "in-field" or "outside" of a second locoregional recurrence (LR). METHODS Among the 55 patients re-irradiated at curative intend for HNC from 2012 to 2019, 48 had an MRI and/or PET before the start of the reRT. Thirty-nine radiomic features (RF) were extracted from the re-irradiated GTV (rGTV) using LIFEx software. Student t tests and Spearman correlation coefficient were used to select the RF that best separate patients who recurred from those who did not, and "in-field" from "outside" recurrences. Principal component analysis involving these features only was used to create a prediction model. Leave-one-out cross-validation was performed to evaluate the models. RESULTS After a median follow-up of 17 months, 40/55 patients had developed a second LR, including 18 "in-field" and 22 "outside" recurrences. From pre-reRT MRI, a model based on three RF (GLSZM_SZHGLE, GLSZM_LGLZE, and skewness) predicted whether patients would recur with a balanced accuracy (BA) of 83.5%. Another model from pre-reRT MRI based on three other RF (GLSZM_ LZHGE, NGLDM_Busyness, and GLZLM_SZE) predicted whether patients would recur "in-field" or "outside" with a BA of 78.5%. From pre-reRT PET, a model based on four RF (Kurtosis, SUVbwmin, GLCM_Correlation, and GLCM_Contrast) predicted the LR location with a BA of 84.5%. CONCLUSION RF characterizing tumor heterogeneity extracted from pre-reRT PET and MRI predicted whether patients would recur, and whether they would recur "in-field" or "outside".
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Affiliation(s)
- Arnaud Beddok
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, U1288, Orsay, France.
- Institut Curie, Radiation Oncology Department, PSL Research University, 25 rue d'Ulm 75005, Paris/Orsay, France.
| | - Fanny Orlhac
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, U1288, Orsay, France
| | - Valentin Calugaru
- Institut Curie, Radiation Oncology Department, PSL Research University, 25 rue d'Ulm 75005, Paris/Orsay, France
| | - Laurence Champion
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, U1288, Orsay, France
- Department of Nuclear Medicine, Institut Curie, Saint-Cloud, France
| | | | - Christophe Nioche
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, U1288, Orsay, France
| | - Gilles Créhange
- Institut Curie, Radiation Oncology Department, PSL Research University, 25 rue d'Ulm 75005, Paris/Orsay, France
| | - Irène Buvat
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, U1288, Orsay, France
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12
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Colevas SM, Merfeld EC, Pflum ZE, Gessert TG, Wieland AM, Glazer TA, Burr AR, Harari PM, Hartig GK. Functional Outcomes After Transoral Plus Lateral Pharyngotomy Approach for Advanced Oral and Oropharyngeal Tumors. OTO Open 2023; 7:e35. [PMID: 36998565 PMCID: PMC10046711 DOI: 10.1002/oto2.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/05/2023] [Accepted: 02/01/2023] [Indexed: 02/25/2023] Open
Abstract
Objective The aim of this study was to evaluate our institutional experience with the combined transoral plus lateral pharyngotomy (TO+LP) approach in a subset of patients with advanced or recurrent oral and oropharyngeal malignancy. Study Design A retrospective study of procedures utilizing TO+LP for cancer resection between January 2007 and July 2019. Setting Tertiary academic medical center. Methods Thirty-one patients underwent a TO+LP approach for the resection of oral and oropharyngeal tumors. Functional and oncologic outcomes were analyzed. Results Eighteen (58.1%) patients were treated with TO+LP for recurrent disease. Twenty-nine required free tissue transfer and 2 (6.5%) had positive margins. The median time to decannulation was 22 days (range 6-100 days). Thirteen (41.9%) patients still required enteral feeding at their most recent follow-up. Patients without a history of prior radiation were decannulated sooner (p = .009) and were less likely to require enteral feeding at the first postoperative follow-up (p = .034) than those who had prior head and neck radiotherapy. Conclusion A TO+LP approach can be used to achieve good functional and oncologic results for selected patients with advanced or recurrent oral and oropharyngeal cancer when minimally invasive options such as transoral robotic surgery, transoral laser microsurgery, or radiotherapy are not possible.
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Affiliation(s)
- Sophia M. Colevas
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Emily C. Merfeld
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Zachary E. Pflum
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Thomas G. Gessert
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Aaron M. Wieland
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Tiffany A. Glazer
- Department of Surgery, Division of Otolaryngology–Head and Neck Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Adam R. Burr
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Paul M. Harari
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Gregory K. Hartig
- Department of Human Oncology University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
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13
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Leddon JL, Gulati S, Haque S, Allen C, Palackdharry S, Mathews M, Kurtzweil N, Riaz MK, Takiar V, Nagasaka M, Patil Y, Zender C, Tang A, Cervenka B, McGrath J, Korn WM, Hinrichs BH, Jandarov R, Harun N, Sukari A, Wise-Draper TM. Phase II Trial of Adjuvant Nivolumab Following Salvage Resection in Patients with Recurrent Squamous Cell Carcinoma of the Head and Neck. Clin Cancer Res 2022; 28:3464-3472. [PMID: 35653116 PMCID: PMC9378458 DOI: 10.1158/1078-0432.ccr-21-4554] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/30/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Locoregional relapse in patients with head and neck squamous cell carcinoma (HNSCC) is common, approaching 50% for some subsites despite multimodality therapy. Salvage surgery is the standard of care, but able to achieve durable control in only a minority of patients. While adjuvant radiotherapy or chemo-radiotherapy is offered to select patients, this approach can be prohibitively toxic. Given the activity and tolerability of programmed death-1 inhibitors in metastatic HNSCC, we investigated the safety and efficacy of adjuvant nivolumab after salvage surgical resection. PATIENTS AND METHODS This was an open-label, multi-institutional phase II clinical trial (NCT03355560). Patients with recurrent, resectable HNSCC were enrolled within 6 weeks of salvage surgery. Six 28-day cycles of adjuvant nivolumab were planned. The primary endpoint was 2-year disease-free survival (DFS) more than 58%, based on an institutional historical control group of 71 patients with recurrent HNSCC who underwent salvage surgery. RESULTS Between February 2018 and February 2020, 39 patients were enrolled. At a median follow-up of 22.1 months, 2-year DFS was 71.4% [95% confidence interval (CI), 57.8-88.1] and the 2-year overall survival (OS) was 73% (95% CI, 58-91.8). Three of 39 (8%) patients experienced grade 3 treatment-related adverse events and 3 of 39 (8%) discontinued treatment due to side effects. Ten of 39 had locoregional recurrence, while 2 of 10 also had synchronous metastatic disease. There was no difference in DFS between PD ligand-1 (PD-L1)-positive and PD-L1-negative patients. There was a nonsignificant trend toward improved DFS in patients with high tumor mutational burden (P = 0.083). CONCLUSIONS Adjuvant nivolumab after salvage surgery in locally recurrent HNSCC is well tolerated and showed improved DFS compared with historical controls.
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Affiliation(s)
- Jennifer L Leddon
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Shuchi Gulati
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Sulsal Haque
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Casey Allen
- University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Sarah Palackdharry
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Maria Mathews
- University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | - Muhammed Kashif Riaz
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati and Cincinnati VA Medical Center, Cincinnati, Ohio
| | - Misako Nagasaka
- Division of Hematology and Oncology, Department of Medicine, University of California Irvine School of Medicine, Orange, California
| | - Yash Patil
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Chad Zender
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Alice Tang
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Brian Cervenka
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Roman Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio
| | - Nusrat Harun
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ammar Sukari
- Department of Oncology, Karmanos Cancer Institute/Wayne State University, Detroit, Michigan
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
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14
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Pellizzon A, Silva M, Fogaroli R, Neto E, Chen M, Godim G, Castro D, Ramos H, Abrahao C. Salvage Post-Operative Stereotatic Ablative Radiotherapy for Re-Current Squamous Cell Carcinoma of Head and Neck. Medicina (B Aires) 2022; 58:medicina58081074. [PMID: 36013541 PMCID: PMC9415665 DOI: 10.3390/medicina58081074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/29/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Objectives: Patients with recurrent squamous cell carcinoma of the head and neck (rHNC) face an aggressive disease. Surgical resection is the gold standard treatment. Immediate adjuvant post-operative stereotactic ablative radiotherapy (PO-SABR) for rHNC is debatable. Materials and Methods: We retrospectively identified patients who were treated with PO-SABR at the AC Camargo Cancer Center, Brazil. Results: Eleven patients were treated between 2018 and 2021. The median time between salvage surgery and PO-SABR was 31 days (range, 25–42) and the median PO-SABR total dose was 40 Gy (range, 30–48 Gy). The 2-and 4-year actuarial DFS were 62.3% and 41.6%, while the 2-and 4-year OS probabilities were 80.0% and 53.3%, respectively. Eight (72.7%) patients were alive and six (54.5%) were without disease at the last follow-up. Two (18.1%) patients had local failure in the PO-SABR field. Three (27.3%) patients had distant metastasis, diagnosed in a median time of 9 months (range, 4–13) after completion of PO-SABR. On univariate analysis, predictive factors related to worse OS were: interval between previous radiotherapy and PO-SABR ≤ 24 months (p = 0.033) and location of the salvage target in the oral cavity (p = 0.013). The total dose of PO-SABR given in more than three fractions was marginally statistically significant, favoring the OS (p = 0.051). Conclusions: Our results encourage the use of a more aggressive approach in selected patients with rHNC by combining salvage surgery with immediate PO-SABRT, but this association needs to be further explored.
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15
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Straetmans JMJAA, Stuut M, Lacko M, Hoebers F, Speel EJM, Kremer B. Additional parameters to improve the prognostic value of the 8th edition of the UICC classification for human papillomavirus-related oropharyngeal tumors. Head Neck 2022; 44:1799-1815. [PMID: 35579041 PMCID: PMC9544856 DOI: 10.1002/hed.27084] [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: 09/28/2021] [Revised: 02/17/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background The prognostic reliability of the UICC's TNM classification (8th edition) for human papillomavirus (HPV)‐positive tonsillar squamous cell carcinomas (TSCCs) compared to the 7th edition was explored, and its improvement by using additional anatomical and nonanatomical parameters. Methods One hundred and ten HPV‐positive and 225 HPV‐negative TSCCs were retrospectively analyzed. Survival was correlated with patient and tumor characteristics (7th and 8th edition UICC TNM classification). Results In HPV‐positive TSCCs, the 8th edition UICC's TNM classification correlated better with prognosis than the 7th edition. Also, smoking status was a stronger prognosticator of survival than UICC staging. Non‐ or former smokers had a 5‐year overall survival of 95.1% regardless of tumor stage. Furthermore, age (>65 years), cN3, and M1 classification were significant prognostic factors. Conclusion The prognostic value of the 8th edition UICC's TNM classification improved significantly when compared to the 7th edition. Nonetheless, further improvement is possible by adding nonanatomical factors (smoking, age >65 year) and separating N0‐N2 from N3.
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Affiliation(s)
- Jos M J A A Straetmans
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Marijn Stuut
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ernst-Jan M Speel
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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16
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Lee HI, Kim JH, Ahn SH, Chung EJ, Keam B, Eom KY, Jeong WJ, Kim JW, Wee CW, Wu HG. Re-irradiation for recurrent or second primary head and neck cancer. Radiat Oncol J 2022; 39:279-287. [PMID: 34986549 PMCID: PMC8743457 DOI: 10.3857/roj.2021.00640] [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: 06/23/2021] [Accepted: 08/17/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the efficacy and safety of intensity-modulated radiotherapy (IMRT)-based re-irradiation (reRT) for recurrent or second primary head and neck cancer (HNC). Materials and Methods Patients who underwent IMRT-based reRT for recurrent or second primary HNC between 2007 and 2019 at two institutions were included. Medical records and dosimetric data were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), severe late toxicities, and clinicopathological prognostic factors were analyzed. Results A total of 42 patients were analyzed. With a median follow-up of 15.1 months (range, 3.7 to 85.8 months), the median OS was 28.9 months with a 2-year OS rate of 54.6%. The median PFS and 2-year PFS rates were 10.0 months and 30.9%, respectively. Multivariate analysis showed that good performance (Eastern Cooperative Oncology Group [ECOG] 0 or 1), a longer time interval (≥24 months) between radiotherapy courses, and higher reRT dose (>60 Gy) were significantly favorable factors for OS (all p < 0.05). Higher reRT dose and salvage surgery were significantly associated with improved PFS (all p < 0.05). Regarding the Multi‐Institution Reirradiation (MIRI) Collaborative RPA classification, the 2-year OS rates of each class were 87.5% in class I, 51.8% in class II, and 0% in class III (p = 0.008). Grade ≥3 late toxicity was reported in 10 (23.8%) patients. There was no significant factor associated with increased late toxicities. Conclusion IMRT-based reRT should be considered as a treatment option for patients with recurrent or second primary HNC. Further trials are needed to establish a subset of patients who may benefit from reRT without severe late toxicity.
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Affiliation(s)
- Hye In Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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17
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Bigelow EO, Harris J, Fakhry C, Gillison ML, Nguyen-Tân PF, Rosenthal DI, Frank SJ, Nair SG, Bahig H, Ridge JA, Caudell J, Donaldson C, Clifford BT, Shenouda G, Birrer MJ, Chen Y, Le QT. Risk stratification after recurrence of human papillomavirus (HPV)-related and non-HPV-related oropharyngeal cancer: A secondary analysis of NRG Oncology RTOG 0129 and 0522. Head Neck 2021; 44:158-167. [PMID: 34729846 DOI: 10.1002/hed.26915] [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: 03/02/2021] [Revised: 09/12/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND No risk-stratification strategies exist for patients with recurrent oropharyngeal cancer (OPC). METHODS Retrospective analysis using data from prospective NRG Oncology clinical trials RTOG 0129 and 0522. Eligibility criteria included known p16 status and smoking history, and locoregional/distant recurrence. Overall survival (OS) was measured from date of recurrence. Recursive partitioning analysis was performed to produce mutually exclusive risk groups. RESULTS Hundred and fifty-four patients were included with median follow-up after recurrence of 3.9 years (range 0.04-9.0). The most important factors influencing survival were p16 status and type of recurrence, followed by surgical salvage and smoking history (≤20 vs. >20 pack-years). Three significantly different risk groups were identified. Patients in the low-, intermediate-, and high-risk groups had 2-year OS after recurrence of 81.1% (95%CI 68.5-93.7), 50.2% (95%CI 36.0-64.5), and 20.8% (95%CI 10.5-31.1), respectively. CONCLUSION Patient and tumor characteristics may be used to stratify patients into risk groups at the time of OPC recurrence.
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Affiliation(s)
- Elaine O Bigelow
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania, USA
| | - Carole Fakhry
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maura L Gillison
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Phuc Felix Nguyen-Tân
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - David I Rosenthal
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Steven J Frank
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Suresh G Nair
- Department of Hematology and Oncology, Lehigh Valley Hospital, Allentown, Pennsylvania, USA
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jimmy Caudell
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | - Bradley T Clifford
- Department of Oncology, Summa Health System - Akron Campus, Akron, Ohio, USA
| | - George Shenouda
- Department of Radiation Oncology, The Research Institute of the McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Michael J Birrer
- Department of Medical Oncology, University of Alabama at Birmingham Cancer Center, Birmingham, Alabama, USA
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester, Rochester, New York, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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18
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Gordon K, Gulidov I, Semenov A, Golovanova O, Koryakin S, Makeenkova T, Ivanov S, Kaprin A. Proton re-irradiation of unresectable recurrent head and neck cancers. ACTA ACUST UNITED AC 2021; 26:203-210. [PMID: 34211770 DOI: 10.5603/rpor.a2021.0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/02/2021] [Indexed: 01/04/2023]
Abstract
Background This study presents a retrospective analysis (efficacy and toxicity) of outcomes in patients with unresectable recurrence of previously irradiated head and neck (H&N) cancers treated with proton therapy. Locoregional recurrence is the main pattern of failure in the treatment of H&N cancers. Proton re-irradiation in patients with relapse after prior radiotherapy might be valid as promising as a challenging treatment option. Materials and methods From November 2015 to January 2020, 30 patients with in-field recurrence of head and neck cancer, who were not suitable for surgery due to medical contraindications, tumor localization, or extent, received re-irradiation with intensity-modulated proton therapy (IMPT). Sites of retreatment included the aerodigestive tract (60%) and the base of skull (40%). The median total dose of prior radiotherapy was 55.0 Gy. The median time to the second course was 38 months. The median re-irradiated tumor volume was 158.1 cm3. Patients were treated with 2.0, 2.4, and 3.0 GyRBE per fraction, with a median equivalent dose (EQD2) of 57.6 Gy (α/β = 10). Radiation-induced toxicity was recorded according to the RTOG/EORTC criteria. Results The 1- and 2-year local control (LC), progression-free survival (PFS), and overall survival (OS) were 52.6/21.0, 21.9/10.9, and 73.4/8.4%, respectively, with a median follow-up time of 21 months. The median overall survival was 16 months. Acute grade 3 toxicity was observed in one patient (3.3%). There were five late severe side effects (16.6%), with one death associated with re-irradiation. Conclusion Re-irradiation with a proton beam can be considered a safe and efficient treatment even for a group of patients with unresectable recurrent H&N cancers.
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Affiliation(s)
- Konstantin Gordon
- Department of Proton and Photon Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | - Igor Gulidov
- Radiation Therapy Department, A. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | - Alexey Semenov
- Department of Proton and Photon Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | - Olga Golovanova
- Radiophysics Department, A. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | - Sergey Koryakin
- Radiophysics Department, A. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | - Tatyana Makeenkova
- Department of Proton and Photon Therapy, A. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | - Sergey Ivanov
- A. Tsyb Medical Radiological Research Center, Obninsk, Russia
| | - Andrey Kaprin
- National Medical Research Center of Radiology, Obninsk, Russia
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Quek LHH, Lim MY, Cheo T, Teo HL, Pua U. Percutaneous Management of Recurrent Head and Neck Cancer: Current Role and Evolving Principles in the Multidisciplinary Setting. Curr Oncol Rep 2021; 23:52. [PMID: 33754244 DOI: 10.1007/s11912-021-01045-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW In this review, we will outline the role of percutaneous interventional radiological management of recurrent head and neck (H&N) cancer in the context of a multidisciplinary setting which consists of surgery, radiation therapy, as well as established and evolving systemic therapies that may impact current practice. RECENT FINDINGS Management of recurrent H&N cancer is complex, with attention to the preservation of function and minimal treatment-related morbidity. The favored treatment modalities in local recurrence previously treated with radiotherapy are surgical resection, and if unresectable, for chemotherapy as definitive treatment, or as a prelude to resection if there is good tumor response. Unfortunately, some of these patients are too frail for major surgery or to withstand the toxicity of chemotherapy. There is a gap for effective local therapy without the morbidity of surgery, toxicity of re-irradiation, and systemic side effects of chemotherapy. Percutaneous interventions have the potential to bridge that gap as well as provide palliative symptomatic treatment for patients that have exhausted all treatment options. In the multidisciplinary setting involving the treatment of complex recurrent H&N cancer, percutaneous management now plays a viable and effective role with a foothold in this team-based approach.
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Affiliation(s)
- Lawrence Han Hwee Quek
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
| | - Ming Yann Lim
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Otorhinolaryngology and Head and Neck Surgery, Tan Tock Seng Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Timothy Cheo
- Department of Radiation Oncology, Tan Tock Seng Hospital, Singapore, Singapore.,Department of Radiation Oncology, National University Health System, Singapore, Singapore
| | - Hui Lin Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Medical Oncology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Basement 1, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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20
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Asairinachan A, O'Duffy F, Fua T, Magarey MJR, Dixon BJ. Salvage transoral robotic surgery in early-stage oropharyngeal recurrence. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:18-25. [PMID: 33744203 DOI: 10.1016/j.oooo.2021.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 09/23/2020] [Accepted: 01/10/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Limited data are currently available regarding outcomes following transoral robotic surgery (TORS) in the salvage setting. This study aims to investigate the functional and oncological outcomes following TORS in salvage oropharyngeal tumors. STUDY DESIGN All patients undergoing salvage TORS for a residual, recurrent, or new primary oropharyngeal squamous cell carcinoma within a previously radiated field between March 2014 and October 2018 were included. Patients undergoing salvage TORS for other subsites were excluded. Margin status, complication rates, long-term tracheostomy, and gastrostomy requirements and overall and disease-free survival outcomes were recorded. RESULTS A total of 26 patients were included. Three patients (11%) experienced a TORS-specific major complication. A gastrostomy tube was required in 42% of patients on discharge (n = 11), and in 28% of patients on long-term follow-up (n = 7) at a median of 34 (interquartile range, 11.8-47.8) months. A tracheostomy was placed in 5 patients and all were removed before discharge. The 3-year overall survival and disease-free survival were 74% and 70%, respectively. CONCLUSION Salvage TORS is a viable and effective option in the management of selected tumors within a previously radiated field.
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Affiliation(s)
- Ashwinna Asairinachan
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
| | - Fergal O'Duffy
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre
| | - Matthew J R Magarey
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Head & Neck Surgery, Epworth Healthcare, Richmond, Victoria, Australia
| | - Benjamin J Dixon
- Department of Surgical Oncology, Head & Neck Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Head & Neck Surgery, Epworth Healthcare, Richmond, Victoria, Australia
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21
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Svajdova M, Dubinsky P, Kazda T. Radical external beam re-irradiation in the treatment of recurrent head and neck cancer: Critical review. Head Neck 2020; 43:354-366. [PMID: 32996265 DOI: 10.1002/hed.26485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/09/2022] Open
Abstract
Management of patients with recurrent head and neck cancer remains a challenge for the surgeon as well as the treating radiation oncologist. Even in the era of modern radiotherapy, the rate of severe toxicity remains high with unsatisfactory treatment results. Intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and heavy-ion irradiation have all emerged as highly conformal and precise techniques that offer many radiobiological advantages in various clinical situations. Although re-irradiation is now widespread in clinical practice, little is known about the differences in treatment response and toxicity using diverse re-irradiation techniques. In this review, we provide a comprehensive overview of the role of radiation therapy in recurrent or second primary head and neck cancer including patient selection, therapeutic outcome, and risk using different re-irradiation techniques. Critical review of published evidence on IMRT, SBRT, and heavy-ion full-dose re-irradiation is presented including data on locoregional control, overall survival, and toxicity.
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Affiliation(s)
- Michaela Svajdova
- Clinic of Radiation and Clinical Oncology, Central Military Hospital-Teaching Hospital Ruzomberok, Slovakia.,Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pavol Dubinsky
- Department of Radiation Oncology, East Slovakia Oncology Institute, Kosice, Slovakia.,Faculty of Health, Catholic University, Ruzomberok, Slovakia
| | - Tomas Kazda
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
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22
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Reirradiation using stereotactic body radiotherapy in the management of recurrent or second primary head and neck cancer: A meta-analysis and systematic review. Oral Oncol 2020; 107:104757. [DOI: 10.1016/j.oraloncology.2020.104757] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 04/27/2020] [Indexed: 12/31/2022]
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23
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Conventionally fractionated large volume head and neck re-irradiation using multileaf collimator-based robotic technique: A feasibility study. Clin Transl Radiat Oncol 2020; 24:102-110. [PMID: 32715109 PMCID: PMC7372092 DOI: 10.1016/j.ctro.2020.06.012] [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: 03/26/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To report on the feasibility and performance of conventionally fractionated multileaf collimator (MLC)-based robotic stereotactic body re-irradiation of the head and neck region using MLC-based Cyberknife (CK) technology. Methods Patients treated for recurrent or second primary head and neck cancer (HNC) with curative proton therapy to a target volume > 30 cm3 between 2011 and 2015 were included. MLC-based CK plans were generated using the CK M6 InCise2 MLC system. Dose statistics from MLC-based CK plans were compared to proton beam therapy (PBT) plans according to the following metrics: target coverage, target homogeneity index, gradient index, Paddick conformity index (CI), prescription isodose volume (PIV), treatment time (tTime) for one fraction as well as doses to organs at risk (OAR). Wilcoxon signed-rank test was used to compare dose metrics. Results Eight patients were included; the tumor sites included: salivary glands, pharynx (oropharynx, hypopharynx and retropharynx) and sinonasal cavities. Five of 8 patients were treated with multifield optimisation intensity modulated proton therapy, 3 were treated with passive scattering proton therapy. Median dose was 67 Gy (range 60-70) in 32 fractions (range 30-35). The median high-dose planning target volume (PTV) was 45.4 cm3 (range 2.4 - 130.2 cm3) and the median elective PTV was 91.9 cm3 (range 61.2 - 269.7 cm3). Overall, the mean target coverage (mean 98.3% vs. 96.2% for CK vs. PBT, respectively), maximum dose to PTV (mean 111% vs. 111%, p = 0.2) and mean dose to PTV (mean 104% vs. 104%) were similar across modalities. Highly conformal plans were achieved with both modalities, but mean CI was better with PBT (0.5 vs. 0.6 for CK vs. PBT, p = 0.04). Homogeneity and gradient indexes were similar between the 2 modalities; mean tTime with PBT and CK was 17 vs. 18 min, respectively (p = 0.7). Case-based study revealed that CK and PBT plans allowed for excellent sparing of OAR, with some clinical scenarios associated with better performance of CK while others with better performance of PBT. Conclusion Our study has demonstrated the dosimetric performance of large volume head and neck re-irradiation using MLC-based CK in various clinical scenarios. While conformity was generally better achieved with PBT, MLC-based CK allowed for high dose gradient leading to rapid dose drop-off and sparing of OAR. Conventionally fractionated MLC-based CK could be a competitive alternative in large volume head and neck re-irradiation that deserves further investigation in the clinical setting.
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Predictors of survival in patients undergoing oropharyngeal surgery for cancer recurrence after radiation therapy. Eur Arch Otorhinolaryngol 2020; 277:2085-2093. [PMID: 32193723 DOI: 10.1007/s00405-020-05913-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The incidence of oropharyngeal squamous cell carcinoma continues to rise with the majority of patients receiving definitive or adjunctive radiation. For patients with locoregional recurrence after radiation, optimal treatment involves salvage surgery. The aim of this study is to identify factors that predict survival to ultimately improve patient selection for salvage surgery. METHODS Retrospective cohort study at an NCI-designated cancer center. We analyzed patients with a history of head and neck radiation who presented with persistent/recurrent or second primary disease requiring salvage oropharyngeal resection from 1998-2017 (n = 120). Patients were stratified into three classes based on time to recurrence and presence of laryngopharyngeal dysfunction. Primary outcomes were 5-year overall survival (OS) and disease specific survival (DSS). RESULTS Median OS was 27 months (median follow-up 20 months). Five-year OS was 47% for class I (recurrence > 2 years), 26% for class II (recurrence ≤ 2 years), and 0% for class III (recurrence ≤ 2 years and laryngopharyngeal dysfunction), (p < 0.0001). Five-year DSS showed significant differences between classes (p < 0.0001). On multivariate analysis, class remained predictive of OS (p = 0.04- < 0.001) and DSS (p = 0.04-0.001). Adjuvant radiation after salvage surgery with negative margins showed superior OS (71% vs. 28%, p = 0.01) and DSS (83% vs 37%, p = 0.02) compared to surgery alone and was a significant predictor of improved survival on multivariate analysis (HR 0.1, p = 0.04). CONCLUSION This study identified a subset of patients with oropharyngeal cancer recurrence within two years of initial treatment and with laryngopharyngeal dysfunction who have poor outcomes for salvage surgery.
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25
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Gogineni E, Zhang I, Rana Z, Marrero M, Gill G, Sharma A, Riegel AC, Teckie S, Ghaly M. Quality of Life Outcomes Following Organ-Sparing SBRT in Previously Irradiated Recurrent Head and Neck Cancer. Front Oncol 2019; 9:836. [PMID: 31552172 PMCID: PMC6746961 DOI: 10.3389/fonc.2019.00836] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/13/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose: To present a retrospective analysis of the efficacy, toxicity, and quality of life (QoL) of patients treated with OAR Extreme -sparing stereotactic body radiotherapy (SBRT) in previously-irradiated head and neck cancer. Materials/Methods: From 11/2012 to 7/2015, 60 patients with in-field recurrence of head and neck cancer underwent re-irradiation with SBRT. Retreatment sites included the aerodigestive tract (43%), lateral neck (22%), and skull base (35%). The median prior RT dose was 63.6 Gy with a median time from prior irradiation of 16.5 months. The median volume treated was 61.0 cc. Patients were treated with 40 Gy in the definitive setting or 35 Gy in the post-operative setting in five fractions. Dose constraints to the OAR Extreme were calculated with a BED calculator using an alpha/beta ratio of 3 to reduce the risk of late toxicities. QoL data was collected from patients at the time of consultation and at subsequent follow up appointments using the MD Anderson Dysphagia Inventory (MDADI) and Symptom Inventory (MDASI). Results: The 1- and 2- year rates of local, regional, and distant control and overall survival were 79/79, 74/70, 74/71, and 59/45%, respectively. Late grade 3 toxicities were seen in 3% in the group treated to the aerodigestive tract and 1% in the group treated to the skull base. No grade 4 or 5 toxicities were observed. Patients with skull base re-irradiation maintained a stable QoL score after radiation treatment, while patients treated to the aerodigestive tract demonstrated a slight impairment associated with worsening dysphagia, compared to their pretreatment baseline. All groups experienced an increase in xerostomia. Conclusions: OAR Extreme -sparing SBRT is able to achieve excellent tumor coverage while protecting the organs at highest risk of re-irradiation-related complications. The potential for lower toxicities and maintained QoL with this treatment makes it a promising option for salvage of recurrent head and neck cancer. Summary Local control and overall survival rates for recurrent head and neck cancer remain poor, despite the use of local therapy. In addition, re-irradiation with conventional radiation therapy confers a high rate of grade 3 and higher late toxicities. SBRT appears to improve the therapeutic ratio in this patient population, and treatment planning with a focus on sparing OAR Extreme may further decrease the rates of morbidity in these patients.
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Affiliation(s)
- Emile Gogineni
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
| | - Isabella Zhang
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
| | - Zaker Rana
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
| | - Mihaela Marrero
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
| | - Gurtej Gill
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
| | - Anurag Sharma
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
| | - Adam C Riegel
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
| | - Sewit Teckie
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
| | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health, New York, NY, United States
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Maskell D, Buckley H, Sission K, Roques T, Geropantas K. Ipsilateral neck radiotherapy in N2b well‐lateralized tonsil cancer – Approach with caution. Head Neck 2019; 41:2937-2946. [DOI: 10.1002/hed.25776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- David Maskell
- Department of OncologyNorfolk and Norwich University Hospital Foundation Trust Norfolk UK
| | - Hannah Buckley
- Department of OncologyNorfolk and Norwich University Hospital Foundation Trust Norfolk UK
| | - Katherine Sission
- Department of HistopathologyNorfolk and Norwich University Hospital Foundation Trust Norfolk UK
| | - Tom Roques
- Department of OncologyNorfolk and Norwich University Hospital Foundation Trust Norfolk UK
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Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma: A review of the literature. Crit Rev Oncol Hematol 2019; 137:84-91. [DOI: 10.1016/j.critrevonc.2019.01.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/14/2018] [Accepted: 01/24/2019] [Indexed: 02/06/2023] Open
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28
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Hay A, Simo R, Hall G, Tharavai S, Oakley R, Fry A, Cascarini L, Lei M, Guerro-Urbano T, Jeannon JP. Outcomes of salvage surgery for the oropharynx and larynx: a contemporary experience in a UK Cancer Centre. Eur Arch Otorhinolaryngol 2019; 276:1153-1159. [DOI: 10.1007/s00405-019-05295-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 01/14/2019] [Indexed: 11/24/2022]
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29
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Maschio F, Lejuste P, Ilankovan V. Evolution in the management of oropharyngeal squamous cell carcinoma: systematic review of outcomes over the last 25 years. Br J Oral Maxillofac Surg 2019; 57:101-115. [PMID: 30665664 DOI: 10.1016/j.bjoms.2018.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022]
Abstract
The treatment of oropharyngeal squamous cell carcinoma (SCC) has evolved over the last 25years, from open surgery to combined chemoradiotherapy, and now to the development of minimally invasive procedures, but evidence for the best treatment is lacking. We therefore did a systematic search of the MEDLINE database for studies published between 1992 and 2017 that reported oncological or functional outcomes, or both. Predefined inclusion and exclusion criteria were used for screening and selection, and 45 studies were chosen. Only one was a randomised controlled trial, all the rest were prospective or retrospective case series. The heterogeneities in their characteristics made meta-analysis impossible and only qualitative analysis was feasible. We found no conclusive evidence to suggest the advantage of one therapeutic approach over another, so we still cannot offer patients the "ideal" treatment. We have, however, raised the possibility of there being two different entities: human papillomavirus (HPV)-positive and HPV-negative disease.
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Affiliation(s)
- F Maschio
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK; Department of Maxillofacial and Reconstructive Surgery, GHdC-Site Notre Dame, Grand'Rue 3, 6000 Charleroi, Belgium.
| | - P Lejuste
- Department of Maxillofacial and Reconstructive Surgery, GHdC-Site Notre Dame, Grand'Rue 3, 6000 Charleroi, Belgium.
| | - V Ilankovan
- Department of Oral and Maxillofacial Surgery, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole BH15 2JB, UK.
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Deng D, Liu J, Chen F, Lv D, Gan W, Li L, Wang J. Double-island anterolateral thigh free flap used in reconstruction for salvage surgery for locally recurrent head and neck carcinoma. Medicine (Baltimore) 2018; 97:e12839. [PMID: 30313121 PMCID: PMC6203530 DOI: 10.1097/md.0000000000012839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Salvage surgery is usually the only treatment for recurrent head and neck tumors but often poses a challenge to surgeons due to post-resected defects at 2 or more sites. Here we present the outcomes and rationale for reconstruction by a double-island anterolateral thigh (ALT) free flap following the salvage surgery.Patients treated with double-island ALT free flaps in salvage surgery between September 2012 and January 2017 at West China Hospital, Sichuan University were retrospectively viewed.A total of 18 patients (15 males) underwent reconstruction with double-island ALT free flaps (range from 40 to 77 years old). All patients had recurrent tumors after surgery and/or chemoradiotherapy and were selected for salvage surgery by a multidisciplinary team. The flaps were initially harvested as 7 cm × 7 cm to 16 cm × 10 cm single blocks and then divided into double-island flaps with each individual paddle ranging from5 cm × 3 cm to 10 cm × 8 cm. The average flap thickness was 3.5 cm (range from 2 to 6 cm), and the average pedicle length was 8 cm (range from 6 to 10 cm). A total of 18 arteries and 32 veins were anastomosed. Three patients developed fistula, 1 developed flap failure due to thrombosis and was re-operated with a pedicle flap. One patient died of pulmonary infection 6 months after the operation.Flap reconstruction for complex head and neck defects after salvage surgery remains challenging, but double-island ALT free flap reconstruction conducted by a multidisciplinary team and experienced surgeons would have a role in this setting.
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The keys to conservative treatment of early-stage squamous cell carcinoma of the tonsillar region. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134:259-264. [DOI: 10.1016/j.anorl.2017.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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32
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Facteurs pronostiques de la ré-irradiation des cancers des voies aérodigestives supérieures : revue de la littérature. Cancer Radiother 2017; 21:316-338. [DOI: 10.1016/j.canrad.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/06/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022]
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Survival outcomes following salvage surgery for oropharyngeal squamous cell carcinoma: systematic review. The Journal of Laryngology & Otology 2017; 132:299-313. [DOI: 10.1017/s0022215117000998] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AbstractBackground:Recurrent oropharyngeal squamous cell carcinoma causes great morbidity and mortality. This systematic review analyses survival outcomes following salvage surgery for recurrent oropharyngeal squamous cell carcinoma.Methods:A comprehensive search of various electronic databases was conducted. Studies included patients with recurrent or residual oropharyngeal squamous cell carcinoma treated with salvage surgery. Primary outcomes were survival rates following salvage surgery. Secondary outcomes included time to recurrence, staging at time of recurrence, post-operative complications, and factors associated with mortality and recurrence. Methodological appraisal and data extraction were conducted as per Joanna Briggs Institute methodology.Results:Eighteen articles were included. The two- and five-year survival rates of the patients were 52 per cent and 30 per cent respectively.Conclusion:Improvements in treatment modalities for recurrent oropharyngeal squamous cell carcinoma were associated with improvements in two-year overall survival rates, with minimal change to five-year overall survival rates. Various factors were identified as being associated with long-term overall survival, thus assisting clinicians in patient counselling and selection for salvage surgery.
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Sims JR, Van Abel K, Martin EJ, Lohse CM, Price DL, Olsen KD, Moore EJ. Management of Recurrent and Metastatic HPV-Positive Oropharyngeal Squamous Cell Carcinoma after Transoral Robotic Surgery. Otolaryngol Head Neck Surg 2017; 157:69-76. [DOI: 10.1177/0194599817696304] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To describe management and oncologic outcomes for patients who develop locoregional recurrence (LRR) or distant metastasis (DM) following transoral robotic surgery for human papilloma virus (HPV)–positive oropharyngeal squamous cell carcinoma (OPSCC). Study Design Case series with chart review. Setting Tertiary care referral center. Subjects and Methods A total of 286 patients with HPV-positive OPSCC who underwent transoral robotic surgery–based treatment from May 2007 to May 2015. Results Of 286 patients (12.2%), 35 met inclusion criteria. Of these, 19 experienced an LRR and 16 developed a DM; 2 patients with LRR subsequently developed DM. In those patients with an LRR, 79% had T1/T2 tumors, and 47% had N0/N1 nodal disease, compared with 75% and 6% in the DM group, respectively. The median time to LRR or DM was 0.6 years (interquartile range [IQR], 0.4-1.0) and 1.8 years (IQR, 1.0-2.1), respectively. Salvage treatment with intent to cure was attempted in 23 patients (16 LRR, 7 DM). The median time from LRR or DM to last follow-up for the 18 patients who were still alive after salvage was 1.9 years (IQR, 0.4-3.8; range, 7 days–6.2 years). Estimated cancer-specific survival rates at 3 years following intent-to-cure treatment were 63% (95% CI, 39-100; number still at risk, 5) in the LRR group and 100% (95% CI, 100-100; number still at risk, 2) in the DM group. Conclusion Overall, LRR and DM for HPV-positive OPSCC following transoral robotic surgery–based therapy are infrequent. In our subset of patients who underwent intent-to-cure treatment, cancer-specific survival rates were favorable. Therefore, aggressive salvage treatment for LRR and DM for HPV-positive OPSCC should be recommended for appropriate candidates.
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Affiliation(s)
- John R. Sims
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kathryn Van Abel
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eliot J. Martin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christine M. Lohse
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L. Price
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kerry D. Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric J. Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota, USA
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Kim YS. Reirradiation of head and neck cancer in the era of intensity-modulated radiotherapy: patient selection, practical aspects, and current evidence. Radiat Oncol J 2017; 35:1-15. [PMID: 28395502 PMCID: PMC5398346 DOI: 10.3857/roj.2017.00122] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 01/11/2023] Open
Abstract
Locoregional failure is the most frequent pattern of failure in locally advanced head and neck cancer patients and it leads to death in most of the patients. Second primary tumors occurring in the other head and neck region reach up to almost 40% of long-term survivors. Recommended and preferred retreatment option in operable patients is salvage surgical resection, reporting a 5-year overall survival of up to 40%. However, because of tumor location, extent, and underlying comorbidities, salvage surgery is often limited and compromised by incomplete resection. Reirradiation with or without combined chemotherapy is an appropriate option for unresectable recurrence. Reirradiation is carefully considered with a case-by-case basis. Reirradiation protocol enrollment is highly encouraged prior to committing patient to an aggressive therapy. Radiation doses greater than 60 Gy are usually recommended for successful salvage. Despite recent technical improvement in intensity-modulated radiotherapy (IMRT), the use of concurrent chemotherapy, and the emergence of molecularly targeted agents, careful patient selection remain as the most paramount factor in reirradiation. Tumors that recur or persist despite aggressive prior chemoradiation therapy imply the presence of chemoradio-resistant clonogens. Treatment protocols that combine novel targeted radiosensitizing agents with conformal high precision radiation are required to overcome the resistance while minimizing toxicity. Recent large number of data showed that IMRT may provide better locoregional control with acceptable acute or chronic morbidities. However, additional prospective studies are required before a definitive conclusion can be drawn on safety and effectiveness of IMRT.
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Affiliation(s)
- Yeon Sil Kim
- Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Sweeny L, Rosenthal EL, Clemons L, Stevens TM, Cook McIntosh ER, Carroll WR. Outcomes after surgical salvage for recurrent oropharyngeal squamous cell carcinoma. Oral Oncol 2016; 60:118-24. [DOI: 10.1016/j.oraloncology.2016.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/05/2016] [Accepted: 07/12/2016] [Indexed: 11/15/2022]
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Jayaram SC, Muzaffar SJ, Ahmed I, Dhanda J, Paleri V, Mehanna H. Efficacy, outcomes, and complication rates of different surgical and nonsurgical treatment modalities for recurrent/residual oropharyngeal carcinoma: A systematic review and meta-analysis. Head Neck 2016; 38:1855-1861. [PMID: 27405247 DOI: 10.1002/hed.24531] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2016] [Indexed: 12/21/2022] Open
Affiliation(s)
- Sharan Chakkyath Jayaram
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Sayed Jameel Muzaffar
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Ikhlaaq Ahmed
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Jagtar Dhanda
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Vinidh Paleri
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham; Birmingham West Midlands United Kingdom
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Gañán L, López M, García J, Esteller E, Quer M, León X. Management of recurrent head and neck cancer: variables related to salvage surgery. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF OTO-RHINO-LARYNGOLOGICAL SOCIETIES (EUFOS) : AFFILIATED WITH THE GERMAN SOCIETY FOR OTO-RHINO-LARYNGOLOGY - HEAD AND NECK SURGERY 2016. [PMID: 27188507 DOI: 10.1007/s00405‐016‐4093‐3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
After a local and/or regional recurrence of head and neck squamous cell carcinoma (HNSCC) not all patients are candidates to salvage treatment. The objective of this study was to identify the variables related to performance of salvage surgery with curative intent in these patients. We performed a retrospective study of 1088 HNSCC patients with a local and/or regional recurrence. According to a multivariate analysis, the variables related to performance of salvage surgery were the Karnofsky index, the location and extension of the primary tumor, the initial treatment, the disease-free interval between treatment of the initial tumor and diagnosis of the recurrence, and the year the recurrence was diagnosed. Considering salvage surgery as the dependent variable, the results of a recursive partitioning analysis defined four categories of patients in function of the category of local and regional extension of the initial tumor, the location of the primary tumor, the initial treatment and the disease-free interval between treatment of the initial tumor and diagnosis of the recurrence.
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Affiliation(s)
- Laura Gañán
- Otorhinolaryngology Department, Hospital Nostra Senyora de Meritxell, Andorra La Vella, Andorra
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Eduard Esteller
- Otorhinolaryngology Department, Hospital General de Catalunya, Universitat Internacional de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Xavier León
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
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Gañán L, López M, García J, Esteller E, Quer M, León X. Management of recurrent head and neck cancer: variables related to salvage surgery. Eur Arch Otorhinolaryngol 2016; 273:4417-4424. [PMID: 27188507 DOI: 10.1007/s00405-016-4093-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
After a local and/or regional recurrence of head and neck squamous cell carcinoma (HNSCC) not all patients are candidates to salvage treatment. The objective of this study was to identify the variables related to performance of salvage surgery with curative intent in these patients. We performed a retrospective study of 1088 HNSCC patients with a local and/or regional recurrence. According to a multivariate analysis, the variables related to performance of salvage surgery were the Karnofsky index, the location and extension of the primary tumor, the initial treatment, the disease-free interval between treatment of the initial tumor and diagnosis of the recurrence, and the year the recurrence was diagnosed. Considering salvage surgery as the dependent variable, the results of a recursive partitioning analysis defined four categories of patients in function of the category of local and regional extension of the initial tumor, the location of the primary tumor, the initial treatment and the disease-free interval between treatment of the initial tumor and diagnosis of the recurrence.
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Affiliation(s)
- Laura Gañán
- Otorhinolaryngology Department, Hospital Nostra Senyora de Meritxell, Andorra La Vella, Andorra
| | - Montserrat López
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Jacinto García
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Eduard Esteller
- Otorhinolaryngology Department, Hospital General de Catalunya, Universitat Internacional de Catalunya, San Cugat del Vallès, Barcelona, Spain
| | - Miquel Quer
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain
| | - Xavier León
- Otorhinolaryngology Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, c/Mas Casanovas, 90, 08041, Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, Spain.
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Kim R, Ock CY, Keam B, Kim TM, Kim JH, Paeng JC, Kwon SK, Hah JH, Kwon TK, Kim DW, Wu HG, Sung MW, Heo DS. Predictive and prognostic value of PET/CT imaging post-chemoradiotherapy and clinical decision-making consequences in locally advanced head & neck squamous cell carcinoma: a retrospective study. BMC Cancer 2016; 16:116. [PMID: 26884055 PMCID: PMC4756525 DOI: 10.1186/s12885-016-2147-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/08/2016] [Indexed: 12/02/2022] Open
Abstract
Background The accuracy of 18F-fluorodeoxygluocose positron emission tomography/computed tomography (PET/CT) in predicting immediate failure after radical chemoradiotherapy (CRT) for HNSCC is poorly characterized at present. The purpose of this study was to examine PET/CT as a predictive and prognostic gauge of immediate failure after CRT and determine the impact of these studies on clinical decision making in terms of salvage surgery. Methods Medical records of 78 consecutive patients receiving radical CRT for locally advanced HNSCC were reviewed, analyzing PET/CTs done before and 3 months after CRT. Immediate failure was defined as residual disease or locoregional and/or systemic relapse within 6 months after CRT. Results Maximum standard uptake value (SUV) of post CRT PET/CT (postSUVmax) was found optimal for predicting immediate failure at a cutpoint of 4.4. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were 90.0 %, 83.8 %, 98.3 %, and 45.0 %, respectively. Of 78 patients studied, postSUVmax ≥4.4 prevailed in 20 (25.6 %), with postSUVmax <4.4 in 58 (74.4 %). At postSUVmax ≥4.4 (vs. postSUVmax <4.4) OS was poorer by comparison (3-year OS: 56.9 vs. 87.7 %; P = 0.005), as was progression-free survival (3-year PFS: 42.9 vs. 81.1 %; P < 0.001). At postSUVmax ≥4.4, OS with and without immediate salvage surgery did not differ significantly (3-year OS: 60.0 vs. 55.6 %; Log-rank P = 0.913). Conclusion Post CRT PET/CT imaging has prognostic value in terms of OS and PFS and is useful in predicting immediate therapeutic failure, given its high NPV. However, OS was not significantly altered by early salvage surgery done on the basis of post CRT PET/CT findings. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2147-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ryul Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea.
| | - Chan-Young Ock
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea.
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
| | - Jin Chul Paeng
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Seong Keun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea.
| | - J Hun Hah
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea.
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea.
| | - Dong-Wan Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.
| | - Myung-Whun Sung
- Department of Otorhinolaryngology, Seoul National University Hospital, Seoul, Korea.
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 110-744, Seoul, Korea. .,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Dabas S, Dewan A, Ranjan R, Dewan AK, Shukla H, Sinha R. Salvage Transoral Robotic Surgery for Recurrent or Residual Head and Neck Squamous Cell Carcinoma: A Single Institution Experience. Asian Pac J Cancer Prev 2015; 16:7627-32. [DOI: 10.7314/apjcp.2015.16.17.7627] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Al-Wassia R, Vakilian S, Holly C, Sultanem K, Shenouda G. A retrospective study of head and neck re-irradiation for patients with recurrent or second primary head and neck cancer: the McGill University experience. J Otolaryngol Head Neck Surg 2015; 44:31. [PMID: 26330008 PMCID: PMC4557220 DOI: 10.1186/s40463-015-0084-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 08/23/2015] [Indexed: 11/13/2022] Open
Abstract
Background We report our experience with patients who received re-irradiation to the head and neck area for locoregional recurrences (LRR) or second primaries (SP) in a previously irradiated field. Methods We reviewed 27 consecutive patients with a diagnosis of LRR or SP head and neck carcinoma treated with a second course of radiotherapy between April 2004 and July 2012. The main outcome measures were local control, overall survival, and complications. The results are expressed as actuarial values using the Kaplan–Meier estimates. Results The median follow-up time was 24.7 months (range: 11 days–79.3 months). There were 23 males and four females with a median age of 61 years (range: 40–87 years). The actuarial overall survival rates at 1, 2, and 5 years were 77, 59, and 57 %, respectively. The actuarial local control rate was 80, 52, and 52 % at 1, 2, and 5 years, respectively. Three patients developed systemic metastases. The rate of grade 3 toxicity was 26 %, and that of grade 4 toxicity was 3 %. There were two treatment-related deaths (grade 5 toxicity). Conclusions Continuous course re-irradiation in patients with LRR or SP head and neck cancer is feasible with acceptable toxicity. With current encouraging rates of local control and overall survival, this option should be discussed with patients who have few alternative therapeutic options.
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Affiliation(s)
- Rolina Al-Wassia
- Department of Radiation Oncology, King Abdulaziz University, Abdullah Suleiman Street, P.O Box 80200, 21589, Jeddah, Saudi Arabia.
| | - Siavosh Vakilian
- Department of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, Québec, Canada.
| | - Crystal Holly
- Department of Clinical Epidemiology, McGill University, Montreal, Québec, Canada.
| | - Khalil Sultanem
- Radiation Oncology, Segal Cancer Centre, Sir Mortimer B. Davis Jewish General Hospital, McGill University, Montreal, Québec, Canada.
| | - George Shenouda
- Department of Radiation Oncology, McGill University Health Centre, McGill University, Montreal, Québec, Canada.
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Patel SN, Cohen MA, Givi B, Dixon BJ, Gilbert RW, Gullane PJ, Brown DH, Irish JC, de Almeida JR, Higgins KM, Enepekides D, Huang SH, Waldron J, O'Sullivan B, Xu W, Su S, Goldstein DP. Salvage surgery for locally recurrent oropharyngeal cancer. Head Neck 2015; 38 Suppl 1:E658-64. [DOI: 10.1002/hed.24065] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Samip N. Patel
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - Marc A. Cohen
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - Babak Givi
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - Benjamin J. Dixon
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - Ralph W. Gilbert
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - Patrick J. Gullane
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - Dale H. Brown
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - Jonathan C. Irish
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - John R. de Almeida
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
| | - Kevin M. Higgins
- Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology; Sunnybrook Odette Cancer Centre, University of Toronto; Toronto Ontario Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery and Surgical Oncology; Sunnybrook Odette Cancer Centre, University of Toronto; Toronto Ontario Canada
| | - Shao Hui Huang
- Department of Radiation Oncology; Princess Margaret Cancer Center, University of Toronto; Toronto Ontario Canada
| | - John Waldron
- Department of Radiation Oncology; Princess Margaret Cancer Center, University of Toronto; Toronto Ontario Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology; Princess Margaret Cancer Center, University of Toronto; Toronto Ontario Canada
| | - Wei Xu
- Department of Biostatistics; Princess Margaret Cancer Center, University of Toronto; Toronto Ontario Canada
| | - Susie Su
- Department of Biostatistics; Princess Margaret Cancer Center, University of Toronto; Toronto Ontario Canada
| | - David P. Goldstein
- Department of Otolaryngology-Head and Neck Surgery; New York University; New York NY
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Laccourreye O, Malinvaud D, Holostenco V, Ménard M, Garcia D, Bonfils P. Value and limits of non-robotic transoral oropharyngectomy for local control of T1-2 invasive squamous cell carcinoma of the tonsillar fossa. Eur Ann Otorhinolaryngol Head Neck Dis 2015; 132:141-6. [DOI: 10.1016/j.anorl.2015.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Squamous cell carcinoma of the oropharynx: single-institution outcome analysis of patients treated with concurrent chemoradiotherapy. The Journal of Laryngology & Otology 2015; 129 Suppl 2:S77-82. [DOI: 10.1017/s0022215114002448] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractPurpose:The object of this study was to analyse our experience with the effects of concurrent chemoradiotherapy for oropharyngeal squamous cell carcinoma, the treatment results of this therapeutic strategy and a salvage treatment for recurrent oropharyngeal squamous cell carcinoma.Methods:Seventy-five patients with oropharyngeal squamous cell carcinoma were treated with chemoradiotherapy. The study included twenty-five of these patients who had recurrent oropharyngeal squamous cell carcinoma after chemoradiotherapyResults:The three-year actuarial survival rates for 75 patients by disease stage were as follows: stage II, 100 per cent; stage III, 71.1 per cent; stage IV, 51.7 per cent and overall, 58.2 per cent. The mean time of detection of recurrence was 6.2 months. The total salvage rates of recurrence were 21 per cent. The one and three-year tumour-free actuarial survival rates of those patients who received salvage treatment were 83 and 33 per cent.Conclusions:Surgical salvage was only feasible for early recurrent tumour. Close follow-up surveillance of early recurrence is essential after primary treatment of patients with chemoradiotherapy.
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Preliminary results of CyberKnife stereotactic radiotherapy (SBRT) boost for primary head and neck cancers: is it the future direction? JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396914000521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AbstractAimTo analyse the preliminary results of CyberKnife stereotactic radiotherapy (SBRT) boost in primary head and neck cancer patients among Indian population.Methods and materialsA total of nine patients of primary head and neck cancer were treated with CyberKnife SBRT boost after intensity-modulated radiation therapy (IMRT). The median phase 1 IMRT dose was 54 Gy/27 fractions. Histological types included squamous cell carcinoma (n=7) and adenoid cystic carcinoma (n=2). Response was evaluated using positron emission tomography/computed tomography and detailed clinical examination.ResultsAs a preliminary analysis with median follow up of 8 months (range: 6–19 months), phase 2 median tumour volume of 16·3 cc and a median dose of 5 Gy per fraction, eight patients had loco-regionally stable disease and one had distant metastasis. With objective assessment five patients had complete response. Treatment was well tolerated with no grade 3 or more acute toxicities directly related to CyberKnife boost.ConclusionCyberKnife SBRT boost is an attractive option for primary head and neck cancers especially where disease is in close proximity to critical structures hindering radical dose delivery. Future prospective analysis and optimum assessment of total biological effective dose (BED) in a properly selected case might actually benefit the use of CyberKnife SBRT boost.
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Adams AK, Wise-Draper TM, Wells SI. Human papillomavirus induced transformation in cervical and head and neck cancers. Cancers (Basel) 2014; 6:1793-820. [PMID: 25226287 PMCID: PMC4190568 DOI: 10.3390/cancers6031793] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 08/13/2014] [Accepted: 08/25/2014] [Indexed: 12/18/2022] Open
Abstract
Human papillomavirus (HPV) is one of the most widely publicized and researched pathogenic DNA viruses. For decades, HPV research has focused on transforming viral activities in cervical cancer. During the past 15 years, however, HPV has also emerged as a major etiological agent in cancers of the head and neck, in particular squamous cell carcinoma. Even with significant strides achieved towards the screening and treatment of cervical cancer, and preventive vaccines, cervical cancer remains the leading cause of cancer-associated deaths for women in developing countries. Furthermore, routine screens are not available for those at risk of head and neck cancer. The current expectation is that HPV vaccination will prevent not only cervical, but also head and neck cancers. In order to determine if previous cervical cancer models for HPV infection and transformation are directly applicable to head and neck cancer, clinical and molecular disease aspects must be carefully compared. In this review, we briefly discuss the cervical and head and neck cancer literature to highlight clinical and genomic commonalities. Differences in prognosis, staging and treatment, as well as comparisons of mutational profiles, viral integration patterns, and alterations in gene expression will be addressed.
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Affiliation(s)
- Allie K Adams
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA.
| | - Susanne I Wells
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Salvage surgery for head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2014; 271:1845-50. [DOI: 10.1007/s00405-014-3043-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 03/31/2014] [Indexed: 02/04/2023]
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Strojan P, Corry J, Eisbruch A, Vermorken JB, Mendenhall WM, Lee AWM, Haigentz M, Beitler JJ, de Bree R, Takes RP, Paleri V, Kelly CG, Genden EM, Bradford CR, Harrison LB, Rinaldo A, Ferlito A. Recurrent and second primary squamous cell carcinoma of the head and neck: when and how to reirradiate. Head Neck 2014; 37:134-50. [PMID: 24481720 DOI: 10.1002/hed.23542] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/22/2013] [Accepted: 10/30/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Local and/or regional recurrence and metachronous primary tumor arising in a previously irradiated area are rather frequent events in patients with head and neck squamous cell carcinoma (HNSCC). Re-treatment is associated with an increased risk of serious toxicity and impaired quality of life (QOL) with an uncertain survival advantage. METHODS We analyzed the literature on the efficacy and toxicity of photon/electron-based external beam reirradiation for previously irradiated patients with HNSCC of non-nasopharyngeal origin. Studies were grouped according to the radiotherapy technique used for reirradiation. Patient selection criteria, target volume identification method, tumor dose, fractionation schedule, systemic therapy administration, and toxicities were reviewed. RESULTS In addition to disease-related factors, current comorbidities and preexisting organ dysfunction must be considered when selecting patients for reirradiation. As morbidity from re-treatment may be considerable and differ depending on which mode of re-treatment is used, it is important to give patients information on potential morbidity outcomes so that an informed choice can be made within a shared decision-making context. With improved dose distribution and adequate imaging support, including positron emission tomography-CT, modern radiotherapy techniques may improve local control and reduce toxicity of reirradiation. A reirradiation dose of ≥60 Gy and a volume encompassing the gross tumor with up to a 5-mm margin are recommended. Concomitant administration of systemic therapeutics and reirradiation is likely to be of similar benefit as observed in large randomized studies of upfront therapy. CONCLUSION Reirradiation, administered either with or without concurrent systemic therapy, is feasible and tolerable in properly selected patients with recurrent or a new primary tumor in a previously irradiated area of the head and neck, offering a meaningful survival (in the range of 10% to 30% at 2 years). Whenever feasible, salvage surgery is the method of choice for curative intent; patients at high-risk for local recurrence should be advised that postoperative reirradiation is expected to increase locoregional control at the expense of higher toxicity and without survival advantage compared to salvage surgery without reirradiation. © 2014 Wiley Periodicals, Inc. Head Neck 37: 134-150, 2015.
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Affiliation(s)
- Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
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Patel PR, Salama JK. Reirradiation for recurrent head and neck cancer. Expert Rev Anticancer Ther 2014; 12:1177-89. [DOI: 10.1586/era.12.97] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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