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Van Abel KM, Quick MH, Graner DE, Lohse CM, Price DL, Price KAR, Ma DJ, Moore EJ. Outcomes following TORS for HPV-positive oropharyngeal carcinoma: PEGs, tracheostomies, and beyond. Am J Otolaryngol 2019; 40:729-734. [PMID: 31303455 DOI: 10.1016/j.amjoto.2019.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/02/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To review swallowing, airway and speech outcomes following transoral robotic surgery (TORS) ± adjuvant therapy for human papillomavirus associated oropharyngeal squamous cell carcinoma (HPV[+]OPSCC). METHODS Patients underwent TORS ± standard adjuvant therapy from 5/1/2007-5/31/2015. Clinical data were recorded and descriptive analysis was performed. RESULTS 267 patients met criteria. All patients underwent surgery at Mayo, however, only 41/81 and 71/119 patients received RT and CRT at a Mayo Clinic site. A PEG was placed in 77 patients (3 prior to any treatment, 74 reactively during adjuvant therapy), with 3 PEG dependent and 3 partially PEG reliant at last follow-up. Tracheostomy was performed in 30 (11%) patients; 28 were decannulated. Swallow evaluations were completed for 20/81 undergoing RT and 50/119 undergoing CRT at a median of 3.8 and 7.6 months post-treatment, respectively. An unrestricted oral diet was reported by 5% following RT and 12% following CRT on the Functional Oral Intake Scale. HN-PSS normalcy of diet scores indicated a diet beyond soft chewable foods for 27% following RT and 46% following CRT. No restriction of place, food, or companion was reported for the HN-PSS for public eating in 13% after RT and 33% after CRT. Aspiration of thin liquid was present in 17% and 28% following RT and CRT, respectively. HN-PSS understandability of speech was "always understandable" in 60% and 63%, following RT and CRT, respectively. Hoarseness was reported in 56% and 45% following RT and CRT respectively. CONCLUSION Long-term PEG and tracheostomy dependence in this cohort is low. However, these outcomes under-represent the decrement in patient speech and swallowing following TORS ± standard adjuvant therapy for HPV(+)OPSCC.
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Affiliation(s)
- Kathryn M Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN 55905, USA.
| | - Melanie H Quick
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN 55905, USA
| | - Darlene E Graner
- Department of Neurology, Mayo Clinic School of Medicine, Rochester, MN 55905, USA
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, MN 55905, USA
| | - Daniel L Price
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN 55905, USA
| | - Katharine A R Price
- Division of Medical Oncology, Mayo Clinic School of Medicine, Rochester, MN 55905, USA
| | - Dan J Ma
- Department of Radiation Oncology, Mayo Clinic School of Medicine, Rochester, MN 55905, USA
| | - Eric J Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, MN 55905, USA
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Quality of life in oropharyngeal cancer: a structured review of the literature. Support Care Cancer 2018; 26:2511-2518. [PMID: 29725802 DOI: 10.1007/s00520-018-4227-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/26/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE To summarize the literature on quality of life (QoL) in patients with oropharyngeal squamous cell carcinoma (OPSCC). METHODS The PubMed database was searched using the inclusion criteria "oropharyngeal cancer," "quality of life," "human," and "English," the exclusion criterion "recurrent," and publication date between January 1, 2005 and October 26, 2015. RESULTS The search yielded 98 articles of which 17 fulfilled all selection criteria. Intensity-modulated radiotherapy (IMRT) showed a better outcome for several QoL domains and was superior to chemoradiotherapy (CRT) in some studies. At 12-month follow up, deterioration of QoL was seen in a smaller proportion of patients after surgery and postoperative radiotherapy (S&PORT) in comparison to CRT. For all treatment modalities, the most important worsening for several QoL domains was seen at 3 months. Stage III/IV patients experienced a greater deterioration of QoL scores for most scores. No consistent results were reported for the correlation between xerostomia assessed with QoL questionnaires and objective swallowing function assessed with modified barium swallow videofluoroscopy. CONCLUSION The different tools used for the assessment of patient-reported QoL and objective measurement of functional outcome make it difficult to evaluate the effect of different treatment modalities. In general, we can conclude that a non-surgical approach is associated with worse QoL scores. IMRT minimizes radiation to the surrounding tissue and therefore has a better outcome in several QoL domains in comparison to conventional RT.
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Pauloski BR, Rademaker AW, Logemann JA, Discekici-Harris M, Mittal BB. Comparison of swallowing function after intensity-modulated radiation therapy and conventional radiotherapy for head and neck cancer. Head Neck 2015; 37:1575-82. [PMID: 24909649 PMCID: PMC4258519 DOI: 10.1002/hed.23796] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/18/2014] [Accepted: 06/04/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) is hoped to protect structures important for swallow function. We compared posttreatment swallow function in 7 pairs of patients with head and neck cancer treated with either IMRT or conventional radiotherapy (RT). METHODS Patients were matched on tumor characteristics. Swallowing function was evaluated with the modified barium swallow procedure pretreatment and at 3 and 6 months postcancer treatment completion. Swallows were analyzed for bolus transit times, bolus residues, laryngeal closure (LAC) duration, cricopharyngeal opening (CPO) duration, and oropharyngeal swallow efficiency (OPSE). Data were analyzed using multifactor repeated measures analysis of variance and adjusted for baseline function. RESULTS Main effect of radiation type was significant for all measures on at least 1 bolus type. Patients treated with IMRT demonstrated shorter bolus transit times, less oral and pharyngeal residue, longer LAC, and larger OPSE. CONCLUSION Patients treated with IMRT demonstrated faster, more efficient swallows, and greater airway protection.
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Affiliation(s)
- Barbara Roa Pauloski
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Alfred W Rademaker
- Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jerilyn A Logemann
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | | | - Bharat B Mittal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Yeh DH, Tam S, Fung K, MacNeil SD, Yoo J, Winquist E, Palma DA, Nichols AC. Transoral robotic surgery vs. radiotherapy for management of oropharyngeal squamous cell carcinoma - A systematic review of the literature. Eur J Surg Oncol 2015; 41:1603-14. [PMID: 26461255 DOI: 10.1016/j.ejso.2015.09.007] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 09/14/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) with or without concurrent chemotherapy is widely utilized for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). However, due to significant acute and late toxicities there has been increasing interest in minimally invasive surgical approaches, particularly transoral robotic surgery (TORS) in an attempt to preserve patient quality of life while maintaining oncologic outcomes. The aim of this study was to review the current literature in order to compare primary IMRT versus TORS in the management of OPSCC. METHODS A MEDLINE search was conducted to identify studies reporting on the outcomes of TORS or IMRT in the treatment of OPSCC. Reference lists were also reviewed for relevant articles. Oncologic, functional, and quality of life data is summarized and discussed. RESULTS One hundred-ninety papers were identified through the MEDLINE search. An additional 52 papers were retrieved by hand searching the reference lists. Ultimately, 44 papers were identified that discussed outcomes after IMRT or TORS for OPSCC. No outcomes from randomized trials were identified. CONCLUSION No randomized trials comparing TORS versus IMRT to each other were identified. Uncontrolled reports from the current literature suggest comparable oncologic outcomes with TORS compared to IMRT and functional outcomes may be superior. However, the median follow-up was relatively short and the TORS studies included patients with earlier stage OPSCC on average compared to IMRT studies. Prospective, randomized controlled trials and direct, well-matched comparisons are needed to further elucidate the role for TORS in the treatment of oropharyngeal squamous cell carcinoma.
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Affiliation(s)
- D H Yeh
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada
| | - S Tam
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada
| | - K Fung
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - S D MacNeil
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - J Yoo
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
| | - E Winquist
- London Health Sciences Centre, London, Ontario, Canada; Division of Medical Oncology, Western University, London, Ontario Canada
| | - D A Palma
- London Health Sciences Centre, London, Ontario, Canada; Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - A C Nichols
- Department of Otolaryngology Head & Neck Surgery, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada
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Kraaijenga SAC, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol 2014; 272:3521-31. [PMID: 25381096 DOI: 10.1007/s00405-014-3379-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/25/2014] [Indexed: 11/30/2022]
Abstract
Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.
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Affiliation(s)
- Sophie A C Kraaijenga
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Irene Jacobi
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT, Amsterdam, The Netherlands. .,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Current assessment and treatment strategies of dysphagia in head and neck cancer patients. Curr Opin Support Palliat Care 2014; 8:152-63. [DOI: 10.1097/spc.0000000000000050] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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de Almeida JR, Villanueva NL, Moskowitz AJ, Miles BA, Teng MS, Sikora A, Gupta V, Posner M, Genden EM. Preferences and utilities for health states after treatment for oropharyngeal cancer: Transoral robotic surgery versus definitive (chemo)radiotherapy. Head Neck 2014; 36:923-33. [DOI: 10.1002/hed.23340] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 01/01/2013] [Accepted: 04/05/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- John R. de Almeida
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Nathaniel L. Villanueva
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Alan J. Moskowitz
- Departments of Health Evidence and Policy and Medicine; Mount Sinai Medical Center; New York New York
| | - Brett A. Miles
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Marita S. Teng
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Andrew Sikora
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
| | - Vishal Gupta
- Department of Radiation Oncology; Mount Sinai Medical Center; New York New York
| | - Marshall Posner
- Department of Medical Oncology; Mount Sinai Medical Center; New York New York
| | - Eric M. Genden
- Department of Otolaryngology-Head and Neck Surgery; Mount Sinai Medical Center; New York New York
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van der Molen L, van Rossum MA, Rasch CRN, Smeele LE, Hilgers FJM. Two-year results of a prospective preventive swallowing rehabilitation trial in patients treated with chemoradiation for advanced head and neck cancer. Eur Arch Otorhinolaryngol 2013; 271:1257-70. [PMID: 23892729 DOI: 10.1007/s00405-013-2640-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/12/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands,
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Impact of p16, p53, smoking, and alcohol on survival in patients with oropharyngeal squamous cell carcinoma treated with primary intensity-modulated chemoradiation. Head Neck 2013; 35:1698-706. [DOI: 10.1002/hed.23231] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2012] [Indexed: 02/06/2023] Open
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10
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Hess CB, Chen AM. Global and health-related quality of life after intensity-modulated radiation therapy for head and neck cancer. Expert Rev Anticancer Ther 2012; 12:1469-77. [PMID: 23249111 DOI: 10.1586/era.12.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study aims to evaluate the current literature regarding the effects of conventional radiation therapy (CRT) versus intensity-modulated radiation therapy (IMRT) on global quality of life (QoL) among patients treated for head and neck cancer. A PubMed literature review was performed. Only articles comparing global QoL scores in head and neck cancer patients treated with CRT versus IMRT were included. Studies were scrutinized for methodology, level of evidence and limitations. Outcomes were evaluated for external validity, level of evidence and applicability. Between 2005 and 2012, 14 eligible studies (six prospective, two randomized controlled trials) were identified. Although all presented data comment on the advantages of IMRT, differences in study design made comparisons difficult. The vast majority of these were also limited by relatively small sample sizes and heterogeneity with respect to patient and treatment-related characteristics. Although more robust evidence is needed in the future, the published data reasonably support the benefits of IMRT as compared with CRT (either 2D or 3D) in improving QoL, beginning at approximately 3-6 months post-treatment, and possibly potentiating with time up to 2 and 3 years.
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Affiliation(s)
- Clayton B Hess
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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11
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Broglie MA, Soltermann A, Haile SR, Röösli C, Huber GF, Schmid S, Stoeckli SJ. Quality of life of oropharyngeal cancer patients with respect to treatment strategy and p16-positivity. Laryngoscope 2012; 123:164-70. [DOI: 10.1002/lary.23622] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2012] [Indexed: 11/12/2022]
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12
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Reitzel LR, Nguyen N, Zafereo ME, Li G, Wei Q, Sturgis EM. Neighborhood deprivation and clinical outcomes among head and neck cancer patients. Health Place 2012; 18:861-8. [PMID: 22445028 DOI: 10.1016/j.healthplace.2012.03.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/03/2012] [Accepted: 03/04/2012] [Indexed: 11/17/2022]
Abstract
The unique effects of neighborhood-level economic deprivation on survival, recurrence, and second primary malignancy development were examined using adjusted Cox proportional hazards regression models among 1151 incident squamous cell carcinomas of the head and neck patients. Cancer site was examined as a potential moderator. Main analyses yielded null results; however, interaction analyses indicated poorer overall survival [HR=1.59 (1.00-2.53)] and greater second primary malignancy development [HR=2.99 (1.46-6.11)] among oropharyngeal cancer patients from highly deprived neighborhoods relative to less deprived neighborhoods. Results suggest a dual focus on individual and neighborhood risk factors could help improve clinical outcomes among oropharyngeal cancer patients.
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Affiliation(s)
- Lorraine R Reitzel
- Department of Health Disparities Research-Unit 1440, PO Box 301402, University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1402, USA.
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A Clinical Concept for Interfractional Adaptive Radiation Therapy in the Treatment of Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2012; 82:590-6. [DOI: 10.1016/j.ijrobp.2010.10.072] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 10/22/2010] [Accepted: 10/28/2010] [Indexed: 11/22/2022]
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Tribius S, Bergelt C. Intensity-modulated radiotherapy versus conventional and 3D conformal radiotherapy in patients with head and neck cancer: is there a worthwhile quality of life gain? Cancer Treat Rev 2011; 37:511-9. [PMID: 21324605 DOI: 10.1016/j.ctrv.2011.01.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Revised: 01/11/2011] [Accepted: 01/20/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) is a technique that allows delivery of lower doses of radiation to normal tissue, while maintaining or increasing the tumour dose, compared with two-dimensional radiotherapy (2DRT) or three-dimensional conformal radiotherapy (3DCRT). This review of published data was undertaken to assess whether IMRT is associated with quality of life (QoL) benefits versus 2DRT and 3DCRT. DESIGN English-language literature published between January 2005 and August 2010 was searched for studies comparing IMRT versus 2DRT or 3DCRT in head and neck cancers that included QoL evaluation. Fourteen studies (five prospective and nine retrospective) were identified, two in abstract form only. Only one study was randomised. Studies included patients with nasopharyngeal cancer only, oropharyngeal cancer only and mixed populations. RESULTS The EORTC QLQ-C30 was the most widely used instrument, generally supplemented with the head and neck cancer module H&N35. IMRT was associated with statistically significant improvements in certain QoL domains versus 2DRT and 3DCRT, particularly those relating to xerostomia, including dry mouth, sticky saliva and eating-related domains. Improvements in global QoL were also observed in the IMRT groups in some studies. CONCLUSION Based on the studies reviewed, patients treated with IMRT experience statistically significant improvements in several important QoL domains versus 2DRT and 3DCRT. However, studies included heterogeneous populations, different timepoints for measurements and a variety of instruments for QoL assessment. Accepting the difficulties in execution, IMRT should be compared with 3DCRT in prospective randomised studies in homogeneous patient populations, using appropriate QoL assessments and clinical end points, to establish if IMRT provides enough value for the additional resources involved.
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Affiliation(s)
- Silke Tribius
- Department of Radiation Oncology, University Medical Center, Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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15
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Clavel S, Nguyen DHA, Fortin B, Després P, Khaouam N, Donath D, Soulières D, Guertin L, Nguyen-Tan PF. Simultaneous integrated boost using intensity-modulated radiotherapy compared with conventional radiotherapy in patients treated with concurrent carboplatin and 5-fluorouracil for locally advanced oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2011; 82:582-9. [PMID: 21277695 DOI: 10.1016/j.ijrobp.2010.10.061] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Revised: 10/03/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare, in a retrospective study, the toxicity and efficacy of simultaneous integrated boost using intensity-modulated radiotherapy (IMRT) vs. conventional radiotherapy (CRT) in patients treated with concomitant carboplatin and 5-fluorouracil for locally advanced oropharyngeal cancer. METHODS AND MATERIALS Between January 2000 and December 2007, 249 patients were treated with definitive chemoradiation. One hundred patients had 70 Gy in 33 fractions using IMRT, and 149 received CRT at 70 Gy in 35 fractions. Overall survival, disease-free survival, and locoregional control were estimated using the Kaplan-Meier method. RESULTS Median follow-up was 42 months. Three-year actuarial rates for locoregional control, disease-free survival, and overall survival were 95.1% vs. 84.4% (p = 0.005), 85.3% vs. 69.3% (p = 0.001), and 92.1% vs. 75.2% (p < 0.001) for IMRT and CRT, respectively. The benefit of the radiotherapy regimen on outcomes was also observed with a Cox multivariate analysis. Intensity-modulated radiotherapy was associated with less acute dermatitis and less xerostomia at 6, 12, 24, and 36 months. CONCLUSIONS This study suggests that simultaneous integrated boost using IMRT is associated with favorable locoregional control and survival rates with less xerostomia and acute dermatitis than CRT when both are given concurrently with chemotherapy.
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Affiliation(s)
- Sébastien Clavel
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
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Chu KP, Shema S, Wu S, Gomez SL, Chang ET, Le QT. Head and neck cancer-specific survival based on socioeconomic status in Asians and Pacific Islanders. Cancer 2010; 117:1935-45. [PMID: 21509771 DOI: 10.1002/cncr.25723] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 09/13/2010] [Accepted: 09/13/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Lower socioeconomic status (SES) has been linked to higher incidence of head and neck cancer (HNC) and lower survival. However, little is known about the effect of SES on HNC survival in Asians and Pacific Islanders (APIs). This study's purpose was to examine the effect of SES on disease-specific survival (DSS) and overall survival (OS) in APIs with HNC using population-based data. METHODS A total of 53,544 HNC patients (4,711 = APIs) were identified from the California Cancer Registry from 1988 to 2007. Neighborhood (block-group-level) SES, based on composite Census 1990 and 2000 data, was calculated for each patient based on address at diagnosis, categorized into statewide quintiles, and collapsed into 2 groups for comparison (low SES = quintiles 1-3; high SES = quintiles 4-5). DSS and OS were computed by the Kaplan-Meier method. Adjusted hazards ratios (HR) were estimated using Cox proportional hazards regression models. RESULTS Among APIs, lower neighborhood SES was significantly associated with poorer DSS (HR range for oral cavity, oropharynx, or larynx/hypopharynx cancer, 1.07-1.34) and OS (HR, 1.13-1.37) after adjusting for patient and tumor characteristics. Lower SES was significantly associated with poorer survival in API with all HNC sites combined: DSS HR: 1.26 (95% confidence interval [CI], 1.08-1.48) and OS HR, 1.30 (95% CI, 1.16-1.45). CONCLUSIONS Neighborhood SES was associated with longer DSS and OS in API with HNC. The effect of SES on HNC survival should be considered in future studies, and particular attention should be paid to clinical care of lower-SES HNC patients.
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Affiliation(s)
- Karen P Chu
- Stanford University Medical Center, Stanford, California 94305-5847, USA
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