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Mireștean CC, Iancu RI, Iancu DPT. Image Guided Radiotherapy (IGRT) and Delta (Δ) Radiomics-An Urgent Alliance for the Front Line of the War against Head and Neck Cancers. Diagnostics (Basel) 2023; 13:2045. [PMID: 37370940 DOI: 10.3390/diagnostics13122045] [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: 03/15/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
The identification of a biomarker that is response predictive could offer a solution for the stratification of the treatment of head and neck cancers (HNC) in the context of high recurrence rates, especially those associated with loco-regional failure. Delta (Δ) radiomics, a concept based on the variation of parameters extracted from medical imaging using artificial intelligence (AI) algorithms, demonstrates its potential as a predictive biomarker of treatment response in HNC. The concept of image-guided radiotherapy (IGRT), including computer tomography simulation (CT) and position control imaging with cone-beam-computed tomography (CBCT), now offers new perspectives for radiomics applied in radiotherapy. The use of Δ features of texture, shape, and size, both from the primary tumor and from the tumor-involved lymph nodes, demonstrates the best predictive accuracy. If, in the case of treatment response, promising Δ radiomics results could be obtained, even after 24 h from the start of treatment, for radiation-induced xerostomia, the evaluation of Δ radiomics in the middle of treatment could be recommended. The fused models (clinical and Δ radiomics) seem to offer benefits, both in comparison to the clinical model and to the radiomic model. The selection of patients who benefit from induction chemotherapy is underestimated in Δ radiomic studies and may be an unexplored territory with major potential. The advantage offered by "in house" simulation CT and CBCT favors the rapid implementation of Δ radiomics studies in radiotherapy departments. Positron emission tomography (PET)-CT Δ radiomics could guide the new concepts of dose escalation on radio-resistant sub-volumes based on radiobiological criteria, but also guide the "next level" of HNC adaptive radiotherapy (ART).
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Affiliation(s)
- Camil Ciprian Mireștean
- Department of Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
- Department of Surgery, Railways Clinical Hospital Iasi, 700506 Iași, Romania
| | - Roxana Irina Iancu
- Oral Pathology Department, "Gr. T. Popa" Faculty of Dental Medicine, University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Clinical Laboratory, "St. Spiridon" Emergency Universitary Hospital, 700111 Iași, Romania
| | - Dragoș Petru Teodor Iancu
- Oncology and Radiotherapy Department, Faculty of Medicine, "Gr. T. Popa" University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Radiation Oncology, Regional Institute of Oncology, 700483 Iași, Romania
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Keil F, Hartl M, Altorjai G, Berghold A, Riedl R, Pecherstorfer M, Mayrbäurl B, De Vries A, Schuster J, Hackl J, Füreder T, Melchardt T, Burian M, Greil R. Docetaxel, cisplatin and 5-FU compared with docetaxel, cisplatin and cetuximab as induction chemotherapy in advanced squamous cell carcinoma of the head and neck: Results of a randomised phase II AGMT trial. Eur J Cancer 2021; 151:201-210. [PMID: 34022697 DOI: 10.1016/j.ejca.2021.03.051] [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: 07/22/2020] [Revised: 03/11/2021] [Accepted: 03/27/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE Induction chemotherapy (ICT) with cisplatin (P), 5-FU (F) and taxanes (T) is a therapeutical option in patients suffering from locally advanced or unresectable stage III or IV squamous cell carcinoma of the head and neck (SCCHN). The role of ICT is controversial, and toxicity and/or delay of radiotherapy (RT) may reduce the potential benefit of this treatment regimen. Here, we report the results of a randomised phase II trial comparing TPF with TP + cetuximab (C). PATIENTS AND METHODS In this trial, 100 patients with locally advanced stage III or IV SCCHN were included in the analysis. Patients were randomly assigned to either TPF-ICT (N = 49) or TPC-ICT (N = 51), both followed by RT + C. The primary end-point of the study was overall response rate (ORR) three months after RT + C was finished. RESULTS On an intention-to-treat basis, the ORR (complete remission + partial remission) was 74.5% in the TPC arm compared with 63.3% in the TPF arm (p = 0.109). OS was similar in both arms 400 days after treatment was initiated (86.1% [95% confidence interval {CI}, 73.0-93.1%] in the TPC arm and 78.5% [95% CI, 63.7-87.8%] in the TPF arm). TPC resulted in slightly less serious adverse events and in less haematological, but more skin toxicities. Two patients randomised in the TPC arm died during ICT and RT. Four patients in the TPF arm died after completion of RT. No delay from the end of ICT to RT + C was observed. A total of 83.1% of patients (80% in the TPC arm; 86% in the TPF arm) received RT without dose reduction and/or modification. CONCLUSION TPC-containing ICT for patients with locally advanced SCCHN was found to be an effective and tolerable one-day regimen. Further prospective evidence from larger trials is warranted.
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Affiliation(s)
- Felix Keil
- Medical Dept. Int. Med. 3, Hematology and Oncology, Hanusch-Krankenhaus, Heinrich-Collin-Straße 30, Wien, A-1140, Austria.
| | - Maximilian Hartl
- Department of Otolaryngology, Head and Neck Surgery, Hospital of Bamherzigen Schwestern, Linz, Seilerstätte 4, Linz, A-4010, Austria
| | - Gabriela Altorjai
- Medical University Vienna, University Clinic of Radiation Therapy and Radiation Biology, General Hospital of Vienna, Währinger Gürtel 18-20, Wien, A-1090, Austria
| | - Andrea Berghold
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Auenbruggerplatz 2, Graz, A-8036, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Auenbruggerplatz 2, Graz, A-8036, Austria
| | - Martin Pecherstorfer
- University Clinic of Internal Medicine II, Department of Hematology and Oncology, Mitterweg 10, Krems, A-3500, Austria
| | - Beate Mayrbäurl
- Department of Internal Medicine IV, Hematology, Internal Oncology and Palliative Medicine, Nephrology and Dialysis, Hospital of Wels-Grieskirchen, Grieskirchner Straße 42, Wels, A-4600, Austria
| | - Alexander De Vries
- Radiation Therapy LKH Feldkirch, Carinagasse 47, Feldkirch, A-6807, Austria
| | - Judith Schuster
- Arbeitsgemeinschaft Medikamento¨se Tumortherapie gemeinnu¨tzige GmbH, Wolfsgartenweg 31, A-5020 Salzburg, Austria
| | - Jutta Hackl
- Kepler University Clinic of Internal Medicine II, Department of Hematology and Oncology, Krankenhausstraße 7a, Linz, A-4020, Austria
| | - Thorsten Füreder
- Medical University of Vienna, Department of Internal Medicine I & Comprehensive Cancer Center Division of Oncology, General Hospital of Vienna, Währinger Gürtel 18-20, Wien, A-1090, Austria
| | - Thomas Melchardt
- 3rd Medical Department with Hematology and Medical Oncology, Paracelsus Medical University Salzburg and Salzburg Cancer Research Institute-CCCIT, Salzburg, Austria
| | - Martin Burian
- Department of Otolaryngology, Head and Neck Surgery, Hospital of Bamherzigen Schwestern, Linz, Seilerstätte 4, Linz, A-4010, Austria
| | - Richard Greil
- Paracelsus Medical University, Internal Medicine III, Hematology & Medical Oncology, Mu¨llner Hauptstraße 48, A-5020 Salzburg, Austria; Salzburg Cancer Research Institute-CCCIT and Cancer Cluster Salzburg, Austria
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Wei XF, Srivastava A, Lin P, Li L, Zhang S, Peng X, Liu C, Liu L, Wu LR, Li GJ, Li YC. Neoadjuvant chemotherapy as a comprehensive treatment in patients with laryngeal and hypopharyngeal carcinoma. Acta Otolaryngol 2020; 140:603-609. [PMID: 32186224 DOI: 10.1080/00016489.2020.1737330] [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] [Indexed: 10/24/2022]
Abstract
Background: Neoadjuvant chemotherapy is important for advanced laryngeal and hypopharyngeal carcinoma (LHC).Aims/objectives: To determine the efficacy and toxicity of the combination of docetaxel, nedaplatin, and 5-fluorouracil in induction treatment of advanced LHC.Material and methods: A total of 157 cancer patients were included. The primary endpoints of this study were overall response rate, pathological complete response rate, the safety of induction treatment, progression-free survival (PFS), and overall survival (OS).Results: After two-cycle induction treatment, 17(10.8%) patients experienced complete remission, 76 (48.4%) experienced partial remission, 47 (30.0%) had stable disease, and 17 (10.8%) had progressive disease. The TNM stage decreased by two or more in 17 cases, decreased by one in 71 cases, increased in 15 cases, and did not change in 54 cases after induction treatment. Most of the adverse chemotherapy responses were alleviated by symptomatic management. After the induction treatment, 29 patients continued receiving chemotherapy followed by radiotherapy, and 112 underwent surgical management depending on tumor site followed by radiotherapy. The median PFS was 13.00 ± 2.10 months and the median OS was 14.20 ± 0.29 months.Conclusions and significance: Combination of docetaxel, nedaplatin, and 5-fluorouracil plays an important role in the comprehensive treatment of advanced LHC.
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Affiliation(s)
- Xian-Feng Wei
- Department of Otorhinolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China
| | - Akanksha Srivastava
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peng Lin
- Department of Otorhinolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China
| | - Li Li
- Department of Otorhinolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China
| | - Shengchi Zhang
- Department of Otorhinolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China
| | - Xin Peng
- Department of Otorhinolaryngology Head and Neck, Tianjin First Central Hospital, Tianjin, China
| | - Chuan Liu
- Department of Otorhinolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Limei Liu
- Department of Ophthalmology, Yuhuangding Hospital of Qingdao University, Yantai, China
| | - Li-rong Wu
- Department of Radiation Oncology, Nanjing Medical University Affiliated Cancer Hospital, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Guo-jun Li
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yun-Cheng Li
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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