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Mao W, Zhang T, Li L, Peng S, Gong H, Li M. Role of primary tumor volume and metastatic lymph node volume in response to curative effect of definitive radiotherapy for locally advanced head and neck cancer. Eur J Med Res 2024; 29:98. [PMID: 38311769 PMCID: PMC10840279 DOI: 10.1186/s40001-024-01691-0] [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: 09/02/2023] [Accepted: 01/20/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Studies have shown mixed results concerning the role of primary tumor volume (TV) and metastatic lymph node (NV) volume in response to the curative effect of definitive radiotherapy for locally advanced head and neck squamous cell carcinoma (LAHNSCC). OBJECTIVE We aimed to evaluate the impact of TV and NV on the efficacy of radical radiotherapy in LAHNSCC patients, with the goal of guiding individualized therapy. PATIENTS AND METHODS Patients with LAHNSCC who received radical radiation therapy and were reexamined within 6 months post-therapy from January 2012 to December 2021 were selected. The volumes of the primary tumors and metastatic lymph nodes were calculated by software and then were divided into a large TV group vs small TV group and a large NV group vs small NV group according to the relationship with the median. Additionally, patients who received concurrent chemoradiotherapy (CCRT) or not were divided into the CCRT group and the radiotherapy (RT) group. Patients with lymph node metastasis were divided into node concurrent chemotherapy (N-CCRT) group and a node metastatic chemotherapy (N-RT) group according to whether they received concurrent chemotherapy or not. The volume shrinkage rate (VSR), objective response rate (ORR), local control rate (LCR) and overall survival (OS) were recorded and analyzed. RESULTS 96 patients were included in the primary tumor volume group, and 73 patients were included in the metastatic lymph node group. Receiver operating characteristic (ROC) curves were constructed for objective remission (OR) endpoints, and a volume threshold was defined for TV and NV patients. The threshold primary tumor volume was 32.45 cm3, and the threshold metastatic lymph node volume was 6.05 cm3.The primary TV shrinkage rates of the small TV and the large TV groups were basically the same, P = 0.801. Similarly, the ORR and LCR were not significantly different between the small TV group and the large TV group (PORR = 0.118, PLCR = 0.315). Additionally, the TV shrinkage rate did not significantly differ between the CCRT group and the RT group, P = 0.133. Additionally, there was no significant difference in ORR or LCR in CCRT group (PORR = 0.057, PLCR = 0.088). However, the metastatic lymph node volume shrinkage rate in the small NV group was significantly greater than that in the large NV group (P = 0.001). The ORR and LCR of the small NV subgroup were significantly greater than those of the large NV subgroup (PORR = 0.002, PLCR = 0.037). Moreover, compared with that of the N-RT group, the NV shrinkage rate of the N-CCRT group was 84.10 ± s3.11%, and the shrinkage rate was 70.76 ± s5.77% (P = 0.047). For the ORR and LCR, the N-CCRT group and N-RT group were significantly different (PORR = 0.030, PLCR = 0.037). The median OS of the whole group was 26 months. However, neither TV/NV nor concurrent chemotherapy seemed to influence OS. CONCLUSION Primary tumor volume is not a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Nevertheless, metastatic lymph nodes are a prognostic factor for the response to curative effect radiotherapy in LAHNSCC patients. Patients with smaller lymph nodes have better local control.
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Affiliation(s)
- Weiling Mao
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
- Department of Oncology, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Tao Zhang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Longhao Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Siyun Peng
- Department of Sociology, Indiana University, Bloomington, IN, USA
| | - Huiying Gong
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Minmin Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Chen X, Zhang L, Lu H, Tan Y, Li B. Development and validation of a nomogram to predict cervical lymph node metastasis in head and neck squamous cell carcinoma. Front Oncol 2024; 13:1174457. [PMID: 38282669 PMCID: PMC10811551 DOI: 10.3389/fonc.2023.1174457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 12/12/2023] [Indexed: 01/30/2024] Open
Abstract
Background Head and neck cancers are a heterogeneous, aggressive, and genetically complex collection of malignancies of the oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, paranasal sinuses and salivary glands, which are difficult to treat. Regional lymph nodes metastasis is a significant poor prognosis factor for head and neck squamous cell carcinoma. Metastasis to the regional lymph nodes reduces the 5-year survival rate by 50% compared with that of patients with early-stage disease. Accurate evaluation of cervical lymph node is a vital component in the overall treatment plan for patients with squamous cell carcinoma of the head and neck. However, current models are struggle to accurately to predict cervical lymph node metastasis. Here, we analyzed the clinical, imaging, and pathological data of 272 patients with HNSCC confirmed by postoperative pathology and sought to develop and validate a nomogram for prediction of lymph node metastasis in patients with head and neck squamous cell carcinoma. Methods We retrospectively analyzed the clinical, imaging, and pathological data of 272 patients with head and neck squamous cell carcinoma (HNSCC) confirmed by postoperative pathology at the Affiliated Hospital of Qingdao University from June 2017 to June 2021. Patients were randomly divided into the training and validation cohorts in a 3:1 ratio, and after screening risk factors by logistic regression, nomogram was developed for predicting lymph nodes metastasis, then the prediction model was verified by C-index, area under curve (AUC), and calibration curve. Results Of the 272 patients, seven variables were screened to establish the predictive model, including the differentiation degree of the tumor [95% confidence interval(CI):1.224~6.735, P=0.015], long-to-short axis ratio of the lymph nodes (95%CI: 0.019~0.217, P<0.001), uneven/circular enhancement (95%CI: 1.476~16.715, P=0.010), aggregation of lymph nodes (95%CI:1.373~10.849, P=0.010), inhomogeneous echo (95%CI: 1.337~23.389, P=0.018), unclear/absent medulla of lymph nodes (95%CI: 2.514~43.989, P=0.001), and rich blood flow (95%CI: 1.952~85.632, P=0.008). The C-index was 0.910, areas under the curve of training cohort and verification cohort were 0.953 and 0.938 respectively, indicating the discriminative ability of this nomogram. The calibration curve showed a favorable compliance between the prediction of the model and actual observations. The clinical decision curve showed this model is clinically useful and had better discriminative ability between 0.25 and 0.9 for the probability of cervical LNs metastasis. Conclusions We established a good prediction model for cervical lymph node metastasis in head and neck squamous cell carcinoma patients which can provide reference value and auxiliary diagnosis for clinicians in making neck management decisions of HNSCC patients.
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Affiliation(s)
- Xiaohan Chen
- Department of Radiation Oncology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lu Zhang
- Department of Radiation Oncology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haijun Lu
- Department of Oncology and Radiotherapy, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ye Tan
- Department of Oncology and Radiotherapy, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Bo Li
- Department of Oncology and Radiotherapy, Affiliated Hospital of Qingdao University, Qingdao, China
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Ai QYH, So TY, Hung KF, King AD. Normal size of benign upper neck nodes on MRI: parotid, submandibular, occipital, facial, retroauricular and level IIb nodal groups. Cancer Imaging 2022; 22:66. [PMID: 36482491 PMCID: PMC9730594 DOI: 10.1186/s40644-022-00504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/10/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Nodal size is an important imaging criterion for differentiating benign from malignant nodes in the head and neck cancer staging. This study evaluated the size of normal nodes in less well-documented nodal groups in the upper head and neck on magnetic resonance imaging (MRI). METHODS Analysis was performed on 289 upper head and neck MRIs of patients without head and neck cancer. The short axial diameters (SAD) of the largest node in the parotid, submandibular, occipital, facial, retroauricular and Level IIb of the upper internal jugular nodal groups were documented and compared to the commonly used threshold of ≥ 10 mm for diagnosis of a malignant node. RESULTS Normal nodes in the parotid, occipital, retroauricular and Level IIb groups were small with a mean SAD ranging from 3.8 to 4.4 mm, nodes in the submandibular group were larger with a mean SAD of 5.5 mm and facial nodes were not identified. A size ≥ 10 mm was found in 0.8% of submandibular nodes. Less than 10% of the other nodal group had a SAD of ≥ 6 mm and none of them had a SAD ≥ 8 mm. CONCLUSION To identify malignant neck nodes in these groups there is scope to reduce the size threshold of ≥ 10 mm to improve sensitivity without substantial loss of specificity.
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Affiliation(s)
- Qi Yong H. Ai
- grid.16890.360000 0004 1764 6123Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong S.A.R, P.R. China ,grid.415197.f0000 0004 1764 7206Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R, P.R. China
| | - Tiffany Y. So
- grid.415197.f0000 0004 1764 7206Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R, P.R. China
| | - Kuo Feng Hung
- grid.194645.b0000000121742757Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong S.A.R, P.R. China
| | - Ann D. King
- grid.415197.f0000 0004 1764 7206Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong S.A.R, P.R. China
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Li F, Hsueh C, Gong H, Zhu Y, Tao L, Zhou L, Wang S, Zhang M. The management of metastatic neck nodes following induction chemotherapy in N2/3 classification hypopharyngeal carcinoma. Head Neck 2022; 44:2009-2017. [PMID: 35915865 DOI: 10.1002/hed.27106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/27/2022] [Accepted: 05/12/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND For patients with less chemosensitive neck nodes, poor prognosis after chemoradiotherapy (CRT) could be predicted and neck dissection is needed. METHODS Ninety-two N2/3 hypopharyngeal carcinoma patients were retrospectively studied. According to response after induction chemotherapy (ICT), patients were treated with neck dissection followed by concurrent CRT (CCRT) (group 1), surgery plus postoperative CRT (group 2), or CCRT for primary and regional sites (group 3). RESULTS Overall survival and disease-free survival rates of group 1 were significantly higher than group 2 (p = 0.038, p = 0.031) and group 3 (both p = 0.018). Regional control rate of group 1 was significantly higher than group 3 (p = 0.041). There were no significant differences between groups 1 and 2 regarding local and regional control (p = 0.746, p = 0.302). CONCLUSIONS Neck dissection followed by CCRT is the best choice for patients with responsive primary but nonresponsive nodes.
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Affiliation(s)
- Feiran Li
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Chiyao Hsueh
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Hongli Gong
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Yi Zhu
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Lei Tao
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Liang Zhou
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Shengzi Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Ming Zhang
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
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Li A, Gao J, Ni J, Che Y, Zhang Q, Hu Q, Pan J, Ge Y, Cao Z, Ni J. Influence of Case Management Model Combined with Continuous Nursing Care on Compliance Behavior and Adverse Emotions in Elderly Patients with Lung Cancer: A Prospective Single-Center Case-Control Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2601852. [PMID: 36060666 PMCID: PMC9433228 DOI: 10.1155/2022/2601852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/10/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022]
Abstract
Aims To ask lots of questions about finding the truth about the influence of the case management model combined with continuous nursing care on following the law behavior and negative feelings of love, hate, fear, etc. in old patients with lung scale-like cell cancer. Materials and Methods One hundred and forty-three elderly patients with squamous cell carcinoma of the lung were selected for this prospective study, 10 cases were shed due to epidemic and transfer, and finally 68 cases were in the control group and 65 cases in the observation group. The differences in anxiety and depression scores, quality of life, and compliance behavior between the two groups were observed and compared. Results After nursing, the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) of the observation group were lower than those of the control group, while the social support score was significantly higher than that of the control group. The scores of psychological behavior, exercise status, drug taking, and balanced diet of the two groups were significantly improved, and the observation group was significantly improved. The scores of medical compliance behavior in the observation group were significantly higher than those in the control group, and the mental vitality score, social interaction score, emotional restriction score, and mental status of the patients in the observation group were significantly higher than those in the control group, and the above statistics showed that the difference was statistically significant (P < 0.05). Conclusion The use of a case management model combined with extended care significantly improved the compliance behavior and anxiety and depression of elderly patients with squamous cell carcinoma of the lung and improved the quality of life and social support.
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Affiliation(s)
- Aomei Li
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Jie Gao
- Department of Cadre Ward, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Juan Ni
- Department of Nursing, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Yuxin Che
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Qing Zhang
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Qian Hu
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Jie Pan
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - YuXin Ge
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Zhenzhu Cao
- Department of Radiotherapy, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
| | - Juan Ni
- Department of Respiratory and Critical Care Medicine, Nanjing Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002 Jiangsu Province, China
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Landin D, Näsman A, Jara SJ, Hammarstedt-Nordenvall L, Munck-Wikland E, Dalianis T, Marklund L. Post-Treatment Neck Dissection of Tonsillar and Base of Tongue Squamous Cell Carcinoma in the Era of PET-CT, HPV, and p16. Viruses 2022; 14:v14081693. [PMID: 36016315 PMCID: PMC9413897 DOI: 10.3390/v14081693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
Human-papillomavirus (HPV)-positive tonsillar and base of tongue carcinomas (TSCC/BOTSCC) are rising in incidence and treatments with radiotherapy, chemoradiotherapy (RT/CRT), and neck dissections (NDs) have several side effects. Therefore, an improved selection of patients needing salvage NDs would be beneficial. We examined the prevalence and localisations of viable tumour cells in neck lymph nodes in patients post-RT/CRT, identified by fluorodeoxyglucose positron-emission tomography with computer-tomography (FDG PET-CT), with a focus on HPV-associated tumours. Patients with 217 TSCC/BOTSCC with tumours assessed for HPV-DNA and p16INK4a undergoing FDG PET-CT 12 weeks after treatment and/or an ND were included. The FDG PET-CT data were compared with the findings in the pathology report after the ND. In total, 36/217 (17%) patients were selected for an ND due to positive findings in post-treatment FDG PET-CT. Of these, 35/36 were HPV-associated, 10/36 (28%) had viable tumour cells in the pathology reports of the neck specimen, and 8/10 (80%) were consistent with the FDG PET-CT findings, while 2/36 (5%) were missed by FDG PET-CT. We conclude that FDG PET-CT 12 weeks after RT/CRT is useful, but not completely reliable for finding all the metastases of HPV-associated TSCC/BOTSCC. Nonetheless, our data indicate that an ND could be more selectively guided by FDG PET-CT.
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Affiliation(s)
- David Landin
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Anders Näsman
- Department of Oncology, Pathology, Karolinska Institute, 17164 Stockholm, Sweden;
- Department of Clinical Pathology, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Sara Jonmarker Jara
- Department of Neuroradiology, Karolinska University Hospital, 17164 Stockholm, Sweden;
| | - Lalle Hammarstedt-Nordenvall
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Eva Munck-Wikland
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
| | - Tina Dalianis
- Department of Oncology, Pathology, Karolinska Institute, 17164 Stockholm, Sweden;
- Correspondence: (T.D.); (L.M.)
| | - Linda Marklund
- Department of Clinical Science, Intervention and Technology, Department of Oto-Rhinolaryngology, Head and Neck Surgery, Karolinska University Hospital, Karolinska Institute, 17164 Stockholm, Sweden; (D.L.); (L.H.-N.); (E.M.-W.)
- Medical Unit Head Neck, Lung and Skin Cancer, Karolinska University Hospital, 17164 Stockholm, Sweden
- Department of Surgical Sciences, Section of Otolaryngology and Head and Neck Surgery, Uppsala University, 75105 Uppsala, Sweden
- Correspondence: (T.D.); (L.M.)
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Klausner G, Troussier I, Kreps S, Fabiano E, Laccourreye O, Giraud P. [Impact of neck dissection in N2-3 oropharyngeal squamous cell carcinomas treated with definitive chemoradiotherapy: An observational real-life study]. Cancer Radiother 2021; 25:771-778. [PMID: 34175226 DOI: 10.1016/j.canrad.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to assess the efficacy in terms of neck failure of an initial neck dissection before definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinomas, as well as the dosimetric impact and the acute and delayed morbidity of this approach. MATERIALS AND METHODS All patients consecutively treated between 2009 and 2018 with definitive chemoradiotherapy using intensity-modulated conformal radiotherapy (IMRT) for a histologically proven N2-3 oropharyngeal squamous cell carcinomas were retrospectively included. The therapeutic approach consisted of induction chemotherapy, followed by cisplatine-based chemoradiotherapy preceded or not by neck dissection. Neck dissection was discussed on a case-by-case basis in a dedicated multidisciplinary tumour board for patients with a dissociated response to induction chemotherapy, defined as a better response on the primary than on the node. Chemoradiotherapy without neck dissection was systematically performed in case of a major lymph node response to induction chemotherapy (decrease in size of 90% or more). Intensity-modulated radiotherapy using a simultaneous-integrated boost delivered 70Gy in 35 fractions on macroscopic tumour volumes, 63Gy on intermediate-risk levels or extra-nodal extension and 54Gy on prophylactic lymph node areas. RESULTS Two groups were constituted: 47 patients without an initial neck dissection (62.7%), and 28 patients with a neck dissection prior to definitive chemoradiotherapy (37.3%). Initial patient characteristics were not statistically different between the two groups. The median follow-up was 60.1months (range: 3.2-119months). Incidence of neck failure was higher in patients without neck dissection (P=0.015). The neck failure rate at 5years was 19.8% (95% confidence interval: 7.4-30.6%; P=0.015) without neck dissection versus 0% following neck dissection. All lymph node failures occurred in the planned target volume at 70Gy. Upfront neck dissection suggested a decrease in the mean dose received by the homolateral parotid gland (P=0.01), mandible (P=0.02), and thyroid gland (P=0.02). Acute toxicity of chemoradiotherapy after neck dissection suggested a reduction in grade≥3 adverse events (P=0.04), early discontinuation of concomitant chemotherapy (P=0.009) and feeding tube-dependence (P=0.008) in univariate analysis. During follow-up, there was no difference between the two groups in terms of xerostomia, dysgeusia, dysphagia or gastrostomy dependence in univariate analysis. CONCLUSION Neck dissection prior to definitive chemoradiotherapy in N2-3 oropharyngeal squamous cell carcinoma was associated with high neck control without additional mid and long-term morbidity.
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Affiliation(s)
- G Klausner
- Université Pierre-et-Marie-Curie, Paris Sorbonne université, 91-105, boulevard de l'Hôpital, 75013 Paris, France
| | - I Troussier
- Oncologie-radiothérapie, centre de haute énergie, 06000 Nice, France; Département de radio-oncologie, hôpitaux universitaires de Genève, 1205 Genève, Suisse
| | - S Kreps
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - E Fabiano
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - O Laccourreye
- Service d'ORL et de chirurgie cervicofaciale, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75015 Paris, France
| | - P Giraud
- Service d'oncologie-radiothérapie, hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France; Université de Paris, 75015 Paris, France.
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Carsuzaa F, Dufour X, Gorphe P, Righini C, Cosmidis A, Rogé M, De Mones E, Servagi Vernat S, Tonnerre D, Morinière S, Dugas A, Malard O, Pasquier F, Vergez S, Schick U, Gérard M, Salleron J, Thariat J. Locoregional control, progression-free survival and morbidity rates in N3 head and neck cancer patients with low primary tumour burden: A 301-patient study. Clin Otolaryngol 2020; 45:877-884. [PMID: 32729227 DOI: 10.1111/coa.13615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/26/2020] [Accepted: 07/21/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In patients with N3 head and neck squamous cell carcinoma (HNSCC), N3 disease is associated with high regional relapse and metastatic risks. Patients with resectable N3 disease have better prognosis although their metastatic risk may be similar as in patients with unresectable disease. Neoadjuvant chemotherapy has been associated with lower metastatic rates, but N3 patients may die of rapid locoregional progression. We assessed outcomes with the three modalities in patients with low primary burden to better assess the specific prognosis of N3 disease. METHODS This retrospective multicentric study included T0-2 N3 HNSCC patients. Outcomes and morbidity in upfront neck dissection (uND) vs non-surgical groups were analysed and oncological outcomes and morbidity compared between patients undergoing chemoradiation or neoadjuvant chemotherapy in patients with initially unresectable N3 nodes. RESULTS Of 301 patients, 142 (47%) underwent uND, 68 (23%) neoadjuvant chemotherapy and 91 (30%) chemoradiation. The 24- and 60-month incidence of locoregional relapse was 23.2% [18.3%; 28.4%] and 27.4% [21.8%; 33.3%]; it was lower in patients undergoing uND (P = .006). In patients with non-surgical treatments, success rates were 57.8% [49.4%; 66.3%] after chemoradiation and 38.1% [29.6%; 46.7%] after neoadjuvant chemotherapy (P = .001). Overall morbidity was more frequent in patients undergoing uND (68.8%) (P < .001). CONCLUSION uND improved locoregional control but increased morbidity and showed no survival benefit. Success rates were better after chemoradiation versus neoadjuvant chemotherapy. Neoadjuvant chemotherapy did not reduce metastatic rates but non-responders to chemoradiation had poor PFS and survival rate, suggesting that predictive criteria are warranted.
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Affiliation(s)
- Florent Carsuzaa
- Head and neck surgery, University Hospital of Poitiers, Poitiers, France
| | - Xavier Dufour
- Head and neck surgery, University Hospital of Poitiers, Poitiers, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Christian Righini
- Head and neck surgery, University Hospital of Grenoble, Grenoble, France
| | - Alain Cosmidis
- Head and neck surgery, University Hospital of Lyon, Lyon, France
| | | | - Erwan De Mones
- Head and neck surgery, University Hospital of Bordeaux, Bordeaux, France
| | | | - Denis Tonnerre
- Head and neck surgery, University Hospital of Poitiers, Poitiers, France
| | | | - Amaury Dugas
- Head and neck surgery, University Hospital of Caen, Caen, France
| | - Olivier Malard
- Head and neck surgery, University Hospital of Nantes, Nantes, France
| | - François Pasquier
- Head and neck surgery, University Hospital of Nantes, Nantes, France
| | - Sébastien Vergez
- Head and neck surgery, Institut Universitaire du Cancer de Toulouse Oncopole / University Hospital of Toulouse, Toulouse, France
| | - Ulrike Schick
- Radiation oncology, University Hospital of Brest, Brest, France
| | - Michael Gérard
- Radiation oncology, Centre François Baclesse / ARCHADE, Caen, France
| | - Julia Salleron
- Cellule Data Biostatistique, Institut de Cancérologie de Lorraine, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Juliette Thariat
- Radiation oncology, Centre François Baclesse / ARCHADE, Caen, France
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Crombet Ramos T, Mestre Fernández B, Mazorra Herrera Z, Iznaga Escobar NE. Nimotuzumab for Patients With Inoperable Cancer of the Head and Neck. Front Oncol 2020; 10:817. [PMID: 32537431 PMCID: PMC7266975 DOI: 10.3389/fonc.2020.00817] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/27/2020] [Indexed: 12/18/2022] Open
Abstract
EGFR activation induces cell proliferation, neoformation of blood vessels, survival, and metastasis of the cancer cells. Nimotuzumab is an engineered, intermediate affinity anti-EGFR antibody, that apart from other drugs in its class, is very safe and does not cause hypomagnesemia or grade 3–4 cutaneous rash. The antibody inhibits cell proliferation and angiogenesis, activates natural killer cells, stimulates dendritic cell maturation, and induces cytotoxic T cells. Nimotuzumab restores MHC-I expression on tumor cells, hindering one of the EGFR immune-escape ways. The antibody has been extensively studied in 7 clinical trials, concurrently with irradiation or irradiation plus chemotherapy in subjects with inoperable head and neck tumors. Nimotuzumab was safe and efficacious in unfit patients receiving irradiation alone and in subjects treated with cisplatin and radiotherapy. In patients with locally advanced squamous cell carcinomas of the head and neck, nimotuzumab in combination with low dose cisplatin and radiotherapy was superior to cisplatin and radiotherapy in progression free survival, disease free survival, and locoregional tumor control.
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10
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Carsuzaa F, Gorphe P, Vergez S, Malard O, Fakhry N, Righini C, Philouze P, Lasne-Cardon A, Gallet P, Tonnerre D, Bozec A, de Mones E, Baujat B, Laccourreye L, Babin E, Dufour X, Thariat J. Consensus on resectability in N3 head and neck squamous cell carcinomas: GETTEC recommendations. Oral Oncol 2020; 106:104733. [PMID: 32335323 DOI: 10.1016/j.oraloncology.2020.104733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Among patients with T0-2 N3 head and neck squamous cell carcinomas (HNSCC), those undergoing upfront neck dissection have better oncological outcomes. However, there is no consensual definition of disease resectability of N3 nodes, leading to major treatment attrition and interpretation biases between studies. We established a Delphi method-based consensus to define resectability and impact on decision-making for upfront neck dissection in N3 patients. METHODS The Delphi method was designed as recommended by the French Haute Autorite de Sante among head and neck surgeons from university hospitals and cancer centers, using a 24-item questionnaire. Strong and relative agreements were subsequently established, and recommendations were written. The resulting recommendations were assessed by 30 independent surgeons. RESULTS N3 nodes with intraparenchymal brain invasion, foramen invasion, skull base erosion, nodes requiring bilateral XIIth cranial nerve sacrifice, retropharyngeal N3 node or a node above the plan of soft palate are major contraindications to neck dissection. When neck dissection requires unilateral sacrifice of the IXth or Xth or XIIth cranial nerves or cervical nerve roots, upfront neck dissection may be performed, based on a case-by-case assessment of other patient and tumor estimates. CONCLUSION Consensual contraindications to neck dissection in patients with T0-2 N3 HNSCC were defined among French head and neck surgeons as concerns skull base invasion, retropharyngeal nodes and bilateral XIIth cranial nerve sacrifice. This consensus should allow more reliable comparisons between surgical and non-surgical strategies in N3 patients.
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Affiliation(s)
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Sébastien Vergez
- Institut Universitaire du Cancer de Toulouse Oncopole, University Hospital of Toulouse, France
| | - Olivier Malard
- Head and Neck Surgery, University Hospital of Nantes, France
| | - Nicolas Fakhry
- Head and Neck Surgery, APHM, La Conception University Hospital, Marseille, France
| | | | - Pierre Philouze
- Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon (Hospital Group of Lyon), France
| | | | - Patrice Gallet
- Head and Neck Surgery, University Hospital of Nancy, France
| | - Denis Tonnerre
- Head and Neck Surgery, University Hospital of Poitiers, France
| | - Alexandre Bozec
- Head and Neck Surgery, Institut Universitaire de la Face et du Cou, Nice, France
| | - Erwan de Mones
- Head and Neck Surgery, University Hospital of Bordeaux, France
| | | | | | - Emmanuel Babin
- Head and Neck Surgery, Centre François Baclesse, Caen, France
| | - Xavier Dufour
- Head and Neck Surgery, University Hospital of Poitiers, France
| | - Juliette Thariat
- Radiation Oncology, Centre François Baclesse/ARCHADE, Caen, France.
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