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Windisch P, Lütscher J, Förster R, Zwahlen DR, Schröder C. Discontinuation of Palliative Brain Radiotherapy in Patients with Brain Metastases: A Case-Control Study. J Clin Med 2024; 13:3603. [PMID: 38930133 PMCID: PMC11204753 DOI: 10.3390/jcm13123603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 05/28/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Discontinuation of radiotherapy is rarely discussed in the scientific literature. The goal of this study was, therefore, to estimate the frequency of and reasons for treatment discontinuations in patients receiving radiotherapy for brain metastases from solid tumors and to identify factors predicting said discontinuations. Methods: All patients treated for brain metastases from solid tumors between 2010 and 2020 at our institution were retrospectively reviewed. In addition to collecting relevant patient characteristics, the Recursive Partitioning Analysis (RPA) and disease-specific Graded Prognostic Assessment (GPA) groups for each patient were calculated to assess the performance of these scores in predicting treatment discontinuations. Results: Out of 468 patients who underwent cranial radiotherapy, 35 treatments (7.5%) were discontinued. The most frequent reason was clinical deterioration, which was documented in 26 (74.3%) of discontinued treatments. Patients whose radiotherapy was discontinued had, on average, more leptomeningeal disease (20.0% vs. 12.6%), worse ECOG performance status (mean ECOG performance status 1.86 vs. 1.39), and more uncontrolled extracranial metastases (85.3% vs. 70.8%). The frequencies of treatment discontinuation increased with worse prognosis and differed significantly across RPA groups (p = 0.037) but not across GPA groups (p = 0.612). Conclusions: Treatment discontinuation occurred in 7.5% of cases, mostly due to clinical deterioration. Poor performance status, as well as more advanced disease and, in turn, poor prognosis, were associated with higher discontinuation rates.
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Affiliation(s)
- Paul Windisch
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Jamie Lütscher
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Daniel R. Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
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2
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Shin JY, Chino F, Cuaron JJ, Washington C, Jablonowski M, McBride S, Gomez DR. Insurance Denials and Patient Treatment in a Large Academic Radiation Oncology Center. JAMA Netw Open 2024; 7:e2416359. [PMID: 38865128 PMCID: PMC11170304 DOI: 10.1001/jamanetworkopen.2024.16359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/11/2024] [Indexed: 06/13/2024] Open
Abstract
Importance Insurance barriers to cancer care can cause significant patient and clinician burden. Objective To investigate the association of insurance denial with changes in technique, dose, and time to delivery of radiation oncology treatment. Design, Setting, and Participants In this single-institution cohort analysis, data were collected from patients with payer-denied authorization for radiation therapy (RT) from November 1, 2021, to December 8, 2022. Data were analyzed from December 15, 2022, to December 31, 2023. Exposure Insurance denial for RT. Main Outcomes and Measures Association of these denials with changes in RT technique, dose, and time to treatment delivery was assessed using χ2 tests. Results A total of 206 cases (118 women [57.3%]; median age, 58 [range, 26-91] years) were identified. Most insurers (199 [96.6%]) were commercial payers, while 7 (3.4%) were Medicare or Medicare Advantage. One hundred sixty-one patients (78.2%) were younger than 65 years. Of 206 cases, 127 (61.7%) were ultimately authorized without any change to the requested RT technique or prescription dose; 56 (27.2%) were authorized after modification to RT technique and/or prescription dose required by the payer. Of 21 cases with required prescription dose change, the median decrease in dose was 24.0 (range, 2.3-51.0) Gy. Of 202 cases (98.1%) with RT delivered, 72 (34.9%) were delayed for a mean (SD) of 7.8 (9.1) days and median of 5 (range, 1-49) days. Four cases (1.9%) ultimately did not receive any authorization, with 3 (1.5%) not undergoing RT, and 1 (0.5%) seeking treatment at another institution. Conclusions and Relevance In this cohort study of patients with payer-denied cases, most insurance denials in radiation oncology were ultimately approved on appeal; however, RT technique and/or effectiveness may be compromised by payer-mandated changes. Further investigation and action to recognize the time and financial burdens on clinicians and clinical effects on patients caused by insurance denials of RT is needed.
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Affiliation(s)
- Jacob Y. Shin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John J. Cuaron
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Charles Washington
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Margaret Jablonowski
- Physician Billing Department, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel R. Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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3
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Li CX, Gong ZC, Zhang WN, Zhang Y, Zhao HR. Radioresistance or/and radiosensitivity of head and neck squamous cell carcinoma: biological angle. Oral Maxillofac Surg 2024; 28:547-555. [PMID: 37935817 DOI: 10.1007/s10006-023-01189-9] [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: 07/15/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVE This narrative review aimed to compile and summarize clinically relevant literature in radiation therapy and to discuss the potential in radioresistant and radiosensitive head and neck squamous cell carcinoma (HNSCC). METHODS AND MATERIALS Google Scholar, PubMed, and the Cochrane Library were retrieved using combined key words such as "radiotherapy" and "head and neck cancer." Search strings additionally queried were "radioresistant," "radiosensitive," "head and neck region," "squamous cell carcinoma," in combination with Boolean operators 'AND' and 'OR.' Subsequently, the resulting publications were included for review of the full text. RESULTS Radiotherapeutic responses currently in clinical observation referred to HNSCC scoping were selected into this review. The compiled mechanisms were then detailed concerning on the clinical significance, biological characteristics, and molecular function. CONCLUSIONS Brachytherapy or/and external-beam radiotherapy are crucial for treating HNSCC especially the early stage patients, but in some patients with locally advanced tumors, their outcome with radiation therapy is poor due to obvious radioresistance. The curative effects mainly depend on the response to radiation therapy so an updated review is needed to optimize further applications in HNSCC radiotherapy.
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Affiliation(s)
- Chen-Xi Li
- Department of Oral and Maxillofacial Oncology & Surgery, School / Hospital of Stomatology, The First Affiliated Hospital of Xinjiang Medical University, No. 137 Liyushan South Road, Urumqi, 830054, China.
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, 830054, China.
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Zhong-Cheng Gong
- Department of Oral and Maxillofacial Oncology & Surgery, School / Hospital of Stomatology, The First Affiliated Hospital of Xinjiang Medical University, No. 137 Liyushan South Road, Urumqi, 830054, China.
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, 830054, China.
| | - Wei-Na Zhang
- Ear, Nose & Throat Department, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Yang Zhang
- The First Ward of Oncological Department, Cancer Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Hua-Rong Zhao
- The First Ward of Oncological Department, Cancer Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
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4
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Chen HMN, Anzela A, Hetherington E, Buddle N, Vignarajah D, Hogan D, Fowler A, Forstner D, Chua B, Gowda R, Min M. A proposed framework for the implementation of head and neck cancer treatment at a new cancer center from a radiation oncology perspective. Asia Pac J Clin Oncol 2024; 20:168-179. [PMID: 37186498 DOI: 10.1111/ajco.13963] [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: 11/01/2022] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Establishing a new head and neck cancer (HNC) treatment center requires multidisciplinary team management and expertise. To our knowledge, there are no clear recommendations or guidelines in the literature for the commencement of HNC radiation therapy (RT) at a new cancer center. We propose a novel framework outlining the necessary components required to set-up a new radiation therapy HNC treatment. METHODS We reviewed the infrastructure and methodology in the commencement of HNC radiation therapy in our cancer care center and invited several external, experienced metropolitan head and neck radiation oncologists to develop a novel consensus guideline that may be used by new RT centers to treat HNC. Recommendations were presented to our internal and external staff specialists using a survey questionnaire with ratings utilized to determine consensus using pre-defined thresholds as per the American Society of Clinical Oncology Guidelines Methodology Manual. CONCLUSION This consensus recommendation aims to improve RT utilization whilst advocating for optimal patient outcomes by presenting a framework for new radiation therapy centers ready to step up and manage the treatment of head and neck cancer patients. We propose these evidence-based consensus guidelines endorsed by external HNC radiation oncologists.
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Affiliation(s)
- Hon Ming N Chen
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Anzela Anzela
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - Ebony Hetherington
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Nicole Buddle
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Dinesh Vignarajah
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - David Hogan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Allan Fowler
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | - Dion Forstner
- GenesisCare, St Vincents Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Benjamin Chua
- Cancer Care Services, Royal Brisbane & Women's Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Raghu Gowda
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Myo Min
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
- School of Health, University of Sunshine Coast, Sunshine Coast, Australia
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5
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Li CX, Tan XR, Wei W, Li MQ, Zhang WN, Gong ZC, Zhang Y, Zhao HR. A radiobiological perspective on radioresistance or/and radiosensitivity of head and neck squamous cell carcinoma. Rep Pract Oncol Radiother 2024; 28:809-822. [PMID: 38515813 PMCID: PMC10954264 DOI: 10.5603/rpor.99355] [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: 07/22/2023] [Accepted: 10/11/2023] [Indexed: 03/23/2024] Open
Abstract
Background This article aimed to compile and summarize clinically relevant literature in radiation therapy, and to discuss the potential in radioresistant and radiosensitive head and neck cancer. Study Design Narrative review. Materials and methods Google Scholar, PubMed and the Cochrane Library were retrieved using combined key words such as "radiotherapy" and "head and neck cancer". Search strings additionally queried were "radioresistant", "radiosensitive", "head and neck region", "squamous cell carcinoma", in combination with Boolean Operators 'AND' and 'OR'. Subsequently, the resulting publications were included for review of the full text. Results Radiotherapeutic response currently in clinical observation referred to HNSCC scoping were selected into this review. The compiled mechanisms were then detailed concerning on the clinical significance, biological characteristics, and molecular function. Conclusions Brachytherapy or/and external-beam radiotherapy are crucial for treating HNSCC, especially the early stage patients, but in patients with locally advanced tumors, their outcome with radiation therapy is poor due to obvious radioresistance. The curative effects mainly depend on the response of radiation therapy, so an updated review is needed to optimize further applications in HNSCC radiotherapy.
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Affiliation(s)
- Chen-xi Li
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-rong Tan
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wei Wei
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Mu-qiu Li
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wei-na Zhang
- Ear, Nose & Throat Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhong-cheng Gong
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yang Zhang
- The First Ward of Oncological Department, Cancer Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hua-rong Zhao
- The First Ward of Oncological Department, Cancer Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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Cooper DJ, Travaglia I, Guller M, Talcott WJ, Ghaly M, Miles BA, Frank D, Seetharamu N, Parashar B. Clinical predictors of premature radiotherapy terminations in senior adults with oral cavity and laryngeal carcinoma. Head Neck 2024; 46:262-268. [PMID: 37950590 DOI: 10.1002/hed.27570] [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: 07/30/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION The underlying factors that contribute to early radiotherapy (RT) termination are understudied, especially in the era of hypofractionated treatment regimens. In this retrospective investigation, we examined the characteristics and causes of premature RT terminations in senior adults (>70 years old) with oral cavity (OC) and laryngeal carcinomas. METHODS Hundred and eighty-eight patients treated with RT ± systemic therapy for OC and laryngeal cancer from 2017 to 2022 were identified. Premature termination was defined as completion of less than 95% of the prescribed RT. Logistic regression analysis was performed to examine factors predictive of premature termination, and survival was determined using the Kaplan-Meier method. RESULTS Twenty patients (10.6%) experienced premature RT terminations. On regression analysis, ECOG score at initiation of RT was the only covariate studied to be independently associated with premature termination (OR 2.00, 95%CI: [1.21, 3.30], p = 0.007). Three-year overall survival (49.1% vs. 77.3%) was significantly reduced in the termination cohort (p < 0.0001). CONCLUSIONS This analysis demonstrated over 1 in 10 patients had premature RT termination, which prognosticated inferior survival outcomes. Poor performance status may highlight patients at risk for premature termination and thus identify good candidates for hypofractionated protocols.
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Affiliation(s)
- Dylan J Cooper
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York, USA
| | | | - Meytal Guller
- Department of Otolaryngology - Head and Neck Surgery, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Wesley J Talcott
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Maged Ghaly
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Brett A Miles
- Department of Otolaryngology - Head and Neck Surgery, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Douglas Frank
- Department of Otolaryngology - Head and Neck Surgery, Northwell Health Cancer Institute, Lake Success, New York, USA
| | - Nagashree Seetharamu
- Division of Hematology-Oncology, Northwell Health Cancer Institute, New Hyde Park, New York, USA
| | - Bhupesh Parashar
- Department of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York, USA
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7
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Lester SC, Moon DH, Patel SH, Awan MJ, Bakst RL. Leave No Cancer Behind: The Conformal Hypofractionation Era and Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2024; 118:165-168. [PMID: 38049222 DOI: 10.1016/j.ijrobp.2023.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Dominic H Moon
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Musaddiq J Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Lu CH, Hsu CC, Su PH, Lin SY, Yeh KY, Hsueh SW, Chang JTC, Wang HM, Hung YS, Chou WC. Effect of prophylactic tube feeding in head and neck cancer patients with high Mallampati score undergoing definitive concurrent chemoradiotherapy. Support Care Cancer 2023; 31:384. [PMID: 37289404 DOI: 10.1007/s00520-023-07859-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE There is no consensus on the selection of appropriate prophylactic tube feeding in patients with head and neck squamous cell carcinoma (HNSCC) undergoing concurrent chemoradiotherapy (CCRT). This study aimed to evaluate the effect of prophylactic tube feeding in patients with HNSCC who presented with a high Mallampati score and underwent CCRT. METHODS We prospectively enrolled 185 consecutive patients with stage II to IVa HNSCC and a pre-treatment Mallampati score of 3 or 4 who received CCRT between August 2017 and December 2018 with follow-up data collected retrospectively. Patients were divided to either with or without prophylactic tube feeding group for comparison of treatment tolerance, toxicities, and quality of life(QOL). Propensity score matching (PSM) was used to achieve balanced covariates across the two groups. RESULTS Of the cohort, 52 (28.1%) and 133 (71.9%) patients were allocated to the prophylactic and non-prophylactic tube feeding groups, respectively. Before and after PSM, patients in the tube feeding group had a significantly lower incidence of incomplete radiotherapy, incompletion of chemotherapy, emergency room visits, and grade 3 or higher infection, and improved symptoms of quality of life after CCRT than those in the non-tube feeding group. CONCLUSION Prophylactic tube feeding was associated with better treatment tolerance, safety profiles, and quality of life in patients with HNSCC and high Mallampati scores who underwent CCRT. Therefore, Mallampati score might serve as a clinical tool for proactive selection of patients receiving prophylactic tube feeding in HNSCC patients upon receiving CCRT.
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Affiliation(s)
- Chang-Hsien Lu
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
| | - Chih-Chung Hsu
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Po-Hsu Su
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shinn-Yn Lin
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kun-Yun Yeh
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shun-Wen Hsueh
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Joseph Tung-Chieh Chang
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Ming Wang
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Shin Hung
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Chi Chou
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan.
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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9
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Contrera KJ, Tam S, Pytynia K, Diaz EM, Hessel AC, Goepfert RP, Lango M, Su SY, Myers JN, Weber RS, Eguia A, Pisters PWT, Adair DK, Nair AS, Rosenthal DI, Mayo L, Chronowski GM, Zafereo ME, Shah SJ. Impact of Cancer Care Regionalization on Patient Volume. Ann Surg Oncol 2023; 30:2331-2338. [PMID: 36581726 DOI: 10.1245/s10434-022-13029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cancer centers are regionalizing care to expand patient access, but the effects on patient volume are unknown. This study aimed to compare patient volumes before and after the establishment of head and neck regional care centers (HNRCCs). METHODS This study analyzed 35,394 unique new patient visits at MD Anderson Cancer Center (MDACC) before and after the creation of HNRCCs. Univariate regression estimated the rate of increase in new patient appointments. Geospatial analysis evaluated patient origin and distribution. RESULTS The mean new patients per year in 2006-2011 versus 2012-2017 was 2735 ± 156 patients versus 3155 ± 207 patients, including 464 ± 78 patients at HNRCCs, reflecting a 38.4 % increase in overall patient volumes. The rate of increase in new patient appointments did not differ significantly before and after HNRCCs (121.9 vs 95.8 patients/year; P = 0.519). The patients from counties near HNRCCs, showed a 210.8 % increase in appointments overall, 33.8 % of which were at an HNRCC. At the main campus exclusively, the shift in regional patients to HNRCCs coincided with a lower rate of increase in patients from the MDACC service area (33.7 vs. 11.0 patients/year; P = 0.035), but the trend was toward a greater increase in out-of-state patients (25.7 vs. 40.3 patients/year; P = 0.299). CONCLUSIONS The creation of HNRCCs coincided with stable increases in new patient volume, and a sizeable minority of patients sought care at regional centers. Regional patients shifted to the HNRCCs, and out-of-state patient volume increased at the main campus, optimizing access for both local and out-of-state patients.
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Affiliation(s)
- Kevin J Contrera
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Samantha Tam
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Kristen Pytynia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Eduardo M Diaz
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Hessel
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Miriam Lango
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shirley Y Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arturo Eguia
- Department of Otorhinolaryngology-Head and Neck Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | | | - Deborah K Adair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ajith S Nair
- Department of Global Business Development, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Mayo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory M Chronowski
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Shalin J Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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10
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Dickstein DR, Powers AE, Vujovic D, Roof S, Bakst RL. Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer. Clin Interv Aging 2023; 18:409-422. [PMID: 36959837 PMCID: PMC10029371 DOI: 10.2147/cia.s366155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
Approximately 30% of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age, and this percentage is expected to increase as the population increases and lives longer. Elderly patients are underrepresented in head and neck oncology clinical trials, and there is minimal evidence on the management of HNSCC for this population. Subsequently, despite their best intentions, physicians may unknowingly recommend an ill-suited course of therapy, which may result in suboptimal oncological or functional outcomes or adverse events. Surgical approaches have the potential to carry a higher risk of morbidity and mortality in older adults, especially in patients with multiple comorbidities. Definitive radiation therapy treatment in patients with HNSCC frequently involves 7 weeks of daily radiation, sometimes with concurrent chemotherapy, and this demanding treatment can be difficult for older adult patients, which may lead to treatment interruptions, potential removal of concurrent systemic therapy, compromised outcomes, and diminished quality of life. There are clinical trials currently underway investigating altered fractionation regimens and novel, less toxic systemic treatments in this population. This review provides an overview of how best to approach an older adult with HNSCC, from initial work-up to treatment selection.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann E Powers
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dragan Vujovic
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Roof
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Correspondence: Richard L Bakst, Icahn School of Medicine at Mount Sinai, 1184 5th Avenue 1st Fl, Box 1236, New York, NY, 10029, USA, Tel/Fax +1 212 241 3545, Email
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Dickstein DR, Lehrer EJ, Hsieh K, Hotca A, Jones BM, Powers A, Sharma S, Liu J, Gupta V, Mell L, Husain Z, Kirke D, Misiukiewicz K, Posner M, Genden E, Bakst RL. Management of Older Adults with Locally Advanced Head and Neck Cancer. Cancers (Basel) 2022; 14:cancers14112809. [PMID: 35681789 PMCID: PMC9179912 DOI: 10.3390/cancers14112809] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Approximately one third of patients with head and neck cancer are older adults. The number of older adults with head and neck cancer continues to rise especially as life expectancy increases. However, this population remains significantly underrepresented in clinical trials. Due to this, there is no clear consensus regarding the optimal treatment for older adults with head and neck cancer. In general, older adults are a complex cohort due to variations in functional and performance status, medical comorbidities, and medication management. Treatment for head and neck cancer involves surgery, radiation therapy, systemic therapy, or a combination. These treatments are highly demanding. Additionally, they are associated with toxicity which can be especially difficult for older adults to tolerate. This may lead to treatment interruptions and compromised outcomes. In order to understand the optimal treatment for older adults with head and neck cancer, novel predictive scores are being developed. Additionally, ongoing clinical trials are investigating less intensive treatments for older adults. This review provides an overview of current clinical data, treatment considerations, and future areas of investigation for older adults with head and neck cancer. Abstract Thirty percent of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age. This number continues to rise as life expectancy continues to increase. Still, older adults with HNSCC remain underrepresented in clinical trials, resulting in ambiguity on optimal management. Older adults are a complex patient population, often requiring increased support due to issues relating to functional and performance status, medical comorbidities, and medication management. Furthermore, in older adults with HNSCC, many of these conditions are independently associated with increased toxicity and worse outcomes. Toxicity in the older adult remains difficult to predict and to understand, and as treatment decisions are based on treatment tolerability, it is essential to understand the toxicities and how to minimize them. Novel predictive scores are being developed specifically for older adults with HNSCC to understand toxicity and to assist in personalized treatment decisions. There are clinical trials presently underway that are investigating shortened radiation courses and novel, less toxic systemic treatments in this population. In the forthcoming sections, we provide a detailed overview of the clinical data, treatment paradigms, and considerations in this population. This review provides a comprehensive overview of existing clinical data and clinical considerations in the older adult head and neck cancer population. Additionally, we provide a detailed overview of pertinent current and ongoing clinical trials, as well as future areas for investigation.
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Affiliation(s)
- Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Alexandra Hotca
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Brianna M. Jones
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Ann Powers
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.P.); (D.K.); (E.G.)
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Jerry Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
| | - Loren Mell
- Department of Radiation Oncology, University of San Diego, La Jolla, CA 92110, USA;
| | - Zain Husain
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - Diana Kirke
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.P.); (D.K.); (E.G.)
| | - Krzysztof Misiukiewicz
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (K.M.); (M.P.)
| | - Marshall Posner
- Department of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (K.M.); (M.P.)
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (A.P.); (D.K.); (E.G.)
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (D.R.D.); (E.J.L.); (K.H.); (A.H.); (B.M.J.); (S.S.); (J.L.); (V.G.)
- Correspondence:
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Kapała A, Surwiłło-Snarska A, Jodkiewicz M, Kawecki A. Nutritional Care in Patients with Head and Neck Cancer during Chemoradiotherapy (CRT) and Bioradiotherapy (BRT) Provides Better Compliance with the Treatment Plan. Cancers (Basel) 2021; 13:cancers13112532. [PMID: 34064057 PMCID: PMC8196687 DOI: 10.3390/cancers13112532] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The nutritional status of patients with head and neck cancer (HNC) during concurrent chemoradiotherapy (CRT) with platinum derivatives or concurrent radiotherapy with cetuximab (bioradiotherapy, BRT) inevitably deteriorates during treatment. Malnutrition is responsible for increased treatment-related toxicity, an increased incidence of infectious complications, the risk of postponing or discontinuing therapy, reduced drug doses (platinum derivatives or cetuximab), deteriorating quality of life (QoL), worse outcome, and increased treatment costs. A nutritional care programme, which included prophylactic dietary counselling and early enteral nutrition, reduced the incidence of complications and prevented drug dose reduction and the deterioration of patients’ anthropometric and laboratory parameters. The study confirmed that nutritional care before and during CRT and BRT in patients with HNC is a determinant of therapeutic benefit. Abstract The treatment of locally advanced head and neck cancer (HNC) is based on extensive resections followed by concurrent chemoradiotherapy (CRT) with platinum derivatives or concurrent radiotherapy with cetuximab (bioradiotherapy; BRT). Malnutrition, which occurs in up to 60% of patients before treatment commencement, severely increases the risk of CRT/BRT drug dose reductions and the incidence of treatment-related adverse events. A prospective observational study was performed regarding the influence of nutritional care on nutritional status, compliance with the treatment’s planned regimen, and the incidence of treatment-related complications in patients with advanced HNC during CRT and BRT. The study population encompassed 153 patients compared with a retrospective control group of 72 patients treated before nutritional care was included in the standard of oncological care. Patients enrolled in the nutritional care programme received significantly higher doses of platinum derivatives or cetuximab than patients in the control group. A significant difference between the compared populations was observed in patients below 70 years of age (92.8% of the study population), after prior surgery, and with initial weight loss lower than 10%. Nutritional care reduced final weight loss and prevented a decline within the laboratory markers of nutritional status. Weight loss was comparable in both modes of treatment—CRT and BRT. The incidence of treatment-related complications was significantly higher in patients without nutritional support in the subgroups of patients under 70 years of age and after primary surgery. Nutritional care before and during CRT and BRT in patients with HNC is a determinant of therapeutic benefit, defined as preventing down-dosing, weight loss, and the incidence of complications. Platinum derivatives and cetuximab had comparable influence on weight loss.
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Affiliation(s)
- Aleksandra Kapała
- Department of Clinical Nutrition, Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-546-3396
| | - Agnieszka Surwiłło-Snarska
- Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland; (A.S.-S.); (M.J.)
| | - Magdalena Jodkiewicz
- Department of Clinical Nutrition, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland; (A.S.-S.); (M.J.)
| | - Andrzej Kawecki
- Head and Neck Cancer Department, Maria Sklodowska-Curie National Research Institute of Oncology, 02781 Warsaw, Poland;
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A comparison of the MNA-SF, MUST, and NRS-2002 nutritional tools in predicting treatment incompletion of concurrent chemoradiotherapy in patients with head and neck cancer. Support Care Cancer 2021; 29:5455-5462. [PMID: 33704566 DOI: 10.1007/s00520-021-06140-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Concurrent chemoradiotherapy (CCRT) treatment incompletion is a known negative prognosticator for patients with head and neck cancer (HNC). Malnutrition is a common phenomenon which leads to treatment interruption in patients with HNC. We aimed to compare the performance of three nutritional tools in predicting treatment incompletion in patients with HNC undergoing definitive CCRT. MATERIAL AND METHODS Three nutritional assessment tools, Mini Nutritional Assessment-Short Form (MNA-SF), Malnutritional Universal Screening Tool (MUST), and Nutritional Risk Screening 2002 (NRS-2002), were prospectively assessed prior to CCRT for HNC patients. Patients were stratified into either normal nutrition or malnourished groups using different nutrition tools. Treatment incompletion and treatment-related toxicities associated with CCRT were recorded. RESULTS A total of 461 patients were included in the study; malnourished rates ranged from 31.0 to 51.0%. The CCRT incompletion rates were 4.9-6.3% and 14.5-18.2% for normal nutrition patients and malnourished patients, respectively. The tools had significant correlations with each other (Pearson correlation 0.801-0.837, p<0.001 for all) and accurately predicted the incompletion of CCRT. MNA-SF had the highest performance in predicting treatment-related toxicity, including emergency room visits, need for hospitalization, any grade III or higher hematological adverse events, and critical body weight loss, compared to the other tools. CONCLUSIONS MNA-SF, MUST, and NRS2002 were all shown to be competent tools for prediction of treatment incompletion and treatment-related toxicity in HNC patients undergoing CCRT. We suggest implementing nutritional assessment prior to treatment to improve the rate of treatment completion and to reduce treatment-related toxicity in HNC patients.
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Haynes DA, Vanison CC, Gillespie MB. The Impact of Dental Care in Head and Neck Cancer Outcomes: A Systematic Review and Meta-Analysis. Laryngoscope 2021; 132:45-52. [PMID: 33635587 DOI: 10.1002/lary.29494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 02/13/2021] [Accepted: 02/17/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE/HYPOTHESIS The objective of this study was to perform a systematic review and meta-analysis to determine the impact of dental care on head and neck (H&N) cancer survival. METHODS A comprehensive literature search was performed using PubMed, MEDLINE, and CINAHL to find all relevant studies from the date of inception to March 2020. Systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and meta-analysis was performed using the random effects logistic regression model. Primary outcomes of interest were 5-year survival and hazard ratios comparing survival between dental care subgroups. RESULTS H&N cancer survival rates strongly correlate with dental care adherence. Patients with good dental care had significantly better survival than patients with poor dental care (HR = 0.67, 95% CI: 0.55-0.83), with similar improved survival among patients with moderate versus poor dental care (HR = 0.67, 95% CI: 0.57-0.80). In addition, patients with good dental care had significantly decreased mortality than those with moderate dental care (HR = 0.81, 95% CI: 0.69-0.96), indicating an exposure-response gradient. CONCLUSIONS For patients with H&N cancer, survival is significantly higher in those who receive recommended dental care compared with those who do not. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- David Aaron Haynes
- Department of Otolaryngology -Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | | | - M Boyd Gillespie
- Department of Otolaryngology -Head and Neck Surgery, UTHSC, Memphis, Tennessee, U.S.A
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Sapienza LG, Nasra K, Berry R, Danesh L, Little T, Abu-Isa E. Clinical effects of morning and afternoon radiotherapy on high-grade gliomas. Chronobiol Int 2021; 38:732-741. [PMID: 33557650 DOI: 10.1080/07420528.2021.1880426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Initial clinical reports comparing the delivery of radiotherapy (RT) at distinct times of the day suggest that this strategy might affect toxicity and oncologic outcomes of radiation for multiple human tissues, but the clinical effects on high-grade gliomas (HGG) are unknown. The present study addresses the hypothesis that radiotherapy treatment time of the day (RT-TTD) influences outcome and/or toxic events in HGG. Patients treated between 2009-2018 were reviewed (n = 109). Outcomes were local control (LC), distant CNS control (DCNSC), progression-free survival (PFS), and overall survival (OS). RT-TTD was classified as morning if ≥50% of fractions were delivered before 12:00 h (n = 70) or as afternoon (n = 39) if after 12:00 h. The average age was 62.6 years (range: 14.5-86.9) and 80% were glioblastoma. The median follow-up was 10.9 months (range: 0.4-57.2). The 1y/3y LC, DCNSC, and PFS were: 61.3%/28.1%, 86.8%/65.2%, and 39.7%/10.2%, respectively. Equivalent PFS was found between morning and afternoon groups (HR 1.27; p = .3). The median OS was 16.5 months. Patients treated in the afternoon had worse survival in the univariate analysis (HR 1.72; p = .05), not confirmed after multivariate analysis (HR 0.92, p = .76). Patients with worse baseline performance status and treatment interruptions showed worse PFS and OS. The proportion of patients that developed grade 3 acute toxicity, pseudo progression, and definitive treatment interruptions were 10.1%, 9.2%, and 7.3%, respectively, and were not affected by RT-TTD. In conclusion, for patients with HGG, there was no difference in PFS and OS between patients treated in the morning or afternoon. Of note, definitive treatment interruptions adversely affected outcomes and should be avoided, especially in patients with low performance status. Based on these clinical findings, high-grade glioma cells may not be the best initial model to be irradiated in order to study the effects of chronotherapy.
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Affiliation(s)
- Lucas Gomes Sapienza
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Karim Nasra
- Department of Radiology, Michigan State University College of Human Medicine/Ascension Providence Hospital, Southfield, Michigan, USA
| | - Ryan Berry
- Department of Internal Medicine, Michigan State University College of Human Medicine, East Lansing, Michigan, USA
| | - Leana Danesh
- Department of Internal Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, Michigan, USA
| | - Tania Little
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, MI, USA
| | - Eyad Abu-Isa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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Dickstein DR, Egerman M, Monrose E, Varma A, Ozbek U, Sharma S, Liu JT, Gupta V, Posner MR, Misiukiewicz K, Miles BA, Genden E, Bakst RL. Treatment tolerability and outcomes in elderly patients with head and neck cancer. Head Neck 2020; 43:858-873. [PMID: 33615611 DOI: 10.1002/hed.26548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The number of elderly patients with head and neck squamous cell carcinoma (HNSCC) continues to grow. Management of this cohort remains poorly defined. We investigated treatment tolerability and clinical outcomes in this underrepresented population. METHODS We identified patients aged ≥70 with nonrecurrent, nonmetastatic HNSCC treated curatively from 2007-2018 and analyzed clinical covariates. RESULTS Two hundred and twenty patients with a median age of 75 (interquartile range:72-80) were identified. Age and comorbidities were not correlated with toxicity (P ≥ .05). Patients who experienced a treatment interruption had significantly greater weight loss (P = .042) and worse overall survival (OS) (P < .001), but not worse disease-specific survival (P = .45), or locoregional control (P = .21). CONCLUSIONS Treatment interruptions were associated with weight loss and worse OS, but not disease related outcomes, suggesting an interruption in the elderly may be a surrogate for another issue. In sum, our data should guide clinical trial design to benefit this growing, neglected cohort.
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Affiliation(s)
- Daniel R Dickstein
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marc Egerman
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erica Monrose
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Achintya Varma
- Division of Biostatistics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Umut Ozbek
- Division of Biostatistics, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry T Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marshall R Posner
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Krzysztof Misiukiewicz
- Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brett A Miles
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Dee EC, Muralidhar V, Arega MA, Kishan AU, Spratt DE, Dess RT, King MT, Sha ST, Santos PMG, Butler SS, Sanford NN, Nguyen PL, Mahal BA. Factors Influencing Noncompletion of Radiation Therapy Among Men With Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2020; 109:1279-1285. [PMID: 33276019 DOI: 10.1016/j.ijrobp.2020.11.064] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/10/2020] [Accepted: 11/25/2020] [Indexed: 02/01/2023]
Abstract
PURPOSE Treatment noncompletion may occur with radiation therapy (RT), especially with protracted treatment courses such as RT for prostate cancer, and may affect the efficacy of RT. For men with localized prostate cancer managed with primary RT, we evaluated associations between rates of treatment noncompletion and RT fractionation schedules. METHODS AND MATERIALS The National Cancer Database identified men diagnosed from 2004 to 2014 treated with primary RT. Patients receiving 180 cGy/fraction or 200 cGy/fraction were defined as having completed radiation therapy if they received ≥41 fractions of 180 cGy/fraction or ≥37 fractions of 200 cGy/fraction. Stereotactic body radiation therapy (SBRT) was defined as 5 to 8 fractions of 600 to 800 cGy/fraction. Odds ratios compared rates of treatment noncompletion, adjusting for sociodemographic covariates. A propensity-adjusted multivariable Cox regression assessed the association between treatment completion and overall survival. RESULTS Of 157,657 patients, 95.7% (n = 150,847) received conventional fractionation and 4.3% (n = 6810) received SBRT. Rates of noncompletion were 12.5% (n = 18,803) among patients who received conventional fractionation and 1.9% (n = 131) among patients who received SBRT (odds ratio [OR] versus conventional, 0.21; 95% confidence interval [CI], 0.18-0.26; P < .001). The rate of noncompletion among 25,727 African American patients was 12.8%, compared with 11.8% among 126,199 white patients (OR, 1.14; 95% CI, 1.09-1.19; P < .001). In a subgroup analysis, the disparity in noncompletion persisted for conventional fractionation (13.2% vs 12.3%, respectively; OR, 1.09; 95% CI, 1.05-1.13; P < .001), but not for SBRT (2.2% vs 1.8%, respectively; OR, 1.26; 95% CI, 0.79-2.00; P = .34). Noncompletion was associated with worse survival in a propensity-adjusted multivariable analysis (hazard ratio, 1.25; 95% CI, 1.22-1.29; P < .001). CONCLUSIONS SBRT was associated with lower rates of RT noncompletion among men with localized prostate cancer. African American race was associated with greater rates of treatment noncompletion, although the disparity may be decreased among men receiving SBRT.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vinayak Muralidhar
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Martin T King
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sybil T Sha
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Patricia Mae G Santos
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Santino S Butler
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Kaiser Permanente, Northern California, Oakland Medical Center, Oakland, California
| | - Nina N Sanford
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brandon A Mahal
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida; Office of Community Outreach and Engagement, Sylvester Comprehensive Cancer Center, Miami, Florida.
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Dharmarajan KV, Mohile SG. Can Geriatric Assessment Measures Be Used to Determine Cancer Treatment Vulnerability in Nongeriatric Patients? Int J Radiat Oncol Biol Phys 2020; 108:612-614. [PMID: 32976787 DOI: 10.1016/j.ijrobp.2020.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/21/2020] [Indexed: 01/18/2023]
Affiliation(s)
- Kavita V Dharmarajan
- Department of Radiation Oncology, Brookdale Department of Geriatrics and Palliative Medicine, the Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Supriya G Mohile
- Division of Hematology/Oncology, Departments of Medicine and Surgery, Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York
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Chiang YY, Chou YC, Chang KP, Liao CT, Wu YY, Yap WK, Pai PC, Chang JTC, Lin CY, Fan KH, Huang BS, Hung TM, Tsang NM. Missed radiation therapy sessions in first three weeks predict distant metastasis and less favorable outcomes in surgically treated patients with oral cavity squamous cell carcinoma. Radiat Oncol 2020; 15:194. [PMID: 32795324 PMCID: PMC7427928 DOI: 10.1186/s13014-020-01632-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
Background We sought to investigate the prognostic impact of missed RT sessions in patients who had undergone surgery for oral cavity squamous cell carcinoma (OCSCC). Methods The study sample consisted of 905 patients with surgically treated OCSCC who fulfilled criteria of RT course ≤8 weeks. The study participants were divided into three groups based on the characteristics of missed RT, as follows: 1) early missed RT, 2) late missed RT, and 3) RT as scheduled. Results The 5-year overall survival (OS) rates in the early missed RT, late missed RT, and RT as scheduled groups were 53.0, 58.1, and 64.5%, respectively (p = 0.046). In multivariate analysis, early missed RT was independently associated with both OS (hazard ratio (HR) = 1.486; 95% confidence interval (CI): 1.122–1.966; p = 0.006) and the occurrence of distant metastasis (HR = 1.644; 95% CI: 1.047–2.583; p = 0.031). Conclusion Early missed RT was independently associated with a higher occurrence of distant metastasis and less favorable OS in patients who had undergone surgery for OCSCC.
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Affiliation(s)
- Yin-Yin Chiang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Yung-Chih Chou
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.,College of Medicine Chang Gung University, Taoyuan, Taiwan.,Department of Head and Neck Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.,College of Medicine Chang Gung University, Taoyuan, Taiwan.,Department of Head and Neck Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yao-Yu Wu
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Wing-Keen Yap
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Ping-Ching Pai
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Tsung-Min Hung
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan. .,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Radiation Oncology, Fangliao General Hospital, No. 139, Zhongshan Rd., Fangliao Township, Pingtung County, 940, Taiwan. .,Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, School of Traditional Chinese Medicine, Chang Gung University, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, 333, Taiwan.
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20
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Wakefield DV, Carnell M, Dove APH, Edmonston DY, Garner WB, Hubler A, Makepeace L, Hanson R, Ozdenerol E, Chun SG, Spencer S, Pisu M, Martin M, Jiang B, Punglia RS, Schwartz DL. Location as Destiny: Identifying Geospatial Disparities in Radiation Treatment Interruption by Neighborhood, Race, and Insurance. Int J Radiat Oncol Biol Phys 2020; 107:815-826. [PMID: 32234552 DOI: 10.1016/j.ijrobp.2020.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/11/2020] [Accepted: 03/07/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Radiation therapy interruption (RTI) worsens cancer outcomes. Our purpose was to benchmark and map RTI across a region in the United States with known cancer outcome disparities. METHODS AND MATERIALS All radiation therapy (RT) treatments at our academic center were cataloged. Major RTI was defined as ≥5 unplanned RT appointment cancellations. Univariate and multivariable logistic and linear regression analyses identified associated factors. Major RTI was mapped by patient residence. A 2-sided P value <.0001 was considered statistically significant. RESULTS Between 2015 and 2017, a total of 3754 patients received RT, of whom 3744 were eligible for analysis: 962 patients (25.8%) had ≥2 RT interruptions and 337 patients (9%) had major RTI. Disparities in major RTI were seen across Medicaid versus commercial/Medicare insurance (22.5% vs 7.2%; P < .0001), low versus high predicted income (13.0% vs 5.9%; P < .0001), Black versus White race (12.0% vs 6.6%; P < .0001), and urban versus suburban treatment location (12.0% vs 6.3%; P < .0001). On multivariable analysis, increased odds of major RTI were seen for Medicaid patients (odds ratio [OR], 3.35; 95% confidence interval [CI], 2.25-5.00; P < .0001) versus those with commercial/Medicare insurance and for head and neck (OR, 3.74; 95% CI, 2.56-5.46; P < .0001), gynecologic (OR, 3.28; 95% CI, 2.09-5.15; P < .0001), and lung cancers (OR, 3.12; 95% CI, 1.96-4.97; P < .0001) compared with breast cancer. Major RTI was mapped to urban, majority Black, low-income neighborhoods and to rural, majority White, low-income regions. CONCLUSIONS Radiation treatment interruption disproportionately affects financially and socially vulnerable patient populations and maps to high-poverty neighborhoods. Geospatial mapping affords an opportunity to correlate RT access on a neighborhood level to inform potential intervention strategies.
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Affiliation(s)
- Daniel V Wakefield
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Matthew Carnell
- University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Austin P H Dove
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Drucilla Y Edmonston
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Wesley B Garner
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Adam Hubler
- University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Lydia Makepeace
- University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Ryan Hanson
- Department of Earth Sciences, Spatial Analysis and Geographic Education Laboratory, University of Memphis, Memphis, Tennessee
| | - Esra Ozdenerol
- Department of Earth Sciences, Spatial Analysis and Geographic Education Laboratory, University of Memphis, Memphis, Tennessee
| | - Stephen G Chun
- Division of Radiation Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | - Sharon Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Bo Jiang
- Department of Radiation Oncology, Biostatistics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rinaa S Punglia
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - David L Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Radiation Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Texas; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
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21
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Morphology, Volume, and Density Characteristics of the Parotid Glands before and after Chemoradiation Therapy in Patients with Head and Neck Tumors. Int J Dent 2020; 2020:8176260. [PMID: 32377200 PMCID: PMC7195655 DOI: 10.1155/2020/8176260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/23/2020] [Accepted: 03/04/2020] [Indexed: 12/12/2022] Open
Abstract
The multimodal approach for patients with head and neck cancer (HNC) includes treatment with chemoradiation therapy (CRT). A common concern regarding CRT side effects is the occurrence of structural and physiological alterations of the salivary glands due to exposure to ionizing radiation. The aim of this study is to examine the morphology, volume, and density of the parotid glands before and after CRT in HNC patients. A total of 49 HNC patients treated exclusively with CRT were included in the study. Ninety-eight parotid glands were evaluated before and after treatment by using contrast-enhanced computed tomography (CECT). Shapiro-Wilk test was performed, and the variables (pre-CRT and post-CRT) presented normal distribution. Pearson's coefficient was used to assess the correlation between volume and density. CRT resulted in a significant decrease in the mean volume of the parotid glands (i.e., original volume reduced by 20.5%; P < 0.0001). CRT induced a 30.0% (7 Hounsfield units) increase in density of the right parotid gland and a 24.9% (8 Hounsfield units) increase in density of the left parotid gland (P=0.0198 and P=0.0079, respectively). Changes in morphology and spatial configuration, increased density, and substantial loss of volume of the parotid glands were observed after CRT. There was also a difference in density (P=0.003) in the right-side parotid glands in comparison between xerostomic and nonxerostomic groups of patients. These facts lead to the need for a personalized CRT planning in order to minimize oral complications related to the treatment.
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22
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Yarn C, Wakefield DV, Spencer S, Martin MY, Pisu M, Schwartz DL. Insurance status and head and neck radiotherapy interruption disparities in the Mid‐Southern United States. Head Neck 2020; 42:2013-2020. [DOI: 10.1002/hed.26128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/15/2020] [Accepted: 02/20/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Charles Yarn
- Department of Radiation OncologyUniversity of Tennessee Health Science Center, College of Medicine Memphis Tennessee USA
| | - Daniel V. Wakefield
- Department of Radiation OncologyUniversity of Tennessee Health Science Center, College of Medicine Memphis Tennessee USA
- Harvard University, T.H. Chan School of Public Health Boston Massachusetts USA
| | - Sharon Spencer
- Department of Radiation OncologyUniversity of Alabama Birmingham School of Medicine Birmingham Alabama USA
| | - Michelle Y. Martin
- Department of Preventive MedicineUniversity of Tennessee Health Science Center College of Medicine Memphis Tennessee USA
- Center for Innovation in Health Equity ResearchUniversity of Tennessee Health Science Center College of Medicine Memphis Tennessee USA
| | - Maria Pisu
- Division of Preventive MedicineUniversity of Alabama Birmingham School of Medicine Birmingham Alabama USA
| | - David L. Schwartz
- Department of Radiation OncologyUniversity of Tennessee Health Science Center, College of Medicine Memphis Tennessee USA
- Department of Preventive MedicineUniversity of Tennessee Health Science Center College of Medicine Memphis Tennessee USA
- Department of Radiation OncologyUniversity of Texas MD Anderson Cancer Center Houston Texas USA
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23
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Sandulache VC, Wilde DC, Sturgis EM, Chiao EY, Sikora AG. A Hidden Epidemic of "Intermediate Risk" Oropharynx Cancer. Laryngoscope Investig Otolaryngol 2019; 4:617-623. [PMID: 31890879 PMCID: PMC6929570 DOI: 10.1002/lio2.316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/13/2019] [Accepted: 09/21/2019] [Indexed: 12/12/2022] Open
Abstract
Objectives Oropharyngeal squamous cell carcinoma (OPSCC) incidence is rapidly increasing in the United States and around the world, driven in large part by infection with the human papillomavirus (HPV). HPV associated OPSCC (HPV+OPSCC) has been shown to have improved response to treatment relative to tobacco‐associated OPSCC. However, improvement in patient survival has not been uniform. Subsets of OPSCC patients in the US and around the world continue to have poor oncologic outcomes. Although the drivers of this phenomenon remain unclear, there is increasing evidence that tobacco exposure plays an important role in modulating HPV+OPSCC clinical outcomes. Methods We conducted a review of the literature. Results We discuss the potential biological and epidemiological interplay between tobacco and HPV exposure in the context of OPSCC. Multiple retrospective and prospective cohorts show that HPV+OPSCC patients with a history of tobacco exposure have response to treatment and clinical outcomes distinct from HPV+OPSCC non‐smokers which poses clinical and scientific challenges to be addressed over the next decade. Conclusions The interaction between tobacco exposure and HPV infection in the context of OPSCC has significant implications for both standard of care treatment regimens and development of novel therapeutic approaches, in particular those which incorporate immunomodulatory agents. Level of Evidence 5
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Affiliation(s)
- Vlad C Sandulache
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A.,ENT Section, Operative Care Line Michael E. DeBakey Veterans Affairs Medical Center Houston Texas U.S.A
| | - David C Wilde
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A
| | - Erich M Sturgis
- Department of Head and Neck Surgery University of Texas MD Anderson Cancer Center Houston Texas U.S.A
| | - Elizabeth Y Chiao
- Department of Medicine Baylor College of Medicine Houston Texas U.S.A
| | - Andrew G Sikora
- Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery Baylor College of Medicine Houston Texas U.S.A.,ENT Section, Operative Care Line Michael E. DeBakey Veterans Affairs Medical Center Houston Texas U.S.A
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24
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Lamba N, Mahal BA, Martinez R, Leland P, Shih HA. Radiation Therapy Pain Management: Prevalence of Symptoms and Effectiveness of Treatment Options. Clin J Oncol Nurs 2019; 23:514-521. [PMID: 31538974 DOI: 10.1188/19.cjon.514-521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The prevalence of pain among patients undergoing radiation therapy (RT) is not well described. OBJECTIVES The purpose of this study was to assess the prevalence and management of pain in patients undergoing RT. METHODS 94 patients undergoing RT were surveyed at two time points during the course of their treatment. Patients reported on pain, fatigue, nausea, headache, and depressive symptoms, as well as on the use of pharmacologic and nonpharmacologic or alternative methods for symptom management. FINDINGS The mean severity of pain did not change significantly between the first week of RT and the final week. Severity of pain was associated with worse fatigue, nausea, headaches, and depressive symptoms, providing opportunities for providers to address multiple co-occurring symptoms. Rates of opioid and marijuana use remained similar between the two time points. More than half of the patients reported use of at least one nonpharmacologic method for pain management, with use increasing during the course of RT.
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25
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Alfaraj F, Craig T, Huang SH, O'Sullivan B, Su J, Bayley A, Bratman S, Cho J, Giuliani M, Kim J, Ringash J, Waldron J, Hansen A, de Almeida J, Perez-Ordonez B, Weinreb I, Tong L, Xu W, Hope A. Treatment outcomes in oropharynx cancer patients who did not complete planned curative radiotherapy. Oral Oncol 2019; 97:124-130. [PMID: 31521053 DOI: 10.1016/j.oraloncology.2019.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 05/02/2019] [Accepted: 05/17/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate outcomes in oropharyngeal cancer (OPC) patients who did not complete their planned curative radiation therapy (RT). METHODS OPC Patients who received less than planned curative RT dose between 2002 and 2016 were identified for analysis. HPV status was assessed. Radiation dose was normalized for fractionation variations using biological effective doses assuming tumor α/β = 10 Gy [BED10]. Outcomes were compared using BED10. Multivariable and univariable analysis identified OS predictors. RESULTS From a total of 80 patients who did not complete therapy, 64 patients were eligible for analysis. RT incompletion was due to: RT side effects (n = 23), patients' decision (n = 21), disease progression or metastases (n = 3), and other causes (n = 7). Median BED10 (Gy) was 56.2 for the HPV-positive and 58 for the HPV-negative. Three-year OS was 74% vs 13% (p < 0.001) for the HPV-positive (n = 29) and HPV-negative (n = 24), respectively. HPV-positive patients who received BED10 ≥55 had higher OS than those received BED10 <55 (94% vs 47%, p = 0.002) while no difference in OS by BED10 ≥55 vs <55 for the HPV-negative (12 vs 13%, p = NS). HPV-positive status was associated with a higher OS (HR 12.5, 95% CI, 4.54 to 33.3, p < 0.001). A total of 37 patients were available to estimate TD50 for local control assessment. TD50 (BED10) was estimated at 60.5 Gy for HPV-negative patients compared to 27.2 Gy for HPV-positive patients. CONCLUSION Overall, in patients with incomplete treatment, HPV-positive OPC patients demonstrated a better OS compared to HPV-negative patients. HPV-positive patients who received BED10 ≥55 have higher rates of OS.
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Affiliation(s)
- Fatimah Alfaraj
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Tim Craig
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Jie Su
- Joint Department of Biostatistics, Princess Margaret Cancer Centre, Room 10-508, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Scott Bratman
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - John Cho
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Meredith Giuliani
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - John Kim
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - John Waldron
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Aaron Hansen
- Department of Medicine, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Bras Drug Development Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2M9, Canada
| | - John de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada
| | - Bayardo Perez-Ordonez
- Department of Pathology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ilan Weinreb
- Department of Pathology, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Li Tong
- Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Wei Xu
- Joint Department of Biostatistics, Princess Margaret Cancer Centre, Room 10-508, 610 University Ave, Toronto, ON M5G 2M9, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, 106-150 College St, Toronto, ON M5S 3E2, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON M5G 2M9, Canada.
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Lorenz JW, Schott D, Rein L, Mostafaei F, Noid G, Lawton C, Bedi M, Li XA, Schultz CJ, Paulson E, Hall WA. Serial T2-Weighted Magnetic Resonance Images Acquired on a 1.5 Tesla Magnetic Resonance Linear Accelerator Reveal Radiomic Feature Variation in Organs at Risk: An Exploratory Analysis of Novel Metrics of Tissue Response in Prostate Cancer. Cureus 2019; 11:e4510. [PMID: 31259119 PMCID: PMC6590865 DOI: 10.7759/cureus.4510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
"Delta-radiomics" investigates variations in quantitative image metrics over time and can yield important clinical information. We hypothesized that in patients undergoing active radiation therapy (RT) for prostate cancer (PCa), there would exist observable variation in the quantitative metrics that describe the T2-weighted (T2W) intensity histogram in the prostate and surrounding organs at risk (OAR) over time. We investigated the feasibility of acquisition and subsequent analysis of the delta-radiomic profiles of these regions of interest (ROI) in serial T2W magnetic resonance (MR) images obtained on a 1.5 Tesla (T) Magnetic Resonance Linear Accelerator (MRL). Principally, we sought to illustrate the significance of longitudinal radiomic data acquisition for tissue response monitoring and provide a framework for future hypothesis driven research. Patients with PCa undergoing treatment with RT were compiled from an ongoing prospective observational imaging trial using a 1.5 T MRL (NCT30500081). Contiguous axial slices of prostate parenchyma were contoured and temporally normalized to sections of Sartorius muscle which served as a control. Similarly, contiguous sections of rectal and bladder wall adjacent to the prostate were contoured and temporally normalized to regions of these organs further removed from the planning target volume (PTV). First order statistical descriptors of the T2W intensity histogram were extracted and evaluated for changes over time using linear mixed effects regression modeling and post-hoc contrasts. Benjamini-Hochberg corrections were employed to reduce the effects of multiple testing and control for the false discovery rate (FDR). Four patients with a median age of 69 comprised this exploratory cohort. One patient had low-risk disease, two had intermediate (one favorable, one unfavorable), and one had high risk disease. Three out of four patients underwent definitive radiation to 75.6 Gray (Gy) in 42 fractions and one received hypofractionated therapy to a total dose of 70 Gy over 28 fractions, and all received treatment on a conventional linear accelerator. The most significant acute toxicity event was grade 2 GU dysfunction observed in two patients. Follow up ranged from 1 month to 10 months post treatment, and no long-term complications were reported in patients who completed treatment at least one month prior. Bladder wall adjacent to the prostate demonstrated significant variation in the mean and median metric values after the first week of treatment. In addition, rectal wall adjacent to the prostate exhibited significant variation in the mean, median, and standard deviation metric values by the second week of treatment. No significant variation in any radiomic feature was observed in the Sartorius control. This exploratory study is one of the earliest examining the delta-radiomic characteristics of the T2W intensity histogram in OAR extracted from images acquired on a 1.5 T MRL in patients actively being treated with RT for PCa. We demonstrated a feasible approach to longitudinal radiomic data acquisition providing limitless opportunity for future research. Analysis of the delta-radiomic profiles in OAR revealed significant variation in metrics after only one week of RT in bladder and rectal wall adjacent to the prostate. These findings must be further investigated and validated with expanded data sets with long-term follow up and correlation to clinical outcomes including toxicity and tumor control.
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Affiliation(s)
- Joshua W Lorenz
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - Diane Schott
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - Lisa Rein
- Biostatistics, Medical College of Wisconsin, Milwaukee, USA
| | | | - George Noid
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - Colleen Lawton
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - Meena Bedi
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - X A Li
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | | | - Eric Paulson
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - William A Hall
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, USA
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27
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Silverman DA, Puram SV, Rocco JW, Old MO, Kang SY. Salvage laryngectomy following organ-preservation therapy – An evidence-based review. Oral Oncol 2019; 88:137-144. [DOI: 10.1016/j.oraloncology.2018.11.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 01/07/2023]
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