1
|
Ueki Y, Ohshima S, Yokoyama Y, Takahashi T, Shodo R, Yamazaki K, Ohtaki K, Saijo K, Tanaka R, Togashi T, Sato Y, Takano S, Omata J, Takahashi N, Okabe R, Horii A. Multicenter prospective phase II trial of concurrent chemoradiotherapy with weekly low-dose carboplatin for cisplatin-ineligible patients with advanced head and neck squamous cell carcinoma. Int J Clin Oncol 2024; 29:20-26. [PMID: 37843751 DOI: 10.1007/s10147-023-02423-w] [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: 07/27/2023] [Accepted: 10/02/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The optimal chemotherapy regimen in concurrent chemoradiotherapy (CCRT) for cisplatin-ineligible head and neck squamous cell carcinoma (HNSCC) has not been established. We aimed to evaluate the feasibility, efficacy, and safety of CCRT with weekly low-dose carboplatin for the treatment of advanced HNSCC in patients who are cisplatin-ineligible. METHODS This prospective phase II study enrolled adult patients (age ≥ 20 years) with HNSCC receiving whole-neck irradiation including bilateral levels II-IV and who were aged (≥ 75-year-old patients with 40 mL/min estimated glomerular filtration rate [eGFR] or better) or had renal dysfunction (< 75-year-old patients with 30-60 mL/min eGFR). Carboplatin was administered weekly (area under the plasma concentration-time curve = 2.0) for up to seven cycles during concurrent radiotherapy (70 Gy/35 Fr). The primary endpoint was the completion rate of CCRT. Secondary endpoints included overall response rate and incidence of adverse events. RESULTS Among the 30 patients enrolled, 28 were men. The median age was 73.5 years. Seventeen patients were < 75 years whereas 13 were ≥ 75 years old. The completion rate of CCRT was 90%. The overall response rate was 90%. Grade 3 adverse events that occurred in 10% or more patients were oral/pharyngeal mucositis (47%), leukocytopenia (20%), and neutropenia (10%). Grade 4 adverse events occurred in one patient (elevation of alanine aminotransferase level). No treatment-related deaths occurred. CONCLUSION CCRT with weekly low-dose carboplatin is a promising treatment option, with favorable feasibility, efficacy, and acceptable toxicity, for patients who are cisplatin-ineligible with advanced HNSCC. CLINICAL TRIAL REGISTRATION NUMBER jRCTs031190028.
Collapse
Affiliation(s)
- Yushi Ueki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 950-8510, Japan.
| | - Shusuke Ohshima
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 950-8510, Japan
| | - Yusuke Yokoyama
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 950-8510, Japan
| | - Takeshi Takahashi
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 950-8510, Japan
| | - Ryusuke Shodo
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 950-8510, Japan
| | - Keisuke Yamazaki
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 950-8510, Japan
| | - Kohei Ohtaki
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata City, Niigata, Japan
| | - Kohei Saijo
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata City, Niigata, Japan
| | - Ryoko Tanaka
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata City, Niigata, Japan
| | - Takafumi Togashi
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata City, Niigata, Japan
| | - Yuichiro Sato
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata City, Niigata, Japan
| | - Satoshi Takano
- Department of Otorhinolaryngology, Nagaoka Red Cross Hospital, Nagaoka City, Niigata, Japan
| | - Jo Omata
- Department of Otorhinolaryngology, Nagaoka Red Cross Hospital, Nagaoka City, Niigata, Japan
| | - Nao Takahashi
- Department of Otorhinolaryngology, Nagaoka Red Cross Hospital, Nagaoka City, Niigata, Japan
| | - Ryuichi Okabe
- Department of Otorhinolaryngology, Nagaoka Red Cross Hospital, Nagaoka City, Niigata, Japan
| | - Arata Horii
- Department of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-Dori, Chuo-Ku, Niigata City, Niigata, 950-8510, Japan
| |
Collapse
|
2
|
Nonsurgical Treatment Strategies for Elderly Head and Neck Cancer Patients: An Emerging Subject Worldwide. Cancers (Basel) 2022; 14:cancers14225689. [PMID: 36428780 PMCID: PMC9688456 DOI: 10.3390/cancers14225689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Consistent with the increasing rate of head and neck cancers among elderly adults, there has been an increase in the rate of those receiving nonsurgical treatments to maintain their function and quality of life. However, various problems, such as poor tolerance to chemoradiotherapy-related toxicity, are of greater concern in elderly adults than in younger individuals. In this review, we describe adverse events that should be particularly noted in elderly patients and provide an overview of countermeasures in nonsurgical treatments. We mainly focus on cisplatin-based chemoradiotherapy-the primary treatment for head and neck squamous cell carcinoma (HNSCC). Furthermore, we review the molecular targeted drugs and immune checkpoint inhibitors for elderly patients with HNSCC. Although the number of older patients is increasing worldwide, clinical trials aimed at determining the standard of care typically enroll younger or well-conditioned elderly patients. There is still very little evidence for treating elderly HNSCC older patients, and the question of optimal treatment needs to be explored.
Collapse
|
3
|
Nethan S, Cherian M, Brain E, Ganguli A, Tullu F, Musolino N, Hariprasad R, Sullivan R, Mehrotra R. Cancer in the older Indian population: Understanding the current context in an emerging economy. J Geriatr Oncol 2021; 13:273-281. [PMID: 34776381 DOI: 10.1016/j.jgo.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/30/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
India is considered a demographically young country with over 65% of the population aged below 35 years. However, improvements in maternal and child health, and infectious diseases, have created a rapid epidemiological transition with an aging population (8.6% in 2011) with a projected increase (19% by 2050), equating to 104 million. In addition to the well-articulated issues surrounding the care of the older patients with cancer, the Indian context as an emerging economy provides additional social, political, economic and clinical challenges. This review addresses the key issues and possible solutions germane to both policymakers in India and other emerging economies. Extension of cancer prevention, equal, optimal treatment opportunities, and inclusion in clinical trials, akin to the younger population, must be encouraged. Various national health initiatives require effective implementation, to provide uniform, evidence-based, cancer care across India. Designated geriatric oncology departments, and required care at the primary healthcare level are essential.
Collapse
Affiliation(s)
- Suzanne Nethan
- Project ECHO (Extension for Community Healthcare Outcomes) - India, Building No 76 (2nd Floor), Okhla Phase III, Okhla Industrial Area, New Delhi 110020, India.
| | - Meena Cherian
- International Society of Geriatric Oncology (SIOG), International Environmental House 2, Chemin de Balexert 7-9, 1219 Chatelaine, Switzerland.
| | - Etienne Brain
- Department of Clinical Research & Medical Oncology, Institut Curie (Hôpital René Huguenin), 35 Rue Dailly, 92210 St Cloud, France.
| | - Atreyi Ganguli
- WHO India Country Office, 537, A Wing, Nirman Bhawan, Maulana Azad Road, New Delhi 110011, India.
| | - Fikru Tullu
- WHO India Country Office, 537, A Wing, Nirman Bhawan, Maulana Azad Road, New Delhi 110011, India.
| | - Najia Musolino
- International Society of Geriatric Oncology (SIOG), International Environmental House 2, Chemin de Balexert 7-9, 1219 Chatelaine, Switzerland.
| | - Roopa Hariprasad
- Division of Clinical Oncology, Indian Council of Medical Research (ICMR), National Institute of Cancer Prevention & Research (NICPR), I-7, Sector 39, Noida 201301, Uttar Pradesh, India.
| | | | - Ravi Mehrotra
- India Cancer Research Consortium (ICMR-DHR), Ministry of Health and Family Welfare, Department of Health Research, First Floor, Indian Red Cross Society (IRCS) Building, 1, Red Cross Road, New Delhi 110001, India; Centre for Health Innovation and Policy (CHIP) Foundation, 361, Sector 15A, Noida, Uttar Pradesh 201301, India.
| |
Collapse
|
4
|
Babu G, Bahl A, Bhattacharya GS, Bhowmik KT, Dattatraya PS, Ghadyalpatil N, Karandikar SM, Kulkarni P, Sridharan N, Parikh P, Prabhash K, Raja T, Rajasundaram S, Subramanian S, Talapatra K, Vaid A. Oncology Gold Standard ® practical consensus recommendations for the use of monoclonal antibodies in the management of squamous cell carcinoma of head and neck. South Asian J Cancer 2020; 6:154-160. [PMID: 29404293 PMCID: PMC5763625 DOI: 10.4103/sajc.sajc_181_17] [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] [Indexed: 12/20/2022] Open
Abstract
We present the 2017 Oncology Gold Standard Practical Consensus Recommendation for use of monoclonal antibodies in the management of advanced squamous cell carcinoma of head neck region.
Collapse
Affiliation(s)
- Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Ankur Bahl
- Department of Medical Oncology, Max Hospital, New Delhi, India
| | - G S Bhattacharya
- Department of Medical Oncology, Fortis Hospital, Kolkata, West Bengal, India
| | - K T Bhowmik
- Department of Radiation Oncology, Safdarjung Hospital, New Delhi, India
| | - P S Dattatraya
- Department of Medical Oncology, Omega Hospital, Hyderabad, Telangana, India
| | - Nikhil Ghadyalpatil
- Department of Medical Oncology, Yashoda Hospitals, Hyderabad, Telangana, India
| | - S M Karandikar
- Department of Medical Oncology, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Padmaj Kulkarni
- Department of Medical Oncology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Nithya Sridharan
- Department of Medical Oncology, VS Hospital, Chennai, Tamil Nadu, India
| | - Purvish Parikh
- Department of Precision Oncology, Asian Cancer Institute, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T Raja
- Department of Medical Oncology, Apollo Speciality Hospital, Chennai, Tamil Nadu, India
| | - S Rajasundaram
- Department of Surgical Oncology, Global Institute of Oncology, Chennai, Tamil Nadu, India
| | - S Subramanian
- Department of Medical Oncology, VS Hospital, Chennai, Tamil Nadu, India
| | - Kaustav Talapatra
- Department of Radiation Oncology, KDA Hospital, Mumbai, Maharashtra, India
| | - Ashok Vaid
- Department of Medical Oncology, Medanta Hospital, Gurugram, Haryana, India
| | | |
Collapse
|
5
|
Srinivasalu VK, Subramaniam N, Balasubramanian D, Kumar N, Philip A, Susan A, Pushpaja KU, Nair AR, Thankappan K, Jose W, Iyer S, Keechilat P. Concurrent chemoradiotherapy for head and neck cancers in older patients: Outcomes and their determinants. Indian J Cancer 2019; 56:261-266. [PMID: 31389391 DOI: 10.4103/ijc.ijc_725_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Meta-analyses have shown concurrent chemoradiotherapy (CCRT) provides no survival benefit over radiotherapy in patients of head and neck squamous cell carcinoma (HNSCC) aged over 70 years. This study was performed to determine the adverse-effect profile, compliance, functional and oncological outcomes in patients of HNSCC over 70 years of age treated with CCRT. MATERIALS AND Methods Retrospective analysis of stage III/IV HNSCC in patients above 70 years of age who received CCRT at our institution (n = 57). Cox-proportional hazards regression model was used for statistical analysis. RESULTS There were 57 patients of stage III/IV HNSCC who underwent curative CCRT. 61% completed chemotherapy with no deaths and acceptable toxicity. The predictors of recurrence were poorer performance status (P = 0.031) and treatment breaks (P = 0.04). Tube dependence was associated with 2.7 times higher risk of mortality (P = 0.005). CONCLUSION CCRT should be considered standard of care in those over seventy with good performance status. Patients with tube dependence have a higher risk of persistent disease or treatment related mortality.
Collapse
Affiliation(s)
- Vijay K Srinivasalu
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Narayana Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Deepak Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Narender Kumar
- Marie Skłodowska-Curie Fellow, Institute of Experimental Endocrinology and Oncology, Naples, Italy
| | - Arun Philip
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Annu Susan
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - K U Pushpaja
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Anoop R Nair
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Wesley Jose
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Pavithran Keechilat
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| |
Collapse
|
6
|
Mohamed A, Twardy B, Zordok MA, Ashraf K, Alkhoder A, Schrapp K, Steuer C, Chen Z, Pakkala S, Pillai R, Trad Wadsworth J, Higgins K, Beitler JJ, Ramalingam SS, Owonikoko TK, Khuri FR, Shin DM, Behera M, Saba NF. Concurrent chemoradiotherapy with weekly versus triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck: Comparative analysis. Head Neck 2019; 41:1490-1498. [PMID: 30835900 DOI: 10.1002/hed.25379] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/10/2018] [Accepted: 05/28/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cisplatin-based chemoradiotherapy is standard of care for locally advanced squamous cell carcinoma of the head and neck. This systemic review compared efficacy and safety of weekly vs triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck. METHODS Among 1500 prospective studies published from 1970 to 2015, 39 (18 weekly, 21 triweekly) including 3668 patients qualified for inclusion. Clinical outcomes were analyzed using weighted estimates and 2-tailed t test for comparisons; significance level was 0.05. RESULTS Locoregional control was 58% (CI 53%-63%) vs 61% (CI 56%-65%; P = .7). The 2-year overall survival (OS) was 74% (CI 66%-80%) for weekly vs 67% (64%-69%) triweekly groups (P = .67). The 2-year progression-free survival (PFS) was 69% (CI 59%-77%) for weekly vs 62% (CI 58%-65%) triweekly groups (P = .9). Grade 3 to 5 toxicities were 36% vs 40% (P = .37) in weekly vs triweekly groups. CONCLUSIONS Weekly cisplatin was comparable in efficacy and safety to the triweekly regimen. Our analysis supports the use of weekly or triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck, with tolerability being a key factor in selection.
Collapse
Affiliation(s)
- Amr Mohamed
- Department of Medical Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Brandon Twardy
- Department of Medical Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Magdi A Zordok
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Khuram Ashraf
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Ayman Alkhoder
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Kelly Schrapp
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Zhengjia Chen
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Suchita Pakkala
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rathi Pillai
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - J Trad Wadsworth
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | | | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| |
Collapse
|
7
|
Coca‐Pelaz A, Halmos GB, Strojan P, Bree R, Bossi P, Bradford CR, Rinaldo A, Vander Poorten V, Sanabria A, Takes RP, Ferlito A. The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review. Head Neck 2019; 41:2410-2429. [DOI: 10.1002/hed.25696] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/03/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andrés Coca‐Pelaz
- Department of OtolaryngologyHospital Universitario Central de Asturias Oviedo Spain
| | - Gyorgy B. Halmos
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Primož Strojan
- Department of Radiation OncologyInstitute of Oncology Ljubljana Slovenia
| | - Remco Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer CenterUniversity Medical Center Utrecht Utrecht The Netherlands
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical SpecialtiesRadiological Sciencesand Public HealthUniversity of Brescia, ASST‐Spedali Civili Brescia Italy
| | - Carol R. Bradford
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Michigan Ann Arbor Michigan
| | | | - Vincent Vander Poorten
- Otorhinolaryngology – Head and Neck Surgery and Department of Oncology, Section Head and Neck OncologyUniversity Hospitals Leuven, KU Leuven Leuven Belgium
| | - Alvaro Sanabria
- Department of Surgery, School of MedicineUniversidad de Antioquia, Clínica Vida Medellín Colombia
| | - Robert P. Takes
- Department of Otolaryngology – Head and Neck SurgeryRadboud University Medical Center Nijmegen The Netherlands
| | - Alfio Ferlito
- International Head and Neck Scientific Group Padua Italy
| |
Collapse
|
8
|
Modulated radiotherapy for head and neck carcinomas: an outcome study. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396918000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundTo evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).Materials and methodsA total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.ResultsAmong the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.ConclusionsIn our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.
Collapse
|
9
|
Castelli J, Simon A, Lafond C, Perichon N, Rigaud B, Chajon E, De Bari B, Ozsahin M, Bourhis J, de Crevoisier R. Adaptive radiotherapy for head and neck cancer. Acta Oncol 2018; 57:1284-1292. [PMID: 30289291 DOI: 10.1080/0284186x.2018.1505053] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Large anatomical variations can be observed during the treatment course intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), leading to potential dose variations. Adaptive radiotherapy (ART) uses one or several replanning sessions to correct these variations and thus optimize the delivered dose distribution to the daily anatomy of the patient. This review, which is focused on ART in the HNC, aims to identify the various strategies of ART and to estimate the dosimetric and clinical benefits of these strategies. MATERIAL AND METHODS We performed an electronic search of articles published in PubMed/MEDLINE and Science Direct from January 2005 to December 2016. Among a total of 134 articles assessed for eligibility, 29 articles were ultimately retained for the review. Eighteen studies evaluated dosimetric variations without ART, and 11 studies reported the benefits of ART. RESULTS Eight in silico studies tested a number of replanning sessions, ranging from 1 to 6, aiming primarily to reduce the dose to the parotid glands. The optimal timing for replanning appears to be early during the first two weeks of treatment. Compared to standard IMRT, ART decreases the mean dose to the parotid gland from 0.6 to 6 Gy and the maximum dose to the spinal cord from 0.1 to 4 Gy while improving target coverage and homogeneity in most studies. Only five studies reported the clinical results of ART, and three of those studies included a non-randomized comparison with standard IMRT. These studies suggest a benefit of ART in regard to decreasing xerostomia, increasing quality of life, and increasing local control. Patients with the largest early anatomical and dose variations are the best candidates for ART. CONCLUSION ART may decrease toxicity and improve local control for locally advanced HNC. However, randomized trials are necessary to demonstrate the benefit of ART before using the technique in routine practice.
Collapse
Affiliation(s)
- J. Castelli
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - A. Simon
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - C. Lafond
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - N. Perichon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - B. Rigaud
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| | - E. Chajon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - B. De Bari
- Radiotherapy Department, CHU Jean-Minjoz, Besançon, France
| | - M. Ozsahin
- Radiotherapy Department, Lausanne University Hospital, Lausanne, Switzerland
| | - J. Bourhis
- Radiotherapy Department, Lausanne University Hospital, Lausanne, Switzerland
| | - R. de Crevoisier
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
- INSERM U1099 LTSI, Rennes, France
- Université de Rennes 1, Rennes, France
| |
Collapse
|
10
|
Iqbal MS, Dua D, Kelly C, Bossi P. Managing older patients with head and neck cancer: The non-surgical curative approach. J Geriatr Oncol 2018; 9:411-417. [PMID: 29685382 DOI: 10.1016/j.jgo.2018.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/27/2018] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
Managing older patients with head and neck cancers poses a challenge due to the often reduced levels of physiological reserve, the frequent comorbidities and treatment related toxicity. These factors have implications on speech, breathing and swallowing functions. Treatment management plans in these patients may result in de-intensification strategies and as a result of this, use of non-standard treatments is increasing. There have been published reports that indicate the addition of concurrent systemic therapy to radiation in selected older patients is feasible, and produces outcomes comparable with younger patients. However, some other studies including meta-analyses suggest a lack of real survival benefit with the addition of chemotherapy. So, the key point appears to be the optimal patient selection. Appropriate geriatric and frailty assessments are required to help determine the optimal treatment for older patients with head and neck cancer. Treatment for this population still needs to be well defined and optimized in both modality and intensity. Qualitative studies are also required to address short and long-term post-treatment quality-of-life and survivorship issues in this specific patient population. This review summarizes the evidence available regarding the non-surgical management of older patients with head and neck cancers.
Collapse
Affiliation(s)
- Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Divyanshu Dua
- Department of Medical Oncology, The Canberra Hospital, Garran ACT 2605, Australia
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Paolo Bossi
- Department of Medical Oncology, Fondazione IRCCS Instituto Nazionale Tumori, Milan, Italy
| |
Collapse
|
11
|
Subramaniam NR, Srinivasalu VK, Balasubramanian D, Pushpaja KU, Nair AR, Prameela C, Thankappan K, Iyer S. Radical radiotherapy for carcinoma of the larynx in the elderly: Functional and oncological outcomes from a tertiary cancer care center in India. Indian J Cancer 2018; 54:493-497. [PMID: 29798945 DOI: 10.4103/ijc.ijc_321_17] [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: 11/04/2022]
Abstract
INTRODUCTION It is estimated that around 10% of all head and neck cancer patients in India are aged over 70 years. Elderly patients are often subjected to palliative or inadequate treatment for head and neck cancers in spite of being candidates for curative intent therapy. In this study we evaluated our use of radical radiotherapy in carcinoma larynx for patients over seventy years of age to determine morbidity, likelihood of completing therapy, functional and oncological outcomes. MATERIALS AND METHODS 132 patients of squamous cell carcinoma of the larynx treated between 2005-2015 at Amrita Institute of Medical Sciences, Kochi who were seventy years of age or older were included. The endpoint for analysis was overall survival. Survival curves were generated using Kaplan Meier method and univariable analysis was performed using log rank test. RESULTS The median age of patients was 77 years (range 70-102). All patients (100%) completed radiotherapy with 6 (5%) requiring treatment breaks. All patients had at least minor (grade I/II) toxicities. Grade III toxicities were seen in 10 (8%) of patients. No grade IV reactions or treatment related deaths occurred. When a univariate analysis was performed for determinants of major toxicities with age range, performance status, smoking, number of co-morbidities or TNM stage, no determinants were statistically significant. 2-year disease free survival for stage I, II, III and IV was 100%, 98%, 80% and 64% respectively, and the 2-year overall survival for all four stages was 100%. CONCLUSION Patients over seventy years tolerate radical radiotherapy for treatment of laryngeal cancer. In spite of minor toxicities, all patients completed treatment and had good oncological outcomes. Patients with stage III/IV unfit for concomitant chemotherapy administration treated with radiotherapy alone had a good disease free survival. Curative intent therapy should not be withheld from elderly patients on the basis of age.
Collapse
Affiliation(s)
- Narayana R Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Vijay Kumar Srinivasalu
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Deepak Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - K U Pushpaja
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Anoop Remesan Nair
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Chelakkot Prameela
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - Subramania Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| |
Collapse
|
12
|
Magnano M, Bertone F, Andreis M, Boffano P, Machetta G. Management of head and neck cancer in older patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:369-375. [PMID: 29501356 DOI: 10.1016/j.oooo.2018.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/21/2017] [Accepted: 01/20/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE A progressive increase in the number of older patients with head and neck cancer has been observed in the last few years. The aim of this study was to assess our experience in the management of older patients with head and neck cancer (HNC) in comparison with younger patients. STUDY DESIGN A retrospective review was conducted for all patients admitted and treated for newly diagnosed HNC between January 2008 and December 2012. The clinical characteristics, management approaches, and outcome data were recorded. RESULTS In total, 316 patients with HNC (232 males, 84 females) were enrolled: 203 (64%) were in the young group, whereas 113 patients (36%) were in the older group. Comorbidities (P < .000005) and stage IV tumors (P < .0005) were more frequently observed in the older group. Treatment options were uniformly distributed within the 2 groups; only radiotherapy alone was more frequently administered in older patients (P < .0005). CONCLUSIONS Chronologic age should not be a reason to deny appropriate treatments that could prevent death in older patients. A careful pretreatment assessment should always be performed.
Collapse
Affiliation(s)
- Mauro Magnano
- Division of Otolaryngology, Pinerolo and Rivoli Hospitals, ASL TO3, Pinerolo, Italy
| | - Fabio Bertone
- Division of Otolaryngology, Pinerolo and Rivoli Hospitals, ASL TO3, Pinerolo, Italy
| | - Marco Andreis
- Division of Otolaryngology, Pinerolo and Rivoli Hospitals, ASL TO3, Pinerolo, Italy
| | - Paolo Boffano
- Division of Otolaryngology, Pinerolo and Rivoli Hospitals, ASL TO3, Pinerolo, Italy.
| | - Giacomo Machetta
- Division of Otolaryngology, Pinerolo and Rivoli Hospitals, ASL TO3, Pinerolo, Italy
| |
Collapse
|
13
|
Falk AT, Hébert C, Tran A, Chand ME, Leysalle A, Thariat J, Dassonville O, Poissonnet G, Bozec A, Saada E, Peyrade F, Benezery K. Radiotherapy for elderly patients and cetuximab, a monocentric study. Eur Arch Otorhinolaryngol 2016; 274:1061-1065. [DOI: 10.1007/s00405-016-4336-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/04/2016] [Indexed: 12/16/2022]
|
14
|
Kataria T, Gupta D, Goyal S, Bisht SS, Basu T, Abhishek A, Narang K, Banerjee S, Nasreen S, Sambasivam S, Dhyani A. Clinical outcomes of adaptive radiotherapy in head and neck cancers. Br J Radiol 2016; 89:20160085. [PMID: 26986461 DOI: 10.1259/bjr.20160085] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The present study evaluated the efficacy and toxicity of adaptive radiotherapy (RT) among patients with head and neck cancer. METHODS 36 patients eligible for radical RT underwent RT planning scans and were planned for 54-Gy dose to both high-risk and low-risk target volumes in Phase I. All patients underwent a second (adaptive) scan during the fifth week of RT. Phase II plans for 16 Gy to high-risk planning target volume were developed on these mid-treatment scans. The primary end point was local response. Disease-free survival (DFS), overall survival (OS) and treatment-related morbidity were secondary end points. RESULTS Median reductions in gross primary and nodal disease volumes on mid-treatment scans were 34% and 43.2%, respectively. 16 patients experienced grade 3 acute mucositis. No patient had grade 3 or above haematologic toxicity. Four patients developed local recurrences, all within the RT field. Median DFS and OS were 17.5 and 23.5 months, respectively. CONCLUSION Adaptation to changes in the anatomic and tumour volume or shape may help tilt the balance towards more efficient dose delivery as well as better normal tissue sparing. ADVANCES IN KNOWLEDGE This study supports the need for adaptive replanning for minimizing normal tissue toxicity without compromising local control and adds to the existing body of literature.
Collapse
Affiliation(s)
- Tejinder Kataria
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Deepak Gupta
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Shikha Goyal
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Shyam S Bisht
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Trinanjan Basu
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Ashu Abhishek
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Kushal Narang
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Susovan Banerjee
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Shahida Nasreen
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| | | | - Aruj Dhyani
- Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India
| |
Collapse
|