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Aral İP, Altinisik Inan G, Dadak B, Görtan FA, Tezcan Y. A Prospective Evaluation of Tubarial Gland Doses With Acute Dysphagia and Treatment Tolerance in Head and Neck Cancer Patients. Cureus 2024; 16:e56566. [PMID: 38646264 PMCID: PMC11029817 DOI: 10.7759/cureus.56566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Background This study prospectively analyzed the clinical significance of tubarial glands (TGs) doses in head and neck cancer (HNC) patients. Methods Patients diagnosed with HNC in Ankara Bilkent City Hospital, Turkey were analyzed. TGs volumes and doses were noted. The patients were evaluated in terms of acute dysphagia (AD) and radiation therapy (RT)-associated xerostomia. Results The median volume of the TGs was 3.5(2.1-5.9)cc. No increased standardized uptake values (SUV) were observed in the TGs. There was no significant relationship between TGs values and the third or sixth months of xerostomia after RT. There was a significant relationship between grade ≥2 AD and TGs-Dmean (p0.020); TGs-V25(%) (p0.007); TGs-V30(%) (p0.009); TGs-V40% (p0.011); TGs-V50% (p0.010), TGs-V60% (p0.045). In terms of the risk of grade ≥2 AD, the cut-off value of the TGs-Dmean was analyzed for 50 Gy, with 75% sensitivity and 73.3% specificity (p 0.020; AUC 0.746; 95% CI 0.561-0.929). Additionally for grade ≥2 AD, the cut-off value of the TGs-V25(%) was analyzed 78 with 81.3% sensitivity and 80.0% specificity (p 0.011; AUC 0.769; 95% CI 0.591-0.947). Conclusion A significant correlation was found between TGs doses and AD during RT. TGs-V25(%) value showed higher significance. In future studies, the clinical significance of TGs can be studied especially on this value. The relationship between TGs doses and xerostomia should be evaluated with a larger series.
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Affiliation(s)
- İpek Pınar Aral
- Radiation Oncology, Ankara Yıldırım Beyazıt University, Ankara, TUR
| | | | - Binnur Dadak
- Radiation Oncology, Ankara Bilkent City Hospital, Ankara, TUR
| | - Fatma Arzu Görtan
- Department of Nuclear Medicine, Ankara Bilkent City Hospital, Ankara, TUR
| | - Yılmaz Tezcan
- Radiation Oncology, Ankara Yıldırım Beyazıt University, Ankara, TUR
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Zhao F, Yang D, Li X. Effect of radiotherapy interruption on nasopharyngeal cancer. Front Oncol 2023; 13:1114652. [PMID: 37091186 PMCID: PMC10116059 DOI: 10.3389/fonc.2023.1114652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/27/2023] [Indexed: 04/25/2023] Open
Abstract
Nasopharyngeal carcinoma (NPC) is a malignant tumor originating from the epithelial cells of the nasopharynx with a unique geographic distribution, and is particularly prevalent in East and Southeast Asia. Due to its anatomical location, the surgery is difficult to access and the high sensitivity of nasopharyngeal cancer to radiotherapy (RT) makes it the main treatment modality. Radical radiotherapy is the first-line treatment for early-stage nasopharyngeal carcinoma and the cornerstone of multidisciplinary treatment for patients with locally advanced nasopharyngeal carcinoma. Nevertheless, radiotherapy interruption is inevitable as a consequence of unavoidable factors such as public holidays, machine malfunction, patient compliance, and adverse response to treatment, which in turn leads to a reduction in bioactivity and causes sublethal loss of tumor cells to repair. Unirradiated tumor cells are more likely to repopulate at or near their original fastest growth rate during this interval. If no measures are taken after the radiotherapy interruption, such as increasing the dose of radiotherapy and systemic therapy, the tumor is most likely to go uncontrolled and then progress. This review describes the effects of radiotherapy interruption on nasopharyngeal carcinoma, the mechanism of the effect, and explores the measures that can be taken in response to such interruption.
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Affiliation(s)
- Fangrui Zhao
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Dashuai Yang
- Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiangpan Li
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Wang CH, Ling HH, Liu MH, Pan YP, Chang PH, Lin YC, Chou WC, Peng CL, Yeh KY. Treatment-Interval Changes in Serum Levels of Albumin and Histidine Correlated with Treatment Interruption in Patients with Locally Advanced Head and Neck Squamous Cell Carcinoma Completing Chemoradiotherapy under Recommended Calorie and Protein Provision. Cancers (Basel) 2022; 14:cancers14133112. [PMID: 35804884 PMCID: PMC9264877 DOI: 10.3390/cancers14133112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
We investigated risk factors for treatment interruption (TI) in patients with locally advanced head and neck squamous-cell carcinoma (LAHNSCC) following concurrent chemoradiotherapy (CCRT), under the provision of recommended calorie and protein intake; we also evaluated the associations between clinicopathological variables, calorie and protein supply, nutrition–inflammation biomarkers (NIBs), total body composition change (TBC), and a four-serum-amino-acid metabolite panel (histidine, leucine, ornithine, and phenylalanine) among these patients. Patients with LAHNSCC who completed the entire planned CCRT course and received at least 25 kcal/kg/day and 1 g of protein/kg/day during CCRT were prospectively recruited. Clinicopathological variables, anthropometric data, blood NIBs, CCRT-related factors, TBC data, and metabolite panels before and after treatment were collected; 44 patients with LAHNSCC were enrolled. Nine patients (20.4%) experienced TIs. Patients with TIs experienced greater reductions in hemoglobin, serum levels of albumin, uric acid, histidine, and appendicular skeletal mass, and suffered from more grade 3/4 toxicities than those with no TI. Neither increased daily calorie supply (≥30 kcal/kg/day) nor feeding tube placement was correlated with TI. Multivariate analysis showed that treatment-interval changes in serum albumin and histidine levels, but not treatment toxicity, were independently associated with TI. Thus, changes in serum levels of albumin and histidine over the treatment course could cause TI in patients with LAHNSCC following CCRT.
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Affiliation(s)
- Chao-Hung Wang
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan; (C.-H.W.); (M.-H.L.)
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
| | - Hang Huong Ling
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung 20401, Taiwan
| | - Min-Hui Liu
- Heart Failure Research Center, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan; (C.-H.W.); (M.-H.L.)
- Department of Nursing, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Yi-Ping Pan
- Department of Nutrition, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Pei-Hung Chang
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung 20401, Taiwan
| | - Yu-Ching Lin
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, College of Medicine, Keelung 20401, Taiwan
- Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital, Keelung 20401, Taiwan
| | - Wen-Chi Chou
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taoyuan 333007, Taiwan
| | - Chia-Lin Peng
- Taiwan Nutraceutical Association, Taipei 104483, Taiwan;
| | - Kun-Yun Yeh
- College of Medicine, Chang Gung University, Taoyuan 333007, Taiwan; (H.H.L.); (P.-H.C.); (Y.-C.L.); (W.-C.C.)
- Division of Hemato-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, College of Medicine, Keelung 20401, Taiwan
- Correspondence: ; Tel.: +886-2-24329292 (ext. 2360); Fax: +886-2-2435342
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Mahmood A, Bhuva N, Fokas E, Glynne-Jones R. Compliance to chemoradiation in squamous cell carcinoma of the anus. Cancer Treat Rev 2022; 106:102381. [DOI: 10.1016/j.ctrv.2022.102381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/09/2022] [Accepted: 03/11/2022] [Indexed: 11/02/2022]
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Xu C, Yang KB, Feng RJ, Chen L, Du XJ, Mao YP, Li WF, Liu Q, Sun Y, Ma J. Radiotherapy interruption due to holidays adversely affects the survival of patients with nasopharyngeal carcinoma: a joint analysis based on large-scale retrospective data and clinical trials. Radiat Oncol 2022; 17:36. [PMID: 35183221 PMCID: PMC8858542 DOI: 10.1186/s13014-022-02006-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/07/2022] [Indexed: 12/26/2022] Open
Abstract
Background The impact of radiotherapy interruption due to the Spring Festival holidays in China on the survival of patients with nasopharyngeal carcinoma (NPC) is unclear. Methods Nontrial patients with locoregionally advanced NPC receiving radiotherapy plus induction chemotherapy (IC) and/or concurrent chemotherapy (CC) were included (N = 5035) and divided into two groups based on the Spring Festival-induced radiotherapy interruption. Kaplan–Meier curves for overall survival (OS) and failure-free survival (FFS) were compared between rival groups. Impact of the timing of radiotherapy interruption (during or outside the Spring Festival) on survival was investigated in a propensity score-matched dataset. We adopted ordination correspondence analysis to determine the cut-off of radiotherapy prolongation for prognostic prediction, and accordingly performed subgroup analysis based on delayed days and chemotherapy details. Individual patient data of three phase III NPC trials (NCT00677118, NCT01245959, NCT01872962) were used for validation (N = 1465). Results Radiotherapy interruption was most frequently observed between December to January of the following year. Significantly lower OS and FFS were associated with the Spring Festival-induced interruption of radiotherapy (P = 0.009 and 0.033, respectively), but not that interruption of IC. In two matched comparison groups, the timing of radiotherapy interruption during the Spring Festival was more likely to lead to a decrease in FFS than outside the Spring Festival (P = 0.046), which was not observed in the validation using clinical trial data or in the subgroup analysis based on the 5-day delayed time. The absence of CC and the accumulated dose of cisplatin < 200 mg were related to the negative influences of the Spring Festival-induced radiotherapy interruption on FFS (P = 0.002) and OS (P = 0.010), respectively. Conclusions The poor survival of patients with NPC is associated with the Spring Festival-induced interruption of radiotherapy. We recommend that these patients receive adequate doses of cisplatin concurrently with radiotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02006-5.
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Kang JJ, Wong RJ, Sherman EJ, Rybkin A, McBride SM, Riaz N, Tsai CJ, Yu Y, Chen L, Zakeri K, Gelblum DY, Gillespie EF, Cohen MA, Cracchiolo JR, Ganly I, Patel S, Singh B, Boyle JO, Roman BR, Morris LG, Shaha AR, Dunn LA, Ho AL, Fetten JV, Shah JP, Pfister DG, Lee NY. The 3 Bs of cancer care amid the COVID-19 pandemic crisis: "Be safe, be smart, be kind"-A multidisciplinary approach increasing the use of radiation and embracing telemedicine for head and neck cancer. Cancer 2020; 126:4092-4104. [PMID: 32639615 PMCID: PMC7361524 DOI: 10.1002/cncr.33031] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/09/2020] [Indexed: 12/22/2022]
Abstract
Because of the national emergency triggered by the coronavirus disease 2019 (COVID-19) pandemic, government-mandated public health directives have drastically changed not only social norms but also the practice of oncologic medicine. Timely head and neck cancer (HNC) treatment must be prioritized, even during emergencies. Because severe acute respiratory syndrome coronavirus 2 predominantly resides in the sinonasal/oral/oropharyngeal tracts, nonessential mucosal procedures are restricted, and HNCs are being triaged toward nonsurgical treatments when cures are comparable. Consequently, radiation utilization will likely increase during this pandemic. Even in radiation oncology, standard in-person and endoscopic evaluations are being restrained to limit exposure risks and preserve personal protective equipment for other frontline workers. The authors have implemented telemedicine and multidisciplinary conferences to continue to offer standard-of-care HNC treatments during this uniquely challenging time. Because of the lack of feasibility data on telemedicine for HNC, they report their early experience at a high-volume cancer center at the domestic epicenter of the COVID-19 crisis.
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Affiliation(s)
- Jung Julie Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric J Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alisa Rybkin
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daphna Y Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A Cohen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Snehal Patel
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bhuvanesh Singh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jay O Boyle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin R Roman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc G Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ashok R Shaha
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lara A Dunn
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James V Fetten
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David G Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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7
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Pozo G, Pérez-Escutia MA, Ruíz A, Ferrando A, Milanés A, Cabello E, Díaz R, Prado A, Pérez-Regadera JF. Management of interruptions in radiotherapy treatments: Adaptive implementation in high workload sites. Rep Pract Oncol Radiother 2019; 24:239-244. [PMID: 30858768 DOI: 10.1016/j.rpor.2019.02.003] [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: 08/08/2018] [Revised: 11/24/2018] [Accepted: 02/07/2019] [Indexed: 01/11/2023] Open
Abstract
Owing to predictable or unpredictable causes, interruptions may arise during therapy. On average, the extension of fractionated radiotherapy treatments is prone to be delayed by several weeks and interruptions can come up extending overall treatment time (OTT). Clonogenic cells of aggressive tumors might benefit from this situation, modifying local control (LC). Preserving treatment quality in radiotherapy is an essential issue for the treatment outcome, and our institution is increasingly concerned about this line of work. Establishing some objective criteria to schedule patients that have suffered interruptions along their treatments is of capital importance and not a trivial issue. Publications strongly encourage departments to minimize the effect of lag periods during treatments. Therefore, in July 2017, our facility implemented the so called 'Protocol to Manage Interruptions in Radiotherapy', based on a scoring system for patient categorization that considers not only histology but also associated comorbidity and sequence of the therapy.
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Affiliation(s)
- Gustavo Pozo
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Ana Ruíz
- Department of Radiation Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Ferrando
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Milanés
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eduardo Cabello
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raul Díaz
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Prado
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
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Clough S, Burke M, Daly B, Scambler S. The impact of pre-radiotherapy dental extractions on head and neck cancer patients: a qualitative study. Br Dent J 2018; 225:28-32. [DOI: 10.1038/sj.bdj.2018.442] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 11/09/2022]
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The "rocky treatment course": identifying a high-risk subgroup of head and neck cancer patients for supportive interventions. Support Care Cancer 2016; 25:719-727. [PMID: 27815711 DOI: 10.1007/s00520-016-3450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/10/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE We aim to identify the risk factors for a "rocky" treatment course (RTC) in head and neck cancer. METHODS A retrospective case-control study was conducted utilizing data from a prospective study. We defined the RTC as a composite of adverse outcomes including G-tube dependence and increased nursing interventions. Statistically associative variables were included in a multivariable logistic regression. We also evaluated whether the RTC, or its components, associated with worse cancer outcomes. RESULTS Being single, unemployed, having N2/3 disease and receiving chemoradiotherapy were associated with a RTC. In turn, G-tube dependence was associated with worse 3-year OS (73 vs 91 %; p = 0.02) and increased nursing interventions with worse 3-year locoregional recurrence-free survival (LRFS) (85 vs 92 %; p = 0.03) and locoregional recurrence (LRR) (14 vs 7 %; p = 0.03). CONCLUSIONS We identified baseline factors associated with a RTC for head and neck cancer patients. Future supportive care interventions could be evaluated using the RTC as a marker of benefit.
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Britton B, Baker A, Clover K, McElduff P, Wratten C, Carter G. Heads Up: a pilot trial of a psychological intervention to improve nutrition in head and neck cancer patients undergoing radiotherapy. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12502] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/30/2022]
Affiliation(s)
- B. Britton
- Psycho-Oncology Service; Calvary Mater Newcastle; Waratah NSW Australia
- Priority Research Centre for Translational Neuroscience and Mental Health; University of Newcastle; Callaghan NSW Australia
| | - A. Baker
- School of Medicine and Public Health; University of Newcastle; Callaghan NSW Australia
| | - K. Clover
- Psycho-Oncology Service; Calvary Mater Newcastle; Waratah NSW Australia
| | - P. McElduff
- School of Medicine and Public Health; University of Newcastle; Callaghan NSW Australia
| | - C. Wratten
- Radiation Oncology Department; Calvary Mater Newcastle; Waratah NSW Australia
| | - G. Carter
- Psycho-Oncology Service; Calvary Mater Newcastle; Waratah NSW Australia
- Priority Research Centre for Translational Neuroscience and Mental Health; University of Newcastle; Callaghan NSW Australia
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Sharma A, Jagadesan P, Chaudhari P, Das S, Bhaskar S, Thakar A, Sharma A, Mohanti BK. Six-year analysis of compliance to weekly concurrent chemoradiotherapy in head and neck carcinomas. Clin Otolaryngol 2015; 41:442-7. [PMID: 26523400 DOI: 10.1111/coa.12580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate treatment compliance to weekly concurrent chemoradiotherapy (CRT) in head and neck squamous cell carcinoma (HNSCC). STUDY DESIGN Retrospective analysis. SETTING Tertiary care hospital. MAIN OUTCOME MEASURES Overall treatment time (OTT), acute radiation morbidity and treatment completion rate without prolongation of overall treatment time of more than 2 days. RESULTS Three hundred and seventy-eight head and neck carcinoma patients treated with radical CRT with 70 Gy/35 fractions of radiotherapy with weekly cisplatin 40 mg/m(2) were included in the study. Median age was 52 years (range 22-77 years), oropharynx was most commonly (54%) involved site, and 55% were in stage IV disease. Majority (86%) of patients were able to complete cancer-directed therapy, median OTT was 52 days (46-140 days). Nineteen per cent of patients completed treatment without prolongation of OTT beyond 2 days and 68% of patients there completed treatment prolongation of OTT beyond 7 days. Nearly, sixty-six of the patients experienced grade II or higher acute radiation morbidities. CONCLUSIONS Delivery of weekly low-dose concurrent CRT is safe and feasible. Two-thirds of the patients experienced treatment prolongation of more than 2 days and 14% could not complete treatment. Results within in the study suggest to a greater need to lay emphasis on continuity of a course of radical CRT for HNSCC.
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Affiliation(s)
- A Sharma
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P Jagadesan
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - P Chaudhari
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Das
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - S Bhaskar
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - A Thakar
- Department of Medical Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - A Sharma
- Department of Otorhinolaryngology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - B K Mohanti
- Department of Radiation Oncology, Dr. B.R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Sreeraman R, Vijayakumar S, Chen AM. Correlation of radiation treatment interruptions with psychiatric disease and performance status in head and neck cancer patients. Support Care Cancer 2013; 21:3301-6. [DOI: 10.1007/s00520-013-1907-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/12/2013] [Indexed: 01/14/2023]
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13
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Martínez Carrillo M, Tovar Martín I, Martínez Lara I, Ruiz de Almodóvar Rivera JM, Del Moral Ávila R. Selective use of postoperative neck radiotherapy in oral cavity and oropharynx cancer: a prospective clinical study. Radiat Oncol 2013; 8:103. [PMID: 23621873 PMCID: PMC3653704 DOI: 10.1186/1748-717x-8-103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 02/16/2013] [Indexed: 12/19/2022] Open
Abstract
Background In cervical postoperative radiotherapy, the target volume is usually the same as the extension of the previous dissection. We evaluated a protocol of selective irradiation according to the risk estimated for each dissected lymph node level. Methods Eighty patients with oral/oropharyngeal cancer were included in this prospective clinical study between 2005 and 2008. Patients underwent surgery of the primary tumor and cervical dissection, with identification of positive nodal levels, followed by selective postoperative radiotherapy. Three types of selective nodal clinical target volume (CTV) were defined: CTV0, CTV1, and CTV2, with a subclinical disease risk of <10%, 10-25%, and 25% and a prescribed radiation dose of <35 Gy, 50 Gy, and 66–70 Gy, respectively. The localization of node failure was categorized as field, marginal, or outside the irradiated field. Results A consistent pattern of cervical infiltration was observed in 97% of positive dissections. Lymph node failure occurred within a high-risk irradiated area (CTV1-CTV2) in 12 patients, marginal area (CTV1/CTVO) in 1 patient, and non-irradiated low-risk area (CTV0) in 2 patients. The volume of selective lymph node irradiation was below the standard radiation volume in 33 patients (mean of 118.6 cc per patient). This decrease in irradiated volume was associated with greater treatment compliance and reduced secondary toxicity. The three-year actuarial nodal control rate was 80%. Conclusion This selective postoperative neck irradiation protocol was associated with a similar failure pattern to that observed after standard neck irradiation and achieved a significant reduction in target volume and secondary toxicity.
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Affiliation(s)
- Miguel Martínez Carrillo
- Department of Radiation Oncology, Virgen de las Nieves University Hospital, Avda, Fuerzas Armadas 4, Granada 18014, Spain.
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14
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Loo SW, Geropantas K, Tasigiannopoulos Z, Martin C, Roques TW. Feasibility and tolerance of sequential chemoradiotherapy in squamous cell carcinoma of the head and neck. Eur J Cancer Care (Engl) 2012; 22:32-40. [DOI: 10.1111/j.1365-2354.2012.01352.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S W Loo
- Department of Oncology, Norfolk and Norwich University Hospital, Norwich, UK.
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Giddings A. Treatment Interruptions in Radiation Therapy for Head-and-Neck Cancer: Rates and Causes. J Med Imaging Radiat Sci 2010; 41:222-229. [PMID: 31051883 DOI: 10.1016/j.jmir.2010.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/12/2010] [Accepted: 08/18/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Extending the period over which a course of radiation therapy is delivered can have detrimental effects on treatment success. This is especially true for fast growing tumors of the head-and-neck region. The goal of this study was to establish the rates and causes of treatment interruptions for head-and-neck patients at the Vancouver Cancer Centre of the BC Cancer Agency, and to explore the link between emotional distress and missed appointments. METHODS Head-and-neck patients who had missed treatments other than public holidays were identified using the Oncology Reporting System. The charts of these patients were pulled and examined for cause of treatment interruption. The Psychosocial Screen for Cancer (PSSCAN) found in these patients' charts was used to establish anxiety and depression levels. A random sample of PSSCANs from the charts of patients who had not missed appointments was recorded for comparison. RESULTS Of the 471 head-and-neck patients included in our analysis, 74% had interruptions in treatment. Gaps of greater than three days were present in 11% of treatment courses. The most common cause of treatment breaks was statutory holidays, responsible for 69% of interruptions. The anxiety and depression scores of patients who had missed appointments for reasons other than holidays were not significantly higher than patients who had not missed appointments. CONCLUSION Rates of treatment time extension in Vancouver were higher than expected, given rates reported from other parts of the world. Policies aimed at reducing or compensating for treatment interruptions have been successful elsewhere, and could also be instituted here. Although many published studies have shown emotional distress can lead to noncompliance in health care, this link was not found here. Several weaknesses in our study design may have contributed to the lack of correlation between anxiety and depression and missed appointments.
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Affiliation(s)
- Alison Giddings
- Vancouver Cancer Centre, BC Cancer Agency, Vancouver, British Columbia, Canada.
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