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Schiegnitz E, Reinicke K, Sagheb K, König J, Al-Nawas B, Grötz KA. Dental implants in patients with head and neck cancer-A systematic review and meta-analysis of the influence of radiotherapy on implant survival. Clin Oral Implants Res 2022; 33:967-999. [PMID: 35841367 DOI: 10.1111/clr.13976] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/23/2022] [Accepted: 06/12/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this meta-analysis was to compare implant survival in irradiated and non-irradiated bone and to investigate potential risk factors for implant therapy in oral cancer patients. MATERIAL AND METHODS An extensive search in the electronic databases of the National Library of Medicine was performed. Systematic review and meta-analysis were conducted according to PRISMA statement. The meta-analysis was performed for studies with a mean follow-up of at least three and five years, respectively. RESULTS The systematic review resulted in a mean overall implant survival of 87.8% (34%-100%). The meta-analysis revealed a significantly higher rate of implant failure in irradiated bone compared to non-irradiated bone (p < .00001, OR 1.97, CI [1.63, 2.37]). The studies also showed that implants placed into irradiated grafted bone were more likely to fail than those in irradiated native bone (p < .0001, OR 2.26, CI [1.50, 3.40]). CONCLUSION Even though overall implant survival was high, radiotherapy proves to be a significant risk factor for implant loss. Augmentation procedures may also increase the risk of an adverse outcome, especially in combination with radiotherapy. CLINICAL RELEVANCE The treatment of patients receiving radiotherapy of any form requires precise individual planning and a close aftercare. Implants should be placed in local bone rather than in bone grafts, if possible.
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Affiliation(s)
- Eik Schiegnitz
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Katrin Reinicke
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Jochem König
- Institute of Medical Biometry, Epidemiology and Informatics, Johannes Gutenberg-University, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Plastic Surgery, University Medical Centre, Johannes Gutenberg-University, Mainz, Germany
| | - Knut A Grötz
- Department of Oral and Maxillofacial Surgery, Dr. Horst Schmidt Clinic Wiesbaden, Wiesbaden, Germany
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Yanwei L, Feng H, Xudong W, Zhanyu P. Traditional Chinese medicine formula 01 for nasopharyngeal carcinoma (NPC01) for head & neck cancer and health-related quality of life: a retrospective study. BMC Complement Med Ther 2022; 22:216. [PMID: 35948924 PMCID: PMC9367151 DOI: 10.1186/s12906-022-03699-7] [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: 09/02/2020] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The traditional Chinese medicine (TCM) formula 01 for nasopharyngeal carcinoma (NPC01) is used in the management of head and neck cancers (HNCs), but whether NPC01 has an impact on the HR-QOL of patients with HNCs is unknown.
Methods
This was a retrospective study of patients with HNCs who were treated between January 2019 and January 2020 at the Head & Neck Cancer Center of Tianjin Medical University Cancer Institute & Hospital. The patients were grouped according to whether they received NPC01 or not (controls). All patients routinely completed the EORTC QLQ-C30 and QLQ-H&N35 modules before and after 3 months of systemic treatment. Health economics were collected.
Results
The patients who received NPC01 were older than the controls (48.6 ± 11.4 vs. 43.4 ± 8.8 years, P = 0.004). All other characteristics were comparable between the two groups (all P > 0.05). In EORTC QLQ-C30, physical functioning (P = 0.03), fatigue (P = 0.04), pain (P = 0.02), appetite loss (P = 0.02), and constipation (P = 0.01) scores were improved more in the NPC01 group than in controls. In EORTC H&N35, the scores for pain (P = 0.02), swallowing (P = 0.01), and dry mouth (P = 0.02) were better in the NPC01 group than in controls. The NPC01 cost was 38.94 RMB/patient compared with 12.81 RMB/patient for regular follow-up, but considering insurance coverage, the financial burden was not higher.
Conclusions
The results suggest that NPC01 improves HNCs-related symptoms and HR-QOL.
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Aras S, Tanzer İO, Can Ü, Demir H, Sümer E, Baydili KN, Orak R. Radioprotective effects of melatonin against varying dose rates on radiotherapy-induced salivary gland damage scintigraphy findings. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2021.109953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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4
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Singla V, Nautiyal V, Gupta M, Kumar V, Mehra S, Ahmad M. Study of dosimetry and clinical factors for assessment of xerostomia in head and neck squamous cell carcinoma treated by intensity-modulated radiotherapy: A prospective study. J Carcinog 2021; 20:14. [PMID: 34729046 PMCID: PMC8511834 DOI: 10.4103/jcar.jcar_5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/03/2021] [Accepted: 07/27/2021] [Indexed: 11/20/2022] Open
Abstract
AIM: Clinical and dosimetric factors related to toxicity in terms of xerostomia in patients with head and neck squamous cell cancer (HNSCC) treated with intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS: Patients older than 18 years, with the WHO Performance Status Score <2 with primary diagnosis of HNSCC Stage II, III, and IV who had undergone primary or postoperative radiotherapy (RT) treated by IMRT at the center, from November 2015 to November 2016 were included in the study. Patients were assessed by physical examination and questioned to score their quality of life for dryness (HNDR) and stickiness (HNSS) by EORTC-HN-35 (Hindi or English version) at baseline (before treatment), at 3, 6, and 12 months following treatment. The validation of EORTC-HN-35 for HNDR and HNSS in patients was handed. RESULTS: Thirty patients were included in the study. The mean symptom score values for HNSS at baseline, 3, 6, and 12 months' post-RT treatment were 17.8, 62.2, 64.4, and 20.8, respectively. Dryness and stickiness also increased over 3–6 months in follow-up but slightly relieved at 12 months, but it could not reach to baseline. In subgroup analysis, at baseline mean score of dryness of mouth in elderly patients (≥60 years) (P = 0.248), poor performance status (Eastern Cooperative Oncology Group 2) (P = 0.80) and patients with advanced stage (Stage III and IVA) (P = 0.185) was higher. Correlation of normal tissue complication probability for xerostomia with contralateral mean parotid gland showed insignificant linearity with shallow curve. CONCLUSION: Patients remained symptomatic for xerostomia chiefly till 6 months' postirradiation, but it was slightly relieved in 12 months but could not reach the baseline. Dosimetric sparing ofcontralateral parotid resulted in decreased probability of developing xerostomia.
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Affiliation(s)
- Vrinda Singla
- Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vipul Nautiyal
- Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Meenu Gupta
- Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Viney Kumar
- Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Shivani Mehra
- Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
| | - Mushtaq Ahmad
- Department of Radiation Oncology, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, Uttarakhand, India
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Washio H, Ohira S, Funama Y, Ueda Y, Isono M, Inui S, Miyazaki M, Teshima T. Accuracy of dose calculation on iterative CBCT for head and neck radiotherapy. Phys Med 2021; 86:106-112. [PMID: 34102546 DOI: 10.1016/j.ejmp.2021.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022] Open
Abstract
PURPOSE To evaluate the feasibility of the use of iterative cone-beam computed tomography (CBCT) for dose calculation in the head and neck region. METHODS This study includes phantom and clinical studies. All acquired CBCT images were reconstructed with Feldkamp-Davis-Kress algorithm-based CBCT (FDK-CBCT) and iterative CBCT (iCBCT) algorithm. The Hounsfield unit (HU) consistency between the head and body phantoms was determined in both reconstruction techniques. Volumetric modulated arc therapy (VMAT) plans were generated for 16 head and neck patients on a planning CT scan, and the doses were recalculated on FDK-CBCT and iCBCT with Anisotropic Analytical Algorithm (AAA) and Acuros XB (AXB). As a comparison of the accuracy of dose calculations, the absolute dosimetric difference and 1%/1 mm gamma passing rate analysis were analyzed. RESULTS The difference in the mean HU values between the head and body phantoms was larger for FDK-CBCT (max value: 449.1 HU) than iCBCT (260.0 HU). The median dosimetric difference from the planning CT were <1.0% for both FDK-CBCT and iCBCT but smaller differences were found with iCBCT (planning target volume D50%: 0.38% (0.15-0.59%) for FDK-CBCT, 0.28% (0.13-0.49%) for iCBCT, AAA; 0.14% (0.04-0.19%) for FDK-CBCT, 0.07% (0.02-0.20%) for iCBCT). The mean gamma passing rate was significantly better in iCBCT than FDK-CBCT (AAA: 98.7% for FDK-CBCT, 99.4% for iCBCT; AXB: 96.8% for FDK_CBCT, 97.5% for iCBCT). CONCLUSION The iCBCT-based dose calculation in VMAT for head and neck cancer was accurate compared to FDK-CBCT.
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Affiliation(s)
- Hayate Washio
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan; Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan
| | - Shingo Ohira
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan.
| | - Yoshinori Funama
- Department of Medical Radiation Sciences, Faculty of Life Science, Kumamoto University, Kumamoto, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Shoki Inui
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan; Department of Medical Physics and Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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Aras S, Tanzer İO, Can Ü, Sümer E, Baydili KN. The role of melatonin on acute thyroid damage induced by high dose rate X-ray in head and neck radiotherapy. Radiat Phys Chem Oxf Engl 1993 2021. [DOI: 10.1016/j.radphyschem.2020.109206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Alterio D, Gugliandolo SG, Augugliaro M, Marvaso G, Gandini S, Bellerba F, Russell‐Edu SW, De Simone I, Cinquini M, Starzyńska A, Zaffaroni M, Bacigalupo A, Fanetti G, Durante S, Dicuonzo S, Orecchia R, Jereczek‐Fossa BA. IMRT versus 2D/3D conformal RT in oropharyngeal cancer: A review of the literature and meta‐analysis. Oral Dis 2020; 27:1644-1653. [DOI: 10.1111/odi.13599] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/07/2020] [Accepted: 07/26/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Daniela Alterio
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
| | | | - Matteo Augugliaro
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Hemato‐Oncology University of Milan Milan Italy
| | - Giulia Marvaso
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Hemato‐Oncology University of Milan Milan Italy
| | - Sara Gandini
- Molecular and Pharmaco‐Epidemiology Unit Department of Experimental Oncology IEOEuropean Institute of Oncology IRCCS Milan Italy
| | - Federica Bellerba
- Molecular and Pharmaco‐Epidemiology Unit Department of Experimental Oncology IEOEuropean Institute of Oncology IRCCS Milan Italy
| | | | - Irene De Simone
- Planning and Design Unit Department of Oncology Pharmacological Research Institute IRCSS Mario Negri Milan Italy
| | - Michela Cinquini
- Methodology of Systematic reviews and Guidelines development Unit Department of Oncology Pharmacological Research Institute IRCSS Mario Negri Milan Italy
| | - Anna Starzyńska
- Department of Oral Surgery Medical University of Gdańsk Gdańsk Poland
| | - Mattia Zaffaroni
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
| | | | - Giuseppe Fanetti
- Department of Radiotherapy Oncology National Cancer Institute CRO Aviano Italy
| | - Stefano Durante
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Hemato‐Oncology University of Milan Milan Italy
| | - Samantha Dicuonzo
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
| | | | - Barbara Alicja Jereczek‐Fossa
- Division of Radiotherapy IEOEuropean Institute of Oncology IRCCS Milan Italy
- Department of Oncology and Hemato‐Oncology University of Milan Milan Italy
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Baudelet M, Van den Steen L, Tomassen P, Bonte K, Deron P, Huvenne W, Rottey S, De Neve W, Sundahl N, Van Nuffelen G, Duprez F. Very late xerostomia, dysphagia, and neck fibrosis after head and neck radiotherapy. Head Neck 2019; 41:3594-3603. [PMID: 31329343 DOI: 10.1002/hed.25880] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 05/24/2019] [Accepted: 07/03/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Acute and late toxicity after intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC) impacts on patient quality of life; yet, very late toxicity data remain scarce. This study assessed dysphagia, xerostomia, and neck fibrosis 3-8 years after IMRT. METHODS A retrospective analysis using generalized estimated equations was performed on 60 patients with HNC treated with fractionated IMRT between 2000 and 2015 who had a follow-up ≥8 years. Toxicity was scored using LENT-SOMA scales. RESULTS A trend towards a nonlinear global time effect (P = .05) was noted for dysphagia with a decrease during the 5 years post-treatment and an increase thereafter. A significant decrease in xerostomia (P = .001) and an increase in neck fibrosis (P = .04) was observed until 8 years. CONCLUSIONS Dysphagia, xerostomia, and neck fibrosis do not appear stable over time and remain highly prevalent in the very late follow-up. Our findings support the need for prospective trials investigating very late toxicity in patients with HNC.
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Affiliation(s)
- Margot Baudelet
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Leen Van den Steen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otolaryngology and Head & Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium
| | - Peter Tomassen
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Katrien Bonte
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium
| | - Philippe Deron
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Wouter Huvenne
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Head and Skin, Ghent University, Ghent, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Nora Sundahl
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Gwen Van Nuffelen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otolaryngology and Head & Neck Surgery-Rehabilitation Center for Communication Disorders, Antwerp University Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Reducing Xerostomia by Comprehensive Protection of Salivary Glands in Intensity-Modulated Radiation Therapy with Helical Tomotherapy Technique for Head-and-Neck Cancer Patients: A Prospective Observational Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:2401743. [PMID: 31380414 PMCID: PMC6662416 DOI: 10.1155/2019/2401743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 12/11/2022]
Abstract
Objective This study aimed to analyze the effects of comprehensive protection of bilateral parotid glands (PG-T), contralateral submandibular gland (cSMG), and accessory salivary glands in the oral cavity (OC) by helical tomotherapy for head-and-neck cancer patients. Methods Totally 175 patients with histologically confirmed head-and-neck cancer treated with helical tomotherapy were recruited. The doses delivered to PG-T, cSMG, and OC were constrained to be as low as possible in treatment planning. The saliva flow rates and xerostomia questionnaire were evaluated. Correlation between xerostomia and other clinical factors were assessed using univariate and multivariate models. The impact of salivary gland dose on locoregional (LR) recurrence was assessed by Cox analysis. ROC curve was used to determine the threshold of mean dose for each gland. Results The median follow-up was 25 (19-36) months. The OC mean dose, PG-T mean dose, cSMG mean dose, age, clinical stage (II and III versus IV), and both unstimulated and stimulated saliva flow rates were significantly correlated with xerostomia. The OC mean dose, cSMG mean dose, age, and clinical stage were predictors of xerostomia after adjusting PG-T mean dose, and unstimulated and stimulated saliva flow rates. Xerostomia was significantly decreased when the mean doses of PG-T, cSMG, and OC were kept below 29.12Gy, 29.29Gy, and 31.44Gy, respectively. At 18 months after radiation therapy, early LR recurrence rate was only 4%. Conclusion Comprehensive protection of salivary glands minimized xerostomia in head-and-neck cancer patients treated by helical tomotherapy, without increasing early LR recurrence risk.
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Bossi P, Giusti R, Tarsitano A, Airoldi M, De Sanctis V, Caspiani O, Alterio D, Tartaro T, Alfieri S, Siano M. The point of pain in head and neck cancer. Crit Rev Oncol Hematol 2019; 138:51-59. [PMID: 31092385 DOI: 10.1016/j.critrevonc.2019.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/12/2022] Open
Abstract
Head and neck cancer (HNC) can have a devastating impact on patient's lives as both disease and treatment may affect the ability to speak, swallow and breathe. These conditions limit the oral intake of food and drugs, reduce social functioning and impact on patient's quality of life. Up to 80% of patients suffering from HNC have pain due to the spread of the primary tumor, because of consequences of surgery, or by developing oral mucositis, dysphagia or neuropathy as toxic side effects of radiotherapy, chemotherapy or both. All healthcare professionals caring for HNC patients should assess palliative and supportive care needs in initial treatment planning and throughout the disease, with awareness when specialist palliative care expertise is needed. This paper focuses on assessment, characterizations and clinical management of pain in advanced HNC patients undergoing surgery, chemotherapy and radiotherapy, also underlining the importance of symptom assessment in HNC survivors and the need of clinical research in this field.
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Affiliation(s)
- Paolo Bossi
- University of Brescia - Medical Oncology Department, ASST Spedali Civili Brescia, Piazzale Spedali Civili 1, Brescia, Italy.
| | - Raffaele Giusti
- Medical Oncology Unit, Azienda Ospedaliero Universitaria Sant'Andrea, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Achille Tarsitano
- Maxillo-Facial Surgery Unit - Head and Neck Dept., Policlinico S. Orsola, DIBINEM - University of Bologna, Via Massarenti 9, Bologna, Italy
| | - Mario Airoldi
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Cso Bramante 88/90, 10126, Torino, Italy
| | - Vitaliana De Sanctis
- Radiotherapy Oncology, "Sapienza" University of Rome, Department of Medical and Surgical Science and Translational Medicine, Via di Grottarossa 1035-39, 00189, Rome, Italy
| | - Orietta Caspiani
- Division of Radiation Oncology, Isola Tiberina Hospital, Rome, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Tiziana Tartaro
- Medical Oncology Department, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Dept., Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Via Venezian 1, Milan, Italy
| | - Marco Siano
- Cantonal Hospital St. Gallen, Clinic for Oncology and Hematology, Rorschacherstrasse 95, CH-9007, St. Gallen, Switzerland; Hôpital Riviera-Chablais, Service of Cancerology, Av. De la Prairie 1, CH-1800, Vevey, Switzerland
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11
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Esteyrie V, Gleyzolle B, Lusque A, Graff P, Modesto A, Rives M, Lapeyre M, Desrousseaux J, Graulières E, Hangard G, Arnaud FX, Ferrand R, Delord JP, Poublanc M, Mounier M, Filleron T, Laprie A. The GIRAFE phase II trial on MVCT-based "volumes of the day" and "dose of the day" addresses when and how to implement adaptive radiotherapy for locally advanced head and neck cancer. Clin Transl Radiat Oncol 2019; 16:34-39. [PMID: 30949592 PMCID: PMC6429538 DOI: 10.1016/j.ctro.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/22/2019] [Accepted: 02/23/2019] [Indexed: 11/25/2022] Open
Abstract
During exclusive curative radiotherapy for head and neck tumors, the patient's organs at risk (OAR) and target volumes frequently change size and shape, leading to a risk of higher toxicity and lower control than expected on planned dosimetry. Adaptive radiotherapy is often necessary but 1) tools are needed to define the optimal time for replanning, and 2) the subsequent workflow is time-consuming. We designed a prospective study to evaluate 1) the validity of automatically deformed contours on the daily MVCT, in order to safely use the "dose-of the day" tool to check daily if replanning is necessary; 2) the automatically deformed contours on the replanning CT and the time gained in the replanning workflow. Forty-eight patients with T3-T4 and/or involved node >2 cm head and neck squamous cell carcinomas, planned for curative radiotherapy without surgery, will be enrolled. They will undergo treatment with helical IMRT including daily repositioning MVCTs. The contours proposed will be compared weekly on intermediate planning CTs (iCTs) on weeks 3, 4, 5 and 6. On these iCTs both manual recontouring and automated deformable registration of the initial contours will be compared with the contours automatically defined on the MVCT. The primary objective is to evaluate the Dice similarity coefficient (DSC) of the volumes of each parotid gland. The secondary objectives will evaluate, for target volumes and all OARs: the DSC, the mean distance to agreement, and the average surface-to-surface distance. Time between the automatic and the manual recontouring workflows will be compared.
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Key Words
- ART, adaptive radiotherapy
- CT, computed tomography
- CTV, clinical target volume
- DIR, deformable image registration
- DSC, Dice similarity coefficient
- GTV, gross tumor volume
- H&N, head and neck
- ICRU, international commission on radiation units and measurements
- IGRT, image-guided radiotherapy
- IMRT, intensity-modulated radiotherapy
- IUCT, Institut Universitaire du cancer de Toulouse
- MVCT, megavoltage computed tomography
- OAR, organ at risk
- PET, positron emission tomography
- PTV, planning target volume
- iCT, intermediate computed tomography
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Affiliation(s)
- Vincent Esteyrie
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | | | - Amélie Lusque
- Biostatistics Unit, Institut Claudius Regaud-, Institut Universitaire du Cancer de Toulouse - Oncopole Toulouse, France
| | - Pierre Graff
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Anouchka Modesto
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Michel Rives
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Michel Lapeyre
- Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Jacques Desrousseaux
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | - Eliane Graulières
- Engineering and Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Gregory Hangard
- Engineering and Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - François-Xavier Arnaud
- Engineering and Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Regis Ferrand
- Engineering and Medical Physics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Jean-Pierre Delord
- Clinical Trials Office , Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Muriel Poublanc
- Clinical Trials Office , Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Muriel Mounier
- Clinical Trials Office , Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse - Oncopole. Toulouse, France
| | - Thomas Filleron
- Biostatistics Unit, Institut Claudius Regaud-, Institut Universitaire du Cancer de Toulouse - Oncopole Toulouse, France
| | - Anne Laprie
- Radiation Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
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Jain S, Popple R, Szychowski J, Sen B, Locher JL, Kilgore ML. Radiation Oncologist Characteristics and their Association with Outcomes in Patients with Head and Neck Cancer. Pract Radiat Oncol 2019; 9:e322-e330. [PMID: 30659934 DOI: 10.1016/j.prro.2019.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE Intensity modulated radiation therapy (IMRT) is widely used in the treatment of head and neck cancers (HNC). There is not enough evidence to suggest that some radiation oncologists (ROs) are associated with better outcomes in patients with HNC. We conducted a cross-sectional analysis to evaluate the effect of ROs' characteristics on outcomes in patients with HNC treated with IMRT. METHODS AND MATERIALS The study used the Surveillance Epidemiology and End Results-Medicare linked database to identify patient characteristics. Physician records were obtained from the American Medical Association. Logistic regression models with propensity scores were analyzed to look for an association between RO characteristics and patient outcomes. RESULTS RO characteristics showed that approximately 30% of ROS completed their training in or after the year 2000 (recently trained), and 17% were in top decile of treatment volume (high volume). Less than 3% of ROs work in academic settings. We found that ROs who were recently trained have higher odds (odds ratio [OR]: 1.10; 95% confidence interval [CI], 1.011-1.191) compared with those who were not. In addition, ROs who were treating high volumes of patients have higher odds (OR: 1.08; 95% CI, 1.010-1.165) compared with those treating low volumes of an event of adverse effect of IMRT or death among patients. ROs who work in academic settings have a protective effect (OR: 0.72; 95% CI, 0.569-0.925). CONCLUSIONS ROs who were recently trained and had a high treatment volume are associated with poorer outcomes among patients with HNC who receive IMRT treatment.
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Affiliation(s)
- Siddharth Jain
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama; Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Richard Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeff Szychowski
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Bisakha Sen
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
| | - Julie L Locher
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Meredith L Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama
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Piron O, Varfalvy N, Archambault L. Establishing action threshold for change in patient anatomy using EPID gamma analysis and PTV coverage for head and neck radiotherapy treatment. Med Phys 2018; 45:3534-3545. [PMID: 29896916 DOI: 10.1002/mp.13045] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 05/24/2018] [Accepted: 05/31/2018] [Indexed: 02/28/2024] Open
Abstract
PURPOSE To present a new adaptive radiotherapy (ART) method based on relative gamma analysis and patient classification for the identification of anatomical changes that induce a sufficient dosimetric impact to affect the treatment delivery and require complete replanning. METHODS This retrospective study includes 55 patients treated for a head and neck cancer with IMRT, VMAT, or 3D conformal RT. Electronic Portal Imaging Device images for all treatment fields were acquired daily at every fraction. CBCTs were collected at least once a week. Gamma analysis was performed using the first fraction of the treatment as a reference once validated that it was delivered without error. Gamma analysis parameters (<γ>, standard deviation and the Top 1% γ) were used to define categories using statistic from a k-means clustering analysis. From these categories an action threshold was defined and correlated with dosimetric changes. For 23 of 55 patients, the V100% for PTV was computed for both, the planning CT and original contours deformed onto CBCT acquired at the last fraction. These values were then compared with 2D image relative γ-analysis of EPID images. Sensitivity and specificity of the method for the detection of dosimetric changes were computed. RESULTS Three categories indicating an increasing level of change with the planned treatment were identified. A threshold was established for which patients were at risk of deviation at <γ> = 0.42. From 23 recomputing plans, it has been confirmed that patients with a strong dosimetric impact were above this threshold, with a specificity of 0.80 and a sensitivity of 0.84. CONCLUSIONS The specificity and the sensitivity value confirmed the performance of the method to detect anatomical changes. The γ-analysis threshold correlated well with morphological changes that have a relevant dosimetric impact. Analysis of daily EPID images provides a method to identify patients at risk of deviation from their planned treatment and can support an early replanning decision.
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Affiliation(s)
- Ophélie Piron
- Department de Radio-oncologie, CHU de Quebec, 11 Côte du Palais, Quebec, QC, Canada
- Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
| | - Nicolas Varfalvy
- Department de Radio-oncologie, CHU de Quebec, 11 Côte du Palais, Quebec, QC, Canada
- Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
| | - Louis Archambault
- Department de Radio-oncologie, CHU de Quebec, 11 Côte du Palais, Quebec, QC, Canada
- Université Laval, 2325 Rue de l'Université, Ville de Québec, QC, G1V 0A6, Canada
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Mahmoud O, Sung K, Civantos FJ, Thomas GR, Samuels MA. Transoral robotic surgery for oropharyngeal squamous cell carcinoma in the era of human papillomavirus. Head Neck 2017; 40:710-721. [DOI: 10.1002/hed.25036] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 08/21/2017] [Accepted: 10/25/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Omar Mahmoud
- Department of Radiation Oncology; Rutgers, the State University of New Jersey, Cancer Institute of New Jersey; New Brunswick New Jersey
- Department of Radiation Oncology; Rutgers, the State University of New Jersey, New Jersey Medical School; Newark New Jersey
| | - Kim Sung
- Department of Radiation Oncology; Rutgers, the State University of New Jersey, Cancer Institute of New Jersey; New Brunswick New Jersey
- Department of Radiation Oncology; Rutgers, the State University of New Jersey, New Jersey Medical School; Newark New Jersey
| | - Francisco J. Civantos
- Department of Otolaryngology - Head and Neck Surgery; University of Miami-Miller School of Medicine; Miami Florida
| | - Giovanna R. Thomas
- Department of Otolaryngology - Head and Neck Surgery; University of Miami-Miller School of Medicine; Miami Florida
| | - Michael A. Samuels
- Department of Radiation Oncology; University of Miami-Miller School of Medicine; Miami Florida
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15
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Abel E, Silander E, Nyman J, Bove M, Johansson L, Björk-Eriksson T, Hammerlid E. Impact on quality of life of IMRT versus 3-D conformal radiation therapy in head and neck cancer patients: A case control study. Adv Radiat Oncol 2017; 2:346-353. [PMID: 29114602 PMCID: PMC5605311 DOI: 10.1016/j.adro.2017.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 05/01/2017] [Accepted: 05/05/2017] [Indexed: 12/25/2022] Open
Abstract
Objective The purpose of this study was to prospectively and longitudinally compare the health-related quality of life (HRQOL) outcomes between head and neck (HN) cancer patients treated with parotid-sparing intensity modulated radiation therapy (IMRT) and patients treated with 3-dimensional conventional radiation therapy (3D-CRT). Methods and materials Before and up to 12 months after treatment, HRQOL was recorded in patients with HN cancer who were referred to the Department of Oncology at Sahlgrenska University Hospital for curative IMRT. The study group's HRQOL was compared with a matched group of patients from previous descriptive HRQOL studies treated with 3D-CRT. Both groups' HRQOL was measured by the European Organization for Research and Treatment for Cancer QLQ-C30 and European Organization for Research and Treatment for Cancer QLQ-HN35 at 6 time points in the first year after diagnosis. Results Two hundred and seven patients were included, 111 treated with IMRT and 96 matched controls treated with 3D-CRT. Both groups' HRQOL deteriorated during and after treatment. Just after treatment, worse HRQOL scores were observed in the IMRT group regarding insomnia (38 vs 27; P = .032), appetite loss (64 vs 50; P = .019), senses (54 vs 41; P = .017), and coughing (39 vs 26, P = .009). At 12 months, however, significantly better HRQOL scores were observed in the IMRT group regarding problems with dry mouth (72 vs 62; P = .018), pain (28 vs 20; P = .018), sexuality (37 vs 23; P = .016), social contacts (10 vs 6; P = .026), cognitive functioning (79 vs 87; P = .0057), and financial difficulties (12 vs 20; P = .0019). Conclusions This study further supports the hypothesis that the introduction of IMRT has improved the long-term quality of life of HN cancer patients who have been treated with radiation therapy, but might cause more acute side effects. Longer follow-up is needed to study late complications.
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Affiliation(s)
- Edvard Abel
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ewa Silander
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mogens Bove
- Department of Otorhinolaryngology, Norra Älvsborgs Hospital, Trollhättan, Sweden
| | - Leif Johansson
- Department of Otorhinolaryngology, Central Hospital, Skövde, Sweden
| | - Thomas Björk-Eriksson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Hammerlid
- Department of Otorhinolaryngology-Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Osborn V, Schwartz D, Lee YC, Lee A, Garay E, Choi K, Han P, Schreiber D. Patterns of care of IMRT usage in postoperative management of uterine cancer. Gynecol Oncol 2017; 144:130-135. [PMID: 27887805 DOI: 10.1016/j.ygyno.2016.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/05/2016] [Accepted: 11/11/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To analyze the patterns of care regarding intensity modulated radiation therapy (IMRT) usage in the postoperative management of uterine cancer. METHODS The National Cancer Database was queried to identify women with endometrial adenocarcinoma who underwent hysterectomy followed by external beam radiation between 2004-2012. Descriptive statistics were used to analyze IMRT usage with comparison via the Chi Square test. Overall survival was also compared between IMRT and three dimensional conformal radiation therapy. Multivariable logistic regression and multivariable Cox Regression were used to identify covariables that impact IMRT usage and improved survival respectively. RESULTS 7839 women were included in this study. IMRT utilization increased from 1.9% in 2004 to 32.4% in 2012 (p<0.001). The adjusted odds ratio (OR) for IMRT in 2012 compared with 2004 was 24.90, 95% CI 15.24-40.67 (p<0.001). Aside from year, other predictors of IMRT usage on multivariate analysis were positive nodes, higher dose, private insurance and higher income. Black race was associated with lower IMRT usage compared to Whites with an OR of 0.60, 95% CI 0.44-0.81 (p=0.001). IMRT was not associated with significantly increased survival (HR 0.86, 95% CI 0.73-1.01, p=0.06). Black race and positive nodes were associated with decreased survival within the group studied whereas private insurance and higher income were associated with improved survival. CONCLUSIONS In this hospital-based registry, IMRT has significantly increased in utilization for postoperative radiation in uterine cancer between 2004-2012 although not resulting in significantly improved survival. Socioeconomic and racial disparities exist in the allocation of IMRT usage.
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Affiliation(s)
- Virginia Osborn
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, United States; SUNY Downstate Medical Center, Brooklyn, NY, United States.
| | - David Schwartz
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, United States; SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Yi-Chun Lee
- SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Anna Lee
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, United States; SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Elizabeth Garay
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, United States; SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Kwang Choi
- SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - Peter Han
- SUNY Downstate Medical Center, Brooklyn, NY, United States
| | - David Schreiber
- Department of Veterans Affairs, New York Harbor Healthcare System, Brooklyn, NY, United States; SUNY Downstate Medical Center, Brooklyn, NY, United States
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17
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Agarwal P, Shiva Kumar HR, Rai KK. Trismus in oral cancer patients undergoing surgery and radiotherapy. J Oral Biol Craniofac Res 2016; 6:S9-S13. [PMID: 27900243 DOI: 10.1016/j.jobcr.2016.10.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/10/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the incidence of trismus before and after surgery and subsequent radiotherapy for patients of oral cancer and to determine the risk factors for the same. METHODS 30 patients diagnosed with oral cancer were included. Maximum mouth opening was measured for each patient as the inter incisal distance and was measured on 4 occasions - preoperatively at the time of diagnosis, post-operatively at discharge from the hospital, post-radiotherapy and at 6 months follow-up. The site of cancer, staging and grading of the malignancy, the surgical treatment performed, method of reconstruction, details of radiotherapy and compliance to physiotherapy were recorded, to evaluate the risk factors for developing trismus. RESULTS Trismus was observed in 53.3% patients at the time of diagnosis which increased significantly post-surgery (86.7%) and post-radiotherapy (85.7%) and gradually decreased (65.4%) at 6 months. The use of flaps for reconstruction, delay in radiotherapy post-surgery and non-compliance of patients to physiotherapy were the risk factors for developing trismus, showing statistical significance (p < 0.05). CONCLUSION Trismus is a significant complication of oral malignancies or its surgical and radiotherapy treatment, or both. Consideration must be given to its early diagnosis, to help in timely intervention and planning of preventive strategies.
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Affiliation(s)
- Padmanidhi Agarwal
- Department of Oral and Maxillofacial Surgery, King George's Medical University, Lucknow, India
| | - H R Shiva Kumar
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
| | - Kirthi Kumar Rai
- Department of Oral and Maxillofacial Surgery, Bapuji Dental College and Hospital, Davangere, India
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18
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Beadle BM, Liao KP, Giordano SH, Garden AS, Hutcheson KA, Lai SY, Guadagnolo BA. Reduced feeding tube duration with intensity-modulated radiation therapy for head and neck cancer: A Surveillance, Epidemiology, and End Results-Medicare Analysis. Cancer 2016; 123:283-293. [PMID: 27662641 DOI: 10.1002/cncr.30350] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) is a technologically advanced and resource-intensive method of delivering radiation therapy (RT) and is used to minimize toxicity for patients with head and neck cancer (HNC). Dependence on feeding tubes is a significant marker of toxicity of RT. The objective of this analysis was to compare the placement and duration of feeding tube use among patients with HNC from 1999 through 2011. METHODS The cohort, demographics, and cancer-related variables were determined using the linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database, and claims data were used to analyze treatment details. RESULTS In total, 2993 patients were identified. At a median follow-up of 47 months, 54.4% of patients had ever had a feeding tube placed. The median duration from feeding tube placement to removal was 277 days. On zero-inflated negative binomial regression, patients who received IMRT and 3-dimensional RT (3DRT) (non-IMRT) had similar rates of feeding tube placement (odds ratio, 1.10; P = .35); however, patients who received 3DRT had a feeding tube in place 1.18 times longer than those who received IMRT (P = .03). The difference was only observed among patients who received definitive RT; patients who underwent surgery and also received adjuvant RT had no statistically significant difference in feeding tube placement or duration. CONCLUSIONS Patients with HNC who received definitive IMRT had a significantly shorter duration of feeding tube placement than those who received 3DRT. These data suggest that there may be significant quality-of-life benefits to IMRT with respect to long-term swallowing function in patients with HNC. Cancer 2017;123:283-293. © 2016 American Cancer Society.
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Affiliation(s)
- Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kai-Ping Liao
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - B Ashleigh Guadagnolo
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Radiation Oncology--New Approaches in Squamous Cell Cancer of the Head and Neck. Hematol Oncol Clin North Am 2016; 29:1093-106. [PMID: 26568550 DOI: 10.1016/j.hoc.2015.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The many advances in radiotherapy for squamous cell cancer of the head and neck described in this article will have significant effects on the ultimate outcomes of patients who receive this treatment. The technological and clinical advances should allow one to maintain or improve disease control, while moderating the toxicity associated with head and neck radiation therapy.
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20
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Miah AB, Gulliford SL, Morden J, Newbold KL, Bhide SA, Zaidi SH, Hall E, Harrington KJ, Nutting CM. Recovery of Salivary Function: Contralateral Parotid-sparing Intensity-modulated Radiotherapy versus Bilateral Superficial Lobe Parotid-sparing Intensity-modulated Radiotherapy. Clin Oncol (R Coll Radiol) 2016; 28:e69-e76. [PMID: 26994893 PMCID: PMC4979532 DOI: 10.1016/j.clon.2016.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
AIMS To establish whether there is a difference in recovery of salivary function with bilateral superficial lobe parotid-sparing intensity-modulated radiotherapy (BSLPS-IMRT) versus contralateral parotid-sparing IMRT (CLPS-IMRT) in patients with locally advanced head and neck squamous cell cancers. MATERIALS AND METHODS A dosimetric analysis was carried out on data from two studies in which patients received BSLPS-IMRT (PARSPORT II) or CLPS-IMRT (PARSPORT). Acute (National Cancer Institute, Common Terminology Criteria for adverse events - NCI CTCAEv3.0) and late (Late Effects of Normal Tissue- subjective, objective, management analytical - LENTSOMA and Radiation Therapy Oncology Group) xerostomia scores were dichotomised: recovery (grade 0-1) versus no recovery (≥grade 2). Incidence of recovery of salivary function was compared between the two techniques and dose-response relationships were determined by fitting dose-response curves to the data using non-linear logistic regression analysis. RESULTS Seventy-one patients received BSLPS-IMRT and 35 received CLPS-IMRT. Patients received 65 Gy in 30 fractions to the primary site and involved nodal levels and 54 Gy in 30 fractions to elective nodal levels. There were significant differences in mean doses to contralateral parotid gland (29.4 Gy versus 24.9 Gy, P < 0.005) and superficial lobes (26.8 Gy versus 30.5 Gy, P = 0.02) for BSLPS and CLPS-IMRT, respectively. Lower risk of long-term ≥grade 2 subjective xerostomia (LENTSOMA) was reported with BSLPS-IMRT (odds ratio 0.50; 95% confidence interval 0.29-0.86; P = 0.012). The percentage of patients who reported recovery of parotid saliva flow at 1 year was higher with BSLPS-IMRT compared with CLPS-IMRT techniques (67.1% versus 52.8%), but the difference was not statistically significant (P = 0.12). For the whole parotid gland, the tolerance doses, D50, were 25.6 Gy (95% confidence interval 20.6-30.5), k = 2.7 (0.9-4.5) (CLPS-IMRT) and 28.9 Gy (26.1-31.9), k = 2.4 (1.4-3.4) (BSLPS-IMRT). For the superficial lobe, D50 were similar: BSLPS-IMRT 23.5 Gy (19.3-27.6), k = 1.9 (0.5-3.8); CLPS-IMRT 24.0 Gy (17.7-30.1), k = 2.1 (0.1-4.1). CONCLUSION BSLPS-IMRT reduces the risk of developing high-grade subjective xerostomia compared with CLPS-IMRT. The D50 of the superficial lobe may be a more reliable predictor of recovery of parotid function than the whole gland mean dose.
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Affiliation(s)
- A B Miah
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S L Gulliford
- Joint Department of Physics, The Institute of Cancer Research, Surrey, UK
| | - J Morden
- The Institute of Cancer Research, Clinical Trials and Statistic Unit, London, UK
| | - K L Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S A Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S H Zaidi
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - E Hall
- The Institute of Cancer Research, Clinical Trials and Statistic Unit, London, UK
| | - K J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C M Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
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Compagnon F, Zerdoud S, Rives M, Laprie A, Sarini J, Grunenwald S, Chaltiel L, Graff P. [Postoperative external beam radiotherapy for medullary thyroid carcinoma with high risk of locoregional relapse]. Cancer Radiother 2016; 20:362-9. [PMID: 27396902 DOI: 10.1016/j.canrad.2016.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/22/2016] [Accepted: 05/14/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the outcome of locally advanced medullary thyroid carcinoma treated with surgery and adjuvant external beam radiotherapy. PATIENTS AND METHODS Twenty-nine consecutive patients with non-metastatic medullary thyroid carcinoma treated in our institution between January 1995 and December 2012 were retrospectively evaluated. All underwent curative-intended optimal surgery, followed by external beam radiotherapy because of high risk of locoregional relapse. Twelve patients were stage III, 16 IVa and 1 IVb. Positive surgical margins were present in 11 cases (10 R1 and 1 R2). Median and average preradiotherapy serum calcitonin were 141pg/mL and 699pg/mL, respectively. Fourteen patients received 3D-conformal radiotherapy and 15 received intensity-modulated radiotherapy. Median prescribed dose was 63Gy to the high-risk volumes and 54Gy to the low-risk volumes. Treatment was delivered in 30 fractions. The median gap between surgery and radiotherapy was 1.9months. Median follow-up was 76.4months. RESULTS Kaplan-Meier estimates of 5-year locoregional relapse-free survival and overall survival were 79 and 96 %, respectively. Among the five locoregional relapses, two were related to a macroscopic metastatic cervical lymph node that was unfortunately not removed during the lymphadenectomy. Eight of ten patients with microscopic positive margins (R1) were controlled regarding the thyroidectomy bed. Eight patients had normal serum calcitonin after external beam radiotherapy, of whom only one developed a locoregional relapse during follow-up. Regarding the 21 patients with persistent positive serum calcitonin after treatment, only ten developed a macroscopic locoregional or distant relapse. One grade III and no grade IV acute morbidity were reported. Fifteen patients reported grade II chronic morbidity and no grade III/IV. CONCLUSION Maximal surgery followed by adjuvant external beam radiotherapy as a treatment for locally advanced medullary thyroid carcinoma provides a high rate of long-term locoregional control and overall survival with limited toxicity. Postoperative external beam radiotherapy should be considered when patients present features indicating a high risk of locoregional relapse.
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Affiliation(s)
- F Compagnon
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
| | - S Zerdoud
- Département de médecine nucléaire, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - M Rives
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - A Laprie
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - J Sarini
- Département de chirurgie cervicofaciale, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - S Grunenwald
- Département d'endocrinologie et des maladies métaboliques, centre hospitalier universitaire Larrey, Toulouse, France
| | - L Chaltiel
- Département de biostatistiques, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - P Graff
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
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Kuo TJ, Leung CM, Chang HS, Wu CN, Chen WL, Chen GJ, Lai YC, Huang WC. Jaw osteoradionecrosis and dental extraction after head and neck radiotherapy: A nationwide population-based retrospective study in Taiwan. Oral Oncol 2016; 56:71-7. [PMID: 27086489 DOI: 10.1016/j.oraloncology.2016.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Osteoradionecrosis of the jaws (ORNJ) is painful for patients and relatively difficult to treat clinically. The high risk of ORNJ for post radiotherapy R/T dental extraction is known; however, many patients still have to have teeth extracted after head and neck R/T. The objective of the present study is to review post R/T dental extraction and determine the ORNJ risk. MATERIALS AND METHODS We preformed a retrospective cohort study of 1759 patients with head and neck cancer s/p R/T from a random sample of 1,000,000 insurants in the National Health Insurance Research Database during 2000-2013 in Taiwan. Statistical methods included two-proportion Z-test. RESULTS We evaluated two cohorts: 522 patients with post R/T dental extraction and 1237 patients without post R/T extraction. Overall moderate-to-severe ORNJ after R/T was 2.22% (39/1759), and a total of 39 ORNJ cases were noted during an average of 3.02years (range: 0.62-8.89years, ±2.07). ORNJ prevalence in the overall post R/T extraction-exposed cohort (5.17%, 27/522) was significantly greater than that in the unexposed cohort (0.97%, 12/1237). In a group of patients with ⩽5 post R/T dental extractions (n=373), the ORNJ risk was 2.4% (ORNJ case n=9); in a group of patients with >5 dental extractions (n=149), the ORNJ risk was 12.1% (ORNJ case n=18) (Z-score=4.5062; p-value<0.0001). In the extraction-exposed cohort, the ORNJ risk is higher if the index day to first extraction day was ⩽0.5year (n=103) compared with the group with the index day to first extraction day >0.5year (n=419) (Z-score=-2.1506; p-value=0.0315). CONCLUSION A tooth extraction time less than half a year after R/T or during the head and neck R/T period, and extraction tooth number ⩽5 would significant lower the ORNJ prevalence.
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Affiliation(s)
- Tsu-Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Chung-Man Leung
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Hao-Sheng Chang
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Chao-Nan Wu
- Department of Dentistry, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Wei-Li Chen
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Guang-Jhong Chen
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Yu-Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Wei-Chun Huang
- Section of Critical Care Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC
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23
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Kamomae T, Itoh Y, Okudaira K, Nakaya T, Tomida M, Miyake Y, Oguchi H, Shiinoki T, Kawamura M, Yamamoto N, Naganawa S. Dosimetric impact of dental metallic crown on intensity-modulated radiotherapy and volumetric-modulated arc therapy for head and neck cancer. J Appl Clin Med Phys 2016; 17:234-245. [PMID: 26894359 PMCID: PMC5690192 DOI: 10.1120/jacmp.v17i1.5870] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 09/03/2015] [Accepted: 08/30/2015] [Indexed: 12/04/2022] Open
Abstract
Metal dental restoration materials cause dose enhancement upstream and dose disturbance downstream of the high‐density inhomogeneous regions in which these materials are used. In this study, we evaluated the impact of a dental metallic crown (DMC) on intensity‐modulated radiotherapy (IMRT) and volumetric‐modulated arc therapy (VMAT) for head and neck cancer. Additionally, the possibility of sparing the oral mucosa from dose enhancement using an individual intraoral mouthpiece was evaluated. An experimental oral phantom was designed to verify the dosimetric impact of a DMC. We evaluated the effect on single beam, parallel opposing beam, arc beam, IMRT, and VMAT treatment plans. To evaluate the utility of a 3‐mm‐thick intraoral mouthpiece, the doses across the mouthpiece were measured. For single beam irradiation, the measured doses at the entrance and exit planes of the DMC were 51% higher and 21% lower than the calculated dose by the treatment planning system, respectively. The maximum dose enhancements were 22% and 46% for parallel opposing beams and the 90° arc rotation beam, respectively. For IMRT and VMAT, the measured doses adjacent to the DMC were 12.2%±6.3% (mean±1.96 SD) and 12.7%±2.5% higher than the calculated doses, respectively. With regard to the performance of the intraoral mouthpiece for the IMRT and VMAT cases, the disagreement between measured and calculated doses at the outermost surface of the mouthpieces were −2.0%, and 2.0%, respectively. Dose enhancements caused by DMC‐mediated radiation scattering occurred during IMRT and VMAT. Because it is difficult to accurately estimate the dose perturbations, careful consideration is necessary when planning head and neck cancer treatments in patients with DMCs. To spare the oral mucosa from dose enhancement, the use of an individual intraoral mouthpiece should be considered. PACS numbers: 87.55.km, 87.55.N‐, 87.55.Qr
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Pauloski BR, Rademaker AW, Logemann JA, Discekici-Harris M, Mittal BB. Comparison of swallowing function after intensity-modulated radiation therapy and conventional radiotherapy for head and neck cancer. Head Neck 2015; 37:1575-82. [PMID: 24909649 PMCID: PMC4258519 DOI: 10.1002/hed.23796] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/18/2014] [Accepted: 06/04/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) is hoped to protect structures important for swallow function. We compared posttreatment swallow function in 7 pairs of patients with head and neck cancer treated with either IMRT or conventional radiotherapy (RT). METHODS Patients were matched on tumor characteristics. Swallowing function was evaluated with the modified barium swallow procedure pretreatment and at 3 and 6 months postcancer treatment completion. Swallows were analyzed for bolus transit times, bolus residues, laryngeal closure (LAC) duration, cricopharyngeal opening (CPO) duration, and oropharyngeal swallow efficiency (OPSE). Data were analyzed using multifactor repeated measures analysis of variance and adjusted for baseline function. RESULTS Main effect of radiation type was significant for all measures on at least 1 bolus type. Patients treated with IMRT demonstrated shorter bolus transit times, less oral and pharyngeal residue, longer LAC, and larger OPSE. CONCLUSION Patients treated with IMRT demonstrated faster, more efficient swallows, and greater airway protection.
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Affiliation(s)
- Barbara Roa Pauloski
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Alfred W Rademaker
- Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jerilyn A Logemann
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | | | - Bharat B Mittal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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25
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Intensity-modulated radiation therapy versus 2D-RT or 3D-CRT for the treatment of nasopharyngeal carcinoma: A systematic review and meta-analysis. Oral Oncol 2015; 51:1041-1046. [DOI: 10.1016/j.oraloncology.2015.08.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 08/02/2015] [Accepted: 08/03/2015] [Indexed: 12/20/2022]
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26
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Samuels SE, Eisbruch A, Beitler JJ, Corry J, Bradford CR, Saba NF, van den Brekel MWM, Smee R, Strojan P, Suárez C, Mendenhall WM, Takes RP, Rodrigo JP, Haigentz M, Rapidis AD, Rinaldo A, Ferlito A. Management of locally advanced HPV-related oropharyngeal squamous cell carcinoma: where are we? Eur Arch Otorhinolaryngol 2015; 273:2877-94. [PMID: 26463714 DOI: 10.1007/s00405-015-3771-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/25/2015] [Indexed: 12/13/2022]
Abstract
HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV-) OPC. This review summarizes and discusses several of the controversies regarding the management of HPV+ OPC, including the mechanism of its treatment sensitivity, modern surgical techniques, chemotherapy regimens, and treatment de-intensification protocols. We also discuss and reconsider potential adverse prognostic factors such as tumor EGFR expression, tumor hypoxia, and patient smoking history, as well as the significance of retropharyngeal adenopathy. Finally, we discuss elective nodal treatment of uninvolved lymph node stations. While this review does not exhaust all controversies related to the management of HPV+ OPC, it aims to highlight some of the most clinically relevant ones.
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Affiliation(s)
- Stuart E Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - June Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Missak Haigentz
- Division of Oncology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alexander D Rapidis
- Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
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27
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Christianen MEMC, Verdonck-de Leeuw IM, Doornaert P, Chouvalova O, Steenbakkers RJHM, Koken PW, Leemans CR, Oosting SF, Roodenburg JLN, van der Laan BFAM, Slotman BJ, Bijl HP, Langendijk JA. Patterns of long-term swallowing dysfunction after definitive radiotherapy or chemoradiation. Radiother Oncol 2015; 117:139-44. [PMID: 26320608 DOI: 10.1016/j.radonc.2015.07.042] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify patterns of long-term, radiation-induced swallowing dysfunction after definitive radiotherapy with or without chemotherapy (RT or CHRT) and to determine which factors may explain these patterns over time. MATERIAL AND METHODS The study population consisted of 238 consecutive head and neck cancer patients treated with RT or CHRT. The primary endpoint was ⩾grade 2 swallowing dysfunction at 6, 12, 18 and 24months after treatment. Cluster analysis was used to identify different patterns over time. The differences between the mean dose to the swallowing organs at risk for each pattern were determined by using dose maps. RESULTS The cluster analysis revealed five patterns of swallowing dysfunction: low persistent, intermediate persistent, severe persistent, transient and progressive. Patients with high dose to the upper pharyngeal, laryngeal and lower pharyngeal region had the highest risk of severe persistent swallowing dysfunction. Transient problems mainly occurred after high dose to the laryngeal and lower pharyngeal regions, combined with moderate dose to the upper pharyngeal region. The progressive pattern was mainly seen after moderate dose to the upper pharyngeal region. CONCLUSIONS Various patterns of swallowing dysfunction after definitive RT or CHRT can be identified over time. This could reflect different underlying biological processes.
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Affiliation(s)
- Miranda E M C Christianen
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center Amsterdam, The Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands
| | - Olga Chouvalova
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Phil W Koken
- Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center Amsterdam, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands
| | - Hendrik P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
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28
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Clément-Colmou K, Troussier I, Bardet É, Lapeyre M. [Clinical and paraclinical follow-up after radiotherapy for head and neck cancer]. Cancer Radiother 2015; 19:597-602. [PMID: 26278985 DOI: 10.1016/j.canrad.2015.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/20/2015] [Indexed: 11/26/2022]
Abstract
Head and neck cancer management often involves heavy multimodal treatments including radiotherapy. Despite the improvement of intensity-modulated radiation therapy, acute and late toxicities remain important. After such treatment, patients have to face different potential problems, depending on the post-therapeutic delay. In this way, short-term follow-up permits to appreciate the healing of acute toxicities and response to treatment. Long-term follow-up aims to recognize second primitive tumours and distant failure, and to detect and manage late toxicities. Medical and psychosocial supportive cares are essential, even after several years of complete remission. The objective of this article is to review the modalities of short-term and long-term follow-up of patients who receive a radiotherapy for head and neck cancer.
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Affiliation(s)
- K Clément-Colmou
- Département de radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France.
| | - I Troussier
- Département d'oncologie-radiothérapie, CHRU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France
| | - É Bardet
- Département de radiothérapie, institut de cancérologie de l'Ouest, centre René-Gauducheau, boulevard Jacques-Monod, 44805 Saint-Herblain cedex, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France
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29
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Huang TL, Chien CY, Tsai WL, Liao KC, Chou SY, Lin HC, Dean Luo S, Lee TF, Lee CH, Fang FM. Long-term late toxicities and quality of life for survivors of nasopharyngeal carcinoma treated with intensity-modulated radiotherapy versus non-intensity-modulated radiotherapy. Head Neck 2015; 38 Suppl 1:E1026-32. [PMID: 26041548 DOI: 10.1002/hed.24150] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/20/2015] [Accepted: 05/31/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate late toxicities and quality of life (QOL) of patients with nasopharyngeal carcinoma (NPC) with long-term survival after treatment by intensity-modulated radiotherapy (IMRT) versus non-IMRT. METHODS An observational, cross-sectional study of QOL and late toxicities was conducted in 242 patients with NPC with survival of >5 years after treatment with IMRT (n = 100) or non-IMRT (n = 142) by using physician-assessed toxicities (Common Terminology Criteria for Adverse Events [CTCAE] version 4) and the patient-reported European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC QLQ-C30) and the Head and Neck 35-questions (EORTC QLQ-C30-H&N35) module. RESULTS The IMRT group had both statistically (p < .05) and clinically (difference of predicted mean scores ≥10 points) better outcome in global QOL, cognitive functioning, social functioning, fatigue, and 11 scales of the head and neck module. Late toxicities, including neuropathy, hearing loss, dysphagia, xerostomia, and neck fibrosis were significantly less severe in the IMRT group. Multivariate analysis revealed that the radiotherapy (RT) technique was statistically significantly associated with late toxicities and QOL outcome after adjusting for other clinical and demographic variables. CONCLUSION The use of the IMRT technique was associated with the improvement of physician-assessed late toxicities and patient-reported QOL in NPC survivors. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1026-E1032, 2016.
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Affiliation(s)
- Tai-Lin Huang
- Department of Hematology and Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Ling Tsai
- Department of Cosmetics and Fashion Styling, Cheng Shiu University, Kaohsiung, Taiwan
| | - Kuan-Cho Liao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shang-Yu Chou
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Ching Lin
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsair-Fwu Lee
- Department of Electronics Engineering, National Kaohsiung University of Applied Sciences, Kaohsiung, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Jiang N, Zhang LJ, Li LY, Zhao Y, Eisele DW. Risk factors for late dysphagia after (chemo)radiotherapy for head and neck cancer: A systematic methodological review. Head Neck 2015; 38:792-800. [PMID: 25532723 DOI: 10.1002/hed.23963] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this systematic review was to identify the risk factors for late dysphagia in patients with head and neck cancer after (chemo)radiotherapy. METHODS The review was performed using search strategies, including PubMed, the Cochrane Library, and Embase databases. The effects of studies were combined with the study quality score using a best-evidence synthesis model. RESULTS Twenty observational studies were evaluated. According to the best-evidence synthesis criteria, there were 2 strong-evidence risk factors for late dysphagia, including the use of chemoradiotherapy (CRT) and the presence of hypopharyngeal carcinoma. We also identified 8 moderate-evidence, 17 limited-evidence, and 1 conflicting-evidence risk factors. CONCLUSION Although there is no conclusive evidence for dysphagia in patients with head and neck cancer after (chemo)radiotherapy, these data provide evidence to guide clinicians in patients who will have late dysphagia and to choose an optimal prophylactic strategy.
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Affiliation(s)
- Nan Jiang
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin, China
| | - Li-Juan Zhang
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin, China
| | - Li-Ya Li
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University, Observatory Road, Heping District, Tianjin, China
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31
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Mendenhall WM, Strojan P, Eisbruch A, Smee R, Rinaldo A, Ferlito A. When is definitive radiotherapy the preferred treatment for head and neck squamous cell carcinoma? Eur Arch Otorhinolaryngol 2015; 272:2583-6. [PMID: 26024696 DOI: 10.1007/s00405-015-3660-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022]
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32
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Kerr P, Myers CL, Butler J, Alessa M, Lambert P, Cooke AL. Prospective functional outcomes in sequential population based cohorts of stage III/ IV oropharyngeal carcinoma patients treated with 3D conformal vs. intensity modulated radiotherapy. J Otolaryngol Head Neck Surg 2015; 44:17. [PMID: 25964113 PMCID: PMC4436159 DOI: 10.1186/s40463-015-0068-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND PURPOSE To compare early (3 and 6 month) and later (12 and 24 month) functional outcomes of stage III and IV (M0) oropharyngeal squamous cancer patients treated in sequential cohorts with 3D conformal (3DCRT) or intensity modulated radiotherapy (IMRT). PATIENTS AND METHODS 200 patients in sequential population based cohorts of 83 and 117 patients treated at a single institution with 3DCRT and then IMRT respectively were prospectively assessed at pre-treatment and 3, 6, 12 and 24 months post treatment. A standard functional outcomes protocol including performance status (KPS, ECOG), 3 Performance Status scales for Head and Neck (PSS-HN), the Royal Brisbane Hospital Outcome Measure for Swallowing (RBHOMS), Voice Handicap Index-10 (VHI-10) and self-rated xerostomia were applied. RESULTS Mean age at diagnosis was 59 years. The primary site was base of tongue in 77 and tonsil or soft palate in 123 patients. Median follow up was 2.5 years for the second cohort. Concomitant therapy was used in 159 (79.5%). Overall survival at 3 years was 75.6% and 71.5% for IMRT and 3DCRT cohorts respectively (not significant). A multiple imputation technique was used to estimate missing values in order to avoid a healthy patient bias. KPS and ECOG reached nadirs at 3 to 6 months but approached baseline values at 12 to 24 months and did not differ by treatment. The 3 PSS-HN scales, Eating in Public (p < 0.001), Understandability of Speech (p = 0.009) and Oral Diet Texture (p = 0.002) and all showed significantly better outcomes in favor of IMRT. The RBHOMS showed a difference in favor of IMRT which appeared during 3 to 6 months (p < 0.001). The VHI-10 also showed a difference in favor of IMRT (p = 0.015). Self-rated xerostomia did not differ at 3 and 6 months but was significantly better in favor of IMRT after 12 months p = 0.005 CONCLUSIONS: A prospectively administered functional outcomes protocol showed meaningful differences in favor of IMRT over 3DCRT early (3-6 months) and later (12-24 months) in the treatment of oropharyngeal carcinoma with equivalent survival. These data support the adoption of IMRT as the standard radiation treatment method for patients with stage III and IV (M0) oropharyngeal squamous carcinoma. KPS and ECOG may not be sensitive to oropharyngeal cancer patients' functional outcomes by treatment.
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Affiliation(s)
- Paul Kerr
- Department of Otolaryngology, Winnipeg, Manitoba, Canada.
| | | | - James Butler
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada. .,Department of Radiology, Winnipeg, Manitoba, Canada.
| | | | | | - Andrew L Cooke
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada. .,Department of Radiation Oncology, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba, R3E 0 V9, Canada.
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Kodaira T, Nishimura Y, Kagami Y, Ito Y, Shikama N, Ishikura S, Hiraoka M. Definitive radiotherapy for head and neck squamous cell carcinoma: update and perspectives on the basis of EBM. Jpn J Clin Oncol 2014; 45:235-43. [DOI: 10.1093/jjco/hyu209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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34
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Khan L, Tjong M, Raziee H, Lee J, Erler D, Chin L, Poon I. Role of stereotactic body radiotherapy for symptom control in head and neck cancer patients. Support Care Cancer 2014; 23:1099-103. [PMID: 25294656 DOI: 10.1007/s00520-014-2421-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Our aim was to determine the efficacy and quality of life outcomes of head and neck (HN) stereotactic body radiotherapy (SBRT) in a palliative population with significant proportions of de novo HN tumors not amenable to surgery or protracted course of curative radiotherapy (RT). METHODS A retrospective review of a prospective database identified 21 patients with 24 sites that were treated. Patients were treated with intensity modulated RT (IMRT), usually 7-9 static fields with a 2-3-mm margin from gross tumor volume to planning target volume only with no microscopic margin added. Electronic patient records and treatment plans were reviewed. Basic demographic information was collected. The EORTC QLQ-H&N35 questionnaire was the tool used to collect QOL data both pre- and on-treatment fraction 5. Univariate analysis was performed for predictors of local control (LC) and prognostic factors for overall survival (OS). RESULTS A total of 21 patients had 24 sites that were treated. The median age was 87 (range 25-103) and median KPS was 70. The most common histology was squamous cell carcinoma (SCC) 19/24 (79 %), basal cell carcinoma (BCC) 3/24 (16 %), and melanoma (4 %). The median maximal diameter was 3.7 cm (range 1-10 cm). The most commonly treated site was lymph nodes in the neck 13/24 (54 %), skin 8/24 (33 %), 4/24 (16 %) other HN mucosal primary sites. Of the 24 lesions, 17 (71 %) were de novo, without prior treatment and 7/24 (29 %) were recurrent. The most commonly used dose/fraction (fx) was 40 Gy/5 (fx) (range 35/5fx-48/6fx). Of the 24 lesions, 6 (25 %) had complete response, 16/24 (67 %) had partial response, and 2/24 (8 %) had no response. Control was defined as no further progression after treatment. For the entire cohort, LC at 3, 6, and 9 months were 66, 50, and 33 %, respectively. In the de novo group, 2/16 (12.5 %) had local failures with the LC rate of 94, 94, and 87 % at 3 months, 6 months, and 1 year, respectively. In the recurrent group, 4/8 (50 %) had failure with LC rates of 87. 5, 62.5, and 50 % at 3 months, 6 months, and 1 year, respectively. Of the 21 patients, 10 died during follow up, with the OS rate at 3 months, 6 months, and 1 year of 90, 70, and 60 %, respectively. Being defined "de novo" showed a trend toward statistical significance p = 0.046 for local failure. Overall survival did not show significant difference between de novo and recurrent with a p value of 0.267. No significant prognostic variables for OS were found. Pre-treatment QOL scores for the entire cohort were 53/130 versus 38/130 (lower scores indicating better QOL) scores with a trend toward statistical significance p = 0.05. CONCLUSIONS SBRT is efficacious with improved quality of life within this elderly frail population in the treatment of de novo and recurrent tumors of the head and neck with promising quality of life scores.
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Affiliation(s)
- Luluel Khan
- Odette Cancer Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
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Bian X, Song T, Wu S. Outcomes of xerostomia-related quality of life for nasopharyngeal carcinoma treated by IMRT: based on the EORTC QLQ-C30 and H&N35 questionnaires. Expert Rev Anticancer Ther 2014; 15:109-19. [PMID: 25231774 DOI: 10.1586/14737140.2015.961427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to review the published literature addressing the question of whether intensity-modulated radiotherapy (IMRT) resulted in an improvement of quality of life (QoL), especially xerostomia-related QoL of all nasopharyngeal carcinoma patients as time progressed. A literature search of PubMed, Embase and Google Scholar was performed, only reports containing original data of the QoL scores after treated by IMRT were included. Two independent reviewers extracted information of study design, study population, interventions, outcome measures and conclusions for each article. The inclusion criteria were met by 14 articles covering outcomes based on the questionnaires treated by IMRT. Data from same questionnaires (European Organization of Research and Treatment of Cancer QLQ-C30 and H&N35 questionnaires) were exacted and we analyzed four items (global health status, dry mouth and sticky saliva, swallowing, social eating and social contact), which have a close relationship with xerostomia-related QoL. Results indicated that a maximal deterioration of most QoL scales including global health status developed during treatment or at the end of the treatment course and then followed by a gradual recovery to 1 year, 1-2 years after IMRT, compared with their baseline level, some specific head and neck items, most in the EORTC QLQ H&N35, remained worse for the surviving patients. In conclusion, the published data reasonably support the benefits of IMRT in improving QoL, but xerostomia-related items still had a significantly negative effect in 2 years to impact a survivor's QoL.
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Affiliation(s)
- Xiuhua Bian
- Department of Radiation Oncology, Jiangsu Cancer Hospital, Nanjing 210000, P. R. China
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Blanchard D, Bollet M, Dreyer C, Binczak M, Calmels P, Couturaud C, Espitalier F, Navez M, Perrichon C, Testelin S, Albert S, Morinière S. Management of somatic pain induced by head and neck cancer treatment: Pain following radiation therapy and chemotherapy. Guidelines of the French Otorhinolaryngology Head and Neck Surgery Society (SFORL). Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:253-6. [DOI: 10.1016/j.anorl.2014.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Galland-Girodet S, Maire JP, De-Mones E, Benech J, Bouhoreira K, Protat B, Demeaux H, Darrouzet V, Huchet A. The role of radiation therapy in the management of head and neck paragangliomas: impact of quality of life versus treatment response. Radiother Oncol 2014; 111:463-7. [PMID: 24996453 DOI: 10.1016/j.radonc.2014.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 05/22/2014] [Accepted: 06/02/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE To assess the impact of radiotherapy in paragangliomas (PGLs) with regard to overall survival, local control, volumetric response and particularly quality of life (QoL). MATERIALS AND METHODS From 1985 to 2010, 130 cases of head and neck (H&N) PGLs were managed at Bordeaux University Hospital. With a median follow-up of 7.6 years, we retrospectively present a cohort of 30 consecutive patients treated with radiation therapy for H&N PGLs. QoL was evaluated for 20 patients by the EORTC QLQ-C30 and H&N35 questionnaires through a cross-sectional study. RESULTS The 5-year overall survival and local control were 95% and 96% respectively. QoL is altered following management of PGLs. The H&N35 score is lower after combined modality therapy (surgery±embolization and radiation therapy) for speech and hearing (p=0.004), trismus (p=0.003) and total score (p=0.01) than after radiotherapy alone. Tumor shrinkage was significant at 2 and 3 years after radiotherapy (p=0.018; p=0.043). CONCLUSION Ultimate QoL should be a major goal of any treatment strategy for this benign disease. Definitive radiotherapy should be considered as a reasonable alternative to multimodality treatment as it provides comparable disease control with an apparent improvement in QoL.
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Affiliation(s)
- Sigolène Galland-Girodet
- Univ. de Bordeaux, France; CHU de Bordeaux, Department of Radiation Oncology, France; Massachusetts General Hospital, Department of Radiation Oncology, Harvard Medical School, Boston, USA.
| | - Jean-Philippe Maire
- Univ. de Bordeaux, France; CHU de Bordeaux, Department of Radiation Oncology, France
| | - Erwan De-Mones
- CHU de Bordeaux, Department of Oto-Rhino-Laryngology and Skull Base Surgery, France
| | - Julie Benech
- CHU de Bordeaux, Department of Radiation Oncology, France
| | | | - Benoit Protat
- CHU de Bordeaux, Department of Radiation Oncology, France
| | - Hélène Demeaux
- CHU de Bordeaux, Department of Radiation Oncology, France
| | - Vincent Darrouzet
- Univ. de Bordeaux, France; CHU de Bordeaux, Department of Oto-Rhino-Laryngology and Skull Base Surgery, France
| | - Aymeri Huchet
- CHU de Bordeaux, Department of Radiation Oncology, France
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Comparing Long-Term Treatment-Associated Toxicities in Cancer Patients: Approaches, Caveats, and Recommendations. Int J Radiat Oncol Biol Phys 2014; 89:232-4. [DOI: 10.1016/j.ijrobp.2014.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 01/20/2014] [Indexed: 11/19/2022]
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Murthy V, Narang K, Ghosh-Laskar S, Gupta T, Budrukkar A, Agrawal JP. Hypothyroidism after 3-dimensional conformal radiotherapy and intensity-modulated radiotherapy for head and neck cancers: Prospective data from 2 randomized controlled trials. Head Neck 2014; 36:1573-80. [DOI: 10.1002/hed.23482] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/06/2013] [Accepted: 08/23/2013] [Indexed: 12/17/2022] Open
Affiliation(s)
- Vedang Murthy
- Department of Radiation Oncology; Tata Memorial Centre; Mumbai India
| | - Kushal Narang
- Department of Radiation Oncology; Tata Memorial Centre; Mumbai India
| | | | - Tejpal Gupta
- Department of Radiation Oncology; Tata Memorial Centre; Mumbai India
| | - Ashwini Budrukkar
- Department of Radiation Oncology; Tata Memorial Centre; Mumbai India
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Using multivariate regression model with least absolute shrinkage and selection operator (LASSO) to predict the incidence of Xerostomia after intensity-modulated radiotherapy for head and neck cancer. PLoS One 2014; 9:e89700. [PMID: 24586971 PMCID: PMC3938504 DOI: 10.1371/journal.pone.0089700] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 01/22/2014] [Indexed: 01/09/2023] Open
Abstract
Purpose The aim of this study was to develop a multivariate logistic regression model with least absolute shrinkage and selection operator (LASSO) to make valid predictions about the incidence of moderate-to-severe patient-rated xerostomia among head and neck cancer (HNC) patients treated with IMRT. Methods and Materials Quality of life questionnaire datasets from 206 patients with HNC were analyzed. The European Organization for Research and Treatment of Cancer QLQ-H&N35 and QLQ-C30 questionnaires were used as the endpoint evaluation. The primary endpoint (grade 3+ xerostomia) was defined as moderate-to-severe xerostomia at 3 (XER3m) and 12 months (XER12m) after the completion of IMRT. Normal tissue complication probability (NTCP) models were developed. The optimal and suboptimal numbers of prognostic factors for a multivariate logistic regression model were determined using the LASSO with bootstrapping technique. Statistical analysis was performed using the scaled Brier score, Nagelkerke R2, chi-squared test, Omnibus, Hosmer-Lemeshow test, and the AUC. Results Eight prognostic factors were selected by LASSO for the 3-month time point: Dmean-c, Dmean-i, age, financial status, T stage, AJCC stage, smoking, and education. Nine prognostic factors were selected for the 12-month time point: Dmean-i, education, Dmean-c, smoking, T stage, baseline xerostomia, alcohol abuse, family history, and node classification. In the selection of the suboptimal number of prognostic factors by LASSO, three suboptimal prognostic factors were fine-tuned by Hosmer-Lemeshow test and AUC, i.e., Dmean-c, Dmean-i, and age for the 3-month time point. Five suboptimal prognostic factors were also selected for the 12-month time point, i.e., Dmean-i, education, Dmean-c, smoking, and T stage. The overall performance for both time points of the NTCP model in terms of scaled Brier score, Omnibus, and Nagelkerke R2 was satisfactory and corresponded well with the expected values. Conclusions Multivariate NTCP models with LASSO can be used to predict patient-rated xerostomia after IMRT.
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Xiang L, Wang Y, Xu BQ, Wu JB, Xia YF. Preliminary results of a phase I/II study of simultaneous boost irradiation radiotherapy for locally advanced nasopharyngeal carcinoma. Asian Pac J Cancer Prev 2014; 14:7569-76. [PMID: 24460335 DOI: 10.7314/apjcp.2013.14.12.7569] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this article is to present preliminary results of simultaneous boost irradiation radiotherapy for locally advanced nasopharyngeal carcinoma (NPC). METHODS Fifty-eight patients who underwent simultaneous boost irradiation radiotherapy for NPC in Cancer Center of Sun Yat-sen University between September 2004 and December 2009 were eligible. Acute and late toxicities were scored weekly according to the Radiation Therapy Oncology Group (RTOG) acute and late radiation morbidity scoring schemes. An especial focus was on evidence of post-radiation brain injury. Also quality of life was analysed according to the EORTC (European Organisation for Research and Treatment of Cancer) recommendations. Discrete variables were compared by ?2 test. The Kaplan-Meier method was used to calculate the survival rates and generate survival curves. RESULTS A total of 58 patients with a mean follow-up time of 36 months completed clinical trials.Fifty- seven patients (98.3) achieved complete remission in the primary sites and cervical lymph nodes, with only one patient (1.7%) showing partial remission.The most frequently observed acute toxicities during the concurrent chemoradiotherapy were mucositis and leucopenia. Four patients (6.9%) had RTOG grade 3 mucositis, whereas four patients (6.9%) had grade 3 leucopenia. No patient had grade 4 acute toxicity. Three (5.17%) of the patients exhibited injury to the brain on routine MRI examination, with a median observation of 32 months (range, 25-42months). All of them were RTOG grade 0. The 3-year overall, regional-free and distant metastasis-free survival rates were 85%, 94% and 91%, respectively. CONCLUSION Simultaneous boost irradiation radiotherapy is feasible in patients with locally advanced nasopharyngeal carcinoma. The results showed excellent local control and overall survival, with no significant increase the incidence of radiation brain injury or the extent of damage. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.
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Affiliation(s)
- Li Xiang
- State Key Laboratory of Oncology in South China, Department of Radiation Therapy, Cancer Centre, Sun Yat-Sen University, Guangzhou, Guangdong, China E-mail : ,
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Beadle BM, Liao KP, Elting LS, Buchholz TA, Ang KK, Garden AS, Guadagnolo BA. Improved survival using intensity-modulated radiation therapy in head and neck cancers: a SEER-Medicare analysis. Cancer 2014; 120:702-10. [PMID: 24421077 DOI: 10.1002/cncr.28372] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/01/2013] [Accepted: 08/26/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intensity-modulated radiation therapy (IMRT) is a technologically advanced, and more expensive, method of delivering radiation therapy with a goal of minimizing toxicity. It has been widely adopted for head and neck cancers; however, its comparative impact on cancer control and survival remains unknown. The goal of this analysis was to compare the cause-specific survival (CSS) for patients with head and neck cancers treated with IMRT versus non-IMRT from 1999 to 2007. METHODS CSS was determined using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and analyzed regarding treatment details, including the use of IMRT versus non-IMRT, using claims data. Hazard ratios (HRs) were estimated by the frailty model with a propensity score matching cohort and instrumental variable analysis. RESULTS A total of 3172 patients were identified. With a median follow-up of 40 months, patients treated with IMRT had a statistically significant improvement in CSS compared with those treated with non-IMRT (84.1% versus 66.0%; P < .001). When each anatomic subsite was analyzed separately, all respective subgroups of patients treated with IMRT had better CSS than those treated with non-IMRT. In multivariable survival analyses, patients treated with IMRT were associated with better CSS (HR = 0.72, 95% confidence interval = 0.59 to 0.90 for propensity score matching; HR = 0.60, 95% confidence interval = 0.41 to 0.88 for instrumental variable analysis). CONCLUSIONS Patients with head and neck cancers who were treated with IMRT experienced significant improvements in CSS compared with patients treated with non-IMRT techniques. This suggests there may be benefits to IMRT in cancer outcomes, in addition to toxicity reduction, for this patient population.
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Affiliation(s)
- Beth M Beadle
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Marta GN, Silva V, de Andrade Carvalho H, de Arruda FF, Hanna SA, Gadia R, da Silva JLF, Correa SFM, Vita Abreu CEC, Riera R. Intensity-modulated radiation therapy for head and neck cancer: systematic review and meta-analysis. Radiother Oncol 2013; 110:9-15. [PMID: 24332675 DOI: 10.1016/j.radonc.2013.11.010] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 11/25/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Intensity-modulated radiation therapy (IMRT) provides the possibility of dose-escalation with better normal tissue sparing. This study was performed to assess whether IMRT can improve clinical outcomes when compared with two-dimensional (2D-RT) or three-dimensional conformal radiation therapy (3D-CRT) in patients with head and neck cancer. METHODS AND MATERIALS Only prospective phase III randomized trials comparing IMRT with 2D-RT or 3D-CRT were eligible. Combined surgery and/or chemotherapy were allowed. Two authors independently selected and assessed the studies regarding eligibility criteria and risk of bias. RESULTS Five studies were selected. A total of 871 patients were randomly assigned for 2D-RT or 3D-CRT (437), versus IMRT (434). Most patients presented with nasopharyngeal cancers (82%), and stages III/IV (62.1%). Three studies were classified as having unclear risk and two as high risk of bias. A significant overall benefit in favor of IMRT was found (hazard ratio - HR=0.76; 95% CI: 0.66, 0.87; p<0.0001) regarding xerostomia scores grade 2-4, with similar loco-regional control and overall survival. CONCLUSIONS IMRT reduces the incidence of grade 2-4 xerostomia in patients with head and neck cancers without compromising loco-regional control and overall survival.
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Affiliation(s)
- Gustavo Nader Marta
- Radiation Oncology Department, Hospital Sírio-Libanês, Brazil; Radiation Oncology Department, Instituto do Câncer de São Paulo (ICESP), Brazil.
| | - Valter Silva
- Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil.
| | - Heloisa de Andrade Carvalho
- Radiation Oncology Department, Hospital Sírio-Libanês, Brazil; Radiation Oncology Department, Faculdade de Medicina da Universidade de São Paulo, Brazil.
| | | | | | - Rafael Gadia
- Radiation Oncology Department, Hospital Sírio-Libanês, Brazil.
| | | | | | | | - Rachel Riera
- Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil.
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Duarte VM, Liu YF, Rafizadeh S, Tajima T, Nabili V, Wang MB. Comparison of Dental Health of Patients with Head and Neck Cancer Receiving IMRT vs Conventional Radiation. Otolaryngol Head Neck Surg 2013; 150:81-6. [DOI: 10.1177/0194599813509586] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To analyze the dental health of patients with head and neck cancer who received comprehensive dental care after intensity-modulated radiation therapy (IMRT) compared with radiation therapy (RT). Study Design Historical cohort study. Setting Veteran Affairs (VA) hospital. Subjects and Methods In total, 158 patients at a single VA hospital who were treated with RT or IMRT between 2003 and 2011 were identified. A complete dental evaluation was performed prior to radiation treatment, including periodontal probing, tooth profile, cavity check, and mobility. The dental treatment plan was formulated to eliminate current and potential dental disease. The rates of dental extractions, infections, caries, mucositis, xerostomia, and osteoradionecrosis (ORN) were analyzed, and a comparison was made between patients treated with IMRT and those treated with RT. Results Of the 158 patients, 99 were treated with RT and 59 were treated with IMRT. Compared with those treated with IMRT, significantly more patients treated with RT exhibited xerostomia (46.5% vs 16.9%; P < .001; odds ratio [OR], 0.24; 95% confidence interval [CI], 0.11-0.52), mucositis (46.5% vs 16.9%; P < .001; OR, 0.24; 95% CI, 0.11-0.52), and ORN (10.1% vs 0%; P = .014; OR, 0.07; 95% CI, 0.00-1.21). However, significantly more patients treated with IMRT were edentulous by the conclusion of radiation treatment (32.2% vs 11.1%; P = .002; OR, 3.8; 95% CI, 1.65-8.73). Conclusion Patients who were treated with IMRT had fewer instances of dental disease, more salivary flow, and fewer requisite posttreatment extractions compared with those treated with RT. The number of posttreatment extractions has been reduced with the advent of IMRT and more so with a complete dental evaluation prior to treatment.
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Affiliation(s)
- Victor M. Duarte
- Department of Head and Neck Surgery, David E. Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Yuan F. Liu
- Department of Head and Neck Surgery, David E. Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sassan Rafizadeh
- Department of Head and Neck Surgery, David E. Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Tracey Tajima
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Oral Medicine, School of Dentistry at UCLA, Los Angeles, California, USA
| | - Vishad Nabili
- Department of Head and Neck Surgery, David E. Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Marilene B. Wang
- Department of Head and Neck Surgery, David E. Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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Évolution des concepts dans les cancers des voies aérodigestives supérieures, sous l’égide de l’Intergroupe ORL (GORTEC, GETTEC, GERCOR). Bull Cancer 2013; 100:983-97. [DOI: 10.1684/bdc.2013.1829] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Graff P, Huger S, Kirby N, Pouliot J. Radiothérapie adaptative ORL. Cancer Radiother 2013; 17:513-22. [DOI: 10.1016/j.canrad.2013.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 06/23/2013] [Indexed: 11/29/2022]
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Chajon E, Lafond C, Louvel G, Castelli J, Williaume D, Henry O, Jégoux F, Vauléon E, Manens JP, Le Prisé E, de Crevoisier R. Salivary gland-sparing other than parotid-sparing in definitive head-and-neck intensity-modulated radiotherapy does not seem to jeopardize local control. Radiat Oncol 2013; 8:132. [PMID: 23721062 PMCID: PMC3680304 DOI: 10.1186/1748-717x-8-132] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/27/2013] [Indexed: 12/25/2022] Open
Abstract
Background The objective was to analyze locoregional (LR) failure patterns in patients with head-and-neck cancer (HNC) treated using intensity-modulated radiotherapy (IMRT) with whole salivary gland-sparing: parotid (PG), submandibular (SMG), and accessory salivary glands represented by the oral cavity (OC). Methods Seventy consecutive patients with Stage I-II (23%) or III/IV (77%) HNC treated by definitive IMRT were included. For all LR failure patients, the FDG-PET and CT scans documenting recurrence were rigidly registered to the initial treatment planning CT. Failure volumes (Vf) were delineated based on clinical, radiological, and histological data. The percentage of Vf covered by 95% of the prescription isodose (Vf-V95) was analyzed. Failures were classified as “in-field” if Vf–V95 ≥ 95%, “marginal” if 20% < Vf-V95 < 95%, and “out-of-field” if Vf-V95 ≤20%. Correlation between Vf-V95 and mean doses (Dmean) in the PG, SMG, and OC was assessed using Spearman’s rank-order correlation test. The salivary gland dose impact on the LR recurrence risk was assessed by Cox analysis. Results The median follow-up was 20 months (6–35). Contralateral and ipsilateral PGs were spared in 98% and 54% of patients, respectively, and contralateral and ipsilateral SMG in 26% and 7%, respectively. The OC was spared to a dose ≤40 Gy in 26 patients (37%). The 2-year LR control rate was 76.5%. One recurrence was “marginal”, and 12 were “in-field”. No recurrence was observed in vicinity of spared structures. Vf-V95 was not significantly correlated with Dmean in PG, SMG, and OC. The LR recurrence risk was not increased by lower Dmean in the salivary glands, but by T (p = 0.04) and N stages (p = 0.03). Conclusion Over 92% of LR failures occurred “in-field” within the high dose region when using IMRT with a whole salivary gland-sparing strategy. Sparing SMG and OC in addition to PG thus appears a safe strategy.
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Miah AB, Gulliford SL, Clark CH, Bhide SA, Zaidi SH, Newbold KL, Harrington KJ, Nutting CM. Dose-response analysis of parotid gland function: what is the best measure of xerostomia? Radiother Oncol 2013; 106:341-5. [PMID: 23566529 DOI: 10.1016/j.radonc.2013.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 02/12/2013] [Accepted: 03/06/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the dose-response relationships for the different measures of salivary gland recovery following radical radiotherapy for locally advanced head and neck squamous cell cancers (LA-HNSCC). METHODS AND MATERIALS Dosimetric analysis of data from the PARSPORT trial, a Phase III study of conventional RT (RT) and intensity modulated radiotherapy (IMRT) for LA-HNSCC was undertaken to determine the relationship between parotid gland mean dose and toxicity endpoints: high-grade subjective and objective xerostomia and xerostomia-related quality of life scores. LKB-NTCP parameters (TD50, m and n) were generated and tolerance doses (D50) reported using non-linear logistic regression analysis. RESULTS Data were available on 63 patients from the PARSPORT trial. Parotid saliva flow rate provided the strongest association between mean dose and recovery, D50=23.4 Gy (20.6-26.2) and k=3.2 (1.9-4.5), R(2)=0.85. Corresponding LKB parameters were TD50=26.3 Gy (95% CI: 24.0-30.1), m=0.25 (0.18-1.0 and n=1). LENTSOMA subjective xerostomia also demonstrated a strong association D50=33.3 Gy (26.7-39.8), k=2.8 (91.4-4.4), R(2)=0.77). CONCLUSION We recommend using the LENT SOMA subjective xerostomia score to predict recovery of salivation due to its strong association with dosimetry and ease of recording.
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Affiliation(s)
- Aisha B Miah
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
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Xiao C, Hanlon A, Zhang Q, Ang K, Rosenthal DI, Nguyen-Tan PF, Kim H, Movsas B, Bruner DW. Symptom clusters in patients with head and neck cancer receiving concurrent chemoradiotherapy. Oral Oncol 2013; 49:360-6. [PMID: 23168337 PMCID: PMC3924732 DOI: 10.1016/j.oraloncology.2012.10.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 10/02/2012] [Accepted: 10/03/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study is to identify symptom clusters for head and neck (HNC) patients treated with concurrent chemoradiotherapy. PATIENTS AND METHODS A secondary data analysis of 684 HNC patients treated on the Radiation Therapy Oncology Group (RTOG) 0129 trial comparing different RT fractionation schedules with concurrent chemotherapy was used to examine clusters. Treatment-related symptoms were measured by clinicians at three time-points during and after chemoradiotherapy using the National Cancer Institute Common Toxicity Criteria v2.0. Exploratory factor analysis was applied to identify symptom clusters, which was further verified by confirmatory factor analysis. Coefficients of congruence and alpha coefficients were employed to examine generalizability of cluster structures over different time-points and in different subgroups. RESULTS Two clusters were identified. The HNC specific cluster is composed of radiodermatitis, dysphagia, radiomucositis, dry mouth, pain, taste disturbance, and fatigue. The gastrointestinal (GI) cluster involves nausea, vomiting, and dehydration. With the exception of patients 65years old or older, diagnosed with larynx cancer, or with stage III cancer, the two clusters were generalizable to different subgroups defined by age, gender, race, education, marital status, history of tobacco use, treatments, primary sites, disease stages, and tube feedings, as well as to the three symptom assessment time-points. CONCLUSIONS The data provides preliminary support for two stable clusters in patients with HNC. These findings may serve to inform the symptom management in clinical practice. Moreover, the findings necessitate future research to examine the generalizability of identified clusters in the late symptom phase or other treatment modalities, and to understand the underlying biological mechanism.
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Affiliation(s)
- Canhua Xiao
- Emory University School of Nursing, 1520 Clifton Road NE, Atlanta, GA 30322, USA.
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50
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Miah AB, Gulliford SL, Bhide SA, Zaidi SH, Newbold KL, Harrington KJ, Nutting CM. The effect of concomitant chemotherapy on parotid gland function following head and neck IMRT. Radiother Oncol 2013; 106:346-51. [PMID: 23540553 DOI: 10.1016/j.radonc.2013.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 02/17/2013] [Accepted: 03/04/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether concomitant chemotherapy increases the incidence of high grade xerostomia following parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with locally advanced head and neck squamous cell cancer. MATERIALS AND METHODS The incidence of high grade (≥G2) acute (CTCAEv3.0) and late (LENTSOMA and RTOG) xerostomia was compared between patients treated with either IMRT or concomitant chemo-IMRT (c-IMRT) in 2 prospective studies. Parotid gland mean tolerance doses (D₅₀) were reported using non-linear logistic regression analysis. RESULTS Thirty-six patients received IMRT alone and 60 patients received c-IMRT. Patients received 65 Gy in 30 daily fractions to the primary site and involved nodal groups and 54 Gy in 30 fractions to elective nodal groups, mean doses to the parotid glands were comparable. Concomitant cisplatin 100mg/m(2) was administered on days 1 and 29 of IMRT. The incidence of ≥G2 subjective xerostomia was similar in both groups; acute-64.7% (IMRT) versus 60.3% (c-IMRT), p=0.83; late-43% (IMRT) versus 34% (c-IMRT), p=0.51. Recovery of parotid salivary flow at 1 year was higher with IMRT (64% vs 50%), but not statistically significant (p=0.15). D₅₀ for absence of parotid saliva flow at 1 year was 23.2 Gy (95% CI: 17.7-28.7) for IMRT and 21.1 Gy (11.8-30.3) for c-IMRT. CONCLUSION Concomitant c-IMRT does not increase the incidence of acute or late xerostomia relative to IMRT alone.
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Affiliation(s)
- Aisha B Miah
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Surrey, UK
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