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Kim YC, Woo SH, Jeong WS, Oh TS, Choi JW. Impact of Dynamic Tongue Reconstruction on Sequential Changes of Swallowing Function in Patients Undergoing Total or Near-Total Glossectomy. Ann Plast Surg 2023; 91:257-264. [PMID: 37489967 DOI: 10.1097/sap.0000000000003629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE This study aimed to compare the effects of motor-innervated free flap on sequential changes of swallowing function in patients undergoing total or near-total glossectomy with laryngeal preservation. MATERIALS AND METHODS The medical charts of 21 patients who underwent tongue reconstruction after total or near-total glossectomy between April 2015 and December 2020 were retrospectively reviewed. Patients were divided into groups by reconstruction type: conventional, reconstruction using an anterolateral thigh free flap (n = 11), and dynamic, reconstruction using an anterolateral thigh with innervated vastus lateralis flap (n = 10). Demographics, surgical details, and survival outcomes were investigated. A videofluoroscopic penetration-aspiration scale and functional outcome swallowing scale were analyzed according to postoperative time courses, classified as within 6 months, 6 to 12 months, and after 12 months postoperative. A time-to-event analysis was performed for gastrostomy tube status. RESULTS The dynamic group showed improved swallowing outcomes at 6 to 12 months postoperative (dynamic vs conventional group, penetration-aspiration scale: 3 ± 1.51 vs 6 ± 1.63, P = 0.024; functional outcome swallowing scale: 1.89 ± 1.36 vs 4 ± 1.41, P = 0.009). In the multivariate analysis, the dynamic group showed a decreased probability of decompensated swallowing function at 6 to 12 months postoperative (odds ratio, 0.062; 95% confidence interval, 0.004-1.084; P = 0.057). A time-to-event analysis revealed no significant difference in gastrostomy tube status between the dynamic and the conventional group. CONCLUSIONS Considering higher mortality in patients subjected to total or near-total glossectomy, dynamic reconstruction with motor-innervated free flap is worth to perform in terms of enhancing the swallowing function within 1-year postoperative period, thereby improving the quality of life.
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Affiliation(s)
- Young Chul Kim
- Department of Plastic and Reconstructive Surgery, University of Ulsan, College of Medicine, SeoulAsan Medical Center, Seoul, Korea
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Honma R, I T, Seki M, Iwatake M, Ogaeri T, Hasegawa K, Ohba S, Tran SD, Asahina I, Sumita Y. Immunomodulatory Macrophages Enable E-MNC Therapy for Radiation-Induced Salivary Gland Hypofunction. Cells 2023; 12:1417. [PMID: 37408251 DOI: 10.3390/cells12101417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 07/07/2023] Open
Abstract
A newly developed therapy using effective-mononuclear cells (E-MNCs) is reportedly effective against radiation-damaged salivary glands (SGs) due to anti-inflammatory and revascularization effects. However, the cellular working mechanism of E-MNC therapy in SGs remains to be elucidated. In this study, E-MNCs were induced from peripheral blood mononuclear cells (PBMNCs) by culture for 5-7 days in medium supplemented with five specific recombinant proteins (5G-culture). We analyzed the anti-inflammatory characteristics of macrophage fraction of E-MNCs using a co-culture model with CD3/CD28-stimulated PBMNCs. To test therapeutic efficacy in vivo, either E-MNCs or E-MNCs depleted of CD11b-positive cells were transplanted intraglandularly into mice with radiation-damaged SGs. Following transplantation, SG function recovery and immunohistochemical analyses of harvested SGs were assessed to determine if CD11b-positive macrophages contributed to tissue regeneration. The results indicated that CD11b/CD206-positive (M2-like) macrophages were specifically induced in E-MNCs during 5G-culture, and Msr1- and galectin3-positive cells (immunomodulatory macrophages) were predominant. CD11b-positive fraction of E-MNCs significantly inhibited the expression of inflammation-related genes in CD3/CD28-stimulated PBMNCs. Transplanted E-MNCs exhibited a therapeutic effect on saliva secretion and reduced tissue fibrosis in radiation-damaged SGs, whereas E-MNCs depleted of CD11b-positive cells and radiated controls did not. Immunohistochemical analyses revealed HMGB1 phagocytosis and IGF1 secretion by CD11b/Msr1-positive macrophages from both transplanted E-MNCs and host M2-macrophages. Thus, the anti-inflammatory and tissue-regenerative effects observed in E-MNC therapy against radiation-damaged SGs can be partly explained by the immunomodulatory effect of M2-dominant macrophage fraction.
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Affiliation(s)
- Ryo Honma
- Department of Medical Research and Development for Oral Disease, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Takashi I
- Department of Medical Research and Development for Oral Disease, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | | | - Mayumi Iwatake
- Department of Medical Research and Development for Oral Disease, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Takunori Ogaeri
- Department of Medical Research and Development for Oral Disease, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Kayo Hasegawa
- Department of Medical Research and Development for Oral Disease, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Seigo Ohba
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Simon D Tran
- Laboratory of Craniofacial Tissue Engineering and Stem Cells, Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC H3A 1G1, Canada
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
| | - Yoshinori Sumita
- Department of Medical Research and Development for Oral Disease, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki 852-8588, Japan
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Zhang L, Li J, Jia C. The efficacy and safety of radiotherapy combined chemotherapy for laryngeal preservation in advanced laryngeal cancer: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31899. [PMID: 36401448 PMCID: PMC9678525 DOI: 10.1097/md.0000000000031899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The appropriate use of surgery or chemoradiotherapy-based approaches for organ preservation has been the subject of much debate. Unfortunately, there has been a lack of improvement in overall survival for patients with laryngeal carcinoma. In this study, we performed a protocol for systematic review and meta-analysis to evaluate the efficacy and safety radiotherapy combined chemotherapy for laryngeal preservation in advanced laryngeal cancer. METHODS This protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. We will search the PubMed, Cochrane Library, EMBASE, and Web of Science databases from the inception dates to October, 2022, using the keywords "laryngeal cancer," "radiotherapy", and "chemotherapy." Cochrane "bias risk" tool is used to assess the bias risk of the quality of the included literature. All calculations were carried out with RevMan V.5.3 software. RESULTS The results of this study will provide evidence for judging whether radiotherapy combined chemotherapy is superior to surgery for treatment of advanced laryngeal cancer. CONCLUSION This review will provide directions and recommendations for future research and clinical practices of radiotherapy combined chemotherapy for laryngeal preservation in advanced laryngeal cancer.
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Affiliation(s)
- Lei Zhang
- Department of Head and Neck Surgery Ward 1, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jianfeng Li
- Department of Otorhinolaryngology, Shanxi Provincial People’s Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Chenle Jia
- Department of Head and Neck Surgery Ward 1, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
- *Correspondence Chenle Jia, MM, Department of Head and Neck Surgery Ward 2, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan 030013, China (e-mail: )
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4
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Sarkar K, Torregrossa-Allen SE, Elzey BD, Narayanan S, Langer MP, Durm GA, Won YY. Effect of Paclitaxel Stereochemistry on X-ray-Triggered Release of Paclitaxel from CaWO 4/Paclitaxel-Coloaded PEG-PLA Nanoparticles. Mol Pharm 2022; 19:2776-2794. [PMID: 35834797 DOI: 10.1021/acs.molpharmaceut.2c00148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
For many locally advanced tumors, the chemotherapy-radiotherapy (CT-RT) combination ("chemoradiation") is currently the standard of care. Intratumoral (IT) CT-based chemoradiation has the potential to overcome the limitations of conventional systemic CT-RT (side effects). For maximizing the benefits of IT CT-RT, our laboratory has previously developed a radiation-controlled drug release formulation, in which anticancer drug paclitaxel (PTX) and radioluminescent CaWO4 (CWO) nanoparticles (NPs) are co-encapsulated with poly(ethylene glycol)-poly(lactic acid) (PEG-PLA) block copolymers ("PEG-PLA/CWO/PTX NPs"). These PEG-PLA/CWO/PTX NPs enable radiation-controlled release of PTX and are capable of producing sustained therapeutic effects lasting for at least one month following a single IT injection. The present article focuses on discussing our recent finding about the effect of the stereochemical structure of PTX on the efficacy of this PEG-PLA/CWO/PTX NP formulation. Stereochemical differences in two different PTX compounds ("PTX-S" from Samyang Biopharmaceuticals and "PTX-B" from Biotang) were characterized by 2D heteronuclear/homonuclear NMR, Raman spectroscopy, and circular dichroism measurements. The difference in PTX stereochemistry was found to significantly influence their water solubility (WS); PTX-S (WS ≈ 4.69 μg/mL) is about 19 times more water soluble than PTX-B (WS ≈ 0.25 μg/mL). The two PTX compounds showed similar cancer cell-killing performances in vitro when used as free drugs. However, the subtle stereochemical difference significantly influenced their X-ray-triggered release kinetics from the PEG-PLA/CWO/PTX NPs; the more water-soluble PTX-S was released faster than the less water-soluble PTX-B. This difference was manifested in the IT pharmacokinetics and eventually in the survival percentages of test animals (mice) treated with PEG-PLA/CWO/PTX NPs + X-rays in an in vivo human tumor xenograft study; at short times (<1 month), concurrent PEG-PLA/CWO/PTX-S NPs produced a greater tumor-suppression effect, whereas PEG-PLA/CWO/PTX-B NPs had a longer-lasting radio-sensitizing effect. This study demonstrates the importance of the stereochemistry of a drug in a therapy based on a controlled release formulation.
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Affiliation(s)
- Kaustabh Sarkar
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana 47907, United States
| | | | - Bennett D Elzey
- Purdue University Center of Cancer Research, West Lafayette, Indiana 47907, United States.,Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana 47907, United States
| | - Sanjeev Narayanan
- Department of Comparative Pathobiology, Purdue University, West Lafayette, Indiana 47907, United States
| | - Mark P Langer
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana 46202, United States
| | - Gregory A Durm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana 46202, United States
| | - You-Yeon Won
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, Indiana 47907, United States.,Purdue University Center of Cancer Research, West Lafayette, Indiana 47907, United States
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Rich B, Huang J, Yang Y, Jin W, Johnson P, Wang L, Yang F. Radiomics Predicts for Distant Metastasis in Locally Advanced Human Papillomavirus-Positive Oropharyngeal Squamous Cell Carcinoma. Cancers (Basel) 2021; 13:cancers13225689. [PMID: 34830844 PMCID: PMC8616361 DOI: 10.3390/cancers13225689] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 01/04/2023] Open
Abstract
Simple Summary There is strong evidence that locally advanced human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) carries a significantly better prognosis than HPV negative OPSCC, suggesting the possibility of treatment de-escalation and, therefore, toxicity reduction in this patient population. The lack of success in clinical trials towards this end presses the need to risk stratify locally advanced HPV+ OPSCC patients who can safely have treatment de-escalated. The present study had recourse to radiomics for this purpose and showed that radiomics has the ability to discriminate patients with locally advanced HPV+ OPSCC who went on to develop distant metastasis after completion of definitive chemoradiation or radiation alone. The implications of this study aid in demonstrating the potential pivotal role of radiomics in predictive risk assessment and personalizing therapy for this patient population. Abstract (1) Background and purpose: clinical trials have unsuccessfully tried to de-escalate treatment in locally advanced human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) with the goal of reducing treatment toxicity. The aim of this study was to explore the role of radiomics for risk stratification in this patient population to guide treatment. (2) Methods: the study population consisted of 225 patients with locally advanced HPV+ OPSCC treated with curative-intent radiation or chemoradiation therapy. Appearance of distant metastasis was used as the endpoint event. Radiomics data were extracted from the gross tumor volumes (GTVs) identified on the planning CT, with gray level being discretized using three different bin widths (8, 16, and 32). The data extracted for the groups with and without distant metastasis were subsequently balanced using three different algorithms including synthetic minority over-sampling technique (SMOTE), adaptive synthetic sampling (ADASYN), and borderline SMOTE. From these different combinations, a total of nine radiomics datasets were derived. Top features that minimized redundancy while maximizing relevance to the endpoint were selected individually and collectively for the nine radiomics datasets to build support vector machine (SVM) based predictive classifiers. Performance of the developed classifiers was evaluated by receiver operating characteristic (ROC) curve analysis. (3) Results: of the 225 locally advanced HPV+ OPSCC patients being studied, 9.3% had developed distant metastases at last follow-up. SVM classifiers built for the nine radiomics dataset using either their own respective top features or the top consensus ones were all able to differentiate the two cohorts at a level of excellence or beyond, with ROC area under curve (AUC) ranging from 0.84 to 0.95 (median = 0.90). ROC comparisons further revealed that the majority of the built classifiers did not distinguish the two cohorts significantly better than each other. (4) Conclusions: radiomics demonstrated discriminative ability in distinguishing patients with locally advanced HPV+ OPSCC who went on to develop distant metastasis after completion of definitive chemoradiation or radiation alone and may serve to risk stratify this patient population with the purpose of guiding the appropriate therapy.
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Affiliation(s)
- Benjamin Rich
- Department of Radiation Oncology, University of Miami, Miami, FL 33136, USA; (B.R.); (W.J.); (L.W.)
| | - Jianfeng Huang
- Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, Wuxi 214125, China;
| | - Yidong Yang
- Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230026, China;
| | - William Jin
- Department of Radiation Oncology, University of Miami, Miami, FL 33136, USA; (B.R.); (W.J.); (L.W.)
| | - Perry Johnson
- Department of Radiation Oncology, University of Florida, Jacksonville, FL 32209, USA;
| | - Lora Wang
- Department of Radiation Oncology, University of Miami, Miami, FL 33136, USA; (B.R.); (W.J.); (L.W.)
| | - Fei Yang
- Department of Radiation Oncology, University of Miami, Miami, FL 33136, USA; (B.R.); (W.J.); (L.W.)
- Correspondence: ; Tel.: +1-(305)-243-4255
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6
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Charalambous M, Papakyriacou C, Tsitsi T, Katodritis N, Vomvas D, Charalambous A. The evaluation of the reliability and validity properties of the Greek version of the xerostomia questionnaire (ΧQ). Eur J Oncol Nurs 2021; 52:101971. [PMID: 34022580 DOI: 10.1016/j.ejon.2021.101971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Xerostomia is one of the multidimensional effects of cancer therapy that can impact on patients' quality of life. This study aims to evaluate the reliability and validity properties of the xerostomia questionnaire. METHODS The data were retrieved from a randomized, interventional and longitudinal follow-up study of 72 head and neck cancer patients on active oral radiotherapy. Data were retrieved by the Xerostomia Questionnaire, the EORTC-QLQ C30 and EORT QLQ HN35. Data analyzes included intrinsic credibility of affinity Cronbach alpha factor, which is related to validity and cross-sectional validity. RESULTS The Cronbach's alpha index of the Greek version of the questionnaire was high. Explicitly, the total scale of the questionnaire had an α = 0.97, and the individual dimensions - Degree of dryness and the quality of life had an alpha of 0.97 and 0.98 respectively. The xerostomia dimension of the questionnaire has a high positive correlation with QLQ C30 overall (r = 0.61, p < 0.001), and with the HN35 xerostomia dimension (r = 0.63, p < 0.001) which demonstrate its' concurrent validity. The dimensions of the xerostomia questionnaire were highly correlated with the EORTC-QLQ C30 dimensions which supports its' predictive validity. The level of xerostomia and the quality of life varied according to the level of pain of the patients (p < 0.001) that support the cross-sectional validity of the questionnaire. CONCLUSION The Greek version of the xerostomia questionnaire is a reliable and valid tool for use in head and neck cancer patients on active oral radiotherapy.
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Affiliation(s)
| | | | | | | | | | - Andreas Charalambous
- Cyprus University of Technology, Limassol, Cyprus and University of Turku, Turku, Finland
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7
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Langer C, Wittekindt C, Jensen AD. [The role of chemoradiotherapy in curative treatment of head and neck cancer]. Laryngorhinootologie 2021; 101:22-34. [PMID: 33506441 DOI: 10.1055/a-1351-0417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Radiotherapy and chemotherapy are integral parts of definitive and adjuvant therapy in the treatment of head and neck squamous cell carcinoma (HNSCC). The outcome of therapy is essentially dependent on selection and dosage of chemotherapeutical substances and on the other hand on the radiotherapeutical setting concerning fractionation, time of therapy and technical aspects. Immunotherapeutical substances have an increasing role in the therapy of HNSCC as well as particle therapy is investigated as part of radiotherapy in actual studies. Further challenges relate to treatment of HPV-induced tumors with regard to their differences in tumor biology and consecutively better prognosis.
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Affiliation(s)
- Christine Langer
- HNO, Universitätsklinikum Gießen und Marburg Standort Gießen, Klinik für Hals-Nasen-Ohrenheilkunde, Kopf-Halschirurgie und plastische Operationen, Gießen, Germany
| | | | - Alexandra Désirée Jensen
- Klinik für Strahlentherapie, Universitätsklinikum Gießen und Marburg GmbH Standort Gießen, Gießen, Germany
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Sumita Y, Iwamoto N, Seki M, Yoshida T, Honma R, Iwatake M, Ohba S, Takashi I, Hotokezaka Y, Harada H, Kuroshima S, Nagai K, Asahara T, Atsushi Kawakam I, Asahina I. Phase 1 clinical study of cell therapy with effective-mononuclear cells (E-MNC) for radiogenic xerostomia (first-in-human study) (FIH study on E-MNC therapy for radiogenic xerostomia). Medicine (Baltimore) 2020; 99:e20788. [PMID: 32590759 PMCID: PMC7328916 DOI: 10.1097/md.0000000000020788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Treatment for most patients with head and neck cancers includes ionizing radiation with or without chemotherapy. This treatment causes irreversible damage to salivary glands in the irradiation field accompanied by a loss of fluid-secreting acinar cells and a considerable decrease of saliva secretion. There is currently no adequate conventional treatment for this condition. In recent years, we developed an effective culture method to enhance the anti-inflammatory and vasculogenic phenotypes of peripheral blood mononuclear cells (PBMNCs), and such effectively conditioned PBMNC (E-MNC) therapy has shown promising improvements to the function of radiation-injured salivary glands in preclinical studies. However, the safety and effect of E-NMC therapy have yet assessed in human. The objective of this ongoing first-in-man study is to assess the safety, tolerability, and in part the efficacy of E-MNC therapy for treating radiation-induced xerostomia. METHODS/DESIGN This phase 1 first-in-man study is an open-label, single-center, two-step dose escalation study. A total of 6 patients, who had no recurrence of head and neck cancer over 5 years following radiation therapy and suffered from radiation-induced xerostomia, will receive a transplantation of E-NMCs derived from autologous PBMNCs to a submandibular gland. The duration of the intervention will be 1 year. To analyze the recovery of salivary secretion, a gum test will be performed. To analyze the recovery of atrophic salivary glands, computed tomography (CT), and magnetic resonance imaging (MRI) of salivary glands will be conducted. The primary endpoint is the safety of the protocol. The secondary endpoints are the changes from baseline in whole saliva secretion and salivary gland atrophy. DISCUSSION This will be the first clinical study of regenerative therapy using E-MNCs for patients with severe radiation-induced xerostomia. The results of this study are expected to contribute to developing the low-invasive cell-based therapy for radiation-induced xerostomia. TRIAL REGISTRATION This study was registered with the Japan Registry of Clinical Trials (http://jrct.niph.go.jp) as jRCTb070190057.
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Affiliation(s)
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | | | - Takako Yoshida
- Basic and Translational Research Center for Hard Tissue Disease
| | - Ryo Honma
- Basic and Translational Research Center for Hard Tissue Disease
- Department of Regenerative Oral Surgery, Unit of Translational Medicine
| | - Mayumi Iwatake
- Basic and Translational Research Center for Hard Tissue Disease
| | - Seigo Ohba
- Department of Regenerative Oral Surgery, Unit of Translational Medicine
| | - I. Takashi
- Department of Regenerative Oral Surgery, Unit of Translational Medicine
| | - Yuka Hotokezaka
- Department of Radiology and Cancer Biology, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Shinichiro Kuroshima
- Department of Applied Prosthodontics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | | | - Takayuki Asahara
- Department of Regenerative Medicine Science, Tokai University School of Medicine, Isehara, Japan
| | - I Atsushi Kawakam
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Unit of Translational Medicine
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I T, Sumita Y, Yoshida T, Honma R, Iwatake M, Raudales JLM, Shizuno T, Kuroshima S, Masuda H, Seki M, Tran SD, Asahara T, Asahina I. Anti-inflammatory and vasculogenic conditioning of peripheral blood mononuclear cells reinforces their therapeutic potential for radiation-injured salivary glands. Stem Cell Res Ther 2019; 10:304. [PMID: 31623661 PMCID: PMC6798785 DOI: 10.1186/s13287-019-1414-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There are currently no effective treatments available for patients with irreversible loss of salivary gland (SG) function caused by radiation therapy for head and neck cancer. In this study, we have developed an effective culture method to enhance the anti-inflammatory and vasculogenic phenotypes of peripheral blood mononuclear cells (PBMNCs) and investigated whether such effectively conditioned PBMNCs (E-MNCs) could regenerate radiation-injured SGs and ameliorate salivary secretory function in mice. METHODS Mouse PBMNCs were expanded in primary serum-free culture with five vasculogenic proteins for 5 days, and then the resulting cells (E-MNCs) were analyzed for their characteristics. Subsequently, 5 × 104 E-MNCs (labeled with EGFP in some experiments) were injected intra-glandularly into a mouse model of radiation-injured atrophic submandibular glands. After 2-3 weeks, the submandibular glands were harvested, and then the injected E-MNCs were tracked. Four, 8, and 12 weeks after irradiation (IR), salivary outputs were measured to evaluate the recovery of secretory function, and the gland tissues were harvested for histological and gene expression analyses to clarify the effects of cell transplantation. RESULTS The resulting E-MNCs contained an enriched population of definitive CD11b/CD206-positive (M2 macrophage-like) cells and showed anti-inflammatory and vasculogenic characteristics. Salivary secretory function in E-MNC-transplanted mice gradually recovered after 4 weeks post-irradiation (post-IR) and reached 3.8-fold higher than that of non-transplanted mice at 12 weeks. EGFP-expressing E-MNCs were detected in a portion of the vascular endothelium and perivascular gland tissues at 2 weeks post-IR, but mainly in some microvessels at 3 weeks. Between 4 and 12 weeks post-IR, mRNA expression and histological analyses revealed that E-MNC transplantation reduced the expression of inflammatory genes and increased the level of tissue-regenerative activities such as stem cell markers, cell proliferation, and blood vessel formation. At 12 weeks post-IR, the areas of acinar and ductal cells regenerated, and the glands had less fibrosis. CONCLUSIONS This effective conditioning of PBMNCs is a simple, rapid, and efficient method that provides a non-invasive source of therapeutic cells for regenerating radiation-injured atrophic SGs.
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Affiliation(s)
- Takashi I
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshinori Sumita
- Basic and Translational Research Center for Hard tissue Disease, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan.
| | - Takako Yoshida
- Basic and Translational Research Center for Hard tissue Disease, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Ryo Honma
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Basic and Translational Research Center for Hard tissue Disease, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Mayumi Iwatake
- Basic and Translational Research Center for Hard tissue Disease, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | - Jorge Luis Montenegro Raudales
- Basic and Translational Research Center for Hard tissue Disease, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan
| | | | - Shinichiro Kuroshima
- Department of Applied Prosthodontics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Haruchika Masuda
- Department of Regenerative Medicine Science, Tokai University School of Medicine, Isehara, Japan
| | | | - Simon D Tran
- Laboratory of Craniofacial Tissue Engineering and Stem Cells, Faculty of Dentistry, McGill University, Montreal, Canada
| | - Takayuki Asahara
- Department of Applied Prosthodontics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Izumi Asahina
- Department of Regenerative Oral Surgery, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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10
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Misra R, Sarkar K, Lee J, Pizzuti VJ, Lee DS, Currie MP, Torregrosa-Allen SE, Long DE, Durm GA, Langer MP, Elzey BD, Won YY. Radioluminescent nanoparticles for radiation-controlled release of drugs. J Control Release 2019; 303:237-252. [PMID: 31026550 DOI: 10.1016/j.jconrel.2019.04.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/10/2019] [Accepted: 04/22/2019] [Indexed: 01/03/2023]
Abstract
The present work demonstrates a novel concept for intratumoral chemo-radio combination therapy for locally advanced solid tumors. For some locally advanced tumors, chemoradiation is currently standard of care. This combination treatment can cause acute and long term toxicity that can limit its use in older patients or those with multiple medical comorbidities. Intratumoral chemotherapy has the potential to address the problem of systemic toxicity that conventional chemotherapy suffers, and may, in our view, be a better strategy for treating certain locally advanced tumors. The present study proposes how intratumoral chemoradiation can be best implemented. The enabling concept is the use of a new chemotherapeutic formulation in which chemotherapy drugs (e.g., paclitaxel (PTX)) are co-encapsulated with radioluminecsnt nanoparticles (e.g., CaWO4 (CWO) nanoparticles (NPs)) within protective capsules formed by biocompatible/biodegradable polymers (e.g., poly(ethylene glycol)-poly(lactic acid) or PEG-PLA). This drug-loaded polymer-encapsulated radioluminescent nanoparticle system can be locally injected in solution form into the patient's tumor before the patient receives normal radiotherapy (e.g., 30-40 fractions of 2-3 Gy daily X-ray dose delivered over several weeks for locally advanced head and neck tumors). Under X-ray irradiation, the radioluminescent nanoparticles produce UV-A light that has a radio-sensitizing effect. These co-encapsulated radioluminescent nanoparticles also enable radiation-triggered release of chemo drugs from the polymer coating layer. The non-toxic nature (absence of dark toxicity) of this drug-loaded polymer-encapsulated radioluminescent nanoparticle ("PEG-PLA/CWO/PTX") formulation was confirmed by the MTT assay in cancer cell cultures. A clonogenic cell survival assay confirmed that these drug-loaded polymer-encapsulated radioluminescent nanoparticles significantly enhance the cancer cell killing effect of radiation therapy. In vivo study validated the efficacy of PEG-PLA/CWO/PTX-based intratumoral chemo-radio therapy in mouse tumor xenografts (in terms of tumor response and mouse survival). Results of a small-scale NP biodistribution (BD) study demonstrate that PEG-PLA/CWO/PTX NPs remained at the tumor sites for a long period of time (> 1 month) following direct intratumoral administration. A multi-compartmental pharmacokinetic model (with rate constants estimated from in vitro experiments) predicts that this radiation-controlled drug release technology enables significant improvements in the level and duration of drug availability within the tumor (throughout the typical length of radiation treatment, i.e., > 1 month) over conventional delivery systems (e.g., PEG-PLA micelles with no co-encapsulated CaWO4, or an organic liquid, e.g., a 50:50 mixture of Cremophor EL and ethanol, as in Taxol), while it is capable of maintaining the systemic level of the chemo drug far below the toxic threshold limit over the entire treatment period. This technology thus has the potential to offer a new therapeutic option that has not previously been available for patients excluded from conventional chemoradiation protocols.
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Affiliation(s)
- Rahul Misra
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Kaustabh Sarkar
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Jaewon Lee
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Vincenzo J Pizzuti
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Deborah S Lee
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States
| | - Melanie P Currie
- Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, United States
| | - Sandra E Torregrosa-Allen
- Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, United States
| | - David E Long
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Gregory A Durm
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Mark P Langer
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN 46202, United States
| | - Bennett D Elzey
- Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, United States
| | - You-Yeon Won
- Davidson School of Chemical Engineering, Purdue University, West Lafayette, IN 47907, United States; Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN 47907, United States.
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11
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Han J, Zhu W, Yu C, Zhou X, Li T, Zhang X. Clinical Study of Concurrent Chemoradiotherapy or Radiotherapy Alone for Esophageal Cancer Patients with Positive Lymph Node Metastasis. TUMORI JOURNAL 2018; 98:60-5. [DOI: 10.1177/030089161209800108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background Esophageal cancer patients with pathologic lymph node involvement generally have a poor prognosis. Many randomized controlled trials have not achieved consistent results similar to those of the RTOG8501 trial, and the long-term survival rate has not increased. The present study aimed to compare the efficacy and toxic side effects of concurrent chemoradiotherapy and radiotherapy alone to treat N1 esophageal carcinoma. Methods and Study Design A total of 130 N1 esophageal carcinoma patients were enrolled and randomly divided into two groups: concurrent chemoradiotherapy group (n = 65) and radiotherapy group (n = 65). Both groups received three-dimensional conformal radiotherapy with a total dose of 64–66 Gy. Meanwhile, to the concurrent chemoradiotherapy group, an additional chemotherapy protocol (nedaplatin, 20 mg/m2/d, 5-FU, 500 mg/m2/d for four days) was given from day 1, and such treatment was repeated until day 29. From day 21 after radiotherapy, two cycles of a consolidated chemotherapy protocol were given at an interval of 28 days. Results The survival rates at one, two, and three years were 72.3%, 55.3%, and 40% in the concurrent chemoradiotherapy group, respectively, and 75.3%, 38.5%, and 18.5% in the radiotheray group (P = 0.007), respectively. The survival rates of the patients in the concurrent chemoradiotherapy group who completed one to two cycles and three to four cycles at one, two, and three years were 70%, 53.3%, and 30%, and 74.2%, 57.1%, 48.6% (P = 0.128), respectively. Three-year distant metastasis rates were 10.7% in the concurrent chemoradiotherapy group and 16.9% in the radiotherapy group. Acute toxicity in the concurrent chemoradiotherapy group was higher than in the radiotherapy group. Late toxic side effects were similar in the two groups. Conclusions Compared with radiotherapy alone, concurrent chemoradiotherapy in the treatment of esophageal carcinoma with local lymph node enlargement can improve the three-year survival rate. Moreover, completion of three to four cycles of chemotherapy may have better efficacy than one to two cycles.
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Affiliation(s)
- Jihua Han
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Weiguo Zhu
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Changhua Yu
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Xilei Zhou
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Tao Li
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
| | - Xiaoye Zhang
- Department of Radiation Oncology, First Hospital of Huaian, Nanjing Medical University, Huaian, China
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Galitis E, Droukas V, Tzakis M, Psarras V, Galiti D, Kyrodimos E, Trichas M, Psyrri A, Papadogeorgakis N, Kouri M, Belli E, Kouloulias V. Trismus and reduced quality of life in patients with oral squamous cell carcinoma, who received post-operative radiotherapy alone or combined with chemotherapy. FORUM OF CLINICAL ONCOLOGY 2017. [DOI: 10.1515/fco-2015-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
Patients, who receive radiotherapy (RT) for head and neck cancer, develop chronic functional abnormalities and survive with reduced quality of life.
Purpose
We aimed to study patients with oral cancer, who received post-operative radiotherapy or chemoradiotherapy.
Patients
Ten patients (mean age 63.8 years) were included.
Methods
Oral mucositis, pain and xerostomia, maximum mouth opening (MMO) and functional abnormalities before and after RT were recorded. The 35 mm MMO or less was accepted as trismus. Patients completed the EORTC QLQ C-30 and Head/Neck35 questionnaires.
Results
Mean RT dose was 64.3 Gray. Six patients received chemoradiotherapy. Severe mucositis, pain and xerostomia were recorded in 6 and 5 patients respectively. MMO was reduced in all patients. The mean MMO (34 mm) reached the level of trismus. The total number of symptoms increased from 3.1 to 6.3 in C-30 and from 3.1 to 8.8 per patient in the H/N35. Severe fatigue, pain, limitations at work, weakness, sad feelings, family problems, sleeping problems, anorexia, financial difficulties, tense/irritable, constipation, nausea, vomiting and depression were most often reported with C-30. Most patients reported low to moderate quality of life. Severe oral, jaw and neck pain, swallowing problems, taste alterations, sticky saliva, dry mouth, coarseness, dental problems, feeling sick and reduced interest in life/sex were the most common symptoms reported with N/H35.
Conclusions
The observed trismus, 2- to 3-fold increase of symptoms and poorer quality of life highlighted the need for support of oral cancer patients, who receive postoperative radiotherapy or chemoradiotherapy.
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Affiliation(s)
- Evangelos Galitis
- Clinic of Orofacial Pain, Dental School , National and Kapodistrian University of Athens , Athens Greece
| | - Vyron Droukas
- Clinic of Orofacial Pain, Dental School , National and Kapodistrian University of Athens , Athens Greece
| | - Michail Tzakis
- Clinic of Orofacial Pain, Dental School , National and Kapodistrian University of Athens , Athens Greece
| | - Vassileios Psarras
- Clinic of Orofacial Pain, Dental School , National and Kapodistrian University of Athens , Athens Greece
| | - Dimitra Galiti
- Clinic of Oral Diagnosis and Radiology, Dental School , National and Kapodistrian University of Athens , Athens Greece
| | - Eythymios Kyrodimos
- ENT Clinic, Head & Neck Oncology Unit, Ippokrateion Hospital, Medical School , National and Kapodistrian University of Athens , Athens Greece
| | - Miltiadis Trichas
- Department of Radiotherapy , Iaso General Hospital , Athens , Greece
| | - Amanda Psyrri
- Oncology Department , ‘Attikon’ University Hospital, Medical School , National and Kapodistrian University of Athens , Athens Greece
| | - Nikolaos Papadogeorgakis
- Oral & Maxillofacial Surgery Clinic, Evangelismos Hospital, Dental School , National and Kapodistrian University of Athens , Athens Greece
| | - Maria Kouri
- Clinic of Hospital Dentistry, Dental School , National and Kapodistrian University of Athens , Athens Greece
| | | | - Vasileios Kouloulias
- Department of Radiotherapy , ‘Attikon’ University Hospital, Medical School , National and Kapodistrian University of Athens , Athens Greece
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Kim J, Shin ES, Kim JE, Yoon SP, Kim YS. Neck muscle atrophy and soft-tissue fibrosis after neck dissection and postoperative radiotherapy for oral cancer. Radiat Oncol J 2015; 33:344-9. [PMID: 26756035 PMCID: PMC4707218 DOI: 10.3857/roj.2015.33.4.344] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/03/2015] [Accepted: 12/08/2015] [Indexed: 11/26/2022] Open
Abstract
Late complications of head and neck cancer survivors include neck muscle atrophy and soft-tissue fibrosis. We present an autopsy case of neck muscle atrophy and soft-tissue fibrosis (sternocleidomastoid, omohyoid, digastric, sternohyoid, sternothyroid, and platysma muscles) within the radiation field after modified radical neck dissection type I and postoperative radiotherapy for floor of mouth cancer. A 70-year-old man underwent primary tumor resection of the left floor of mouth, left marginal mandibulectomy, left modified radical neck dissection type I, and reconstruction with a radial forearm free flap. The patient received adjuvant radiotherapy. The dose to the primary tumor bed and involved neck nodes was 63 Gy in 35 fractions over 7 weeks. Areas of subclinical disease (left lower neck) received 50 Gy in 25 fractions over 5 weeks. Adjuvant chemotherapy was not administered.
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Affiliation(s)
- Jinu Kim
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea.; Department of Biomedicine & Drug Development, Jeju National University, Jeju, Korea
| | - Eun Seow Shin
- Medical Course, Jeju National University School of Medicine, Jeju, Korea
| | - Jeong Eon Kim
- Medical Course, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Pil Yoon
- Department of Anatomy, Jeju National University School of Medicine, Jeju, Korea
| | - Young Suk Kim
- Department of Radiation Oncology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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14
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Pfister DG, Spencer S, Brizel DM, Burtness B, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Dunphy F, Eisele DW, Foote RL, Gilbert J, Gillison ML, Haddad RI, Haughey BH, Hicks WL, Hitchcock YJ, Jimeno A, Kies MS, Lydiatt WM, Maghami E, McCaffrey T, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rodriguez CP, Samant S, Shah JP, Weber RS, Wolf GT, Worden F, Yom SS, McMillian N, Hughes M. Head and Neck Cancers, Version 1.2015. J Natl Compr Canc Netw 2015; 13:847-55; quiz 856. [PMID: 26150579 PMCID: PMC4976490 DOI: 10.6004/jnccn.2015.0102] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
These NCCN Guidelines Insights focus on recent updates to the 2015 NCCN Guidelines for Head and Neck (H&N) Cancers. These Insights describe the different types of particle therapy that may be used to treat H&N cancers, in contrast to traditional radiation therapy (RT) with photons (x-ray). Research is ongoing regarding the different types of particle therapy, including protons and carbon ions, with the goals of reducing the long-term side effects from RT and improving the therapeutic index. For the 2015 update, the NCCN H&N Cancers Panel agreed to delete recommendations for neutron therapy for salivary gland cancers, because of its limited availability, which has decreased over the past 2 decades; the small number of patients in the United States who currently receive this treatment; and concerns that the toxicity of neutron therapy may offset potential disease control advantages.
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15
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Effectiveness of chemotherapy and radiotherapy for laryngeal preservation in advanced laryngeal cancer: a meta-analysis and systematic review. Radiol Med 2015; 120:1153-69. [DOI: 10.1007/s11547-015-0547-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
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16
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Francis DO, Hall E, Dang JH, Vlacich GR, Netterville JL, Vaezi MF. Outcomes of serial dilation for high-grade radiation-related esophageal strictures in head and neck cancer patients. Laryngoscope 2014; 125:856-62. [PMID: 25345779 DOI: 10.1002/lary.24987] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 09/18/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Dysphagia and esophageal stricture are frequent consequences of treatment for head and neck cancer. This study examines the effectiveness of the anterograde-retrograde rendezvous procedure and serial dilations in reestablishing esophageal patency to allow return to oral diet and gastrostomy tube removal in a cohort of patients with complete or near-complete esophageal stricture following nonsurgical cancer treatment. STUDY DESIGN Retrospective review of patients treated with radiation therapy with or without concurrent chemotherapy presented with complete or near-complete esophageal stricture. Patients underwent serial dilations using combined anterograde-retrograde dilation (rendezvous) techniques. METHODS Medical records of patients having undergone treatment between 2006 and 2012 were reviewed, and semistructured interviews were also conducted to determine current swallowing function and actual patient experience. The primary outcome was swallowing improvement that allowed for return to oral diet and/or gastrostomy tube removal. Outcomes were compared between patients with complete and near-complete (<5 mm in diameter) strictures and univariate analysis performed to identify associations between patient, cancer, and treatment characteristics on odds of gastrostomy tube removal. RESULTS Twenty-four patients (median age 59.5 years, 63% male, 91% Caucasian) underwent treatment. Fifty percent of patients had complete occlusion of the esophageal lumen. The majority of patients (92%) underwent either anterograde (54%) or combined antero-retrograde (38%) approach. Following a median (interquartile range) of 9 (6-20) dilation sessions, 42% of patients were able to return to an oral diet and/or had their gastrostomy tube removed. This outcome was independent of whether the stricture was complete or near complete (P = .67). Of patients who had their gastrostomy tubes removed, only 33.3% had ever smoked, compared to 92.3% of those whose tubes were not discharged (P = .007). CONCLUSIONS Recannulation is possible even in cases of complete or near-complete stricture. Several factors appear to impact the likelihood of successful outcome, but in this study, only patients with a history of smoking had a significantly lower likelihood of return to full oral diet.
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Affiliation(s)
- David O Francis
- Department of Otolaryngology, Nashville, Tennessee; Bill Wilkerson Center, Center for Surgical Quality & Outcomes Research, Nashville, Tennessee
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17
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Wopken K, Bijl HP, van der Schaaf A, van der Laan HP, Chouvalova O, Steenbakkers RJHM, Doornaert P, Slotman BJ, Oosting SF, Christianen MEMC, van der Laan BFAM, Roodenburg JLN, Leemans CR, Verdonck-de Leeuw IM, Langendijk JA. Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy/chemo-radiotherapy in head and neck cancer. Radiother Oncol 2014; 113:95-101. [PMID: 25443500 DOI: 10.1016/j.radonc.2014.09.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/16/2014] [Accepted: 09/22/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Curative radiotherapy/chemo-radiotherapy for head and neck cancer (HNC) may result in severe acute and late side effects, including tube feeding dependence. The purpose of this prospective cohort study was to develop a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence 6 months (TUBEM6) after definitive radiotherapy, radiotherapy plus cetuximab or concurrent chemoradiation based on pre-treatment and treatment characteristics. MATERIALS AND METHODS The study included 355 patients with HNC. TUBEM6 was scored prospectively in a standard follow-up program. To design the prediction model, the penalized learning method LASSO was used, with TUBEM6 as the endpoint. RESULTS The prevalence of TUBEM6 was 10.7%. The multivariable model with the best performance consisted of the variables: advanced T-stage, moderate to severe weight loss at baseline, accelerated radiotherapy, chemoradiation, radiotherapy plus cetuximab, the mean dose to the superior and inferior pharyngeal constrictor muscle, to the contralateral parotid gland and to the cricopharyngeal muscle. CONCLUSIONS We developed a multivariable NTCP model for TUBEM6 to identify patients at risk for tube feeding dependence. The dosimetric variables can be used to optimize radiotherapy treatment planning aiming at prevention of tube feeding dependence and to estimate the benefit of new radiation technologies.
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Affiliation(s)
- Kim Wopken
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
| | - Hendrik P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Hans Paul van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 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
| | - Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Miranda E M C Christianen
- Department of Radiation Oncology, 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
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
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Abstract
Squamous cell carcinoma of the larynx continues to be the commonest head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. The goals of laryngeal cancer treatment are thus to provide best possible oncologic control, while optimizing functional outcomes. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from one of primary surgery (total laryngectomy) as gold standard, toward non-surgical organ-preserving treatment using radiotherapy or chemoradiotherapy. However, concerns have emerged regarding functional outcomes after chemoradiotherapy, as well as possible decreased overall survival in patients with laryngeal cancer. The purpose of the present review is to review surgical and non-surgical options for treatment of advanced laryngeal cancer, as well as the evidence supporting each of these.
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Semrau S, Schmidt D, Lell M, Waldfahrer F, Lettmaier S, Kuwert T, Iro H, Fietkau R. Results of chemoselection with short induction chemotherapy followed by chemoradiation or surgery in the treatment of functionally inoperable carcinomas of the pharynx and larynx. Oral Oncol 2013; 49:454-60. [DOI: 10.1016/j.oraloncology.2012.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 10/27/2022]
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Abstract
Objectives: Although laryngotracheal stenosis is well described in the literature, the vast majority of cases are of stenosis at either the subglottic or glottic level. Supraglottic stenosis is an unusual subset of laryngotracheal stenosis that has distinctly different causes, symptoms, and treatment options. Methods: A retrospective chart review was conducted on all adult patients at our institution with a diagnosis of supraglottic stenosis. Clinical records, videolaryngoscopic examinations, and operative and clinic procedure records were reviewed. All patients had a minimum follow-up of 12 months. Results: Eight patients with supraglottic stenosis were identified. Five (62.5%) had a history of radiation therapy, and the remaining 3 cases were associated with autoimmune disorders. Our data revealed a frequent association with dysphagia (7 of 8 cases, or 87.5%), including 2 patients with complete pharyngoesophageal stricture and 3 who required a percutaneous gastrostomy tube. All of the patients required more than 1 surgical intervention because of symptomatic recurrent airway stenosis. Three patients underwent successful endoscopic treatment with a carbon dioxide laser in the operating room. One of these patients and 5 additional patients were successfully managed with pulsed KTP laser treatment in the clinic setting without complications. We observed 2 cases of acute intraoperative supraglottic edema in the setting of suspension laryngoscopy and jet ventilation, 1 of which necessitated emergent tracheostomy. Conclusions: Supraglottic stenosis is a rare condition that is often associated with external-beam radiation or autoimmune disorders. All of the patients in our series experienced some degree of symptomatic airway obstruction that required management. The majority also had coexisting dysphagia, often associated with pharyngeal or esophageal stricture. Despite the favorable response to endoscopic treatment, all patients eventually required additional procedures because of symptomatic recurrence of their stenosis. Although endoscopic surgical treatment with a carbon dioxide laser in the operating room setting is a viable option, office-based treatment with a pulsed KTP laser appears to be an effective and potentially safer alternative.
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Lee J, Yoon N, Choi SY, Moon JH, Chung MK, Son YI, Ko YH, Jeong HS, Baek CH. Extent of local invasion and safe resection in cT1-2 tonsil cancer. J Surg Oncol 2012; 107:469-73. [DOI: 10.1002/jso.23286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 10/02/2012] [Indexed: 11/11/2022]
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Nishimura Y, Hiraoka M, Koike R, Nakamatsu K, Itasaka S, Kawamura M, Negoro Y, Araki N, Ishikawa H, Fujii T, Mitsuhashi N. Long-term follow-up of a randomized Phase II study of cisplatin/5-FU concurrent chemoradiotherapy for esophageal cancer (KROSG0101/JROSG021). Jpn J Clin Oncol 2012; 42:807-12. [PMID: 22811410 DOI: 10.1093/jjco/hys112] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Long-term survival and late toxicities of a randomized Phase II study of chemoradiotherapy for esophageal cancer were analyzed. METHODS Eligible patients were <75 years old and performance status 0-2, and had Stages II-IVA esophageal cancer. For arm A (short-term infusion), cisplatin 70 mg/m(2) Days 1 and 29 and 5-fluorouracil 700 mg/m(2) Days 1-5 and 29-33 were given concurrently with radiotherapy of 60 Gy/30 fr/7 weeks (1 week split). For arm B (protracted infusion), cisplatin 7 mg/m(2) Days 1-5, 8-12, 29-33 and 36-40, and 5-fluorouracil 250 mg/m(2) Days 1-14 and 29-42 were given with the same radiotherapy. Two cycles of consolidation cisplatin/5-fluorouracil chemotherapy were given to both arms. RESULTS Between 2001 and 2006, 91 patients were enrolled; 46 were randomized to arm A, and 45 to arm B. The 2- and 5-year overall survival rates for arm A were 46 and 35% (95% confidence interval: 22-48%), while those for arm B were 44 and 22% (11-35%), respectively. Excluding four patients with early death, seven (17%) patients in arm A and eight (18%) in arm B showed late toxicities of Grade 3 or more. Most of the toxicities were cardiac or pleural toxicities. Patients with severe late toxicities often had coexistent hypothyroidism. There were three patients with a secondary malignancy possibly related to treatment. CONCLUSIONS Low-dose protracted infusion chemotherapy with radiotherapy is not superior to full-dose short-term infusion chemotherapy with radiotherapy for esophageal cancer. Late toxicities, including cardiac and pleural toxicities, hypothyroidism and secondary malignancy, should be carefully monitored.
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Affiliation(s)
- Yasumasa Nishimura
- Department of Radiation Oncology, Kinki University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
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Deboni ALDS, Giordani AJ, Lopes NNF, Dias RS, Segreto RA, Jensen SB, Segreto HRC. Long-term oral effects in patients treated with radiochemotherapy for head and neck cancer. Support Care Cancer 2012; 20:2903-11. [DOI: 10.1007/s00520-012-1418-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 02/14/2012] [Indexed: 11/24/2022]
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Chapuy CI, Annino DJ, Snavely A, Li Y, Tishler RB, Norris CM, Haddad RI, Goguen LA. Swallowing function following postchemoradiotherapy neck dissection: review of findings and analysis of contributing factors. Otolaryngol Head Neck Surg 2011; 145:428-34. [PMID: 21493276 DOI: 10.1177/0194599811403075] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assesses swallowing function following chemoradiotherapy and neck dissection in head and neck cancer patients and investigates clinical, treatment, and neck dissection factors associated with dysphagia. STUDY DESIGN Case series with chart review. SETTING Tertiary care center. SUBJECTS AND METHODS Eighty-eight patients undergoing neck dissection after chemoradiotherapy for advanced head and neck cancer were reviewed. Dysphagia outcome measures included weight loss, diet, gastrostomy tube (GT) dependency,and video swallow findings of aspiration or stenosis. In addition,the researchers created a Diet/GT Scale, with scores ranging from 1 to 5. Univariate and multivariate analysis of clinical, treatment, or neck dissection factors potentially associated with dysphagia outcome measures was undertaken. RESULTS Peak mean weight loss was 17% at 6 months after chemoradiotherapy. At 12 months, a soft/regular diet was taken by 78 of 88 patients (89%), and only 1 of 88 patients (1%)was nil per os. Gastrostomy tube dependence at 6, 12, and 24 months was 53%, 25%, and 10%, respectively. The Diet/GT score was 5 (gastrostomy tube removed and soft/regular diet)for 47% at 6 months, 74% at 12 months, and 89% at 24 months.Multivariate analyses revealed that higher tumor stage was associated with a lower Diet/GT score at 12 months (P = .02)and gastrostomy dependence at 12 months (P = .01) and 24 months (P = .04). CONCLUSION Despite the addition of neck dissection to chemoradiotherapy,nearly all patients took a soft or regular diet and reached a Diet/GT score of 5, and only 1% remained nil per os. A higher tumor stage is associated with a lower Diet/GT score and gastrostomy tube dependency beyond 12 months.
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Affiliation(s)
- Claudia I Chapuy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Semrau R, Temming S, Preuss SF, Klubmann JP, Guntinas-Lichius O, Müller RP. Definitive radiochemotherapy of advanced head and neck cancer with carboplatin and paclitaxel : a phase II study. Strahlenther Onkol 2011; 187:645-50. [PMID: 21947123 DOI: 10.1007/s00066-011-1111-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 07/11/2011] [Indexed: 12/31/2022]
Abstract
PURPOSE To report outcome and toxicity of concurrent radiochemotherapy with carboplatin and paclitaxel in advanced squamous cell carcinomas of the oropharynx and hypopharynx. PATIENTS AND METHODS Advanced inoperable carcinomas of the oropharynx and hypopharynx were treated with either hyper-fractionated, accelerated radiotherapy (50.0 Gy/2.0 with concomitant boost to 69.2 Gy/1.6) or conventional fractionated radiotherapy (70.2-72 Gy/1.8) concurrent with paclitaxel 40 mg/m2 and carboplatin AUC 1 weekly for 6 weeks. Acute and long-term toxicity was measured according to WHO- and CTC-criteria. RESULTS A total of 84 patients were included between 2000 and 2008. Median follow-up time of patients alive was 36 months. Conventionally fractionated radiotherapy was given to 16 patients, while 68 patients were treated with concomitant boost. Finally, 88.1% of patients received full dose paclitaxel. Acute mucositis ≥ grade 3 was present in 51.2% of patients, while 6% of patients experienced ≥ grade 3 leucopenia and thrombopenia. A supportive gastric feeding tube was implanted in 89.1% of patients. Overall survival after 2 years was 46.3%, progression-free survival after 2 years was 41.0%. There was no significant survival difference between the different radiotherapy protocols. CONCLUSION Concomitant carboplatin and paclitaxel is feasible and effective in advanced carcinomas of the head and neck.
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Affiliation(s)
- Robert Semrau
- Department of Radiation Oncology, University of Cologne, Germany.
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Wang JJ, Goldsmith TA, Holman AS, Cianchetti M, Chan AW. Pharyngoesophageal stricture after treatment for head and neck cancer. Head Neck 2011; 34:967-73. [PMID: 21953721 DOI: 10.1002/hed.21842] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 03/17/2011] [Accepted: 05/12/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to report the risk of pharyngoesophageal stricture after treatment for head and neck cancer. METHODS Human studies on radiation therapy with or without chemotherapy for head and neck cancer published in peer-reviewed journals with assessment of pharyngoesophageal stricture with barium swallow or endoscopy were included. RESULTS A total of 4727 patients from 26 studies treated between 1989 and 2008 were eligible for analysis. The reported overall risk of stricture was 7.2%. The risks of pharyngoesophageal stricture in both conventional and intensity-modulated radiation therapy (IMRT) studies were 5.7% and 16.7%, respectively (p < .001). Use of concurrent (p < .001) and taxane (p = .01) chemotherapy was associated with the IMRT technique. Prospective studies reported a 3.3-fold increased risk of stricture compared with that of retrospective studies (odds ratio: 3.3; 95% confidence interval: 2.3-4.8; p < .001). CONCLUSIONS Pharyngoesophageal stricture after IMRT and chemotherapy treatment for head and neck cancer is not uncommon. Videofluoroscopic swallow study should be performed prospectively to evaluate swallowing function.
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Affiliation(s)
- Jing Jing Wang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Risk of Xerostomia in Association With the Receipt of Radiation Therapy in Older Patients With Head and Neck Cancer. Am J Ther 2011; 18:206-15. [DOI: 10.1097/mjt.0b013e3181c960dc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lu W, Posner MR, Wayne P, Rosenthal DS, Haddad RI. Acupuncture for dysphagia after chemoradiation therapy in head and neck cancer: a case series report. Integr Cancer Ther 2010; 9:284-90. [PMID: 20713374 DOI: 10.1177/1534735410378856] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dysphagia is a common side effect following chemoradiation therapy (CRT) in patients with head and neck cancer (HNC). METHODS In this retrospective case series, 10 patients with HNC were treated with acupuncture for radiation-induced dysphagia and xerostomia. All patients were diagnosed with stage III/IV squamous cell carcinoma. In all, 7 of 10 patients were percutaneous endoscopic gastrostomy (PEG) tube dependent when they began acupuncture. Manual acupuncture and electroacupuncture were used once a week. RESULTS A total of 9 of 10 patients reported various degrees of subjective improvement in swallowing functions, xerostomia, pain, and fatigue levels. Overall, 6 (86%) of 7 PEG tube-dependent patients had their feeding tubes removed after acupuncture, with a median duration of 114 days (range 49 to 368 days) post CRT. One typical case is described in detail. CONCLUSIONS A relatively short PEG tube duration and reduced symptom severity following CRT were observed in these patients. Formal clinical trials are required to determine the causality of the observations.
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Affiliation(s)
- Weidong Lu
- Dana-Farber Cancer Institute, Harvard Medical School, 44 Binney Street, Boston, MA 02115, USA.
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Abstract
Xerostomia (dry mouth) as a consequence of treatment of head and neck malignancy is almost always due to radiotherapy. The resultant salivary gland dysfunction can adversely affect oral and systemic health as well as lessen quality of life. While the present management of radiotherapy-associated salivary dysfunction is challenging there have been striking advances in preventative strategies and a number of possible treatment options may be over the near horizon.
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vandecaveye V, Dirix P, De Keyzer F, de Beeck KO, Vander Poorten V, Roebben I, Nuyts S, Hermans R. Predictive value of diffusion-weighted magnetic resonance imaging during chemoradiotherapy for head and neck squamous cell carcinoma. Eur Radiol 2010; 20:1703-14. [PMID: 20179939 DOI: 10.1007/s00330-010-1734-6] [Citation(s) in RCA: 151] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/25/2009] [Accepted: 12/17/2009] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate diffusion-weighted (DWI) magnetic resonance imaging (MRI) for treatment prediction during chemoradiotherapy (CRT) of head and neck squamous cell carcinoma (HNC). METHODS Thirty patients with HNC underwent echo-planar DWI and anatomical MRI before and 2 and 4 weeks into CRT. Patient follow-up lasted 2 years post-CRT. Tumour ADC (DeltaADC) and volume changes (DeltaV) between baseline, and 2 and 4 weeks' follow-up were compared for lesions with recurrence versus complete remission (CR) using a Mann-Whitney U test. The predictive value of the DeltaADC and DeltaV for locoregional control (LRC) was examined with the Kaplan-Meier method. The study was approved by the local ethics committee. All patients gave written informed consent. RESULTS The DeltaADC in primary tumours and nodal metastases, 2 and 4 weeks after the start of CRT, was significantly lower in lesions with post-CRT recurrence than in lesions with CR (DeltaADC(2 weeks) and DeltaADC(4 weeks) for primary tumours, relative to nodal metastases: p < 0.0001). The DeltaV only showed a significant difference for primary tumours at 2 weeks (DeltaV(2 weeks): p = 0.03). The DeltaADC correlated significantly with 2-year LRC (p < 0.001); the DeltaV did not (p > 0.05). CONCLUSION DWI during CRT for HNC allows more accurate response prediction than anatomical imaging, correlating significantly with 2-year LRC.
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Goguen LA, Norris CM, Jaklitsch MT, Sullivan CA, Posner MR, Haddad RI, Tishler RB, Burke E, Annino DJ. Combined antegrade and retrograde esophageal dilation for head and neck cancer-related complete esophageal stenosis. Laryngoscope 2010; 120:261-6. [PMID: 19998421 DOI: 10.1002/lary.20727] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS Assess the safety and efficacy of combined antegrade and retrograde esophageal dilation (CARD) for complete esophageal stenosis following head and neck cancer (HNC) treatment. Review HNC dysphagia management. STUDY DESIGN Retrospective review of all patients undergoing CARD following HNC treatment between May 2001 and September 2008. METHODS Forty-five patients were identified for review. Parameters assessed included: ability to obtain intraoperative esophageal patency, complications, number of dilations required, diet, and gastric tube (GT) status. Factors associated with dilation failure were analyzed. RESULTS Intraoperative esophageal patency was obtained in 91% of patients. Median number of all dilations per patient was three. Median number of CARDs per patient was one. Resumption of oral intake occurred in 36/45 (80%). Diet results included: regular or soft diet 32/45 (71%), GT removal 27/45 (60%), and GT dependence with nothing by mouth 9/45 (20%). Laryngeal and pharyngeal stenosis, radionecrosis, tracheotomy dependence, and elongated stenosis were associated with dilation failure. Complications occurred in 18/63 (29%) CARD procedures: eight pneumomediastinum, seven GT site problems, two esophageal perforations, and one pharyngeal infection. All complications resolved spontaneously or with minimal interventions. CONCLUSIONS CARD was safe and effective. Intraoperative patency was achieved in 91% of patients. Eighty percent resumed oral intake. The majority of patients had their GTs removed and resumed a soft or regular diet. Dilation failure was associated with laryngeal, pharyngeal, and excessively long esophageal stenosis, often resulting from radionecrosis. Complications were minor. CARD should be considered before relegating patients with complete esophageal stenosis to chronic GT dependence or subjecting them to laryngopharyngo esophagectomy.
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Affiliation(s)
- Laura A Goguen
- Department of Surgery/Division of Otolaryngology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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He XY, Hu CS, Ying HM, Wu YR, Zhu GP, Liu TF. Paclitaxel with cisplatin in concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2009; 267:773-8. [PMID: 19820959 DOI: 10.1007/s00405-009-1112-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2009] [Accepted: 09/18/2009] [Indexed: 12/27/2022]
Abstract
The aim of this study was to evaluate the efficacy and the toxicity of paclitaxel and cisplatin in patients in concurrent radiotherapy for locally advanced nasopharyngeal carcinoma, and to see whether such a regime would be better tolerated than high dose cisplatin plus fluoracil in Chinese patients. Thirty-one patients with locally advanced nasopharyngeal carcinoma were enrolled. Patients were scheduled to receive two courses of concomitant chemotherapy, starting on day 1 and then day 28 during radiotherapy (70-76 Gy in 35-38 fractions in 7-7.5 weeks). Chemotherapy was given by intravenous infusion, paclitaxel 120 mg/m(2) in 3 h, cisplatin 75 mg/m(2) (25 mg/m(2) days 1-3). Adjuvant therapy was paclitaxel 135 mg/m(2) in 3 h, cisplatin 75 mg/m(2) (25 mg/m(2) days 1-3) on weeks 3, 6, 9 after radiotherapy. All patients completed radiotherapy, but for concomitant chemoradiotherapy, 20 of the 31 patients completed the 2 cycles of chemotherapy, while the other 11 could only receive 1 cycle due to various reasons. The median follow-up was 40 months, 2 patients developed locoregional recurrences, one of whom in the cervical lymph nodes, the other in the nasopharynx. The 3-year overall survival rate was 83.9% and the distant metastasis rate at 3 years was 13.6%. Grade 3-4 toxicities were neutropenia 12.9%, anaemia 6.45%, thrombocytopenia 3.22%, severe arrhythmia 3.2%, and hypersensitivity reaction 3.2%. In conclusion, paclitaxel with cisplatin as concurrent chemoradiotherapy for locoregionally advanced nasopharyngeal carcinoma is feasible, safe, and might improve regional control and survival rates in Chinese patients.
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Affiliation(s)
- Xia-Yun He
- Department of Radiation Oncology, Cancer Hospital, Fudan University, 399 Ling Ling Road, 200032, Shanghai, People's Republic of China
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