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Lorini L, Bossi P, Psyrri A, Bonomo P. Human Papilloma Virus (HPV) driven oropharyngeal cancer in current or previous heavy smokers: should we look for a different treatment paradigm? Front Oncol 2024; 14:1383019. [PMID: 38651143 PMCID: PMC11033308 DOI: 10.3389/fonc.2024.1383019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction Human papillomavirus Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OSCC) has increased in incidence in recent decades and represents a heterogeneous disease entity in the context of Head and Neck Squamous Cell Carcinoma (HNSCC), in terms of disease prognosis. Treatment of locoregionally advanced OSCC is mainly based on concurrent chemoradiotherapy. Given the younger age of patients, if compared with HPV-negative counterparts, and the high cure rates, the acute- and long-term toxicity in survivors represents a field of interest. However, patient selection for de-escalation trials remains a major challenge due to the lack of robust validated prognostic indicators within the HPV-associated OSCC. Discussion The impact of smoking status on HPV-associated OSCC prognosis has been demonstrated in the majority of studies. However, the magnitude of the association is unclear due to variability in smoking metrics and study outcomes. Smoking status has been identified as a potential confounding factor in HPV-positive de-escalation trials. Smokers with HPV-positive OSCC have a worse prognosis in most studies than non-smokers and may require different and more aggressive therapeutic strategies.
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Affiliation(s)
- Luigi Lorini
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Paolo Bossi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Amanda Psyrri
- Section of Medical Oncology, 2(nd) Department of Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Athens, Greece
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Borges MMF, Malta CEN, Ribeiro RS, Cetira-Filho EL, de Moura JFB, Rebouças LM, Costa FWG, Silva PGDB, Mota MRL. Chemotherapy increases the prevalence of radiotherapy-related trismus in head and neck cancer patients: A systematic review and meta-analysis. J Clin Exp Dent 2024; 16:e503-e515. [PMID: 38725825 PMCID: PMC11078508 DOI: 10.4317/jced.61385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/12/2024] [Indexed: 05/12/2024] Open
Abstract
Background To evaluate the influence of chemotherapy on the prevalence of trismus in irradiated head and neck cancer patients. Material and Methods This systematic review guided by PRISMA-2020 and registered in PROSPERO (CRD42021255377) screened 963 articles in 7 scientific-databases (PubMed, Lilacs, Livivo, Scopus, Embase, Web of Science, EBSCO) and 3 grey-literature databases (Open Grey, Google Scholar, ProQuest) and eight articles were included for qualitative synthesis, meta-analysis (combined odds ratio, inverse variance method plus random effects), heterogeneity analysis (I² and Tau²), one-of-out evaluation and publication bias analysis (Eggs' and Begg's tests) (RevMan®, p<0.05). The Newcastle-Ottawa Quality Assessment Scale Cohort Studies was used to assess the risk of bias (RoB). The classification assessment, development, and recommendations (GRADE) approach was used to assess the certainty of evidence. Results The eight articles evaluated 1474 patients treated with chemoradiotherapy and 858 patients treated with radiotherapy. Five articles had low RoB, and three had high RoB. Chemoradiotherapy significantly (p=0.0003) increased the prevalence of trismus (OR=2.55, 95% CI = 1.53-4.23) compared to radiotherapy, with significant (p=0.010) but low heterogeneity (I²=59%;Tau²=0.29). There was no significant risk of publication bias, one-out analysis showed no significant difference between studies, and GRADE showed a moderate level of evidence. Trismus was directly associated to worse quality of life. Conclusions The incidence of trismus increases when chemotherapy is combined with radiotherapy for head and neck cancer, which negatively impacts the quality of life. Key words:Radiotherapy, Chemoradiotherapy, Head and Neck Neoplasms, Trismus, Quality of Life.
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Affiliation(s)
- Marcela-Maria-Fontes Borges
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Cássia-Emanuella-Nóbrega Malta
- Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
- Hospital Haroldo Juaçaba, Ceará Cancer Institute, Fortaleza, Ceará, Brazil
| | | | - Edson-Luiz Cetira-Filho
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
| | | | | | - Fábio-Wildson-Gurgel Costa
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Paulo-Goberlânio-de Barros Silva
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
- Hospital Haroldo Juaçaba, Ceará Cancer Institute, Fortaleza, Ceará, Brazil
| | - Mario-Rogerio-Lima Mota
- Department of Dental Clinic, Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
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Holloman BL, Wilson K, Cannon A, Nagarkatti M, Nagarkatti PS. Indole-3-carbinol attenuates lipopolysaccharide-induced acute respiratory distress syndrome through activation of AhR: role of CCR2+ monocyte activation and recruitment in the regulation of CXCR2+ neutrophils in the lungs. Front Immunol 2024; 15:1330373. [PMID: 38596679 PMCID: PMC11002125 DOI: 10.3389/fimmu.2024.1330373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/27/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Indole-3-carbinol (I3C) is found in cruciferous vegetables and used as a dietary supplement. It is known to act as a ligand for aryl hydrocarbon receptor (AhR). In the current study, we investigated the role of AhR and the ability of I3C to attenuate LPS-induced Acute Respiratory Distress Syndrome (ARDS). Methods To that end, we induced ARDS in wild-type C57BL/6 mice, Ccr2gfp/gfp KI/KO mice (mice deficient in the CCR2 receptor), and LyZcreAhRfl/fl mice (mice deficient in the AhR on myeloid linage cells). Additionally, mice were treated with I3C (65 mg/kg) or vehicle to investigate its efficacy to treat ARDS. Results I3C decreased the neutrophils expressing CXCR2, a receptor associated with neutrophil recruitment in the lungs. In addition, LPS-exposed mice treated with I3C revealed downregulation of CCR2+ monocytes in the lungs and lowered CCL2 (MCP-1) protein levels in serum and bronchoalveolar lavage fluid. Loss of CCR2 on monocytes blocked the recruitment of CXCR2+ neutrophils and decreased the total number of immune cells in the lungs during ARDS. In addition, loss of the AhR on myeloid linage cells ablated I3C-mediated attenuation of CXCR2+ neutrophils and CCR2+ monocytes in the lungs from ARDS animals. Interestingly, scRNASeq showed that in macrophage/monocyte cell clusters of LPS-exposed mice, I3C reduced the expression of CXCL2 and CXCL3, which bind to CXCR2 and are involved in neutrophil recruitment to the disease site. Discussion These findings suggest that CCR2+ monocytes are involved in the migration and recruitment of CXCR2+ neutrophils during ARDS, and the AhR ligand, I3C, can suppress ARDS through the regulation of immune cell trafficking.
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Affiliation(s)
| | | | | | | | - Prakash S. Nagarkatti
- Nagarkatti Laboratory, University of South Carolina School of Medicine, Department of Pathology, Microbiology, and Immunology, Columbia, SC, United States
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Gharzai LA, Morris E, Suresh K, Nguyen-Tân PF, Rosenthal DI, Gillison ML, Harari PM, Garden AS, Koyfman S, Caudell JJ, Jones CU, Mitchell DL, Krempl G, Ridge JA, Gensheimer MF, Bonner JA, Filion E, Dunlap NE, Stokes WA, Le QT, Torres-Saavedra P, Mierzwa M, Schipper MJ. Surrogate endpoints in clinical trials of p16-positive squamous cell carcinoma of the oropharynx: an individual patient data meta-analysis. Lancet Oncol 2024; 25:366-375. [PMID: 38423050 PMCID: PMC10962533 DOI: 10.1016/s1470-2045(24)00016-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The increased incidence of human papillomavirus (HPV)-related cancers has motivated efforts to optimise treatment for these patients with excellent prognosis. Validation of surrogates for overall survival could expedite the investigation of new therapies. We sought to evaluate candidate intermediate clinical endpoints in trials assessing definitive treatment of p16-positive oropharyngeal cancer with chemotherapy or radiotherapy. METHODS We did a retrospective review of five multicentre, randomised trials (NRG/RTOG 9003, 0129, 0234, 0522, and 1016) that tested radiotherapy with or without chemotherapy in patients (aged ≥18 years) with p16-positive localised head or neck squamous-cell carcinomas. Eight intermediate clinical endpoints were considered as potential surrogates for overall survival: freedom from local progression, freedom from regional progression, freedom from distant metastasis, freedom from locoregional progression, freedom from any progression, locoregional progression-free survival, progression-free survival, and distant metastasis-free survival. We used a two-stage meta-analytical framework, which requires high correlation between the intermediate clinical endpoint and overall survival at the patient level (condition 1), and high correlation between the treatment effect on the intermediate clinical endpoint and the treatment effect on overall survival (condition 2). For both, an r2 greater than 0·7 was used as criteria for clinically relevant surrogacy. FINDINGS We analysed 1373 patients with oropharyngeal cancer from May 9, 2020, to Nov 22, 2023. 1231 (90%) of patients were men, 142 (10%) were women, and 1207 (88%) were White, with a median age of 57 years (IQR 51-62). Median follow-up was 4·2 years (3·1-5·1). For the first condition, correlating the intermediate clinical endpoints with overall survival at the individual and trial level, the three composite endpoints of locoregional progression-free survival (Kendall's τ 0·91 and r2 0·72), distant metastasis-free survival (Kendall's τ 0·93 and r2 0·83), and progression-free survival (Kendall's τ 0·88 and r2 0·70) were highly correlated with overall survival at the patient level and at the trial-group level. For the second condition, correlating treatment effects of the intermediate clinical endpoints and overall survival, the composite endpoints of locoregional progression-free survival (r2 0·88), distant metastasis-free survival (r2 0·96), and progression-free survival (r2 0·92) remained strong surrogates. Treatment effects on the remaining intermediate clinical endpoints were less strongly correlated with overall survival. INTERPRETATION We identified locoregional progression-free survival, distant metastasis-free survival, and progression-free survival as surrogates for overall survival in p16-positive oropharyngeal cancers treated with chemotherapy or radiotherapy, which could serve as clinical trial endpoints. FUNDING NRG Oncology Operations, NRG Oncology SDMC, the National Cancer Institute, Eli Lilly, Aventis, and the University of Michigan.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago, IL, USA
| | - Emily Morris
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Krithika Suresh
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Phuc Felix Nguyen-Tân
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Maura L Gillison
- Department of Thoracic and Head/Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul M Harari
- Department of Radiation Oncology, University of Wisconsin, Madison, WI, USA
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, University of Cleveland Medical Center, Cleveland, OH, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Christopher U Jones
- Department of Radiation Oncology, Sutter Cancer Research Consortium, Novato, CA, USA
| | - Darrion L Mitchell
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Greg Krempl
- Department of Otolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - John A Ridge
- Department of Otolaryngology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | | | - James A Bonner
- Department of Radiation Oncology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - Neal E Dunlap
- Department of Radiation Oncology, The James Graham Brown Cancer Center at University of Louisville, Louisville, KY, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
| | | | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.
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Brahmbhatt S, Overfield CJ, Rhyner PA, Bhatt AA. Imaging of the Posttreatment Head and Neck: Expected Findings and Potential Complications. Radiol Imaging Cancer 2024; 6:e230155. [PMID: 38276904 PMCID: PMC10825710 DOI: 10.1148/rycan.230155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024]
Abstract
Interpretation of posttreatment imaging findings in patients with head and neck cancer can pose a substantial challenge. Malignancies in this region are often managed through surgery, radiation therapy, chemotherapy, and newer approaches like immunotherapy. After treatment, patients may experience various expected changes, including mucositis, soft-tissue inflammation, laryngeal edema, and salivary gland inflammation. Imaging techniques such as CT, MRI, and PET scans help differentiate these changes from tumor recurrence. Complications such as osteoradionecrosis, chondroradionecrosis, and radiation-induced vasculopathy can arise because of radiation effects. Radiation-induced malignancies may occur in the delayed setting. This review article emphasizes the importance of posttreatment surveillance imaging to ensure proper care of patients with head and neck cancer and highlights the complexities in distinguishing between expected treatment effects and potential complications. Keywords: CT, MR Imaging, Radiation Therapy, Ear/Nose/Throat, Head/Neck, Nervous-Peripheral, Bone Marrow, Calvarium, Carotid Arteries, Jaw, Face, Larynx © RSNA, 2024.
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Affiliation(s)
- Sneh Brahmbhatt
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd,
Cannaday Building and Davis Building, Jacksonville, FL 32224
| | - Cameron J. Overfield
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd,
Cannaday Building and Davis Building, Jacksonville, FL 32224
| | - Patricia A. Rhyner
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd,
Cannaday Building and Davis Building, Jacksonville, FL 32224
| | - Alok A. Bhatt
- From the Department of Radiology, Mayo Clinic, 4500 San Pablo Rd,
Cannaday Building and Davis Building, Jacksonville, FL 32224
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Borges MMF, Malta CEN, Carlos ACAM, Crispim AA, de Moura JFB, Rebouças LM, Coelho da Silva BC, de Albuquerque CGP, de Barros Silva PG. Photobiomodulation therapy in the treatment of radiotherapy-related trismus of the head and neck. Lasers Med Sci 2023; 38:259. [PMID: 37935876 DOI: 10.1007/s10103-023-03920-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
This study evaluated photobiomodulation therapy (PBMT) for treatment of trismus in patients undergoing radiotherapy for head and neck cancer (HNC). Sixteen patients, 10 men and 6 women, who had a mouth opening < 35 mm and underwent RT were included. The patients were evaluated daily before and after the PBMT application, measuring mouth opening and performing pain scores for the masticatory muscles using the visual analog scale (VAS). We used the infrared laser (~ 808 nm) extraorally, 0.1 W power, 3 J energy, 30 s (107 J/cm2) per point, applied to temporalis anterior, masseter muscles, and temporomandibular joints (TMJ). An intraoral point was made in the trigonoretromolar region towards the medial pterygoid muscle. The mean mouth opening of the patients increased by more than 7 mm throughout the treatment. The pain scores on the initial days showed an immediate reduction after PBMT on the ipsilateral side in the muscles and TMJ. Throughout PBMT applications, there was a significant reduction in pain scores in all muscles and the TMJ. The radiation dose of all patients was above 40 Gy, which is the threshold dose for the risk of developing trismus. SPSS software was used and adopted a confidence of 95%. The Kolmogorov-Smirnov normality test, Wilcoxon test, and Spearman correlation were performed. PBMT controls muscular pain and reduced mouth opening limitation in HNC during radiotherapy. Further studies are needed to evaluate the preventive capacity of PBMT protocols for RT trismus-related HNC.
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Affiliation(s)
- Marcela Maria Fontes Borges
- Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil.
- Hospital Haroldo Juaçaba, Ceará Cancer Institute, Fortaleza, Ceará, Brazil.
| | - Cássia Emanuella Nóbrega Malta
- Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
- Hospital Haroldo Juaçaba, Ceará Cancer Institute, Fortaleza, Ceará, Brazil
| | - Anna Clara Aragão Matos Carlos
- Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - André Alves Crispim
- Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
- Hospital Haroldo Juaçaba, Ceará Cancer Institute, Fortaleza, Ceará, Brazil
| | | | | | | | | | - Paulo Goberlânio de Barros Silva
- Division of Oral Pathology, Department of Dental Clinic, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Dentistry, Unichristus, Fortaleza, Ceará, Brazil
- Hospital Haroldo Juaçaba, Ceará Cancer Institute, Fortaleza, Ceará, Brazil
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Adrian G, Gebre-Medhin M, Nilsson P. Importance of tumor volume, overall treatment time and fractionation sensitivity for p16-positive and p16-negative oropharyngeal tumors. Acta Oncol 2023; 62:1375-1383. [PMID: 37682690 DOI: 10.1080/0284186x.2023.2251084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Analyses of clinical outcomes following radiotherapy (RT) have advanced our understanding of fundamental radiobiological characteristics in head and neck squamous cell carcinoma (HNSCC). Low fractionation sensitivity appears to be a common feature, as well as susceptibility to changes in overall treatment time (OTT). Large tumors should be harder to cure if a successful RT requires the sterilization of all clonogenic cells. Congruently, primary tumor volume has proven to be an important parameter. However, most findings come from an era when p16-negative HNSCC was the dominant tumor type. HPV-associated, p16-positive, oropharyngeal tumors (OPSCC) are more radiosensitive and have better outcome. The current study aims to investigate the role of primary tumor volume, OTT and estimate α/ β -ratio for p16-positive OPSCC, and to quantify the differences in radiosensitivity depending on p16-status. METHODS A cohort of 523 patients treated with RT was studied using a tumor control probability (TCP)-model that incorporates primary tumor volume (V) raised to an exponent c, OTT and α/ β -estimation. The significance of V was also investigated in Cox-regression models. RESULTS In the p16-positive cohort (n = 433), the volume exponent c was 1.44 (95%CI 1.06-1.91), compared to 0.90 (0.54-1.32) for p16-negative tumors (n = 90). Hazard ratios per tumor volume doubling were 2.37 (1.72-3.28) and 1.83 (1.28-2.62) for p16-positive and p16-negative, respectively. The estimated α/ β -ratio was 9.7 Gy (-2.3-21.6), and a non-significant daily loss of 0.30 Gy (-0.17-0.92) was found. An additional dose of 6.8 Gy (interquartile range 4.8-9.1) may theoretically counteract the more radioresistant behavior of p16-negative tumors. CONCLUSION Primary tumor volume plays a crucial role in predicting local tumor response, particularly in p16-positive OPSCC. The estimated α/β-ratio for p16-positive oropharyngeal tumors aligns with previous HNSCC studies, whereas the impact of prolonged OTT was slightly less than previously reported. The differences in radiosensitivity depending on p16-status were quantified. The findings should be validated in independent cohorts.
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Affiliation(s)
- Gabriel Adrian
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
- Department of Clinical Sciences Lund, Division of Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Maria Gebre-Medhin
- Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
| | - Per Nilsson
- Department of Clinical Sciences, Medical Radiation Physics, Skåne University Hospital, Lund University, Lund, Sweden
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Balchander D, Shorbaji K, Cabrera CI, Hoying D, Clancy K, Fowler N, Thuener JE, Lavertu P, Pan Q, Teknos TN, Rezaee RP, Li S, Tamaki A. Prognostic significance of time trends in treatment of head and neck squamous cell carcinoma. Am J Otolaryngol 2023; 44:103966. [PMID: 37481899 DOI: 10.1016/j.amjoto.2023.103966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To analyze the impact of demographic, clinical, and management variables on time to treatment initiation (TTI) and overall survival (OS). STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS Medical records of patients diagnosed with head and neck cancer from 2018 to 2020 were reviewed. Univariate linear and Cox-regressions identified predictors of TTI and OS. Kaplan Meier (KM) curves assessed the difference in survival by diagnostic year and TTI. RESULTS 381 patients met eligibility criteria. Median TTI was 35.0 days (IQR: 25.0-49.0). Only 10.8 % of all patients reported any treatment delay, with TTI exceeding 90 days found in 3.7 % of patients. TTI increased with African American race (p = 0.02), ED referrals (p = 0.02), and direct admission status (p = 0.01). When compared to treatment with surgery alone, TTI was shorter in patients undergoing surgery with adjuvant radiation (p = 0.02), adjuvant chemoradiation (p = 0.04), and salvage surgery (p = 0.04). Univariate Cox-regressions found smoking (p = 0.01), direct admission status (p = 0.02), increased duration of symptoms (p = 0.02), placement of PEG tubes (p < 0.01) and tracheostomies (p < 0.01), combination treatment (p < 0.01), and surgery with adjuvant chemoradiation treatment (p = 0.01) to increase mortality risk. Disease characteristics, including tumor size (p < 0.01), presence of nodal disease (p = 0.02), and late-stage disease (p < 0.01), increased mortality risk. TTI and diagnostic year did not impact survival. CONCLUSIONS Our analysis determined several demographic, referral, and treatment factors impacted TTI. However, increased TTI did not impact survival. Characteristics consistent with advanced disease worsened OS. Despite the pandemic burden, patients diagnosed in 2020 showed no difference in short-term survival compared to prior years.
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Affiliation(s)
| | - Khaled Shorbaji
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Hoying
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kate Clancy
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicole Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jason E Thuener
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pierre Lavertu
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Quintin Pan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Theodoros N Teknos
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rod P Rezaee
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Shawn Li
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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9
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Amin DR, Philips R, Bertoni DG, Mastrolonardo EV, Campbell DJ, Agarwal AM, Tekumalla S, Urdang ZD, Luginbuhl AJ, Cognetti DM, Curry JM. Differences in Functional and Survival Outcomes Between Patients Receiving Primary Surgery vs Chemoradiation Therapy for Treatment of T1-T2 Oropharyngeal Squamous Cell Carcinoma. JAMA Otolaryngol Head Neck Surg 2023; 149:980-986. [PMID: 37422846 PMCID: PMC10331619 DOI: 10.1001/jamaoto.2023.1944] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023]
Abstract
Importance Due to lack of data from high-powered randomized clinical trials, the differences in functional and survival outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) undergoing primary transoral robotic surgery (TORS) vs primary radiation therapy and/or chemoradiation therapy (RT/CRT) are unclear. Objectives To compare 5-year functional (dysphagia, tracheostomy dependence, and gastrostomy tube dependence) and survivorship outcomes in patients with T1-T2 OPSCC receiving primary TORS vs RT/CRT. Design, Setting, and Population This national multicenter cohort study used data from a global health network (TriNetX) to identify differences in functional and survival outcomes among patients with OPSCC who underwent primary TORS or RT/CRT in 2002 to 2022. After propensity matching, 726 patients with OPSCC met inclusion criteria. In the TORS group, 363 (50%) patients had undergone primary surgery, and in the RT/CRT group, 363 (50%) patients had received primary RT/CRT. Data analyses were performed from December 2022 to January 2023 using the TriNetX platform. Exposure Primary surgery with TORS or primary treatment with radiation therapy and/or chemoradiation therapy. Main Outcomes and Measures Propensity score matching was used to balance the 2 groups. Functional outcomes were measured at 6 months, 1 year, 3 years, 5 years, and more than 5 years posttreatment and included dysphagia, gastrostomy tube dependence, and tracheostomy dependence according to standard medical codes. Five-year overall survivorship was compared between patients undergoing primary TORS vs RT/CRT. Results Propensity score matching allowed a study sample with 2 cohorts comprising statistically similar parameters with 363 (50%) patients in each. Patients in the TORS cohort had a mean (SD) age of 68.5 (9.9) vs 68.8 (9.7) years in RT/CRT cohort; 86% and 88% were White individuals, respectively; 79% of patients were men in both cohorts. Primary TORS was associated with clinically meaningful increased risk of dysphagia at 6 months (OR, 1.37; 95% CI, 1.01-1.84) and 1 year posttreatment (OR, 1.71; 95% CI, 1.22-2.39) compared with primary RT/CRT. Patients receiving surgery were less likely to be gastrostomy tube dependent at 6 months (OR, 0.46; 95% CI, 0.21-1.00) and 5 years posttreatment (risk difference, -0.05; 95% CI, -0.07 to -0.02). Differences in overall rates of tracheostomy dependence (OR, 0.97; 95% CI, 0.51-1.82) between groups were not clinically meaningful. Patients with OPSCC, unmatched for cancer stage or human papillomavirus status, who received RT/CRT had worse 5-year overall survival than those who underwent primary surgery (70.2% vs 58.4%; hazard ratio, 0.56; 95% CI, 0.40-0.79). Conclusions and Relevance This national multicenter cohort study of patients undergoing primary TORS vs primary RT/CRT for T1-T2 OPSCC found that primary TORS was associated with a clinically meaningful increased risk of short-term dysphagia. Patients treated with primary RT/CRT had an increased risk of short- and long-term gastrostomy tube dependence and worse 5-year overall survival than those who underwent surgery.
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Affiliation(s)
- Dev R. Amin
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ramez Philips
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Dylan G. Bertoni
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Eric V. Mastrolonardo
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Daniel J. Campbell
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Aarti M. Agarwal
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sruti Tekumalla
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Zachary D. Urdang
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Adam J. Luginbuhl
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - David M. Cognetti
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Joseph M. Curry
- Department of Otolaryngology–Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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10
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Garden AS, Harris J, Eisbruch A, Chao KSC, Morrison WH, Harari PM, Swanson TA, Jones CU, Yom SS, Spencer SA, Scrimger R, Shenouda G, Shukla M, Lau HY, Mierzwa M, Torres-Saavedra P, Le QT. Final Report of NRG Oncology RTOG 0022: A Phase 1/2 Study of Conformal and Intensity Modulated Radiation for Oropharyngeal Cancer. Int J Radiat Oncol Biol Phys 2023; 117:333-340. [PMID: 36925074 PMCID: PMC10956572 DOI: 10.1016/j.ijrobp.2023.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/02/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Affiliation(s)
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania; American College of Radiology, Reston, Virginia
| | | | - K S Clifford Chao
- NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center, New York, New York
| | | | - Paul M Harari
- University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | | | | | - Sue S Yom
- University of California, San Francisco, California
| | - Sharon A Spencer
- University of Alabama at Birmingham Cancer Center, Birmingham, Alabama
| | | | - George Shenouda
- Department of Oncology, McGill University, Montreal, Quebec, Canada
| | | | - Harold Y Lau
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Michelle Mierzwa
- University of Michigan Comprehensive Cancer Center, Ann Arbor, Michigan
| | - Pedro Torres-Saavedra
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania; American College of Radiology, Reston, Virginia
| | - Quynh Thu Le
- Stanford Cancer Institute, Palo Alto, California
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11
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Hartl DM, Guerlain J, Gorphe P, Kapre M, Kapre Gupta N, Saba NF, Robbins KT, Ronen O, Rodrigo JP, Strojan P, Mäkitie AA, Kowalski LP, Shah JP, Ferlito A. Review of Outcomes after Salvage Surgery for Recurrent Squamous Cell Carcinoma of the Head and Neck. Cancers (Basel) 2023; 15:4692. [PMID: 37835386 PMCID: PMC10571840 DOI: 10.3390/cancers15194692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Surgery with adjuvant chemoradiotherapy or chemoradiotherapy is the mainstay in treatment for advanced stage head and neck squamous cell carcinoma; however, locoregional recurrences are frequent. Salvage surgery could be proposed in selected patients to improve local control, disease-free, and overall survival. Factors for improved disease-free and overall survival in patients treated with salvage surgery include age, tumor location, the initial T stage, HPV status, resection margins, and the time elapsing from the initial treatment. Clinical trials with adjuvant therapies have shown promise after salvage surgery in terms of tolerance and response, but clinical guidelines for using these adjuvant treatments are currently lacking. The aim of this review is to present current knowledge concerning the incidence and management of recurrent head and neck squamous cell carcinoma and current data concerning survival and morbidity after salvage surgery.
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Affiliation(s)
- Dana M. Hartl
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Joanne Guerlain
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Philippe Gorphe
- Department of Anesthesia, Surgery, and Interventional Radiology, Head and Neck Oncology Service, 94805 Villejuif, France
| | - Madan Kapre
- Department of ENT and Head Neck Surgery, Neeti Clinics Nagpur, Nagpur 440010, India
| | - Neeti Kapre Gupta
- Department of ENT and Head Neck Surgery, Neeti Clinics Nagpur, Nagpur 440010, India
| | - Nabil F. Saba
- The Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA
| | - K. Thomas Robbins
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University Medical School, Springfield, IL 62703, USA
| | - Ohad Ronen
- Department of Otolaryngology—Head and Neck Surgery, Galilee Medical Center Affiliated with Azrieli Faculty of Medicine, Bar Ilan University, Safed 5290002, Israel
| | - Juan P. Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, IUOPA, ISPA, CIBERONC, 33204 Oviedo, Spain
| | - Primož Strojan
- Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology—Head and Neck Surgery, Research Program in Systems Oncology, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Luiz P. Kowalski
- Head and Neck Surgery Department, University of São Paulo Medical School, Sao Paulo 05403-000, Brazil
- Head and Neck Surgery and Otorhinolaryngology Department, A C Camargo Cancer Center, Sao Paulo 01509-001, Brazil
| | - Jatin P. Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35100 Padua, Italy
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12
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Rades D, Zwaan I, Idel C, Pries R, Bruchhage KL, Hakim SG, Yu NY, Soror T. A New Prognostic Instrument for Predicting the Probability of Completion of Cisplatin during Chemoradiation for Head and Neck Cancer. J Pers Med 2023; 13:1120. [PMID: 37511733 PMCID: PMC10381843 DOI: 10.3390/jpm13071120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Many head and neck cancer patients assigned to definitive or adjuvant chemoradiation treatment do not complete the concurrent cisplatin dose. We determined corresponding risk factors and developed a prognostic instrument to help identify these patients. Ten pre-treatment characteristics were retrospectively analyzed in 154 patients with head and neck cancer who were treated via chemoradiation with cisplatin. These pre-treatment characteristics included age, sex, Karnofsky performance score, tumor site, primary tumor stage, nodal stage, histologic grade, upfront surgery, human papilloma virus status, and history of smoking. The characteristics significantly associated with the completion of cisplatin-based treatment, the receipt of ≥80% cisplatin, or showing a strong trend of association after multivariate analyses were used for the prognostic instrument. For each characteristic, 0 points were assigned for worse outcomes, and 1 point was assigned for better outcomes. Patients' scores were calculated by adding these points. Age ≤ 60 years and a Karnofsky performance score of 90-100 were significantly associated with both endpoints after multivariate analysis, and male gender showed a trend for association with the receipt of ≥80% cisplatin. Patient scores were 0, 1, 2, and 3 points. The corresponding rates of completion of cisplatin-based treatment were 14%, 41%, 62%, and 72%, respectively (p = 0.004). The rates of receipt of ≥80% cisplatin were 29%, 54%, 72%, and 94%, respectively (p < 0.001). This new prognostic instrument helps to predict whether head and neck cancer patients scheduled for chemoradiation will receive cisplatin as planned.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Inga Zwaan
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Christian Idel
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Ralph Pries
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Karl L Bruchhage
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Samer G Hakim
- Department of Oral and Maxillofacial Surgery, University of Lubeck, 23562 Lubeck, Germany
- Department of Oral and Maxillofacial Surgery, MSH Medical School Hamburg, Schwerin Campus, 19055 Schwerin, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Tamer Soror
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
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13
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Scolari C, Buchali A, Franzen A, Förster R, Windisch P, Bodis S, Zwahlen DR, Schröder C. Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database. Front Oncol 2023; 13:1175609. [PMID: 37456239 PMCID: PMC10346436 DOI: 10.3389/fonc.2023.1175609] [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: 02/27/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC). Methods From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-RT, defined as having a second course of RT with curative intent resulting in a cumulative dose of ≥100 Gy in an overlapping volume. Postoperative or definitive dynamic intensity-modulated and/or volumetric modulated re-RT was administered using twice daily hyperfractionation to 60 Gy combined with cisplatin or carboplatin/5-fluorouracil. Overall survival (OS), progression-free survival (PFS), locoregional control (LRC) and distant metastasis control (DMC) were analyzed and prognostic factors evaluated. Toxicity was prospectively recorded and graded. Results The median follow-up was 9.8 months. In 41 patients (67.1%), complete administration of the intended treatment was not feasible. In 9 patients (15%) re-RT was interrupted prematurely and in other 9, the complete re-RT dose was lower than 60 Gy, and 37 patients (61%) could not receive or complete chemotherapy. Two-year OS, PFS and LRC rates were 19%, 18% and 30%, respectively. 20 patients (33%) received the complete intended treatment, and 1- and 2-year OS rates were 70% and 47%, respectively. Charlson comorbidity index was an important predictor for treatment completion. Multivariate analysis revealed recurrent N stage 0-1, age, chemotherapy administration and re-RT dose of 60 Gy as prognostic factors for clinical outcomes. No grade 5 re-RT-related toxicity was observed. The most common new grade ≥3 acute toxicities were dysphagia (52%) and mucositis (46%). Late toxicity included grade ≥3 dysphagia in 5% and osteoradionecrosis in 10% of evaluable patients, respectively. 6 patients (10%) were alive after 9 years without progression and no late toxicity grade ≥3, except for 2 patients presenting with osteoradionecrosis. Conclusion Hyperfractionated re-RT with 60 Gy combined with platinum-based chemotherapy was a curative treatment option with acceptable toxicity in LRR/SP patients. Patients with higher comorbidity had a higher probability of failing to receive and complete the intended therapy. Consequently, they derived unsatisfactory benefits from re-RT, highlighting the importance of patient selection.
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Affiliation(s)
- Chiara Scolari
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - André Buchali
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
| | - Achim Franzen
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg university of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Paul Windisch
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Stephan Bodis
- Center for Radiation Oncology, Cantonal Hospital Aarau and Baden (KSA-KSB), Aarau/Baden, Switzerland
| | - Daniel R. Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
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14
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Patil V, Noronha V, Menon N, Mathrudev V, Bhattacharjee A, Nawale K, Parekh D, Banavali S, Prabhash K. Metronomic adjuvant chemotherapy evaluation in locally advanced head and neck cancers post radical chemoradiation - a randomised trial. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 12:100162. [PMID: 37384061 PMCID: PMC10305911 DOI: 10.1016/j.lansea.2023.100162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 06/30/2023]
Abstract
Background Locally advanced head and neck cancers treated with radical chemoradiation have unsatisfactory outcomes. Oral metronomic chemotherapy improves outcomes in comparison to maximum tolerated dose chemotherapy in the palliative setting. Limited evidence suggests that it may do so in an adjuvant setting. Hence this randomized study was conducted. Methods Patients of head and neck (HN) cancer with primary in oropharynx, larynx or hypopharynx, with PS 0-2 post radical chemoradiation with documented complete response were randomized 1:1 to either observation or oral metronomic adjuvant chemotherapy (MAC) for 18 months. MAC consisted of weekly oral methotrexate (15 mg/m2) and celecoxib (200 mg PO BD). The primary endpoint was OS and the overall sample size was 1038. The study had 3 planned interim analyses for efficacy and futility. Trial registration- Clinical Trials Registry- India (CTRI): CTRI/2016/09/007315 [Registered on: 28/09/2016] Trial Registered Prospectively. Findings 137 patients were recruited and an interim analysis was done. The 3 year PFS was 68.7% (95% CI 55.1-79.0) versus 60.8% (95% CI 47.9-71.4) in the observation and metronomic arm respectively (P value = 0.230). The hazard ratio was 1.42 (95% CI 0.80-2.51; P value = 0.231). The 3 year OS was 79.4% (95% CI 66.3-87.9) versus 62.4% (95% CI 49.5-72.8) in the observation and metronomic arm respectively (P value = 0.047). The hazard ratio was 1.83 (95% CI 1.0-3.36; P value = 0.051). Interpretation In this phase 3 randomized study, oral metronomic combinations of weekly methotrexate and daily celecoxib failed to improve the PFS or OS. Hence observation post-complete response post radical chemoradiation remains the standard of care. Funding ICON funded this study.
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Affiliation(s)
- Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Deevyashali Parekh
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Shripad Banavali
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
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15
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The Usefulness of Machine Learning-Based Evaluation of Clinical and Pretreatment [ 18F]-FDG-PET/CT Radiomic Features for Predicting Prognosis in Hypopharyngeal Cancer. Mol Imaging Biol 2023; 25:303-313. [PMID: 35864282 DOI: 10.1007/s11307-022-01757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/06/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To examine whether the machine learning (ML) analyses using clinical and pretreatment 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography ([18F]-FDG-PET)-based radiomic features were useful for predicting prognosis in patients with hypopharyngeal cancer. PROCEDURES This retrospective study included 100 patients with hypopharyngeal cancer who underwent [18F]-FDG-PET/X-ray computed tomography (CT) before treatment, and these patients were allocated to the training (n=80) and validation (n=20) cohorts. Eight clinical (age, sex, histology, T stage, N stage, M stage, UICC stage, and treatment) and 40 [18F]-FDG-PET-based radiomic features were used to predict disease progression. A feature reduction procedure based on the decrease of the Gini impurity was applied. Six ML algorithms (random forest, neural network, k-nearest neighbors, naïve Bayes, logistic regression, and support vector machine) were compared using the area under the receiver operating characteristic curve (AUC). Progression-free survival (PFS) was assessed using Cox regression analysis. RESULTS The five most important features for predicting disease progression were UICC stage, N stage, gray level co-occurrence matrix entropy (GLCM_Entropy), gray level run length matrix run length non-uniformity (GLRLM_RLNU), and T stage. Patients who experienced disease progression displayed significantly higher UICC stage, N stage, GLCM_Entropy, GLRLM_RLNU, and T stage than those without progression (each, p<0.001). In both cohorts, the logistic regression model constructed by these 5 features was the best performing classifier (training: AUC=0.860, accuracy=0.800; validation: AUC=0.803, accuracy=0.700). In the logistic regression model, 5-year PFS was significantly higher in patients with predicted non-progression than those with predicted progression (75.8% vs. 8.3%, p<0.001), and this model was only the independent factor for PFS in multivariate analysis (hazard ratio = 3.22; 95% confidence interval = 1.03-10.11; p=0.045). CONCLUSIONS The logistic regression model constructed by UICC, T and N stages and pretreatment [18F]-FDG-PET-based radiomic features, GLCM_Entropy, and GLRLM_RLNU may be the most important predictor of prognosis in patients with hypopharyngeal cancer.
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16
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You R, Liu YP, Xie YL, Lin C, Duan CY, Chen DP, Pan Y, Qi B, Zou X, Guo L, Cao JY, Zhang YN, Wang ZQ, Liu YL, Ouyang YF, Wen K, Yang Q, Xie RQ, Li HF, Duan XT, Ding X, Peng L, Chen SY, Liang JL, Feng ZK, Xia TL, Xie RL, Jiang R, Gu CM, Liu RZ, Sun R, Yang X, Liu LZ, Ling L, Liu Q, Ng WT, Hua YJ, Huang PY, Chen MY. Hyperfractionation compared with standard fractionation in intensity-modulated radiotherapy for patients with locally advanced recurrent nasopharyngeal carcinoma: a multicentre, randomised, open-label, phase 3 trial. Lancet 2023; 401:917-927. [PMID: 36842439 DOI: 10.1016/s0140-6736(23)00269-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Reirradiation in standard fractionation for locally advanced recurrent nasopharyngeal carcinoma after a previous course of high-dose radiotherapy is often associated with substantial late toxicity, negating its overall benefit. We therefore aimed to investigate the efficacy and safety of hyperfractionation compared with standard fractionation in intensity-modulated radiotherapy. METHODS This multicentre, randomised, open-label, phase 3 trial was done in three centres in Guangzhou, China. Eligible patients were aged 18-65 years with histopathologically confirmed undifferentiated or differentiated, non-keratinising, advanced locally recurrent nasopharyngeal carcinoma. Participants were randomly assigned (1:1) to either receive hyperfractionation (65 Gy in 54 fractions, given twice daily with an interfractional time interval of at least 6 h) or standard fractionation (60 Gy in 27 fractions, given once a day). Intensity-modulated radiotherapy was used in both groups. A computer program generated the assignment sequence and randomisation was stratified by treatment centre, recurrent tumour stage (T2-T3 vs T4), and recurrent nodal stage (N0 vs N1-N2), determined at the time of randomisation. The two primary endpoints were the incidence of severe late complications defined as the incidence of grade 3 or worse late radiation-induced complications occurring 3 months after the completion of radiotherapy until the latest follow-up in the safety population, and overall survival defined as the time interval from randomisation to death due to any cause in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02456506. FINDINGS Between July 10, 2015, and Dec 23, 2019, 178 patients were screened for eligibility, 144 of whom were enrolled and randomly assigned to hyperfractionation or standard fractionation (n=72 in each group). 35 (24%) participants were women and 109 (76%) were men. After a median follow-up of 45·0 months (IQR 37·3-53·3), there was a significantly lower incidence of grade 3 or worse late radiation-induced toxicity in the hyperfractionation group (23 [34%] of 68 patients) versus the standard fractionation group (39 [57%] of 68 patients; between-group difference -23% [95% CI -39 to -7]; p=0·023). Patients in the hyperfractionation group had better 3-year overall survival than those in the standard fractionation group (74·6% [95% CI 64·4 to 84·8] vs 55·0% [43·4 to 66·6]; hazard ratio for death 0·54 [95% CI 0·33 to 0·88]; p=0·014). There were fewer grade 5 late complications in the hyperfractionation group (five [7%] nasal haemorrhage) than in the standard fractionation group (16 [24%], including two [3%] nasopharyngeal necrosis, 11 [16%] nasal haemorrhage, and three [4%] temporal lobe necrosis). INTERPRETATION Hyperfractionated intensity-modulated radiotherapy could significantly decrease the rate of severe late complications and improve overall survival among patients with locally advanced recurrent nasopharyngeal carcinoma. Our findings suggest that hyperfractionated intensity-modulated radiotherapy could be used as the standard of care for these patients. FUNDING Key-Area Research and Development of Guangdong Province, the National Natural Science Foundation of China, the Special Support Program for High-level Talents in Sun Yat-sen University Cancer Center, the Guangzhou Science and Technology Plan Project, and the National Ten Thousand Talents Program Science and Technology Innovation Leading Talents, Sun Yat-Sen University Clinical Research 5010 Program.
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Affiliation(s)
- Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - You-Ping Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yu-Long Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chao Lin
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Dong-Ping Chen
- Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Yi Pan
- Department of Radiation Oncology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Bin Qi
- Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Xiong Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Cooperative Surgical Ward of Nasopharyngeal Carcinoma, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ling Guo
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jing-Yu Cao
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yi-Nuan Zhang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Zhi-Qiang Wang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yong-Long Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yan-Feng Ouyang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Kai Wen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Qi Yang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ruo-Qi Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Hui-Feng Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiao-Tong Duan
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xi Ding
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Lan Peng
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Si-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jiong-Lin Liang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Zheng-Kai Feng
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Tian-Liang Xia
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rui-Ling Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rou Jiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chen-Mei Gu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rong-Zeng Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rui Sun
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xin Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li-Zhi Liu
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qing Liu
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi-Jun Hua
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Pei-Yu Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Cooperative Surgical Ward of Nasopharyngeal Carcinoma, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
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17
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Liu JC, Egleston BL, Blackman E, Ragin C. Racial survival disparities in head and neck cancer clinical trials. J Natl Cancer Inst 2023; 115:288-294. [PMID: 36477855 PMCID: PMC9996207 DOI: 10.1093/jnci/djac219] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Survival disparities between Black and White head and neck cancer patients are well documented, with access to care and socioeconomic status as major contributors. We set out to assess the role of self-reported race in head and neck cancer by evaluating treatment outcomes of patients enrolled in clinical trials, where access to care and socioeconomic status confounders are minimized. METHODS Clinical trial data from the Radiation Therapy Oncology Group studies were obtained. Studies were included if they were therapeutic trials that employed survival as an endpoint. Studies that did not report survival as an endpoint were excluded; 7 Radiation Therapy Oncology Group Studies were included for study. For each Black patient enrolled in a clinical trial, a study arm-matched White patient was used as a control. RESULTS A total of 468 Black participants were identified and matched with 468 White study arm-specific controls. White participants had better outcomes than Black participants in 60% of matched pairs (P < .001). Black participants were consistently more likely to have worse outcomes. When outcomes were measured by progression-free survival or disease-free survival, the failure rate was statistically significantly higher in Black participants (hazard ratio [HR] = 1.50, P < .001). Failure was largely due to locoregional failure, and Black participants were at higher risk (subdistribution HR =1.51, P = .002). The development of distant metastasis within the paired cohorts was not statistically significantly different. CONCLUSION In this study of clinical trial participants using self-reported race, Black participants consistently had worse outcomes in comparison to study arm-specific White controls. Further study is needed to confirm these findings and to explore causes underlying this disparity.
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Affiliation(s)
- Jeffrey C Liu
- Department of Otolaryngology-Head and Neck Surgery, Lewis Katz School of Medicine of Temple University, Philadelphia, PA, USA.,Division of Head and Neck Surgery, Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Brian L Egleston
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Elizabeth Blackman
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Camille Ragin
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
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18
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Kang JJ, Yu Y, Chen L, Zakeri K, Gelblum DY, McBride SM, Riaz N, Tsai CJ, Kriplani A, Hung T, Fetten JV, Dunn LA, Ho A, Boyle JO, Ganly IS, Singh B, Sherman EJ, Pfister DG, Wong RJ, Lee NY. Consensuses, controversies, and future directions in treatment deintensification for human papillomavirus-associated oropharyngeal cancer. CA Cancer J Clin 2023; 73:164-197. [PMID: 36305841 PMCID: PMC9992119 DOI: 10.3322/caac.21758] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 01/19/2023] Open
Abstract
The most common cancer caused by human papillomavirus (HPV) infection in the United States is oropharyngeal cancer (OPC), and its incidence has been rising since the turn of the century. Because of substantial long-term morbidities with chemoradiation and the favorable prognosis of HPV-positive OPC, identifying the optimal deintensification strategy for this group has been a keystone of academic head-and-neck surgery, radiation oncology, and medical oncology for over the past decade. However, the first generation of randomized chemotherapy deintensification trials failed to change the standard of care, triggering concern over the feasibility of de-escalation. National database studies estimate that up to one third of patients receive nonstandard de-escalated treatments, which have subspecialty-specific nuances. A synthesis of the multidisciplinary deintensification data and current treatment standards is important for the oncology community to reinforce best practices and ensure optimal patient outcomes. In this review, the authors present a summary and comparison of prospective HPV-positive OPC de-escalation trials. Chemotherapy attenuation compromises outcomes without reducing toxicity. Limited data comparing transoral robotic surgery (TORS) with radiation raise concern over toxicity and outcomes with TORS. There are promising data to support de-escalating adjuvant therapy after TORS, but consensus on treatment indications is needed. Encouraging radiation deintensification strategies have been reported (upfront dose reduction and induction chemotherapy-based patient selection), but level I evidence is years away. Ultimately, stage and HPV status may be insufficient to guide de-escalation. The future of deintensification may lie in incorporating intratreatment response assessments to harness the powers of personalized medicine and integrate real-time surveillance.
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Affiliation(s)
- Jung Julie Kang
- Yale University School of Medicine, Department of Therapeutic Radiology
| | - Yao Yu
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Linda Chen
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Kaveh Zakeri
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | | | | | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - C. Jillian Tsai
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology
| | - Anuja Kriplani
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Tony Hung
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - James V. Fetten
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Lara A. Dunn
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Alan Ho
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | - Jay O. Boyle
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Ian S. Ganly
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Bhuvanesh Singh
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Eric J. Sherman
- Memorial Sloan Kettering Cancer Center, Department of Medicine
| | | | - Richard J. Wong
- Memorial Sloan Kettering Cancer Center, Department of Surgery
| | - Nancy Y. Lee
- Memorial Sloan Kettering Cancer Center, Department of Medicine
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19
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Bentahila R, Giraud P, Decazes P, Kreps S, Nay P, Chatain A, Fabiano E, Durdux C. The impact of sarcopenia on survival and treatment tolerance in patients with head and neck cancer treated with chemoradiotherapy. Cancer Med 2023; 12:4170-4183. [PMID: 36263581 PMCID: PMC9972161 DOI: 10.1002/cam4.5278] [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: 04/28/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Sarcopenia appears to be a negative prognostic factor for poor survival outcomes and worse treatment tolerance in patients with head-and-neck squamous cell carcinoma (HNSCC). We evaluated sarcopenia's impact on overall survival (OS), disease-free survival (DFS) and chemo-radiation tolerance in patients with head-and-neck cancer (HNC) treated with chemoradiotherapy (CRT) from a monocentric observational study. METHODS We identified patients with HNC treated by CRT between 2009 and 2018 with pretreatment imaging using positron emission tomography-computed tomography scans (PET/CT). Sarcopenia was measured using the pretreatment PET/CT at the L3 vertebral body using previously published methods. Clinical variables were retrospectively retrieved. RESULTS Of 216 patients identified, 54 patients (25.47%) met the criteria for sarcopenia. These patients had a lower mean body mass index before treatment (21.92 vs. 25.65 cm/m2 , p < 0.001) and were more likely to have a history of smoking (88.89% vs. 71.52%, p = 0.01), alcohol use (55.56% vs. 38.61%, p = 0.03) and positive human papilloma virus status (67.74% vs. 41.75%, p = 0.011). At 3 years of follow-up, OS and DFS were 75% and 70% versus 82% and 85% for sarcopenic and non-sarcopenic patients, respectively (p = 0.1 and p = 0.00015). On multivariate analysis, sarcopenia appeared as a pejorative factor on DFS (hazard ratio 2.174, p = 0.0001) in the overall cohort. Sarcopenic patients did not require more chemotherapy and radiation-treatment interruptions and did not suffer from more chemo-induced and radiation-induced grade 3-4 toxicities than their non-sarcopenic counterparts. CONCLUSION Sarcopenia in HNSCC patients is an independent adverse prognostic factor for DFS after definitive chemoradiotherapy.
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Affiliation(s)
- Rita Bentahila
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Philippe Giraud
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France
| | - Sarah Kreps
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Paula Nay
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Augustin Chatain
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Emmanuelle Fabiano
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
| | - Catherine Durdux
- Department of Radiation Oncology, European Georges Pompidou Hospital, Paris, France
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20
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Lee A, Woods R, Mahfouz A, Kitpanit S, Cartano O, Mohamed N, Youssef I, Marqueen K, Sine K, Mah D, Neal B, Zakeri K, Kang JJ, Riaz N, Yu Y, McBride SM, Chen LD, Tsai CJ, Gelblum DY, Press RH, Michel LS, Sherman EJ, Pfister D, Dunn LA, Ho AL, Fetten J, Wong RJ, Boyle JO, Singh B, Cracchiolo JR, Ganly I, Cohen MA, Lee NY. Evaluation of Proton Therapy Reirradiation for Patients With Recurrent Head and Neck Squamous Cell Carcinoma. JAMA Netw Open 2023; 6:e2250607. [PMID: 36689229 PMCID: PMC9871797 DOI: 10.1001/jamanetworkopen.2022.50607] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/09/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Use of proton therapy reirradiation (PT-ReRT) for head and neck cancer is increasing; however, reports are heterogenous and outcomes can be difficult to interpret. Objective To evaluate outcomes and toxic effects following PT-ReRT in a uniform and consecutive cohort of patients with head and neck squamous cell carcinoma. Design, Setting, and Participants This retrospective cohort study included patients with recurrent primary head and neck squamous cell carcinoma who were treated with PT-ReRT from January 1, 2013, to December 31, 2020, at a single institution. Patient, clinical, and treatment characteristics were obtained, and multidisciplinary review was performed to record and grade early and late toxic effects. Exposures Proton therapy reirradiation. Main Outcomes and Measures Follow-up was defined from the start of PT-ReRT. The Kaplan-Meier method was used for outcomes of interest, including local control (LC), locoregional control, distant metastatic control, progression-free survival, and overall survival (OS). Cox proportional hazards regression modeling was used to assess associations of covariates with OS. Results A total of 242 patients (median [range] age, 63 [21-96] years; 183 [75.6%] male) were included. Of these patients, 231 (95.9%) had a Karnofsky performance status score of 70 or higher, and 145 (59.9%) had at least a 10-pack-year smoking history. Median (range) follow-up was 12.0 (5.8-26.0) months for all patients and 24.5 (13.8-37.8) months for living patients. A total of 206 patients (85.1%) had recurrent disease vs second primary or residual disease. The median (range) interval between radiation courses was 22 (1-669) months. Median PT-ReRT dose was 70 cobalt gray equivalents (CGE) for the fractionated cohort and 44.4 CGE for the quad shot cohort. For the fractionated cohort, the 1-year LC was 71.8% (95% CI, 62.8%-79.0%) and the 1-year OS was 66.6% (95% CI, 58.1%-73.8%). For the quad shot cohort, the 1-year LC was 61.6% (95% CI, 46.4%-73.6%) and the 1-year OS was 28.5% (95% CI, 19.4%-38.3%). Higher Karnofsky performance status scores (hazard ratio [HR], 0.50; 95% CI, 0.25-0.99; P = .046) and receipt of salvage surgery prior to PT-ReRT (HR, 0.57; 95% CI, 0.39-0.84; P = .005) were associated with improved OS, whereas receipt of quad shot (HR, 1.97; 95% CI, 1.36-2.86; P < .001) was associated with worse OS. There were a total of 73 grade 3 and 6 grade 4 early toxic effects. There were 79 potential grade 3, 4 grade 4, and 5 grade 5 late toxic effects. Conclusions and Relevance The findings of this cohort study suggest that, compared with previous reports with photon-based reirradiation, patients are living longer with aggressive PT-ReRT; however, surviving patients remain at risk of early and late complications.
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Affiliation(s)
- Anna Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Robbie Woods
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Amgad Mahfouz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sarin Kitpanit
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Olivia Cartano
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nader Mohamed
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Irini Youssef
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kathryn Marqueen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kevin Sine
- ProCure Proton Therapy Center, Somerset, New Jersey
| | - Dennis Mah
- ProCure Proton Therapy Center, Somerset, New Jersey
| | - Brian Neal
- ProCure Proton Therapy Center, Somerset, New Jersey
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jung J. Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M. McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda D. Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C. Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daphna Y. Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Loren S. Michel
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric J. Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lara A. Dunn
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alan L. Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - James Fetten
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J. Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jay O. Boyle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bhuvanesh Singh
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Ian Ganly
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marc A. Cohen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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21
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Liu H, Zhao D, Huang Y, Li C, Dong Z, Tian H, Sun Y, Lu Y, Chen C, Wu H, Zhang Y. Comprehensive prognostic modeling of locoregional recurrence after radiotherapy for patients with locoregionally advanced hypopharyngeal squamous cell carcinoma. Front Oncol 2023; 13:1129918. [PMID: 37025592 PMCID: PMC10072214 DOI: 10.3389/fonc.2023.1129918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/13/2023] [Indexed: 04/08/2023] Open
Abstract
Purpose To propose and evaluate a comprehensive modeling approach combing radiomics, dosiomics and clinical components, for more accurate prediction of locoregional recurrence risk after radiotherapy for patients with locoregionally advanced HPSCC. Materials and methods Clinical data of 77 HPSCC patients were retrospectively investigated, whose median follow-up duration was 23.27 (4.83-81.40) months. From the planning CT and dose distribution, 1321 radiomics and dosiomics features were extracted respectively from planning gross tumor volume (PGTV) region each patient. After stability test, feature dimension was further reduced by Principal Component Analysis (PCA), yielding Radiomic and Dosiomic Principal Components (RPCs and DPCs) respectively. Multiple Cox regression models were constructed using various combinations of RPC, DPC and clinical variables as the predictors. Akaike information criterion (AIC) and C-index were used to evaluate the performance of Cox regression models. Results PCA was performed on 338 radiomic and 873 dosiomic features that were tested as stable (ICC1 > 0.7 and ICC2 > 0.95), yielding 5 RPCs and DPCs respectively. Three comprehensive features (RPC0, P<0.01, DPC0, P<0.01 and DPC3, P<0.05) were found to be significant in the individual Radiomic or Dosiomic Cox regression models. The model combining the above features and clinical variable (total stage IVB) provided best risk stratification of locoregional recurrence (C-index, 0.815; 95%CI, 0.770-0.859) and prevailing balance between predictive accuracy and complexity (AIC, 143.65) than any other investigated models using either single factors or two combined components. Conclusion This study provided quantitative tools and additional evidence for the personalized treatment selection and protocol optimization for HPSCC, a relatively rare cancer. By combining complementary information from radiomics, dosiomics, and clinical variables, the proposed comprehensive model provided more accurate prediction of locoregional recurrence risk after radiotherapy.
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Affiliation(s)
- Hongjia Liu
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Dan Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yuliang Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Chenguang Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhengkun Dong
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongbo Tian
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yijie Sun
- School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Yanye Lu
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Chen Chen
- School of Electronics Engineering and Computer Science, Peking University, Beijing, China
| | - Hao Wu
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yibao Zhang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
- *Correspondence: Yibao Zhang,
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Nagarajan M, Banu R, Shrividhya A, Chellapandian TP, Rajkumar A, Mohanraj R. Outcomes and Management of Head and Neck Cancer at a South Indian Cancer Centre: A Retrospective Study. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1758541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Introduction Head and neck cancers are one of the most common cancers in the Indian subcontinent. The trends of these cancers worldwide have drastically changed over the past 15 years. In spite of all the new technology and timely diagnosis, the treatment of these cancers is still a challenge. These cancers still continue to be a significant cause of morbidity and mortality worldwide.
Objectives To identify different patterns of care received by patients with primary head and neck cancer in a single center and analyze the outcomes of the different patterns of care received by these patients in terms of overall survival and disease-free survival.
Materials and Methods We included 707 patients with primary head and neck cancer registered and treated in our institution from January 2015 to December 2017. The demographic details of the patient, treatment received, and outcomes of treatment were collected retrospectively from our hospital's medical registry. Descriptive analysis was performed by calculating mean and standard deviation for quantitative variables, whereas frequency and proportion were calculated for categorical variables. The mean/median overall survival and recurrence-free survival were compared across various explanatory parameters using log rank–test. A p-value < 0.05 was considered statistically significant.
Results A total of 707 patients were included in the final analysis. The median age of presentation was 60 years. In total, 50% of patients presented with stage IV disease at diagnosis and 78% had a history of smoking or other tobacco use. Oral cavity was the most common primary site. Concurrent chemotherapy with radiation therapy was the most common modality of treatment used in 49% of patients: RT was the common modality of treatment in 21% patients. Fourteen percent patients were treated by only surgery. All patients who underwent treatment were included for survival analysis, which showed that the median overall survival time was 42 months (34–49 months). The median duration of disease free-survival time was 37 months (30–43 months).
Conclusion In our study, most patients presented with locally advanced disease. Multimodality treatment yielded better results. Based on our study, in early-stage cancer, where single modality treatment was used, adjuvant therapy should be tailored based on nomogram.
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Affiliation(s)
- Murugaiyan Nagarajan
- Department of Oncology, Valavadi Narayanasamy Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Ramesh Banu
- Department of Oncology, Valavadi Narayanasamy Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Ananthakrishnan Shrividhya
- Department of Oncology, Valavadi Narayanasamy Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | | | - Arumugham Rajkumar
- Department of Oncology, Valavadi Narayanasamy Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
| | - Ramaswamy Mohanraj
- Department of Oncology, Valavadi Narayanasamy Cancer Centre, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, Tamil Nadu, India
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Meccariello G, Catalano A, Cammaroto G, Iannella G, Vicini C, Hao SP, De Vito A. Treatment Options in Early Stage (Stage I and II) of Oropharyngeal Cancer: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58081050. [PMID: 36013517 PMCID: PMC9415053 DOI: 10.3390/medicina58081050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: to show an overview on the treatments’ options for stage I and II oropharyngeal carcinomasquamous cell carcinoma (OPSCC). Background: The traditional primary treatment modality of OPSCC at early stages is intensity modulated radiation therapy (IMRT). Trans-oral robotic surgery (TORS) has offered as an alternative, less invasive surgical option. Patients with human papilloma virus (HPV)-positive OPSCC have distinct staging with better overall survival in comparison with HPV-negative OPSCC patients. Methods: a comprehensive review of the English language literature was performed using PubMed, EMBASE, the Cochrane Library, and CENTRAL electronic databases. Conclusions: Many trials started examining the role of TORS in de-escalating treatment to optimize functional consequences while maintaining oncologic outcome. The head–neck surgeon has to know the current role of TORS in HPV-positive and negative OPSCC and the ongoing trials that will influence its future implementation. The feasibility of this treatment, the outcomes ensured, and the side effects are key factors to consider for each patient. The variables reported in this narrative review are pieces of a bigger puzzle called tailored, evidence-based driven medicine. Future evidence will help in the construction of robust and adaptive algorithms in order to ensure the adequate treatment for the OPSCC at early stages.
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Affiliation(s)
- Giuseppe Meccariello
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Andrea Catalano
- Otolaryngology Unit, University of Ferrara, 44121 Ferrara, Italy
| | - Giovanni Cammaroto
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Giannicola Iannella
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Claudio Vicini
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Morgagni Pierantoni Hospital, Health Local Agency Romagna, 47121 Forlì, Italy
| | - Sheng-Po Hao
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, School of Medicine, Fu-Jen University, Taipei 111, Taiwan
| | - Andrea De Vito
- Otolaryngology and Head-Neck Surgery Unit, Department of Head-Neck Surgeries, Santa Maria delle Croci Hospital, Health Local Agency of Romagna, 48121 Ravenna, Italy
- Correspondence:
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Fekadu A, Rick TJ, Tigeneh W, Kantelhardt EJ, Incrocci L, Jemal A. Clinicopathology and Treatment Patterns of Head and Neck Cancers in Ethiopia. JCO Glob Oncol 2022; 8:e2200073. [PMID: 35939776 PMCID: PMC9470133 DOI: 10.1200/go.22.00073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Head and neck cancers are the third most common cancers treated with radiation in Ethiopia. There is, however, a lack of published data on clinical and pathological characteristics and treatment patterns of head and neck cancers in the country. The objective of the study was to assess clinical and pathological characteristics and treatment patterns of head and neck cancers at Tikur Anbessa Specialized Hospital, which housed the only radiotherapy facility in Ethiopia during the study period. Curative radiation dosing for #headandneck #cancer in #Ethiopia is challenged by the limitations of 2D radiation and long wait times. @JCOGO_ASCO
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Affiliation(s)
- Adugna Fekadu
- Department of Radiation Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tara J. Rick
- Department of Radiation Oncology, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC, Rotterdam, the Netherlands
| | - Ahmedin Jemal
- Surveillance and Health Service Research, American Cancer Society, Atlanta, GA
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25
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Escalating a Biological Dose of Radiation in the Target Volume Applying Stereotactic Radiosurgery in Patients with Head and Neck Region Tumours. Biomedicines 2022; 10:biomedicines10071484. [PMID: 35884789 PMCID: PMC9313164 DOI: 10.3390/biomedicines10071484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The treatment of head and neck tumours is a complicated process usually involving surgery, radiation therapy, and systemic treatment. Despite the multidisciplinary approach, treatment outcomes are still unsatisfactory, especially considering malignant tumours such as squamous cell carcinoma or sarcoma, where the frequency of recurrence has reached 50% of cases. The implementation of modern and precise methods of radiotherapy, such as a radiosurgery boost, may allow for the escalation of the biologically effective dose in the gross tumour volume and improve the results of treatment. Methods: The administration of a stereotactic radiotherapy boost can be done in two ways: an upfront boost followed by conventional radio(chemo)therapy or a direct boost after conventional radio(chemo)therapy. The boost dose depends on the primary or nodal tumour volume and localization regarding the organs at risk. It falls within the range of 10–18 Gy. Discussion: The collection of detailed data on the response of the disease to the radiosurgery boost combined with conventional radiotherapy as well as an assessment of early and late toxicities will contribute crucial information to the prospective modification of fractionated radiotherapy. In the case of beneficial findings, the stereotactic radiosurgery boost in the course of radio(chemo)therapy in patients with head and neck tumours will be able to replace traditional techniques of radiation, and radical schemes of treatment will be possible for future development.
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26
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Rocha PHP, Reali RM, Decnop M, Souza SA, Teixeira LAB, Júnior AL, Sarpi MO, Cintra MB, Pinho MC, Garcia MRT. Adverse Radiation Therapy Effects in the Treatment of Head and Neck Tumors. Radiographics 2022; 42:806-821. [PMID: 35302867 DOI: 10.1148/rg.210150] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Whether used as a single modality or as part of a combined approach, radiation therapy (RT) plays an essential role in the treatment of several head and neck malignancies. Despite the improvement in radiation delivery techniques, normal structures in the vicinity of the target area remain susceptible to a wide range of adverse effects. Given their high incidence, some of these effects are referred to as expected postradiation changes (eg, mucositis, sialadenitis, and edema), while others are considered true complications, meaning they should not be expected and can even represent life-threatening conditions (eg, radionecrosis, fistulas, and radiation-induced neoplasms). Also, according to their timing of onset, these deleterious effects can be divided into four groups: acute (during RT), subacute (within weeks to months), delayed onset (within months to years), and very delayed onset (after several years).The authors provide a comprehensive review of the most important radiation-induced changes related to distinct head and neck sites, focusing on their typical cross-sectional imaging features and correlating them with the time elapsed after treatment. Radiologists should not only be familiar with these imaging findings but also actively seek essential clinical data at the time of interpretation (including knowledge of the RT dose and time, target site, and manifesting symptoms) to better recognize imaging findings, avoid pitfalls and help guide appropriate management. © RSNA, 2022.
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Affiliation(s)
- Pedro H P Rocha
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Raphael M Reali
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Marcos Decnop
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Soraia A Souza
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Lorine A B Teixeira
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Ademar Lucas Júnior
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Maíra O Sarpi
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Murilo B Cintra
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Marco C Pinho
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
| | - Marcio R T Garcia
- From the Division of Head and Neck Radiology, Diagnósticos da América SA/DASA, São Paulo, Brazil (P.H.P.R., R.M.R., S.A.S., M.O.S., M.B.C., M.R.T.G.); Division of Head and Neck Radiology, Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil (M.D.); Departments of Diagnostic Imaging (S.A.S., M.B.C.) and Radiation Therapy (L.A.B.T.), Instituto do Câncer do Estado de São Paulo (ICESP) do HCFMUSP, São Paulo, Brazil; Department of Radiation Therapy, Hospital Santa Paula, São Paulo, Brazil (L.A.B.T.); Division of Head and Neck and Neuroradiology, Grupo São Camilo/ DASA, Maringá, Brazil (A.L.J.); Division of Head and Neck Radiology, Instituto de Radiologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/ HC-FMUSP), São Paulo, Brazil (M.O.S.); and Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (M.C.P.)
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Zhao L, Day AT, Moon D, Avkshtol V, Sumer BD, Hughes R, Sher DJ. Survival and disease progression following solitary locoregional recurrence after head and neck radiotherapy. Head Neck 2022; 44:1153-1163. [PMID: 35212070 DOI: 10.1002/hed.27012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The management of solitary locoregional recurrence (sLRR) of head and neck squamous cell carcinoma (HNSCC) previously treated with radiotherapy (RT) is challenging. We aimed to identify characteristics associated with improved outcome. METHODS We identified patients treated with non-sinus, mucosal HNSCC who initially received IMRT. We characterized overall survival (OS) and locoregional control (LRC). Multivariable analysis (MVA) on survival and patterns-of-failure were performed using Cox and Fine-Gray competing risks analysis. RESULTS We identified 90 patients with available follow-up. In total, 67 (74%) patients received curative-intent salvage, while 23 (26%) received palliative care. On MVA, significantly improved OS and LRC were associated with lower initial N-classification and use of salvage total laryngectomy (TL) or neck dissection (ND). CONCLUSION A nontrivial number of patients with sLRR cannot undergo salvage. Among patients treated with curative intent, TL or ND were clearly associated with improved OS and LRC.
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Affiliation(s)
- Lucian Zhao
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew T Day
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Dominic Moon
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Vladimir Avkshtol
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Baran D Sumer
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Randall Hughes
- Department of Medical Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - David J Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas, USA
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Riechelmann H, Dejaco D, Steinbichler TB, Lettenbichler-Haug A, Anegg M, Ganswindt U, Gamerith G, Riedl D. Functional Outcomes in Head and Neck Cancer Patients. Cancers (Basel) 2022; 14:cancers14092135. [PMID: 35565265 PMCID: PMC9099625 DOI: 10.3390/cancers14092135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Simple Summary With increasing long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. Recently, a tool for the rapid clinical assessment of the functional status in HNC-patients based on observable clinical criteria, termed “HNC-Functional InTegrity (FIT) Scales, was validated. Here, the functional outcomes of 681 newly diagnosed HNC-patients were reported using the HNC-FIT Scales. A normal/near-normal outcome in all six functional domains was observed in 61% of patients, with individual scores of 79% for food intake, 89% for breathing, 84% for speech, 89% for pain, 92% for mood, and 88% for neck and shoulder mobility. Clinically relevant impairment in at least one functional domain was observed in 30% of patients, and 9% had loss of function in at least one functional domain. Thus, clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of HNC-patients. The treatment of these functional deficits is an essential task of oncologic follow-up. Abstract With the increase in long-term survivorship of head and neck cancer (HNC), the functional outcomes are gaining importance. We reported the functional outcomes of HNC patients using the HNC-Functional InTegrity (FIT) Scales, which is a validated tool for the rapid clinical assessment of functional status based on observable clinical criteria. Patients with newly diagnosed HNC treated at the Medical University of Innsbruck between 2008 and 2020 were consecutively included, and their status in the six functional domains of food-intake, breathing, speech, pain, mood, and neck and shoulder mobility was scored by the treating physician at oncological follow-up visits on a scale from 0 (loss of function) to 4 (full function). HNC-FIT scales were available for 681 HNC patients at a median of 35 months after diagnosis. The response status was complete remission in 79.5%, 18.1% had recurrent or persistent disease, and 2.4% had a second primary HNC. Normal or near-normal scores (3 and 4) were seen in 78.6% for food intake, 88.7% for breathing, 83.7% for speech, 89% for pain, 91.8% for mood, and 87.5% for neck and shoulder mobility. A normal or near-normal outcome in all six functional domains was observed in 61% of patients. Clinically relevant impairment (score 1–2) in at least one functional domain was observed in 30%, and 9% had loss of function (score 0) in at least one functional domain. The main factors associated with poor functional outcome in a multivariable analysis were recurrence or persistent disease, poor general health (ASA III and IV), and higher T stage. Particularly, laryngeal and hypopharyngeal tumors impaired breathing and speech function, and primary radiation therapy or concomitant systemic therapy and radiotherapy worsened food intake. Clinically relevant persistent functional deficits in at least one functional domain must be expected in 40% of the patients with HNC. The treatment of these functional deficits is an essential task of oncologic follow-up.
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Affiliation(s)
- Herbert Riechelmann
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Daniel Dejaco
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
- Correspondence: ; Tel.: +43-512-504-23142
| | - Teresa Bernadette Steinbichler
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Anna Lettenbichler-Haug
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Maria Anegg
- Department of Otorhinolaryngology—Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria; (H.R.); (T.B.S.); (A.L.-H.); (M.A.)
| | - Ute Ganswindt
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Gabriele Gamerith
- Internal Medicine V, Department of Hematology & Oncology, Medical University Innsbruck, 6020 Innsbruck, Austria;
| | - David Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
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Sethi HK, Walker E, Weinsheim T, Brennan MJ, Fundakowski CE. Examination of care processes and treatment optimization for head and neck cancer patients in a community setting “hub and hub” model. World J Otorhinolaryngol Head Neck Surg 2022; 8:152-157. [PMID: 35782402 PMCID: PMC9242418 DOI: 10.1002/wjo2.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/24/2021] [Indexed: 11/10/2022] Open
Abstract
Objective To examine referral pattern, the timing of diagnostic/staging processes, and treatment initiation for new head and neck cancer patients in a community setting. Methods Patients with a newly diagnosed previously untreated diagnosis of head neck cancer managed at Asplundh Cancer Pavilion/Abington Memorial Hospital from October 2018 to March 2020. Source of referral and preceding workup were examined as well as intervals between initial head and neck consult and various timepoints of treatment initiation. Results One hundred and five patients were included in the study. The primary referral sources were external general otolaryngology (56.3%). Oral surgery and dermatology obtained tissue biopsy approximately 80% of the time before referral. The average time from the ordering of initial staging positron emission tomography/computed tomography to finalized results was 14 days (range: 10–25 days). Patients referred from dermatology and oral surgery were more likely to require single modality care, namely definitive surgical management. Time to treatment initiation average was 37 days (range: 29–41 days). Patients with longer treatment times noted significantly higher times to both radiation and medical oncology consults (48.42 vs. 18.13 days; P < 0.001). Conclusions No notable differences in treatment initiation times were identified based on referral source or extent of workup performed before head/neck surgery consult. It appears the largest opportunities for improvement in terms of reducing overall treatment length exist in the optimization of radiation initiation time. Head/neck cancer, treatment initiation.
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Affiliation(s)
- Harleen K. Sethi
- Department of Otolaryngology‐Head and Neck Surgery Sidney Kimmel Cancer Center at Abington—Jefferson Health Willow Grove Pennsylvania USA
- Department of Otolaryngology‐Head and Neck Surgery Philadelphia College of Osteopathic Medicine Philadelphia Pennsylvania USA
| | - Elijah Walker
- College of Applied Health Science, University of Illinois at Urbana‐Champaign Urbana Illinois USA
| | - Travis Weinsheim
- Department of Otolaryngology‐Head and Neck Surgery Sidney Kimmel Cancer Center at Abington—Jefferson Health Willow Grove Pennsylvania USA
- Department of Otolaryngology‐Head and Neck Surgery Philadelphia College of Osteopathic Medicine Philadelphia Pennsylvania USA
| | - Matthew J. Brennan
- Department of Otolaryngology‐Head and Neck Surgery Sidney Kimmel Cancer Center at Abington—Jefferson Health Willow Grove Pennsylvania USA
- Department of Otolaryngology‐Head and Neck Surgery Philadelphia College of Osteopathic Medicine Philadelphia Pennsylvania USA
| | - Christopher E. Fundakowski
- Department of Otolaryngology‐Head and Neck Surgery Sidney Kimmel Cancer Center at Abington—Jefferson Health Willow Grove Pennsylvania USA
- Department of Otolaryngology‐Head and Neck Surgery Thomas Jefferson University Hospital Philadelphia Pennsylvania USA
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Schrijvers D, Charlton R. Palliative Care and End-of-Life Issues in Elderly Cancer Patients With Head and Neck Cancer. Front Oncol 2022; 12:769003. [PMID: 35311138 PMCID: PMC8931678 DOI: 10.3389/fonc.2022.769003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
The number of elderly patients with incurable head and neck cancer will increase. They are in need of geriatric palliative care, that takes into account oncology, palliative care and geriatric medicine. In this review of the most recent and relevant literature and includes the expert opinion of the authors, several physical problems (e.g. pain, fatigue, malnutrition, and loco-regional problems) encountered by the elderly head and neck cancer patients are addressed. In addition end-of life issues in this patient population are discussed.
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Affiliation(s)
- Dirk Schrijvers
- Department of Medical Oncology, Ziekenhuisnetwerk Antwerpen, Antwerp, Belgium
- *Correspondence: Dirk Schrijvers,
| | - Rodger Charlton
- Leicester Medical School, College of Life Sciences, University of Leicester, Leicester, United Kingdom
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31
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Transoral robotic surgery for oropharyngeal cancer in the era of chemoradiation therapy. Auris Nasus Larynx 2022; 49:535-546. [DOI: 10.1016/j.anl.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/26/2021] [Accepted: 01/18/2022] [Indexed: 12/26/2022]
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An Overview of Phase 2 Clinical Trial Designs. Int J Radiat Oncol Biol Phys 2022; 112:22-29. [PMID: 34363901 PMCID: PMC8688307 DOI: 10.1016/j.ijrobp.2021.07.1700] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 01/03/2023]
Abstract
Clinical trials are studies to test new treatments in humans. Typically, these treatments are evaluated over several phases to assess their safety and efficacy. Phase 1 trials are designed to evaluate the safety and tolerability of a new treatment, typically with a small number of patients (eg, 20-80), generally spread across several dose levels. Phase 2 trials are designed to determine whether the new treatment has sufficiently promising efficacy to warrant further investigation in a large-scale randomized phase 3 trial, as well as to further assess safety. These studies usually involve a few hundred patients. This article provides an overview of some of the most commonly used phase 2 designs for clinical trials and emphasizes their critical elements and considerations. Key references to some of the most commonly used phase 2 designs are given to allow the reader to explore in more detail the critical aspects when planning a phase 2 trial. A comparison of 3 potential designs in the context of the NRG-HN002 trial is presented to complement the discussion about phase 2 trials.
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Zahid MU, Mohamed ASR, Caudell JJ, Harrison LB, Fuller CD, Moros EG, Enderling H. Dynamics-Adapted Radiotherapy Dose (DARD) for Head and Neck Cancer Radiotherapy Dose Personalization. J Pers Med 2021; 11:jpm11111124. [PMID: 34834476 PMCID: PMC8622616 DOI: 10.3390/jpm11111124] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 12/23/2022] Open
Abstract
Standard of care radiotherapy (RT) doses have been developed as a one-size-fits all approach designed to maximize tumor control rates across a population. Although this has led to high control rates for head and neck cancer with 66-70 Gy, this is done without considering patient heterogeneity. We present a framework to estimate a personalized RT dose for individual patients, based on pre- and early on-treatment tumor volume dynamics-a dynamics-adapted radiotherapy dose (DDARD). We also present the results of an in silico trial of this dose personalization using retrospective data from a combined cohort of n = 39 head and neck cancer patients from the Moffitt and MD Anderson Cancer Centers that received 66-70 Gy RT in 2-2.12 Gy weekday fractions. This trial was repeated constraining DDARD between (54, 82) Gy to test more moderate dose adjustment. DDARD was estimated to range from 8 to 186 Gy, and our in silico trial estimated that 77% of patients treated with standard of care were overdosed by an average dose of 39 Gy, and 23% underdosed by an average dose of 32 Gy. The in silico trial with constrained dose adjustment estimated that locoregional control could be improved by >10%. We demonstrated the feasibility of using early treatment tumor volume dynamics to inform dose personalization and stratification for dose escalation and de-escalation. These results demonstrate the potential to both de-escalate most patients, while still improving population-level control rates.
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Affiliation(s)
- Mohammad U. Zahid
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA;
| | - Abdallah S. R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.S.R.M.); (C.D.F.)
| | - Jimmy J. Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.J.C.); (L.B.H.); (E.G.M.)
| | - Louis B. Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.J.C.); (L.B.H.); (E.G.M.)
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (A.S.R.M.); (C.D.F.)
| | - Eduardo G. Moros
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.J.C.); (L.B.H.); (E.G.M.)
| | - Heiko Enderling
- Department of Integrated Mathematical Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA;
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.J.C.); (L.B.H.); (E.G.M.)
- Correspondence:
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Narvaez C, Schild SE, Rades D. Comparison of Conventional Fractionation and Accelerated Fractionation With Concomitant Boost for Radiotherapy of Non-metastatic Stage IV Head-and-Neck Cancer. In Vivo 2021; 35:411-415. [PMID: 33402490 DOI: 10.21873/invivo.12272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/AIM Some patients with unresectable or incompletely resected head-and-neck cancer (SCCHN) cannot tolerate radiochemotherapy. Alternatives are needed that are more effective than conventional radiotherapy alone. PATIENTS AND METHODS This retrospective study investigated patients irradiated for non-metastatic stage IV SCCHN who could not receive concurrent chemotherapy. Eight patients received accelerated radiotherapy with concomitant boost (group A) and 31 patients conventionally fractionated radiotherapy (group B). Groups were matched for tumor site, gender, age, performance score and histologic grade. RESULTS Two-year PFS-rates were 63% in group A vs. 41% in group B, and median PFS-times were 36 vs. 10 months (p=0.48). Two-year OS-rates were 88% vs. 37%, and median OS-times were 44 vs. 14 months (p=0.19). Grade ≥2 radiation dermatitis was significantly (p=0.040) more common in group B; other toxicities were similar. CONCLUSION Accelerated fractionation with concomitant boost appeared superior to conventional fractionation and can be considered for patients with stage IV SCCHN not suitable for radiochemotherapy. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Carlos Narvaez
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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35
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Poh SS, Soong YL, Sommat K, Lim CM, Fong KW, Tan TW, Chua ML, Wang FQ, Hu J, Wee JT. Retreatment in locally recurrent nasopharyngeal carcinoma: Current status and perspectives. Cancer Commun (Lond) 2021; 41:361-370. [PMID: 33955719 PMCID: PMC8118589 DOI: 10.1002/cac2.12159] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 01/31/2023] Open
Affiliation(s)
- Sharon Shuxian Poh
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Kiattisa Sommat
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Chwee Ming Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Singapore General Hospital, Singapore, 169608.,Surgery Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Terence Wk Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Melvin Lk Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Fu Qiang Wang
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Jing Hu
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
| | - Joseph Ts Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, 169610.,Oncology Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, 169857
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Huang J, Lei L, Chen B, Pan G, Wang X, Fang M. Remarkable Response of Toripalimab Combined with Chemotherapy in Sarcomatoid Carcinoma of Palatine Tonsil: A Case Report. J Multidiscip Healthc 2021; 14:599-604. [PMID: 33727822 PMCID: PMC7955754 DOI: 10.2147/jmdh.s296584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Sarcomatoid carcinoma (SaCa) of the palatine tonsil is a rare and aggressive subset of head and neck (H&N) cancer which is characterized by insensitivity to surgery and radiotherapy and a poor prognosis. Immunotherapy has led advances in the treatment of melanoma and H&N cancer, but the combined effects of immunotherapy and chemotherapy have not been sufficiently investigated. Case Presentation Herein, we report the case of 29-year-old Chinese women with local advanced non-resectable SaCa of the palatine tonsil who exhibited a substantial partial response to toripalimab and chemotherapy followed by radiation therapy. To the best of our knowledge, this is the first report of its successful application in this context. Conclusion Toripalimab combined with chemotherapy may be an effective approach for locally advanced H&N cancer in rare categories of patients, which was the first application as far as we know.
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Affiliation(s)
- Jiahuan Huang
- Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Lei Lei
- Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Bo Chen
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.,Department of Pathology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, People's Republic of China
| | - Guoqiang Pan
- Department of Thoracic Oncology, Wenzhou Medical University, Wenzhou, 325035, People's Republic of China
| | - Xiaojiao Wang
- Department of Breast Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, People's Republic of China.,Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China
| | - Meiyu Fang
- Institute of Cancer and Basic Medicine (IBMC), Chinese Academy of Sciences, Hangzhou, 310022, People's Republic of China.,Department of Medical Oncology of Rare Cancer and Head and Neck Cancer, Cancer Hospital of University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Hangzhou, Zhejiang, 310022, People's Republic of China
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Awan MJ, Gittleman H, Barnholtz-Sloan J, Machtay M, Nguyen-Tan PF, Rosenthal DI, Schultz C, Huth BJ, Thorstad WL, Frank SJ, Kim H, Foote RL, Lango MN, Shenouda G, Suntharalingam M, Harris J, Zhang Q, Le QT, Yao M. Risk groups of laryngeal cancer treated with chemoradiation according to nomogram scores - A pooled analysis of RTOG 0129 and 0522. Oral Oncol 2021; 116:105241. [PMID: 33640577 DOI: 10.1016/j.oraloncology.2021.105241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/05/2021] [Accepted: 02/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To develop nomograms predicting overall survival (OS), freedom from locoregional recurrence (FFLR), and freedom from distant metastasis (FFDM) for patients receiving chemoradiation for laryngeal squamous cell carcinoma (LSCC). MATERIAL AND METHODS Clinical and treatment data for patients with LSCC enrolled on NRG Oncology/RTOG 0129 and 0522 were extracted from the RTOG database. The dataset was partitioned into 70% training and 30% independent validation datasets. Significant predictors of OS, FFLR, and FFDM were obtained using univariate analysis on the training dataset. Nomograms were built using multivariate analysis with four a priori variables (age, gender, T-stage, and N-stage) and significant predictors from the univariate analyses. These nomograms were internally and externally validated using c-statistics (c) on the training and validation datasets, respectively. RESULTS The OS nomogram included age, gender, T stage, N stage, and number of cisplatin cycles. The FFLR nomogram included age, gender, T-stage, N-stage, and time-equivalent biologically effective dose. The FFDM nomogram included age, gender, N-stage, and number of cisplatin cycles. Internal validation of the OS nomogram, FFLR nomogram, and FFDM nomogram yielded c = 0.66, c = 0.66 and c = 0.73, respectively. External validation of these nomograms yielded c = 0.59, c = 0.70, and c = 0.73, respectively. Using nomogram score cutoffs, three risk groups were separated for each outcome. CONCLUSIONS We have developed and validated easy-to-use nomograms for LSCC outcomes using prospective cooperative group trial data.
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Affiliation(s)
- Musaddiq J Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Haley Gittleman
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Jill Barnholtz-Sloan
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Mitchell Machtay
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH, United States
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal Hopital Notre Dame, Montreal, Quebec, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christopher Schultz
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Bradley J Huth
- Department of Radiation Oncology, University of Cincinatti, Cincinatti, OH, United States; Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, United States
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Harold Kim
- Department of Radiation Oncology, Wayne State University, Detroit, MI, United States
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Miriam N Lango
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - George Shenouda
- Department of Radiation Oncology, McGill University Healthcare, Toronto, Ontario, Canada
| | - Mohan Suntharalingam
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, United States
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, United States
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, United States
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, United States
| | - Min Yao
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH, United States
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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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Jacobs CD, Williamson H, Barak I, Rocke DJ, Kahmke RR, Suneja G, Mowery YM. Postoperative radiotherapy is associated with improved overall survival for alveolar ridge squamous cell carcinoma with adverse pathologic features. Head Neck 2021; 43:203-211. [PMID: 32969107 PMCID: PMC9113753 DOI: 10.1002/hed.26475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 08/24/2020] [Accepted: 09/09/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Alveolar ridge squamous cell carcinoma (ARSCC) is poorly represented in randomized trials. METHODS Adults in the National Cancer Database diagnosed with ARSCC between 2010 and 2014 who should be considered for postoperative radiotherapy (PORT) based on National Comprehensive Cancer Network (NCCN)-defined risk factors were identified. RESULTS Eight hundred forty-five (58%) of 1457 patients meeting the inclusion criteria received PORT. PORT was associated with improved overall survival (OS) on unadjusted (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.70-0.98, P = .02) and multivariable (HR 0.78, 95% CI 0.64-0.94, P = .002) analyses. PORT was associated with significantly improved 5-year OS for patients with 1 (68% vs 58%, P < .001), 2 (52% vs 31%, P < .001), and ≥3 (38% vs 24%, P < .001) NCCN-defined risk factors. Prognostic variables significantly associated with worse OS on multivariable analysis included advanced age, primary tumor size ≥3 cm, high grade, positive margin(s), stage N2-3, level IV/V nodal metastasis, and extranodal extension. CONCLUSION PORT for resected ARSCC with adverse pathologic features is associated with significantly improved OS.
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Affiliation(s)
- Corbin D. Jacobs
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Hannah Williamson
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Ian Barak
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Daniel J. Rocke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Russel R. Kahmke
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina
| | - Gita Suneja
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Yvonne M. Mowery
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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40
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Xin W, Ding H, Fang Q, Zheng X, Tong Y, Xu G, Yang G. Cost-effectiveness of pembrolizumab for treatment of platinum-resistant recurrent or metastatic head and neck squamous cell carcinoma in China: an economic analysis based on a randomised, open-label, phase III trial. BMJ Open 2020; 10:e038867. [PMID: 33371020 PMCID: PMC7751211 DOI: 10.1136/bmjopen-2020-038867] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Pembrolizumab was recently demonstrated to have survival benefit in patients with recurrent or metastatic head and neck squamous cell carcinoma (r/mHNSCC). However, the cost-effectiveness of pembrolizumab versus chemotherapy in China remains uncertain. OBJECTIVE This analysis aimed to describe the cost-effectiveness of pembrolizumab versus standard-of-care (SOC) therapy in r/mHNSCC in China. DESIGN A Markov model consisting of three health states (stable, progressive and dead) was developed to compare the cost and effectiveness of pembrolizumab with SOC in platinum-resistant r/mHNSCC. Model inputs for transition probabilities and toxicity were collected from the KEYNOTE-040 trial, while health utilities were estimated from a literature review. Cost data were acquired for the payer's perspective in China. Costs and outcomes were discounted at an annual rate of 3.0%. Sensitivity analyses were conducted to test the uncertainties surrounding model parameters. OUTCOME MEASURES The primary outcome was incremental cost-effectiveness ratios (ICERs), which were calculated as the cost per quality-adjusted life years (QALYs). RESULTS The total mean cost of pembrolizumab and SOC was US$45 861 and US$41 950, respectively. As for effectiveness, pembrolizumab yielded 0.31 QALYs compared with 0.25 QALYs for SOC therapy. The ICER for pembrolizumab versus SOC was US$65 186/QALY, which was higher than the willingness-to-pay threshold (WTP) of US$28 130/QALY in China. The univariate sensitivity analysis indicated that utility values for progressive state, probability from stable to progressive in the SOC group, as well as cost of pembrolizumab were the three most influential variables on ICER. The probabilistic sensitivity analysis demonstrated that standard therapy was more likely to be cost-effective compared with pembrolizumab at a WTP value of US$28 130/QALY. Results were robust across both univariate analysis and probabilistic sensitivity analysis. CONCLUSIONS Pembrolizumab is not likely to be a cost-effective strategy compared with SOC therapy in patients with platinum-resistant r/mHNSCC in China. TRIAL REGISTRATION NUMBER NCT02252042; Post-results.
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Affiliation(s)
- Wenxiu Xin
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Haiying Ding
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Qilu Fang
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Xiaowei Zheng
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yinghui Tong
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Gaoqi Xu
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Guonong Yang
- Department of Pharmacy, The Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Institute of Basic Medicine and Cancer(IBMC),Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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Dahlstrom KR, Song J, Thall PF, Fuller CD, Hutcheson KA, Johnson FM, Gunn GB, Phan J, Frank SJ, Morrison WH, Ferrarotto R, Rosenthal DI, Sturgis EM, Garden AS. Conditional survival among patients with oropharyngeal cancer treated with radiation therapy and alive without recurrence 5 years after diagnosis. Cancer 2020; 127:1228-1237. [PMID: 33306202 DOI: 10.1002/cncr.33370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND Risk of recurrence among patients with oropharyngeal cancer (OPC) who survive 5 years is low. The goal of this study was to assess long-term survival of patients with OPC alive without recurrence 5 years after diagnosis. METHODS This study included newly diagnosed patients with OPC, who had been treated with radiation and were alive without recurrence 5 years after diagnosis. Overall survival (OS) probabilities beyond 5 years were estimated using the Kaplan-Meier method. Factors associated with OS were determined using Bayesian piecewise exponential survival regression. Standardized mortality ratios for all-cause death were estimated controlling for study year, age, and sex in the US general population. RESULTS Among 1699 patients, the additional 2-year, 5-year, and 10-year OS probabilities were 94%, 83%, and 63%, respectively, and were lower than those in the general population. Patients who were older, were current or former smokers, had other than tonsil or base of tongue tumors, or had T4 tumors had a higher risk of death. Patients who had base of tongue tumors and had received intensity-modulated radiation therapy (IMRT) or lower-radiation doses had a lower risk of death. Standardized mortality ratios were higher among current and heavy smokers and lower among recipients of IMRT and lower radiation doses. CONCLUSIONS In this large cohort, long-term survival among patients with OPC was good but lower than predicted for the general population. Patients treated with IMRT and those with less tobacco exposure had better outcomes.
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Affiliation(s)
- Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter F Thall
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- 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
| | - Faye M Johnson
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,University of Texas Graduate School of Biomedical Sciences, Houston, Texas
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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42
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Anandhi P, Sharief RM, Rahila C. The Benefit of Zinc Sulfate in Oropharyngeal Mucositis during Hyperfractionated Accelerated Concomitant Boost Radiotherapy with Concurrent Cisplatin for Advanced-Stage Oropharyngeal and Hypopharyngeal Cancers. Indian J Palliat Care 2020; 26:437-443. [PMID: 33623304 PMCID: PMC7888420 DOI: 10.4103/ijpc.ijpc_20_20] [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: 01/27/2020] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Radiation-induced oropharyngeal mucositis is a major problem causing widespread clinical symptoms and may interfere with treatment plans, ultimately jeopardizing patient outcome. Zinc supplementation may be considered beneficial in preventing acute toxicity during chemoradiation. Aims and Objective: The aim of the study is to determine the effect of zinc supplementation on radiation-induced oropharyngeal mucositis in Stage III and IV-A oropharynx and hypopharynx cancers treated by hyperfractionated accelerated concomitant boost radiotherapy with weakly cisplatin. The objective behind the study is to know any changes in the onset, duration, and severity of oropharyngeal mucositis by implementation of oral zinc sulfate. Materials and Methods: The study is double-blinded randomized controlled assessment involving 120 patients (60 – control and 60 – experimental) treated with chemoradiation for oropharyngeal and hypopharyngeal cancers. The experimental group received oral zinc sulfate 150 mg once daily during and after treatment, whereas the control group patients were given placebo. The categorical data were analyzed using the Chi-square test and Pearson correlation. The Friedman test was used for comparison of oral mucositis grading between the groups. Results: A statistically significant difference was found in the zinc-supported experimental group showing delay in onset, decrease in severity, and duration of oropharyngeal mucositis. Conclusion: Zinc supplementation could be beneficial in managing oropharyngeal mucositis during chemoradiation of head-and-neck cancers with no untoward side effects.
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Affiliation(s)
- P Anandhi
- Department of Radiation Oncology,Government Arignar Anna Memorial Cancer Institute, Kanchipuram, Tamil Nadu, India.,Affiliated to the Tamil Nadu Dr. MGR Medical University, Kanchipuram, Tamil Nadu, India
| | - Rahamathulla Mudassar Sharief
- Affiliated to the Tamil Nadu Dr. MGR Medical University, Kanchipuram, Tamil Nadu, India.,Department of Dental Surgery, Government Arignar Anna Memorial Cancer Institute, Kanchipuram, Tamil Nadu, India
| | - C Rahila
- Department of Public Health Dentistry, Statistical Analysis, Vivekananda Dental College for Women, Namakkal, Tamil Nadu, India
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Svajdova M, Dubinsky P, Kazda T. Radical external beam re-irradiation in the treatment of recurrent head and neck cancer: Critical review. Head Neck 2020; 43:354-366. [PMID: 32996265 DOI: 10.1002/hed.26485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/28/2020] [Accepted: 09/21/2020] [Indexed: 11/09/2022] Open
Abstract
Management of patients with recurrent head and neck cancer remains a challenge for the surgeon as well as the treating radiation oncologist. Even in the era of modern radiotherapy, the rate of severe toxicity remains high with unsatisfactory treatment results. Intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and heavy-ion irradiation have all emerged as highly conformal and precise techniques that offer many radiobiological advantages in various clinical situations. Although re-irradiation is now widespread in clinical practice, little is known about the differences in treatment response and toxicity using diverse re-irradiation techniques. In this review, we provide a comprehensive overview of the role of radiation therapy in recurrent or second primary head and neck cancer including patient selection, therapeutic outcome, and risk using different re-irradiation techniques. Critical review of published evidence on IMRT, SBRT, and heavy-ion full-dose re-irradiation is presented including data on locoregional control, overall survival, and toxicity.
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Affiliation(s)
- Michaela Svajdova
- Clinic of Radiation and Clinical Oncology, Central Military Hospital-Teaching Hospital Ruzomberok, Slovakia.,Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pavol Dubinsky
- Department of Radiation Oncology, East Slovakia Oncology Institute, Kosice, Slovakia.,Faculty of Health, Catholic University, Ruzomberok, Slovakia
| | - Tomas Kazda
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Research Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
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44
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Mendenhall WM, Strojan P, Lee AWM, Rinaldo A, Eisbruch A, Ng WT, Smee R, Ferlito A. Radiotherapy in the management of glottic squamous cell carcinoma. Head Neck 2020; 42:3558-3567. [PMID: 32896071 DOI: 10.1002/hed.26419] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/01/2020] [Accepted: 07/28/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Our purpose is to review the role radiotherapy (RT) in the treatment of glottic squamous cell carcinoma (SCC). METHODS A concise review of the pertinent literature. RESULTS RT cure rates are Tis- T1N0, 90% to 95%; T2N0, 70% to 80%; low-volume T3-T4a, 65% to 70%. Concomitant cisplatin is given for T3-T4a SCCs. Severe complications occur in 1% to 2% for Tis-T2N0 and 10% for T3-T4a SCCs. Patients with high-volume T3-T4 SCCs undergo total laryngectomy, neck dissection, and postoperative RT. Those with positive margins and/or extranodal extension receive concomitant cisplatin. The likelihood of local-regional control at 5 years is 85% to 90%. Severe complications occur in 5% to 10%. CONCLUSIONS RT is a good treatment option for patients with Tis-T2N0 and low-volume T3-T4a glottic SCCs. Patients with higher volume T3-T4 cancers are best treated with surgery and postoperative RT.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Anne W M Lee
- Department of Clinical Oncology, University of Hong Kong Shenzhen Hospital, University of Hong Kong, Hong Kong, China
| | | | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Wai Tong Ng
- Department of Clinical Oncology, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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45
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De Felice F, Bonomo P, Sanguineti G, Orlandi E. Moderately accelerated intensity-modulated radiation therapy using simultaneous integrated boost: Practical reasons or evidence-based choice? A critical appraisal of literature. Head Neck 2020; 42:3405-3414. [PMID: 32767530 DOI: 10.1002/hed.26400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/29/2020] [Accepted: 07/14/2020] [Indexed: 01/03/2023] Open
Abstract
Concurrent chemo-radiotherapy is the non-surgical mainstay of treatment for locally advanced head and neck squamous cell carcinoma (HNSCC). The following aspects have emerged as fundamental components of the combined approach: first, intensity modulated radiotherapy (IMRT) is the minimum standard technical requirement, with level 1 evidence in support of its reduction of late treatment-induced morbidity in comparison with 3D conformal radiotherapy. Second, cisplatin-based chemotherapy is the preferred systemic agent to be associated with radiation, with 100 mg/m2 every 3 weeks deemed as the reference schedule. Because of significant progress in irradiation techniques achieved in last 15 years, the optimal fractionation schedule in modern radiation era remains controversial, especially for locally advanced disease. The purpose of this work was to perform a critical review on the value of moderately accelerated IMRT using simultaneous-integrated boost (SIB) in HNSCC, aiming to provide insights on current clinical practice and directions for future research.
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Affiliation(s)
- Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | | | - Ester Orlandi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Lee J, Kim TH, Kim YS, Kim M, Park JW, Kim SH, Kim HJ, Lee CG. Intensity-Modulated Radiotherapy-Based Reirradiation for Head and Neck Cancer: A Multi-institutional Study by Korean Radiation Oncology Group (KROG 1707). Cancer Res Treat 2020; 52:1031-1040. [PMID: 32632081 PMCID: PMC7577818 DOI: 10.4143/crt.2020.310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose The benefits of reirradiation for head and neck cancer (HNC) have not been determined. This study evaluated the efficacy of reirradiation using intensity-modulated radiotherapy (IMRT) for recurrent or second primary HNC (RSPHNC) and identified subgroups for whom reirradiation for RSPHNC is beneficial. Materials and Methods A total of 118 patients from seven Korean institutions with RSPHNC who underwent IMRT-based reirradiation between 2006 and 2015 were evaluated through retrospective review of medical records. We assessed overall survival (OS) and local control (LC) within the radiotherapy (RT) field following IMRT-based reirradiation. Additionally, the OS curve according to the recursive partitioning analysis (RPA) suggested by the Multi-Institution Reirradiation (MIRI) Collaborative was determined. Results At a median follow-up period of 18.5 months, OS at 2 years was 43.1%. In multivariate analysis, primary subsite, recurrent tumor size, interval between RT courses, and salvage surgery were associated with OS. With regard to the MIRI RPA model, the class I subgroup had a significantly higher OS than class II or III subgroups. LC at 2 years was 53.5%. Multivariate analyses revealed that both intervals between RT courses and salvage surgery were prognostic factors affecting LC. Grade 3 or more toxicity and grade 5 toxicity rates were 8.5% and 0.8%, respectively. Conclusion IMRT-based reirradiation was an effective therapeutic option for patients with RSPHNC, especially those with resectable tumors and a long interval between RT courses. Further, our patients' population validated the MIRI RPA classification by showing the difference of OS according to MIRI RPA class.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Tae Hyung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Yeon-Sil Kim
- Department of Radiation Oncology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Myungsoo Kim
- Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, Korea
| | - Sung Hyun Kim
- Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hyun Ju Kim
- Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea
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Razavi CR, Hostetter J, Shukla A, Cheng Z, Aygun N, Boahene K, Byrne PJ, Richmon J, Quon H, Desai SC. Predictors of Free Flap Volume Loss in Nonosseous Reconstruction of Head and Neck Oncologic Defects. EAR, NOSE & THROAT JOURNAL 2020; 101:48-53. [PMID: 32633655 DOI: 10.1177/0145561320938903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Free tissue reconstruction of the head and neck must be initially overcorrected due to expected postoperative free flap volume loss, which can be accelerated by adjuvant radiation therapy. In this study, we aim to identify patient and treatment-specific factors that may significantly contribute to this phenomenon and translate these characteristics into a predictive model for expected percent free flap volume loss in a given patient. METHODS Patients with a history of oral cavity and/or oropharyngeal cancer who underwent nonosseous free flap reconstruction were reviewed between January 2009 and November 2018 at a tertiary care center. Demographics/characteristics, total radiation dose, radiation fractionation (RF), and pre/postradiation free flap volume as evaluated by computed tomography imaging were collected. Free flap volume was measured by a fellowship-trained neuroradiologist in all cases. Only patients receiving adjuvant radiotherapy with available pre/postradiation imaging were included. Multivariable linear regression modeling for prediction of free flap volume loss was performed with optimization via stepwise elimination. RESULTS Thirty patients were included for analysis. Mean flap volume loss was 42.7% ± 17.4%. The model predicted flap volume loss in a significant fashion (P = .004, R2 = 0.49) with a mean magnitude of error of 9.8% ± 7.5%. Age (β = 0.01, P = .003) and RF (β = -0.01, P = .009) were individual predictors of flap volume loss. CONCLUSIONS Our model predicts percent free flap volume loss in a significant fashion. Age and RF are individual predictors of free flap volume loss, the latter being a novel finding that is also modifiable through hyperfractionation radiotherapy schedules.
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Affiliation(s)
- Christopher R Razavi
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jason Hostetter
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Aishwarya Shukla
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nafi Aygun
- Division of Neuroradiology, Department of Radiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kofi Boahene
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Patrick J Byrne
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, USA
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Shaun C Desai
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
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Green M, Van Nest SJ, Soisson E, Huber K, Liao Y, McBride W, Dominello MM, Burmeister J, Joiner MC. Three discipline collaborative radiation therapy (3DCRT) special debate: We should treat all cancer patients with hypofractionation. J Appl Clin Med Phys 2020; 21:7-14. [PMID: 32602186 PMCID: PMC7324689 DOI: 10.1002/acm2.12954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Michael Green
- Department of Radiation OncologyUniversity of MichiganAnn ArborMIUSA
| | | | - Emilie Soisson
- Department of RadiologyUniversity of VermontBurlingtonVTUSA
| | - Kathryn Huber
- Department of Radiation OncologyTufts Medical CenterBostonMAUSA
| | - Yixiang Liao
- Department of Radiation OncologyRush University Medical CenterChicagoILUSA
| | - William McBride
- Department of Radiation OncologyUniversity of California at Los Angeles (UCLA)Los AngelesCAUSA
| | | | - Jay Burmeister
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
- Gershenson Radiation Oncology CenterBarbara Ann Karmanos Cancer InstituteDetroitMIUSA
| | - Michael C. Joiner
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
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49
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Zhai TT, Langendijk JA, van Dijk LV, van der Schaaf A, Sommers L, Vemer-van den Hoek JGM, Bijl HP, Halmos GB, Witjes MJH, Oosting SF, Noordzij W, Sijtsema NM, Steenbakkers RJHM. Pre-treatment radiomic features predict individual lymph node failure for head and neck cancer patients. Radiother Oncol 2020; 146:58-65. [PMID: 32114267 DOI: 10.1016/j.radonc.2020.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/26/2019] [Accepted: 02/09/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE To develop and validate a pre-treatment radiomics-based prediction model to identify pathological lymph nodes (pLNs) at risk of failures after definitive radiotherapy in head and neck squamous cell carcinoma patients. MATERIALS AND METHODS Training and validation cohorts consisted of 165 patients with 558 pLNs and 112 patients with 467 pLNs, respectively. All patients were primarily treated with definitive radiotherapy, with or without systemic treatment. The endpoint was the cumulative incidence of nodal failure. For each pLN, 82 pre-treatment CT radiomic features and 7 clinical features were included in the Cox proportional-hazard analysis. RESULTS There were 68 and 23 nodal failures in the training and validation cohorts, respectively. Multivariable analysis revealed three clinical features (T-stage, gender and WHO Performance-status) and two radiomic features (Least-axis-length representing nodal size and gray level co-occurrence matrix based - Correlation representing nodal heterogeneity) as independent prognostic factors. The model showed good discrimination with a c-index of 0.80 (0.69-0.91) in the validation cohort, significantly better than models based on clinical features (p < 0.001) or radiomics (p = 0.003) alone. High- and low-risk groups were defined by using thresholds of estimated nodal failure risks at 2-year of 60% and 10%, resulting in positive and negative predictive values of 94.4% and 98.7%, respectively. CONCLUSION A pre-treatment prediction model was developed and validated, integrating the quantitative radiomic features of individual lymph nodes with generally used clinical features. Using this prediction model, lymph nodes with a high failure risk can be identified prior to treatment, which might be used to select patients for intensified treatment strategies targeted on individual lymph nodes.
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Affiliation(s)
- Tian-Tian Zhai
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands; Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China.
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Lisanne V van Dijk
- 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
| | - Linda Sommers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | | | - Henk P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Max J H Witjes
- Department of Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Nanna M Sijtsema
- 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
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Mashhour K, Atef H, Selim A, A Moez M, Zawam H, Abo-Madyan Y. Accelerated Radiotherapy with Concurrent Chemotherapy in Locally Advanced Head and Neck Cancers: Evaluation of Response and Compliance. Asian Pac J Cancer Prev 2020; 21:1399-1407. [PMID: 32458648 PMCID: PMC7541886 DOI: 10.31557/apjcp.2020.21.5.1399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Concurrent chemo-radiotherapy (CCRT) is the primary treatment modality for locally advanced head and neck squamous cell cancer patients (LAHNSCC). Intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) and concurrent chemotherapy is not broadly implicated in our region mainly because of the lack of experience. This study aims at evaluating the response and compliance of this approach in our patients. METHODS Forty patients with LAHNSCC were included and 50% received induction chemotherapy. All the patients were treated with IMRT-SIB radiotherapy for 70Gy over 33 daily fractions. Weekly cisplatin (40mg/m2) was administered during the radiation course. RESULTS With median follow-up of 1.5 years, LC was achieved in 82.5% of cases and distant control rate was 90%. More than 5 interrupted radiation sessions and GTV volume > 50 cc significantly affected LRC (P= 0.02 and 0.001 respectively). Eighty percent of cases experienced grade 3 or 4 toxicities. Induction chemotherapy and PTV-70 volume >150 cc significantly affected the degree of toxicities (P=0.018 and 0.0001 respectively).The 2 years disease free survival (DFS) was 77%. ECOG PS, large GTV volume (> 50 cc) and RT interruption (>5 sessions) had negative impact on DFS (P= 0.041, 0.002 and 0.001 respectively). The 2 years overall survival (OS) was 87%. Radiation interruption (> 5 sessions) was the only factor which had significant detrimental effect on OS (P= 0.001). CONCLUSION Induction chemotherapy seems to have a negative impact on patient's compliance to CCRT. Bulky tumors and prolonged radiation interruptions were associated with significantly lower LRC, DFS and OS.
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Affiliation(s)
- Karim Mashhour
- Kasralainy Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
| | - Hisham Atef
- Kasralainy Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Selim
- Kasralainy Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
| | - Mostafa A Moez
- Physics department at Kasralainy Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
| | - Hussam Zawam
- Kasralainy Center of Clinical Oncology and Nuclear Medicine, Cairo University, Cairo, Egypt
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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