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Weng JJ, Wei JZ, Li M, Ning LP, Liu F, Wei YZ, Xiong WM, Zhang BJ, Lu JL, Jiang H, Lu QT, Qu SH. Prognostic value of hypothyroidism in patients undergoing intensity-modulated radiation therapy for nasopharyngeal carcinoma. Head Neck 2022; 44:1114-1123. [PMID: 35170140 DOI: 10.1002/hed.27006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 11/09/2021] [Accepted: 02/08/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effect of hypothyroidism and thyroxine replacement therapy on the prognosis of nasopharyngeal carcinoma (NPC) patients. METHODS The clinical data of 284 NPC patients, who received intensity-modulated radiation therapy (IMRT) between January 2011 and December 2016, were retrospectively analyzed. RESULTS Hypothyroidism occurred in 38% of patients. Patients with hypothyroidism had significantly better disease-free survival (DFS) (p = 0.002) and relapse-free survival (RFS) (p = 0.008). Multivariate analysis showed that hypothyroidism was a positive independent prognostic factor (DFS and RFS). Among the patients with hypothyroidism, thyroxine replacement therapy did not yield inferior survival (DFS, RFS, all p > 0.05). CONCLUSIONS The NPC patients with complete response are at risk of hypothyroidism, which is attributable to escalating dose. These patients experienced clinical hypothyroidism could be adequately treated with thyroid hormone replacement. Further investigation of the underlying biological mechanism and potential therapeutic implications are required.
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Affiliation(s)
- Jing-Jin Weng
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jia-Zhang Wei
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Min Li
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Le-Ping Ning
- Department of Laboratory Medicine, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Fei Liu
- Research Center of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Yun-Zhong Wei
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Wei-Ming Xiong
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Ben-Jian Zhang
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Jin-Long Lu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - He Jiang
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Qiu-Tian Lu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
| | - Shen-Hong Qu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences, Nanning, China
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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7
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Nekhlyudov L, Lacchetti C, Davis NB, Garvey TQ, Goldstein DP, Nunnink JC, Ninfea JIR, Salner AL, Salz T, Siu LL. Head and Neck Cancer Survivorship Care Guideline: American Society of Clinical Oncology Clinical Practice Guideline Endorsement of the American Cancer Society Guideline. J Clin Oncol 2017; 35:1606-1621. [PMID: 28240970 DOI: 10.1200/jco.2016.71.8478] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose This guideline provides recommendations on the management of adults after head and neck cancer (HNC) treatment, focusing on surveillance and screening for recurrence or second primary cancers, assessment and management of long-term and late effects, health promotion, care coordination, and practice implications. Methods ASCO has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. The American Cancer Society (ACS) HNC Survivorship Care Guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel reviewed the content and recommendations, offering modifications and/or qualifying statements when deemed necessary. Results The ASCO Expert Panel determined that the ACS HNC Survivorship Care Guideline, published in 2016, is clear, thorough, clinically practical, and helpful, despite the limited availability of high-quality evidence to support many of the recommendations. ASCO endorsed the ACS HNC Survivorship Care Guideline, adding qualifying statements aimed at promoting team-based, multispecialty, multidisciplinary, collaborative head and neck survivorship care. Recommendations The ASCO Expert Panel emphasized that caring for HNC survivors requires a team-based approach that includes primary care clinicians, oncology specialists, otolaryngologists, dentists, and other allied professionals. The HNC treatment team should educate the primary care clinicians and patients about the type(s) of treatment received, the likelihood of potential recurrence, and the potential late and long-term complications. Primary care clinicians should recognize symptoms of recurrence and coordinate a prompt evaluation. They should also be prepared to manage late effects either directly or by referral to appropriate specialists. Health promotion is critical, particularly regarding tobacco cessation and dental care. Additional information is available at www.asco.org/HNC-Survivorship-endorsement and www.asco.org/guidelineswiki .
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Affiliation(s)
- Larissa Nekhlyudov
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Christina Lacchetti
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy B Davis
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thomas Q Garvey
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David P Goldstein
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - J Chris Nunnink
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jose I Ruades Ninfea
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrew L Salner
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Talya Salz
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lillian L Siu
- Larissa Nekhlyudov, Brigham & Women's Hospital, Harvard Medical School, Boston; Thomas Q. Garvey, Harvard Vanguard Medical Associates, Billerica, MA; Christina Lacchetti, American Society of Clinical Oncology, Alexandria VA; Nancy B. Davis, Aurora Cancer Care, Green Bay, WI; David P. Goldstein and Lillian L. Siu, Princess Margaret Cancer Centre, Toronto, Canada; J. Chris Nunnink and Jose I. Ruades Ninfea, University of Vermont, Burlington, VT; Andrew L. Salner, Hartford Hospital, Hartford, CT; and Talya Salz, Memorial Sloan Kettering Cancer Center, New York, NY
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