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Jin YN, Xiao ZW, Yao W, Yu J, Zhang WJ, Marks T, Zhang HY, Yao JJ, Xia LP. Neoadjuvant chemotherapy plus concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in elderly patients with stage III-IVa nasopharyngeal carcinoma: A real-world study based on medical comorbidities. Head Neck 2024; 46:2020-2030. [PMID: 38366693 DOI: 10.1002/hed.27689] [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: 05/29/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024] Open
Abstract
PURPOSE To evaluate the outcomes and toxicities of adding neoadjuvant chemotherapy (NAC) to concurrent chemoradiotherapy (CCRT) in elderly (≥65 years) patients with locoregionally advanced nasopharyngeal carcinoma (LANPC, stage III-IVa). METHODS AND MATERIALS Using an NPC-specific database, 245 elderly patients with stage III-IVa NPC, receiving CCRT +/- NAC, and an Adult Co-morbidity Evaluation 27 (ACE-27) score <2 were included. Recursive partitioning analysis (RPA) based on TNM stage and Epstein-Barr virus (EBV) DNA were applied for risk stratification. The primary end point was disease-free survival (DFS). RESULTS Two risk groups were generated by the RPA model. In the high-risk group (EBV DNA < 4000 copy/ml with stage IVa & EBV DNA ≥4000 copy/ml with stage III-IVa), patients treated with NAC plus CCRT achieved improved 5-year DFS rates compared to those who received CCRT alone (56.9% vs. 29.4%; p = 0.003). But we failed to observe the survival benefit of additional NAC in the low-risk group (EBV DNA <4000 copy/ml with stage III). The most common severe acute toxic effects were leucopenia (46.8% vs. 24.4%) and neutropenia (43.7% vs. 20.2%) in the NAC plus CCRT group versus CCRT group with statistically significant differences. CONCLUSIONS The addition of NAC to CCRT was associated with better DFS for the high-risk group of elderly LANPC patients with ACE-27 score <2. However, the survival benefit of additional NAC was not observed in low-risk patients.
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Affiliation(s)
- Ya-Nan Jin
- VIP Region, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Zhi-Wen Xiao
- Department of Otolaryngology Head and Neck Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wei Yao
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Jing Yu
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Wang-Jian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tia Marks
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, USA
| | - Hong-Yu Zhang
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Ji-Jin Yao
- The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Liang-Ping Xia
- VIP Region, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China
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Chaowchuen S, Warin K, Somyanonthanakul R, Panichkitkosolkul W, Suebnukarn S. The Discovery of Oral Cancer Prognostic Factor Ranking Using Association Rule Mining. Eur J Dent 2024; 18:907-917. [PMID: 38744326 PMCID: PMC11290937 DOI: 10.1055/s-0043-1777050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVE A 5-year survival rate is a predictor for the assessment of oral cancer prognosis. The purpose of this study is to analyze oral cancer data to discover and rank the prognostic factors associated with oral cancer 5-year survival using the association rule mining (ARM) technique. MATERIALS AND METHODS This study is a retrospective analysis of 897 oral cancer patients from a regional cancer center between 2011 and 2017. The 5-year survival rate was assessed. The multivariable Cox proportional hazards analysis was performed to determine prognostic factors. ARM was applied to clinicopathologic and treatment modalities data to identify and rank the prognostic factors associated with oral cancer 5-year survival. RESULTS The 5-year overall survival rate was 35.1%. Multivariable Cox proportional hazards analysis showed that tumor (T) stage, lymph node metastasis, surgical margin, extranodal extension, recurrence, and distant metastasis of tumor were significantly associated with overall survival rate (p < 0.05). The top associated death within 5 years rule was positive extranodal extension, followed by positive perineural and lymphovascular invasion, with confidence levels of 0.808, 0.808, and 0.804, respectively. CONCLUSION This study has shown that extranodal extension, and perineural and lymphovascular invasion were the top ranking and major deadly prognostic factors affecting the 5-year survival of oral cancer.
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Affiliation(s)
| | - Kritsasith Warin
- Faculty of Dentistry, Thammasat University, Pathum Thani, Thailand
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Alem T, Nigatu D, Birara A, Fetene T, Giza M. Quality of life of breast cancer patients in Amhara region, Ethiopia: A cross-sectional study. PLoS One 2024; 19:e0305263. [PMID: 38935776 PMCID: PMC11210875 DOI: 10.1371/journal.pone.0305263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/28/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Although breast cancer has a markedly higher incidence in developed countries, seven out of ten deaths occur in developing countries, including Ethiopia. However, there is a limited information on the quality of life (QoL) among breast cancer patients in Ethiopia, notably in the Amhara region. Therefore, this study aimed to assess the QoL and its associated factors among patients with breast cancer in the Amhara Region, Ethiopia. METHODS An institutional based cross-sectional study was conducted from 25th March 2019 to 7th July 2019. A systematically selected sample of 256 breast cancer patients were participated in the study. A standardized interviewer-administered Amharic version questionnaire was used to collect the data. We used the European Organization for Research and Treatment of Cancer quality of life questionnaire core 30 (EORTC QLQ C30) and breast cancer supplementary measure (QLQ-BR23) to measure QoL. The data were analyzed by SPSS version 23. A binary logistic regression model was fitted to identify the predictors of QoL. The adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported to show the strength of the association. RESULTS Sixty-eight percent of breast cancer patients had poor QoL (68.4%; 95% CI: 62.5-73.8). The mean score of QoL was 70.6 (standard deviation (SD) ±13.9; 95% CI: 69.0-72.4). All functional component scores were less than 75 on the symptom scale. Diarrhea (11.6), constipation (17.5), and dyspnea (24.7) were less noticeable symptoms. Being out of marriage (AOR = 2.59, 95% CI: 1.32-5.07), being poor (AOR = 2.39, 95%CI: 1.32-5.03), being non-housewife (AOR = 3.25, 95% CI: 1.16-7.22), and being complaints of dyspnea (AOR = 3.48, 95% CI: 1.79-6.79), and insomnia (AOR = 2.03, 95% CI: 1.05-3.91) were significantly associated with QoL. CONCLUSIONS The proportion of poor QoL among breast cancer patients was high. Health care professionals should give attention to breast cancer patients who are out of marriage, poor and non-housewife while offering the recommended treatment courses.
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Affiliation(s)
- Tamrat Alem
- Felege Hiwot Regional Referral Hospital, Bahir Dar, Ethiopia
| | - Dabere Nigatu
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amsalu Birara
- Department of Environment Health Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tamene Fetene
- Department of Pediatrics Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Mastewal Giza
- Department of Nutrition, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia
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Xu XL, Xu JH, He JQ, Li YH, Cheng H. Novel prognostic nomograms for postoperative patients with oral cavity squamous cell carcinoma in the central region of China. BMC Cancer 2024; 24:730. [PMID: 38877437 PMCID: PMC11177417 DOI: 10.1186/s12885-024-12465-6] [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: 01/24/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Oral cavity squamous cell carcinoma (OCSCC) is the most common pathological type in oral tumors. This study intends to construct a novel prognostic nomogram model based on China populations for these resectable OCSCC patients, and then validate these nomograms. METHODS A total of 607 postoperative patients with OCSCC diagnosed between June 2012 and June 2018 were obtained from two tertiary medical institutions in Xinxiang and Zhengzhou. Then, 70% of all the cases were randomly assigned to the training group and the rest to the validation group. The endpoint time was defined as overall survival (OS) and disease-free survival (DFS). The nomograms for predicting the 3-, and 5-year OS and DFS in postoperative OCSCC patients were established based on the independent prognostic factors, which were identified by the univariate analysis and multivariate analysis. A series of indexes were utilized to assess the performance and net benefit of these two newly constructed nomograms. Finally, the discrimination capability of OS and DFS was compared between the new risk stratification and the American Joint Committee on Cancer (AJCC) stage by Kaplan-Meier curves. RESULTS 607 postoperative patients with OCSCC were selected and randomly assigned to the training cohort (n = 425) and validation cohort (n = 182). The nomograms for predicting OS and DFS in postoperative OCSCC patients had been established based on the independent prognostic factors. Moreover, dynamic nomograms were also established for more convenient clinical application. The C-index for predicting OS and DFS were 0.691, 0.674 in the training group, and 0.722, 0.680 in the validation group, respectively. Besides, the calibration curve displayed good consistency between the predicted survival probability and actual observations. Finally, the excellent performance of these two nomograms was verified by the NRI, IDI, and DCA curves in comparison to the AJCC stage system. CONCLUSION The newly established and validated nomograms for predicting OS and DFS in postoperative patients with OCSCC perform well, which can be helpful for clinicians and contribute to clinical decision-making.
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Affiliation(s)
- Xue-Lian Xu
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Jin-Hong Xu
- Department of Otolaryngology, AnYang District Hospital, Anyang, 455000, Henan, China
| | - Jia-Qi He
- Department of Radiotherapy Oncology, Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, 450000, Henan, China
| | - Yi-Hao Li
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China
| | - Hao Cheng
- Department of Radiotherapy Oncology, The First Affiliated Hospital of Xinxiang Medical University, 88 Jiankang Road, Xinxiang, 453100, Henan, China.
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Rodrigues-Oliveira L, Rivera C, López-Cortés XA, Mak MP, Mores AL, Migliorati CA, Querido de Oliveira MC, Palmier NR, Gueiros LA, Vargas PA, Brandão TB, Santos-Silva AR, Prado-Ribeiro AC. Prospective Cohort Study Identifies Medical Predictors of Treatment-Related Oral Toxicities in Oral and Oropharyngeal Cancer Patients. Dent J (Basel) 2024; 12:89. [PMID: 38668001 PMCID: PMC11049634 DOI: 10.3390/dj12040089] [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: 11/28/2023] [Revised: 12/31/2023] [Accepted: 01/29/2024] [Indexed: 04/28/2024] Open
Abstract
The dental treatment of patients with oral cavity and oropharyngeal squamous cell carcinoma (OOPSCC) may be challenging for dentists. This study aimed to characterize systemic changes in patients with OOPSCC undergoing dental treatment prior to cancer therapy, with a specific focus on laboratory assessments. The primary objectives included identifying potential adverse events, such as infections or bleeding, resulting from dental procedures. Additionally, the study aimed to correlate baseline patient characteristics with treatment-related toxicities. This was a prospective cohort study that included 110 OOPSCC patients referred to the Dental Oncology Service at São Paulo State Cancer Institute, Brazil, between November/2019 and December/2020. Comorbidities, sociodemographic data, medication in use, cancer treatment-related toxicities, and altered laboratory tests results were correlated. The most common comorbidities and altered laboratory results were hypertension, dyslipidemia, diabetes, as well as elevated levels of C-reactive protein, hemoglobin, and hematocrit. Toxicities exhibited a progressive pattern over time, encompassing oral mucositis (OM), xerostomia, dysphagia, dysgeusia, trismus, and radiodermatitis. No correlation between comorbidities and cancer treatment-related toxicities, a positive correlation between medications in use and OM, and a negative correlation between medications and dysgeusia were found. OM was associated with altered thyroxine (T4) and free thyroxine (FT4), calcium, urea, creatinine, alkaline phosphatase, and syphilis. Family income and housing were OM predictors. Altered T4/FT4/urea/calcium/alkaline phosphatase/creatinine/syphilis may be useful clinical predictors of OM. Despite the elevated prevalence of comorbidities and abnormal laboratory findings, dental treatment prior to cancer treatment yielded no adverse events.
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Affiliation(s)
- Leticia Rodrigues-Oliveira
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba 13414-903, Brazil; (L.R.-O.); (A.L.M.); (P.A.V.); (A.C.P.-R.)
| | - César Rivera
- Stomatology and Basic Biomedical Sciences Departments, Faculty of Health Sciences, Universidad de Talca (UTALCA), Talca 3460000, Chile;
| | - Xaviera A. López-Cortés
- Department of Computer Sciences and Industries, Catholic University of the Maule, Talca 3460000, Chile;
| | - Milena Perez Mak
- Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil;
| | - Ana Leticia Mores
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba 13414-903, Brazil; (L.R.-O.); (A.L.M.); (P.A.V.); (A.C.P.-R.)
| | - Cesar Augusto Migliorati
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL 32603, USA;
| | - Maria Cecília Querido de Oliveira
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; (M.C.Q.d.O.); (N.R.P.); (T.B.B.)
| | - Natalia Rangel Palmier
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; (M.C.Q.d.O.); (N.R.P.); (T.B.B.)
| | - Luiz Alcino Gueiros
- Departamento de Clínica e Odontologia Preventiva, Universidade Federal de Pernambuco, Recife 50670-901, Brazil;
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba 13414-903, Brazil; (L.R.-O.); (A.L.M.); (P.A.V.); (A.C.P.-R.)
| | - Thaís Bianca Brandão
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; (M.C.Q.d.O.); (N.R.P.); (T.B.B.)
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba 13414-903, Brazil; (L.R.-O.); (A.L.M.); (P.A.V.); (A.C.P.-R.)
| | - Ana Carolina Prado-Ribeiro
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba 13414-903, Brazil; (L.R.-O.); (A.L.M.); (P.A.V.); (A.C.P.-R.)
- Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-000, Brazil; (M.C.Q.d.O.); (N.R.P.); (T.B.B.)
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Dang S, Kallogjeri D, Dizdar K, Lee D, Bao JW, Varghese J, Walia A, Zhan K, Youssef S, Durakovic N, Wick CC, Herzog JA, Buchman CA, Piccirillo JF, Shew MA. Individual Patient Comorbidities and Effect on Cochlear Implant Performance. Otol Neurotol 2024; 45:e281-e288. [PMID: 38437816 PMCID: PMC10939851 DOI: 10.1097/mao.0000000000004144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
OBJECTIVE To examine the association between preoperative comorbidities and cochlear implant speech outcomes. STUDY DESIGN Retrospective cohort. SETTING Tertiary referral center. PATIENTS A total of 976 patients who underwent cochlear implantation (CI) between January 2015 and May 2022. Adult patients with follow-up, preoperative audiologic data, and a standardized anesthesia preoperative note were included. EXPOSURE Adult Comorbidity Evaluation 27 (ACE-27) based on standardized anesthesia preoperative notes. MAIN OUTCOME MEASURES Postoperative change in consonant-nucleus-consonant (CNC) score, AzBio Sentence score in quiet, and AzBio + 10 dB signal-to-noise ratio (SNR). Sentence score of the implanted ear at 3, 6, and 12 months. RESULTS A total of 560 patients met inclusion criteria; 112 patients (20%) had no comorbidity, 204 patients (36.4%) had mild comorbidities, 161 patients (28.8%) had moderate comorbidities, and 83 patients (14.8%) had severe comorbidities. Mixed model analysis revealed all comorbidity groups achieved a clinically meaningful improvement in all speech outcome measures over time. This improvement was significantly different between comorbidity groups over time for AzBio Quiet ( p = 0.045) and AzBio + 10 dB SNR ( p = 0.0096). Patients with severe comorbidities had worse outcomes. From preop to 12 months, the estimated marginal mean difference values (95% confidence interval) between the no comorbidity group and the severe comorbidity group were 52.3 (45.7-58.9) and 32.5 (24.6-40.5), respectively, for AzBio Quiet; 39.5 (33.8-45.2) and 21.2 (13.6-28.7), respectively, for AzBio + 10 dB SNR; and 43.9 (38.7-49.0) and 31.1 (24.8-37.4), respectively, for CNC. CONCLUSIONS Comorbidities as assessed by ACE-27 are associated with CI performance. Patients with more severe comorbidities have clinically meaningful improvement but have worse outcome compared to patients with no comorbidities.
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Affiliation(s)
- Sabina Dang
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | | | - Karmela Dizdar
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - David Lee
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - James W Bao
- Miller School of Medicine, University of Miami, Florida
| | - Jordan Varghese
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Amit Walia
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Kevin Zhan
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Stephanie Youssef
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Nedim Durakovic
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Cameron C Wick
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jacques A Herzog
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Craig A Buchman
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Matthew A Shew
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine in St. Louis, Missouri
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Wieland MWM, Pilz W, Winkens B, Hoeben A, Willemsen ACH, Kremer B, Baijens LWJ. Multi-Domain Screening: Identification of Patient's Risk Profile Prior to Head-and-Neck Cancer Treatment. Cancers (Basel) 2023; 15:5254. [PMID: 37958427 PMCID: PMC10648822 DOI: 10.3390/cancers15215254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/27/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Head-and-neck cancer (HNC) can give rise to oropharyngeal dysphagia (OD), malnutrition, sarcopenia, and frailty. Early identification of these phenomena in newly diagnosed HNC patients is important to reduce the risk of complications and to improve treatment outcomes. The aim of this study was (1) to determine the prevalence of the risk of OD, malnutrition, sarcopenia, and frailty; and (2) to investigate the relation between these phenomena and patients' age, performance status, and cancer group staging. METHODS Patients (N = 128) underwent multi-domain screening consisting of the Eating Assessment Tool-10 for OD, Short Nutritional Assessment Questionnaire and BMI for malnutrition, Short Physical Performance Battery and Hand Grip Strength for sarcopenia, and Distress Thermometer and Maastricht Frailty Screening Tool for frailty. RESULTS 26.2%, 31.0%, 73.0%, and 46.4% of the patients were at risk for OD, malnutrition, sarcopenia, or frailty, respectively. Patients with an advanced cancer stage had a significantly higher risk of OD and high levels of distress prior to cancer treatment. CONCLUSIONS This study identified the risk profile of newly diagnosed HNC patients using a standardized 'quick and easy' multi-domain screening prior to cancer treatment.
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Affiliation(s)
- Monse W. M. Wieland
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, 6200 MD Maastricht, The Netherlands
- Care and Public Health Research Institute—CAPHRI, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Ann Hoeben
- GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, 6202 AZ, The Netherlands
| | - Anna C. H. Willemsen
- Department of Internal Medicine, Diakonessenhuis, 3508 TG Utrecht, The Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Laura W. J. Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, 6202 AZ Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, 6229 ER Maastricht, The Netherlands
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Chen J, Ding J, Xu Y, Hong H, Lin X, Xu M, Yan L, Xu T, Fei Z, Chen C. Significance of chemotherapy for older patients with nasopharyngeal carcinoma in the intensity-modulated radiotherapy era: A propensity score matching analysis. J Geriatr Oncol 2023; 14:101648. [PMID: 37897887 DOI: 10.1016/j.jgo.2023.101648] [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: 06/11/2023] [Revised: 08/02/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION This study aimed to evaluate the survival and prognosis of older patients with nasopharyngeal carcinoma (NPC) who received intensity-modulated radiotherapy (IMRT) alone versus IMRT plus chemotherapy using propensity score matching (PSM). MATERIALS AND METHODS We enrolled 841 older patients with NPC aged 60 years and above without metastasis receiving IMRT alone or chemoradiotherapy from 2012 to 2019. The comorbidity was assessed by adult comorbidity evaluation (ACE-27). PSM (1:3 ratio) was conducted between the two treatment groups based on four clinical factors including age, T-stage, N-stage, and ACE-27. Differences in overall survival (OS) and cancer-specific survival (CSS) were analyzed by the Kaplan-Meier method and Cox proportional hazard model. RESULTS A total of 841 patients with NPC were included in the study, there were 94 patients in the IMRT alone group and 747 patients in the chemoradiotherapy (CRT) group. After a 1:3 ratio PSM, 89 patients underwent IMRT alone and 223 patients underwent CRT. The baseline analysis showed an insignificant difference after PSM (P > 0.05). In multivariate analysis, we found that ACE-27 (≥2) was associated with worse five-year OS and CSS (HR = 1.994, 95%CI: 1.276-3.116, P = 0.002; HR = 1.849, 95%CI: 1164-2.935, P = 0.009, respectively). Chemotherapy was an independent prognosticator of better five-year OS and CSS (HR = 0.333, 95%CI: 0.213-0.552, P < 0.001; HR = 0.327, 95%CI: 0.204-0.524, P < 0.001, respectively). In terms of subgroup analysis, chemotherapy was a statistically beneficial predictor for stage III-IV patients (P < 0.05), but no significant difference in stage II patients (P > 0.05). About the adverse events, the incidence of hepatotoxicity (P = 0.002), neutropenia (P < 0.001), anemia (P < 0.001), and thrombocytopenia (P < 0.001) were significantly higher in the CRT group. DISCUSSION Combined modality therapy was associated with improved five-year OS and CSS in older adults with stage III-IV NPC, but was not associated with improved survival over IMRT alone in patients with stage II disease. Risk factors including T3-4 disease, positive lymph nodes, ACE-27 score ≥ 2, and IMRT alone were were associated with worse OS and CSS. There was a significantly higher incidence of hepatotoxicity and blood toxicity in the CRT group.
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Affiliation(s)
- Jiawei Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Jianming Ding
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Yiying Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Huiling Hong
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Xiaoting Lin
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Mengting Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Linghui Yan
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Ting Xu
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China
| | - Zhaodong Fei
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China.
| | - Chuanben Chen
- Department of Radiation Oncology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian, China.
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Chatterjee S, Kiyota N, Vaish R, Sharma A, Tahara M, Noronha V, Prabhash K, D'Cruz A. Weekly versus 3-weekly cisplatin along with radiotherapy for locoregionally advanced non-nasopharyngeal head and neck cancers: Is the equipoise in literature addressed yet? Head Neck 2023; 45:1594-1603. [PMID: 37019856 DOI: 10.1002/hed.27365] [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: 11/28/2022] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/07/2023] Open
Abstract
Concurrent chemoradiotherapy with 3-weekly cisplatin 100 mg/m2 has been the standard of care for locoregionally advanced head and neck cancer (LA-HNC) with level I evidence. While the outcomes in terms of efficacy have been well established, the toxicity profile, compliance, and real-world applicability has been an area of ongoing concern for this regimen, leading the oncologists to explore weekly cisplatin chemoradiotherapy regimen to potentially address the issue. A review of literature was conducted in Pubmed, Scopus, and Medline to compare and evaluate the present role of weekly cisplatin chemotherapy along with radiotherapy versus 3-weekly cisplatin chemotherapy along with radiotherapy in both adjuvant and definitive settings for locoregionally advanced head and neck cancers. Nasopharyngeal subsites were excluded from the literature review and 50 relevant articles were included in the analysis. Recently published evidences of noninferiority of weekly over 3-weekly cisplatin chemoradiotherapy regimen in definitive as well as adjuvant settings in locoregionally advanced head and neck cancers is highlighted and interpreted. Results supporting and against the above in different publications is elaborated in this article. Trials designed to demonstrate noninferiority of the weekly cisplatin chemoradiotherapy regimen over 3-weekly regimen, especially in definitive setting may conclude the debate in future. A lacunae in the existing literature is noted in the form of lack of superiority trials on the above topic, which may impact future conclusions.
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Affiliation(s)
- Sataksi Chatterjee
- Department of Oncology, Apollo Hospitals Navi Mumbai, Navi Mumbai, Maharashtra, India
| | - Naomi Kiyota
- Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Richa Vaish
- Tata Memorial Hospital, Parel, Mumbai, 400012, India
| | - Atul Sharma
- All India Institute of Medical Sciences, New Delhi, India
| | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital and Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anil D'Cruz
- Department of Oncology (Head and Neck Surgery), Apollo Hospitals Group, Chennai, India
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10
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Matos LL, Sanabria A, Robbins KT, Halmos GB, Strojan P, Ng WT, Takes RP, Angelos P, Piazza C, de Bree R, Ronen O, Guntinas-Lichius O, Eisbruch A, Zafereo M, Mäkitie AA, Shaha AR, Coca-Pelaz A, Rinaldo A, Saba NF, Cohen O, Lopez F, Rodrigo JP, Silver CE, Strandberg TE, Kowalski LP, Ferlito A. Management of Older Patients with Head and Neck Cancer: A Comprehensive Review. Adv Ther 2023; 40:1957-1974. [PMID: 36920746 DOI: 10.1007/s12325-023-02460-x] [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: 12/19/2022] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
The projected increase in life expectancy over the next few decades is expected to result in a rise in age-related diseases, including cancer. Head and neck cancer (HNC) is a worldwide health problem with high rates of morbidity and mortality. In this report, we have critically reviewed the literature reporting the management of older patients with HNC. Older adults are more prone to complications and toxicities secondary to HNC treatment, especially those patients who are frail or have comorbidities. Thus, this population should be screened prior to treatment for such predispositions to maximize medical management of comorbidities. Chronologic age itself is not a reason for choosing less intensive treatment for older HNC patients. Whenever possible, also older patients should be treated according to the best standard of care, as nonstandard approaches may result in increased treatment failure rates and mortality. The treatment plan is best established by a multidisciplinary tumor board with shared decision-making with patients and family. Treatment modifications should be considered for those patients who have severe comorbidities, evidence of frailty (low performance status), or low performance status or those who refuse the recommendations of the tumor board.
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Affiliation(s)
- Leandro L Matos
- Department of Head and Neck Surgery, Instituto do Cancer do Estado de São Paulo (ICESP), University of São Paulo Medical School, and Faculdade Israelita de Ciências da Saúde Albert Einstein Medical School, São Paulo, Brazil
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Medellin, Colombia
| | - K Thomas Robbins
- Division of Otolaryngology, Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Gyorgy B Halmos
- Department of Otolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Wai Tong Ng
- Department of Clinical Oncology, School of Clinical Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Robert P Takes
- Department of Otolaryngology, Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL, USA
| | - Cesare Piazza
- Unit of Otorhinolaryngology, Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Surgical and Medical Specialties, Radiological Sciences, and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ohad Ronen
- Department of Otolaryngology, Head and Neck Surgery, Galilee Medical Center, Affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Mark Zafereo
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Soroka Medical Center, Israel, Affiliated with Ben-Gurion University of the Negev, Sheva, Israel
| | - Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
- Department of Otolaryngology, Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Timo E Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Center for Life-Course Health Research, University of Oulu, Oulu, Finland
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, 8th Floor, Room 8174, São Paulo, SP, CEP: 05403-000, Brazil.
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil.
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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11
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Han C, Khan NI, Mady LJ. Prognosis. Otolaryngol Clin North Am 2023; 56:389-402. [PMID: 37030950 DOI: 10.1016/j.otc.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
Prognosis is defined as the likely outcome or course of a disease and is the result of a complex interplay between patient and tumor factors. Unfortunately, the prognosis of patients with laryngeal cancer has not changed significantly over the past several decades. However, as our understanding of these patient and tumor factors becomes more nuanced and the resulting treatment options become more precise, there is the potential to improve the prognosis for these patients.
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12
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Malnutrition risk and frailty in head and neck cancer patients: coexistent but distinct conditions. Eur Arch Otorhinolaryngol 2023; 280:1893-1902. [PMID: 36484854 PMCID: PMC9988738 DOI: 10.1007/s00405-022-07728-6] [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: 07/17/2022] [Accepted: 10/25/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE Both malnutrition and frailty are associated with adverse treatment outcomes. Malnutrition (risk) and frailty are each commonly present in patients with head and neck cancer (HNC). However, their coexistence and association is unknown. Main goal of this study is to determine the coexistence of, and the association between malnutrition risk and frailty in patients with HNC. METHODS In this retrospective analysis on prospectively collected data, newly diagnosed patients with HNC, enrolled in the OncoLifeS databiobank were included. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) was used to assess malnutrition risk. The Groningen Frailty Indicator (GFI) was used to assess frailty status. Multivariate logistic regression analyses were performed, taking into account several patient- and tumor-related factors. RESULTS In total, 197 patients were included. Seventy-six patients (39%) had a medium or high malnutrition risk and 71 patients (36%) were frail. In 38 patients (19%), malnutrition risk coexisted with frailty. Patients with medium and high malnutrition risk were, respectively, 4.0 (95% CI 1.5-11.2) and 13.4 (95% CI 4.0-48.7) times more likely to be frail, compared to patients with low malnutrition risk. In turn, frail patients were 6.4 times (95% CI 2.6-14.9) more likely to have malnutrition risk compared to non-frail patients. CONCLUSIONS Malnutrition risk and frailty frequently coexist but not fully overlap in newly diagnosed patients with HNC. Therefore, screening for both conditions is recommended.
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13
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Tuomi L, Magnusson-Sandkvist J, Fridolfsson J, Arvidsson D, Börjesson M, Finizia C. A pilot study using pre-treatment physical activity level to predict long-term health-related quality of life in patients with head and neck cancer. Head Neck 2023; 45:1288-1298. [PMID: 36912147 DOI: 10.1002/hed.27345] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 02/23/2023] [Accepted: 03/02/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Pre-treatment levels of physical activity (PA) in head and neck cancer (HNC) are rarely evaluated using accelerometry. This study aimed to investigate whether pre-treatment PA level in HNC predicts aspects of long-term health-related quality of life (HRQL) at 12 months after end of treatment. METHODS This pilot study included 48 patients diagnosed with HNC, 41 participants remaining at 12 months post-treatment. Pre-treatment PA was objectively assessed by an accelerometer. Self-perceived PA and HRQL were assessed pre-treatment and at 6- and 12-months post-treatment. RESULTS Patients with a higher pre-treatment PA level scored higher on physical function and role function and less fatigue and pain at the 12 months follow-up compared to patients with a lower pre-treatment PA. At 6 months the groups differed only on physical functioning. When comparing changes over time, there were statistically significant differences comparing high and low pre-treatment PA in the fatigue and pain domains between 6 and 12 months. Exploratory multiple regression analyses also indicated that higher pre-treatment PA levels were associated with greater favorable change in the four HRQL measures. CONCLUSIONS Higher levels of PA assessed with accelerometer before oncologic treatment associated favorably with aspects of self-perceived HRQL and PA over time in patients with HNC.
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Affiliation(s)
- Lisa Tuomi
- Department of Otorhinolaryngology - Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology - Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Julia Magnusson-Sandkvist
- Department of Otorhinolaryngology - Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonatan Fridolfsson
- Center for Health and Performance, Department of Food and Nutrition, and Sports Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
| | - Daniel Arvidsson
- Center for Health and Performance, Department of Food and Nutrition, and Sports Science, Faculty of Education, University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Center for Health and Performance, Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medicine, Geriatric and Acute Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology - Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology - Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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14
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Kim SS, Liu HC, Mell LK. Treatment Considerations for Patients with Locoregionally Advanced Head and Neck Cancer with a Contraindication to Cisplatin. Curr Treat Options Oncol 2023; 24:147-161. [PMID: 36696081 PMCID: PMC9992074 DOI: 10.1007/s11864-023-01051-w] [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] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
OPINION STATEMENT Significant advancements have been made in the treatment of locally advanced head and neck cancer, predominantly driven by the integration of concurrent chemotherapy with radiation therapy as a standard of care for many patients. The most heavily investigated chemotherapeutic is cisplatin, yet many patients are ineligible for cisplatin due to the presence of pre-existing medical comorbidities. Moreover, given the toxicity profile of cisplatin, identifying which patients stand to benefit from cisplatin is challenging, which is particularly evident in older patients. Efforts to better risk-stratify patients based on age, performance status, and the degree of pre-existing comorbidities are ongoing and have been increasingly utilized in national clinical trials. In parallel, exploration into alternative systemic agents, including novel targeted therapies and immunotherapies, in cisplatin-ineligible patients are rapidly expanding. Cumulatively, identifying appropriate treatment paradigms in patients who harbor contraindications to cisplatin can not only improve clinical outcomes but also critically mitigate detrimental adverse effects.
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Affiliation(s)
- Sangwoo S Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 3855 Health Sciences Drive, MC0843, La Jolla, CA, 92093, USA
| | - Hannah C Liu
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 3855 Health Sciences Drive, MC0843, La Jolla, CA, 92093, USA
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, 3855 Health Sciences Drive, MC0843, La Jolla, CA, 92093, USA.
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15
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Khadela A, Vyas B, Mansuri M, Sureja D, Bodiwala K. Impact of cetuximab plus cisplatin alone and cetuximab plus cisplatin and paclitaxel regimen on humanistic outcome in head and neck cancer. J Egypt Natl Canc Inst 2023; 35:1. [PMID: 36656444 DOI: 10.1186/s43046-023-00160-9] [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: 08/28/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The prevalence of head and neck cancer (HNC) is increasing rapidly, and the prognosis is poor in the advance stage. For the patient suffering from advance stage HNC, the improvement in quality of life and decrease mortality remain as the mainstay of treatment. The aim was to assess the change in quality-adjusted life-years (QALYs) in recurrent or metastatic HNC patients receiving cetuximab plus cisplatin and cetuximab plus cisplatin-paclitaxel. METHODS It was a single-centric prospective-observational study. Patients were divided into two cohorts based on the chemotherapy regimens they were prescribed. Patients in cohort 1 were prescribed with cetuximab and cisplatin and in cohort 2 were prescribed with cetuximab, cisplatin, and paclitaxel. The QALYs were the primary outcome of the study, and it was calculated using EQ-5D-5L instrument. Patients were followed until the completion of the therapy, i.e., six chemotherapy cycles. The statistical analysis was carried out using SPSS for descriptive and inferential analysis. RESULTS Amongst 175 patients screened, 100 patients were enrolled which further distributed in cohorts 1 and 2 equally. The mean QALYs were 0.016 and 0.017 at the time of diagnosis, i.e., before initiation of chemotherapy for patients in cohorts 1 and 2, respectively. At every chemotherapy cycle, the QALYs were calculated. After the completion of six chemotherapy cycles, the mean QALYs were 0.029 and 0.032 for patients in cohorts 1 and 2, respectively. CONCLUSION The three-drug therapy consisting of cetuximab, cisplatin, and paclitaxel has shown significant improvement in patients' QALYs compared to two-drug regimens of cetuximab and cisplatin. Thus, if the therapy consisted of three-drug regimen is used instead of two-drug regimen, it will have a positive impact on humanistic outcome in recurrent or metastatic HNC patients.
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Affiliation(s)
- Avinash Khadela
- Department of Pharmacology, L. M. College of Pharmacy, Navrangpura, Ahmedabad, Gujarat, 380009, India.
| | - Bhavin Vyas
- Department of Pharmacology, Maliba Pharmacy College, Uka Tarsadia University, Surat, Gujarat, India
| | - Mustakim Mansuri
- Department of Pharmacology, L. M. College of Pharmacy, Navrangpura, Ahmedabad, Gujarat, 380009, India
| | - Dipen Sureja
- Department of Pharmaceutical Chemistry, L. M. College of Pharmacy, Navrangpura, Ahmedabad, Gujarat, 380009, India
| | - Kunjan Bodiwala
- Department of Pharmaceutical Chemistry and Quality Assurance, L. M. College of Pharmacy, Navrangpura, Ahmedabad, Gujarat, 380009, India
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16
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Roeder F, Jensen AD, Lindel K, Mattke M, Wolf F, Gerum S. Geriatric Radiation Oncology: What We Know and What Can We Do Better? Clin Interv Aging 2023; 18:689-711. [PMID: 37168037 PMCID: PMC10166100 DOI: 10.2147/cia.s365495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
Elderly patients represent a growing subgroup of cancer patients for whom the role of radiation therapy is poorly defined. Older patients are still clearly underrepresented in clinical trials, resulting in very limited high-level evidence. Moreover, elderly patients are less likely to receive radiation therapy in similar clinical scenarios compared to younger patients. However, there is no clear evidence for a generally reduced radiation tolerance with increasing age. Modern radiation techniques have clearly reduced acute and late side effects, thus extending the boundaries of the possible regarding treatment intensity in elderly or frail patients. Hypofractionated regimens have further decreased the socioeconomic burden of radiation treatments by reducing the overall treatment time. The current review aims at summarizing the existing data for the use of radiation therapy or chemoradiation in elderly patients focusing on the main cancer types. It provides an overview of treatment tolerability and outcomes with current standard radiation therapy regimens, including possible predictive factors in the elderly population. Strategies for patient selection for standard or tailored radiation therapy approaches based on age, performance score or comorbidity, including the use of prediction tests or geriatric assessments, are discussed. Current and future possibilities for improvements of routine care and creation of high-level evidence in elderly patients receiving radiation therapy are highlighted.
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Affiliation(s)
- Falk Roeder
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
- Correspondence: Falk Roeder, Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Müllner Hauptstrasse 48, Salzburg, 5020, Austria, Tel +43 57255 55569, Email
| | - Alexandra D Jensen
- Department of Radiation Oncology, University Hospital Marburg-Giessen, Giessen, Germany
| | - Katja Lindel
- Department of Radiation Oncology, Städtisches Klinikum, Karlsruhe, Germany
| | - Matthias Mattke
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Frank Wolf
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Sabine Gerum
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
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Pisani C, Mastroleo F, Collo A, Ferrante D, Carabelli G, Franco P, Riso S, Dell’Era V, Garzaro M, Aluffi Valletti P, Krengli M. Variation in Body Mass and Skeletal Muscle Indices in Head and Neck Cancer Patients Undergoing (Chemo)Radiotherapy and Nutritional Intervention. Curr Oncol 2022; 30:250-260. [PMID: 36661669 PMCID: PMC9857332 DOI: 10.3390/curroncol30010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 12/28/2022] Open
Abstract
The aim of this study was to analyze variation in body mass index (BMI) and skeletal muscle index (SMI) in head and neck squamous cell carcinoma (HNSCC) patients who underwent exclusive radiotherapy (RT) or concurrent chemo-radiotherapy (RT-CHT). We enrolled 73 HNSCC pts treated with definitive or post-operative RT (14 pts) or RT-CHT (59 pts). At the time of diagnosis (t0) and 3 months after treatment completion (t3), CT scans were retrieved to measure skeletal muscle at the level of the C3 vertebra. Median follow-up was 16 months. Nine disease progressions with distant metastases and eleven local relapses were observed. Fifty-three pts were free from progression at 1 year. At t0, average BMI was 25.8 (SD 4.1), while at t3 it was 24.5, with no reduction in 54 pts. A BMI decrease of −1.3 (p-value < 0.0001) between t0 and t3 was found with the Wilcoxon signed-rank test. SMI was 57.1 and 59.2 at t0 and t3, respectively (p-value = 0.005). According to our analysis, SMI variation seems to reflect the effect of an appropriate nutritional intervention and may represent a reliable, simple tool for muscle mass analysis.
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Affiliation(s)
- Carla Pisani
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Alessandro Collo
- Clinical Nutrition and Dietetic Unit, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Daniela Ferrante
- Unit of Medical Statistics, Department of Translational Medicine, University of Piemonte Orientale (UPO) and Cancer Epidemiology, CPO Piemonte, Via Solaroli 17, 28100 Novara, Italy
| | - Greta Carabelli
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Pierfrancesco Franco
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetic Unit, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Valeria Dell’Era
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Massimiliano Garzaro
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Paolo Aluffi Valletti
- ENT Division, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
| | - Marco Krengli
- Division of Radiation Oncology, University Hospital “Maggiore della Carità”, Corso Mazzini 18, 28100 Novara, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy
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18
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An algorithm to predict data completeness in oncology electronic medical records for comparative effectiveness research. Ann Epidemiol 2022; 76:143-149. [PMID: 35878784 PMCID: PMC9741728 DOI: 10.1016/j.annepidem.2022.07.007] [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: 03/07/2022] [Revised: 07/01/2022] [Accepted: 07/14/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Electronic health record (EHR) discontinuity (missing out-of-network encounters) can lead to information bias. We sought to construct an algorithm that identifies high EHR-continuity among oncology patients. METHODS Using a linked Medicare-EHR database and regression, we sought to 1) measure how often Medicare claims for outpatient encounters were substantiated by visits recorded in the EHR, and 2) predict continuity ratio, defined as the yearly proportion of outpatient encounters reported to Medicare that were captured by EHR data. The prediction model...s performance was evaluated with the coefficient of determination and Spearman...s correlation. We quantified variable misclassification by decile of continuity ratio using standardized difference and sensitivity. RESULTS A total of 79,678 subjects met all eligibility criteria. Predicted and observed continuity was highly correlated (σSpearman=0.86). On average across all variables measured, MSD was reduced by a factor of 1/7th and sensitivity was improved 35-fold comparing subjects in the highest vs. lowest decile of CR. CONCLUSION In the oncology population, restricting EHR-based study cohorts to subjects with high continuity may reduce misclassification without greatly impacting representativeness. Further work is needed to elucidate the best manner of implementing continuity prediction rules in cohort studies.
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19
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Li D, Wang C, Wei W, Li B, Liu H, Cheng A, Niu Q, Han Z, Feng Z. Postoperative Complications of Free Flap Reconstruction in Moderate-Advanced Head and Neck Squamous Cell Carcinoma: A Prospective Cohort Study Based on Real-World Data. Front Oncol 2022; 12:792462. [PMID: 35814388 PMCID: PMC9263716 DOI: 10.3389/fonc.2022.792462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostoperative complications (POCs) of moderate-advanced head and neck squamous cell carcinoma (HNSCC) after free flap reconstruction have received little attention. We investigated the risk factors that lead to POCs and their impact on management and prognosis.Patients and MethodsA single-center, prospective cohort study was conducted at Beijing Stomatological Hospital on primary HNSCC patients treated between 2015 and 2020.ResultsIn total, 399 consecutive HNSCC patients who underwent radical resection of the primary tumor and free flap reconstruction were enrolled in this study, 155(38.8%) experienced POCs. The occurrence of POCs directly led to worse short-term outcomes and poorer long-term overall survival (P=0.0056). Weight loss before the operation (P=0.097), Tumor site (P=0.002), stage T4b (P=0.016), an ACE-27 index of 2-3 (P=0.040), operation time≥8h (P=0.001) and Clindamycin as antibiotic prophylaxis (P=0.001) were significantly associated with POCs.ConclusionsThe occurrence of POCs significantly leads to worse short-term outcomes and increases the patients’ burden.
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Affiliation(s)
- Delong Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Chong Wang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Wei Wei
- Clinical Epidemiology and EBM Unit, National Clinical Research Center for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo Li
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Huan Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Aoming Cheng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Qifang Niu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhengxue Han
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
| | - Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
- *Correspondence: Zhien Feng,
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20
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Multi-domain analysis of non-surgical risk factors amenable to pre-operative optimization in microvascular head and neck surgery. Am J Otolaryngol 2022; 43:103346. [PMID: 35016097 DOI: 10.1016/j.amjoto.2021.103346] [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: 09/24/2021] [Revised: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The goal of this study was to conduct a multi-domain, organ system-based analysis of non-surgical comorbidities amenable to pre-operative optimization in patients undergoing free tissue transfer, in order to better understand factors that influence patient outcomes. STUDY DESIGN Retrospective review. SETTINGS Tertiary academic center. MATERIALS AND METHODS A retrospective analysis of 546 patients in a prospectively maintained database who underwent free tissue transfer reconstruction between 2007 and 2016 was performed. Analysis of the relationship between binary-coded system-based domains and log-transformed length of stay (LOS), rehabilitation requirement, 30-day readmission, and post-operative complications was conducted with multiple linear regression or logistic regression models. RESULTS Poor nutritional status and the presence of anxiety/depression independently increased median hospital LOS. Endocrine and metabolic deficits, poor nutrition status, and psychiatric comorbidities were significant predictors for rehabilitation facility requirement upon discharge. CONCLUSION Interventions targeted to patient psychiatric and nutritional health may yield substantially improved outcomes in the head and neck cancer population receiving free tissue transfer surgery.
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21
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Janto M, Iurcov R, Daina CM, Neculoiu DC, Venter AC, Badau D, Cotovanu A, Negrau M, Suteu CL, Sabau M, Daina LG. Oral Health among Elderly, Impact on Life Quality, Access of Elderly Patients to Oral Health Services and Methods to Improve Oral Health: A Narrative Review. J Pers Med 2022; 12:372. [PMID: 35330372 PMCID: PMC8950250 DOI: 10.3390/jpm12030372] [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: 12/31/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
Dental health is often neglected among the elderly because of the numerous comorbidities in this population, such as cardiovascular diseases. However, dental health influences general health and quality of life by impacting both the general health and the psychological state of the individual. The present review highlights the main dental comorbidities in the elderly population, their impact on the quality of life, the barriers towards access to dental care in the elderly and methods to improve their dental health. Information related to dental care and its importance must be provided both to older individuals and their caregivers in order to detect dental pathology and treat it adequately. Ensuring dental health involves the whole society of elders, caregivers, dental care providers, the public sector, health policymakers, and the private sector.
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Affiliation(s)
- Michael Janto
- Faculty of Medicine and Pharmacy, Doctoral School, University of Oradea, 1 December Sq., 410081 Oradea, Romania;
| | - Raluca Iurcov
- Dentistry Department, Faculty of Medicine, University of Oradea, 410073 Oradea, Romania;
| | - Cristian Marius Daina
- Psycho-Neurosciences and Recovery Department, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (C.M.D.); (C.L.S.); (M.S.); (L.G.D.)
| | | | - Alina Cristiana Venter
- Department of Morphologycal Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania
| | - Dana Badau
- Faculty of Sciences and Letters, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania;
- Interdisciplinary Doctoral School, Transilvania University, 500068 Brasov, Romania
| | - Adrian Cotovanu
- Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania;
| | - Marcel Negrau
- Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania;
| | - Corina Lacramioara Suteu
- Psycho-Neurosciences and Recovery Department, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (C.M.D.); (C.L.S.); (M.S.); (L.G.D.)
| | - Monica Sabau
- Psycho-Neurosciences and Recovery Department, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (C.M.D.); (C.L.S.); (M.S.); (L.G.D.)
| | - Lucia Georgeta Daina
- Psycho-Neurosciences and Recovery Department, Faculty of Medicine and Pharmacy, University of Oradea, 1 December Sq., 410081 Oradea, Romania; (C.M.D.); (C.L.S.); (M.S.); (L.G.D.)
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22
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Peeters F, Van Dessel J, Croonenborghs TM, Smeets M, Sun Y, Willaert R, Politis C, Bila M. Value of six comorbidity scales for predicting survival of patients with primary surgery for oral squamous cell carcinoma. Head Neck 2022; 44:1142-1152. [PMID: 35194882 DOI: 10.1002/hed.27015] [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: 07/04/2021] [Revised: 02/02/2022] [Accepted: 02/14/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Comorbidities influence treatment outcome of oral squamous cell carcinoma (OSCC). This study compared the predictive performance of six comorbidity scales for overall survival after surgery for OSCC. METHODS We retrospectively analyzed OSCC patients, surgically treated at an academic center in Belgium between January 01, 2000 and January 01, 2020. Validity of the scales was evaluated using the area under the curve (AUC) of receiver operating characteristic curves. RESULTS Three hundred and twenty three patients were included. Elixhauser Comorbidity Index (AUC = 0.74, 95% CI: 0.55-0.92; AUC = 0.73, 95% CI: 0.55-0.80), modified Elixhauser Comorbidity Index (AUC = 0.72, 95% CI: 0.54-0.91; AUC = 0.69, 95% CI: 0.51-0.77), and Combined Comorbidity Index (AUC = 0.76, 95% CI: 0.58-0.84; AUC = 0.76, 95% CI: 0.59-0.84) were meaningful predictors for 2 and 5-year survival, respectively. CONCLUSION Selected comorbidity scales were capable of predicting overall survival for OSCC patients 2 and 5 years after primary surgery.
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Affiliation(s)
- Frederik Peeters
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Van Dessel
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tomas-Marijn Croonenborghs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Maximiliaan Smeets
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Yi Sun
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Robin Willaert
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Michel Bila
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Faculty of Medicine, KU Leuven and Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
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23
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Association of Surrogate Objective Measures With Work Relative Value Units. Ochsner J 2022; 21:371-380. [PMID: 34984052 PMCID: PMC8675618 DOI: 10.31486/toj.20.0153] [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] [Indexed: 11/18/2022] Open
Abstract
Background: The determination of accurate measures of evaluating surgeon work for reimbursement is poorly characterized. This study defines the correlation of surgical work relative value units (work RVUs) with several surrogate objective measures for otolaryngologic work. The defined surrogate objective measures evaluated in this study are length of hospital stay (LOS), operative time, 30-day mortality, 30-day unplanned readmission, 30-day reoperation, and 30-day morbidity. Methods: We collected data on otolaryngologic cases from 2016 to 2018 from the American College of Surgeons National Surgical Quality Improvement Program. Pearson correlation coefficient was used to associate work RVUs with objective measures of surgeon work. Linear regressions were used to identify predictors of work RVUs from the surrogate objective measures. Studentized residuals were used to identify outlying procedures. Results: Work RVUs correlated strongly with operative time (R=0.6775), 30-day readmission (R=0.6100), and LOS (R=0.6083); moderately with 30-day reoperation (R=0.5257) and 30-day morbidity (R=0.4842); and very weakly with 30-day mortality (R=0.1383). The best predictors for work RVUs based on multivariable linear regression analysis were morbidity, reoperation, and operative time. Analysis revealed that the projected work RVU is 12.23 units higher than the current value for excision of bone, mandible (Current Procedural Terminology [CPT] code 21025) and 19.48 units lower than the current value for resection/excision of lesion infratemporal fossa space apex extradural (CPT code 61605). Conclusion: Using objective surrogate measures for time and intensity of physician work in head and neck cases may improve work RVU assignment accuracy compared to the current system of physician survey. Future investigation with additional objective parameters may be beneficial to make work RVU assignments less subjective.
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24
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Kang EJ, Lee YG, Keam B, Choi JH, Kim JS, Park KU, Lee KE, Kim HJ, Lee KW, Kim MK, Ahn HK, Shin SH, Lee JB, Kwon JH, Kim HR, Kim SB, Yun HJ. Characteristics and treatment patterns in older patients with locally advanced head and neck cancer (KCSG HN13-01). Korean J Intern Med 2022; 37:190-200. [PMID: 34929077 PMCID: PMC8747907 DOI: 10.3904/kjim.2020.636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 10/05/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND/AIMS Treatment decisions for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) are complicated, and multi-modal treatments are usually indicated. However, it is challenging for older patients to complete treatments. Thus, we investigated disease characteristics, real-world treatment, and outcomes in older LA-HNSCC patients. METHODS Older patients (aged ≥ 70 years) were selected from a large nationwide cohort that included 445 patients with stage III-IVB LA-HNSCC from January 2005 to December 2015. Their data were retrospectively analyzed and compared with those of younger patients. RESULTS Older patients accounted for 18.7% (83/445) of all patients with median age was 73 years (range, 70 to 89). Proportions of primary tumors in the hypopharynx and larynx were higher in older patients and older patients had a more advanced T stage and worse performance status. Regarding treatment strategies of older patients, 44.5% of patients received concurrent chemoradiotherapy (CCRT), 41.0% underwent surgery, and 14.5% did not complete the planned treatment. Induction chemotherapy (IC) was administered to 27.7% (23/83) of older patients; the preferred regimen for IC was fluorouracil and cisplatin (47.9%). For CCRT, weekly cisplatin was prescribed 3.3 times more often than 3-weekly cisplatin (62.2% vs. 18.9%). Older patients had a 60% higher risk of death than younger patients (hazard ratio, 1.6; p = 0.035). Oral cavity cancer patients had the worst survival probability. CONCLUSION Older LA-HNSCC patients had aggressive tumor characteristics and received less intensive treatment, resulting in poor survival. Further research focusing on the older population is necessary.
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Affiliation(s)
- Eun Joo Kang
- Department of Internal Medicine, Korea University Guro Hospital, Seoul,
Korea
| | - Yun-Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
| | - Jin-Hyuk Choi
- Department of Hematology-Oncology, Ajou University Hospital, Suwon,
Korea
| | - Jin-Soo Kim
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul,
Korea
| | - Keon Uk Park
- Department of Hemato-Oncology, Keimyung University Dongsan Medical Center, Daegu,
Korea
| | - Kyoung Eun Lee
- Department of Hematology and Oncology, Ewha Womans University Mokdong Hospital, Seoul,
Korea
| | - Hyo Jung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - Keun-Wook Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
| | - Min Kyoung Kim
- Department of Hematology-Oncology, Yeungnam University Medical Center, Daegu,
Korea
| | - Hee Kyung Ahn
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon,
Korea
| | - Seong Hoon Shin
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan,
Korea
| | - Jii Bum Lee
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,
Korea
| | - Jung Hye Kwon
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon,
Korea
| | - Hye Ryun Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,
Korea
| | - Sung-Bae Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Hwan Jung Yun
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon,
Korea
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25
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Kung LY, Li TI, Chung CH, Lee SP, Chen GS, Chien WC, Tzeng NS. Risk of depression in patients with oral cancer: a nationwide cohort study in Taiwan. Sci Rep 2021; 11:23524. [PMID: 34876632 PMCID: PMC8651796 DOI: 10.1038/s41598-021-02996-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 11/22/2021] [Indexed: 01/01/2023] Open
Abstract
This study investigates an association between oral cancers and the risk of developing depression. We conducted a total of 3031 patients with newly diagnosed oral cancers and 9093 age-, sex-, and index year-matched controls (1:3) from 2000 to 2013 were selected from the National Health Insurance Research Database (NHIRD) of Taiwan. After adjusting for confounding factors, multivariate Cox proportional hazards analysis was used to compare the risk of depression over a 13-year follow-up. Of the patients with oral cancer, 69 (2.28%, or 288.57 per 105 person-years) developed depression compared to 150 (1.65%, 135.64 per 105 person-years) in the control group. The Cox proportional hazards regression analysis showed that the adjustment hazard ratio (HR) for subsequent depression in patients with oral cancer diagnosed was 2.224 (95% Confidence Interval [CI] 1.641–3.013, p < 0.001). It is noteworthy that in the sensitivity analysis is the adjusted HR in the group with depression diagnosis was 3.392 and in the oral cancer subgroup of “Tongue” was 2.539. This study shows oral cancer was associated with a significantly increased risk for developing subsequent depression and early identification and treatment of depression in oral cancer patients is crucial.
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Affiliation(s)
- Ling-Yu Kung
- Department of Family Dentistry and Oral Diagnosis, Tri-Service General Hospital, Taipei, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Tsung-I Li
- Department of Family Dentistry and Oral Diagnosis, Tri-Service General Hospital, Taipei, Taiwan, ROC.,School of Dentistry, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No. 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, 11490, Taiwan, ROC.,Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan, ROC
| | - Shiao-Pieng Lee
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan, ROC.,Department of Oral and Maxillofacial Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Gunng-Shinng Chen
- School of Dentistry, National Defense Medical Center, Taipei, Taiwan, ROC. .,Department of Orthodontics and Pediatrics Dentistry, School of Dentistry, Tri-Service General Hospital, National Defense Medical Center, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan, ROC.
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC. .,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, 7115R, No. 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, 11490, Taiwan, ROC. .,Taiwanese Injury Prevention and Safety Promotion Association (TIPSPA), Taipei, Taiwan, ROC. .,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC.
| | - Nian-Sheng Tzeng
- Department of Psychiatry, School of Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Gung Road, Nei-Hu District, Taipei, Taiwan, ROC. .,Student Counseling Center, National Defense Medical Center, Taipei, Taiwan, ROC.
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26
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Pauli N, Fagerberg Mohlin B, Mejersjö C, Finizia C. Temporomandibular disorder as risk factor for radiation-induced trismus in patients with head and neck cancer. Clin Exp Dent Res 2021; 8:123-129. [PMID: 34755469 PMCID: PMC8874055 DOI: 10.1002/cre2.511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives The aim of this study was to investigate if patients with temporomandibular disorders (TMD) prior to head and neck cancer (HNC) treatment are at higher risk of developing trismus after oncological treatment. Materials and Methods Eighty‐three study patients underwent detailed dental examination prior oncological treatment and 6 months after radiotherapy completion, including evaluation of temporomandibular jaw function, palpation of the jaw muscles, and measurement of mouth opening capacity. TMD criteria were based on both clinical examination findings and patient‐reported symptoms. TMD at baseline was used in regression analysis in order to predict restricted mouth opening. Results At the 6 months follow‐up more than a third of the patients (35%) were examined with reduced mouth opening of >20% compared to baseline. A majority of the patients had bilateral tenderness of both the temporal and the masseter muscle. At the 6 months follow‐up, 42% of the study patients reported mouth opening problems. About one‐third of the patients suffered from fatigue and stiffness of the jaw as well as pain when mowing the jaw. Two questions from the validated symptom‐specific Gothenburg Trismus Questionnaire were found to be related to a statistically significant increased risk of restricted mouth opening after radiotherapy; “During the last week, have you felt: Pain on moving the jaw?” (OR [95% CI] 5.9 (1.2–29.4) [p = 0.030]) and “During the last week, have you felt pain and tenderness in the muscles of mastication?” (OR [95% CI] 5.90 [1.19–29.40] [p = 0.030]). Conclusions TMD is common amongst HNC patients. Patients who suffer from pain in the jaw muscles and pain when moving the jaw before start of treatment are at higher risk of radiation‐induced trismus after 6 months. Clinicians should strive for optimizing the patients pain treatment and oral health before, during, and after radiotherapy.
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Affiliation(s)
- Nina Pauli
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bodil Fagerberg Mohlin
- Department of Oral and Maxillofacial Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christina Mejersjö
- Clinic of Orofacial Pain, Sahlgrenska Academy and Public Dental Health, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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27
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Bril SI, Al-Mamgani A, Chargi N, Remeijer P, Devriese LA, de Boer JP, de Bree R. The association of pretreatment low skeletal muscle mass with chemotherapy dose-limiting toxicity in patients with head and neck cancer undergoing primary chemoradiotherapy with high-dose cisplatin. Head Neck 2021; 44:189-200. [PMID: 34713519 PMCID: PMC9298001 DOI: 10.1002/hed.26919] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/01/2021] [Accepted: 10/18/2021] [Indexed: 12/25/2022] Open
Abstract
Background Low skeletal muscle mass (SMM) is an adverse prognostic factor for chemotherapy dose‐limiting toxicity (CDLT). In patients with locally advanced head and neck squamous cell carcinoma (HNSCC) undergoing chemoradiotherapy (CRT), low SMM is a predictor for CDLT. We aimed to validate these findings. Methods Consecutive LA‐HNSCC patients treated with primary CRT with high‐dose cisplatin were retrospectively included. SMM was measured on pre‐treatment CT‐imaging. A cumulative cisplatin dose below 200 mg/m2 was defined as CDLT. Results One hundred and fifty three patients were included; 37 (24.2%) experienced CDLT, and 84 had low SMM (54.9%). Patients with low SMM experienced more CDLT than patients with normal SMM (35.7% vs. 10.1%, p < 0.01). Low SMM (OR 3.99 [95% CI 1.56–10.23], p = 0.01) and an eGFR of 60–70 ml/min (OR 5.40 [95% CI 1.57–18.65], p < 0.01) were predictors for CDLT. Conclusion Pre‐treatment low SMM is associated with CDLT in LA‐HNSCC patients treated with primary CRT. Routine SMM assessment may allow for CDLT risk assessment and treatment optimization.
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Affiliation(s)
- Sandra I Bril
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Najiba Chargi
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Remeijer
- Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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28
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Mucha-Małecka A, Małecki K, Amrogowicz N, Biesaga B, Modrzejewski M. Prognostic factors in elderly patients with T1 glottic cancer treated with radiotherapy. Sci Rep 2021; 11:17717. [PMID: 34489495 PMCID: PMC8421427 DOI: 10.1038/s41598-021-96146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/08/2021] [Indexed: 12/05/2022] Open
Abstract
The aim of the study was the evaluation of the effectiveness of radiotherapy in elderly T1 glottic cancer patients and prognostic factors with particular focus on comorbidities. Five-year overall survival, disease-specific survival, and local control rates were 63%, 92%, and 93%, respectively. Multivariate analysis showed that the following factors had statistically significant impact on local relapse risk and cancer death risk: diabetes, underweight, and fraction dose of 2 Gy. High number of comorbidities, high CCI, and underweight negatively influenced overall survival. A retrospective analysis was performed in a group of 131 T1N0M0 glottic cancer patients aged 70 and above treated with irradiation at the National Institute of Oncology in Cracow between 1977 and 2007. In the analyzed group men prevailed (92%) of mean age of 74 years. Each patient was diagnosed with at least one comorbidity with the following comorbid conditions being most frequent: hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. In the studied group, the effect of comorbidities on overall survival was evaluated using Charlson Comorbidity Index (CCI). Twenty five (19%) patients showed underweight. All patients were irradiated once daily, 5 days a week, to a total dose of 60-70 Gy with a fraction dose of 2 or 2.5 Gy. Radiotherapy is an effective treatment modality in elderly T1 glottic cancer patients. Diabetes as comorbidity, underweight, and conventional dose fractionation decrease the probability of curative effect of radiotherapy in this group of patients, while high number of comorbidities diminishes the probability of long-term survival.
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Affiliation(s)
- Anna Mucha-Małecka
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland.
| | - Krzysztof Małecki
- Department of Radiotherapy for Children and Adults, University Children's Hospital of Cracow, Wielicka 265, 30-663, Cracow, Poland
- Faculty of Health Sciences, Jagiellonian University in Cracow, Michałowskiego 12, 31-126, Cracow, Poland
| | - Natalia Amrogowicz
- 1St Radiation and Clinical Oncology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Beata Biesaga
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland
- Department of Tumour Pathology, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
| | - Maciej Modrzejewski
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Cracow Branch, Garncarska 11, 31-115, Cracow, Poland
- Department of Otolaryngology, Head and Neck Surgery, 5th Military Hospital with Polyclinic, Wroclawska 1-3, 30-901, Cracow, Poland
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29
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Sleiwah A, Mughal M, Thomas N, Roblin P, Townley W, Jeannon JP. Locally Advanced Scalp Tumors: Clinical and Survival Outcomes of a Tertiary Unit. Ann Plast Surg 2021; 87:271-277. [PMID: 34397516 DOI: 10.1097/sap.0000000000002673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Locally advanced nonmelanoma skin cancers of the head and neck are well described in the current literature. However, data about clinical and survival outcomes are lacking. We present survival data from a tertiary head and neck cancer unit in London. METHODS A retrospective analysis of data collected from a single institution was conducted. All patients with locally advanced cutaneous scalp carcinomas invading the skull between 2011 and 2019 were included. Data included patient demographics, tumor, comorbidities, interventions, flap survival, and metal work exposure. Survival outcomes were examined using Kaplan-Meier analysis. RESULTS Twenty-three patients were identified. The mean age was 72 years. Eighteen patients were male, and 5 were female. Five patients were immunosuppressed. Nineteen patients underwent outer cortex drill-down/full-thickness calvarial resection, followed by reconstruction with free tissue transfer. Six patients had titanium mesh reconstruction after segmental skull resections. Three patients underwent further surgery because of exposed metalwork. Disease-free survival at 3 years after surgery was 60%. CONCLUSIONS Locally advanced nonmelanoma skin cancers invading the bone are sporadic. There are little published data on clinical and survival outcomes in this group. Despite the nature of these skin lesions, a high degree of local control can be obtained by extensive surgical resection, outer table drill-down, and calvarial resection. We conclude that aggressive management of the bony invasion improves disease-free survival and improves local control.
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Affiliation(s)
- Aseel Sleiwah
- From the Plastic Surgery Department, Guy's & St Thomas Hospital
| | - Maleeha Mughal
- From the Plastic Surgery Department, Guy's & St Thomas Hospital
| | | | - Paul Roblin
- From the Plastic Surgery Department, Guy's & St Thomas Hospital
| | - William Townley
- From the Plastic Surgery Department, Guy's & St Thomas Hospital
| | - Jean-Pierre Jeannon
- Ear, Nose and Throat Department, Guy's & St Thomas Hospital, London, United Kingdom
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30
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Karczewska‐Lindinger M, Tuomi L, Fridolfsson J, Arvidsson D, Börjesson M, Finizia C. Low physical activity in patients diagnosed with head and neck cancer. Laryngoscope Investig Otolaryngol 2021; 6:747-755. [PMID: 34401499 PMCID: PMC8356879 DOI: 10.1002/lio2.610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/19/2021] [Accepted: 06/18/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This pilot study aimed to describe physical activity (PA) and self-perceived function, health and quality of life (QoL) prior to oncological treatment in patients with head and neck cancer (HNC). METHODS In a prospective study including 49 patients, self-perceived PA (Saltin-Grimby scale) and health-related QoL (European Organization for Research and Treatment of Cancer Quality of Life questionnaire Core 30 and EQ-5D) were assessed. Further, PA was also measured by an accelerometer attached to the thigh for eight consecutive days. The accelerometer PA was compared to the PA of a reference population assessed with the same method. Results presented are from data collected before start of oncological treatment. RESULTS The patients (44-79 years, 65% males) spent most of their time in sedentary behavior: a median of 555 minutes/day in bed (39% of total) and 606 minutes/day sitting (41%). Only 129 minutes/day were spent moving/walking. Patients with higher education, reduced physical function and higher fatigue were less physically active (P ≤ .01). Further, the different PA measures demonstrated a pattern of being less physically active compared to the reference population. CONCLUSIONS Patients diagnosed for HNC may have low PA level. Assessment of PA from accelerometer data may be an important component of oncological treatment to identify patients in need for PA intervention that may enhance treatment outcome.
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Affiliation(s)
- Magdalena Karczewska‐Lindinger
- Department of Molecular and Clinical MedicineCenter for Health and Performance, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck SurgeryInstitute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Jonatan Fridolfsson
- Department of Food and Nutrition, and Sports Science, Faculty of EducationCenter for Health and Performance, University of GothenburgGothenburgSweden
| | - Daniel Arvidsson
- Department of Food and Nutrition, and Sports Science, Faculty of EducationCenter for Health and Performance, University of GothenburgGothenburgSweden
| | - Mats Börjesson
- Department of Molecular and Clinical MedicineCenter for Health and Performance, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatric and Acute MedicineSahlgrenska University HospitalGothenburgRegion Västra GötalandSweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck SurgeryInstitute of Clinical Sciences, Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
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31
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Haehl E, Rühle A, Klink R, Kalckreuth T, Sprave T, Gkika E, Zamboglou C, Meiß F, Grosu AL, Nicolay NH. The value of primary and adjuvant radiotherapy for cutaneous squamous cell carcinomas of the head-and-neck region in the elderly. Radiat Oncol 2021; 16:105. [PMID: 34118984 PMCID: PMC8199417 DOI: 10.1186/s13014-021-01832-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/01/2021] [Indexed: 12/09/2022] Open
Abstract
Purpose To examine treatment patterns, oncological outcomes and toxicity rates in elderly patients receiving radiotherapy for cutaneous squamous cell carcinoma (cSCC) of the head-and-neck region. Material and methods In this retrospective single-center analysis, locoregional control (LRC), progression-free survival (PFS) and overall survival (OS) of elderly patients > 65 years with cSCC of the head-and-neck region undergoing radiotherapy between 2010 and 2019 were calculated. The prognostic value of clinicopathological parameters on radiotherapy outcomes was analyzed using the Cox proportional hazards model. In addition, both acute and chronic toxicities were retrospectively quantified according to CTCAE version 5.0. Results A total of 69 elderly patients with cSCC of the head-and-neck region with a median age of 85 years were included in this analysis, of whom 21.7% (15 patients) presented with nodal disease. The majority of patients exhibited a good performance status, indicated by a median Karnofsky performance status (KPS) and Charlson Comorbidity Index (CCI) of 80% and 6 points, respectively. Radiotherapy was administered as primary (48%), adjuvant (32%) or palliative therapy (20%). 55 patients (79.7%) completed treatment and received the scheduled radiotherapy dose. Median EQD2 radiation doses were 58.4 Gy, 60 Gy and 51.3 Gy in the definitive, adjuvant and palliative situation, respectively. 2-year LRC, PFS and OS ranged at 54.2%, 33.5 and 40.7%, respectively. Survival differed significantly between age groups with a median OS of 20 vs. 12 months (p < 0.05) for patients aged 65–80 or above 80 years. In the multivariate analysis, positive lymph node status remained the only significant prognostic factor deteriorating OS (HR 3.73, CI 1.54–9.03, p < 0.01). Interestingly, neither KPS nor CCI impaired survival in this elderly patient cohort. Only 3 patients (4.3%) experienced acute CTCAE grade 3 toxicities, and no chronic CTCAE grade 2–5 toxicities were observed in our cohort. Conclusion Radiotherapy was feasible and well-tolerated in this distinct population, showing the general feasibility of radiotherapy for cSCC of the head-and-neck region also in the older and oldest olds. The very mild toxicities may allow for moderate dose escalation to improve LRC. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01832-3.
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Affiliation(s)
- Erik Haehl
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Rabea Klink
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Tobias Kalckreuth
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Tanja Sprave
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Eleni Gkika
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Frank Meiß
- Department of Dermatology and Venereology, University of Freiburg - Medical Center, Hauptstr. 7, 79104, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany.,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Freiburg - Medical Center, Robert-Koch-Str. 3, 79106, Freiburg, Germany. .,German Cancer Research Center (Dkfz), German Cancer Consortium (DKTK) Partner Site Freiburg, Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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Tzelnick S, Mizrachi A, Shavit SS, Ben-Ner D, Reuven Y, Elias B, Shpitzer T, Bachar G. Major head and neck surgeries in the elderly population, a match-control study. Eur J Surg Oncol 2021; 47:1947-1952. [PMID: 34120808 DOI: 10.1016/j.ejso.2021.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/29/2021] [Accepted: 06/03/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate complication rates in elderly cancer patients undergoing major head and neck surgeries. METHODS A retrospective, matched-control, analysis. For each elderly (≥70 years) patient, a younger, (<70 years) patients were matched based on sex, tumor location, disease stage, and operation time. Post-operative complication and survival analyses were performed. RESULTS Of 225 patients, 75 (33.3%) were elderly (mean age 76.2 (70-88) years) and compared with a match control group (53.2 (23-69) years). A higher rate of cardio-vascular comorbidity was noted in the elderly group (70.6% vs. 34%, respectively, P < 0.001). The majority (62.7%) of elderly patients required reconstruction with 24% receiving vascularized flap reconstruction. Total postoperative complication rate was 49.9% in the study versus 42.3% in the control group, with a major complication rate of 22.5% in the elderly versus 11.9% in the control group (P = 0.154). Mean follow-up was 41 (0-144) months. Five-year disease-specific (67.1% vs. 80.7%, P < 0.001) and overall survival rates (48.6% vs. 75.4%, P < 0.001) were significantly lower among elderly patients. CONCLUSIONS Major head and neck surgery in the elderly population does not entail higher complication rate, compared with younger patients, and should be allowed when curative intent is feasible and patient's general condition allows.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Aviram Mizrachi
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Stern Shavit
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Ben-Ner
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yonathan Reuven
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bshara Elias
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Thomas Shpitzer
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otolaryngology, Head and Neck Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Schoonbeek RC, Bult FFS, Plaat BEC, Witjes MJH, van der Hoorn A, van Dijk BAC, Halmos GB. Incidental findings during the diagnostic work-up in the head and neck cancer pathway: Effects on treatment delay and survival. Oral Oncol 2021; 118:105350. [PMID: 34030108 DOI: 10.1016/j.oraloncology.2021.105350] [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: 03/05/2021] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES As a result of the increasing number of diagnostic scans, incidental findings (IFs) are more frequently encountered during oncological work-up in patients with head and neck squamous cell carcinomas (HNSCC). IFs are unintentional discoveries found on diagnostic imaging. Relevant IFs implicate clinical consequences, resulting in delay in oncologic treatment initiation, which is associated with unfavorable outcomes. This study is the first to investigate the incidence and nature of IFs over the years and establish the effect of relevant IFs on delay. MATERIAL AND METHODS This retrospective study compared two time periods (2010-2011 and 2016-2017), described associations between relevant IFs and delay in carepathway interval (days between first visit and treatment initiation) and assessed the effect of relevant IFs on overall two-year survival. RESULTS In total, 592 patients were included. At least one IF was found in 61.5% of the patients, most frequently on chest-CT. In 128 patients (21.6%) a relevant IF was identified, resulting for the majority in radiologist recommendations (e.g. additional scanning). Presence of a relevant IF was an independent significant factor associated with delay in treatment initiation. The risk of dying was higher for patients with a relevant IF, although not significant in the multivariable model (HR: 1.46, p = 0.079). CONCLUSION In diagnostic work-up for HNSCC patients, relevant IFs are frequently encountered. As the frequency of additional imaging rises over the years, the number of IFs increased simultaneously. These relevant IFs yield clinical implications and this study described that relevant IFs result in significant delay in treatment initiation.
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Affiliation(s)
- R C Schoonbeek
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Groningen, the Netherlands.
| | - F F S Bult
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Groningen, the Netherlands
| | - B E C Plaat
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Groningen, the Netherlands
| | - M J H Witjes
- University of Groningen, University Medical Center Groningen, Department of Oral and Maxillofacial Surgery, Groningen, the Netherlands
| | - A van der Hoorn
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, the Netherlands
| | - B A C van Dijk
- Netherlands Comprehensive Cancer Organization (IKNL), Department of Research, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - G B Halmos
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, Groningen, the Netherlands
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Mirian C, Gerds TA, Pedersen MM, de Ridder M, Balm A, Mattavelli D, Piazza C, Jensen LR, Balasubramanian D, Subramaniam N, Dokhe Y, Thankappan K, Iyer S, Karam SD, Wiegand S, Feeley L, Milross C, Gao K, Palme CE, Low THH, Gupta R, Freudlsperger C, Moratin J, Sheahan P, Clark J, Ovesen T. Metrics of pN-staging in oral squamous cell carcinoma: An analysis of 1,905 patients. Eur J Cancer 2021; 150:33-41. [PMID: 33887515 DOI: 10.1016/j.ejca.2021.03.019] [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: 01/13/2021] [Revised: 02/20/2021] [Accepted: 03/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND We aimed to compare the predictive performance of pN-categories in oral squamous cell carcinoma (OSCC) encompassing the most recent 8th edition (TNM8), its predecessor (TNM7), and a newly proposed algorithm (pN-N+), which classifies patients according to the number of positive lymph nodes and extranodal extension. METHODS Consecutive, primary OSCC patients from seven previously published cohorts were included and classified according to the three pN-classifications: TNM7, TNM8 and pN-N+. Overall survival probabilities were summarised with the Kaplan-Meier method. We added each of the three metrics to a Cox regression adjusted for pT-category, lymph nodal yield, age, sex, radiotherapy and chemotherapy, and trained these models in one institution. We evaluated the predictive performance in the remaining six institutions and assessed the predicted 5-year risk of death using the area under the receiver operating characteristics curve (AUC) and Brier scores. RESULTS All 1,905 included patients were classified according to TNM7 and pN-N+. A subset of 1,575 patients was additionally classified according to TNM8, leading to upstaging in 27.0%. The pN-N+ ranked overall best determined by the obtained AUC and Brier scores. In contrast to pN-N+, TNM7 and TNM8 both suffered from disproportionate patient distribution across pN-categories and poor pN-categorial discrimination on overall survival. CONCLUSIONS The TNM8 pN-classification designates a larger subset to more advanced disease stages but failed to show improvement of its predictive performance compared to TNM7. The pN-categories of TNM7/8 are disproportionate and inconsistently discriminated. The pN-N+ conveyed the best measures of prognosis and should be considered in future TNM iterations.
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Affiliation(s)
- Christian Mirian
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark.
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Maria M Pedersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Mischa de Ridder
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Alfons Balm
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands; Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Davide Mattavelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Lasse R Jensen
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark
| | - Deepak Balasubramanian
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Narayana Subramaniam
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Yogesh Dokhe
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Krishnakumar Thankappan
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Subramania Iyer
- Department of Head and Neck Surgery, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, India
| | - Sana D Karam
- Department of Radiation Oncology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Susanne Wiegand
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Linda Feeley
- Department of Pathology, Cork University Hospital, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland
| | - Chris Milross
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Department of Radiation Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Kan Gao
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - Carsten E Palme
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Tsu-Hui Hubert Low
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Ruta Gupta
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Sydney, Australia
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Patrick Sheahan
- ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Ireland; Department of Otolaryngology - Head and Neck Surgery, South Infirmary Victoria, University Hospital, Cork, Ireland; Department of Surgery, University College Cork, Cork, Ireland
| | - Jonathan Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia; Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
| | - Therese Ovesen
- Department of Otorhinolaryngology, Region Hospital West Jutland, Holstebro, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus C, Denmark
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Farrugia M, Erickson K, Wendel E, Platek ME, Ji W, Attwood K, Ma SJ, Gu F, Singh AK, Ray AD. Change in Physical Performance Correlates with Decline in Quality of Life and Frailty Status in Head and Neck Cancer Patients Undergoing Radiation with and without Chemotherapy. Cancers (Basel) 2021; 13:cancers13071638. [PMID: 33915867 PMCID: PMC8037640 DOI: 10.3390/cancers13071638] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Quality of life (QoL) scores and frailty status are becoming increasingly important criterion with implications on both how patients are treated and survival in head and neck cancer (HNC). Despite this, physicians lack tools to identify patients who are at risk of suffering declines in QoL and becoming frail following treatment. Therefore, we investigated whether functional decline, as measured by a series of physical tests called the Short Physical Performance Battery (SPPB), correlated with a reduction in QoL and increased risk of frailty. In the current study, patients who experienced a decline in SPPB scores were significantly more likely to have changes in physical functioning QoL measures as well as transition to frail status following treatment. In conclusion, the SPPB may be a useful tool to identify patients who may benefit from additional rehabilitation in future studies. Abstract Patient-reported quality of life (QoL) metrics, frailty status, and physical functioning are emerging concepts in head and neck cancer (HNC) with implications on both treatment decision-making and prognosis. The impact of treatment-related functional decline on QoL and frailty has not been well-characterized in HNC and was the focus of this investigation. Methods: Patients who underwent radiation therapy for HNC from 2018 to 2020 were evaluated as a prospective observational cohort. Functional decline, QoL, and the frailty phenotype were measured via the Short Physical Performance Battery (SPPB), European Organization for Research and Treatment of Cancer (EORTC) qlq-C30, and Fried Frailty index, respectively. Results: A total of 106 HNC patients were included, 75 of which received concurrent chemoradiation therapy (CCRT) and 31 received radiation alone, both with and without surgery. There was a decrease in SPPB overall (p < 0.001) from the beginning to the end of treatment in the CCRT group but not the radiation group (p = 0.43). Change in overall SPPB points following treatment correlated with the decline in physical QoL for both groups (p < 0.05) as well as transition frail status in the CCRT group (p < 0.001) with a trend in the radiation group (p = 0.08). Conclusions: Change in SPPB correlates with QoL and transition to frailty status in patients undergoing definitive CCRT for HNC with similar trends in those receiving radiation alone. Decline in SPPB could potentially be useful in identification of those who may benefit from rehabilitation in future studies.
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Affiliation(s)
- Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Kayleigh Erickson
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Elizabeth Wendel
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Dietetics, D’Youville College, Buffalo, NY 14203, USA
| | - Wenyan Ji
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Kristopher Attwood
- Department of Biostatistics, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (W.J.); (K.A.)
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Fangyi Gu
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (M.F.); (M.E.P.); (S.J.M.); (A.K.S.)
| | - Andrew D. Ray
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA; (K.E.); (E.W.); (F.G.)
- Department of Rehabilitation Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
- Correspondence: ; Tel.: +1-716-845-2381; Fax: +1-716-845-8487
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Kim D, Kim N, Koh S, Chung MK, Son YI, Oh D, Jeong HS, Ahn YC. Oncological and Functional Outcomes of Larynx-preserving Surgery for Hypopharyngeal Cancer: A Comparison with Definitive Radiation-based Treatment. Cancer Res Treat 2021; 54:84-95. [PMID: 33781050 PMCID: PMC8756124 DOI: 10.4143/crt.2020.1197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/24/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose Larynx-preserving surgery (LPS) have recently gained popularity and achieved comparable oncologic outcomes to conventional radical surgery for localized hypopharyngeal cancer (HPC). In the current study, the role of LPS has been assessed thoroughly in comparison with upfront radiation therapy (RT). Materials and Methods We retrospectively reviewed 185 candidates for LPS with cT1–2 disease; 59 patients underwent upfront LPS while 126 patients received upfront RT, respectively. Oncological and functional outcomes were investigated and compared. Results Following LPS, safe margin (≥ 5 mm) was achieved in 37.3% of patients. Overall, better clinical outcomes at 5 years were achieved following upfront LPS than those following upfront RT: overall survival (OS) (72.7% vs. 59.0%, p=0.045), disease-free survival (DFS) (59.8% vs. 45.0%, p=0.039), and functional laryngeal preservation (100% vs. 89.7%, p=0.010). Although similar outcomes were observed in patients with cT1 disease, better 5-year DFS was achieved following upfront LPS in patients with cT2 disease (57.0% vs. 36.4%, p=0.023) by virtue of better local control. Despite frequent cN2–3 disease in upfront LPS group, comparable outcomes were observed between upfront RT and LPS group. However, multivariable analyses revealed that performance status and double primary cancer diagnosed within 6 months of HPC diagnosis affected OS significantly, while treatment modality per se did not. Conclusion Although upfront LPS could provide better local control than upfront RT in patients with cT2 disease, overall outcomes were comparable following either modality. Treatment selection of larynx-preserving approach for HPC should be individualized based on tumor and patient factors.
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Affiliation(s)
- Donghyeok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nalee Kim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sungmin Koh
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Ik Son
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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37
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Kase S, Baburin A, Kuddu M, Innos K. Incidence and Survival for Head and Neck Cancers in Estonia, 1996-2016: A Population-Based Study. Clin Epidemiol 2021; 13:149-159. [PMID: 33658861 PMCID: PMC7917307 DOI: 10.2147/clep.s293929] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/28/2021] [Indexed: 11/23/2022] Open
Abstract
Background Changing patterns of alcohol and tobacco consumption and human papillomavirus (HPV) infection have affected the epidemiology of head and neck cancers. The aim of this study was to examine 20-year trends in the incidence and survival of head and neck cancers in Estonia by site, sex, morphology, and stage. Methods Data on all adult cases of invasive head and neck cancers diagnosed in Estonia in 1996–2016 were obtained from a population-based cancer registry. TNM stage was available for 2010–2016. Incidence trends were modeled with join-point regression, and five-year relative survival ratios (RSRs) were calculated. Results A total of 6,769 cases were included, 64% men. We observed declining incidence of lip and laryngeal cancer and substantial increases in the incidence of hypopharyngeal and oropharyngeal cancers. Over 60% of mouth and pharyngeal cancers were diagnosed at stage IV. Age-standardized 5-year RSR for mouth and pharyngeal cancer increased substantially over the study period, from 21% (95% CI 16%–25%) in 1996–2002 to 33% (29%–38%) in 2010–2016. The largest survival increases were seen for cancers of the oral cavity (reaching 44% in 2010–2016), tongue (41%), and larynx (63%), while modest changes were seen for the oropharynx (24%) and hypopharynx (17%). The latest 5-year RSR was 90% for thyroid cancers (99% for papillary carcinoma). Large female survival advantage was seen for most sites. Conclusion The observed trends suggest an emerging role of HPV infection in combination with traditional risk factors in the development of head and neck cancers in Estonia. Efforts targeting health behavior, HPV vaccination, and earlier diagnosis are crucial for reducing mortality from these cancers.
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Affiliation(s)
- Sandra Kase
- Medical Faculty of Tartu University, Tartu, Estonia
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Maire Kuddu
- Department of Radiotherapy, Clinic of Haematology and Oncology, North Estonia Medical Centre, Tallinn, Estonia
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
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38
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Ramsey T, Lee B, Curran K, Desai V, Debiase C, Galati L, Gildener-Leapman N. Associations of insurance, urbanity, and comorbidity with types of palliative care received by patients with head and neck cancer. Head Neck 2021; 43:1499-1508. [PMID: 33599358 DOI: 10.1002/hed.26648] [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: 07/30/2020] [Revised: 01/08/2021] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our study examined some of the social and medical factors associated with receiving pain palliation alone over more aggressive cytoreductive palliative measures, such as surgery, chemotherapy, or radiation among patients with head and neck cancer. METHODS This retrospective study used the National Cancer Database 2016 for data analysis. Patient and tumor characteristics were examined using bivariate analysis and logistic regression to identify their association with receiving pain palliation alone versus cytoreductive palliation treatment. RESULTS Using multivariate logistic regression analysis, insurance status (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.15-0.50, p < 0.001), urbanity (OR: 1.73, 95%CI: 1.21-2.46, p = 0.002), and Charlson-Deyo scores greater than 3 (OR: 2.49, 95%CI: 1.38-4.47, p = 0.002) were significantly associated with receipt of pain palliation alone. CONCLUSIONS Clinicians should be aware of non-health-related factors, such as insurance status, that may influence patients' receipt of treatments in head and neck cancer.
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Affiliation(s)
- Tam Ramsey
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Brian Lee
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Kent Curran
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Vilok Desai
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Carolyn Debiase
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Lisa Galati
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
| | - Neil Gildener-Leapman
- Department of Otolaryngology - Head and Neck Surgery, Albany Medical Center, Albany, New York, USA
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39
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New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era. J Clin Med 2021; 10:jcm10040587. [PMID: 33557273 PMCID: PMC7915471 DOI: 10.3390/jcm10040587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
Locally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infection is confirmed in the case of patients with moderate and mild symptoms. For an early scenario, the standard chemo-radiotherapy using simultaneous integrated boost (SIB) technique is the preferred option, because it reduces the overall treatment time. For a late scenario with limited resources, hypo-fractionated treatment, with possible omission of chemotherapy for elderly patients and for those who have comorbidities, is recommended. Concurrent chemotherapy is controversial for dose values >2.4 Gy per fraction. The implementation of hypo-fractionated regimens should be based on a careful assessment of dose-volume constraints for organs at risks (OARs), using recommendations from clinical trials or dose conversion based on the linear-quadratic (LQ) model. Induction chemotherapy is not considered the optimal solution in this situation because of the risk of immunosuppression even though in selected groups of patients TPF regimen may bring benefits. Although the MACH-NC meta-analysis of chemotherapy in head and neck cancers did not demonstrate the superiority of induction chemotherapy over concurrent chemoradiotherapy, an induction regimen could be considered for cases with an increased risk of metastasis even in the case of a possible Covid-19 pandemic scenario.
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40
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Adjei Boakye E, Osazuwa-Peters N, Chen B, Cai M, Tobo BB, Challapalli SD, Buchanan P, Piccirillo JF. Multilevel Associations Between Patient- and Hospital-Level Factors and In-Hospital Mortality Among Hospitalized Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2021; 146:444-454. [PMID: 32191271 DOI: 10.1001/jamaoto.2020.0132] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Risk factors for in-hospital mortality of patients with head and neck cancer (HNC) are multilevel. Studies have examined the effect of patient-level characteristics on in-hospital mortality; however, there is a paucity of data on multilevel correlates of in-hospital mortality. Objective To examine the multilevel associations of patient- and hospital-level factors with in-hospital mortality and develop a nomogram to predict the risk of in-hospital mortality among patients diagnosed with HNC. Design, Setting, and Participants This cross-sectional study used the 2008-2013 National Inpatient Sample database. Hospitalized patients 18 years and older diagnosed (both primary and secondary diagnosis) as having HNC using the International Classification of Diseases, Ninth Revision, Clinical Modification codes were included. Analysis began December 2018. Main Outcomes and Measures The primary outcome of interest was in-hospital mortality. A weighted multivariable hierarchical logistic regression model estimated patient- and hospital-level factors associated with in-hospital mortality. Moreover, a multivariable logistic regression analysis was used to build an in-hospital mortality prediction model, presented as a nomogram. Results A total of 85 440 patients (mean [SD] age, 62.2 [13.5] years; 61 281 men [71.1%]) were identified, and 4.2% (n = 3610) died in the hospital. Patient-level risk factors associated with higher odds of in-hospital mortality included age (adjusted odds ratio [aOR], 1.03 per 1-year increase; 95% CI, 1.02-1.03), male sex (aOR, 1.23; 95% CI, 1.12-1.35), higher number of comorbidities (aOR, 1.14; 95% CI, 1.11-1.17), having a metastatic cancer (aOR, 1.49; 95% CI, 1.36- 1.64), having a nonelective admission (aOR, 3.26; 95% CI, 2.83-3.75), and being admitted to the hospital on a weekend (aOR, 1.30; 95% CI, 1.16-1.45). Of the hospital-level factors, admission to a nonteaching hospital (aOR, 1.48; 95% CI, 1.24-1.77) was associated with higher odds of in-hospital mortality. The nomogram showed fair in-hospital mortality discrimination (area under the curve of 72%). Conclusions and Relevance This cross-sectional study found that both patient- and hospital-level factors were associated with in-hospital mortality, and the nomogram estimated with fair accuracy the probability of in-hospital death among patients with HNC. These multilevel factors are critical indicators of survivorship and should thus be considered when planning programs or interventions aimed to improve survival among this unique population.
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Affiliation(s)
- Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield.,Simmons Cancer Institute at SIU, Southern Illinois University School of Medicine, Springfield
| | - Nosayaba Osazuwa-Peters
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, Missouri.,Saint Louis University Cancer Center, St Louis, Missouri
| | - Betty Chen
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield
| | - Miao Cai
- Department of Epidemiology and Biostatistics, Saint Louis University College for Public Health and Social Justice, St Louis, Missouri
| | | | - Sai D Challapalli
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School, Houston, Texas
| | - Paula Buchanan
- Saint Louis University Center for Health Outcomes Research, St Louis, Missouri
| | - Jay F Piccirillo
- Department of Otolaryngology-Head & Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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41
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Huang RD, Sun Z, Wang XH, Tian YM, Peng YL, Wang JY, Xiao WW, Chen CY, Deng XW, Han F. Development of a Comorbidity-Based Nomogram to Predict Survival After Salvage Reirradiation of Locally Recurrent Nasopharyngeal Carcinoma in the Intensity-Modulated Radiotherapy Era. Front Oncol 2021; 10:625184. [PMID: 33552995 PMCID: PMC7855849 DOI: 10.3389/fonc.2020.625184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/26/2020] [Indexed: 01/22/2023] Open
Abstract
Purpose To assess the impact of comorbidity on treatment outcomes in patients with locally recurrent nasopharyngeal carcinoma (lrNPC) using intensity-modulated radiotherapy (IMRT) and to develop a nomogram that combines prognostic factors to predict clinical outcome and guide individual treatment. Methods This was a retrospective analysis of patients with lrNPC who were reirradiated with IMRT between 2003 and 2014. Comorbidity was evaluated by Adult Comorbidity Evaluation-27 grading (ACE-27). The significant prognostic factors (P < 0.05) by multivariate analysis using the Cox regression model were adopted into the nomogram model. Harrell concordance index (C-index) calibration curves were applied to assess this model. Results Between 2003 and 2014, 469 lrNPC patients treated in our institution were enrolled. Significant comorbidity (moderate or severe grade) was present in 17.1% of patients by ACE-27. Patients with no or mild comorbidity had a 5-year overall survival (OS) rate of 36.2 versus 20.0% among those with comorbidity of moderate or severe grade (P < 0.0001). The chemotherapy used was not significantly different in patients with lrNPC (P > 0.05). For the rT3-4 patients, the 5-year OS rate in the chemotherapy + radiation therapy (RT) group was 30.0 versus 16.7% for RT only (P = 0.005). The rT3-4 patients with no or mild comorbidity were associated with a higher 5-year OS rate in the chemotherapy + RT group than in the RT only group (32.1 and 17.1%, respectively; P=0.003). However, for the rT3-4 patients with a comorbidity (moderate or severe grade), the 5-year OS rate in the chemotherapy + RT group vs. RT alone was not significantly different (15.7 vs. 15.0%, respectively; p > 0.05). Eight independent prognostic factors identified from multivariable analysis were fitted into a nomogram, including comorbidity. The C-index of the nomogram was 0.715. The area under curves (AUCs) for the prediction of 1-, 3-, and 5-year overall survival were 0.770, 0.764, and 0.780, respectively. Conclusion Comorbidity is among eight important prognostic factors for patients undergoing reirradiation. We developed a nomogram for lrNPC patients to predict the probability of death after reirradiation and guide individualized management.
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Affiliation(s)
- Run-Da Huang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Zhuang Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiao-Hui Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yun-Ming Tian
- Department of Radiation Oncology, Hui Zhou Municipal Centre Hospital, Huizhou, China
| | - Ying-Lin Peng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jing-Yun Wang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wei-Wei Xiao
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chun-Yan Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiao-Wu Deng
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Fei Han
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China.,State Key Laboratory of Oncology in South China, Guangzhou, China.,Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.,Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
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Montero Ruiz E, Pérez Sánchez L, Barberá Durbán R, Agudo Alonso R, Domínguez Alegría A, Montes-Jovellar González L. [Outcomes of comanagement with Internal Medicine in Otolaryngology]. J Healthc Qual Res 2021; 36:98-102. [PMID: 33397600 DOI: 10.1016/j.jhqr.2020.07.005] [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: 05/19/2020] [Revised: 06/30/2020] [Accepted: 07/12/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE The age and comorbidity of patients admitted to Otolaryngology are increasing, leading to increased consultations/referrals to Internal Medicine, but do not reach the required effectiveness. An alternative is comanagement. A study is conducted on the effect of comanagement on Otolaryngology. METHODS A retrospective observational study was conducted on patients ≥16 years old admitted in Otolaryngology between 03 December 2017 and 03 December 2019, since 03/12/2018 with comanagement with Internal Medicine since 03 December 2018. An analysis was performed on age, gender, type of admission, and whether the patient had surgery, administrative weight associated with (diagnosis-related group) DRG, total number of diagnoses at discharge, Charlson comorbidity index, deaths, urgent readmissions, and length of stay. RESULTS Comanaged patients were younger (3.1 years, 95% confidence interval [95% CI] 1.4 to 4.8), but with higher Charlson comorbidity index (0.2; 95% CI; 0.1 to 0.3), number of diagnoses (0.9; 95% CI; 0.6 to 1.2), and administrative weight (0.04; 95% CI; 0 to 0.09). On adjustment, comanagement reduced Otolaryngology length of stay by 26.7%, 0.8 days (95% CI; 0.3 to 1.3), 50% of urgent readmissions, and 60% mortality, both non-significant. The decrease in length of stay implies an Otolaryngology savings of at least € 320,476.5. CONCLUSIONS Patients admitted to Otolaryngology are increasing in age and comorbidity. Comanagement is associated with reduced length of stay and costs similar to those observed in other surgical services.
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Affiliation(s)
- E Montero Ruiz
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - L Pérez Sánchez
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Barberá Durbán
- Servicio de Otorrinolaringología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Agudo Alonso
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Domínguez Alegría
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Madrid, España
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43
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Karlsson O, Karlsson T, Pauli N, Andréll P, Finizia C. Jaw exercise therapy for the treatment of trismus in head and neck Cancer: a prospective three-year follow-up study. Support Care Cancer 2020; 29:3793-3800. [PMID: 32435968 PMCID: PMC8163667 DOI: 10.1007/s00520-020-05517-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
Purpose This study aims to examine effects of jaw exercise on trismus 3 years following completion of a post-radiotherapy jaw exercise intervention. Methods Prospective study including 50 patients with head-and-neck cancer receiving radiotherapy and/or chemotherapy, plus a matched control group. The intervention group underwent 10 weeks of jaw exercise training. Patients were followed pre-and postintervention and 3 years postintervention completion. Outcome measures were maximal interincisal opening (MIO), trismus-related symptoms, and health-related quality-of-life as measured by Gothenburg Trismus Questionnaire, EORTC QLQ-C30, and EORTC QLQ-H&N35. Results The intervention group had a statistically significantly higher mean MIO compared with the control group (40.1 mm and 33.9 mm, respectively, p < 0.001), reported less trismus-related problems and had an improved health-related quality-of-life when compared with the control group at the 3-year follow-up. These differences were all statistically significant. Conclusion Jaw exercise therapy resulted in increased MIO, less trismus-related symptoms, and improved health-related quality-of-life. Jaw exercise therapy should be initiated early, in a structured manner and continued long-term.
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Affiliation(s)
- Ove Karlsson
- Department of Anaesthesiology, Institute of Clinical Science, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Therese Karlsson
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden. .,Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Nina Pauli
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paulin Andréll
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine/Pain Center, Institute of Medicine, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
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Rühle A, Stromberger C, Haehl E, Senger C, David H, Stoian R, Zamboglou C, Knopf A, Budach V, Grosu AL, Nicolay NH. Development and validation of a novel prognostic score for elderly head-and-neck cancer patients undergoing radiotherapy or chemoradiation. Radiother Oncol 2020; 154:276-282. [PMID: 33245947 DOI: 10.1016/j.radonc.2020.11.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE To establish a clinically feasible prognostic score and nomogram based on easily accessible clinical data that will aid decision-making in elderly head-and-neck squamous cell carcinoma (HNSCC) patients undergoing (chemo)radiotherapy. MATERIAL AND METHODS 284 elderly HNSCC patients (≥65 years) undergoing curative (chemo)radiotherapy were included for the development of a score predicting overall survival (OS) based on the beta regression coefficients from significant parameters in a multivariate Cox regression analysis with p < 0.1 as inclusion criterion. A second, external cohort of 217 elderly HNSCC patients receiving (chemo)radiotherapy was used for validation. Using the aggregated data (n = 501), a nomogram was developed to predict 2- and 4-year OS. RESULTS Karnofsky Performance Status (HR = 2.654; p < 0.001), Charlson Comorbidity Index (HR = 2.598; p < 0.001) and baseline C-reactive protein (CRP) level (HR = 1.634; p = 0.068) were prognostic for OS in the multivariate analysis. An OS score based on beta regression coefficients was created, in which reduced performance status, increased comorbidity burden and increased CRP levels were included, leading to 3 distinct survival groups. The median OS for the 3 groups amounted to 107, 28 and 6 months, respectively (p < 0.001). The developed score was able to significantly differentiate between a favorable (median OS = 130 months), intermediate (29 months) and unfavorable prognosis (9 months) also in the external validation cohort (p = 0.005). CONCLUSION We propose a novel, validated prognostic score based on easily accessible clinical data allowing stratification between prognostic groups of elderly HNSCC patients receiving (chemo)radiotherapy. The derived nomogram for the prediction of 2-year and 4-year OS may aid decision-making for this vulnerable population.
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Affiliation(s)
- Alexander Rühle
- Department of Radiation Oncology, University of Freiburg - Medical Center, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Augustenburger Platz 1, Berlin, Germany
| | - Erik Haehl
- Department of Radiation Oncology, University of Freiburg - Medical Center, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Augustenburger Platz 1, Berlin, Germany
| | - Hélène David
- Department of Radiation Oncology, University of Freiburg - Medical Center, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Raluca Stoian
- Department of Radiation Oncology, University of Freiburg - Medical Center, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University of Freiburg - Medical Center, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Andreas Knopf
- Department of Otorhinolaryngology, University of Freiburg - Medical Center, Germany
| | - Volker Budach
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany; Augustenburger Platz 1, Berlin, Germany; German Cancer Consortium (DKTK) Partner Site Berlin, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Freiburg - Medical Center, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (dkfz), Heidelberg, Germany.
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Montalvo C, Finizia C, Pauli N, Fagerberg-Mohlin B, Andréll P. Impact of exercise with TheraBite device on trismus and health-related quality of life: A prospective study. EAR, NOSE & THROAT JOURNAL 2020:145561320961727. [PMID: 33035128 DOI: 10.1177/0145561320961727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Trismus is a common symptom in patients with head and neck cancer that affects many aspects of daily life negatively. The aim of this study was to investigate the impact of structured exercise with the jaw-mobilizing device TheraBite on trismus, trismus-related symptomatology, and health-related quality of life (HRQL) in patients with head and neck cancer. Fifteen patients with trismus (maximum interincisal opening [MIO] ≤35 mm) after oncologic treatment for head and neck cancer, underwent a 10-week exercise program with the TheraBite device and were followed regularly. Time between oncologic treatment and start of TheraBite exercise ranged from 0.7 to 14.8 years (average 6.2 years). MIO, trismus-related symptoms, and HRQL was assessed before and after exercise and after 6 months. A significant improvement in MIO was observed post-exercise (3.5 mm, 15.3%, p = 0.0002) and after 6-month of follow-up (4.7 mm, 22.1%, p = 0.0029). A statistically significant correlation was found between increased MIO and fewer trismus-related symptoms. In conclusion, exercise with TheraBite improved MIO and trismus-related symptoms in patients with trismus secondary to head and neck cancer. Structured exercise with the jaw-mobilizing device seems to be beneficial for patients with trismus independent of time since oncologic treatment.
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Affiliation(s)
- Charlotte Montalvo
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Nina Pauli
- Department of Otorhinolaryngology, Head and Neck Surgery, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Bodil Fagerberg-Mohlin
- Department of Oral and Maxillofacial Surgery, Faculty of Odontology, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Paulin Andréll
- Department of Molecular and Clinical Medicine/Multidisciplinary Pain Centre, Sahlgrenska University Hospital, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
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Lyu Y, Ni M, Zhai R, Kong F, Du C, Hu C, Ying H. Clinical characteristics and prognosis of elderly nasopharyngeal carcinoma patients receiving intensity-modulated radiotherapy. Eur Arch Otorhinolaryngol 2020; 278:2549-2557. [PMID: 33021689 PMCID: PMC8165069 DOI: 10.1007/s00405-020-06399-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/23/2020] [Indexed: 01/22/2023]
Abstract
Purpose To evaluate the clinical characteristics and prognosis of elderly nasopharyngeal carcinoma (NPC) patients receiving intensity-modulated radiotherapy (IMRT). Methods From June 2008 to October 2014, 148 newly diagnosed non-metastatic elderly NPC patients (aged ≥ 70 years) receiving IMRT were recruited. Comorbid condition was evaluated using the age-adjusted Charlson Comorbidity Index (ACCI). Kaplan–Meier method was used to estimate survival rates and the differences were compared using log-rank test. Hazard ratio (HR) and the associated 95% confidence interval (CI) were calculated using Cox proportional hazard model by means of multivariate analysis. Results The median follow-up time was 66.35 months. Estimated OS rate at 5 years for the entire group was 61.8% (95% confidence interval [CI] 0.542–0.703). The 5-year OS rate of RT alone group was 58.4% (95% [CI] 0.490–0.696) compared with 65.2% (95% [CI] 0.534–0.796) in CRT group (p = 0.45). In patients receiving IMRT only, ACCI score equal to 3 was correlated with superior 5-year OS rate in comparison with higher ACCI score 62.1% (95% [CI] 0.510–0.766) to 48.5% (95% [CI] 0.341–0.689), respectively; p = 0.024). A 5-year OS rate of 63.1% (95% [CI] 0.537–0.741) was observed in patients younger than 75 years old compared with 57.5% (95% [CI] 0.457–0.723) in patients older (p = 0.026). Patients with early-stage disease (I–II) showed better prognosis than patients with advanced-stage (III–IV) disease (5-year OS, 72.3–55.4%, respectively; p = 0.0073). The Cox proportional hazards model suggested that age independently predicted poorer OS (HR, 1.07; 95%CI 1.00–1.15, p = 0.04). Conclusion The survival outcome of patients aged ≥ 70 years receiving IMRT only was similar to chemoradiotherapy with significantly less acute toxicities. Among the population, age is significantly prognostic for survival outcomes.
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Affiliation(s)
- Yingchen Lyu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Mengshan Ni
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ruiping Zhai
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Fangfang Kong
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chengrun Du
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong'an Road, Shanghai, 200032, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Patel KB, Martin D, Zhao S, Kumar B, Carrau R, Ozer E, Agrawal A, Kang S, Rocco JW, Schuller D, Teknos T, Brock G, Old M. Impact of age and comorbidity on survival among patients with oral cavity squamous cell carcinoma. Head Neck 2020; 43:268-277. [PMID: 32996249 DOI: 10.1002/hed.26487] [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: 02/03/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To identify predictors of overall survival (OS) and to stratify patients according to significant prognostic variables. METHODS A retrospective study of 274 consecutive patients with primary Oral Cavity Squamous Cell Carcinoma. Kaplan-Meier, Cox proportional hazard models, and recursive partitioning analysis (RPA) were used for analysis of OS. These results were further validated using National Cancer Database cohort of 21 895 patients. RESULTS Median OS was 3.65 years. T-classification and N-classification, alcoholic beverages/week, age, and adjuvant treatment were significant predictors of OS. RPA identified high-risk subpopulations: N0-1 patients with CCI ≥ 4.5 and N2-3 patients ordered by those not receiving adjuvant treatment, those with T3-4 disease despite adjuvant therapy, and those having T1-2 disease with adjuvant therapy. CONCLUSIONS This study utilized significant prognostic indicators and RPA to highlight the importance of age, N-classification, T-classification, comorbidity, and adjuvant therapy in conjunction with American Joint Committee on Cancer staging to improve preoperative counseling.
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Affiliation(s)
- Krupal B Patel
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Daniel Martin
- School of Medicine & Dentistry, University of Rochester, Rochester, New York, USA
| | - Songzhu Zhao
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Bhavna Kumar
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Ricardo Carrau
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Stephen Kang
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - James W Rocco
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - David Schuller
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
| | - Theodoros Teknos
- Department of Otolaryngology-Head and Neck Surgery, Case Western University, Cleveland, Ohio, USA
| | - Guy Brock
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, Wexner Medical Center at The Ohio State University, Columbus, Ohio, USA
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Monteiro AR, Garcia AR, Pereira TC, Macedo F, Soares RF, Pereira K, Serra T, Khouri L, Ribeiro J, Teixeira MM. ACE-27 as a prognostic tool of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy: a real-world, prospective, observational study. Support Care Cancer 2020; 29:1863-1871. [PMID: 32789624 DOI: 10.1007/s00520-020-05679-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/08/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the association between comorbidities as assessed by the "Adult Comorbidity Evaluation 27" (ACE-27) and the development of severe acute toxicities in patients with head and neck cancer treated with chemoradiotherapy. METHODS Prospective, single-center cohort of patients with head and neck cancer treated with chemoradiotherapy (cisplatin 100 mg/m2 on days 1, 22, and 43; intensity-modulated radiotherapy 60 to 69.96 gray, in 30 to 33 fractions,) between June 2018 and December 2019. ACE-27 was assessed before the start of treatment. Patients were divided in two groups based on ACE-27 grading (none to mild versus moderate to severe comorbidities). Differences in incidence of severe acute toxicity and change in treatment plan between groups were examined. RESULTS A total of 101 patients were included: 90.1% were male, and median age was 57 years. ACE-27 grading was none in 6.9% of patients, mild in 52.5%, moderate in 29.7%, and severe in 10.9%. Severe acute toxicities occurred more frequently in patients with moderate to severe comorbidities (75.6% versus 48.3%), with a statically significant difference (p = 0.006, OR 3.314, 95%-CI (1.382-7.944)). In the group with moderate to severe comorbidities, omission of at least one cisplatin cycle (75.6% versus 60.0%) and premature ending of radiotherapy (12.2% versus 5.0%) also occurred more frequently (p ≥ 0.05). CONCLUSION In patients with head and neck cancer treated with chemoradiotherapy, the presence of moderate to severe comorbidities seems to correlate with higher incidences of severe acute toxicities. ACE-27 may identify patients at higher risk of major toxicities and assist decisions regarding treatment.
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Affiliation(s)
- Ana Raquel Monteiro
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal.
| | - Ana Rita Garcia
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Tatiana Cunha Pereira
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Filipa Macedo
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Rita Félix Soares
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Kayla Pereira
- Radiation Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Tânia Serra
- Radiation Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Leila Khouri
- Radiation Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - João Ribeiro
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
| | - Maria Margarida Teixeira
- Medical Oncology Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Av. Bissaya Barreto 98, 3000-075, Coimbra, Portugal
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Cheng HC, Yang CC, Kao SY, Wu TY, Wu CH. Evaluation of factors associated with the risk stratification of survivorship for stage IV squamous cell carcinoma of the oral cavity: A 10-year retrospective study. J Chin Med Assoc 2020; 83:491-499. [PMID: 32132387 DOI: 10.1097/jcma.0000000000000292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) leads to thousands of deaths every year in Taiwan. Nearly 40% of OSCC patients are diagnosed with stage IV disease, which has a poor prognosis. Multimodality treatments including surgery and adjuvant therapy have been utilized, but their treatment outcomes are generally poor. In this study, we sought to identify possible clinical impact factors that may contribute to the survival of stage IV OSCC. METHODS Data for patients with malignant neoplasms of the oral cavity registered in the Cancer Registry Database of Taipei Veterans General Hospital between 2002 and 2011 were retrieved. The study patients consisted of OSCC patients with clinical stage IV disease who had undergone a surgery and adjuvant therapy. The primary endpoints were the 5-year disease-free survival (DFS) and overall survival (OS) rates. The clinicopathological characteristics of the patients were also stratified and compared. RESULTS A total of 191 OSCC patients were included for retrospective analysis. The different subgroups of stage IV disease presented different treatment outcomes. The 5-year OS versus DFS rates of each subgroup were as follows: T4N0: 70.9% versus 52.6%; T1-3N23: 66.1% versus 49.8%; T4N1: 49.6% versus 31.6%; and T4N23: 40.9% versus 31.0% (p < 0.01). Patients with diabetes, moderate or poor cell differentiation, perineural invasion, and extracapsular spread presented lower 5-year OS rates (hazard ratio [HR] = 1.87, 1.65, 2.42, and 2.14, respectively), and patients with perineural invasion, positive cut margin, and extracapsular spread presented lower 5-year DFS rates (HR = 1.57, 1.62, and 1.71, respectively). CONCLUSION In this study, we elucidated the different survival rates of different subgroups of stage IV OSCC following the same treatment scheme. The results of the study provide clinical physicians with references by which to evaluate prognosis and determine post-operative disease monitoring timetables based upon different characteristics.
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Affiliation(s)
- Han-Chieh Cheng
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Cheng-Chieh Yang
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shou-Yen Kao
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzu-Ying Wu
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Stomatology, Orthodontic and Pediatric Dentistry, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Cheng-Hsien Wu
- Department of Stomatology, Oral and Maxillofacial Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan, ROC
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50
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Giudice LW, Graff EA, Haripersad Y, Frydrych AM, Parsons R, Kujan O, Farah CS. Chronic disease comorbidity in patients with oral leukoplakia: A matched case-control study. Oral Dis 2020; 26:894-902. [PMID: 32106348 DOI: 10.1111/odi.13315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate the presence of chronic diseases in patients with oral leukoplakia (OL) compared to controls matched for age group, gender, smoking and alcohol use. SUBJECTS AND METHODS This case-control study examined the general demographics, medical and social histories of 105 OL cases and 391 controls matched for age group, gender, tobacco and alcohol use. All OL cases were diagnosed based on both clinical and histopathological findings. RESULTS Chronic diseases were significantly associated with OL, namely dyslipidaemia (p < .0001), musculoskeletal diseases (p = .0101) and asthma (p = .0052). The use of ACE inhibitors (p = .0177), opioid analgesics (p = .0300), anticoagulants (p = .0055) and statins (p = .0010) was significantly associated with OL. Dyslipidaemia (p < .0001; odds ratio [95% CI]: 6.4 [3.5-11.6]) and asthma (p = .0110; odds ratio [95% CI]: 2.2 [1.2-4.0]) were identified as independent predictors of OL in multivariate analysis, both of which were significantly more common amongst cases than controls. CONCLUSIONS Results from this first Australian study suggest that dyslipidaemia and asthma may constitute independent predictors for the presence of OL. However, longitudinal studies are needed to ascertain the temporal relationship between OL and chronic disease comorbidity and the mechanisms underlying these associations.
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Affiliation(s)
- Lance W Giudice
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Emrik A Graff
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Yasmita Haripersad
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | | | - Richard Parsons
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, WA, Australia
| | - Omar Kujan
- UWA Dental School, The University of Western Australia, Nedlands, WA, Australia
| | - Camile S Farah
- Australian Centre for Oral Oncology Research & Education, Nedlands, WA, Australia.,Oral, Maxillofacial and Dental Surgery, Fiona Stanley Hospital, Murdoch, WA, Australia
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