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Kjems J, Elisabet Håkansson K, Andrup Kristensen C, Grau Eriksen J, Horsholt Kristensen M, Ivalu Sander Holm A, Overgaard J, Rønn Hansen C, Zukauskaite R, Johansen J, Richter Vogelius I, Friborg J. The influence of tumor volume on the risk of distant metastases in head and neck squamous cell carcinomas. Radiother Oncol 2023; 186:109771. [PMID: 37385382 DOI: 10.1016/j.radonc.2023.109771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND PURPOSE Distant metastases (DM) in head and neck squamous cell carcinomas (HNSCC) are in most circumstances non-curable. The TNM staging system is insufficient to predict the risk of DM. This study investigates if the DM risk can be predicted using a multivariate model including pre-treatment total tumor volume for both p16-positive oropharyngeal squamous cell carcinoma (OPSCC) and all other sites (other HNSCC). MATERIALS AND METHODS The study includes patients with localized pharyngeal and laryngeal squamous cell carcinomas treated with primary radiotherapy from 2008-2017 from three head and neck cancer centers. Patients were identified in the Danish Head and Neck Cancer (DAHANCA) database. Total (nodal and primary) tumor volume (Gross Tumor Volume, GTV) was extracted from local treatment planning systems. The GTV was grouped by volume (cm3) in four intervals and included in a multivariate Cox proportional hazard regression controlled for pre-selected clinical values incl. stage. RESULTS The study includes 2,865 patients, of which 321 (11 %) had DM post-treatment. The risk of DM was assessed in a multivariate model based on 2,751 patients (p16-positive OPSCC: 1,032; and other HNSCC: 1,719). There was a significant association between GTV and the risk of DM, and in tumor volumes ≥ 50 cm3 hazard ratios of 7.6 (2.5-23.4) for p16-positive OPSCC and 4.1 (2.3-7.2) in other HNSCC were observed. CONCLUSION Tumor volume is an independent risk factor for DM. The addition of total tumor volume to a predictive model is important to identify subgroups of HNSCC patients at high risk of DM.
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Affiliation(s)
- Julie Kjems
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | | | - Claus Andrup Kristensen
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus 8200, Denmark.
| | | | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus 8200, Denmark.
| | - Christian Rønn Hansen
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark; Laboratory of Radiation Physics, Odense University Hospital, Odense 5000, Denmark; Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark.
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark.
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense 5000, Denmark.
| | - Ivan Richter Vogelius
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
| | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital - Rigshospitalet, Copenhagen 2100, Denmark.
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2
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Zhang Q, Xu T, Shen C, Qian W, Ying H, He X, Wang Y, Ji Q, Hu C, Zhou X, Lu X. Response to induction chemotherapy predicts survival outcomes in oropharyngeal cancer. Cancer Med 2023; 12:9175-9185. [PMID: 36708134 PMCID: PMC10166893 DOI: 10.1002/cam4.5656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 01/10/2023] [Accepted: 01/17/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The role of induction chemotherapy (IC) in oropharyngeal squamous cell carcinoma (OPSCC) remains controversial. Its interpretation can be confounded by heterogeneity in chemosensitivity and human papillomavirus (HPV) status. This study aimed to investigate the prognostic impact of IC response in HPV-positive and -negative OPSCC. METHODS Patients with OPSCC who underwent IC and concurrent chemoradiotherapy (CCRT) were retrospectively analyzed. Radiologic response to IC by ≥50% was defined as IC-sensitive (IC-s), while lesser response was deemed as IC-resistant (IC-r). Progression-free survival (PFS) and overall survival (OS) were compared between subgroups. RESULTS A total of 51 HPV-positive and 57 HPV-negative patients were included. IC-s patients accounted for 55.6%, 62.7%, and 49.1% in the entire cohort, HPV-positive, and HPV-negative subgroup, respectively. Compared with IC-r subgroup, IC-s was associated with better clinical outcomes either in the entire cohort (3y-PFS 91.7%vs.43.7%, P < 0.001; 3y-OS 98.3% vs. 67.4%, P = 0.002), the HPV-positive subgroup (3-year PFS 94.7% vs. 47.9%, P < 0.001; 3-year OS 100% vs. 73.5%, P = 0.055) or the HPV-negative subgroup (3-year PFS 88.2% vs. 40.9%, P = 0.001; 3-year OS 96.4% vs. 63.1%, P = 0.026). Multivariate analysis demonstrated that response to IC represents an independent prognosticator for 3-year PFS (HR, 0.088; 95% CI, 0.027-0.289; P < 0.001) and 3-year OS (HR, 0.100; 95% CI, 0.021-0.477; P = 0.004). CONCLUSIONS Response to IC exerts a critical predictive effect on prognosis of both HPV-positive and -negative OPSCC. Personalized treatment strategy based on IC response is worthy of further exploration in the future.
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Affiliation(s)
- Qixian Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Tingting Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Chunying Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Wei Qian
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Yu Wang
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qinghai Ji
- Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Xin Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
| | - Xueguan Lu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College of Fudan University, Shanghai, China.,Shanghai Clinical Research Center for Radiation Oncology, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology, Shanghai, China
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3
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Khan H, Pandey SN, Mishra A, Srivastava R. Suppression of TLR signaling by IRAK-1 and -4 dual inhibitor decreases TPF-resistance-induced pro-oncogenic effects in HNSCC. 3 Biotech 2023; 13:14. [PMID: 36540413 PMCID: PMC9759608 DOI: 10.1007/s13205-022-03420-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
Combination of docetaxel, cisplatin and 5-FU, known as TPF, is an FDA-approved treatment for head and neck squamous cell carcinoma (HNSCC). Acquired chemo-resistance to TPF, a primary reason for non-responsiveness to the treatment and relapse of tumor is a major concern for treatment failure, especially in elder patients. In this study, we investigated the role of Interleukin-1 receptor-associated kinases (IRAK) mediated Toll-like receptor (TLR)-signaling in chemo-resistance using a cell line-based in-vitro TPF-resistant HNSCC model of laryngeal origin. TPF chemo-resistant state showed over-expression and phosphorylation of the active downstream kinases IRAK-1 and IRAK-4 along with enhanced proliferative potential, survival, stemness and metastatic capability as compared to the parent cell line. Pharmacological inhibition of IRAK-1 and -4 had a cytostatic effect on chemo-resistant cells and re-sensitized them to chemotherapy. The treatment also decreased the pro-oncogenic effects of the chemo-resistant cells. Our study provides insights into the pro-oncogenic role of amplified IRAK-1 and-4 mediated TLR signaling in TPF-resistant HNSCC. Pharmacological inhibition of IRAK-1 and-4 signaling is a promising therapeutic strategy for TPF-resistant HNSCC. It can also be used as a combination therapy or a chemo-drug sparing regimen in HNSCC.
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Affiliation(s)
- Humayara Khan
- Department of Microbiology and Biotechnology Centre, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat 390020 India
| | | | - Abhishek Mishra
- King George Medical University, Lucknow, Uttar Pradesh 226003 India
| | - Ratika Srivastava
- Department of Microbiology and Biotechnology Centre, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat 390020 India
- Department of Biotechnology, School of Life Sciences, Babasaheb Bhimrao Ambedkar University, Vidya Vihar, Rae Bareli Road, Lucknow, Uttar Pradesh 226025 India
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4
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Mulcahy CF, Gross ND. Advances in Surgical Therapy for HPV-Associated Squamous Cell Carcinoma. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00421-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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5
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Petrelli F, Luciani A, Ghidini A, Cherri S, Gamba P, Maddalo M, Bossi P, Zaniboni A. Treatment de-escalation for HPV+ oropharyngeal cancer: A systematic review and meta-analysis. Head Neck 2022; 44:1255-1266. [PMID: 35238114 DOI: 10.1002/hed.27019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 12/12/2022] Open
Abstract
Human Papillomavirus (HPV) related oropharyngeal carcinoma (OPC) carries a better prognosis compared with HPV-counterparts, thereby pushing the adoption of de-intensification treatment approaches as new strategies to preserve superior oncologic outcomes while minimizing toxicity. We evaluated the effect of treatment de-intensification in terms of overall survival (OS), progression-free survival (PFS), locoregional and distant control (LRC and DM) by selecting prospective or retrospective studies, providing outcome data with reduced intensification versus standard curative treatment in HPV+ OPC patients, with a systematic analysis till September 2020. The primary outcome of interest was OS. Secondary endpoints were PFS, LRC, and DM expressed as HR. A total of 55 studies (from 1393 screened references) were employed for quantitative synthesis for 38 929 patients. Among n = 48 studies with data available, de-intensified treatments reduced OS in HPV+ OPCs (HR = 1.33, 95% CI 1.17-1.52; p < 0.01). In de-escalated treatments, PFS was also decreased (HR = 2.11, 95% CI 1.65-2.69; p < 0.01). Compared with standard treatments, reduced intensity approaches were associated with reduced locoregional and distant disease control (HR = 2.51, 95% CI 1.75-3.59; p < 0.01; and HR = 1.9, 95% CI 1.25-2.9; p < 0.01). Chemoradiation improved survival in a definitive curative setting compared with radiotherapy alone (HR = 1.42, 95% CI 1.16-1.75; p < 0.01). When adjuvant treatments were compared, standard and de-escalation strategies provided similar OS. In conclusion, in patients with HPV+ OPC, de-escalation treatments should not be widely and agnostically adopted in clinical practice, as therein lies a concrete risk of offering a sub-optimal treatment to patients.
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Affiliation(s)
| | | | | | - Sara Cherri
- Oncology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Gamba
- Otolaryngology Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Marta Maddalo
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences, Public Health, University of Brescia, Brescia, Italy
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6
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Shama M, Al-Qurayshi Z, Dahl M, Amdur RJ, Bates J, Mendenhall W, Hitchcock K, Festa BM, Ghanem T, Dziegielewski PT. Human Papillomavirus-Negative Oropharyngeal Cancer Survival Outcomes Based on Primary Treatment: National Cancer Database Analysis. Otolaryngol Head Neck Surg 2021; 167:100-108. [PMID: 34546828 DOI: 10.1177/01945998211047169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare survival outcomes between primary surgery and primary radiation therapy (RT) in patients with human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN A retrospective observational cohort study. SETTING National Cancer Database. METHODS A National Cancer Database review was conducted of 2635 patients with HPV-negative OPSCC who underwent surgery or RT ± chemotherapy between 2010 and 2014. Univariate analysis was performed on all variables and entered into a multivariate model. The main outcome was overall survival (OS). RESULTS A total of 2635 patients with HPV-negative OPSCC were organized into 4 groups based on cancer staging. In group 1 (T1-2 N0-1; n = 774), up-front surgery had significantly better 5-year OS (76.2%) than RT (56.8%; adjusted hazard ratio [aHR], 1.76; P = .009; 95% CI, 1.15-2.69) and chemoradiation therapy (CRT; 69.5%; aHR, 1.56; P = .019; 95% CI, 1.08-2.26). In group 2 (T3-4 N0-1; n = 327), no significant difference existed between surgery and CRT (5-year OS, 51.3% vs 52.4%; aHR, 0.96; P = .88; 95% CI, 0.54-1.69). In group 3a (T1-2 N2-3; n = 807), surgery with adjuvant treatment showed significantly better 5-year OS than CRT (78.6% vs 68.8%; aHR, 1.51; P = .027; 95% CI, 1.05-2.18). In group 3b (T3-4 N2-3; n = 737), surgery with adjuvant treatment was not statistically associated with better 5-year OS as compared with CRT (61.0% vs 43.7%; aHR, 1.53; P = .06; 95% CI, 0.98-2.39). CONCLUSION Primary surgery may provide improved survival outcomes in many cases of HPV-negative OPSCCs. These data should be used in weighing treatment options and may serve as a basis to better delineate treatment algorithms for HPV-negative disease.
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Affiliation(s)
- Mohamed Shama
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.,Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Zaid Al-Qurayshi
- Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA
| | - Mohammad Dahl
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.,University of Mosul, Mosul, Iraq
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - James Bates
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Kathryn Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Bianca M Festa
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Tamer Ghanem
- Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
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7
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Guo TW, Saiyed F, Yao CMKL, Kiong KL, Martinez J, Sacks R, Lee JJ, Moreno AC, Frank SJ, Rosenthal DI, Glisson BS, Ferrarotto R, Mott FE, Johnson FM, Myers JN. Outcomes of patients with oropharyngeal squamous cell carcinoma treated with induction chemotherapy followed by concurrent chemoradiation compared with those treated with concurrent chemoradiation. Cancer 2021; 127:2916-2925. [PMID: 33873251 DOI: 10.1002/cncr.33491] [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: 08/24/2020] [Revised: 12/23/2020] [Accepted: 01/18/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Induction chemotherapy (IC) has been associated with a decreased risk of distant metastasis in locally advanced head and neck squamous cell carcinoma. However, its role in the treatment of oropharyngeal squamous cell carcinoma (OPSCC) is not well established. METHODS The outcomes of patients with OPSCC treated with IC followed by concurrent chemoradiation (CRT) were compared with the outcomes of those treated with CRT alone. The primary outcome was overall survival (OS), and the secondary end points were the times to locoregional and distant recurrence. RESULTS In an existing database, 585 patients met the inclusion criteria: 137 received IC plus CRT, and 448 received CRT. Most patients were positive for human papillomavirus (HPV; 90.9%). Patients receiving IC were more likely to present with a higher T stage, a higher N stage, and low neck disease. The 3-year OS rate was significantly lower in patients receiving IC (75.7%) versus CRT alone (92.9%). In a multicovariate analysis, receipt of IC (adjusted hazard ratio [aHR], 3.4; P < .001), HPV tumor status (aHR, 0.36; P = .002), and receipt of concurrent cetuximab (aHR, 2.7; P = .002) were independently associated with OS. The risk of distant metastasis was also significantly higher in IC patients (aHR, 2.8; P = .001), whereas an HPV-positive tumor status (aHR, 0.44; P = .032) and completion of therapy (aHR, 0.51; P = .034) were associated with a lower risk of distant metastasis. In HPV-positive patients, IC remained associated with distant metastatic progression (aHR, 2.6; P = .004) but not OS. CONCLUSIONS In contrast to prior studies, IC was independently associated with worse OS and a higher risk of distant metastasis in patients with OPSCC. Future studies are needed to validate these findings.
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Affiliation(s)
- Theresa W Guo
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California, San Diego, California
| | - Faiez Saiyed
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Otorhinolaryngology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Christopher M K L Yao
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kimberley L Kiong
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julian Martinez
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ruth Sacks
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - J Jack Lee
- Department of Biostatistics, Division of Basic Sciences, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Amy C Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bonnie S Glisson
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Renata Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Frank E Mott
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Faye M Johnson
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Graduate School of Biomedical Sciences, University of Texas, Houston, Texas
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Graduate School of Biomedical Sciences, University of Texas, Houston, Texas
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8
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Induction chemotherapy in head and neck cancers: Results and controversies. Oral Oncol 2019; 95:164-169. [DOI: 10.1016/j.oraloncology.2019.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/07/2019] [Indexed: 11/20/2022]
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9
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Tumati V, Hoang L, Sumer BD, Truelson JM, Myers LL, Khan S, Hughes RS, Nedzi L, Sher DJ. Association between treatment delays and oncologic outcome in patients treated with surgery and radiotherapy for head and neck cancer. Head Neck 2018; 41:315-321. [PMID: 30548892 DOI: 10.1002/hed.25457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/31/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study sought to determine the oncologic impact of delays to surgery, radiotherapy, and completion of therapy in patients with head and neck squamous cell carcinoma. METHODS The impact of biopsy to surgery (BTS) time, surgery to start of radiation time (STSR), and radiation treatment time (RTT) on locoregional recurrence (LRR), distant metastases (DMs), and cancer-specific mortality (CSM) was examined. The cumulative incidences (CI) of LRR, DMs, and CSM were examined using Fine-Gray testing. RESULTS A total of 277 patients treated with surgery and adjuvant radiotherapy were analyzed. On multivariable testing, BTS >50 days was associated with DM (P = .03), whereas RTT and STSR were not. RTT >43 days was associated with LRR (P = .02) in patients with non-p16-positive-oropharynx cancer. CONCLUSIONS An increase in DM appears to be the mechanism by which prolonged time to treatment initiation leads to worse overall survival. Prolonged RTT has the greatest impact on patients with non-p16 positive oropharynx cancers.
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Affiliation(s)
- Vasu Tumati
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lawrence Hoang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Baran D Sumer
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.,Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John M Truelson
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.,Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Larry L Myers
- Department of Otolaryngology, University of Texas Southwestern Medical Center, Dallas, Texas.,Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Saad Khan
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Randall S Hughes
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lucien Nedzi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - David J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.,Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Outcomes and Health Services Research, University of Texas Southwestern Medical Center, Dallas, Texas
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10
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Morse E, Berson E, Fujiwara R, Judson B, Mehra S. Hypopharyngeal Cancer Treatment Delays: Benchmarks and Survival Association. Otolaryngol Head Neck Surg 2018; 160:267-276. [DOI: 10.1177/0194599818797605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To characterize treatment delays in hypopharyngeal cancer, identify factors associated with delays, and associate delays with overall survival. Study Design Retrospective cohort. Setting Commission on Cancer hospitals nationwide. Subjects and Methods We included patients in the National Cancer Database who were treated for hypopharyngeal cancer with primary radiation, concurrent chemoradiation, or induction chemotherapy and radiation. We identified median durations of diagnosis to treatment initiation (DTI), radiation treatment duration (RTD), and diagnosis to treatment end (DTE). We associated delays with patient, tumor, and treatment factors and overall survival via multivariable logistic and Cox proportional hazards regression, respectively. Results A total of 3850 patients treated with primary radiation or concurrent chemoradiation were included. Median durations of DTI, RTD, and DTE were 37, 52, and 92 days, respectively. Nonwhite race was associated with delays in DTI (odds ratio [OR] = 0.64; 95% CI, 0.51-0.80; P < .001) and DTE (OR = 0.60; 95% CI, 0.49-0.75; P < .001). Medicaid insurance was associated with delays in DTI (OR = 1.43; 95% CI, 1.07-1.90; P = .015), RTD (OR = 1.39; 95% CI, 1.06-1.83; P = .018), and DTE (OR = 1.48; 95% CI, 1.12-1.97; P = .007). Delays in RTD (hazard ratio [HR] = 1.24; 95% CI, 1.11-1.37; P < .001), not DTI (HR = 0.92; 95% CI, 0.82-1.03; P = .150) or DTE (HR = 1.01; 95% CI, 0.90-1.15; P = .825), were associated with impaired overall survival. We identified 922 patients who received induction chemotherapy. Delays in DTI, RTD, and DTE were not associated with overall survival in this cohort (HR = 1.10; 95% CI, 0.87-1.39; P = 0.435; HR = 1.05; 95% CI, 0.83-1.32; P = 0.686; HR = 1.11; 95% CI, 0.88-1.41; P = 0.377, respectively). Conclusions The median durations identified can serve as national benchmarks. Delays during radiation are associated with impaired overall survival among patients treated with primary radiation or chemoradiation but not patients treated with induction chemotherapy.
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Affiliation(s)
- Elliot Morse
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Elisa Berson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Rance Fujiwara
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Benjamin Judson
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Saral Mehra
- Division of Otolaryngology, Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
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11
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Mañós M, Giralt J, Rueda A, Cabrera J, Martinez-Trufero J, Marruecos J, Lopez-Pousa A, Rodrigo J, Castelo B, Martínez-Galán J, Arias F, Chaves M, Herranz J, Arrazubi V, Baste N, Castro A, Mesía R. Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 1). Oral Oncol 2017; 70:58-64. [DOI: 10.1016/j.oraloncology.2017.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/31/2017] [Accepted: 04/08/2017] [Indexed: 01/15/2023]
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12
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Assessing cumulative acute toxicity of chemoradiotherapy in head and neck cancer with or without induction chemotherapy. Am J Otolaryngol 2017; 38:456-461. [PMID: 28427799 DOI: 10.1016/j.amjoto.2017.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 04/09/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND To compare cumulative acute toxicity in head and neck cancer patients treated with concurrent chemoradiotherapy alone (CCRT) versus induction chemotherapy (IC) followed by CCRT (I/CCRT). METHODS 77 patients underwent definitive CCRT (30 I/CCRT and 47 CCRT). Toxicity was graded using the Common Terminology Criteria for Adverse Events version 4.0. Using the TAME adverse event reporting system, short-term toxicity (T) scores were generated for IC (TIC), CCRT (TCCRT), total treatment duration (TRx), post-treatment period (TPT) and an overall score (Toverall) from treatment start to post treatment period. RESULTS Acute toxicity other than dysphagia, odynophagia, or dermatitis was reported in 90.0% and 66.0% of I/CCRT and CCRT patients, respectively (P=0.02). Compared to CCRT group, I/CCRT patients reported greater mean TRx (TRx: 2.11 vs. 2.87, P=0.01) and Toverall (Toverall: 2.60 vs. 3.70, P=0.003). CONCLUSION I/CCRT patients reported more cumulative acute toxicity during treatment compared to CCRT patients using the TAME reporting system.
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13
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Stokes WA, Amini A, Jones BL, McDermott JD, Raben D, Ghosh D, Goddard JA, Bowles DW, Karam SD. Survival impact of induction chemotherapy in advanced head and neck cancer: A National Cancer Database analysis. Head Neck 2017; 39:1113-1121. [PMID: 28301079 DOI: 10.1002/hed.24739] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 10/20/2016] [Accepted: 12/29/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Adding induction chemotherapy to concurrent chemotherapy and radiotherapy (RT) has generally not improved the overall survival (OS) in randomized trials of patients with head and neck cancer. This failure may stem from inadequate power or inappropriate patient selection, prompting this National Cancer Data Base analysis. METHODS 8031 patients with T4 or N2b to N3 disease undergoing RT and chemotherapy were divided into induction chemotherapy and concurrent chemotherapy cohorts. Multivariate analysis was used to explore the association of treatment with survival and to identify predictors of radiation dose. RESULTS On multivariate analysis incorporating sociodemographic and clinical variables, survival of the induction chemotherapy cohort was not significantly different from that of the concurrent cohort (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.88-1.05; p = .35), nor on subgroup analyses of advanced disease. Multivariate analysis demonstrated increased odds of receiving <66 Gy among the patients in the induction chemotherapy cohort (p < .01). CONCLUSION Induction chemotherapy subjects experienced no survival advantage over concurrent chemotherapy subjects but were more likely to receive lower RT doses. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1113-1121, 2017.
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Affiliation(s)
- William A Stokes
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Arya Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jessica D McDermott
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Julie A Goddard
- Department of Otolaryngology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel W Bowles
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
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14
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Induction chemotherapy for head and neck squamous cell carcinoma. Oral Oncol 2016; 58:e12. [DOI: 10.1016/j.oraloncology.2016.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/10/2016] [Indexed: 11/17/2022]
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