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Tang E, Schwartz B, Limkin E, Even C, Blanchard P, Haddy N, Gorphe P, Ferrand FR, Tao Y, Nguyen TVF. Locoregional treatment of primary tumor in synchronous metastatic head and neck squamous cell carcinomas. Acta Oncol 2023:1-8. [PMID: 37151099 DOI: 10.1080/0284186x.2023.2209266] [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: 05/09/2023]
Abstract
PURPOSE Patients with synchronous metastatic head and neck squamous cell carcinomas (mHNSCC) are at risk of locoregional progression associated with significant morbidity and mortality. The aim of this study is to assess whether the addition of aggressive locoregional treatment to systemic therapy could be associated with an improved overall survival (OS) compared to systemic therapy alone in upfront mHNSCC patients. MATERIAL AND METHODS This retrospective study included patients presenting with previously untreated mHNSCC who underwent first-line systemic therapy at a single institution between 1998 and 2018. Locoregional treatment was defined as either exclusive locoregional radiotherapy (RT) or surgery with or without adjuvant RT. RESULTS One hundred forty-eight patients were included. Eighty patients were treated with systemic therapy alone and 68 patients were treated with a combination of locoregional treatment and systemic therapy. Median overall survival (OS) was 13 months [10.7-15] and median progression free survival (PFS) was 7.7 month [6.5-8.9]. The addition of a locoregional treatment to systemic therapy compared to systemic therapy alone was associated with improved survival (1-year OS, 65.8% vs. 41.1%, p < .001, and 1-year PFS, 42.5% vs. 18.5%, p < .001). Moreover, RT dose equal to 70 Gy was associated with even longer OS compared to a RT dose below 70 Gy and to no locoregional treatment (23.4 vs. 12.7 vs 7.5 months respectively). In a subgroup analysis on 75 patients presenting with a responding or stable metastatic disease after first-line systemic therapy, oropharyngeal primary tumor site and the addition of a locoregional treatment, especially a high radiation dose of 70 Gy, were evidenced as independent prognostic factors for improved OS. CONCLUSION The addition of a high-dose RT locoregional treatment to systemic therapy is associated with prolonged OS in patients with synchronous mHNSCC and should be discussed for patients who respond to or have a stable disease after first-line systemic therapy.
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Affiliation(s)
- Eliane Tang
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Boris Schwartz
- Department of Radiation Epidemiology, Unité 1018 INSERM, Gustave Roussy, Villejuif, France
| | - Elaine Limkin
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Caroline Even
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif, France
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Nadia Haddy
- Department of Radiation Epidemiology, Unité 1018 INSERM, Gustave Roussy, Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | | | - Yungan Tao
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
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Fu E, Liu T, Yu S, Chen X, Song L, Lou H, Ma F, Zhang S, Hussain S, Guo J, Sun J, Yu P, Mao X, Wei L. M2 macrophages reduce the radiosensitivity of head and neck cancer by releasing HB‑EGF. Oncol Rep 2020; 44:698-710. [PMID: 32627036 PMCID: PMC7336513 DOI: 10.3892/or.2020.7628] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
The aim of the present study was to examine the potential role of human heparin‑binding epidermal growth factor (HB‑EGF) secreted by M2 macrophages in the development of radioresistance in head and neck squamous cell carcinoma (HNSCC). Immunohistochemistry was used to detect radiosensitivity in human papilloma virus (HPV)‑positive and HPV‑negative HNSCC tissues and immunohistochemical staining with specific antibodies for macrophage surface markers was used to assess the infiltration of M1 and M2 macrophages in HPV‑positive and ‑negative HNSCC tissues. The expression of HB‑EGF in HPV‑positive and ‑negative HNSCC tissues was determined by multi‑cytokine detection in order to determine the relationship between HB‑EGF and radiosensitivity. M1 and M2 macrophages were co‑cultured with the HNSCC cell line CAL27 and treated with HB‑EGF and its neutralizing antibodies to assess radiation sensitivity. Finally, the major DNA double‑strand break repair pathways required for the activation of HB‑EGF and promotion of epidermal growth factor receptor (EGFR) were identified. The results revealed that radiosensitivity was higher in HPV‑positive HNSCC compared with HPV‑negative. There was a higher infiltration of M2 macrophages in HPV‑negative HNSCC, which were revealed as the main source of HB‑EGF secretion. Furthermore, it was determined that overexpression of HB‑EGF induced radioresistance in HPV‑negative HNSCC. HB‑EGF promoted the activation of the non‑homologous end‑joining pathway by activating EGFR. To the best of our knowledge, this is the first study to demonstrate the association between HB‑EGF and radiosensitivity in HNSCC. These results indicated that the secretion of HB‑EGF by M2 macrophages could induce radioresistance of HPV‑negative HNSCC.
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Affiliation(s)
- Enhui Fu
- Department of Microbiology, Harbin Medical University, Wu Lien‑Teh Institute, The Heilongjiang Key Laboratory of Immunity and Infection, Harbin, Heilongjiang 150081, P.R. China
| | - Tianyang Liu
- Department of Microbiology, Harbin Medical University, Wu Lien‑Teh Institute, The Heilongjiang Key Laboratory of Immunity and Infection, Harbin, Heilongjiang 150081, P.R. China
| | - Siyang Yu
- Department of Microbiology, Harbin Medical University, Wu Lien‑Teh Institute, The Heilongjiang Key Laboratory of Immunity and Infection, Harbin, Heilongjiang 150081, P.R. China
| | - Xiaohang Chen
- The Genetics Laboratory, Longgang District Maternity and Child Healthcare Hospital, Shenzhen, Guangdong 518100, P.R. China
| | - Lianhao Song
- Department of Microbiology, Harbin Medical University, Wu Lien‑Teh Institute, The Heilongjiang Key Laboratory of Immunity and Infection, Harbin, Heilongjiang 150081, P.R. China
| | - Huihuang Lou
- The Second Department of Microbiological Examination, Center for Disease Control and Prevention in Wenzhou, Wenzhou Zhejiang 325000, P.R. China
| | - Fen Ma
- Department of Microbiology, Harbin Medical University, Wu Lien‑Teh Institute, The Heilongjiang Key Laboratory of Immunity and Infection, Harbin, Heilongjiang 150081, P.R. China
| | - Siwei Zhang
- Department of Microbiology, Harbin Medical University, Wu Lien‑Teh Institute, The Heilongjiang Key Laboratory of Immunity and Infection, Harbin, Heilongjiang 150081, P.R. China
| | - Sajjad Hussain
- Department of Microbiology, Harbin Medical University, Wu Lien‑Teh Institute, The Heilongjiang Key Laboratory of Immunity and Infection, Harbin, Heilongjiang 150081, P.R. China
| | - Junnan Guo
- Department of Head and Neck Surgery, The Tumor Hospital of HMU, Harbin, Heilongjiang 150080, P.R. China
| | - Ji Sun
- Department of Head and Neck Surgery, The Tumor Hospital of HMU, Harbin, Heilongjiang 150080, P.R. China
| | - Pingyang Yu
- Department of Head and Neck Surgery, The Tumor Hospital of HMU, Harbin, Heilongjiang 150080, P.R. China
| | - Xionghui Mao
- Department of Head and Neck Surgery, The Tumor Hospital of HMU, Harbin, Heilongjiang 150080, P.R. China
| | - Lanlan Wei
- Department of Microbiology, Harbin Medical University, Wu Lien‑Teh Institute, The Heilongjiang Key Laboratory of Immunity and Infection, Harbin, Heilongjiang 150081, P.R. China
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Gaulin NB, Lesnock JL, Tian C, Osei-Bonsu K, Jacobs A, Richard SD, Krivak TC, Miller EM, Shriver CD, Casablanca Y, Maxwell GL, Darcy KM. Survival disparities in vulvar cancer patients in Commission on Cancer®-accredited facilities. Gynecol Oncol 2020; 157:136-145. [PMID: 31954540 DOI: 10.1016/j.ygyno.2019.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/07/2019] [Accepted: 11/17/2019] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To investigate survival disparities and prognostic factors in vulvar cancer by age at diagnosis. METHODS Women who underwent surgery and were diagnosed with stage I-IV vulvar cancer from 2004 to 2014 in the National Cancer Database were eligible. Proportions were compared using Chi-Square test. Survival was evaluated using Cox analysis. RESULTS There were 18,207 eligible women. Median age at diagnosis was 64 years, and 31% diagnosed ≥75 years old were categorized as elderly. Most vulvar cancers were diagnosed at stage I and with squamous histology. Diagnosis with higher stage or non-squamous histology was more common in elderly vs. non-elderly patients (P < 0.001). Survival was 3.5 times worse in the elderly than the non-elderly (P < 0.0001). Risk of death for each 5-year increment in age increased by 22% for non-elderly and 43% for elderly patients (P < 0.0001). The prognostic value of comorbidity score, stage, regional node assessment and histology was smaller in elderly vs. non-elderly women (each P < 0.05). Adjuvant chemoradiotherapy (CTRT) use in the elderly vs. non-elderly was rare for stage I-II disease (3% vs. 2%) and more common for stage III-IV disease (6% vs. 43%), respectively (P < 0.0001). The survival disadvantage for elderly patients persisted following no adjuvant therapy, radiotherapy or chemotherapy alone, or CTRT (P < 0.0001). In stage III-IV disease, survival was superior following CTRT vs. radiotherapy when diagnosed <75 years (HR = 0.80, 95% CI = 0.69-0.93) but not in the elderly (HR = 0.99, P > 0.05). CONCLUSIONS Age-associated risk of death increased at different rates in vulvar cancer and was larger in elderly vs. non-elderly patients. The impact of other prognostic factors was smaller in elderly vs. non-elderly women. The survival benefit of CTRT over radiotherapy in stage III-IV did not extend to the elderly.
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Affiliation(s)
- Nicole B Gaulin
- Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Jamie L Lesnock
- Division of Gynecologic Oncology, University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA, USA.
| | - Chunqiao Tian
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
| | - Kathryn Osei-Bonsu
- Virginia Commonwealth University, Inova Fairfax Medical Campus, Falls Church, VA, USA.
| | - Allison Jacobs
- Virginia Commonwealth University, Inova Fairfax Medical Campus, Falls Church, VA, USA.
| | - Scott D Richard
- Department of Obstetrics and Gynecology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Thomas C Krivak
- Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Eirwen M Miller
- Department of Obstetrics and Gynecology, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Craig D Shriver
- John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Yovanni Casablanca
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - G Larry Maxwell
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Falls Church, VA, USA; Inova Schar Cancer Institute, Inova Center for Personalized Health, Falls Church, VA, USA.
| | - Kathleen M Darcy
- Gynecologic Cancer Center of Excellence, Department of Obstetrics & Gynecology, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA; The Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA; John P Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center, Bethesda, MD, USA.
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