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Costantino A, Sampieri C, Pace GM, Festa BM, Cerri L, Giordano GG, Dalè M, Spriano G, Peretti G, De Virgilio A. Development of machine learning models for the prediction of long-term feeding tube dependence after oral and oropharyngeal cancer surgery. Oral Oncol 2024; 148:106643. [PMID: 38006688 DOI: 10.1016/j.oraloncology.2023.106643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/11/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE To predict the necessity of enteral nutrition at 28 days after surgery in patients undergoing major head and neck oncologic procedures for oral and oropharyngeal cancers. MATERIAL AND METHODS Data from 193 patients with oral cavity and oropharyngeal squamous cell carcinoma were retrospectively collected at two tertiary referral centers to train (n = 135) and validate (n = 58) six supervised machine learning (ML) models for binary prediction employing 29 clinical variables available pre-operatively. RESULTS The accuracy of the six ML models ranged between 0.74 and 0.88, while the measured area under the curve (AUC) between 0.75 and 0.87. The ML algorithms showed high specificity (range 0.87-0.96) and moderate sensitivity (range: 0.31-0.77) in detecting patients with ≥28 days feeding tube dependence. Negative predictive value was higher (range: 0.81-0.93) compared to positive predictive value (range: 0.40-0.71). Finally, the F1 score ranged between 0.35 and 0.74. CONCLUSIONS Classification performance of the ML algorithms showed optimistic accuracy in the prediction of enteral nutrition at 28 days after surgery. Prospective studies are mandatory to define the clinical benefit of a ML-based pre-operative prediction of a personalized nutrition protocol.
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Affiliation(s)
- Andrea Costantino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Claudio Sampieri
- Department of Medical Science (DIMES), University of Genoa, Genoa, Italy; Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain; Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain.
| | - Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Luca Cerri
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy
| | - Giorgio Gregory Giordano
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Michael Dalè
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giuseppe Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Armando De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20090 Pieve Emanuele (MI), Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano (MI), Italy
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2
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Prediction model for tube feeding dependency during chemoradiotherapy for at least four weeks in head and neck cancer patients: A tool for prophylactic gastrostomy decision making. Clin Nutr 2020; 39:2600-2608. [DOI: 10.1016/j.clnu.2019.11.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/18/2019] [Accepted: 11/20/2019] [Indexed: 11/19/2022]
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3
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Baxi SS, Cullen G, Xiao H, Atoria CL, Sherman EJ, Ho A, Lee NY, Elkin EB, Pfister DG. Long-term quality of life in older patients with HPV-related oropharyngeal cancer. Head Neck 2018; 40:2321-2328. [PMID: 30421835 DOI: 10.1002/hed.25159] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 12/19/2017] [Accepted: 02/08/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We explored if age affects quality of life (QOL) in survivors of locally advanced human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC). METHODS In a cross-sectional survey of 185 patients, at least 12 months from radiation, we evaluated generic (EuroQOL-5D questionnaire [EQ-5D]) and head and neck specific (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions [EORTC-QLQ-H&N35]) QOL questionnaires and compared differences between younger (<65) and older (≥65) patients. RESULTS The median age was 57.0 years (range 25-77 years), and 31 patients (16.8%) were ≥65 years old. There was no significant difference in EQ-5D global QOL scores by age (P = .53). Patients ≥65 years reported more immobility (P < .01), problems with social eating (P < .0001), and coughing (P < .01). Patients ≥65 years were not more likely to ever require a gastrostomy (P = .24) but were more likely to remain gastrostomy-dependent at the time of the survey (P = .02). CONCLUSION Despite similar generic QOL, older survivors may have more mobility problems and issues with social eating compared with younger survivors deserving of further evaluation.
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Affiliation(s)
- Shrujal S Baxi
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weil Medical College of Cornell University, New York, New York
| | - Grace Cullen
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Han Xiao
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weil Medical College of Cornell University, New York, New York
| | - Coral L Atoria
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric J Sherman
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weil Medical College of Cornell University, New York, New York
| | - Alan Ho
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weil Medical College of Cornell University, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Elena B Elkin
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Public Health, Weill Medical College of Cornell University, New York, New York
| | - David G Pfister
- Head and Neck Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Medicine, Weil Medical College of Cornell University, New York, New York
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4
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Brown T, Banks M, Hughes BG, Lin C, Kenny LM, Bauer JD. Impact of early prophylactic feeding on long term tube dependency outcomes in patients with head and neck cancer. Oral Oncol 2017; 72:17-25. [DOI: 10.1016/j.oraloncology.2017.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/24/2017] [Indexed: 12/28/2022]
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5
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van der Linden NC, Kok A, Leermakers-Vermeer MJ, de Roos NM, de Bree R, van Cruijsen H, Terhaard CHJ. Indicators for Enteral Nutrition Use and Prophylactic Percutaneous Endoscopic Gastrostomy Placement in Patients With Head and Neck Cancer Undergoing Chemoradiotherapy. Nutr Clin Pract 2016; 32:225-232. [DOI: 10.1177/0884533616682684] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nina C. van der Linden
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemieke Kok
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marja J. Leermakers-Vermeer
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nicole M. de Roos
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hester van Cruijsen
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris H. J. Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
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Abstract
Feeding tubes are valuable assets in the rehabilitation of adult patients with dysphagia. Feeding tubes may be placed in response to perceived risks of airway compromise or insufficient nutrient intake. However, not all patients require long-term enteral feeding. With intensive dysphagia therapy, many patients will experience resolving deficits or improvement in swallowing ability. These patients require an appropriate strategy to transition from tube to oral feeding. This article reviews some of the basic characteristics of dysphagia and identifies specific swallowing difficulties in 2 groups of patients who often benefit from temporary enteral feeding: stroke survivors and patients treated for head and neck cancer. Specific suggestions are offered for clinical strategies to reinstitute oral feeding in these groups of tube-fed patients.
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7
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Caroline B, Sundus Y, Dawn D, Carol G, Susan M. Cost analysis of cetuximab (Erbitux) plus radiotherapy (ERT) versus concomitant cisplatin plus radiotherapy (CRT) within an NHS oncology unit (single institution): a pilot study. Br J Radiol 2016; 89:20160105. [PMID: 27734748 DOI: 10.1259/bjr.20160105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this feasibility study is to define the resource effectiveness of cetuximab vs cisplatin given concomitantly with radiotherapy for squamous cell carcinoma within a National Health Service clinical oncology unit. METHODS 20 patients with Stage 3 or 4 head and neck squamous cell cancers were randomized to receive either cetuximab with radiotherapy (ERT) or cisplatin with radiotherapy concurrent with external beam radiotherapy 70 Gy in 35 fractions on a 1 : 1 basis over a 12-month duration. The study compared the resource utilization of ERT vs cisplatin with radiotherapy taking into account drug costs, clinical management and the costs of managing treatment-related toxicity from first fraction of radiotherapy to 6 months after the completion of therapy. Outcome measures were quality of life (recorded at the entry, end of radiotherapy, 6 weeks post treatment and 6 months post treatment), admissions to hospital, delays to radiotherapy, locoregional control and survival. RESULTS Total drug costs including cost of nutritional supplements for patients treated with cetuximab were £7407.45 compared with £3959.07 for patients treated with cisplatin. Unscheduled admissions for toxicity management were significantly more common in the ERT arm. Healthcare personnel spent significantly more time delivering unscheduled outpatient care for patients receiving cisplatin than for those receiving cetuximab (p = 0.01). No significant difference in the quality of life was suggested at baseline, 6 weeks and 6 months. The mean time to removal of percutaneous gastrostomy (PEG) after completion of radiotherapy was 49.7 weeks in the cisplatin arm and 18.5 weeks in the cetuximab arm (p = 0.04). There was a statistically significant difference in patient-reported use of PEG between the cisplatin and cetuximab arms at 6 months following completion of treatment (p = 0.04). At 21 months, overall survival was 80% in the cisplatin arm vs 50% in the cetuximab (p = 0.332), with disease-free survival being 80% in the cisplatin arm vs 40% in the cetuximab (p = 0.097). CONCLUSION Cetuximab is still more expensive in simple drug cost terms than cisplatin when delivered with radiotherapy taking into account costs of drugs for toxicity management and nutritional supplements but other resource implications such as inpatient admission, time spent delivering unscheduled care and cost of additional investigations to manage toxicity for patients treated with cisplatin significantly reduce differential. The study suggested significant differences in patient-reported PEG use at 6 months and in time to PEG removal in favour of the cetuximab arm. Advances in knowledge: There is paucity of randomized data on cost analysis for cisplatin vs cetuximab radiotherapy; this trial informs on the cost analysis between the two approaches.
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Affiliation(s)
| | - Yahya Sundus
- 2 University Hospitals of Birmingham, NHS Foundation Trust, Birmingham, UK
| | - Dawson Dawn
- 1 Royal Wolverhampton Hospitals Trust, Wolverhampton, UK
| | - Glaister Carol
- 1 Royal Wolverhampton Hospitals Trust, Wolverhampton, UK
| | - Merrick Susan
- 1 Royal Wolverhampton Hospitals Trust, Wolverhampton, UK
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8
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Dysphagia, Speech, Voice, and Trismus following Radiotherapy and/or Chemotherapy in Patients with Head and Neck Carcinoma: Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6086894. [PMID: 27722170 PMCID: PMC5045989 DOI: 10.1155/2016/6086894] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/01/2016] [Indexed: 01/19/2023]
Abstract
Introduction. Patients with head and neck cancer suffer from various impairments due to the primary illness, as well as secondary consequences of the oncological treatment. This systematic review describes the effects of radiotherapy and/or chemotherapy on the functions of the upper aerodigestive tract in patients with head and neck cancer. Methods. A systematic literature search was performed by two independent reviewers using the electronic databases PubMed and Embase. All dates up to May 2016 were included. Results. Of the 947 abstracts, sixty articles met the inclusion criteria and described one or more aspects of the sequelae of radiotherapy and/or chemotherapy. Forty studies described swallowing-related problems, 24 described voice-related problems, seven described trismus, and 25 studies described general quality of life. Only 14 articles reported that speech pathologists conducted the interventions, of which only six articles described in detail what the interventions involved. Conclusion. In general, voice quality improved following intervention, whereas quality of life, dysphagia, and oral intake deteriorated during and after treatment. However, as a consequence of the diversity in treatment protocols and patient characteristics, the conclusions of most studies cannot be easily generalised. Further research on the effects of oncological interventions on the upper aerodigestive tract is needed.
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9
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Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI. Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/- chemotherapy) for head and neck cancer. EUROPEAN ARCHIVES OF OTO-RHINO-LARYNGOLOGY : OFFICIAL JOURNAL OF THE EUROPEAN FEDERATION OF OTO-RHINO-LARYNGOLOGICAL SOCIETIES (EUFOS) : AFFILIATED WITH THE GERMAN SOCIETY FOR OTO-RHINO-LARYNGOLOGY - HEAD AND NECK SURGERY 2016. [PMID: 27498203 DOI: 10.1007/s00405-016-4241-9.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
A proportion of patients with head and neck cancer (HNC) experience significant swallowing difficulty during and post-radiotherapy/chemoradiotherapy (RT/CRT). Identifying patients during the pretreatment period who are anticipated to have compromised oral intake would allow for early and accurate patient education, and prioritisation of their management. Ascertaining a clear set of pretreatment predictors from the literature is challenging due to heterogeneity in study designs and patient cohorts, with minimal prospective data available (especially at 1-month post-treatment). The objectives of this study were to investigate which pretreatment factors predicted compromised oral intake and feeding tube use at 1 and 6 months post-RT/CRT. Prospective data were collected on 80 consecutive HNC patients receiving RT/CRT from 2011 to 2014. The primary outcome was to identify predictors of a modified diet at 1 and 6 months post-RT/CRT. Secondary outcomes were to identify predictors of feeding tube use at these time intervals, and <6 vs. >6 week duration of feeding tube use. Multivariate analysis revealed bilateral neck radiotherapy treatment was a strong predictor of modified diets at 1 month (p < 0.001), and T-stages T3/T4 a predictor of modified diets at 6 months (p = 0.03). Patients treated with concurrent CRT (p = 0.02) and bilateral neck treatment (p = 0.02) predicted feeding tube use at 1 month, and concurrent CRT predicted feeding tube use for >6 weeks (p = 0.04). Therefore, patients receiving bilateral neck treatment and/or CRT are at greatest risk of requiring modified diets and feeding tube use early post-treatment, and should be prioritised for intervention and ongoing support.
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Affiliation(s)
- Molly K Barnhart
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia. .,The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.
| | - Elizabeth C Ward
- The University of Queensland, School of Health and Rehabilitation Sciences, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia
| | - Bena Cartmill
- Centre for Functioning and Health Research, Queensland Health, Buranda, QLD, 4102, Australia.,Speech Pathology, Princess Alexandra Hospital, Woolloongabba, QLD, 4102, Australia
| | - Rachelle A Robinson
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Virginia A Simms
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Sophie J Chandler
- Speech Pathology, Prince of Wales Hospital (POWH), Level 2 High Street Entrance, Randwick, NSW, 2031, Australia
| | - Elea T Wurth
- Simba Analytics, Melbourne, VIC, 3000, Australia
| | - Robert I Smee
- Comprehensive Cancer Centre, POWH, Randwick, NSW, 2031, Australia.,The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia.,Acting Dir, Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, 2340, Australia
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10
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Barnhart MK, Ward EC, Cartmill B, Robinson RA, Simms VA, Chandler SJ, Wurth ET, Smee RI. Pretreatment factors associated with functional oral intake and feeding tube use at 1 and 6 months post-radiotherapy (+/− chemotherapy) for head and neck cancer. Eur Arch Otorhinolaryngol 2016; 274:507-516. [DOI: 10.1007/s00405-016-4241-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
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11
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Klöß S, Chambron N, Gardlowski T, Arseniev L, Koch J, Esser R, Glienke W, Seitz O, Köhl U. Increased sMICA and TGFβ 1 levels in HNSCC patients impair NKG2D-dependent functionality of activated NK cells. Oncoimmunology 2015; 4:e1055993. [PMID: 26451327 PMCID: PMC4589991 DOI: 10.1080/2162402x.2015.1055993] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 03/27/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022] Open
Abstract
Disseminated head-and-neck squamous cell carcinoma (HNSCC) escapes immune surveillance and thus frequently manifests as fatal disease. Here, we report on the distribution of distinct immune cell subpopulations, natural killer (NK) cell cytotoxicity and tumor immune escape mechanisms (TIEMs) in 55 HNSCC patients, either at initial diagnosis or present with tumor relapse. Compared to healthy controls, the regulatory NK cells and the ratio of pro/anti-inflammatory cytokines were decreased in HNSCC patients, while soluble major histocompatibility complex Class I chain-related peptide A (sMICA) and transforming growth factor β1 (TGFβ1) plasma levels were markedly elevated. Increased sMICA and TGFβ1 concentrations correlated with tumor progression and staging characteristics in 7 follow-up HNSCC patients, with significantly elevated levels of both soluble factors from the time of initial diagnosis to that of relapse. Patient plasma containing elevated sMICA and TGFβ1 markedly impaired NKG2D-dependent cytotoxicity against HNSCC cells upon incubation with patient-derived and IL-2 activated NK cells vs. those derived from healthy donors. Decreased antitumor recognition was accompanied by reduced NKG2D expression on the NK cell surface and an enhanced caspase-3 activity. In-vitro blocking and neutralization experiments demonstrated a synergistic negative impact of sMICA and TGFβ1 on NK cell functionality. Although we previously showed the feasibility and safety of transfer of allogeneic donor NK cells in a prior clinical study encompassing various leukemia and tumor patients, our present results suggest the need for caution regarding the sole use of adoptive NK cell transfer. The presence of soluble NKG2D ligands in the plasma of HNSCC patients and the decreased NK cell cytotoxicity due to several factors, especially TGFβ1, indicates timely depletion of these immunosuppressing molecules may promote NK cell-based immunotherapy.
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Affiliation(s)
- Stephan Klöß
- Institute for Cellular therapeutics; IFB-Tx; Hannover Medical School; Hannover, Germany
| | - Nicole Chambron
- Department of Oral; Cranio-Maxillofacial and Facial Plastic Surgery; Klinikum Hanau GmbH; Hanau, Germany
| | - Tanja Gardlowski
- Institute for Cellular therapeutics; IFB-Tx; Hannover Medical School; Hannover, Germany
| | - Lubomir Arseniev
- Institute for Cellular therapeutics; IFB-Tx; Hannover Medical School; Hannover, Germany
| | - Joachim Koch
- Georg-Speyer-Haus; Institute for Tumor Biology and Experimental Therapy; Frankfurt, Germany
| | - Ruth Esser
- Institute for Cellular therapeutics; IFB-Tx; Hannover Medical School; Hannover, Germany
| | - Wolfgang Glienke
- Institute for Cellular therapeutics; IFB-Tx; Hannover Medical School; Hannover, Germany
| | - Oliver Seitz
- Department of Oral; Cranio-Maxillofacial and Facial Plastic Surgery; Klinikum Hanau GmbH; Hanau, Germany
| | - Ulrike Köhl
- Institute for Cellular therapeutics; IFB-Tx; Hannover Medical School; Hannover, Germany
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12
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Brown TE, Crombie J, Spurgin AL, Tripcony L, Keller J, Hughes BGM, Dickie G, Kenny LM, Hodge RA. Improving guideline sensitivity and specificity for the identification of proactive gastrostomy placement in patients with head and neck cancer. Head Neck 2015; 38 Suppl 1:E1163-71. [DOI: 10.1002/hed.24184] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 03/02/2015] [Accepted: 07/03/2015] [Indexed: 01/28/2023] Open
Affiliation(s)
- Teresa E. Brown
- Department of Nutrition and Dietetics; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jane Crombie
- Department of Speech Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Ann-Louise Spurgin
- Department of Speech Pathology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lee Tripcony
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Jacqui Keller
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Brett G. M. Hughes
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine, University of Queensland; Queensland Australia
| | - Graeme Dickie
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Lizbeth Moira Kenny
- Cancer Care Services, Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Robert A. Hodge
- Department of ENT/Head and Neck Surgery; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
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13
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It is not just IMRT: Human papillomavirus related oropharynx squamous cell carcinoma is associated with better swallowing outcomes after definitive chemoradiotherapy. Oral Oncol 2015; 51:800-4. [PMID: 25977228 DOI: 10.1016/j.oraloncology.2015.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/09/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Long term swallowing dysfunction in patients with oropharynx squamous cell carcinoma (OPSCC) treated with concurrent chemoradiation (CRT) is declining. While the use of intensity modulated radiotherapy (IMRT) is commonly believed to be a potential cause, we hypothesize that the increasing incidence of human papillomavirus (HPV) related disease may also favorably impact this outcome. MATERIALS AND METHODS We reviewed 130 HPV+ and 17 HPV- patients with stage III-IV OPSCC treated exclusively with conventional 3-field radiotherapy with chemotherapy between 2002 and 2010. The rates of normal diet, limited diet (significant restrictions in the types of foods eaten, and/or requiring nutritional supplementation for weight maintenance) and feeding tube dependence (FTD) were compared between HPV+ and HPV- patients. Cox proportional hazards modeling were used to perform univariate analysis (UVA) to examine predictors of a combined endpoint of dietary limitation, which included limited diet and/or FTD. These outcomes were also compared to our previously reported cohort of OPSCC patients treated between 1989 and 2002 to assess changes in toxicity over time given the changing disease epidemiology, in the setting of identical treatment regimens. RESULTS With a median follow-up of 55 months, HPV+ patients more frequently had resumed a normal diet (87% vs. 65%) at last follow up and had lower rates of limited diet (9% vs. 18%) and FTD (4% vs. 18%) compared to HPV- patients (p=0.02). HPV status was the only significant predictor of reduced swallowing dysfunction on UVA (HR 0.19; p=0.008). When compared to our 1989-2002 cohort, patients treated between 2002 and 2010 had less FTD (7.5% vs. 34%, p<0.001) and dietary limitations (26% vs.46%, p<0.001) at 6 months post treatment. CONCLUSIONS HPV+ patients with OPSCC have reduced late swallowing dysfunction after chemoradiation compared to HPV- patients. The changing epidemiology of OPSCC may play a role in toxicity reduction in these patients, independent of the increasing use of IMRT.
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14
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Lewis SL, Brody R, Touger-Decker R, Parrott JS, Epstein J. Feeding tube use in patients with head and neck cancer. Head Neck 2014; 36:1789-95. [DOI: 10.1002/hed.23538] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sherri L. Lewis
- James A. Haley Veteran's Affairs Hospital; Tampa Florida
- University of Medicine and Dentistry of New Jersey; Newark New Jersey
| | - Rebecca Brody
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - Riva Touger-Decker
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - James S. Parrott
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - Joel Epstein
- City of Hope; Oral Medicine Division of Otolaryngology and Head and Neck Surgery; Duarte California
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15
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van den Berg MGA, Rütten H, Rasmussen-Conrad EL, Knuijt S, Takes RP, van Herpen CML, Wanten GJA, Kaanders JHAM, Merkx MAW. Nutritional status, food intake, and dysphagia in long-term survivors with head and neck cancer treated with chemoradiotherapy: A cross-sectional study. Head Neck 2013; 36:60-5. [DOI: 10.1002/hed.23265] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Manon G. A. van den Berg
- Department of Gastroenterology and Hepatology-Dietetics and Intestinal Failure; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Ellen L. Rasmussen-Conrad
- Department of Gastroenterology and Hepatology-Dietetics and Intestinal Failure; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Simone Knuijt
- Department of Rehabilitation/Speech and Language Pathology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
- Nijmegen Centre of Evidence-Based Practice; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Robert P. Takes
- Department of Otolaryngology and Head and Neck Surgery; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Carla M. L. van Herpen
- Department of Medical Oncology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Geert J. A. Wanten
- Intestinal Failure Unit-Department of Gastroenterology and Hepatology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | | | - Matthias A. W. Merkx
- Department of Oral and Maxillofacial Surgery; Radboud University Nijmegen Medical Centre; Nijmegen the Netherlands
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The role of dietary counseling and nutrition support in head and neck cancer patients. Curr Opin Support Palliat Care 2012; 6:438-45. [DOI: 10.1097/spc.0b013e32835999d5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Brown TE, Spurgin AL, Ross L, Tripcony L, Keller J, Hughes BGM, Hodge R, Walker Q, Banks M, Kenny LM, Crombie J. Validated swallowing and nutrition guidelines for patients with head and neck cancer: identification of high-risk patients for proactive gastrostomy. Head Neck 2012; 35:1385-91. [PMID: 22972623 DOI: 10.1002/hed.23146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The "Swallowing and Nutrition Guidelines for Patients with Head and Neck Cancer" were developed to guide early identification and management of dysphagia and nutritional risk before, during, and after cancer treatment. The purpose of this study was to validate these guidelines. METHODS Patients attending a Combined Head and Neck Clinic at a major tertiary hospital in 2007 to 2008 were assessed using the guidelines, with high-risk category patients recommended for proactive gastrostomy. Data were collected on guideline adherence, gastrostomy tube insertion, and weight. Sensitivity, specificity, and positive predictive value were calculated for validation. RESULTS Proactive gastrostomy tubes were inserted in 173 of 501 patients (25%). Overall guideline adherence was 87%. High-risk category adherence was 75%. Validation outcomes were sensitivity 54%, specificity 93%, and positive predictive value 82%. CONCLUSION The risk categories in the guidelines are valid to assist early identification of swallowing and nutritional risk and guide decision-making on proactive gastrostomy tube insertion.
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Affiliation(s)
- Teresa E Brown
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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18
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Prophylactic swallowing exercises for patients receiving radiotherapy for head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2011; 19:144-9. [DOI: 10.1097/moo.0b013e3283457616] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Hirano S, Tateya I, Kitamura M, Kada S, Ishikawa S, Kanda T, Tanaka S, Ito J. Organ preservation surgery for advanced hypopharyngeal cancer. Acta Otolaryngol 2010:50-5. [PMID: 20879819 DOI: 10.3109/00016489.2010.487496] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Organ preservation surgery with partial pharyngectomy preserving the larynx is feasible for the treatment of advanced hypopharyngeal cancer with comparable local control and preservation of function. OBJECTIVES To examine the feasibility and therapeutic effects of organ preservation surgery for advanced hypopharyngeal cancer. METHODS Fourteen patients with stage III/IV hypopharyngeal cancer were treated by partial pharyngectomy with or without partial laryngectomy to preserve the larynx. Ten cases were T1/2 primary while four cases had T3/4 tumors. Reconstruction of the pharyngolarynx was completed by primary mucosal suture in six, while free forearm flap was used in eight cases. Induction chemotherapy was administered for six cases including three with T3/4 tumors. RESULTS Five-year overall survival and disease-specific survival rates were 57.1% and 66.7%, respectively. The 5-year locoregional control rate was 66.7% and the larynx preservation rate was 100%. No patients presented with local recurrence at the pharyngolaryngeal segment, while two cases showed nodal recurrence, from which they died. Tracheal stoma was closed in 9 of 14 cases. Vocal function was excellent in five cases, moderate in five, and poor in three. Swallowing function was excellent to moderate in eight cases and poor in six.
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Affiliation(s)
- Shigeru Hirano
- Department of Otolaryngology Head and Neck Surgery, Kyoto University, Kyoto, Japan.
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Morton RP, Crowder VL, Mawdsley R, Ong E, Izzard M. Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy. ANZ J Surg 2010; 79:713-8. [PMID: 19878166 DOI: 10.1111/j.1445-2197.2009.05056.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Chemoradiotherapy for treatment of advanced head and neck cancer (HNC) is used to achieve organ preservation without compromising survival. Because chemoradiotherapy usually impacts adversely on nutritional and functional status, feeding by percutaneous endoscopic gastrostomy (PEG) is often part of the management regimen for these patients, but the presence of a PEG tube can also be associated with reduced quality of life (QOL). This study aimed to examine the factors associated with PEG insertion and the effects of PEG use on QOL and functional outcomes in HNC patients receiving chemoradiotherapy. METHOD Survey of 36 consecutive patients treated by primary chemoradiotherapy for HNC. Patient weight, age, tumour type, details of PEG insertion, feeding regimens and treatment were noted. The survey comprised the Performance Status Scale, the Functional Measure for Swallowing, Nutritional Mode and a self-assessment of QOL. RESULTS PEG insertion within 1 month of treatment was associated with smaller fall in body mass index at 12 months than PEG insertion 1 month or more after the start of the treatment (P < 0.05). Body mass index change was inversely correlated with health-related quality of life and significantly related to lower speech and swallowing function scores. Longer PEG duration correlated with poorer performance status and swallowing function (P < 0.01). Longer PEG duration also predicted poorer overall QOL (P < 0.01) and poorer swallowing (P < 0.01) and speech (P < 0.05). Nutritional mode was related to overall QOL (P < 0.01). CONCLUSIONS Nutritional support for HNC patients undergoing chemoradiotherapy is an essential component of patient care. Early PEG insertion and shorter PEG duration are associated with more favourable QOL-related outcomes.
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Affiliation(s)
- Randall P Morton
- Department of Otolaryngology - Head and Neck Surgery, Counties - Manukau District Health Board, Manukau, New Zealand.
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McLaughlin BT, Gokhale AS, Shuai Y, Diacopoulos J, Carrau R, Heron DE, Smith RP, Gibson MK, Ferris RL, Grandis JR, Johnson JT, Argiris A. Management of patients treated with chemoradiotherapy for head and neck cancer without prophylactic feeding tubes: the University of Pittsburgh experience. Laryngoscope 2010; 120:71-5. [PMID: 19877245 DOI: 10.1002/lary.20697] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES/HYPOTHESIS Mucositis and dysphagia are common complications of chemoradiotherapy (CRT) for head and neck cancer that may necessitate nutritional support with a gastrostomy tube (G-tube). METHODS We reviewed records of patients who underwent and completed CRT, which included at least one traditional chemotherapeutic, for previously untreated head and neck cancer. G-tubes were placed as needed. The timing and duration of G-tube placement and treatment-related complications and risk factors for long-term G-tube use were analyzed. RESULTS A total of 91 consecutive patients who received CRT, 68 as primary and 23 as postoperative treatment, were studied. Radiation doses ranged from 59.4 to 74 Gy (median, 70 Gy). Seventy-nine percent of patients received platinum-based therapy during CRT. Severe mucositis occurred in 40% of patients. Forty percent of patients required G-tube placement (15 prior to CRT and 21 during CRT). Median duration of G-tube use was 5.8 months. Two patients who had a G-tube placed during CRT developed a G-tube-related complication. At 6 and 12 months, 15 (18%) and four (6%) patients who were disease free were using G-tubes, respectively. Patients with G-tubes placed prior to CRT or advanced T stage had longer G-tube dependence. CONCLUSIONS With aggressive supportive care it is feasible to avoid G-tubes in the majority of patients undergoing CRT for head and neck cancer. G-tube placement prior to CRT due to pre-existing dysphagia and advanced T stage are associated with prolonged G-tube dependence.
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Affiliation(s)
- Brian T McLaughlin
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15232, USA
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Chang JH, Gosling T, Larsen J, Powell S, Scanlon R, Chander S. Prophylactic gastrostomy tubes for patients receiving radical radiotherapy for head and neck cancers: a retrospective review. J Med Imaging Radiat Oncol 2010; 53:494-9. [PMID: 19788486 DOI: 10.1111/j.1754-9485.2009.02103.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients undergoing radical radiotherapy for head and neck cancers often experience significant complications. We sought to evaluate the impact of prophylactic gastrostomy tubes (PGTs) among these patients on four easily evaluable adverse outcomes, namely, absolute weight loss, percentage weight loss, admissions for nutritional reasons and treatment interruptions. A retrospective review was carried out on patients undergoing radical radiotherapy for primary head and neck cancers from September 1999 to October 2005 at the Wellington Blood and Cancer Centre (n = 71). PGTs were placed in 7 (10%) patients. Patients with PGTs were compared with the patients without PGTs (the control group) by univariate and multivariate analyses. By univariate analysis, there was no significant difference in absolute or percentage weight loss between those with PGTs and the control group. By multivariate analysis, those with PGTs lost 5.2% (P = 0.016) less weight than the control group. There were no significant differences between the two groups with regard to admissions for nutritional reasons or treatment interruptions. The use of PGTs can reduce weight loss in patients undergoing radical radiotherapy for head and neck cancers, and its use should be further evaluated in future studies.
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Affiliation(s)
- J H Chang
- Radiation Oncology Centre, Austin Health, Melbourne, Victoria, Australia
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van der Molen L, van Rossum MA, Ackerstaff AH, Smeele LE, Rasch CRN, Hilgers FJM. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views. BMC EAR, NOSE, AND THROAT DISORDERS 2009. [PMID: 19912667 DOI: 10.1186/1472-6815-9-10.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Aim of this study is to thoroughly assess pretreatment organ function in advanced head and neck cancer through various clinical outcome measures and patients' views. METHODS A comprehensive, multidimensional assessment was used, that included quality of life, swallowing, mouth opening, and weight changes. Fifty-five patients with stage III-IV disease were entered in this study prior to organ preserving (chemoradiation) treatment. RESULTS All patients showed pretreatment abnormalities or problems, identified by one or more of the outcome measures. Most frequent problems concerned swallowing, pain, and weight loss. Interestingly, clinical outcome measures and patients' perception did no always concur. E.g. videofluoroscopy identified aspiration and laryngeal penetration in 18% of the patients, whereas only 7 patients (13%) perceived this as problematic; only 2 out of 7 patients with objective trismus actually perceived trismus. CONCLUSION The assessment identified several problems already pre-treatment, in this patient population. A thorough assessment of both clinical measures and patients' views appears to be necessary to gain insight in all (perceived) pre-existing functional and quality of life problems.
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Affiliation(s)
- Lisette van der Molen
- Department of Head and Neck Oncology & Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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van der Molen L, van Rossum MA, Ackerstaff AH, Smeele LE, Rasch CRN, Hilgers FJM. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views. BMC EAR, NOSE, AND THROAT DISORDERS 2009; 9:10. [PMID: 19912667 PMCID: PMC2779790 DOI: 10.1186/1472-6815-9-10] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 11/15/2009] [Indexed: 11/30/2022]
Abstract
Background Aim of this study is to thoroughly assess pretreatment organ function in advanced head and neck cancer through various clinical outcome measures and patients' views. Methods A comprehensive, multidimensional assessment was used, that included quality of life, swallowing, mouth opening, and weight changes. Fifty-five patients with stage III-IV disease were entered in this study prior to organ preserving (chemoradiation) treatment. Results All patients showed pretreatment abnormalities or problems, identified by one or more of the outcome measures. Most frequent problems concerned swallowing, pain, and weight loss. Interestingly, clinical outcome measures and patients' perception did no always concur. E.g. videofluoroscopy identified aspiration and laryngeal penetration in 18% of the patients, whereas only 7 patients (13%) perceived this as problematic; only 2 out of 7 patients with objective trismus actually perceived trismus. Conclusion The assessment identified several problems already pre-treatment, in this patient population. A thorough assessment of both clinical measures and patients' views appears to be necessary to gain insight in all (perceived) pre-existing functional and quality of life problems.
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Affiliation(s)
- Lisette van der Molen
- Department of Head and Neck Oncology & Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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25
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Prevalence and influence of malnutrition on quality of life and performance status in patients with locally advanced head and neck cancer before treatment. Support Care Cancer 2009; 18:433-7. [DOI: 10.1007/s00520-009-0681-8] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 06/10/2009] [Indexed: 11/27/2022]
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van der Molen L, van Rossum MA, Burkhead LM, Smeele LE, Hilgers FJM. Functional outcomes and rehabilitation strategies in patients treated with chemoradiotherapy for advanced head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol 2008; 266:889-900. [DOI: 10.1007/s00405-008-0817-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 08/11/2008] [Indexed: 01/23/2023]
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Abstract
Several different approaches have been tested in an effort to integrate chemotherapy into definitive non-operative management of squamous cell head and neck cancer. In phase III randomized trials and in meta-analyses, the concomitant use of chemotherapy and radiation has proven to be the most consistently successful, and to produce both locoregional control and survival benefits, when compared to radiation therapy alone. Large, multi-institutional and cooperative group studies have now established high-dose single-agent cisplatin and concurrent radiation therapy as the standard of care for patients with advanced nasopharynx cancer, for patients with unresectable head and neck tumors, and as a postoperative adjuvant for patients with high-risk pathologic features. This same treatment regimen also has been demonstrated to be the most effective multi-modality treatment strategy for larynx preservation. Future investigation will focus on optimizing the concomitant chemotherapy and radiotherapy schedules used, integrating targeted agents into these established treatment schedules, addressing the problem of distant metastases, minimizing both acute and late toxicities, and identifying the most appropriate patient populations for this kind of aggressive treatment.
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Affiliation(s)
- David J Adelstein
- Department of Solid Tumor Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, OH 44195, USA.
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Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck 2008; 30:503-8. [PMID: 18098310 DOI: 10.1002/hed.20737] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to determine the influence of weight loss on outcome in patients with head and neck cancer undergoing concomitant chemoradiotherapy (CCRT): treatment interruption, infections, mortality, and hospital readmission rate. METHODS Forty patients with head and neck cancer were enrolled. All patients were counseled to follow a nutritional program during CCRT. Body weight was evaluated at baseline, at the end, and 30 days after radiochemotherapy. RESULTS Ninety percent of compliant patients with nutritional program maintained body weight (mean, 1 +/- 2.4 kg) and 100% of noncompliant patients continued to lose weight (mean, -9 +/- 4 kg; p < .001). A reduction greater than 20% of prediagnosis weight significantly correlated with treatment interruption (p = .003), infections (p = .002), early mortality (p = .011), hospital readmission rate (p = .001), and survival (log-rank test: z = -2.722, p = .006). CONCLUSION In patients with head and neck cancer undergoing CCRT, the early nutritional management reduces weight loss and improve outcome.
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Affiliation(s)
- Giorgio Capuano
- Clinical Nutrition Unit, Ospedale San Pietro, Fatebenefratelli, Rome, Italy.
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29
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Evidence based practice guidelines for the nutritional management of patients receiving radiation therapy. Nutr Diet 2008. [DOI: 10.1111/j.1747-0080.2008.00252.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Complicaciones quirúrgicas en la cirugía de rescate de pacientes con carcinomas de cabeza y cuello tratados con quimioterapia y radioterapia concomitantes. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s0001-6519(07)74966-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Palazzi M, Tomatis S, Orlandi E, Guzzo M, Sangalli C, Potepan P, Fantini S, Bergamini C, Gavazzi C, Licitra L, Scaramellini G, Cantu' G, Olmi P. Effects of treatment intensification on acute local toxicity during radiotherapy for head and neck cancer: prospective observational study validating CTCAE, version 3.0, scoring system. Int J Radiat Oncol Biol Phys 2007; 70:330-7. [PMID: 17881148 DOI: 10.1016/j.ijrobp.2007.06.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 06/10/2007] [Accepted: 06/19/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE To quantify the incidence and severity of acute local toxicity in head and neck cancer patients treated with radiotherapy (RT), with or without chemotherapy (CHT), using the Common Terminology Criteria for Adverse Events, version 3.0 (CTCAE v3.0), scoring system. METHODS AND MATERIALS Between 2004 and 2006, 149 patients with head and neck cancer treated with RT at our center were prospectively evaluated for local toxicity during treatment. On a weekly basis, patients were monitored and eight toxicity items were recorded according to the CTCAE v3.0 scoring system. Of the 149 patients, 48 (32%) were treated with RT alone (conventional fractionation), 82 (55%) with concomitant CHT and conventional fractionation RT, and 20 (13%) with accelerated-fractionation RT and CHT. RESULTS Severe (Grade 3-4) adverse events were recorded in 28% (mucositis), 33% (dysphagia), 40% (pain), and 12% (skin) of patients. Multivariate analysis showed CHT to be the most relevant factor independently predicting for worse toxicity (mucositis, dysphagia, weight loss, salivary changes). In contrast, previous surgery, RT acceleration and older age, female gender, and younger age, respectively, predicted for a worse outcome of mucositis, weight loss, pain, and dermatitis. The T-score method confirmed that conventional RT alone is in the "low-burden" class (T-score = 0.6) and suggests that concurrent CHT and conventional fractionation RT is in the "high-burden" class (T-score = 1.15). Combined CHT and accelerated-fractionation RT had the highest T-score at 1.9. CONCLUSIONS The CTCAE v3.0 proved to be a reliable tool to quantify acute toxicity in head and neck cancer patients treated with various treatment intensities. The effect of CHT and RT acceleration on the acute toxicity burden was clinically relevant.
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Affiliation(s)
- Mauro Palazzi
- Unit of Radiotherapy, Istituto Nazionale Tumori, Milan, Italy.
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Encinas Vicente A, Souvirón Encabo R, Paramás ÁR, Losa MM, de Pedro FG, Yurrita BS. Surgical Complications in Salvage Surgery of Patients With Head and Neck Carcinomas Treated With Concomitant Chemoradiotherapy (CCR). ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007. [DOI: 10.1016/s2173-5735(07)70388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Adelstein DJ, Saxton JP, Rybicki LA, Esclamado RM, Wood BG, Strome M, Lavertu P, Lorenz RR, Carroll MA. Multiagent Concurrent Chemoradiotherapy for Locoregionally Advanced Squamous Cell Head and Neck Cancer: Mature Results From a Single Institution. J Clin Oncol 2006; 24:1064-71. [PMID: 16505425 DOI: 10.1200/jco.2005.01.5867] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose A retrospective review with long-term follow-up is reported from the Cleveland Clinic Foundation studying radiation and concurrent multiagent chemotherapy in patients with locoregionally advanced squamous cell head and neck cancer. Patients and Methods Between 1989 and 2002, 222 patients were treated with 4-day continuous infusions of fluorouracil (1,000 mg/m2/d) and cisplatin (20 mg/m2/d) during weeks 1 and 4 of either once daily or twice daily radiation therapy. Primary site resection was reserved for patients with residual or recurrent primary site disease after chemoradiotherapy. Neck dissection was considered for patients with N2 or greater disease, irrespective of clinical response, and for patients with residual or recurrent neck disease. Results With a median follow-up of 73 months, the Kaplan-Meier 5-year projected overall survival rate is 65.7%, freedom from recurrence rate is 74.0%, local control without the need for surgical resection rate is 86.7%, and overall survival rate with organ preservation is 62.2%. Including patients undergoing primary site resection as salvage therapy, the overall local control rate is 92.4%. Regional control rate at 5 years is 92.4%. Among patients with N2-3 disease, regional control was significantly better if a planned neck dissection was performed. Distant control at 5 years was achieved in 85.4% of patients and was significantly worse in patients with hypopharyngeal primary sites and patients with poorly differentiated tumors. Conclusion Concurrent multiagent chemoradiotherapy can result in organ preservation and cure in the majority of appropriately selected patients with locoregionally advanced, nonmetastatic, squamous cell head and neck cancer. Distant metastatic disease was the most common cause of treatment failure. Late functional outcomes will require further investigation.
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Affiliation(s)
- David J Adelstein
- Department of Hematology and Medical Oncology, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Frowen JJ, Perry AR. Swallowing outcomes after radiotherapy for head and neck cancer: A systematic review. Head Neck 2006; 28:932-44. [PMID: 16906517 DOI: 10.1002/hed.20438] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A systematic review of the current data on swallowing function after radiotherapy or chemoradiotherapy is presented. METHODS Electronic databases were searched for 1966-2005. Papers were categorized according to level of evidence, methodological quality, and the specific domain of swallowing being measured. RESULTS Of 109 papers retrieved, 33 were identified and reviewed. Evidence was primarily classified as either level III.2 (cohort studies) or level IV (case series). Methodological quality was found to be compromised in most studies. Although many researchers had investigated swallowing impairment, a wide variety of measurement tools were employed. CONCLUSIONS There are limited data on swallowing outcomes after radiotherapy or chemoradiotherapy for head and neck cancer. Further work is needed to ascertain which aspects of swallowing should be measured, and then to use such measures in well-designed clinical trials and prospective cohort studies of this under-researched population.
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Affiliation(s)
- Jacqui J Frowen
- School of Human Communication Sciences, La Trobe University, Bundoora 3083, Victoria, Australia.
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McMahon MM, Hurley DL, Kamath PS, Mueller PS. Medical and ethical aspects of long-term enteral tube feeding. Mayo Clin Proc 2005; 80:1461-76. [PMID: 16295026 DOI: 10.4065/80.11.1461] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Clinicians frequently care for patients in whom long-term enteral tube feeding is being considered. The substantial increase in the use of endoscopically placed tubes for long-term feeding reflects the aging population, advances in medicine and technology, and inadequate advance care planning. Physicians should address advance care planning with all patients at the earliest opportunity. Prospective randomized trials measuring clinical outcomes for patients receiving long-term tube feeding are understandably limited. In addition, confusion regarding medical and ethical guidelines for long-term tube feeding often exists among clinicians, patients, and surrogate decision makers. Therefore, we discuss the physiology and clinical tolerance of limited oral nutritional intake, the prevalence of and Indications for long-term tube feeding, the endoscopic procedures and their complications, the reported medical and quality-of-life outcomes, and the critical importance of advance care planning. We present our multidisciplinary approach that combines medical, nutritional, and ethical principles for the care of these patients.
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Affiliation(s)
- M Molly McMahon
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
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