1
|
Ladbury C, Wilde T, Amini A, Xiao Y, Maghami E, Massarelli E, Vora N, Sun V, Sampath S. The impact of pretreatment symptom burden on long-term quality of life following head and neck radiation: A prospective longitudinal study. Head Neck 2024. [PMID: 38817083 DOI: 10.1002/hed.27804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND This study characterized the impact of baseline symptom burden on long-term quality-of-life in patients receiving head and neck radiation therapy (RT). METHODS The Vanderbilt Head and Neck Symptom Survey was collected prior to head and neck RT and at follow-up visits. Responses were divided into symptom clusters of toxicities and scored from 0 (asymptomatic) to 10 (severe). Patients with responses at baseline and 1-year or 2-year follow-up were stratified by scores ≤1 or >1 and compared using the Mann-Whitney U-test. RESULTS At 1-year follow-up (n = 75), patients with higher baseline scores had greater symptom burden for every cluster except in taste/smell. At 2-year follow-up (n = 47), patients with higher baseline scores had greater symptom burden for every cluster except in nutrition, dry mouth, trismus, neck tightness, and hearing. CONCLUSION The Vanderbilt Head and Neck Symptom Survey demonstrated a relationship between baseline symptom burden and long-term quality-of-life and might be useful as a screening tool.
Collapse
Affiliation(s)
- Colton Ladbury
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Taylor Wilde
- Department of Rehabilitation, City of Hope National Medical Center, Duarte, California, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Yi Xiao
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California, USA
| | - Ellie Maghami
- Division of Head and Neck Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Erminia Massarelli
- Department of Medical Oncology & Therapeutics Research, City of Hope National Medical Center, Duarte, California, USA
| | - Nayana Vora
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Virginia Sun
- Department of Population Sciences, City of Hope National Medical Center, Duarte, California, USA
| | - Sagus Sampath
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| |
Collapse
|
2
|
Rullan A, Marín-Jiménez JA, Lozano A, Bermejo O, Arribas L, Ruiz N, Linares I, Taberna M, Pérez X, Plana M, Oliva M, Mesía R. Study of late toxicity biomarkers of locally advanced head and neck cancer patients treated with radiotherapy plus cisplatin or cetuximab points to the relevance of skin macrophages (TOX-TTCC-2015-01). Clin Transl Oncol 2024:10.1007/s12094-024-03526-0. [PMID: 38782865 DOI: 10.1007/s12094-024-03526-0] [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: 02/12/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Radiotherapy (RT) with concomitant cisplatin (CRT) or cetuximab (ERT) are accepted treatment options for locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Long-term adverse events (AEs) have a vast impact on patients' quality of life. This study explored tissue biomarkers which could help predict late toxicity. METHODS/PATIENTS Single-institution prospective study including patients aged ≥ 18 with histologically confirmed newly diagnosed LA-SCCHN treated with RT and either concomitant cisplatin q3w or weekly cetuximab, according to institutional protocols. All patients underwent pre- and post-treatment skin biopsies of neck regions included in the clinical target volume. Angiogenesis, macrophages, and extracellular matrix (ECM) markers were evaluated by immunohistochemistry (IHC). RESULTS From April 15, 2016, to December 11, 2017; 31 patients were evaluated [CRT = 12 (38.7%) and ERT = 19 (61.3%)]. 27 patients (87%) had received induction chemotherapy. All patients finished RT as planned. IHC expression of vasculature (CD34) and collagen (Masson's Trichrome) did not differ significantly between and within CRT and ERT arms. Conversely, an increased CD68 and CD163 macrophage infiltration expression was observed after treatment, without significant impact of treatment modality. Patients with higher late toxicity showed lower expression of macrophage markers in pre-treatment samples compared with those with lower late toxicity, with statistically significant differences for CD68. CONCLUSIONS Angiogenesis and ECM biomarkers did not differ significantly between CRT and ERT. Macrophage markers increased after both treatments and deserve further investigation as predictors of late toxicity in LA-SCCHN patients. [Protocol code: TOX-TTCC-2015-01/Spanish registry of clinical studies (REec): 2015-003012-21/Date of registration: 27/01/2016].
Collapse
Affiliation(s)
- Antonio Rullan
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan A Marín-Jiménez
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alicia Lozano
- Department of Radiation Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Bermejo
- Departament of Plastic and Reconstructive Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lorena Arribas
- Clinical Nutrition Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Ruiz
- Department of Pathology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, Barcelona, Spain
| | - Isabel Linares
- Department of Radiation Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miren Taberna
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavi Pérez
- Clinical Investigation Unit (UIC), Catalan Institute of Oncology (ICO) L'Hospitalet, Barcelona, Spain
| | - María Plana
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Oliva
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ricard Mesía
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), B-ARGO Group, IGTP, Badalona, Barcelona, Spain.
| |
Collapse
|
3
|
Ermongkonchai T, Khor R, Wada M, Lau E, Xing DT, Ng SP. A review of diffusion-weighted magnetic resonance imaging in head and neck cancer patients for treatment evaluation and prediction of radiation-induced xerostomia. Radiat Oncol 2023; 18:20. [PMID: 36710364 PMCID: PMC9885695 DOI: 10.1186/s13014-022-02178-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
The incidence of head and neck cancers (HNC) is rising worldwide especially with HPV-related oropharynx squamous cell carcinoma. The standard of care for the majority of patients with locally advanced pharyngeal disease is curative-intent radiotherapy (RT) with or without concurrent chemotherapy. RT-related toxicities remain a concern due to the close proximity of critical structures to the tumour, with xerostomia inflicting the most quality-of-life burden. Thus, there is a paradigm shift towards research exploring the use of imaging biomarkers in predicting treatment outcomes. Diffusion-weighted imaging (DWI) is a functional MRI feature of interest, as it quantifies cellular changes through computation of apparent diffusion coefficient (ADC) values. DWI has been used in differentiating HNC lesions from benign tissues, and ADC analyses can be done to evaluate tumour responses to RT. It is also useful in healthy tissues to identify the heterogeneity and physiological changes of salivary glands to better understand the inter-individual differences in xerostomia severity. Additionally, DWI is utilised in irradiated salivary glands to produce ADC changes that correlate to clinical xerostomia. The implementation of DWI into multi-modal imaging can help form prognostic models that identify patients at risk of severe xerostomia, and thus guide timely interventions to mitigate these toxicities.
Collapse
Affiliation(s)
- Tai Ermongkonchai
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| | - Richard Khor
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| | - Morikatsu Wada
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| | - Eddie Lau
- grid.410678.c0000 0000 9374 3516Department of Radiology, Austin Health, Heidelberg, Melbourne, Australia ,grid.410678.c0000 0000 9374 3516Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Radiology, The University of Melbourne, Parkville, Melbourne, Australia
| | - Daniel Tao Xing
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| | - Sweet Ping Ng
- grid.410678.c0000 0000 9374 3516Department of Radiation Oncology, Olivia-Newton John Cancer and Wellness Centre, Austin Health, 145 Studley Road, Heidelberg, Melbourne, VIC 3084 Australia
| |
Collapse
|
4
|
Can Bioelectrical Impedance Analysis and BMI be a Prognostic Tool in Head and Neck Cancer Patients? A Review of the Evidence. Cancers (Basel) 2020; 12:cancers12030557. [PMID: 32121058 PMCID: PMC7139769 DOI: 10.3390/cancers12030557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Malnutrition can significantly affect disease progression and patient survival. The efficiency of weight loss and bioimpedance analysis (BIA)-derived measures in the evaluation of malnutrition, and disease progression and prognosis in patients with head and neck cancer (HNC) are an important area of research. Method: The PubMed database was thoroughly searched, using relative keywords in order to identify clinical trials that investigated the role of BIA-derived measures and weight loss on the disease progression and prognosis of patients with HNC. Twenty-seven studies met the criteria. More specifically, six studies examined the prognostic role of the tissue electrical properties in HNC patients; five examined the role of the tissue electrical properties on identifying malnutrition; four studies looked at the changes in the tissue electrical properties of HNC patients; and 12 examined the prognostic role of weight loss on survival and/or treatment outcomes. Results: Several studies have investigated the role of nutritional status tools on prognosis in HNC patients. Current studies investigating the potential of BIA-derived raw data have shown that phase angle (PA) and capacitance of the cell membrane may be considered prognostic factors of survival. Weight loss may be a prognostic factor for treatment toxicity and survival, despite some conflicting evidence. Conclusions: Further studies are recommended to clarify the role of BIA-derived measures on patients’ nutritional status and the impact of PA on clinical outcomes as well as the prognostic role of weight loss.
Collapse
|
5
|
Che J, Wang Y, Zhang X, Chen J. Comparative efficacy of six therapies for Hypopharyngeal and laryngeal neoplasms: a network meta-analysis. BMC Cancer 2019; 19:282. [PMID: 30922243 PMCID: PMC6439970 DOI: 10.1186/s12885-019-5412-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/27/2019] [Indexed: 11/18/2022] Open
Abstract
Background Hypopharyngeal and laryngeal neoplasms are both fatal and hard to catch in early stages. Yet which treatment is the most efficacious one still remain unanswered. This network meta-analysis (NMA) was conducted to investigate effectiveness of six therapies being utilized in clinical practice nowadays. Methods PubMed and Embase were retrieved to synthesize data. Direct and indirect evidence was combined to compare efficacy of treatments. A relative ranking of the six regimens was calculated by the surface under the curve ranking area (SUCRA). Results A total of 28 trials with 9109 patients were included in our NMA. Five endpoints investigated included 3/5-year overall survival (3/5-OS), 3/5-year disease free survival (3/5-DFS) and 5-year overall survival rate (5-OSR). In terms of all efficacy outcomes, radiotherapy combined with surgery (RT + S) proved to be better than other therapies while radiotherapy (RT) alone also performed well. Induction chemoradiotherapy (ICRT) was the best regarding 3-DFS (SUCRA = 0.846) while current chemoradiotherapy (CCRT) ranked first in 5-DFS (SUCRA = 0.933) according to SUCRA results. No significant differences were demonstrated in 5-DFS and 5-OSR as shown in the results of NMA. Conclusions RT combined with surgery turned out to be optimal therapy of all the outcomes while the efficacy of RT was relatively poorer in the treatment of patients with larynx stage III-IV and hypopharynx stage II-IV. Also, the good performance of CCRT and ICRT in terms of DFS made them as secondary recommended therapies. There is no significant difference between surgery and transoral laser microsurgery (TLM) alone. Electronic supplementary material The online version of this article (10.1186/s12885-019-5412-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Juan Che
- Department of Otorhinolaryngology, Binzhou Medical University Hospital, No. 661 Second Huanghe Road, Binzhou, 256603, Shandong, China
| | - Yanlin Wang
- Department of Otorhinolaryngology, Binzhou Medical University Hospital, No. 661 Second Huanghe Road, Binzhou, 256603, Shandong, China
| | - Xiaolin Zhang
- Department of Otorhinolaryngology, Binzhou Medical University Hospital, No. 661 Second Huanghe Road, Binzhou, 256603, Shandong, China
| | - Jun Chen
- Department of Otorhinolaryngology, Binzhou Medical University Hospital, No. 661 Second Huanghe Road, Binzhou, 256603, Shandong, China.
| |
Collapse
|
6
|
Deschuymer S, Nevens D, Duprez F, Laenen A, Dejaeger E, De Neve W, Goeleven A, Nuyts S. Clinical factors impacting on late dysphagia following radiotherapy in patients with head and neck cancer. Br J Radiol 2018; 91:20180155. [PMID: 29668302 DOI: 10.1259/bjr.20180155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE Patient and treatment characteristics of patients with head and neck cancer (HNSCC) were correlated with dysphagia scored on swallowing-videofluoroscopy (VFS) and with patient- and physician-scored dysphagia. METHODS 63 HNSCC patients treated with radiotherapy (RT) were evaluated at baseline, and 6 and 12 months post-RT. VFS was scored with Penetration Aspiration Scale (PAS) and Swallowing Performance Scale (SPS). Physician- and patient-scored dysphagia were prospectively recorded according to Common Terminology Criteria for Adverse Events scoring system, Radiation Therapy Oncology Group/EORTC scoring system and European Organization for Research and Treatment of Cancer Quality of Life questionnaire (EORTC-QLQ H&N35). RESULTS Univariable analysis revealed a significant association between tumour-subsite and higher SPS (p = 0.02) and patient-scored dysphagia (p = 0.02) at baseline. At 12 months, tumour-subsite was significantly associated with higher PAS and SPS. Multivariable analysis and pairwise comparison showed that hypopharyngeal cancer and carcinoma of unknown primary were associated with higher SPS at baseline and at 12 months, respectively (p = 0.03 and p = 0.01). Upfront neck dissection (UFND) was significantly associated with higher SPS and physician-scored dysphagia in univariable analysis at all timepoints. At 12 months, there was also a significant association with higher PAS (p < 0.01) and patient-scored dysphagia (p < 0.01). After multivariable analysis, the association between UFND and higher PAS (p < 0.01) and SPS (p < 0.01) remained significant at 12 months. CONCLUSION Hypopharyngeal tumours and carcinoma of unknown primary were related to more dysphagia at baseline and at 12 months, respectively. Furthermore, UFND was associated with more severe dysphagia scored by physicians and patients and on VFS at 12 months. Advances in knowledge: This is the first paper reporting a significant link between UFND and late dysphagia scored with VFS. We advocate abandoning UFND and preserving neck dissection as a salvage option post-RT.
Collapse
Affiliation(s)
- Sarah Deschuymer
- 1 Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven , Leuven , Belgium
| | - Daan Nevens
- 1 Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven , Leuven , Belgium
| | - Fréderic Duprez
- 2 Department of Radiotherapy-Oncology, Ghent University Hospital , Ghent , Belgium
| | - Annouschka Laenen
- 3 Leuven Biostatistics and Statistical Bioinformatics Centre, University of Leuven , Leuven , Belgium
| | - Eddy Dejaeger
- 4 Department of Geriatric Medicine, University Hospitals Leuven, Swallowing Clinic , Leuven , Belgium
| | - Wilfried De Neve
- 2 Department of Radiotherapy-Oncology, Ghent University Hospital , Ghent , Belgium
| | - Ann Goeleven
- 5 Department of ENT, University Hospitals Leuven, Swallowing Clinic , Leuven , Belgium.,6 Department of Head and Neck Surgery, University Hospitals Leuven, Swallowing Clinic , Leuven , Belgium
| | - Sandra Nuyts
- 1 Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven , Leuven , Belgium
| |
Collapse
|
7
|
Lonkvist CK, Vinther A, Zerahn B, Rosenbom E, Deshmukh AS, Hojman P, Gehl J. Progressive resistance training in head and neck cancer patients undergoing concomitant chemoradiotherapy. Laryngoscope Investig Otolaryngol 2017; 2:295-306. [PMID: 29094074 PMCID: PMC5654939 DOI: 10.1002/lio2.88] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 04/23/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022] Open
Abstract
Objectives Patients with head and neck squamous cell carcinoma undergoing concomitant chemoradiotherapy (CCRT) frequently experience weight loss, especially loss of lean body mass (LBM), and reduced functional performance. This study investigated whether a 12‐week hospital‐based progressive resistance training (PRT) program during CCRT is feasible in the clinical setting before planning initiation of a larger randomized study which is the long‐term goal. Study design Prospective pilot study. Methods Twelve patients receiving CCRT were planned to attend a 12‐week PRT program. Primary endpoint was feasibility measured as attendance to training sessions. Secondary endpoints included changes in functional performance, muscle strength, and body composition measured by Dual‐energy X‐ray Absorptiometry (DXA) scans. Furthermore, sarcomeric protein content, pentose phosphate pathway (PPP) activity, and glycolysis were determined in muscle biopsies. Results Twelve patients with p16 positive oropharyngeal cancer were enrolled. The primary endpoint was met with 9 of the 12 patients completing at least 25 of 36 planned training sessions. The mean attendance rate was 77%. Functional performance was maintained during the treatment period and increased during follow‐up (p < 0.01). Strength was regained after an initial dip during treatment, paralleling responses in LBM and sarcomeric protein content. LBM began to increase immediately after treatment. The PPP was upregulated after the treatment period, whilst glycolysis remained unchanged. No adverse events were related to PRT and in questionnaires, patients emphasized the social and psychological benefits of attendance. Conclusion Progressive resistance training is feasible and safe during CCRT for head and neck cancer, and is associated with high patient satisfaction. Level of Evidence 2C.
Collapse
Affiliation(s)
| | - Anders Vinther
- Department of Rehabilitation, University of Copenhagen Herlev Denmark
| | - Bo Zerahn
- Department of Clinical Physiology and Nuclear Medicine, University of Copenhagen Herlev Denmark
| | - Eva Rosenbom
- Nutritional Research Unit, Herlev and Gentofte Hospital, University of Copenhagen Herlev Denmark
| | - Atul S Deshmukh
- Proteomics Program, Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen Copenhagen Denmark
| | - Pernille Hojman
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research , Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Julie Gehl
- Department of Oncology, University of Copenhagen Herlev Denmark
| |
Collapse
|
8
|
Borchiellini D, Etienne-Grimaldi M, Bensadoun R, Benezery K, Dassonville O, Poissonnet G, Llorca L, Ebran N, Formento P, Château Y, Thariat J, Milano G. Candidate apoptotic and DNA repair gene approach confirms involvement of ERCC1, ERCC5, TP53 and MDM2 in radiation-induced toxicity in head and neck cancer. Oral Oncol 2017; 67:70-76. [DOI: 10.1016/j.oraloncology.2017.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/01/2017] [Accepted: 02/03/2017] [Indexed: 02/07/2023]
|
9
|
Li W, Shen LJ, Chen T, Sun XQ, Zhang Y, Wu M, Shu WH, Chen C, Pan CC, Xia YF, Wu PH. Overweight/obese status associates with favorable outcome in patients with metastatic nasopharyngeal carcinoma: a 10-year retrospective study. CHINESE JOURNAL OF CANCER 2016; 35:75. [PMID: 27507261 PMCID: PMC4977870 DOI: 10.1186/s40880-016-0139-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 07/22/2016] [Indexed: 01/08/2023]
Abstract
Background Although the prognostic impact of body mass index (BMI) in patients with non-metastatic nasopharyngeal carcinoma (NPC) had been extensively studied, its effect among metastatic NPC patients remains unknown. The purpose of this study was to evaluate the prognostic effect of BMI in patients with metastatic NPC. Methods We retrospectively studied 819 patients who were diagnosed with distant metastasis from NPC and received treatment between 1998 and 2007. The patients were divided into three subgroups according to the World Health Organization classifications for Asian populations: underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–22.9 kg/m2), and overweight/obese (BMI ≥23.0 kg/m2). The associations of BMI with overall survival (OS) and progression-free survival (PFS) were determined by Cox regression analysis. Results Of the 819 patients, 168 (20.5%) were underweight, 431 (52.6%) were normal weight, and 220 (26.9%) were overweight/obese. Multivariate analysis adjusted for covariates showed that overweight/obese patients had a longer OS than underweight patients [hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.49–0.84] and normal weight patients (HR, 0.72; 95% CI, 0.57–0.90); no significant difference in PFS was observed among these three groups (P = 0.407). Moreover, in stratified analysis, no statistically significant differences in the effect of overweight/obese status among different subgroups were observed. Conclusion For patients with metastatic NPC, overweight/obese status was associated with longer OS but not longer PFS compared with underweight or normal weight status.
Collapse
Affiliation(s)
- Wang Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Lu-Jun Shen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Tao Chen
- Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Xu-Qi Sun
- Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Ying Zhang
- Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Ming Wu
- Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Wan-Hong Shu
- Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Zhongshan School of Medical, Sun Yat-sen University, Guangzhou, 510080, Guangdong, P. R. China
| | - Chen Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Chang-Chuan Pan
- Department of Medical Oncology, Sichuan Cancer Hospital and Institute, Second People's Hospital of Sichuan Province, Chengdu, 610041, Sichuan, P. R. China
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Pei-Hong Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China. .,Department of Medical Imaging and Interventional Radiology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China.
| |
Collapse
|
10
|
Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F, Rottey S, Lievens Y, Van Den Noortgate N, Geldhof K, Buyse V, Kargar-Samani K, Ghekiere V, Debruyne PR. G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy. BMC Cancer 2015; 15:875. [PMID: 26553007 PMCID: PMC4640221 DOI: 10.1186/s12885-015-1800-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/16/2015] [Indexed: 12/12/2022] Open
Abstract
Background Evidence-based guidelines concerning the older head and neck cancer (HNCA) patient are lacking. Accurate patient selection for optimal care management is therefore challenging. We examined if geriatric assessment is indicative of long-term health-related quality of life (HRQOL) and overall survival in this unique population. Methods All HNCA patients, aged ≥65 years, eligible for curative radio(chemo)therapy were evaluated with the Geriatric-8 (G-8) questionnaire and a comprehensive geriatric assessment (CGA). Euroqol-5 dimensions (EQ-5D) and survival were collected until 36 months post treatment start. Repeated measures ANOVA was applied to analyse HRQOL evolution in ‘fit’ and ‘vulnerable’ patients, defined by G-8. Kaplan-Meier curves and cox proportional hazard analysis were established for determination of the prognostic value of geriatric assessments. Quality-adjusted survival was calculated in both patient subgroups. Results One hundred patients were recruited. Seventy-two percent of patients were considered vulnerable according to CGA (≥2 abnormal tests). Fit patients maintained a relatively acceptable long-term HRQOL, whilst vulnerable patients showed significantly lower median health states. The difference remained apparent at 36 months. Vulnerability, as classified by G-8 or CGA, came forward as independent predictor for lower EQ-5D index scores. After consideration of confounders, a significantly lower survival was observed in patients defined vulnerable according to G-8, compared to fit patients. A similar trend was seen based on CGA. Calculation of quality-adjusted survival showed significantly less remaining life months in perfect health in vulnerable patients, compared to fit ones. Conclusions G-8 is indicative of quality-adjusted survival, and should be considered at time of treatment decisions for the older HNCA patient. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1800-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Lies Pottel
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Michelle Lycke
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Hans Pottel
- Department of Public Health and Primary Care, Subfaculty of Medicine, Catholic University Leuven Kulak, Etienne Sabbelaan 53, B-8500, Kortrijk, Belgium.
| | - Laurence Goethals
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Nele Van Den Noortgate
- Department of Geriatrics, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Kurt Geldhof
- Department of Internal Medicine, Jan Yperman Hospital, Briekestraat 12, B-8900, Ypres, Belgium.
| | - Véronique Buyse
- Department of Internal Medicine, General Hospital OLV Lourdes, Vijfseweg 150, B-8790, Waregem, Belgium.
| | - Khalil Kargar-Samani
- Department of Oncology, Centre Hospitalier de Wallonie Picarde, RHMS, Chaussée de Saint-Amand 80, B-7500, Tournai, Belgium.
| | - Véronique Ghekiere
- Department of Geriatrics, General Hospital Groeninge, Reepkaai 4, B-8500, Kortrijk, Belgium.
| | - Philip R Debruyne
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium. .,Ageing & Cancer Research Cluster, Centre for Positive Ageing, University of Greenwich, Avery Hill Rd., SE9 2UG, Eltham, London, UK.
| |
Collapse
|
11
|
Krisciunas GP, Platt M, Trojanowska M, Grillone GA, Haines PC, Langmore SE. A Novel In Vivo Protocol for Molecular Study of Radiation-Induced Fibrosis in Head and Neck Cancer Patients. Ann Otol Rhinol Laryngol 2015; 125:228-34. [PMID: 26453487 DOI: 10.1177/0003489415607527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Radiation-induced fibrosis is a common complication for patients following head and neck cancer treatment. This study presents a novel minimally invasive protocol for molecular study of fibrosis in the stromal tissues. METHODS Subjects with radiation-induced fibrosis in the head and neck who were at least 6 months post treatment received submental core needle biopsies, followed by molecular processing and quantification of gene expression for 14 select pro-inflammatory and pro-fibrotic genes. Control biopsies from the upper arm were obtained from the same subjects. Patients were followed up at 1 and 2 weeks to monitor for safety and adverse outcomes. RESULTS Six subjects were enrolled and completed the study. No subjects experienced adverse outcomes or complication. An 18 gauge core biopsy needle with a 10 mm notch inserted for up to 60 seconds was needed. Subcutaneous tissue yielded 3 ng of RNA, amplified to 6 µg of cDNA, allowing for adequately sensitive quantitative polymerase chain reaction (qPCR) analysis of approximately 28 genes. CONCLUSIONS This study demonstrates the safety and utility of a novel technique for the molecular study of fibrosis in head and neck cancer patients. Longitudinal studies of patients undergoing radiation therapy will allow for identification of molecular targets that contribute to the process of fibrosis in the head and neck.
Collapse
Affiliation(s)
- Gintas P Krisciunas
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Michael Platt
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Maria Trojanowska
- Department of Medicine, Arthritis Center, Boston University, Boston, Massachusetts, USA
| | - Gregory A Grillone
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts, USA
| | - Paul C Haines
- Department of Medicine, Arthritis Center, Boston University, Boston, Massachusetts, USA
| | - Susan E Langmore
- Department of Otolaryngology, Boston University Medical Center, Boston, Massachusetts, USA
| |
Collapse
|
12
|
O'Gorman C, Sasiadek W, Denieffe S, Gooney M. Predicting radiotherapy-related clinical toxicities in cancer: a literature review. Clin J Oncol Nurs 2015; 18:E37-44. [PMID: 24867122 DOI: 10.1188/14.cjon.e37-e44] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assessment of patients receiving radiotherapy for cancer is essential, with the ability to identify those who may be more likely to experience radiotherapy-related side effects noted as an important issue for nurses. Body mass, age, and radiation dose may be predictive factors for the development of such side effects. This review considers these factors and how nurses can use this evidence to inform their care, with results indicating that the dose of radiation, the site treated, and body mass index are predictive of toxicities that may develop. Increased awareness of these predictive factors will aid nurses in identifying patients at greater risk of developing radiation-related side effects. This will assist in guiding nursing interventions, as well as enabling the individualization of patient education, by placing greater emphasis on preventive measures for patients who are more vulnerable to the development of radiation-related toxicities.
Collapse
Affiliation(s)
- Claire O'Gorman
- Department of Nursing, Waterford Institute of Technology in Ireland
| | | | | | - Martina Gooney
- Department of Nursing, Waterford Institute of Technology
| |
Collapse
|
13
|
Effectiveness of chemotherapy and radiotherapy for laryngeal preservation in advanced laryngeal cancer: a meta-analysis and systematic review. Radiol Med 2015; 120:1153-69. [DOI: 10.1007/s11547-015-0547-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
|
14
|
Final long-term results of a phase I/II study of dose-escalated intensity-modulated radiotherapy for locally advanced laryngo-hypopharyngeal cancers. Oral Oncol 2014; 50:1089-97. [PMID: 25200524 DOI: 10.1016/j.oraloncology.2014.07.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 11/20/2022]
Abstract
OBJECTIVES We previously described dose-escalated intensity-modulated radiotherapy (IMRT) in squamous cell cancer of the larynx/hypopharynx (SCCL/H) to offer improved locoregional control with a low incidence of toxicity at 2 years. We now present outcome and safety data at 5 years. MATERIALS AND METHODS A sequential cohort Phase I/II trial design was used. Patients with SCCL/H received IMRT at two dose levels (DL): DL1, 63 Gy/28 fractions to planning target volume 1 (PTV1) and 51.8 Gy/28 Fx to PTV2; DL2, 67.2 Gy/28 Fx and 56 Gy/28 Fx to PTV1 and PTV2, respectively. Patients received induction cisplatin/5-fluorouracil and concomitant cisplatin. RESULTS Between 09/2002 and 01/2008, 60 patients (29 DL1, 31 DL2) with stage III (41% DL1, 52% DL2) and stage IV (52% DL1, 48% DL2) disease were recruited. Median (range) follow-up for DL1 was 5.7 (1.0-10.2) years and for DL2 was 6.0 (0.3-8.4) years. Five-year local control rates (95% confidence interval) for DL1 and DL2, respectively, were 68% (50.6-85.4%) and 75% (58.9-91.1%), locoregional progression-free survival rates were 54% (35.6-72.4%) and 62.6% (44.8-80.4%), and overall survival was 61.9% (44.1-79.7) and 67.6 (51.1-84.1%). Five-year laryngeal preservation rates were 66.7% (37.4-87.9%) and 71.4% (44.4-85.8%), respectively. Cumulative toxicities reported were: one patient in DL1 and 2 in DL2 developed benign pharyngeal strictures. No other G3/4 toxicities were reported. CONCLUSIONS Dose-escalated IMRT at DL2 achieves higher 5-year local control, larynx preservation and survival rates with acceptable late toxicity. Recruitment into a Cancer Research UK Phase III study (ART-DECO), with DL2 as the experimental arm, is ongoing.
Collapse
|
15
|
Abstract
Squamous cell carcinoma of the larynx continues to be the commonest head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. The goals of laryngeal cancer treatment are thus to provide best possible oncologic control, while optimizing functional outcomes. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from one of primary surgery (total laryngectomy) as gold standard, toward non-surgical organ-preserving treatment using radiotherapy or chemoradiotherapy. However, concerns have emerged regarding functional outcomes after chemoradiotherapy, as well as possible decreased overall survival in patients with laryngeal cancer. The purpose of the present review is to review surgical and non-surgical options for treatment of advanced laryngeal cancer, as well as the evidence supporting each of these.
Collapse
|
16
|
Lartigau EF, Tresch E, Thariat J, Graff P, Coche-Dequeant B, Benezery K, Schiappacasse L, Degardin M, Bondiau PY, Peiffert D, Lefebvre JL, Lacornerie T, Kramar A. Multi institutional phase II study of concomitant stereotactic reirradiation and cetuximab for recurrent head and neck cancer. Radiother Oncol 2013; 109:281-5. [PMID: 24262821 DOI: 10.1016/j.radonc.2013.08.012] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 07/17/2013] [Accepted: 08/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Recurrent head and neck cancer is associated to a poor survival prognosis. A high toxicity rate is demonstrated when surgery and/or radiotherapy and/or chemotherapy are combined. Furthermore, the duration of treatment is often not ethically compatible with the expected survival (median survival<1year). Normal tissues tolerance limits the use of reirradiation and stereotactic body radiotherapy (SBRT) could offer precise irradiation while sparing healthy tissues. After completion of a feasibility study, results of a multicentric study (Lille, Nancy & Nice) using SBRT with cetuximab are reported. The aim of the study was to deliver non toxic short course SBRT (2weeks) in order to get the same local control as the one demonstrated with longer protocols. METHODS AND MATERIALS Patients with inoperable recurrent, or new primary tumor in a previously irradiated area, were included (WHO<3). Reirradiation (RT) dose was 36Gy in six fractions of 6Gy to the 85% isodose line covering 95% of the PTV with 5 injections of concomitant cetuximab (CT). All patients had previous radiotherapy, 85% had previous surgery and 48% previous chemotherapy. RESULTS Between 11/2007 and 08/2010, 60 were included (46 men and 14 women), 56 received CT+RT, 3 were not treated and 1 received only CT. Median age was 60 (42-87)) and all 56 patients had squamous carcinoma and received concomitant cetuximab. Mean time between previous radiotherapy and the start of SBRT was 38months. Cutaneous toxicity was observed for 41 patients. There was one toxic death from hemorrhage and denutrition. Median follow-up was 11.4months. At 3months, response rate was 58.4% (95% CI: 43.2-72.4%) and disease control rate was 91.7% (95% CI: 80.0-97.7%). The one-year OS rate was 47.5% (95% CI: 30.8-62.4). CONCLUSION These results suggest that short SBRT with cetuximab is an effective salvage treatment with good response rate in this poor prognosis population with previously irradiated HNC. Treatment is feasible and, with appropriate care to limiting critical structure, acute toxicities are acceptable. This combination may be the reference treatment is this population.
Collapse
Affiliation(s)
- Eric F Lartigau
- Centre Oscar Lambret, University Lille II & ONCOLille Consortium, France.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Mortensen HR, Overgaard J, Jensen K, Specht L, Overgaard M, Johansen J, Evensen JF, Andersen E, Andersen LJ, Hansen HS, Grau C. Factors associated with acute and late dysphagia in the DAHANCA 6 & 7 randomized trial with accelerated radiotherapy for head and neck cancer. Acta Oncol 2013; 52:1535-42. [PMID: 24047339 DOI: 10.3109/0284186x.2013.824609] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Dysphagia is a common and debilitating side effect in head and neck radiotherapy (RT). Prognostic factors are numerous and their interrelationship not well understood. The aim of this study was to establish a multivariate prognostic model for acute and late dysphagia after RT, based on information from a prospective trial. MATERIAL AND METHODS The DAHANCA 6&7 randomized study included 1476 patients with head and neck cancer eligible for primary RT alone. Patients were randomized between 5 and 6 weekly fractions of conventional RT, and received 62-70 Gy in 31-35 fractions. Patients were scored for dysphagia weekly during treatment and at regular intervals until five years after treatment. Dysphagia scores were available from 1461 patients. RESULTS Acute dysphagia according to DAHANCA grades 1, 2, 3 and 4 occurred in 83%, 71%, 43% and 23%, respectively. Severe dysphagia occurred in 47% and 38% of patients receiving accelerated or conventional radiotherapy, respectively (p = 0.001). At one, two, three, four and five years the prevalence of chronic dysphagia above grade 0, was 46%, 32%, 29%, 24%, 23%, respectively with no difference between 5 and 6 fractions. In multivariate analysis, the following parameters were independent factors for severe acute dysphagia: T3-T4 tumors, N-positive disease, non-glottic cancer, age> median, baseline dysphagia > 1 and accelerated radiotherapy. The following factors were prognostic factors for late dysphagia: non-glottic cancer, T3-T4, N-positive disease and baseline dysphagia > 1. The data confirmed previously published predictive models, as it was possible to separate patients in groups with low, medium and high risk of dysphagia, respectively, based on pre-treatment risk scores. CONCLUSION Prognostic models were established to characterize patients at risk of developing acute or late dysphagia in the DAHANCA 6&7 trial. The results may be useful to identify patients at risk of dysphagia and thus candidates for prophylactic measures against swallowing dysfunction.
Collapse
|
18
|
Changes in parotid gland morphology and function in patients treated with intensity-modulated radiotherapy for nasopharyngeal and oropharyngeal tumors. Oral Radiol 2013; 30:135-141. [PMID: 24817788 PMCID: PMC4009139 DOI: 10.1007/s11282-013-0151-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/30/2013] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the morphological changes of the parotid glands in patients treated with intensity-modulated radiotherapy (IMRT) for nasopharyngeal and oropharyngeal tumors and the correlations with parotid function. METHODS Ten patients with nasopharyngeal and oropharyngeal tumors treated with IMRT between May 2009 and January 2010 at Hokkaido University Hospital were included in this study. In the morphological assessment of the parotid glands, the sizes and computed tomography (CT) numbers of the bilateral parotid glands before and after IMRT with CT were calculated. For functional assessment of the parotid glands, we conducted the Saxon test and used a visual analog scale (VAS) for xerostomia evaluation. RESULTS Reductions in saliva secretion were observed in the patients treated with IMRT for nasopharyngeal and oropharyngeal tumors, and there was a significant correlation between the reduction in saliva secretion and the VAS. The reductions in the parotid gland size and CT number were larger on the ipsilateral side than on the contralateral side. The reduction in saliva secretion was not significantly correlated with the reduction in parotid gland size, but was significantly correlated with the reduction in CT number. CONCLUSIONS Morphological and functional changes of the parotid glands were observed after IMRT for nasopharyngeal and oropharyngeal tumors, and preservation of the contralateral parotid glands was only partly achieved. Among the morphological changes of the parotid glands, the CT number may be considered a predictor of parotid function after radiotherapy.
Collapse
|
19
|
High weight loss during radiation treatment changes the prognosis in under-/normal weight nasopharyngeal carcinoma patients for the worse: a retrospective analysis of 2433 cases. PLoS One 2013; 8:e68660. [PMID: 23869226 PMCID: PMC3711826 DOI: 10.1371/journal.pone.0068660] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 05/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although weight loss is common in nasopharyngeal carcinoma (NPC) patients receiving radiotherapy, the prognostic influence of weight loss and its impact modified by body mass index (BMI) are still unclear. METHODS 2433 NPC patients receiving radical radiotherapy at Sun Yat-sen University Cancer Center from November, 2000 to December, 2004 were enrolled. Weight change during radiation treatment was categorized into high weight loss (HWL) and low weight loss (LWL). The associations of HWL with overall survival (OS) and disease-specific survival (DSS) were analyzed by Cox regression. RESULTS Among underweight patients, HWL was independently associated with poor OS (hazard ratio [HR], 2.06; 95% CI 1.36-3.11) and DSS (HR, 2.27; 95% CI 1.38-3.73), as compared with LWL, after adjusting for covariates. In normal weight patients, the impact of HWL on OS (HR, 1.47; 95% CI 1.19-1.80) and DSS (HR, 1.59; 95% CI 1.24-2.03) was moderate. Among overweight/obese patients, no significant association between HWL and OS (HR, 1.22; 95% CI 0.95-1.55), or DSS (HR, 1.23; 95% CI 0.93-1.64) was found. CONCLUSION Except for overweight/obese patients, high weight loss during radiation treatment was independently associated with poor survival in NPC. This impact was more prominent in the underweight patient group.
Collapse
|
20
|
Leclerc M, Maingon P, Hamoir M, Dalban C, Calais G, Nuyts S, Serre A, Grégoire V. A dose escalation study with intensity modulated radiation therapy (IMRT) in T2N0, T2N1, T3N0 squamous cell carcinomas (SCC) of the oropharynx, larynx and hypopharynx using a simultaneous integrated boost (SIB) approach. Radiother Oncol 2013; 106:333-40. [PMID: 23541643 DOI: 10.1016/j.radonc.2013.03.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 03/02/2013] [Accepted: 03/03/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND The simultaneous integrated boost (SIB) technique with dose per fraction slightly higher than 2Gy offers the advantages of shortening the treatment time and increasing the biologically equivalent dose to the tumor. This study was designed to evaluate the feasibility of a dose-escalating radiotherapy treatment by using a SIB-IMRT approach in patients with early and moderately advanced head and neck cancers. MATERIALS AND METHODS Fifty-seven consecutive patients with pharyngo-laryngeal T2N0 or T2N1, or laryngeal T3N0 SCC were included. The therapeutic PTVs were treated according to three consecutive dose levels i.e., 69 Gy in 30 fractions of 2.3 Gy (dose level I), 72 Gy in 30 fractions of 2.4 Gy (dose level II) or 75 Gy in 30 fractions of 2.5 Gy (dose level III). The prophylactic PTVs received a dose of 55.5 Gy delivered in 30 fractions of 1.85 Gy. The primary endpoint of the study was acute toxicity assessed during treatment and during the first 3 months following the completion of radiotherapy. The secondary endpoints included loco-regional control, disease-free survival, overall survival and late toxicity at 2 years of follow-up. The study design allowed patients to be enrolled in the second dose level group if no more than 10% of grade 4 acute toxicity was observed on the first dose level group within 3 months after the completion of IMRT, and so on for the third level group. RESULTS Forty-four men and 13 women were included in the trial. The majority of them presented with oropharyngeal cancer (53%) and laryngeal cancer (33%). Only 3 patients developed grade 4 acute mucositis during treatment, one in each dose level. Thirty-two patients (56%) experienced grade 3 toxicity, mostly dermatitis and mucositis, without any significant difference between the groups. Late grade 1 and 2 xerostomia was seen in 53% and 33% of patients, respectively. Transient grade 4 late toxicity was observed in 16% of all patients and was equally distributed among the groups. The 2-year loco-regional control was 82% for all 3 groups (79% dose level I, 88% dose level II, 79% dose level III). The 2-year overall survival was 89% for dose level I and II, and 95% for dose level III. CONCLUSIONS This dose escalation SIB-IMRT protocol was safe and effective as the sole treatment of early and moderately advanced SCC of head and neck. No toxicity difference was observed between the groups.
Collapse
Affiliation(s)
- Mathieu Leclerc
- Cancer Center and Department of Radiation Oncology, Université catholique de Louvain, Cliniques Universitaires St-Luc, Brussels, Belgium
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Urban D, Gluck I, Pfeffer MR, Symon Z, Lawrence YR. Lymph node ratio predicts the benefit of post-operative radiotherapy in oral cavity cancer. Radiother Oncol 2013; 106:74-9. [DOI: 10.1016/j.radonc.2012.09.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 09/12/2012] [Accepted: 09/20/2012] [Indexed: 12/31/2022]
|