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Wilke C, Henson C, Huang SH, Bakst RL, Ng WT, Paterson C, McDowell L. Optimizing Therapy: The Art and Science of Modern Head and Neck Radiation. Int J Radiat Oncol Biol Phys 2024; 119:709-715. [PMID: 38851266 DOI: 10.1016/j.ijrobp.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 06/10/2024]
Affiliation(s)
- Christopher Wilke
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh, Pennsylvania.
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Shao Hui Huang
- Department of Radiation Oncology, The Princess Margaret Cancer Centre, University of Toronto, Canada
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine, New York, New York
| | - Wai Tong Ng
- Clinical Oncology Center, The University of Hong Kong, Hong Kong SAR, China
| | - Claire Paterson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Lachlan McDowell
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
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2
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Bertholet J, Mackeprang PH, Loebner HA, Mueller S, Guyer G, Frei D, Volken W, Elicin O, Aebersold DM, Fix MK, Manser P. Organs-at-risk dose and normal tissue complication probability with dynamic trajectory radiotherapy (DTRT) for head and neck cancer. Radiother Oncol 2024; 195:110237. [PMID: 38513960 DOI: 10.1016/j.radonc.2024.110237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/07/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
We compared dynamic trajectory radiotherapy (DTRT) to state-of-the-art volumetric modulated arc therapy (VMAT) for 46 head and neck cancer cases. DTRT had lower dose to salivary glands and swallowing structure, resulting in lower predicted xerostomia and dysphagia compared to VMAT. DTRT is deliverable on C-arm linacs with high dosimetric accuracy.
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Affiliation(s)
- Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.
| | - Paul-Henry Mackeprang
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Hannes A Loebner
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Silvan Mueller
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Gian Guyer
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Daniel Frei
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Werner Volken
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Olgun Elicin
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Daniel M Aebersold
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Michael K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
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3
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Rühle A, Nicolay NH. [Hypoxia-based de-escalation of radiochemotherapy in patients with human papillomavirus-related oropharyngeal carcinoma]. Strahlenther Onkol 2024; 200:453-456. [PMID: 38396139 DOI: 10.1007/s00066-024-02215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Alexander Rühle
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Leipzig, Stephanstraße 9a, 04103, Leipzig, Deutschland.
- Arbeitsgruppe junge DEGRO der Deutschen Gesellschaft für Radioonkologie e. V. (DEGRO), Berlin, Deutschland.
- Mitteldeutsches Krebszentrum (CCCG), Partnerstandort Leipzig, Leipzig, Deutschland.
| | - Nils H Nicolay
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Leipzig, Stephanstraße 9a, 04103, Leipzig, Deutschland
- Mitteldeutsches Krebszentrum (CCCG), Partnerstandort Leipzig, Leipzig, Deutschland
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4
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De Bruycker A, De Neve W, Daisne JF, Vercauteren T, De Gersem W, Olteanu L, Berwouts D, Deheneffe S, Madani I, Goethals I, Duprez F. Disease Control and Late Toxicity in Adaptive Dose Painting by Numbers Versus Nonadaptive Radiation Therapy for Head and Neck Cancer: A Randomized Controlled Phase 2 Trial. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00025-7. [PMID: 38387811 DOI: 10.1016/j.ijrobp.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/03/2023] [Accepted: 01/02/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Local recurrence remains the main cause of death in stage III-IV nonmetastatic head and neck cancer (HNC), with relapse-prone regions within high 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)-signal gross tumor volume. We investigated if dose escalation within this subvolume combined with a 3-phase treatment adaptation could increase local (LC) and regional (RC) control at equal or minimized radiation-induced toxicity, by comparing adaptive 18F-FDG-PET voxel intensity-based dose painting by numbers (A-DPBN) with nonadaptive standard intensity modulated radiation therapy (S-IMRT). METHODS AND MATERIALS This 2-center randomized controlled phase 2 trial assigned (1:1) patients to receive A-DPBN or S-IMRT (+/-chemotherapy). Eligibility: nonmetastatic HNC of oral cavity, oro-/hypopharynx, or larynx, needing radio(chemo)therapy; T1-4N0-3 (exception: T1-2N0 glottic); KPS ≥ 70; ≥18 years; and informed consent. PRIMARY OUTCOMES 1-year LC and RC. The dose prescription for A-DPBN was intercurrently adapted in 2 steps to an absolute dose-volume limit (≤1.75 cm3 can receive >84 Gy and normalized isoeffective dose >96 Gy) as a safety measure during the study course after 4/7 A-DPBN patients developed ≥G3 mucosal ulcers. RESULTS Ninety-five patients were randomized (A-DPBN, 47; S-IMRT, 48). Median follow-up was 31 months (IQR, 14-48 months); 29 patients died (17 of cancer progression). A-DPBN resulted in superior LC compared with S-IMRT, with 1- and 2-year LC of 91% and 88% versus 78% and 75%, respectively (hazard ratio, 3.13; 95% CI, 1.13-8.71; P = .021). RC and overall survival were comparable between arms, as was overall grade (G) ≥3 late toxicity (36% vs 20%; P = .1). More ≥G3 late mucosal ulcers were observed in active smokers (29% vs 3%; P = .005) and alcohol users (33% vs 13%; P = .02), independent of treatment arm. Similarly, in the A-DPBN arm, significantly more patients who smoked at diagnosis developed ≥G3 (46% vs 12%; P = .005) and ≥G4 (29% vs 8%; P = .048) mucosal ulcers. One arterial blowout occurred after a G5 mucosal toxicity. CONCLUSIONS A-DPBN resulted in superior 1- and 2-year LC for HNC compared with S-IMRT. This supports further exploration in multicenter phase 3 trials. It will, however, be challenging to recruit a substantial patient sample for such trials, as concerns have arisen regarding the association of late mucosal ulcers when escalating the dose in continuing smokers.
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Affiliation(s)
- Aurélie De Bruycker
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
| | - Wilfried De Neve
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Jean-François Daisne
- Department of Radiation Oncology, Université Catholique de Louvain, CHU-UCL-Namur, Namur, Belgium; Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium; Department of Oncology, Leuven Cancer Institute (LKI), Catholic University of Leuven, Leuven, Belgium
| | - Tom Vercauteren
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Werner De Gersem
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Luiza Olteanu
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Dieter Berwouts
- Department of Nuclear Medicine, AZ Maria-Middelares, AZ Jan Palfijn, Ghent, Belgium
| | - Stéphanie Deheneffe
- Department of Radiation Oncology, Université Catholique de Louvain, CHU-UCL-Namur, Namur, Belgium
| | - Indira Madani
- Department of Radiation Oncology, University Hospital of Zurich, Zurich, Switzerland
| | - Ingeborg Goethals
- Faculty of Medicine and Health Sciences, Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
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5
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Reinders FC, de Ridder M, Stijnman PR, Doornaert PA, Raaijmakers CP, Philippens ME. Detectability and intra-fraction motion of individual elective lymph nodes in head and neck cancer patients on the Magnetic Resonance Image guided linear accelerator. Phys Imaging Radiat Oncol 2024; 29:100532. [PMID: 38317852 PMCID: PMC10839763 DOI: 10.1016/j.phro.2024.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/22/2023] [Accepted: 12/30/2023] [Indexed: 02/07/2024] Open
Abstract
Background and purpose Individual elective lymph node irradiation instead of elective neck irradiation is a new concept for head-and-neck cancer (HNC) patients developed for the Magnetic Resonance Image guided linear accelerator (MR-linac). To prepare this, the detectability, volume changes and intra-fraction motion of elective lymph nodes on the MR-linac was assessed. Materials and methods A total of 15 HNC patients underwent diagnostic pre-treatment MRI. Additionally, two MR-linac scans were obtained with a 10-minute time difference in the first week of radiation treatment. Elective lymph node contours inside lymph node levels (Ib-V) were segmented on the pre-treatment MRI and the MR-linac scans and compared on number and maximal transversal diameter. Intra-fraction motion of elective lymph nodes on the MR-linac was estimated using Center of Mass (COM) distances and incremental isotropic expansion of lymph node segmentations. Results Of all 679 detected lymph nodes on the pre-treatment MRI, eight lymph nodes were not detectable on the first MR-linac scan and 16 new lymph nodes were detected. Lymph node diameters between the pre-treatment MRI scan and the MR-linac scan varied from -0.19 to + 0.13 mm. COM distances varied from 1.2 to 1.7 mm and lymph node contours had to be expanded with 3 mm. Conclusions Nearly all elective lymph nodes were detectable on the 1.5T MR-linac scan with no major changes in target volumes compared to the pre-treatment MRI. Simulated intra-fraction motion during the MR-linac scans was smaller than the 5-mm margin that will be used in the first elective lymph node radiation treatment.
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Affiliation(s)
| | - Mischa de Ridder
- Department of Radiotherapy, University Medical Centre Utrecht, the Netherlands
| | - Peter R.S. Stijnman
- Department of Radiotherapy, University Medical Centre Utrecht, the Netherlands
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Tomita N, Hayashi N, Mizuno T, Kitagawa Y, Yasui K, Saito Y, Sudo S, Takano S, Kita N, Torii A, Niwa M, Okazaki D, Takaoka T, Kawakita D, Iwasaki S, Hiwatashi A. Dosimetric and radiobiological analyses of a de-escalation strategy for elective nodal regions in human papillomavirus-associated oropharyngeal cancer. Tech Innov Patient Support Radiat Oncol 2023; 28:100221. [PMID: 37886016 PMCID: PMC10598397 DOI: 10.1016/j.tipsro.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/24/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction In this simulation study, we examined the effects of a de-escalation strategy with a reduced dose to subclinical nodal regions in patients with human papillomavirus (HPV)-associated oropharyngeal carcinoma (OPC). Methods We created two patterns of intensity-modulated radiotherapy for 16 patients with HPV-associated OPC. In the standard and de-escalation plans, the initial field including elective nodal regions received 46 and 30 Gy, followed by 20 and 36 Gy to the cutdown field, respectively. Comparison metrics were set for each organ at risk (OAR). We compared these metric values and the probability of adverse effects based on the normal tissue complication probability (NTCP) model between the two plans. Results Both plans generally met the dose constraints for the targets and all OAR. Among the comparison metrics, the mean doses to the brain, pharyngeal constrictor muscle, thyroid, and skin and the dose to a 1 % volume of the skin were higher in the standard plan than in the de-escalation plan (P = 0.031, 0.007, < 0.001, < 0.001, and 0.006, respectively). NTCP analyses revealed that the probability of adverse effects in the ipsilateral parotid gland and thyroid was higher in the standard plan than in the de-escalation plan (standard vs. de-escalation plans: ipsilateral parotid gland, 6.4 % vs. 5.0 %, P = 0.016; thyroid, 3.3 % vs. 0.5 %, P < 0.001). Conclusions A de-escalation strategy with elective nodal regions is a promising treatment to prevent a decline in the quality of life in patients with HPV-associated OPC, particularly xerostomia, dysphagia, and hypothyroidism.
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Affiliation(s)
- Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Naoki Hayashi
- Division of Medical Physics, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Tomoki Mizuno
- Department of Radiology, Toyokawa City Hospital, 23 Yawatachonoji, Toyokawa, Aichi 442-8561, Japan
| | - Yuto Kitagawa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Keisuke Yasui
- Division of Medical Physics, School of Medical Sciences, Fujita Health University, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Yasunori Saito
- Department of Radiology, Fujita Health University Hospital, 1-98 Dengakugakubo Kutsukake-cho, Toyoake, Aichi 470-1192, Japan
| | - Shuo Sudo
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Daisuke Kawakita
- Department of Otolaryngology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
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Abdel-Halim CN, O'Byrne TJ, Graves JP, Akpala CO, Moore EJ, Price DL, Tasche KT, Ma DJ, Neben-Wittich MA, Lester SC, Gamez M, Price KA, Bayne HEF, Rwigema JCM, Patel SH, McGee LA, Janus JR, Nagel TH, Hinni ML, Savvides PS, Van Abel KM, Routman DM. Patterns and distribution of regional nodal involvement and recurrence in a surgically treated oropharyngeal squamous cell carcinoma cohort at a tertiary center. Oral Oncol 2023; 146:106569. [PMID: 37734203 DOI: 10.1016/j.oraloncology.2023.106569] [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: 05/08/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVES To investigate and describe the patterns of regional metastases and recurrences after surgical treatment of oropharyngeal squamous cell cancer (OPSCC). MATERIALS AND METHODS Retrospective study of patients diagnosed with OPSCC from 2006 to 2021 at a tertiary referral center. Only patients treated with surgery including a neck dissection were included. Patients with unknown human papillomavirus (HPV) status, prior head and neck cancer, distant metastases, or synchronous head and neck cancer were excluded. RESULTS A total of 928 patients were included. 89% were males, the average age was 58.6 years (range: 25.2-87.5), 874 (94%) were HPV(+), and 513 (55.3%) had a tonsil cancer. Among cN + patients, the most commonly involved levels at presentation were level II (85.2%), level III (33.3%), and level IV (9.4%). In cN0 patients, metastases were only observed in level II (16.2%) and level III (9.2%). Nodal recurrence occurred in 48 (5.2%) patients after a median time of 1.0 years (interquartile range: 0.6-2.0). Nodal recurrence incidence was similar in HPV(+) and HPV(-) patients (5.0% vs. 7.4%, p = 0.44). The most common levels for regional recurrence were ipsilateral level II (45.8%), contralateral level II (43.8%), and ipsilateral level V (25.0%). Multivariable analysis revealed that pN was a significant predictor for regional recurrence (p = 0.02). CONCLUSION There is no difference in the distribution of regional metastases and recurrences in HPV(+) and HPV(-) OPSCC patients. Our findings align with the established understanding that regional metastases predominantly manifest in the ipsilateral level II-IV at presentation. Moreover, the data support the clinical recommendation to restrict elective neck dissection in cN0 patients to ipsilateral levels IIa and III, excluding level IIb. Regional recurrence is significantly associated with pN status.
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Affiliation(s)
- Chadi N Abdel-Halim
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Thomas J O'Byrne
- Department of Quantitative Health Sciences, Rochester, MN, United States
| | - Jeffrey P Graves
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Christeebella O Akpala
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel L Price
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Kendall T Tasche
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Mauricio Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Katharine A Price
- Department of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Jeffrey R Janus
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Thomas H Nagel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ, United States
| | - Michael L Hinni
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Scottsdale, AZ, United States
| | | | - Kathryn M Van Abel
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States.
| | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
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8
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Ma TM, Wong DJ, Chai-Ho W, Mendelsohn A, St John M, Abemayor E, Chhetri D, Sajed D, Dang A, Chu FI, Xiang M, Savjanji R, Weidhaas J, Steinberg ML, Cao M, Kishan AU, Chin RK. High Recurrence for HPV-Positive Oropharyngeal Cancer With Neoadjuvant Radiation Therapy to Gross Disease Plus Immunotherapy: Analysis From a Prospective Phase Ib/II Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 117:348-354. [PMID: 37141981 DOI: 10.1016/j.ijrobp.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023]
Affiliation(s)
| | | | | | | | - Maie St John
- Head and Neck Surgery, David Geffen School of Medicine
| | | | | | - Dipti Sajed
- Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, California
| | - Audrey Dang
- Department of Radiation Oncology, Tulane University School of Medicine, New Orleans, Louisiana
| | | | | | | | | | | | | | - Amar U Kishan
- Departments of Radiation Oncology; Department of Radiation Urology, University of California Los Angeles, Los Angeles, California
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Jelonek K, Mrowiec K, Gabryś D, Widłak P. The Metabolic Footprint of Systemic Effects in the Blood Caused by Radiotherapy and Inflammatory Conditions: A Systematic Review. Metabolites 2023; 13:1000. [PMID: 37755280 PMCID: PMC10534379 DOI: 10.3390/metabo13091000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/27/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
Response to radiotherapy (RT) includes tissue toxicity, which may involve inflammatory reactions. We aimed to compare changes in metabolic patterns induced at the systemic level by radiation and inflammation itself. Patients treated with RT due to head and neck cancer and patients with inflammation-related diseases located in the corresponding anatomical regions were selected. PubMed and Web of Science databases were searched from 1 January 2000 to 10 August 2023. Twenty-five relevant studies where serum/plasma metabolic profiles were analyzed using different metabolomics approaches were identified. The studies showed different metabolic patterns of acute and chronic inflammatory diseases, yet changes in metabolites linked to the urea cycle and metabolism of arginine and proline were common features of both conditions. Although the reviewed reports showed only a few specific metabolites common for early RT response and inflammatory diseases, partly due to differences in metabolomics approaches, several common metabolic pathways linked to metabolites affected by radiation and inflammation were revealed. They included pathways involved in energy metabolism (e.g., metabolism of ketone bodies, mitochondrial electron transport chain, Warburg effect, citric acid cycle, urea cycle) and metabolism of certain amino acids (Arg, Pro, Gly, Ser, Met, Ala, Glu) and lipids (glycerolipids, branched-chain fatty acids). However, metabolites common for RT and inflammation-related diseases could show opposite patterns of changes. This could be exemplified by the lysophosphatidylcholine to phosphatidylcholine ratio (LPC/PC) that increased during chronic inflammation and decreased during the early phase of response to RT. One should be aware of dynamic metabolic changes during different phases of response to radiation, which involve increased levels of LPC in later phases. Hence, metabolomics studies that would address molecular features of both types of biological responses using comparable analytical and clinical approaches are needed to unravel the complexities of these phenomena, ultimately contributing to a deeper understanding of their impact on biological systems.
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Affiliation(s)
- Karol Jelonek
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-100 Gliwice, Poland;
| | - Katarzyna Mrowiec
- Center for Translational Research and Molecular Biology of Cancer, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-100 Gliwice, Poland;
| | - Dorota Gabryś
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-100 Gliwice, Poland;
| | - Piotr Widłak
- 2nd Department of Radiology, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
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10
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Wei C, Lan X, Qiu M, Cui R, Fu Q, Shinge SAU, Muluh TA, Jiang O. Expanding the role of combined immunochemotherapy and immunoradiotherapy in the management of head and neck cancer (Review). Oncol Lett 2023; 26:372. [PMID: 37965160 PMCID: PMC10641411 DOI: 10.3892/ol.2023.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 11/16/2023] Open
Abstract
Immunotherapy has become one of the most promising approaches in tumor therapy, and there are numerous associated clinical trials in China. As an immunosuppressive tumor, head and neck squamous cell carcinoma (HNSCC) carries a high mutation burden, making immune checkpoint inhibitors promising candidates in this field due to their unique mechanism of action. The present review outlines a comprehensive multidisciplinary cancer treatment approach and elaborates on how combining immunochemotherapy and immunoradiotherapy guidelines could enhance clinical efficacy in patients with HNSCC. Furthermore, the present review explores the immunology of HNSCC, current immunotherapeutic strategies to enhance antitumor activity, ongoing clinical trials and the future direction of the current immune landscape in HNSCC. Advanced-stage HNSCC presents with a poor prognosis, low survival rates and minimal improvement in patient survival trends over time. Understanding the potential of immunotherapy and ways to combine it with surgery, chemotherapy and radiotherapy confers good prospects for the management of human papillomavirus (HPV)-positive HNSCC, as well as other HPV-positive malignancies. Understanding the immune system and its effect on HNSCC progression and metastasis will help to uncover novel biomarkers for the selection of patients and to enhance the efficacy of treatments. Further research on why current immune checkpoint inhibitors and targeted drugs are only effective for some patients in the clinic is needed; therefore, further research is required to improve the overall survival of affected patients.
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Affiliation(s)
- Chun Wei
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Xiaojun Lan
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Maona Qiu
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Ran Cui
- Department of Oncology, The First People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Qiuxia Fu
- Department of General Medicine, The People's Hospital of Luzhou City, Luzhou, Sichuan 646000, P.R. China
| | - Shafiu A. Umar Shinge
- Department of Cardiothoracic Surgery, Sun Yat Sen Memorial Hospital, Sun Yat Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Tobias Achu Muluh
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong 518060, P.R. China
| | - Ou Jiang
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
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11
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Benavente S. Remodeling the tumor microenvironment to overcome treatment resistance in HPV-negative head and neck cancer. CANCER DRUG RESISTANCE (ALHAMBRA, CALIF.) 2023; 6:291-313. [PMID: 37457128 PMCID: PMC10344731 DOI: 10.20517/cdr.2022.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/02/2023] [Accepted: 05/22/2023] [Indexed: 07/18/2023]
Abstract
Despite intensive efforts and refined techniques, overall survival in HPV-negative head and neck cancer remains poor. Robust immune priming is required to elicit a strong and durable antitumor immune response in immunologically cold and excluded tumors like HPV-negative head and neck cancer. This review highlights how the tumor microenvironment could be affected by different immune and stromal cell types, weighs the need to integrate metabolic regulation of the tumor microenvironment into cancer treatment strategies and summarizes the emerging clinical applicability of personalized immunotherapeutic strategies in HPV-negative head and neck cancer.
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Affiliation(s)
- Sergi Benavente
- Correspondence to: Dr. Sergi Benavente, Department of Radiation Oncology, Vall d’Hebron University Hospital, Passeig Vall d’Hebron 119, Barcelona 08035, Spain. E-mail:
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García-Anaya MJ, Segado-Guillot S, Cabrera-Rodríguez J, Toledo-Serrano MD, Medina-Carmona JA, Gómez-Millán J. DOSE AND VOLUME DE-ESCALATION OF RADIOTHERAPY IN HEAD AND NECK CANCER. Crit Rev Oncol Hematol 2023; 186:103994. [PMID: 37061074 DOI: 10.1016/j.critrevonc.2023.103994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 03/16/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023] Open
Abstract
Radiotherapy plays a key role in the treatment of head and neck cancer. However, irradiation of the head and neck region is associated with high rates of acute and chronic toxicity. Technological advances have led to better visualisation of target volumes and critical structures and improved dose conformality in the treatment volume. Despite this, acute toxicity has not been substantially reduced and late toxicity has a significant impact on patients' quality of life. The greater radiosensitivity of tumours associated with the HPV and the development of new imaging techniques have encouraged research into new deintensified strategies to reduce the side effects of radiotherapy. The aim of this paper is to review the literature on the strategies of de-escalated treatment in dose and/or volume in head and neck cancer.
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Affiliation(s)
- M J García-Anaya
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Malaga, Spain.
| | - S Segado-Guillot
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - J Cabrera-Rodríguez
- Department of Radiation Oncology, Hospital Universitario de Badajoz. Badajoz, Spain
| | - M D Toledo-Serrano
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - J A Medina-Carmona
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - J Gómez-Millán
- Department of Radiation Oncology, Hospital Universitario Virgen de la Victoria, Malaga, Spain; Instituto de Investigación Biomédica de Malaga, Malaga, Spain
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13
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Burr A, Harari P, Wieland A, Kimple R, Hartig G, Witek M. Patterns of failure for hypopharynx cancer patients treated with limited high-dose radiotherapy treatment volumes. Radiat Oncol J 2022; 40:225-231. [PMID: 36456541 PMCID: PMC9830040 DOI: 10.3857/roj.2022.00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/20/2022] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Optimal radiotherapy treatment volumes for patients with locally advanced hypopharynx squamous cell carcinoma should ensure maximal tumor coverage with minimal inclusion of normal surrounding structures. Here we evaluated the effectiveness of a direct 3-mm high-dose gross tumor volume to planning target volume expansion on clinical outcomes for hypopharynx cancers. MATERIALS AND METHODS We performed a retrospective analysis of patients with hypopharynx carcinoma treated between 2004 and 2018 with primary radiotherapy using a direct high-dose gross tumor volume to planning target volume expansion and with or without concurrent systemic therapy. Diagnostic imaging of recurrences was co-registered with the planning CT. Spatial and volumetric analyses of contoured recurrences were compared with planned isodose lines. Failures were initially defined as in field, marginal, elective nodal, and out of field. Each failure was further classified as central high-dose, peripheral high-dose, central intermediate/low-dose, peripheral intermediate/low-dose, and extraneous. Clinical outcomes were analyzed by Kaplan-Meier estimation. RESULTS Thirty-six patients were identified. At a median follow-up at 52.4 months, estimated 5-year overall survival was 59.3% (95% confidence interval [CI], 36.3%-74.1%), 5-year local and nodal control was 71.7% (95% CI, 47.1%-86.3%) and 69.9% (95% CI, 57.0%-82.6%), respectively. The most common failure was in the high-dose primary target volume. The gastrostomy tube retention rate at 1 year among patients without recurrence was 13.0% (95% CI, 3.2%-29.7%). CONCLUSION Minimal high-dose target volume expansions for hypopharynx cancers were associated with favorable locoregional control. This approach may enable therapy intensification to improve clinical outcomes.
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Affiliation(s)
- Adam Burr
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Paul Harari
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Aaron Wieland
- Division of Otolaryngology and Head and Neck Surgery, Department of Surgery, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Randall Kimple
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Gregory Hartig
- Division of Otolaryngology and Head and Neck Surgery, Department of Surgery, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Matthew Witek
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA,Correspondence: Matthew E. Witek Department of Human Oncology, University of Wisconsin – Madison, 600 Highland Avenue, K4/B100-0600, Madison, WI 53792, USA. Tel: +1-608-263-8500 E-mail:
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14
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Reinders FCJ, Stijnman PRS, de Ridder M, Doornaert PAH, Raaijmakers CPJ, Philippens MEP. MRI visibility and displacement of elective lymph nodes during radiotherapy in head and neck cancer patients. FRONTIERS IN RADIOLOGY 2022; 2:1033521. [PMID: 37492674 PMCID: PMC10365081 DOI: 10.3389/fradi.2022.1033521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/27/2022] [Indexed: 07/27/2023]
Abstract
Background and purpose To decrease the impact of radiotherapy to healthy tissues in the head and neck region, we propose to restrict the elective neck irradiation to elective lymph nodes at risk of containing micro metastases instead of the larger lymph node volumes. To assess whether this new concept is achievable in the clinic, we determined the number, volume changes and displacement of elective lymph nodes during the course of radiotherapy. Materials and methods MRI scans of 10 head and neck cancer (HNC) patients were acquired before radiotherapy and in week 2, 3, 4 and 5 during radiotherapy. The weekly delineations of elective lymph nodes inside the lymph node levels (Ib/II/III/IVa/V) were rigidly registered and analyzed regarding number and volume. The displacement of elective lymph nodes was determined by center of mass (COM) distances, vector-based analysis and the isotropic contour expansion of the lymph nodes of the pre-treatment scan or the scan of the previous week in order to geographically cover 95% of the lymph nodes in the scans of the other weeks. Results On average, 31 elective lymph nodes in levels Ib-V on each side of the neck were determined. This number remained constant throughout radiotherapy in most lymph node levels. The volume of the elective lymph nodes reduced significantly in all weeks, up to 50% in week 5, compared to the pre-treatment scan. The largest median COM displacements were seen in level V, for example 5.2 mm in week 5 compared to the pre-treatment scan. The displacement of elective lymph nodes was mainly in cranial direction. Geographical coverage was obtained when the lymph node volumes were expanded with 7 mm in case the pre-treatment scan was used and 6.5 mm in case the scan of the previous week was used. Conclusion Elective lymph nodes of HNC patients remained visible on MRI and decreased in size during radiotherapy. The displacement of elective lymph nodes differ per lymph node level and were mainly directed cranially. Weekly adaptation does not seem to improve coverage of elective lymph nodes. Based on our findings we expect elective lymph node irradiation is achievable in the clinic.
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Affiliation(s)
- Floris C J Reinders
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Peter R S Stijnman
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Mischa de Ridder
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, Netherlands
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15
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van den Bosch S, Czerwinski M, Govers T, Takes RP, de Bree R, Al‐Mamgani A, Hannink G, Kaanders JHAM. Diagnostic test accuracy of sentinel lymph node biopsy in squamous cell carcinoma of the oropharynx, larynx, and hypopharynx: A systematic review and meta-analysis. Head Neck 2022; 44:2621-2632. [PMID: 36047597 PMCID: PMC9826301 DOI: 10.1002/hed.27175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 01/11/2023] Open
Abstract
The aim of this meta-analysis was to determine the diagnostic test accuracy of sentinel lymph node biopsy (SLNB) in patients with oropharyngeal, laryngeal, and hypopharyngeal squamous cell carcinoma (SCC). For this purpose, MEDLINE, EMBASE, and Web of Science were searched from inception to March 8, 2022. Included were studies evaluating diagnostic test accuracy of SLNB to identify cervical lymph node metastases with elective neck dissection or follow-up as reference. A bivariate generalized linear mixed model approach was used for the meta-analysis. Nineteen studies were eligible, evaluating 377 cases in total. The pooled estimates of sensitivity and negative predictive value were 0.93 (95% CI: 0.86-0.96) and 0.97 (95% CI: 0.94-0.98), respectively. The excellent accuracy of SLNB justifies a place in the diagnostic workup of patients with larynx and pharynx SCC. Randomized trials are required to demonstrate oncologic safety and benefits on treatment related morbidity and quality of life when omitting elective neck treatment based on SLNB.
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Affiliation(s)
- Sven van den Bosch
- Department of Radiation OncologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Michal Czerwinski
- Department of Radiation OncologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Tim Govers
- Department of Operating RoomsRadboud University Medical CenterNijmegenthe Netherlands
| | - Robert P. Takes
- Department of Otolaryngology – Head and Neck SurgeryRadboud University Medical CenterNijmegenthe Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical OncologyUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Abrahim Al‐Mamgani
- Department of Radiation OncologyNetherlands Cancer Institute/Antoni van LeeuwenhoekAmsterdamthe Netherlands
| | - Gerjon Hannink
- Department of Operating RoomsRadboud University Medical CenterNijmegenthe Netherlands
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16
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Svajdova M, Dubinsky P, Kazda T, Jeremic B. Human Papillomavirus-Related Non-Metastatic Oropharyngeal Carcinoma: Current Local Treatment Options and Future Perspectives. Cancers (Basel) 2022; 14:5385. [PMID: 36358801 PMCID: PMC9658535 DOI: 10.3390/cancers14215385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/26/2022] [Accepted: 10/31/2022] [Indexed: 08/26/2023] Open
Abstract
Over the last two decades, human papillomavirus (HPV) has caused a new pandemic of cancer in many urban areas across the world. The new entity, HPV-associated oropharyngeal squamous cell carcinoma (OPSCC), has been at the center of scientific attention ever since, not only due to its distinct biological behavior, but also because of its significantly better prognosis than observed in its HPV-negative counterpart. The very good treatment outcomes of the disease after primary therapy (minimally-invasive surgery, radiation therapy with or without chemotherapy) resulted in the creation of a separate staging system, reflecting this excellent prognosis. A substantial proportion of newly diagnosed HPV-driven OPSCC is diagnosed in stage I or II, where long-term survival is observed worldwide. Deintensification of the primary therapeutic methods, aiming at a reduction of long-term toxicity in survivors, has emerged, and the quality of life of the patient after treatment has become a key-point in many clinical trials. Current treatment recommendations for the treatment of HPV-driven OPSCC do not differ significantly from HPV-negative OPSCC; however, the results of randomized trials are eagerly awaited and deemed necessary, in order to include deintensification into standard clinical practice.
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Affiliation(s)
- Michaela Svajdova
- Department of Radiation and Clinical Oncology, General Hospital Rimavska Sobota, 979 01 Rimavska Sobota, Slovakia
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 602 00 Brno, Czech Republic
| | - Pavol Dubinsky
- Department of Radiation Oncology, East Slovakia Oncology Institute, 040 01 Kosice, Slovakia
- Faculty of Health, Catholic University Ruzomberok, 034 01 Ruzomberok, Slovakia
| | - Tomas Kazda
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, 625 00 Brno, Czech Republic
- Department of Radiation Oncology, Masaryk Memorial Cancer Institute, 602 00 Brno, Czech Republic
| | - Branislav Jeremic
- School of Medicine, University of Kragujevac, 340 00 Kragujevac, Serbia
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17
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Bertholet J, Mackeprang PH, Mueller S, Guyer G, Loebner HA, Wyss Y, Frei D, Volken W, Elicin O, Aebersold DM, Fix MK, Manser P. Organ-at-risk sparing with dynamic trajectory radiotherapy for head and neck cancer: comparison with volumetric arc therapy on a publicly available library of cases. Radiat Oncol 2022; 17:122. [PMID: 35841098 PMCID: PMC9284789 DOI: 10.1186/s13014-022-02092-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Dynamic trajectory radiotherapy (DTRT) extends volumetric modulated arc therapy (VMAT) with dynamic table and collimator rotation during beam-on. The aim of the study is to establish DTRT path-finding strategies, demonstrate deliverability and dosimetric accuracy and compare DTRT to state-of-the-art VMAT for common head and neck (HN) cancer cases. Methods A publicly available library of seven HN cases was created on an anthropomorphic phantom with all relevant organs-at-risk (OARs) delineated. DTRT plans were generated with beam incidences minimizing fractional target/OAR volume overlap and compared to VMAT. Deliverability and dosimetric validation was carried out on the phantom. Results DTRT and VMAT had similar target coverage. For three locoregionally advanced oropharyngeal carcinomas and one adenoid cystic carcinoma, mean dose to the contralateral salivary glands, pharynx and oral cavity was reduced by 2.5, 1.7 and 3.1 Gy respectively on average with DTRT compared to VMAT. For a locally recurrent nasopharyngeal carcinoma, D0.03 cc to the ipsilateral optic nerve was above tolerance (54.0 Gy) for VMAT (54.8 Gy) but within tolerance for DTRT (53.3 Gy). For a laryngeal carcinoma, DTRT resulted in higher dose than VMAT to the pharynx and brachial plexus but lower dose to the upper oesophagus, thyroid gland and contralateral carotid artery. For a single vocal cord irradiation case, DTRT spared most OARs better than VMAT. All plans were delivered successfully on the phantom and dosimetric validation resulted in gamma passing rates of 93.9% and 95.8% (2%/2 mm criteria, 10% dose threshold). Conclusions This study provides a proof of principle of DTRT for common HN cases with plans that were deliverable on a C-arm linac with high accuracy. The comparison with VMAT indicates substantial OAR sparing could be achieved. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02092-5.
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Affiliation(s)
- Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland.
| | - Paul-Henry Mackeprang
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Silvan Mueller
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Gian Guyer
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Hannes A Loebner
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Yanick Wyss
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland.,Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Daniel Frei
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Werner Volken
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Olgun Elicin
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Daniel M Aebersold
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Michael K Fix
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
| | - Peter Manser
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital and University of Bern, Friedbühlschulhaus, 3010, Bern, Switzerland
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Caudell JJ, Gillison ML, Maghami E, Spencer S, Pfister DG, Adkins D, Birkeland AC, Brizel DM, Busse PM, Cmelak AJ, Colevas AD, Eisele DW, Galloway T, Geiger JL, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Mell LK, Mittal BB, Pinto HA, Rocco JW, Rodriguez CP, Savvides PS, Schwartz D, Shah JP, Sher D, St John M, Weber RS, Weinstein G, Worden F, Yang Bruce J, Yom SS, Zhen W, Burns JL, Darlow SD. NCCN Guidelines® Insights: Head and Neck Cancers, Version 1.2022. J Natl Compr Canc Netw 2022; 20:224-234. [PMID: 35276673 DOI: 10.6004/jnccn.2022.0016] [Citation(s) in RCA: 178] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Head and Neck Cancers address tumors arising in the oral cavity (including mucosal lip), pharynx, larynx, and paranasal sinuses. Occult primary cancer, salivary gland cancer, and mucosal melanoma (MM) are also addressed. The specific site of disease, stage, and pathologic findings guide treatment (eg, the appropriate surgical procedure, radiation targets, dose and fractionation of radiation, indications for systemic therapy). The NCCN Head and Neck Cancers Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights summarize the panel's most recent recommendations regarding management of HPV-positive oropharynx cancer and ongoing research in this area.
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Affiliation(s)
| | | | | | | | | | - Douglas Adkins
- 6Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | | | | | | | | | | | - David W Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | - Jessica L Geiger
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Debra Leizman
- 14Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | - Bharat B Mittal
- 20Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - James W Rocco
- 21The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | - David Schwartz
- 24St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - David Sher
- 25UT Southwestern Simmons Comprehensive Cancer Center
| | | | | | | | | | | | - Sue S Yom
- 30UCSF Helen Diller Family Comprehensive Cancer Center
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Tsai CJ, McBride SM, Riaz N, Kang JJ, Spielsinger DJ, Waldenberg T, Gelblum D, Yu Y, Chen LC, Zakeri K, Wong RJ, Dunn L, Pfister DG, Sherman EJ, Lee NY. Evaluation of Substantial Reduction in Elective Radiotherapy Dose and Field in Patients With Human Papillomavirus-Associated Oropharyngeal Carcinoma Treated With Definitive Chemoradiotherapy. JAMA Oncol 2022; 8:364-372. [PMID: 35050342 PMCID: PMC8778604 DOI: 10.1001/jamaoncol.2021.6416] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Several de-escalation strategies for human papillomavirus (HPV)-associated oropharyngeal carcinoma (OPC) have focused on deintensifying gross disease treatment. Reduction of radiotherapy dose and target volume to subclinical regions may achieve good clinical outcomes with favorable patient quality of life (QOL). OBJECTIVE To determine outcomes from a systematic approach of reducing radiotherapy dose and target volume to the elective treatment regions in patients with HPV-associated OPC undergoing concurrent chemoradiotherapy (CCRT). DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included 276 consecutive patients with HPV-positive OPC receiving CCRT from March 1, 2017, to July 31, 2019. Data were analyzed from February 23 to September 13, 2021. INTERVENTIONS Elective nodal and subclinical regions received 30 Gy of radiotherapy in 15 fractions, followed by a cone down of 40 Gy in 20 fractions to gross disease for a total dose of 70 Gy. The high retropharyngeal nodal basins in the node-negative neck and bilateral levels IB and V basins were omitted. MAIN OUTCOMES AND MEASURES Patients were followed up to evaluate locoregional control as the primary outcome and distant metastasis-free survival, progression-free survival, and overall survival as secondary outcomes. Quality-of-life data were obtained at each visit when feasible. RESULTS Among the 276 patients included in the analysis, the median age was 61 (range, 36-87) years; 247 (89.5%) were men; and 183 (66.3%) had less than 10 pack-years of smoking history. Most patients (251 [90.9%]) were White. Overall, 87 (31.5%) had cT3-cT4 disease and 65 (23.5%) had cN2-cN3 disease per the 8th edition of the American Joint Committee on Cancer Staging Manual. One hundred seventy-two patients (62.3%) completed 300-mg/m2 high-dose cisplatin therapy. During a median follow-up of 26 (range, 21-32) months, 8 patients developed locoregional recurrence, including 7 at the primary site or gross nodes that received a total dose of 70 Gy and 1 with a persistent node not previously identified as gross disease that received a total dose of only 30 Gy. The 24-month locoregional control was 97.0%; progression-free survival, 88.0%; distant metastasis-free survival, 95.2%; and overall survival, 95.1%. During treatment, 17 patients (6.2%) required a feeding tube. At 24 months, most of the QOL composite scores (jaw-related problems, pain, social contact, eating, speech, and swallow) were comparable or superior to baseline measures except for senses, dry mouth, muscular tension, and cognitive functioning, which improved over time but remained marginally worse than baseline. CONCLUSIONS AND RELEVANCE This cohort study found that the evaluated de-escalation strategy for elective regions showed favorable clinical outcomes and QOL profiles. Long-term follow-up data will help affirm the efficacy of this strategy as a care option for treating HPV-associated OPC with primary CCRT.
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Affiliation(s)
- C. Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M. McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jung J. Kang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel J. Spielsinger
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Todd Waldenberg
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daphna Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda C. Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Richard J. Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lara Dunn
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David G. Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric J. Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Reinders FCJ, Heijst TCFV, Mases J, Terhaard CHJ, Doornaert PAH, Philippens MEP, Raaijmakers CPJ. Magnetic resonance guided elective neck irradiation targeting individual lymph nodes: A new concept. Phys Imaging Radiat Oncol 2022; 20:76-81. [PMID: 35169639 PMCID: PMC8829887 DOI: 10.1016/j.phro.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/24/2022] Open
Abstract
Individual elective lymph nodes can be identified using multiple Dixon T2-weighted turbo spin echo with fat suppression. Magnetic Resonance guided individual lymph node irradiation results in lower dose to the organs at risk. Especially the submandibular glands, carotid arteries and thyroid can be spared. The magnetic field on the magnetic resonance imaging - linear accelerator did not lead to increased skin dose depositions.
Background and purpose Conventional elective neck irradiation (ENI) in head and neck cancer consists of radiotherapy (RT) to the regional lymph node (LN) levels contoured on computed tomography. Hybrid Magnetic Resonance (MR) - RT modalities, such as combined magnetic resonance imaging - linear accelerators (MRLs), might enable new ENI strategies in which individual non-suspect lymph nodes (i-LNs) are targeted. In this treatment planning study, new MR-based strategies targeting i-LNs (i-ENI) were compared to conventional treatment. Materials and methods All i-LNs were delineated on MR images of ten retrospectively selected patients with T2-4aN0M0 laryngeal cancer. Three strategies were considered. Strategy A: Conventional ENI delivered with a conventional linear accelerator (35x 1.55 Gy). Strategy B: MRL-based i-ENI (35x 1.55 Gy) to the individual lymph nodes including a background dose to the conventional elective neck volumes (35x 1.03 Gy). Strategy C: Same as Strategy B, but without background dose. In all plans the dose prescription to the primary tumor was 35x 2 Gy. Mean dose (Dmean) reductions in the organs at risk (OAR) were compared using the Wilcoxon signed rank test. Results Compared to conventional ENI (strategy A), significant Dmean reductions of 6.0 Gy and 8.0 Gy were observed in the submandibular glands, of 9.4 Gy and 13 Gy in the carotid arteries and of 9.9 Gy and 19.4 Gy in the thyroid for strategy B and C, respectively. Large inter-patient variations of Dmean reductions were observed in all OARs. Conclusion MRL-based i-ENI is a new promising concept that could reduce the mean dose to OARs in the neck significantly for patients with laryngeal cancer.
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Key Words
- CA, carotid arteries
- Dmean, mean dose
- ENI, elective neck irradiation
- Head and neck neoplasms
- LNs, lymph nodes
- Lymph nodes
- MRL, magnetic resonance imaging linear accelerator
- Magnetic resonance imaging
- OAR, organ at risk
- OC, oral cavity (OC)
- PCM, pharynx constrictor muscle
- PG, parotid gland
- Radiotherapy
- SMG, submandibular gland
- Squamous cell carcinoma of head and neck
- i-ENI, individual non-suspect lymph node elective neck irradiation
- i-LNs, individual lymph nodes
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Affiliation(s)
- Floris C J Reinders
- Department of Radiotherapy, University Medical Centre Utrecht, the Netherlands
| | | | - Joel Mases
- Department of Radiotherapy, University Medical Centre Utrecht, the Netherlands
| | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Centre Utrecht, the Netherlands
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21
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Dragan T, Duprez F, Van Gossum A, Gulyban A, Beauvois S, Digonnet A, Lalami Y, Van Gestel D. Prophylactic gastrostomy in locally advanced head and neck cancer: results of a national survey among radiation oncologists. BMC Cancer 2021; 21:656. [PMID: 34078309 PMCID: PMC8171041 DOI: 10.1186/s12885-021-08348-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/12/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Nutritional complications in patients with locally advanced head and neck cancer (LA-HNC) treated by concurrent chemoradiotherapy (CCRT) often lead to placement of a prophylactic gastrostomy (PG) tube, while indication lacks harmonization. Our aim was to explore the current PG tube utilization among Belgian radiation oncology centers. METHODS A survey was distributed to all 24 Belgian Radiation oncology departments, with questions about the number of patient treated per year, whether the PG indication is discussed at the multidisciplinary board, placement technique, time of starting nutrition and removal, its impact on swallowing function and importance of clinical factors. For the latter Relative Importance and Discordance Indexes were calculated to describe the ranking and agreement. RESULTS All 24 centers submitted the questionnaire. Twenty three treat more than 20 head and neck (HNC) patients per year, while four (1 in 21-50; 3 in 51-100) are not discussing the gastrostomy tube indication at the multidisciplinary board. For the latter, endoscopic placement (68%) is the dominant technique, followed by the radiologic (16%) and laparoscopic (16%) methods. Seventy-five percent start the enteral nutrition when clinically indicated, 17% immediately and 8% from the start of radiotherapy. Majority of specialists (19/24) keep the gastrostomy tube until the patient assume an adequate oral feeding. Fifteen centres are considering PG decrease swallowing function. Regarding factors and their importance in the decision for the PG, foreseen irradiated volume reached highest importance, followed by 'anatomical site', 'patients' choice' and 'postoperative versus definitive' and 'local expertise', with decreasing importance respectively. Disagreement indexes showed moderate variation. CONCLUSIONS The use of a PG tube for LAHNC patients treated by CCRT shows disparity at national level. Prospective studies are needed to ensure proper indication of this supportive measure.
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Affiliation(s)
- Tatiana Dragan
- Department of Radiation Oncology (Head and Neck Unit), Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet - 1000 Bruxelles, Brussels, Belgium.
| | - Fréderic Duprez
- Department of Radiotherapy-Oncology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - André Van Gossum
- Consultant at the Department of Gastroenterology and Clinical Nutrition, Hopital Erasme and Institut Jules Bordet, Brussels, Belgium
| | - Akos Gulyban
- Medical Physics Department, Institut Jules Bordet, Brussels, Belgium
| | - Sylvie Beauvois
- Department of Radiation Oncology (Head and Neck Unit), Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet - 1000 Bruxelles, Brussels, Belgium
| | - Antoine Digonnet
- Department of Head and Neck Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Yassine Lalami
- Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Department of Radiation Oncology (Head and Neck Unit), Institut Jules Bordet, Université Libre de Bruxelles, 1 rue Héger Bordet - 1000 Bruxelles, Brussels, Belgium
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22
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Ng WT, Tsang RKY, Beitler JJ, de Bree R, Coca-Pelaz A, Eisbruch A, Guntinas-Lichius O, Lee AWM, Mäkitie AA, Mendenhall WM, Nuyts S, Rinaldo A, Robbins KT, Rodrigo JP, Silver CE, Simo R, Smee R, Strojan P, Takes RP, Ferlito A. Contemporary management of the neck in nasopharyngeal carcinoma. Head Neck 2021; 43:1949-1963. [PMID: 33780074 DOI: 10.1002/hed.26685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/29/2021] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
Up to 85% of the patients with nasopharyngeal carcinoma present with regional nodal metastasis. Although excellent nodal control is achieved with radiotherapy, a thorough understanding of the current TNM staging criteria and pattern of nodal spread is essential to optimize target delineation and minimize unnecessary irradiation to adjacent normal tissue. Selective nodal irradiation with sparing of the lower neck and submandibular region according to individual nodal risk is now emerging as the preferred treatment option. There has also been continual refinement in staging classification by incorporating relevant adverse nodal features. As for the uncommon occurrence of recurrent nodal metastasis after radiotherapy, surgery remains the standard of care.
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Affiliation(s)
- Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Raymond K Y Tsang
- Department of Otorhinolaryngology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology/Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Anne W M Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sandra Nuyts
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.,Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University Medical School, Springfield, Illinois, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Ricard Simo
- Departement of Otorhinolaryngology, Head and Neck Surgery, Head and Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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23
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Bauwens L, Baltres A, Fiani DJ, Zrounba P, Buiret G, Fleury B, Benzerdjeb N, Grégoire V. Prevalence and distribution of cervical lymph node metastases in HPV-positive and HPV-negative oropharyngeal squamous cell carcinoma. Radiother Oncol 2021; 157:122-129. [PMID: 33545255 DOI: 10.1016/j.radonc.2021.01.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE In oropharyngeal squamous cell carcinoma (OP-SCC), the prevalence and distribution of clinical and pathological lymph node metastasis in the neck have been extensively reported. It served as the basis for consensus recommendations on the selection of the lymph node levels in the neck requiring a treatment. The objective of the study is to compare the prevalence and distribution of neck node metastases in HPV+ and HPV- OP-SCC from a large series of patients with OP-SCC who underwent a cervical lymph-node dissection (LND) as part of their treatment. METHODS The study concentrated on OP-SCC patients treated by various neck node dissection (LND) procedures from January 2014 to December 2018 in 3 French institutions. Patients with prior head and neck cancer, prior neck surgery, the use of induction chemotherapy, or patients with carcinoma of unknown primary were excluded. HPV-status was assessed by p16 immunohistochemistry. For each patient, the clinical and the pathological nodal status, as well as the distribution of the positive nodes in each neck level (from Ia to V) were reported. RESULTS Two-hundred and sixty-three patients were included (126 p16-negative (p16-), and 137 p16-positive (p16+). The rate of clinical positive node (cN+) reached 54% and 88.3% in the p16- and p16+ groups, respectively (p < 0.001); the corresponding rate of pathological positive node (pN+) reached 61.9% and 91.2%, respectively (p < 0.001). Regarding the clinical lymph node distribution, in p16+ patients, more positive nodes were observed in the ipsilateral level IV (p = 0.003), and less positive nodes were observed in the contralateral levels III and IV (p = 0.003 and p = 0.045, respectively). Regarding the pathologic lymph node distribution in the ipsilateral neck, in the cN0 patients, no significant difference was observed between p16- and p16+ patients (p = 0.33 to 1); in the cN+ patients, the nodes were distributed in levels Ib, II, III, IV and V without differences between the p16- and the p16+ patients. In the contralateral neck of p16- patients, nodes metastases were mainly observed in levels II, III and IV, whereas for the p16+ patients, positive nodes were only observed in level II (p = 0.03). CONCLUSION This study demonstrated the higher prevalence of cN+ and pN+ in p16+ OP-SCC patients, but without meaningful difference in the distribution of the lymph node drainage between p16- and p16+ OP-SCC. It indicates that no difference should be made between p16- and p16+ patients regarding the extend of neck treatment.
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Affiliation(s)
| | - Aline Baltres
- Pathology Department, Centre Léon Bérard, Lyon, France
| | | | | | - Guillaume Buiret
- Surgical Department, Centre Hospitalier de Valence, Valence, France
| | - Bertrand Fleury
- Radiation Oncology Department, Centre Marie Curie, Valence, France
| | - Nazim Benzerdjeb
- Pathology Department, Centre Hopsitalier Lyon Sud, Pierre-Bénite, France
| | - Vincent Grégoire
- Radiation Oncology Department, Centre Léon Bérard, Lyon, France.
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24
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HDAC1 regulates the chemosensitivity of laryngeal carcinoma cells via modulation of interleukin-8 expression. Eur J Pharmacol 2021; 896:173923. [PMID: 33539818 DOI: 10.1016/j.ejphar.2021.173923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 01/28/2023]
Abstract
Chemotherapies such as 5-fluorouracil (5-FU) and cisplatin (CDDP) have been widely used to treat laryngeal squamous cell carcinoma (LSCC), the second most common head and neck squamous cell carcinoma. However, chemoresistance seriously impairs chemotherapeutic efficacy. Our present study reveals that 5-FU and CDDP treatment increase the expression of histone deacetylase 1 (HDAC1) in LSCC cells. Consistently, increased levels of HDAC1 are observed in chemoresistant cells. Knockdown of HDAC1 significantly restores the sensitivity of LSCC cells, as HDAC1 increases the expression of interleukin-8 (IL-8), which is essential for LSCC chemoresistance. Mechanistically, HDAC1 directly initiates the transcription of IL-8 though binding to its promoter. Simultaneously, si-HDAC1 increases the levels of miR-93, which binds to the 3'UTR of IL-8 mRNA to trigger its degradation. In summary, the HDAC1/IL-8 axis can confer chemotherapeutic resistance to LSCC cells.
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25
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Sher DJ, Pham NL, Shah JL, Sen N, Williams KA, Subramaniam RM, Moore W, Chorley R, Ahn C, Khan SM. Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer. Int J Radiat Oncol Biol Phys 2020; 109:932-940. [PMID: 33127491 DOI: 10.1016/j.ijrobp.2020.09.063] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The required elective nodal dose and volumes for head and neck intensity modulated radiation therapy have largely been extrapolated from conventional radiation therapy fields. In this prospective, dual-center, phase 2 study, we investigated the efficacy and tolerability of reduced elective nodal volume and dose in oropharyngeal and laryngeal squamous cell carcinoma. METHODS AND MATERIALS Patients with newly diagnosed squamous cell carcinoma of the oropharynx and larynx were eligible for enrollment. Each lymph node was characterized as involved or suspicious based on imaging criteria. For oropharynx cancer, only involved and immediately adjacent stations were treated to 40 Gy in 20 fractions. In larynx patients, at least bilateral levels II and III were treated to 40 Gy, with level IV treated only if level III was involved. Involved and suspicious nodes were then boosted with 30 Gy and 24 Gy in 15 fractions, respectively. Concurrent chemotherapy was required for stage T3N0-1 and IVA/B patients. The primary endpoint of the study was solitary elective volume recurrence, with secondary endpoints including patterns of failure and patient-reported outcomes. RESULTS A total of 72 (51 oropharynx, 21 larynx) patients completed treatment on this trial from January 2017 through November 2018. The stages at presentations were 5, 17, and 50 stage I-II, III, and IV, respectively, with 90% treated with chemoradiation therapy. At a median follow-up of 24.7 months for surviving patients, there have been no solitary elective nodal recurrences. Seven patients developed a nodal recurrence, 5 of which were in-field and 2 were elective with synchronous in-field recurrence. Patient-reported outcomes assessment at 1 year showed superior or equivalent outcomes compared with baseline, except for saliva and taste measures. CONCLUSIONS The results of this trial suggest that elective dose and volume reduction is oncologically sound for oropharyngeal and laryngeal cancer treated with intensity modulated radiation therapy, with promising quality-of-life outcomes.
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Affiliation(s)
- David J Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas.
| | - Nhat-Long Pham
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Jennifer L Shah
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Neilayan Sen
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Kimberly A Williams
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | | | - William Moore
- Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Regina Chorley
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Chul Ahn
- Department Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas
| | - Saad M Khan
- Department of Medical Oncology, UT Southwestern Medical Center, Dallas, Texas
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26
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Deschuymer S, Nevens D, Duprez F, Daisne JF, Voordeckers M, De Neve W, Nuyts S. Randomized Clinical Trial on Reduction of Radiotherapy Dose to the Elective Neck in Head and Neck Squamous Cell Carcinoma: Results on the Quality of Life. Qual Life Res 2020; 30:117-127. [PMID: 32920767 DOI: 10.1007/s11136-020-02628-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 01/06/2023]
Abstract
PURPOSE A randomized trial was initiated to investigate whether a reduction of the dose to the elective nodal sites would result in less toxicity and improvement in Quality of Life (QoL) without compromising tumor control. This paper aimed to compare QoL in both treatment arms. METHODS Two-hundred head and neck cancer patients treated with radiotherapy (RT) or chemo-RT were randomized (all stages, mean age: 60 years, M/F: 82%/18%). The elective nodal volumes of patients randomized in the experimental arm were treated up to a 40 Gy equivalent dose. In the standard arm, the elective nodal volumes were treated up to a 50 Gy equivalent dose. The QoL data were collected using The European Organization for Research and Treatment of Cancer (EORTC) core questionnaire QLQ-C30 and the EORTC Head and Neck Cancer module (H&N35). RESULTS A trend toward less decline in QoL during treatment was observed in the 40 Gy arm compared to the 50 Gy arm. Statistically significant differences for global health status, physical functioning, emotional functioning, speech problems, and trouble with social eating in favor of the 40 Gy arm were observed. A clinically relevant better outcome in the 40 Gy arm was found for physical functioning at the end of therapy. CONCLUSION QoL during RT for head and neck cancer tends to be less impaired in the 40 Gy arm. However, reducing the dose only on the elective neck does not result in clinically relevant improvement of QoL. Therefore, additional treatment strategies must be examined to further improve the QoL of HNSCC patients.
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Affiliation(s)
- S Deschuymer
- Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - D Nevens
- Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Radiation Oncology, Iridium Kanker Netwerk, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - F Duprez
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - J F Daisne
- Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Radiation Oncology, Université Catholique de Louvain, CHU-UCL-Namur, Site Ste-Elisabeth, Namur, Belgium
| | - M Voordeckers
- Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel, Brussel, Belgium
| | - W De Neve
- Department of Radiotherapy-Oncology, Ghent University Hospital, Ghent, Belgium
| | - S Nuyts
- Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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