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Doi H, Ri A, Inada M, Tatsuno S, Uehara T, Matsuura T, Ishikawa K, Nakamatsu K, Hosono M, Nishimura Y. Clinical course of longer than five years after definitive radiotherapy for nasopharyngeal carcinoma. Int J Clin Oncol 2023; 28:1607-1615. [PMID: 37798414 DOI: 10.1007/s10147-023-02418-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND This study aimed to reveal the long-term outcomes and late toxicities (> 5 years) after definitive intensity-modulated radiation therapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). METHODS Data from 43 patients (median age, 55 years; range, 17-72 years) with NPC who underwent definitive IMRT between 2001 and 2018 were analyzed. All patients were alive and disease-free 5 years after IMRT. A total dose of 70 (range, 66-70) Gy was delivered in 35 (33-35) fractions with concurrent cisplatin chemotherapy. RESULTS The median follow-up duration was 119 (range, 61.5-242.1) months. Three patients developed locoregional failure at 79, 92, and 149 months after IMRT, respectively. Of these, 2 patients died of disease progression at 136 and 153 months after IMRT. One patient died of aspiration pneumonia 141 months after IMRT, despite salvage of the recurrent tumor by re-irradiation. In addition, one patient died of aspiration pneumonia 62 months after the IMRT. Thus, the 10-year overall survival, progression-free survival, and locoregional control rates were 98%, 92%, and 94%, respectively. Grade ≥ 2 and ≥ 3 late toxicities were observed in 28 (65%) and 9 (21%) patients, respectively. Nine second primary cancers, including five tongue cancers and two external auditory canal carcinomas, were observed in seven (16%) patients. CONCLUSION Late recurrences, severe late toxicities, and second primary cancers were observed > 5 years after IMRT. A long-term follow-up of > 5 years is needed in patients with NPC.
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Affiliation(s)
- Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan.
| | - Aritoshi Ri
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Masahiro Inada
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Saori Tatsuno
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Takuya Uehara
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Tomohiro Matsuura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Kazuki Ishikawa
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, Japan
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Wang R, Zhang J, He M, Chen H, Xu J. Procalcitonin as a biomarker of nosocomial pneumonia in aneurysmal subarachnoid hemorrhage patients treated in neuro-ICU. Clin Neurol Neurosurg 2023; 231:107870. [PMID: 37421741 DOI: 10.1016/j.clineuro.2023.107870] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/19/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Nosocomial pneumonia commonly develops in aneurysmal subarachnoid hemorrhage (aSAH) patients and is associated with poor prognosis of these patients. This study is designed to verify the predictive value of procalcitonin (PCT) on nosocomial pneumonia in aSAH patients. METHODS 298 aSAH patients received treatments in the neuro-intensive care unit (NICU) of West China hospital were included. Logistic regression was conducted to verify the association between PCT level and nosocomial pneumonia and to construct a model for predicting pneumonia. Area under the receiver operating characteristic curve (AUC) were calculated to evaluate the accuracy of the single PCT and the constructed model. RESULTS 90 (30.2%) patients developed pneumonia during hospitalizations among included aSAH patients. Pneumonia group had higher procalcitonin level (p < 0.001) than non-pneumonia group. The mortality (p < 0.001), mRS (p < 0.001), length of ICU stay (p < 0.001), length of hospital stay (p < 0.001) were both higher or longer in pneumonia group. Multivariate logistic regression indicated WFNS (p = 0.001), acute hydrocephalus (p = 0.007), WBC (p = 0.021), PCT (p = 0.046) and C-reactive protein (CRP) (p = 0.031) were independently associated with the development of pneumonia in included patients. The AUC value of procalcitonin for predicting nosocomial pneumonia was 0.764. Composed of WFNS, acute hydrocephalus, WBC, PCT and CRP, the predictive model for pneumonia has higher AUC of 0.811. CONCLUSIONS PCT is an available and effective predictive marker of nosocomial pneumonia in aSAH patients. Composed of WFNS, acute hydrocephalus, WBC, PCT and CRP, our constructed predictive model is helpful for clinicians to evaluate the risk of nosocomial pneumonia and guide therapeutics in aSAH patients.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hongxu Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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Cheng PC, Kao YC, Lo WC, Cheng PW, Wu CY, Hsieh CH, Shueng PW, Wang CT, Liao LJ. Speech and Swallowing Rehabilitation Potentially Decreases Body Weight Loss and Improves Survival in Head and Neck Cancer Survivors. Dysphagia 2023; 38:641-649. [PMID: 35819528 DOI: 10.1007/s00455-022-10493-7] [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: 02/12/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
This retrospective observational cohort study aims to assess the outcomes and associated factors in head and neck cancer (HNC) survivors with dysphagia, and to investigate the relationship between outcomes and speech and swallowing rehabilitation (SSR). We enrolled patients who were diagnosed with HNC between October 2016 and July 2018; we included 393 patients who developed dysphagia after definite treatment and were referred to speech-language pathologists (SLPs). We then classified patients into groups according to whether they received SSR. We used the clinical variables-including age, sex, site of malignancy, cancer stage, treatment modality, SSR, initial ECOG score, initial KPS, initial body weight (BW), and initial BMI-to evaluate the association between the percentage of BW change and overall survival (OS). There were 152 (39%) and 241 (61%) patients who received and did not receive SSR, respectively. In multivariate linear regression, SSR was significantly associated with percentage change in BW at 3 months post-treatment. Having SSR was positively associated with the percentage change in BW and decreased the BW loss [β coefficient (95% CIs) = 2.53 (0.92 to 4.14)] compared to having no SSR. In the multivariate Cox regression, SSR was an independent factor for OS. Compared to no SSR, the hazard ratio (95% CIs) for patients who received SSR was 0.48 (0.31 to 0.74). SSR helps to avoid BW loss and increases overall survival. HNC patients who develop dysphagia after treatment should be encouraged to participate in SSR.
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Affiliation(s)
- Ping-Chia Cheng
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Communication Engineering, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Yih-Chia Kao
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
| | - Wu-Chia Lo
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medicine, Yuan Ze University, Taoyuan, Taiwan
| | - Po-Wen Cheng
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
| | - Chia-Yun Wu
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Oncology and Hematology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chen-Hsi Hsieh
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Pei-Wei Shueng
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chi-Te Wang
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan
| | - Li-Jen Liao
- Department of Otolaryngology, Head and Neck Surgery, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banqiao Dist., New Taipei City, 220, Taiwan.
- Head and Neck Cancer Surveillance and Research Study Group, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan.
- Medical Engineering Office, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Ebersole BM, McMillan H, Hutcheson K. Evaluation and Management of Speech and Swallowing Issues in RFS. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023. [DOI: 10.1007/s40141-023-00388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
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Nielsen MH, Madsen LB, Bendstrup E. Exogenous lipoid pneumonia due to silent aspiration following surgery and radiotherapy for cancer of the tongue. Respir Med Case Rep 2022; 40:101767. [DOI: 10.1016/j.rmcr.2022.101767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
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Patil V, Noronha V, Shrirangwar S, Menon N, Abraham G, Chandrasekharan A, Prabhash K. Aspiration pneumonia in head and neck cancer patients undergoing concurrent chemoradiation from India: Findings from a post hoc analysis of a phase 3 study. Cancer Med 2021; 10:6725-6735. [PMID: 34498421 PMCID: PMC8495270 DOI: 10.1002/cam4.4210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/07/2021] [Accepted: 06/16/2021] [Indexed: 12/16/2022] Open
Abstract
Background There are limited data from low‐ to middle‐income countries (LMIC) on the incidence, risk factors, treatment outcomes, and antibiotic susceptibility spectrum of aspiration pneumonia (AsP). Methods We conducted a post hoc analysis of a randomized control trial in which adult patients with locally advanced head and neck cancers had received 66–70 Gy of radiation combined with cisplatin 30 mg/m2 weekly for 6–7 weeks or cisplatin at the same dose with nimotuzumab 200 mg once weekly till the completion of radiation. The following data were extracted and analyzed—the incidence of AsP, time to the onset of AsP, risk factors, treatment outcomes of AsP, and its impact on progression‐free survival (PFS), locoregional control (LRC) rates, and overall survival (OS). Results Out of 536 patients enrolled in the study, 151 (28.3%, 95% confidence interval [CI] 24.5–2.1) patients developed AsP. The median time to develop AsP was 39 days (95% CI 34–44). Only baseline dysphagia (odds ratio = 3.76, 95% CI 1.05–13.51, p = 0.042) was associated with a significant risk of development of AsP. Among the patients in which pathogenic organism was isolated (69 patients), gram‐negative species was isolated in 63 patients (89%). Cisplatin at 200 mg/m2 or more was delivered in 312 (81%) patients in the non‐AsP cohort versus 107 (70.9%) patients in AsP cohort (p = 0.014). There was no statistical difference in LRC (hazard ratio [HR] = 1.057; 95% CI 0.771–1.448), PFS (HR = 1.176; 95% CI 0.89–1.553), and OS (HR = 1.233; 95% CI 0.939–1.618) between the two cohorts. Conclusion Aspiration pneumonia is a common complication in head and neck malignancies and patients with baseline dysphagia are at high risk. Gram‐negative bacteria are the predominant causative agents. The use of broad‐spectrum antibiotics results in resolution of symptoms.
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Affiliation(s)
- Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sameer Shrirangwar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - George Abraham
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
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