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King SN, Kuntz A, Scott N, Smiley B, Portocarrero Bonifaz A, Blackburn M. Chemoradiation to the submental muscles alters hyoid movement during swallowing in a rat model. J Appl Physiol (1985) 2024; 136:1076-1086. [PMID: 38482576 DOI: 10.1152/japplphysiol.00538.2023] [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: 08/02/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 04/30/2024] Open
Abstract
Hyolaryngeal dysfunction is a commonly reported swallowing problem after chemoradiation treatment for head and neck cancer. The displacement of the hyolaryngeal complex during swallowing protects the airway and assists in opening the upper esophageal sphincter. Activation of the submental muscles, specifically the mylohyoid and geniohyoid muscles, is thought to facilitate movement of the hyoid. The purpose of this study was to determine if targeted radiation to the submental muscles given concurrently with chemotherapy alters hyolaryngeal displacement 1 mo after treatment. We hypothesized that chemoradiation treatment would result in abnormal patterns of hyoid movement compared with controls. Furthermore, we propose that these changes are associated with alterations in bolus size and discoordination of the jaw during drinking. Eighteen rats underwent either chemoradiation, radiation, or no treatment. Radiation treatment was targeted to submental muscles using a clinical linear accelerator given in 12 fractions of 4 Gy (3 days per week). Cycles of 1 mg/kg of cisplatin were administered concurrently each week of radiation. One month posttreatment, videofluoroscopy swallow studies (VFSS) were performed in self-drinking rats using a fluoroscope customized with a high-speed camera. The hyoid, jaw, and hard palate were tracked during swallowing from VFSS. Hyoid kinematics were analyzed from the start to the end of hyoid movement, and parameters were compared with bolus size and jaw movement. Significant differences in hyoid retraction parameters were found postchemoradiation. Alterations in the trajectory of hyoid motion during swallowing were observed. The findings demonstrate early changes in hyoid motion during swallowing associated with chemoradiation treatment.NEW & NOTEWORTHY Chemoradiation treatment for head and neck cancer can cause functional impairments in swallowing, which can adversely affect quality of life. This study provides new evidence that chemoradiation targeted to the submental muscles provokes early adaptations in hyoid movement during swallowing, which correlate with changes in bolus size. We also demonstrate a method for tracking the hyoid during swallowing in a rat model of chemoradiation injury.
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Affiliation(s)
- Suzanne N King
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Abigail Kuntz
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Nathan Scott
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Brittany Smiley
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Andres Portocarrero Bonifaz
- Department of Radiation Oncology, School of Medicine, University of Louisville, Louisville, Kentucky, United States
| | - Megan Blackburn
- Department of Radiation Oncology, School of Medicine, University of Louisville, Louisville, Kentucky, United States
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Kutuk T, Atak E, Villa A, Kalman NS, Kaiser A. Interdisciplinary Collaboration in Head and Neck Cancer Care: Optimizing Oral Health Management for Patients Undergoing Radiation Therapy. Curr Oncol 2024; 31:2092-2108. [PMID: 38668058 PMCID: PMC11049200 DOI: 10.3390/curroncol31040155] [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: 01/12/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Radiation therapy (RT) plays a crucial role in the treatment of head and neck cancers (HNCs). This paper emphasizes the importance of effective communication and collaboration between radiation oncologists and dental specialists in the HNC care pathway. It also provides an overview of the role of RT in HNC treatment and illustrates the interdisciplinary collaboration between these teams to optimize patient care, expedite treatment, and prevent post-treatment oral complications. The methods utilized include a thorough analysis of existing research articles, case reports, and clinical guidelines, with terms such as 'dental management', 'oral oncology', 'head and neck cancer', and 'radiotherapy' included for this review. The findings underscore the significance of the early involvement of dental specialists in the treatment planning phase to assess and prepare patients for RT, including strategies such as prophylactic tooth extraction to mitigate potential oral complications. Furthermore, post-treatment oral health follow-up and management by dental specialists are crucial in minimizing the incidence and severity of RT-induced oral sequelae. In conclusion, these proactive measures help minimize dental and oral complications before, during, and after treatment.
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Affiliation(s)
- Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
| | - Ece Atak
- Department of Radiation Oncology, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey;
| | - Alessandro Villa
- Oral Medicine and Oral Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
| | - Noah S. Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
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Yamic F, Koca T, Tuncel N, Aksoy RA, Korcum AF. Comparison of Doses to Parotid, Temporomandibular Joint, and Pharyngeal Constrictor Muscles Using Different Techniques in Radiotherapy for Oropharyngeal Cancer. Technol Cancer Res Treat 2024; 23:15330338241260646. [PMID: 38841792 PMCID: PMC11155356 DOI: 10.1177/15330338241260646] [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: 02/01/2024] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE The purpose of this research was to compare two treatment techniques for oropharyngeal cancers: conventional linac-based static intensity-modulated radiotherapy (sIMRT) and helical tomotherapy (HT). The study examined several parameters, including target coverage, organs at risk, integral dose, and beam on time. Additionally, the study evaluated the doses to the parotid, temporomandibular joint, and pharyngeal constrictor muscles, which are important for swallowing. METHOD The present study retrospectively analyzed the data of 13 patients with oropharyngeal cancer who underwent radiotherapy between 2019 and 2021. The treatment plans for each patient were regenerated using both sIMRT and HT treatment planning systems with the sequential boost method. The techniques were evaluated and compared based on dose-volume histogram, homogeneity index, and conformity index parameters. The target coverage and organs at risk were statistically compared for two techniques. Additionally, the doses received by the healthy tissue volume were obtained for integral dose evaluation. The beam on time for each technique was assessed. RESULTS When considering planning target volume evaluation, there was no difference in Dmeans between the two techniques and sIMRT demonstrated higher D2% values compared to the HT. The HT technique had better results for all organs at risk, such as the parotid, temporomandibular joint, and pharyngeal constrictor muscle. As for integral dose, it has been shown that the sIMRT technique provides better protection compared to HT. In addition, the beam on time was also longer with the HT technique. CONCLUSION Both techniques may provide optimal target coverage for patients with oropharyngeal cancer. HT conferred notable advantages, especially with regard to critical structures implicated in swallowing, such as the parotid, temporomandibular joint, and pharyngeal constrictor muscle, in comparison to sIMRT.
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Affiliation(s)
- Ferda Yamic
- Department of Radiation Oncology, Bakirkoy Dr Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Timur Koca
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Nina Tuncel
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Rahmi Atil Aksoy
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Aylin Fidan Korcum
- Department of Radiation Oncology, Akdeniz University School of Medicine, Antalya, Turkey
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van Rijn-Dekker MI, van Luijk P, Schuit E, van der Schaaf A, Langendijk JA, Steenbakkers RJHM. Prediction of Radiation-Induced Parotid Gland-Related Xerostomia in Patients With Head and Neck Cancer: Regeneration-Weighted Dose. Int J Radiat Oncol Biol Phys 2023; 117:750-762. [PMID: 37150262 DOI: 10.1016/j.ijrobp.2023.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/09/2023]
Abstract
PURPOSE Despite improvements to treatment, patients with head and neck cancer (HNC) still experience radiation-induced xerostomia due to salivary gland damage. The stem cells of the parotid gland (PG), concentrated in the gland's main ducts (stem cell rich [SCR] region), play a critical role in the PG's response to radiation. Treatment optimization requires a dose metric that properly accounts for the relative contributions of dose to this SCR region and the PG's remainder (non-SCR region) to the risk of xerostomia in normal tissue complication probability (NTCP) models for xerostomia. MATERIALS AND METHODS Treatment and toxicity data of 1013 prospectively followed patients with HNC treated with definitive radiation therapy (RT) were used. The regeneration-weighted dose, enabling accounting for the hypothesized different effects of dose to the SCR and non-SCR region on the risk of xerostomia, was defined as Dreg PG = Dmean SCR region + r × Dmean non-SCR region, where Dreg is the regeneration-weighted dose, Dmean is the mean dose, and r is the weighting factor. Considering the different volumes of these regions, r > 3.6 in Dreg PG demonstrates an enhanced effect of the SCR region. The most predictive value of r was estimated in 102 patients of a previously published trial testing stem cell sparing RT. For each endpoint, Dreg PG, dose to other organs, and clinical factors were used to develop NTCP models using multivariable logistic regression analysis in 663 patients. The models were validated in 350 patients. RESULTS Dose to the contralateral PG was associated with daytime, eating-related, and physician-rated grade ≥2 xerostomia. Consequently, r was estimated and found to be smaller than 3.6 for most PG function-related endpoints. Therefore, the contribution of Dmean SCR region to the risk of xerostomia was larger than predicted by Dmean PG. Other frequently selected predictors were pretreatment xerostomia and Dmean oral cavity. The validation showed good discrimination and calibration. CONCLUSIONS Tools for clinical implementation of stem cell sparing RT were developed: regeneration-weighted dose to the parotid gland that accounted for regional differences in radiosensitivity within the gland and NTCP models that included this new dose metric and other prognostic factors.
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Affiliation(s)
- Maria I van Rijn-Dekker
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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Ureba A, Toma-Dasu I, Lazzeroni M. Biologically guided automated treatment planning and evaluation: potential for treatment adaptation in head and neck cancer. Acta Oncol 2023; 62:1389-1393. [PMID: 37643087 DOI: 10.1080/0284186x.2023.2249221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Ana Ureba
- Department of Physics, Medical Radiation Physics, Stockholms Universitet, Stockholm, Sweden
- Department of Oncology-Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
| | - Iuliana Toma-Dasu
- Department of Physics, Medical Radiation Physics, Stockholms Universitet, Stockholm, Sweden
- Department of Oncology-Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
| | - Marta Lazzeroni
- Department of Physics, Medical Radiation Physics, Stockholms Universitet, Stockholm, Sweden
- Department of Oncology-Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
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Tomatis S, Mancosu P, Reggiori G, Lobefalo F, Gallo P, Lambri N, Paganini L, La Fauci F, Bresolin A, Parabicoli S, Pelizzoli M, Navarria P, Franzese C, Lenoci D, Scorsetti M. Twenty Years of Advancements in a Radiotherapy Facility: Clinical Protocols, Technology, and Management. Curr Oncol 2023; 30:7031-7042. [PMID: 37504370 PMCID: PMC10378035 DOI: 10.3390/curroncol30070510] [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: 05/22/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Hypo-fractionation can be an effective strategy to lower costs and save time, increasing patient access to advanced radiation therapy. To demonstrate this potential in practice within the context of temporal evolution, a twenty-year analysis of a representative radiation therapy facility from 2003 to 2022 was conducted. This analysis utilized comprehensive data to quantitatively evaluate the connections between advanced clinical protocols and technological improvements. The findings provide valuable insights to the management team, helping them ensure the delivery of high-quality treatments in a sustainable manner. METHODS Several parameters related to treatment technique, patient positioning, dose prescription, fractionation, equipment technology content, machine workload and throughput, therapy times and patients access counts were extracted from departmental database and analyzed on a yearly basis by means of linear regression. RESULTS Patients increased by 121 ± 6 new per year (NPY). Since 2010, the incidence of hypo-fractionation protocols grew thanks to increasing Linac technology. In seven years, both the average number of fractions and daily machine workload decreased by -0.84 ± 0.12 fractions/year and -1.61 ± 0.35 patients/year, respectively. The implementation of advanced dose delivery techniques, image guidance and high dose rate beams for high fraction doses, currently systematically used, has increased the complexity and reduced daily treatment throughput since 2010 from 40 to 32 patients per 8 h work shift (WS8). Thanks to hypo-fractionation, such an efficiency drop did not affect NPY, estimating 693 ± 28 NPY/WS8, regardless of the evaluation time. Each newly installed machine was shown to add 540 NPY, while absorbing 0.78 ± 0.04 WS8. The COVID-19 pandemic brought an overall reduction of 3.7% of patients and a reduction of 0.8 fractions/patient, to mitigate patient crowding in the department. CONCLUSIONS The evolution of therapy protocols towards hypo-fractionation was supported by the use of proper technology. The characteristics of this process were quantified considering time progression and organizational aspects. This strategy optimized resources while enabling broader access to advanced radiation therapy. To truly value the benefit of hypo-fractionation, a reimbursement policy should focus on the patient rather than individual treatment fractionation.
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Affiliation(s)
- Stefano Tomatis
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Pietro Mancosu
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Giacomo Reggiori
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Francesca Lobefalo
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Pasqualina Gallo
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Nicola Lambri
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Lucia Paganini
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Francesco La Fauci
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Andrea Bresolin
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Sara Parabicoli
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Marco Pelizzoli
- Medical Physics Service, Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Pierina Navarria
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Domenico Lenoci
- Development Strategic Initiatives Unit, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
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7
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King SN, Kaissieh N, Haxton C, Shojaei M, Malott L, Devara L, Thompson R, Osman KL, Millward J, Blackburn M, Lever TE. Radiation induced changes in profibrotic markers in the submental muscles and their correlation with tongue movement. PLoS One 2023; 18:e0287044. [PMID: 37352202 PMCID: PMC10289304 DOI: 10.1371/journal.pone.0287044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/29/2023] [Indexed: 06/25/2023] Open
Abstract
Swallowing impairment is a major complication of radiation treatment for oropharyngeal cancers. Developing targeted therapies that improve swallowing outcomes relies on an understanding of the mechanisms that influence motor function after radiation treatment. The purpose of this study was to determine whether there is a correlation between radiation induced changes in tongue movement and structural changes in irradiated submental muscles, as well as assess other possible causes for dysfunction. We hypothesized that a clinically relevant total radiation dose to the submental muscles would result in: a) quantifiable changes in tongue strength and displacement during drinking two months post treatment; and b) a profibrotic response and/or fiber type transition in the irradiated tissue. Sprague-Dawley adult male rats received radiation to the submental muscles at total dose-volumes known to provoke dysphagia in humans. A clinical linear accelerator administered 8 fractions of 8Gy for a total of 64Gy. Comparisons were made to sham-treated rats that received anesthesia only. Swallowing function was assessed using videofluoroscopy and tongue strength was analyzed via force lickometer. TGFβ1 expression was analyzed via ELISA. The amount of total collagen was analyzed by picrosirius red staining. Immunofluorescence was used to assess fiber type composition and size. Significant changes in licking function during drinking were observed at two months post treatment, including a slower lick rate and reduced tongue protrusion during licking. In the mylohyoid muscle, significant increases in TGFβ1 protein expression were found post radiation. Significant increases in the percentage of collagen content were observed in the irradiated geniohyoid muscle. No changes in fiber type expression were observed. Results indicate a profibrotic transition within the irradiated swallowing muscles that contributes to tongue dysfunction post-radiation treatment.
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Affiliation(s)
- Suzanne N. King
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Nada Kaissieh
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Chandler Haxton
- Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Marjan Shojaei
- Department of Radiation Oncology, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Luke Malott
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Lekha Devara
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Rebecca Thompson
- Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Kate L. Osman
- Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
| | - Jessica Millward
- Department of Otolaryngology–Head and Neck Surgery and Communicative Disorders, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Megan Blackburn
- Department of Radiation Oncology, School of Medicine, University of Louisville, Louisville, KY, United States of America
| | - Teresa E. Lever
- Department of Otolaryngology—Head and Neck Surgery, University of Missouri School of Medicine, Columbia, MO, United States of America
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Lucido JJ, DeWees TA, Leavitt TR, Anand A, Beltran CJ, Brooke MD, Buroker JR, Foote RL, Foss OR, Gleason AM, Hodge TL, Hughes CO, Hunzeker AE, Laack NN, Lenz TK, Livne M, Morigami M, Moseley DJ, Undahl LM, Patel Y, Tryggestad EJ, Walker MZ, Zverovitch A, Patel SH. Validation of clinical acceptability of deep-learning-based automated segmentation of organs-at-risk for head-and-neck radiotherapy treatment planning. Front Oncol 2023; 13:1137803. [PMID: 37091160 PMCID: PMC10115982 DOI: 10.3389/fonc.2023.1137803] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/24/2023] [Indexed: 04/09/2023] Open
Abstract
IntroductionOrgan-at-risk segmentation for head and neck cancer radiation therapy is a complex and time-consuming process (requiring up to 42 individual structure, and may delay start of treatment or even limit access to function-preserving care. Feasibility of using a deep learning (DL) based autosegmentation model to reduce contouring time without compromising contour accuracy is assessed through a blinded randomized trial of radiation oncologists (ROs) using retrospective, de-identified patient data.MethodsTwo head and neck expert ROs used dedicated time to create gold standard (GS) contours on computed tomography (CT) images. 445 CTs were used to train a custom 3D U-Net DL model covering 42 organs-at-risk, with an additional 20 CTs were held out for the randomized trial. For each held-out patient dataset, one of the eight participant ROs was randomly allocated to review and revise the contours produced by the DL model, while another reviewed contours produced by a medical dosimetry assistant (MDA), both blinded to their origin. Time required for MDAs and ROs to contour was recorded, and the unrevised DL contours, as well as the RO-revised contours by the MDAs and DL model were compared to the GS for that patient.ResultsMean time for initial MDA contouring was 2.3 hours (range 1.6-3.8 hours) and RO-revision took 1.1 hours (range, 0.4-4.4 hours), compared to 0.7 hours (range 0.1-2.0 hours) for the RO-revisions to DL contours. Total time reduced by 76% (95%-Confidence Interval: 65%-88%) and RO-revision time reduced by 35% (95%-CI,-39%-91%). All geometric and dosimetric metrics computed, agreement with GS was equivalent or significantly greater (p<0.05) for RO-revised DL contours compared to the RO-revised MDA contours, including volumetric Dice similarity coefficient (VDSC), surface DSC, added path length, and the 95%-Hausdorff distance. 32 OARs (76%) had mean VDSC greater than 0.8 for the RO-revised DL contours, compared to 20 (48%) for RO-revised MDA contours, and 34 (81%) for the unrevised DL OARs.ConclusionDL autosegmentation demonstrated significant time-savings for organ-at-risk contouring while improving agreement with the institutional GS, indicating comparable accuracy of DL model. Integration into the clinical practice with a prospective evaluation is currently underway.
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Affiliation(s)
- J. John Lucido
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: J. John Lucido,
| | - Todd A. DeWees
- Department of Health Sciences Research, Mayo Clinic, Phoenix, AZ, United States
| | - Todd R. Leavitt
- Department of Health Sciences Research, Mayo Clinic, Phoenix, AZ, United States
| | - Aman Anand
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Chris J. Beltran
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | | | - Justine R. Buroker
- Research Services, Comprehensive Cancer Center, Mayo Clinic, Rochester, MN, United States
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Olivia R. Foss
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Angela M. Gleason
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Teresa L. Hodge
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | - Ashley E. Hunzeker
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Nadia N. Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Tamra K. Lenz
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Douglas J. Moseley
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Lisa M. Undahl
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Yojan Patel
- Google Health, Mountain View, CA, United States
| | - Erik J. Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | | | | | - Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
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9
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Siddiq S, Stephen S, Lin D, Fox H, Robinson M, Paleri V. Robotic lateral oropharyngectomy following diagnostic tonsillectomy is oncologically safe in patients with human papillomavirus-related squamous cell cancer: Long-term results. Head Neck 2022; 44:2753-2759. [PMID: 36056651 DOI: 10.1002/hed.27186] [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: 04/08/2022] [Revised: 06/19/2022] [Accepted: 08/23/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To report the long-term oncological and functional outcomes of en bloc TORS lateral oropharyngectomy to address the close/involved margin following diagnostic tonsillectomy in HPV-related SCC of unknown primary. MATERIAL AND METHODS A single tertiary center observational cohort over a 4-year period. Primary outcome measures were disease-specific survival (DSS), overall survival (OS), and PSS NOD (Performance Status Scale-Normalcy of Diet) scores. RESULTS TORS specimens did not evidence residual carcinoma in 93% of patients. Of 14 patients, 50% received surgery alone (median follow-up 57 months; range 46-96), the remainder surgery and adjuvant therapy (median follow-up of 58 months; range 51-69) with 100% DSS, OS and no deterioration of PSS NOD scores. CONCLUSIONS Long-term oncological outcomes confirm TORS lateral oropharyngectomy alone is an oncologically safe treatment. Due consideration of this approach is warranted to mitigate against the morbidity of adjuvant radiotherapy treatment in this group of patients.
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Affiliation(s)
- Somiah Siddiq
- Head and Neck Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sarah Stephen
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Daniel Lin
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Hannah Fox
- Otolaryngology - Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle upon Tyne, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
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10
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Bayatiani M, Seif F, Molavi S, Ansari Z, Parastesh M. The effect of resistance training on serum levels of sex hormones and sperm quality in male rats under X-ray radiation. Horm Mol Biol Clin Investig 2022; 43:441-447. [PMID: 35521895 DOI: 10.1515/hmbci-2021-0086] [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: 10/13/2021] [Accepted: 03/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The present study aims to investigate the effects of resistance training on sex hormones and sperm parameters in male rats under X-ray. METHODS In this experimental study, 24 Sprague Dawley rats (200-250 g) were randomly assigned into four groups: healthy control, irradiated control, healthy training and irradiated training. Irradiation was induced at a dose of 4 Gy on the whole body. The resistance training protocol was performed for 10 weeks. Finally, blood serum was used to assess FSH, LH and testosterone and sperm quality. Data were analyzed using ANOVA and Tukey's post hoc test. RESULTS The results showed that radiation significantly reduced serum levels of LH (p=0.42), FSH (p=0.001) and testosterone (p=0.28) between radiation control and healthy control groups. Also, no significant difference was observed between serum levels of LH (p=0.135) and testosterone (p=0.419) in radiation resistance training and the healthy control groups. In addition, significant differences were observed between radiation resistance training and radiation control groups in sperm parameters such as sperm count (p=0.02) and progressively motile sperm (p=0.031). CONCLUSIONS It seems that short-term resistance training can improve sperm parameters, including sperm count and sperm motility through increasing serum levels testosterone and LH in male rat under X-ray.
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Affiliation(s)
- Mohammadreza Bayatiani
- Department of Radiotherapy and Medical Physics, Faculty of Para Medicine, Arak University of Medical Sciences and Khansari Hospital, Arak, Iran
| | - Fatemeh Seif
- Department of Radiotherapy and Medical Physics, Faculty of Para Medicine, Arak University of Medical Sciences and Khansari Hospital, Arak, Iran
| | - Shiva Molavi
- Department of Sports Physiology and Pathology, Faculty of Sport Sciences, Arak University, Arak, Iran
| | - Zahra Ansari
- Department of Sports Physiology and Pathology, Faculty of Sport Sciences, Arak University, Arak, Iran
| | - Mohammad Parastesh
- Department of Sports Physiology, Faculty of Sport Sciences and Research Institute of Applied Studies of Sports Sciences, Arak University, Arak, Iran
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11
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Development and Clinical Implementation of an Automated Virtual Integrative Planner for Radiation Therapy of Head and Neck Cancer. Adv Radiat Oncol 2022; 8:101029. [PMID: 36578278 PMCID: PMC9791598 DOI: 10.1016/j.adro.2022.101029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/10/2022] [Indexed: 12/31/2022] Open
Abstract
Purpose Head and neck (HN) radiation (RT) treatment planning is complex and resource intensive. Deviations and inconsistent plan quality significantly affect clinical outcomes. We sought to develop a novel automated virtual integrative (AVI) knowledge-based planning application to reduce planning time, increase consistency, and improve baseline quality. Methods and Materials An in-house write-enabled script was developed from a library of 668 previously treated HN RT plans. Prospective hazard analysis was performed, and mitigation strategies were implemented before clinical release. The AVI-planner software was retrospectively validated in a cohort of 52 recent HN cases. A physician panel evaluated planning limitations during initial deployment, and feedback was enacted via software refinements. A final second set of plans was generated and evaluated. Kolmogorov-Smirnov test in addition to generalized evaluation metric and weighted experience score were used to compare normal tissue sparing between final AVI planner versus respective clinically treated and historically accepted plans. A t test was used to compare the interactive time, complexity, and monitor units for AVI planner versus manual optimization. Results Initially, 86% of plans were acceptable to treat, with 10% minor and 4% major revisions or rejection recommended. Variability was noted in plan quality among HN subsites, with high initial quality for oropharynx and oral cavity plans. Plans needing revisions were comprised of sinonasal, nasopharynx, P-16 negative squamous cell carcinoma unknown primary, or cutaneous primary sites. Normal tissue sparing varied within subsites, but AVI planner significantly lowered mean larynx dose (median, 18.5 vs 19.7 Gy; P < .01) compared with clinical plans. AVI planner significantly reduced interactive optimization time (mean, 2 vs 85 minutes; P < .01). Conclusions AVI planner reliably generated clinically acceptable RT plans for oral cavity, salivary, oropharynx, larynx, and hypopharynx cancers. Physician-driven iterative learning processes resulted in favorable evolution in HN RT plan quality with significant time savings and improved consistency using AVI planner.
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12
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Arbab M, Chen YH, Tishler RB, Gunasti L, Glass J, Fugazzotto JA, Killoran JH, Sethi R, Rettig E, Annino D, Goguen L, Uppaluri R, Hsu C, Burke E, Hanna GJ, Lorch J, Haddad RI, Margalit DN, Schoenfeld JD. Association between radiation dose to organs at risk and acute patient reported outcome during radiation treatment for head and neck cancers. Head Neck 2022; 44:1442-1452. [PMID: 35355358 DOI: 10.1002/hed.27031] [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: 05/25/2021] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Associations between patient-reported outcomes and dose to organs at risk (OARs) may promote management and guide future investigations. METHODS We retrospectively evaluated PROs and OAR dose in head and neck (H&N) cancer. RESULTS In 169 patients, we identified weak associations between: "Difficulty swallowing/chewing" and increased mean RT dose to the oral cavity, larynx, pharyngeal constrictor muscles (PCM) and contralateral parotid; "choking/coughing" and larynx mean dose; "problems with mucus in mouth and throat" and oral cavity, contralateral parotid mean dose and parotid V30, contralateral submandibular gland and PCM mean dose; "difficulty with voice/speech" and oral cavity, contralateral parotid, contralateral submandibular gland and larynx mean dose; and "dry mouth" and ipsilateral submandibular gland, oral cavity and PCM mean dose. CONCLUSION We identified weak associations between PRO and dose to OARs-these data can guide on treatment management, patient counseling, and serve as a baseline for future investigations.
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Affiliation(s)
- Mona Arbab
- Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Radiation Oncology, Indiana University, Indianapolis, Indiana, USA
| | - Yu-Hui Chen
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Roy B Tishler
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lauren Gunasti
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason Glass
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jo Ann Fugazzotto
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Joseph H Killoran
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rosh Sethi
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eleni Rettig
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Donald Annino
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Laura Goguen
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ravindra Uppaluri
- Department of Otolaryngology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Carolyn Hsu
- Speech Language Pathology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Elaine Burke
- Speech Language Pathology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Glenn J Hanna
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jochen Lorch
- Department of Oncology, Northwestern University, Evanston, Illinois, USA
| | - Robert I Haddad
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Danielle N Margalit
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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13
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Nuyts S, Bollen H, Ng SP, Corry J, Eisbruch A, Mendenhall WM, Smee R, Strojan P, Ng WT, Ferlito A. Proton Therapy for Squamous Cell Carcinoma of the Head and Neck: Early Clinical Experience and Current Challenges. Cancers (Basel) 2022; 14:cancers14112587. [PMID: 35681568 PMCID: PMC9179360 DOI: 10.3390/cancers14112587] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Proton therapy is a promising type of radiation therapy used to destroy tumor cells. It has the potential to further improve the outcomes for patients with head and neck cancer since it allows to minimize the radiation dose to vital structures around the tumor, leading to less toxicity. This paper describes the current experience worldwide with proton therapy in head and neck cancer. Abstract Proton therapy (PT) is a promising development in radiation oncology, with the potential to further improve outcomes for patients with squamous cell carcinoma of the head and neck (HNSCC). By utilizing the finite range of protons, healthy tissue can be spared from beam exit doses that would otherwise be irradiated with photon-based treatments. Current evidence on PT for HNSCC is limited to comparative dosimetric analyses and retrospective single-institution series. As a consequence, the recognized indications for the reimbursement of PT remain scarce in most countries. Nevertheless, approximately 100 PT centers are in operation worldwide, and initial experiences for HNSCC are being reported. This review aims to summarize the results of the early clinical experience with PT for HNSCC and the challenges that are currently faced.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven, 3000 Leuven, Belgium;
- Department of Oncology, Leuven Cancer Institute, Universitair Ziekenhuis Leuven, 3000 Leuven, Belgium
- Correspondence:
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven, 3000 Leuven, Belgium;
- Department of Oncology, Leuven Cancer Institute, Universitair Ziekenhuis Leuven, 3000 Leuven, Belgium
| | - Sweet Ping Ng
- Department of Radiation Oncology, Austin Health, The University of Melbourne, Melbourne, VIC 3000, Australia;
| | - June Corry
- Division of Medicine, Department of Radiation Oncology, St. Vincent’s Hospital, The University of Melbourne, Melbourne, VIC 3000, Australia;
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA;
| | - William M Mendenhall
- Department of Radiation Oncology, College of Medicine, University of Florida, Gainesville, FL 32209, USA;
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW 2031, Australia;
| | - Primoz Strojan
- Department of Radiation Oncology, Institute of Oncology, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35125 Padua, Italy;
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14
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Kutuk T, McAllister NC, Rzepczynski AE, Williams A, Young G, Crawley MB, Rabinowits G, Kaiser A, Contreras JA, Kalman NS. Submandibular gland transfer for the prevention of radiation-induced xerostomia in oropharyngeal cancer: Dosimetric impact in the intensity modulated radiotherapy era. Head Neck 2022; 44:1213-1222. [PMID: 35243719 DOI: 10.1002/hed.27021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Submandibular gland (SMG) transfer decreased radiation-associated xerostomia in the 2/3-dimensional radiotherapy era. We evaluated the dosimetric implications of SMG transfer on modern intensity modulated radiotherapy (IMRT) plans. METHODS Eighteen oropharynx cancer patients underwent SMG transfer followed by IMRT; reoptimized plans using the baseline SMG location were generated. Mean salivary gland, oral cavity, and larynx doses were compared between clinical plans and reoptimized plans. RESULTS No statistically significant difference in mean SMG dose (27.53 Gy vs. 29.61 Gy) or total salivary gland dose (26.12 Gy vs. 26.41 Gy) was observed with or without SMG transfer (all p > 0.05). Mean oral cavity and larynx doses were not statistically different. Neither tumor site, target volume crossing midline, stage, nor salivary gland volumes were associated with mean doses. CONCLUSIONS Salivary gland doses were similar with or without SMG transfer. IMRT likely decreases the benefit of SMG transfer on the risk of radiation-associated xerostomia.
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Affiliation(s)
- Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Nicole C McAllister
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Amy E Rzepczynski
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Andre Williams
- Office of Clinical Research, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Geoffrey Young
- Department of Surgical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Meghan B Crawley
- Department of Surgical Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Guilherme Rabinowits
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA.,Department of Hematology/Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Jessika A Contreras
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Noah S Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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15
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Jeans EB, Shiraishi S, Manzar G, Morris LK, Amundson A, McGee LA, Rwigema JC, Neben-Wittich M, Routman DM, Ma DJ, Patel SH, Foote RL, Lester SC. An comparison of acute toxicities and patient-reported outcomes between intensity-modulated proton therapy and volumetric-modulated arc therapy after ipsilateral radiation for head and neck cancers. Head Neck 2021; 44:359-371. [PMID: 34859516 DOI: 10.1002/hed.26937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 10/27/2021] [Accepted: 11/05/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Intensity-modulated proton therapy (IMPT) demonstrates superior dose distribution over volumetric-modulated arc therapy (VMAT) for sparing organs-at-risk (OARs) in ipsilateral radiotherapy. To determine a clinical benefit, assessment of patient-reported outcomes (PRO) and physician-reported toxicities alongside a dosimetric analysis is needed. METHODS Plans were analyzed for dosimetric differences. PROs were compared for patients undergoing ipsilateral curative-intent radiotherapy for tonsil and salivary gland cancers with VMAT or IMPT from 2015 to 2020. Physician-reported toxicities were compared. RESULTS In 40 patients, IMPT was associated with decreased dose to multiple OARs and less deterioration in the following PROs: pain, swallowing function, dry mouth, sticky saliva, sensory change, cough, speech, feeling ill, and social eating. Physician-reported toxicities demonstrated less oral pain. CONCLUSION IMPT is associated with decreased dose to OARs and less patient-reported acute deterioration in multiple head and neck domains. A strong consideration for IMPT in ipsilateral head and neck patients with cancer is warranted.
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Affiliation(s)
- Elizabeth B Jeans
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Satomi Shiraishi
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gohar Manzar
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lindsay K Morris
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Lisa A McGee
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | | | | | - David M Routman
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel J Ma
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Samir H Patel
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Robert L Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Scott C Lester
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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16
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Pratson CL, Larkins MC, Karimian BH, Curtis CM, Lepera PA, Brodish BN, Ju AW. The Impact of Smoking, Alcohol Use, Recurrent Disease, and Age on the Development of Neck Fibrosis in Head and Neck Cancer Patients Following Radiation Therapy. Front Oncol 2021; 11:707418. [PMID: 34485144 PMCID: PMC8415001 DOI: 10.3389/fonc.2021.707418] [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: 05/10/2021] [Accepted: 07/21/2021] [Indexed: 01/08/2023] Open
Abstract
There is a paucity of information regarding the demographic factors associated with the development of neck fibrosis in head and neck cancer (HNC) patients following radiotherapy. A retrospective review of all patients being treated for HNC at a tertiary care center between 2013 and 2017 was performed. Chi-squared and Mann-Whitney U tests were used to identify differences in incidence and grade of fibrosis, respectively, between populations. A total of 90 patients aged 19 to 99 years were included. Factors associated with an increased incidence of fibrosis included smoking during radiotherapy (p < 0.001), alcohol use (p = 0.026), recurrent disease (p = 0.042), and age less than 60 (p < 0.001) on univariate analysis. Factors associated with increased grade of fibrosis in HNC patients included recurrent HNC (p = 0.033), alcohol use (p = 0.013), patient age younger than 60 years (p = 0.018), smoking during radiotherapy (p < 0.001), and non-Caucasian race (p = 0.012). Identification and intervention directed at patients that possess risk factors associated with fibrosis prior to treatment has the potential to improve the long-term quality of life for HNC patients.
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Affiliation(s)
- Connor L Pratson
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Michael C Larkins
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Brandon H Karimian
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Caitrin M Curtis
- Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Pamela A Lepera
- Division of Hematology/Oncology, Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Brian N Brodish
- Eastern Carolina Head and Neck Surgery, Greenville, NC, United States
| | - Andrew W Ju
- Department of Radiation Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
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17
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Bruixola G, Remacha E, Jiménez-Pastor A, Dualde D, Viala A, Montón JV, Ibarrola-Villava M, Alberich-Bayarri Á, Cervantes A. Radiomics and radiogenomics in head and neck squamous cell carcinoma: Potential contribution to patient management and challenges. Cancer Treat Rev 2021; 99:102263. [PMID: 34343892 DOI: 10.1016/j.ctrv.2021.102263] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/06/2021] [Accepted: 07/23/2021] [Indexed: 12/12/2022]
Abstract
The application of imaging biomarkers in oncology is still in its infancy, but with the expansion of radiomics and radiogenomics a revolution is expected in this field. This may be of special interest in head and neck cancer, since it can promote precision medicine and personalization of treatment by overcoming several intrinsic obstacles in this pathology. Our goal is to provide the medical oncologist with the basis to approach these disciplines and appreciate their main uses in clinical research and clinical practice in the medium term. Aligned with this objective we analyzed the most relevant studies in the field, also highlighting novel opportunities and current challenges.
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Affiliation(s)
- Gema Bruixola
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Elena Remacha
- Quantitative Imaging Biomarkers in Medicine (QUIBIM SL), Valencia, Spain
| | - Ana Jiménez-Pastor
- Quantitative Imaging Biomarkers in Medicine (QUIBIM SL), Valencia, Spain
| | - Delfina Dualde
- Department of Radiology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Alba Viala
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Jose Vicente Montón
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain
| | - Maider Ibarrola-Villava
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Andrés Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain.
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18
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Van den Bosch L, van der Laan HP, van der Schaaf A, Oosting SF, Halmos GB, Witjes MJH, Oldehinkel E, Meijer TWH, van den Hoek JGM, Steenbakkers RJHM, Langendijk JA. Patient-Reported Toxicity and Quality-of-Life Profiles in Patients With Head and Neck Cancer Treated With Definitive Radiation Therapy or Chemoradiation. Int J Radiat Oncol Biol Phys 2021; 111:456-467. [PMID: 34048816 DOI: 10.1016/j.ijrobp.2021.05.114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/07/2021] [Accepted: 05/19/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE Radiation therapy is an effective but burdensome treatment for head and neck cancer (HNC). We aimed to characterize the severity and time pattern of patient-reported symptoms and quality of life in a large cohort of patients with HNC treated with definitive radiation therapy, with or without systemic treatment. METHODS AND MATERIALS A total of 859 patients with HNC treated between 2007 and 2017 prospectively completed the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Head and Neck Cancer module (QLQ-HN35) and Core Quality of Life Questionnaire (QLQ-C30) at regular intervals during and after treatment for up to 5 years. Patients were classified into 3 subgroups: early larynx cancer, infrahyoideal cancer, and suprahyoideal cancer. Outcome scales of both questionnaires were quantified per subgroup and time point by means of average scores and the frequency distribution of categorized severity (none, mild, moderate, and severe). Time patterns and symptom severity were characterized. Toxicity profiles were compared using linear mixed model analysis. Additional toxicity profiles based on age, human papillomavirus status, treatment modality, smoking status, tumor site, and treatment period were characterized as well. RESULTS The study population consisted of 157 patients with early larynx cancer, 304 with infrahyoideal cancer, and 398 with suprahyoideal cancer. The overall questionnaire response rate was 83%. Generally, the EORTC QLQ-HN35 symptoms reported showed a clear time pattern, with increasing scores during treatment followed by a gradual recovery in the first 2 years. Distinct toxicity profiles were seen across subgroups (P < .001), with generally less severe symptom scores in the early larynx subgroup. The EORTC QLQ-C30 functioning, quality-of-life, and general symptoms reported showed a less evident time pattern and less pronounced differences in mean scores between subgroups, although differences were still significant (P < .001). Differences in mean scores were most pronounced for role functioning, appetite loss, fatigue, and pain. CONCLUSIONS We established patient-reported toxicity and quality-of-life profiles that showed different patterns for 3 subgroups of patients with HNC. These profiles provide detailed information on the severity and persistence of various symptoms as experienced by patients during and after definitive radiation therapy. These profiles can be used to inform treatment of future patients and may serve as a benchmark for future studies.
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Affiliation(s)
- Lisa Van den Bosch
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Hans Paul van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gyorgy B Halmos
- Department of Otorhinolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Max J H Witjes
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Edwin Oldehinkel
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Tineke W H Meijer
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna G M van den Hoek
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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19
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MRI Dynamic Contrast Imaging of Oral Cavity and Oropharyngeal Tumors. Top Magn Reson Imaging 2021; 30:97-104. [PMID: 33828061 DOI: 10.1097/rmr.0000000000000283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In the past decade, dynamic contrast-enhanced magnetic resonance imaging has had an increasing role in assessing the microvascular characteristics of various tumors, including head and neck cancer. Dynamic contrast-enhanced magnetic resonance imaging allows noninvasive assessment of permeability and blood flow, both important parametric features of tumor hypoxia, which is in turn a marker for treatment resistance for head and neck cancer.In this article we will provide a comprehensive review technique in evaluating tumor proliferation and application of its parameters in differentiating between various tumor types of the oral cavity and how its parameters can correlate between epidermal growth factor receptor and human papillomavirus which can have an implication in patient's overall survival rates.We will also review how the parameters of this method can predict local tumor control after treatment and compare its efficacy with other imaging modalities. Lastly, we will review how its parameters can be used prospectively to identify early complications from treatment.
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20
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Gharzai LA, Burger N, Li P, Jaworski EM, Henderson C, Spector M, Rosko A, Chen MM, Prince ME, Bradford CR, Malloy KM, Stucken CL, Swiecicki P, Worden F, Schipper MJ, Schonewolf CA, Shah J, Jagsi R, Chinn S, Shuman A, Casper K, Mierzwa ML. Patient Burden with Current Surveillance Paradigm and Factors Associated with Interest in Altered Surveillance for Early Stage HPV-Related Oropharyngeal Cancer. Oncologist 2021; 26:676-684. [PMID: 33823077 DOI: 10.1002/onco.13784] [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: 01/19/2021] [Accepted: 03/26/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Optimal surveillance paradigms for survivors of early stage human papillomavirus (HPV)-related oropharyngeal cancer are not well defined. This study aimed to characterize patient interest in and factors associated with an altered surveillance paradigm. MATERIALS AND METHODS We surveyed patients with Stage I or II HPV-related oropharyngeal cancer treated at a tertiary care institution from 2016 to 2019. Primary outcomes were descriptive assessment of patient knowledge, interest in altered surveillance, burdens of in-person appointments, and priorities for surveillance visits. Ordinal regression was used to identify correlates of interest in altered surveillance. RESULTS Sixty-seven patients completed surveys from February to April 2020 at a median of 21 months since completing definitive treatment. A majority (61%) of patients were interested in a surveillance approach that decreased in-person clinic visits. Patients who self-identified as medical maximizers, had higher worry of cancer recurrence, or were in long-term relationships were less likely to be interested. Patients reported significant burdens associated with surveillance visits, including driving distance, time off work, and nonmedical costs. Patients were most concerned with discussing cancer recurrence (76%), physical quality of life (70%), mortality (61%), and mental quality of life (52%) with their providers at follow-up visits. CONCLUSION Patients with early stage HPV-related oropharyngeal cancers are interested in altered surveillance approaches, experience significant burdens related to surveillance visits, and have concerns that are not well addressed with current surveillance approaches, including physical and mental quality of life. Optimized surveillance approaches should incorporate patient priorities and minimize associated burdens. IMPLICATIONS FOR PRACTICE The number of patients with HPV-related oropharyngeal cancers is increasing, and numerous clinical trials are investigating novel approaches to treating these good-prognosis patients. There has been limited work assessing optimal surveillance paradigms in these patients. Patients experience significant appointment-related burdens and have concerns such as physical and mental quality of life. Additionally, patients with early stage HPV-related oropharyngeal cancers express interest in altered surveillance approaches that decrease in-person clinic visits. Optimization of surveillance paradigms to promote broader survivorship care in clinical practice is needed.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicholas Burger
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Pin Li
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth M Jaworski
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin Henderson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andy Rosko
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle M Chen
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Kelly M Malloy
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chaz L Stucken
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Swiecicki
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Francis Worden
- Department of Medical Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew J Schipper
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
| | - Caitlin A Schonewolf
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer Shah
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Steve Chinn
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Andrew Shuman
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
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21
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Barry R, Forde E, Barrett S. Improving organ at risk sparing in oropharyngeal treatment planning by increasing target dose heterogeneity: A feasibility study. Med Dosim 2021; 46:304-309. [PMID: 33865674 DOI: 10.1016/j.meddos.2021.03.001] [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: 01/07/2021] [Revised: 02/23/2021] [Accepted: 03/02/2021] [Indexed: 11/24/2022]
Abstract
Target dose homogeneity has historically been a priority in radiotherapy treatment planning. However, in an era of more advanced modulated techniques, there is now greater flexibility in shaping dose distributions suggesting that allowing controlled target dose heterogeneity may consequently improve organ at risk (OAR) sparing. This study sought to determine the feasibility of allowing an increase in target dose heterogeneity in oropharyngeal VMAT plans, and to examine the dosimetric impact this has on target coverage and OARs such as the parotid glands, spinal cord, brainstem and mandible. Nineteen oropharyngeal patients' plans were created with homogeneous dose distributions specified in the London Cancer Head and Neck Radiotherapy Protocol. The upper dose constraint (UDC) objective of the primary planning target volumes (PTV) for each plan were increased in increments of 10% until a maximum of 150% of the prescribed dose was reached. These plans were dosimetrically compared to plans with a uniform dose distribution in terms of OAR sparing and target coverage. Minimal coverage was not compromised, with the largest median changes being a 0.81% decrease [98.6 to 97.8%] to the PTV_70Gy D98% and a 2.86% decrease [99.81 to 96.96%] to the PTV_54Gy D98% at a UDC of 150% of the prescription dose. An OAR sparing effect was observed for the parotid glands, spinal cord and oral cavity sub PTV. Mandible and brainstem Dmax values increased as the PTV UDC increased. Changes in brainstem dose were not statistically significant. All other differences were statistically significant for UDC's above 130%. Target coverage was not compromised as a result of increased target dose heterogeneity. The OAR sparing effect was promising for most organs, however further research with a larger dataset is necessary surrounding the effect on organs that overlap with the PTV.
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Affiliation(s)
- Rachel Barry
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St. James's Cancer Institute, Trinity College Dublin, St. James's Hospital Campus, Dublin 8, Ireland
| | - Elizabeth Forde
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St. James's Cancer Institute, Trinity College Dublin, St. James's Hospital Campus, Dublin 8, Ireland.
| | - Sarah Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St. James's Cancer Institute, Trinity College Dublin, St. James's Hospital Campus, Dublin 8, Ireland
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22
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King SN, Hurley J, Carter Z, Bonomo N, Wang B, Dunlap N, Petruska J. Swallowing dysfunction following radiation to the rat mylohyoid muscle is associated with sensory neuron injury. J Appl Physiol (1985) 2021; 130:1274-1285. [PMID: 33600281 DOI: 10.1152/japplphysiol.00664.2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Radiation-based treatments for oropharyngeal and hypopharyngeal cancers result in impairments in swallowing mobility, but the mechanisms behind the dysfunction are not clear. The purpose of this study was to determine if we could establish an animal model of radiation-induced dysphagia in which mechanisms could be examined. We hypothesized that 1) radiation focused at the depth of the mylohyoid muscle would alter normal bolus transport and bolus size and 2) radiation to the mylohyoid muscle will induce an injury/stress-like response in trigeminal sensory neurons whose input might modulate swallow. Rats were exposed to 48 or 64 Gy of radiation to the mylohyoid given 8 Gy in 6 or 8 fractions. Swallowing function was evaluated by videofluoroscopy 2 and 4 wk following treatment. Neuronal injury/stress was analyzed in trigeminal ganglion by assessing activating transcription factor (ATF)3 and GAP-43 mRNAs at 2, 4, and 8 wk post treatment. Irradiated rats exhibited decreases in bolus movement through the pharynx and alterations in bolus clearance. In addition, ATF3 and GAP-43 mRNAs were upregulated in trigeminal ganglion in irradiated rats, suggesting that radiation to mylohyoid muscle induced an injury/stress response in neurons with cell bodies that are remote from the irradiated tissue. These results suggest that radiation-induced dysphagia can be assessed in the rat and radiation induces injury/stress-like responses in sensory neurons.NEW & NOTEWORTHY Radiation-based treatments for head and neck cancer can cause significant impairments in swallowing mobility. This study provides new evidence supporting the possibility of a neural contribution to the mechanisms of swallowing dysfunction in postradiation dysphagia. Our data demonstrated that radiation to the mylohyoid muscle, which induces functional deficits in swallowing, also provokes an injury/stress-like response in the ganglion, innervating the irradiated muscle.
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Affiliation(s)
- Suzanne N King
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, Kentucky
| | - Justin Hurley
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Zachary Carter
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Nicholas Bonomo
- School of Medicine, University of Louisville, Louisville, Kentucky
| | - Brian Wang
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky.,Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Neal Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Jeffrey Petruska
- Department of Anatomical Sciences & Neurobiology, University of Louisville, Louisville, Kentucky.,Kentucky Spinal Cord Injury Research Center, Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
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23
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Westgaard KL, Hynne H, Amdal CD, Young A, Singh PB, Chen X, Rykke M, Hove LH, Aqrawi LA, Utheim TP, Herlofson BB, Jensen JL. Oral and ocular late effects in head and neck cancer patients treated with radiotherapy. Sci Rep 2021; 11:4026. [PMID: 33597629 PMCID: PMC7889862 DOI: 10.1038/s41598-021-83635-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 02/04/2021] [Indexed: 01/21/2023] Open
Abstract
A broader understanding of oral and ocular late effects in head and neck cancer (HNC) patients who underwent intensity-modulated radiotherapy (IMRT) may provide valuable information in follow-up and improve quality of life. Twenty-nine HNC patients treated at least 6 months earlier and 30 age-matched controls were recruited. After completing several questionnaires: Oral Health Impact Profile-14 (OHIP-14), Shortened Xerostomia Inventory (SXI), Ocular Surface Disease Index (OSDI) and McMonnies Dry Eye questionnaire (MDEQ), participants underwent oral and ocular examinations. Oral examination included clinical oral dryness score (CODS) and secretion rates of unstimulated and stimulated saliva (UWS, SWS). Ocular examination included tear film break-up time, Schirmer test and ocular surface staining. The patients had more problems related to dry mouth than controls based on CODS and SXI, and more complaints of dry eye disease based on OSDI and MDEQ. UWS and SWS rates and oral health related quality of life were significantly lower in the patient group. Subjective oral dryness (SXI) correlated significantly with subjective ocular dryness (OSDI and MDEQ). Our study demonstrates that HNC patients treated with IMRT experience late effects in terms of xerostomia and ocular dryness underlining the importance of interdisciplinary approach in the evaluation and follow-up of HNC patients.
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Affiliation(s)
- Kristine Løken Westgaard
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Division for Head, Neck and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Håvard Hynne
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Cecilie Delphin Amdal
- Section for Head and Neck Oncology, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Alix Young
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Preet Bano Singh
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Division for Head, Neck and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Xiangjun Chen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Morten Rykke
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lene Hystad Hove
- Department of Cariology and Gerodontology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Lara A Aqrawi
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Tor P Utheim
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - Bente Brokstad Herlofson
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.,Division for Head, Neck and Reconstructive Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Janicke Liaaen Jensen
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, University of Oslo, Oslo, Norway.
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24
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Greco E, Ringash J, Tomlinson G, Huang SH, O'Sullivan B, Waldron J, Martino R. Presence and duration of feeding tube in a 5-year cohort of patients with head and neck cancer treated with curative intensity-modulated radiation therapy. Head Neck 2021; 43:1610-1620. [PMID: 33580567 DOI: 10.1002/hed.26638] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Our study assessed post-radiation therapy (RT) G-tube presence, duration, and clinical predictors in patients with head and neck cancer (HNC). METHODS We identified those 1-5-years post-RT with stage III/IV nasopharyngeal, oropharyngeal, hypopharyngeal, laryngeal, or unknown primaries. Logistic regression identified predictors of post-RT G-tube presence, Kaplan-Meier analysis estimated G-tube days, and log-rank test compared by tumor site. RESULTS The 977 patients had mean age 60.6 ± 11.6 years, 804 (82.3%) male, 764 (78.2%) stage IV, and 618 (63.3%) oropharyngeal primaries. All patients received intensity-modulated RT (IMRT), 571 (58.4%) received chemotherapy, and 698 (71.4%) prophylactic G-tube. G-tube prevalence 1- and 5-years post-IMRT was 7.1% and 4.8%, respectively. Median post-IMRT G-tube days were overall 63 (95%CI: 56-70), nasopharynx 119 (95%CI: 109-131), oropharynx 57 (95%CI: 51-68), hypopharynx 126 (95%CI: 77-256), larynx 53 (95%CI: 21-63), unknown 30 (95%CI: 17-55), of which hypopharynx was highest p < 0.001. CONCLUSIONS At an institution offering prophylactic G-tube for patients with advanced HNC, no differences were found in yearly G-tube use 1-5 years post-IMRT. Across all patients, median post-IMRT days with G-tube was 63 day but those with hypopharyngeal tumors registered the most days.
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Affiliation(s)
- Elissa Greco
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rosemary Martino
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
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25
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Zhang S, Wang H, Tian S, Zhang X, Li J, Lei R, Gao M, Liu C, Yang L, Bi X, Zhu L, Zhu S, Xu T, Yang R. A slice classification model-facilitated 3D encoder-decoder network for segmenting organs at risk in head and neck cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:94-103. [PMID: 33029634 PMCID: PMC7779351 DOI: 10.1093/jrr/rraa094] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/30/2020] [Indexed: 06/06/2023]
Abstract
For deep learning networks used to segment organs at risk (OARs) in head and neck (H&N) cancers, the class-imbalance problem between small volume OARs and whole computed tomography (CT) images results in delineation with serious false-positives on irrelevant slices and unnecessary time-consuming calculations. To alleviate this problem, a slice classification model-facilitated 3D encoder-decoder network was developed and validated. In the developed two-step segmentation model, a slice classification model was firstly utilized to classify CT slices into six categories in the craniocaudal direction. Then the target categories for different OARs were pushed to the different 3D encoder-decoder segmentation networks, respectively. All the patients were divided into training (n = 120), validation (n = 30) and testing (n = 20) datasets. The average accuracy of the slice classification model was 95.99%. The Dice similarity coefficient and 95% Hausdorff distance, respectively, for each OAR were as follows: right eye (0.88 ± 0.03 and 1.57 ± 0.92 mm), left eye (0.89 ± 0.03 and 1.35 ± 0.43 mm), right optic nerve (0.72 ± 0.09 and 1.79 ± 1.01 mm), left optic nerve (0.73 ± 0.09 and 1.60 ± 0.71 mm), brainstem (0.87 ± 0.04 and 2.28 ± 0.99 mm), right temporal lobe (0.81 ± 0.12 and 3.28 ± 2.27 mm), left temporal lobe (0.82 ± 0.09 and 3.73 ± 2.08 mm), right temporomandibular joint (0.70 ± 0.13 and 1.79 ± 0.79 mm), left temporomandibular joint (0.70 ± 0.16 and 1.98 ± 1.48 mm), mandible (0.89 ± 0.02 and 1.66 ± 0.51 mm), right parotid (0.77 ± 0.07 and 7.30 ± 4.19 mm) and left parotid (0.71 ± 0.12 and 8.41 ± 4.84 mm). The total segmentation time was 40.13 s. The 3D encoder-decoder network facilitated by the slice classification model demonstrated superior performance in accuracy and efficiency in segmenting OARs in H&N CT images. This may significantly reduce the workload for radiation oncologists.
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Affiliation(s)
- Shuming Zhang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Hao Wang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Suqing Tian
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xuyang Zhang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
- Cancer Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Jiaqi Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
- Department of Emergency, Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | - Runhong Lei
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Mingze Gao
- Beijing Linking Medical Technology Co., Ltd, Beijing, China
| | - Chunlei Liu
- Beijing Linking Medical Technology Co., Ltd, Beijing, China
| | - Li Yang
- Beijing Linking Medical Technology Co., Ltd, Beijing, China
| | - Xinfang Bi
- Beijing Linking Medical Technology Co., Ltd, Beijing, China
| | - Linlin Zhu
- Beijing Linking Medical Technology Co., Ltd, Beijing, China
| | - Senhua Zhu
- Beijing Linking Medical Technology Co., Ltd, Beijing, China
| | - Ting Xu
- Institute of Science and Technology Development, Beijing University of Posts and Telecommunications, Beijing, China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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26
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Lee J, Liu SH, Dai KY, Huang YM, Li CJ, Chen JCH, Leu YS, Liu CJ, Chen YJ. Sarcopenia and Systemic Inflammation Synergistically Impact Survival in Oral Cavity Cancer. Laryngoscope 2020; 131:E1530-E1538. [PMID: 33135827 DOI: 10.1002/lary.29221] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Sarcopenia and systemic inflammation can affect survival of advanced-stage oral squamous cell carcinoma (OSCC) patients; however, their reciprocal associations with survival outcomes are yet to be investigated. STUDY DESIGN Retrospective review at a tertiary cancer center. METHODS Patients with stage III-IVB OSCC that underwent surgery and (chemo)radiotherapy at our institution between 2010 and 2015 were reviewed. Skeletal muscle index (SMI) was assessed using computed tomography scans at the C3 vertebra. Sarcopenia was defined at the lowest sex-specific tertile for SMI. Systemic inflammation was estimated using the modified Glasgow prognostic score (mGPS), which ranges from 0 to 2 based on serum C-reactive protein and albumin levels. The predictors of overall survival (OS) were evaluated using Cox regression models. RESULTS A total of 174 patients were included in the study. The cut-off values for sarcopenia were set at SMI <52.4 cm2 /m2 (men) and < 36.2 cm2 /m2 (women) corresponding to the lowest sex-specific tertile. An mGPS 1-2 was independently associated with sarcopenia (odds ratio: 2.05; 95% confidence interval: 1.06-3.97; P = .03). On multivariate analysis for OS, sarcopenia and mGPS 1-2 independently predicted OS (hazard ratio: 2.12; 95% confidence interval: 1.17-3.85; P = .01 and hazard ratio: 7.85; 95% confidence interval: 3.7-16.65; P < .001, respectively). Patients with both sarcopenia and mGPS 1-2 (vs. neither) had worse OS (hazard ratio: 16.80; 95% confidence interval: 6.01-46.99; P < .001). CONCLUSIONS Sarcopenia and systemic inflammation may exert a negative synergistic prognostic impact in advanced-stage OSCC patients. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1530-E1538, 2021.
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Affiliation(s)
- Jie Lee
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Shih-Hua Liu
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Kun-Yao Dai
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Ming Huang
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Jung Li
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - John Chun-Hao Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan.,Department of Death Care Service, MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Yi-Shing Leu
- Department of Otorhinolaryngology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Ji Liu
- Department of Oral and Maxillofacial Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei, Taiwan
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27
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Patel V, Di Silvio L, Kwok J, Burns M, Henley Smith R, Thavaraj S, Veschini L. The impact of intensity-modulated radiation treatment on dento-alveolar microvasculature in pharyngeal cancer implant patients. J Oral Rehabil 2020; 47:1411-1421. [PMID: 32841377 DOI: 10.1111/joor.13084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/09/2020] [Accepted: 07/29/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Dental rehabilitation post-radiotherapy often requires the consideration of dental implants. However, these are tentatively prescribed due to the concern of hypovascularisation and possible osteoradionecrosis. Hence, the current study assessed the microvasculature of the dento-alveolar bone at implant sites taking into consideration the exact radiotherapy dose received to the region. MATERIALS AND METHODS Bone cores were taken from nine patients during implant treatment and compared to nine control patients. Specimens were stained using CD31 and digitalised using a high-resolution scanner for qualitative and quantitative assessment of the microvasculature. Monaco® treatment planning system was used to volume the implant site providing mean dose (Dmean ) and maximum dose (Dmax ). RESULTS A total of 23 bone cores were retrieved for analysis. The cohort had a Dmean of 38.4 Gy (59.6-24.3 Gy). Qualitative analysis identified a clear reduction in the miniscule terminal capillaries and high incidence of obliterated lumens with increasing radiotherapy. Microvasculature density of irradiated patients was markedly reduced (P = .0034) compared to the control group with an inverse correlation to RT doses (P < .0001). Specifically, doses up to 30 Gy appear to preserve sufficient vascularisation (~77% in comparison with control) and tissue architecture. By contrast, exposure to higher doses 40%-61% of the micro-vessels were lost. CONCLUSION Intensity-modulated radiotherapy doses above 30 Gy identified reduction in microvasculature which is a lower threshold than previously accepted. In pharyngeal cancer patients' doses to the jaw bones often exceed this threshold. Coupled with favourable survival in certain oropharyngeal and nasopharyngeal cancer, dental rehabilitation via implants provides a significant clinical challenge.
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Affiliation(s)
- Vinod Patel
- Oral Surgery Department, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Di Silvio
- King's College London, Centre for Clinical, Oral & Translational Science, Guys Dental Hospital, London, UK
| | - Jerry Kwok
- Oral Surgery Department, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Megan Burns
- Oral Surgery Department, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Rhonda Henley Smith
- King's Health Partners Head and Neck Cancer Biobank, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Selvam Thavaraj
- Department of Head and Neck pathology, King's College London, Centre for Clinical, Oral & Translational Science, Guys Hospital, London, UK
| | - Lorenzo Veschini
- Academic Centre of Reconstructive Science, King's College London, Centre for Clinical, Oral & Translational Science, Guys Dental Hospital, London, UK
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28
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Hargreaves S, Beasley M, Hurt C, Jones TM, Evans M. Deintensification of Adjuvant Treatment After Transoral Surgery in Patients With Human Papillomavirus-Positive Oropharyngeal Cancer: The Conception of the PATHOS Study and Its Development. Front Oncol 2019; 9:936. [PMID: 31632901 PMCID: PMC6779788 DOI: 10.3389/fonc.2019.00936] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
PATHOS is a phase II/III randomized controlled trial (RCT) of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery (TOS) for human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). The study opened in the UK in October 2015 and, after successful recruitment into the phase II, transitioned into phase III in the autumn of 2018. PATHOS aims to establish whether the de-intensification of adjuvant treatment in patients with favorable prognosis HPV-positive OPSCC will confer improved swallowing outcomes, whilst maintaining high rates of cure. In this article, we will outline the rationale for the study and how it aims to answer fundamentally important questions about the safety, effectiveness and functional outcomes of minimally invasive TOS techniques followed by adjuvant radiotherapy (RT) or chemo-radiotherapy (CRT) in this patient population.
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Affiliation(s)
| | - Matthew Beasley
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Chris Hurt
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Terry M. Jones
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
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Hedström J, Tuomi L, Finizia C, Olsson C. Identifying organs at risk for radiation-induced late dysphagia in head and neck cancer patients. Clin Transl Radiat Oncol 2019; 19:87-95. [PMID: 31646203 PMCID: PMC6804434 DOI: 10.1016/j.ctro.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 11/02/2022] Open
Abstract
Background and purpose Dysphagia is a common, severe and dose-limiting toxicity after oncological treatment of head and neck cancer (HNC). This study aims to investigate relationships between radiation doses to structures involved in normal swallowing and patient-reported as well as clinically measured swallowing function in HNC patients after curative (chemo-) radiation therapy (RT) with focus on late effects. Materials and methods Patients (n = 90) with HNC curatively treated with RT ± chemotherapy in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific symptom score was used to determine patient-reported dysphagia. The Penetration-Aspiration Scale (PAS) was applied to determine swallowing function by VFS (PAS ≥ 4/ ≥ 6 = moderate/severe dysphagia). Thirteen anatomical structures involved in normal swallowing were individually delineated on the patients' original planning CT scans and associated dose-volume histograms (DVHs) retrieved. Relationships between structure doses and late toxicity were investigated through univariable and multivariable logistic regression analysis (UVA/MVA) accounting for effects by relevant clinical factors. Results Median assessment time was 7 months post-RT (range: 5-34 months). Mean dose to the contralateral parotid gland and supraglottic larynx as well as maximum dose to the contralateral anterior digastric muscle predicted patient-reported dysphagia (AUC = 0.64-0.67). Mean dose to the pharyngeal constrictor muscle, the larynx, the supraglottic larynx and the epiglottis, as well as maximum dose to the contralateral submandibular gland predicted moderate and severe dysphagia by VFS (AUC = 0.71-0.80). Conclusion The patients in this cohort were consecutively identified pre-treatment, and were structurally approached and assessed for dysphagia after treatment at a specific time point. In addition to established dysphagia organs-at-risk (OARs), our data suggest that epiglottic and submandibular gland doses are important for swallowing function post-RT. Keeping DVH thresholds below V60 = 60% and V60 = 17%, respectively, may increase chances to reduce occurrence of severe late dysphagia. The results need to be externally validated in future studies.
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Key Words
- 3D-CRT, Three Dimensional Conformal Radiation Therapy
- AAA, Anisotropic Analytical Algorithm
- ACE-27, Adult Comorbidity Evaluation 27
- AUC, area under the Receiver Operating Characteristic (ROC) curve
- BMI, body mass index
- CI, confidence interval
- CT, computed tomography
- Cc, cubic centimeter
- DARS, dysphagia-aspiration-related structures
- DESdC, Drinking, Eating, Swallowing difficulties and Coughing when eating/drinking
- DVH, dose-volume histogram
- Deglutition disorders
- Dysphagia-aspiration-related structures
- EBRT, external beam radiation therapy
- EQD2, equivalent dose in 2Gy fractions
- Gy, Gray
- HNC, head and neck cancer
- Head and neck neoplasms
- ICRU, International Commission on Radiation Units and Measurements
- IMRT, intensity-modulated radiation therapy
- MVA, multivariable logistic regression
- N.A, non applicable
- OAR, organ-at-risk
- OR, odds ratio
- PAS, penetration-aspiration scale
- PCM, pharyngeal constrictor muscle
- PRO, patient-reported outcome
- QoL, quality of life
- ROC, Receiver Operating Characteristic curve
- RT, radiation therapy
- Radiation dose
- Radiation therapy
- SD, standard deviation
- SEM, standard error of the mean
- SLP, speech-language pathologist
- TNM, Tumor location, Nodular engagement, Metastasis
- UES, upper esophageal sphincter
- UVA, univariable logistic regression
- VFS, videofluoroscopy
- VMAT, volumetric-modulated radiation therapy
- Vx, the volume (%) of a structure receiving ≥xGy.
- ρ, Spearman’s Correlation Coefficient
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Affiliation(s)
- Johanna Hedström
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Anesthesia and Intensive Care, Area 2, 416 85 Gothenburg, Sweden
| | - Lisa Tuomi
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, 413 45 Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 413 45 Gothenburg, Sweden.,Region Västra Götaland, Sahlgrenska University Hospital, Department of Otorhinolaryngology, 413 45 Gothenburg, Sweden
| | - Caroline Olsson
- Department of Radiation Physics, Institute of Clinical Sciences, the Sahlgrenska Academy Gothenburg University, 413 45 Gothenburg, Sweden.,Regional Cancer Center West, the Western Sweden Healthcare Region, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
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Windon MJ, Fakhry C, Faraji F, Troy T, Gourin CG, Kiess AP, Koch W, Eisele DW, D'Souza G. Priorities of human papillomavirus-associated oropharyngeal cancer patients at diagnosis and after treatment. Oral Oncol 2019; 95:11-15. [PMID: 31345377 PMCID: PMC6662631 DOI: 10.1016/j.oraloncology.2019.05.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/13/2019] [Accepted: 05/18/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Little is known regarding how human papillomavirus-positive oropharyngeal cancer (HPV-OPC) patient goals change with treatment. This study evaluates whether patient ranking of non-oncologic priorities relative to cure and survival shift after treatment as compared to priorities at diagnosis. MATERIALS AND METHODS This is a prospective study of HPV-OPC patient survey responses at diagnosis and after treatment. The relative importance of 12 treatment-related priorities was ranked on an ordinal scale (1 as highest). Median rank (MR) was compared using Wilcoxon matched-pairs signed-rank tests. Prevalence of high concern for 11 treatment-related issues was compared using paired t-test. The effect of patient characteristics on change in priority rank and concern was evaluated using linear regression. RESULTS Among 37 patients, patient priorities were generally unchanged after treatment compared with at diagnosis, with cure and survival persistently ranked top priority. Having a moist mouth uniquely rose in importance after treatment. Patient characteristics largely did not affect change in priority rank. Concerns decreased after treatment, except concern regarding recurrence. DISCUSSION Treatment-related priorities are largely similar at diagnosis and after treatment regardless of patient characteristics. The treatment experience does not result in a shift of priorities from cure and survival to non-oncologic domains over cure and survival. The rise in importance of moist mouth implies that xerostomia may have been underappreciated as a sequelae of treatment. A decrease in most treatment-related concerns is encouraging, whereas the persistence of specific areas of concern may inform patient counseling.
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Affiliation(s)
- Melina J Windon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States; Bloomberg∼Kimmel Institute for Cancer Immunotherapy, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans Street, Baltimore, MD 21287, United States
| | - Farhoud Faraji
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States
| | - Tanya Troy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States
| | - Ana P Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 North Broadway, Baltimore, MD 21231, United States
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States
| | - Gypsyamber D'Souza
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, Baltimore, MD 21287, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, United States.
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Berger T, Seppenwoolde Y, Pötter R, Assenholt MS, Lindegaard JC, Nout RA, de Leeuw A, Jürgenliemk-Schulz I, Tan LT, Georg D, Kirisits C, Dumas I, Nesvacil N, Swamidas J, Hudej R, Lowe G, Hellebust TP, Menon G, Fokdal L, Tanderup K. Importance of Technique, Target Selection, Contouring, Dose Prescription, and Dose-Planning in External Beam Radiation Therapy for Cervical Cancer: Evolution of Practice From EMBRACE-I to II. Int J Radiat Oncol Biol Phys 2019; 104:885-894. [PMID: 30904706 DOI: 10.1016/j.ijrobp.2019.03.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe the evolution of external beam radiation therapy (EBRT) from EMBRACE-I (general guidelines for EBRT) to the initial phase of the EMBRACE-II study (detailed protocol for EBRT). METHODS AND MATERIALS EMBRACE-I enrolled 1416 locally advanced cervical cancer patients treated with chemoradiation including image-guided adaptive brachytherapy during 2008 to 2015. From March 2016 until March 2018, 153 patients were enrolled in the ongoing EMBRACE-II study, which involves a comprehensive detailed strategy and accreditation procedure for EBRT target contouring, treatment planning, and image guidance. EBRT planning target volumes (PTVs), treated volumes (V43 Gy), and conformity index (CI; V43 Gy/PTV) were evaluated in both studies and compared. RESULTS For EMBRACE-I, conformal radiation therapy (60% of patients) or intensity-modulated radiation therapy (IMRT) and volumetric arc therapy (VMAT; 40%) was applied with 45 to 50 Gy over 25 to 30 fractions to the elective clinical target volume (CTV). For pelvic CTVs (82%), median PTV and V43 Gy volumes were 1549 and 2390 mL, respectively, and CI was 1.54. For pelvic plus paraortic nodal (PAN) CTVs (15%), median PTV and V43 Gy volumes were 1921 and 2895 mL, and CI was 1.51. For pelvic CTVs treated with 45 to 46 Gy, the use of conformal radiation therapy was associated with a median V43 Gy volume that was 546 mL larger than with IMRT/VMAT. For pelvic CTVs treated with IMRT, the use of a dose prescription ≥48 Gy was associated with a median V43 Gy volumes that was 428 mL larger than with a dose prescription of 45 to 46 Gy. For EMBRACE-II, all patients were treated with: IMRT/VMAT, daily IGRT, 45 Gy over 25 fractions for the elective CTV, and simultaneously integrated boost for pathologic lymph nodes. For pelvic CTVs (61%), median PTV and V43 Gy volumes were 1388 and 1418 mL, and CI was 1.02. For pelvic plus PAN CTVs (32%), median PTV and V43 Gy volumes were 1720 and 1765 mL, and CI was 1.03. From EMBRACE-I to initial II, median V43 Gy was decreased by 972 mL (41%) and 1130 mL (39%), and median CI decreased from 1.54 to 1.02 and 1.51 to 1.03 for pelvic and pelvic plus PAN irradiation, respectively. CONCLUSIONS Application of IMRT/VMAT, IGRT, and a 45-Gy dose provides the potential of higher conformality inducing significant reduction of treated volume. Adherence to a detailed protocol including comprehensive accreditation, as in EMBRACE-II, reduces considerably V43 Gy and V50 Gy and improves conformality and interinstitutional consistency.
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Affiliation(s)
- Thomas Berger
- Department of Oncology, Aarhus University Hospital, Denmark.
| | - Yvette Seppenwoolde
- Department of Radiation Oncology, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | | | | | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Astrid de Leeuw
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Ina Jürgenliemk-Schulz
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Li Tee Tan
- Departments of Oncology, Radiology and Gynae-oncology, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Trust, United Kingdom
| | - Dietmar Georg
- Department of Radiation Oncology, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Christian Kirisits
- Department of Radiation Oncology, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Isabelle Dumas
- Department of Radiotherapy, Gustave-Roussy, Villejuif, France
| | - Nicole Nesvacil
- Department of Radiation Oncology, Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology, Medical University of Vienna, Austria
| | - Jamema Swamidas
- Department of Radiation Oncology, ACTREC, Tata Memorial Centre, Navi Mumbai, India
| | - Robert Hudej
- Department of Radiotherapy, Institute of Oncology Ljubljana, Slovenia
| | - Gerry Lowe
- Cancer Centre, Mount Vernon Hospital, London, United Kingdom
| | - Taran Paulsen Hellebust
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Oslo, Norway
| | - Geetha Menon
- Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, Canada
| | - Lars Fokdal
- Department of Oncology, Aarhus University Hospital, Denmark
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Denmark
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Soldatova L, Mirza N. Long-Term Voice and Swallowing Outcomes for Oral and Oropharyngeal Cancer Following Primary or Adjuvant Chemoradiation. Ann Otol Rhinol Laryngol 2019; 128:802-810. [DOI: 10.1177/0003489419842256] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Chemoradiation (CRT) for nonlaryngeal head and neck cancer (HNC) can lead to voice and swallowing dysfunction. The purpose of this study was to examine voice and swallowing from the patient’s perspective at least 5 years after treatment. Design: Patient survey. Methods: Twenty-eight patients treated with primary or adjuvant CRT at least 5 years ago (mean = 10.7 years, SD = 5.5, range, 5-28) completed a survey created based on previously validated questionnaires (the Patient Perception of Swallowing Function Questionnaire, PPSFQ; the Eating Assessment Tool, EAT-10; the Voice Handicap Index, VHI-10; the Voice Related Quality of Life, V-RQOL). Results: Patients reported some voice and swallowing dysfunction (39% of V-RQOL scores in categories of fair, poor, or worst possible and 32% of VHI-10 scores ≥20 or greater than 50% of the maximum; 39% of PPSFQ scores greater than 50% of the maximum and 32% of EAT-10 scores ≥20 or 50% of the maximum). There was a correlation between V-RQOL and VHI-10 scores (Pearson product moment correlation coefficient r = .96, calculated probability value p = 0), PPSFQ and EAT-10 scores (r = 0.87, p = 0.8 × 10−8), as well as between V-RQOL and PPSFQ/EAT-10 scores (r = .94, p = 0), VHI-10 and PPSFQ/EAT-10 scores (r = .97, p = 0). Conclusions: Perceived voice and swallowing dysfunction following CRT for nonlaryngeal HNC can persist or worsen beyond 5 years.
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Affiliation(s)
- Liuba Soldatova
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
| | - Natasha Mirza
- Department of Otolaryngology-Head and Neck Surgery, Philadelphia, Pennsylvania, USA
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Perspectives on optimizing radiotherapy dose to the dysphagia/aspiration-related structures for patients with head and neck cancer. Curr Opin Otolaryngol Head Neck Surg 2019; 27:157-161. [PMID: 30893132 DOI: 10.1097/moo.0000000000000532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this study is to provide an overview on the methodologies, outcomes and clinical implications of studies that have investigated swallowing outcomes after head and neck cancer (HNC) treatment when reducing radiotherapy dose to specific dysphagia/aspiration-related structures (DARS). RECENT FINDINGS Overall, there is limited recent evidence, with a lack of high-quality studies, which examine the outcomes of DARS-optimized radiotherapy treatment. Large variations exist in the methodology of these studies in regards to which DARS are delineated and how swallowing outcomes are measured. Consequently, there is a wide range of dose limits recommended to a variety of DARS structures. Despite these limitations, there appears to be a general consensus that optimizing dose to the DARS will result in some reduction of dysphagia after radiotherapy without compromising on treatment to the tumour. SUMMARY More rigorous study must be completed to determine the true extent of clinical benefit from this practice. Institutions must take into consideration the limitations of the evidence as well as logistical costs of implementing this technique into practice. However, optimizing dose to the DARS appears to be a well-tolerated practice that may have substantial positive benefits for patients' swallowing function and quality of life after HNC treatment.
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Barnhart MK, Cartmill B, Ward EC, Brown E, Sim J, Saade G, Rayner S, Robinson RA, Simms VA, Smee RI. Optimising Radiation Therapy Dose to the Swallowing Organs at Risk: An In Silico Study of feasibility for Patients with Oropharyngeal Tumours. Dysphagia 2019; 34:869-878. [PMID: 30741335 DOI: 10.1007/s00455-019-09983-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
Recent evidence suggests that reducing radiotherapy dose delivered to specific anatomical swallowing structures [Swallowing Organs at Risk (SWOARs)] may improve swallowing outcomes post-treatment for patients with head and neck cancer. However, for those patients with tumours of the oropharynx, which typically directly overlap the SWOARs, reducing dose to these structures may be unachievable without compromising on the treatment of the disease. To assess the feasibility of dose reduction in this cohort, standard IMRT plans (ST-IMRT) and plans with reduced dose to the SWOARs (SW-IMRT) were generated for 25 oropharyngeal cancer patients (Brouwer et al. in Radiother Oncol 117(1):83-90, https://doi.org/10.1016/j.radonc.2015.07.041 , 2015; Christianen et al. in Radiother Oncol 101(3):394-402, https://doi.org/10.1016/j.radonc.2011.05.015 , 2011). ST-IMRT and SW-IMRT plans were compared for: mean dose to the SWOARs, volume of pharynx and larynx receiving 50 Gy and 60 Gy (V50 and V60 respectively) and overlap between the tumour volume and the SWOARs. Additionally, two different SWOARs delineation guidelines (Brouwer et al. in Radiother Oncol 117(1):83-90, https://doi.org/10.1016/j.radonc.2015.07.041 , 2015; Christianen et al. in Radiother Oncol 101(3):394-402, https://doi.org/10.1016/j.radonc.2011.05.015 , 2011) were used to highlight differences in calculated volumes between existing contouring guidelines. Agreement in SWOARs volumes between the two guidelines was calculated using a concordance index (CI). Despite a large overlap between the tumour and SWOARs, significant (p < 0.05) reductions in mean dose to 4 of the 5 SWOARs, and V50/V60 for the pharynx and larynx were achieved with SW-IMRT plans. Low CIs per structure (0.15-0.45) were found between the two guidelines highlighting issues comparing data between studies when different guidelines have been used (Hawkins et al. in Semin Radiat Oncol 28(1):46-52, https://doi.org/10.1016/j.semradonc.2017.08.002 , 2018; Brodin et al. in Int J Radiat Oncol Biol Phys 100(2):391-407, https://doi.org/10.1016/j.ijrobp.2017.09.041 , 2018). This study found reducing dose to the SWOARs is a feasible practice for patients with oropharyngeal cancer. However, future prospective research is needed to determine if the extent of dose reduction achieved equates to clinical benefits.
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Affiliation(s)
- Molly K Barnhart
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia. .,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Bena Cartmill
- Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, QLD, 4102, Australia.,Speech Pathology, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Woolloongabba, QLD, 4102, Australia
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia.,Centre for Functioning and Health Research, Metro South Hospital and Health Service, Queensland Health, Buranda, QLD, 4102, Australia
| | - Elizabeth Brown
- Radiation Oncology, Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Woolloongabba, QLD, 4102, Australia
| | - Jonathon Sim
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - George Saade
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - Sandra Rayner
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia
| | - Rachelle A Robinson
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia
| | - Virginia A Simms
- Speech Pathology Department, Prince of Wales Hospital (POWH), Randwick, Sydney, NSW, 2031, Australia
| | - Robert I Smee
- Radiation Oncology, Nelune Comprehensive Cancer Centre, POWH, Sydney, NSW, 2031, Australia.,The Clinical Teaching School, University New South Wales, Kensington, NSW, Australia
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Silveira A, Monteiro E, Sequeira T. Head and Neck Cancer: Improving Patient-Reported Outcome Measures for Clinical Practice. Curr Treat Options Oncol 2018; 19:59. [PMID: 30276480 DOI: 10.1007/s11864-018-0578-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OPINION STATEMENT Head and neck cancer includes a wide range of tumors that occur in several areas of the upper aerodigestive tract. Most head and neck cancer patients report treatment-related late effects (both physical and psycho-social). High-quality and patient-centered care in head and neck cancer depend on the understanding of the continuum patient's experience-the disease pathway. Healthcare has been improved by involving patients more actively in the disease process, and a few reports support that patient-reported outcomes-built around the patient's experience-given in a timely manner to oncologists are extremely valuable in oncology clinical care. Implementation and clinical use of patient-reported outcomes requires some procedures involving head and neck cancer patients, clinicians, researchers, and institutional leaders The unified and integrated vision is still absent and some current concerns are being discussed to optimize benefits of patient-reported outcomes use in clinical practice. The inclusion of all first-line caregivers, team formation and training, continuous monitoring improvement, and analysis are critical success factors to consider. Our team developed a broader and inclusive understanding of patient-reported outcomes. Patient-reported outcome (Health-Related Quality of Life) assessment is implemented as a systematic and routine process in Head and Neck Unit. Head and neck cancer patients consider the questionnaire administration as part of the clinical approach. We are currently working in a program (PROimp) using mathematical models to identify common head and neck cancer patterns and building prognostic predictive models, to predict future outcomes, to appraise risk/benefit of treatments (standard or new), and to estimate patient's risk of future disease development. It is our aim to better comprehend the singular and unexpected perceptions to really provide directed and personalized cancer care defining the patient pathway. The future holds promising for PROs that are ascending as a nuclear outcome in head and neck oncology.
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Affiliation(s)
- Augusta Silveira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal. .,Center for Health Studies and Research of the University of Coimbra, Center for Innovation in Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal.
| | - Eurico Monteiro
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Portuguese Oncology Institute - Porto, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Teresa Sequeira
- Health Sciences Faculty, Fernando Pessoa University (UFP-FCS), Rua Carlos da Maia, 296, 4200-150, Porto, Portugal.,Center for Health Studies and Research of the University of Coimbra, Center for Innovation in Biomedicine and Biotechnology, Avenida Dias da Silva, 165, 3004-512, Coimbra, Portugal
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Marzi S, Farneti A, Vidiri A, Di Giuliano F, Marucci L, Spasiano F, Terrenato I, Sanguineti G. Radiation-induced parotid changes in oropharyngeal cancer patients: the role of early functional imaging and patient-/treatment-related factors. Radiat Oncol 2018; 13:189. [PMID: 30285893 PMCID: PMC6167883 DOI: 10.1186/s13014-018-1137-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023] Open
Abstract
Background Functional magnetic resonance imaging may provide several quantitative indices strictly related to distinctive tissue signatures with radiobiological relevance, such as tissue cellular density and vascular perfusion. The role of Intravoxel Incoherent Motion Diffusion Weighted Imaging (IVIM-DWI) and Dynamic Contrast-Enhanced (DCE) MRI in detecting/predicting radiation-induced volumetric changes of parotids both during and shortly after (chemo)radiotherapy of oropharyngeal squamous cell carcinoma (SCC) was explored. Methods Patients with locally advanced oropharyngeal SCC were accrued within a prospective study offering both IVIM-DWI and DCE-MRI at baseline; IVIM-DWI was repeated at the 10th fraction of treatment. Apparent diffusion coefficient (ADC), tissue diffusion coefficient Dt, perfusion fraction f and perfusion-related diffusion coefficient D* were estimated both at baseline and during RT. Semi-quantitative and quantitative parameters, including the transfer constant Ktrans, were calculated from DCE-MRI. Parotids were contoured on T2-weighted images at baseline, 10th fraction and 8th weeks after treatment end and the percent change of parotid volume between baseline/10th fr (∆Vol10fr) and baseline/8th wk. (∆Volpost) computed. Correlations among volumetric changes and patient-, treatment- and imaging-related features were investigated at univariate analysis (Spearman’s Rho). Results Eighty parotids (40 patients) were analyzed. Percent changes were 18.2 ± 10.7% and 31.3 ± 15.8% for ∆Vol10fr and ∆Volpost, respectively. Among baseline characteristics, ∆Vol10fr was correlated to body mass index, patient weight as well as the initial parotid volume. A weak correlation was present between parotid shrinkage after the first 2 weeks of treatment and dosimetric variables, while no association was found after radiotherapy. Percent changes of both ADC and Dt at the 10th fraction were also correlated to ∆Vol10fr. Significant relationships were found between ∆Volpost and baseline DCE-MRI parameters. Conclusions Both IVIM-DWI and DCE-MRI can help to detect/predict early (during treatment) and shortly after treatment completion the parotid shrinkage. They may contribute to clarify the correlations between volumetric changes of parotid glands and patient−/treatment-related variables by assessing individual microcapillary perfusion and tissue diffusivity. Electronic supplementary material The online version of this article (10.1186/s13014-018-1137-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Francesca Di Giuliano
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.,Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy
| | - Laura Marucci
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Filomena Spasiano
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy
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Pattern of dysphagia after swallowing-sparing intensity-modulated radiotherapy (IMRT) of head and neck cancers: results of a mono-institutional prospective study. Strahlenther Onkol 2018; 194:1114-1123. [DOI: 10.1007/s00066-018-1328-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 06/16/2018] [Indexed: 10/28/2022]
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