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Costantino A, Haughey B, Alamoudi U, Biskup M, Magnuson JS. Safety and Postoperative Outcomes of Transoral Surgery for Oropharyngeal Carcinoma in Older Adults. JAMA Otolaryngol Head Neck Surg 2024; 150:879-886. [PMID: 39207743 PMCID: PMC11362969 DOI: 10.1001/jamaoto.2024.2596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/01/2024] [Indexed: 09/04/2024]
Abstract
Importance Transoral surgery (TOS) has become the primary surgical treatment for oropharyngeal squamous cell carcinoma (OPSCC). However, despite the increasing incidence of OPSCC in older patients, data regarding the safety and postoperative outcomes of TOS in this subgroup are lacking. Objective This study aimed to evaluate the safety and postoperative outcomes of TOS in patients with OPSCC aged 70 years or older compared with younger individuals. Design, Setting, and Participants This retrospective cohort study included patients with microscopic diagnostic confirmation of invasive OPSCC diagnosed between 2010 and 2021. Data were obtained from the US National Cancer Database. Data were analyzed in March 2024. Exposure Minimally invasive TOS not converted to an open approach. Main Outcomes and Measures Multivariable logistic and linear regression models were constructed to compare postoperative outcomes, adjusting for baseline patient and tumor characteristics. The results are reported as odds ratios (ORs) or mean differences with corresponding 95% CI, as appropriate. Results A total of 10 430 patients (mean [SD] age, 60.7 [9.6] years; 8744 [83.8%] male) were included, with 1808 patients (17.3%) aged at least 70 years. No clinically meaningful difference was observed in terms of postoperative mortality at 30 days (adjusted OR, 1.24; 95% CI, 0.65-2.33) or 90 days (adjusted OR, 1.11; 95% CI, 0.65-1.87). Patients aged 70 years or older were less likely to undergo adjuvant radiotherapy (adjusted OR, 0.69; 95% CI, 0.57-0.83) and chemotherapy (adjusted OR, 0.63; 95% CI, 0.51-0.77). In addition, the adjuvant treatment was more frequently not administered in the older population due to patient refusal or comorbidities, despite being clinically indicated (radiotherapy: adjusted OR, 1.36; 95% CI, 1.05-1.77; chemotherapy: adjusted OR, 1.70; 95% CI, 1.17-2.45). No meaningful differences were observed regarding the remaining study outcomes, apart from a slightly longer hospitalization time for older patients, with an adjusted mean difference of 0.39 (95% CI, 0.05-0.74) days. Conclusions and Relevance Findings from this study suggest that age was not independently associated with postoperative mortality in older patients undergoing TOS for OPSCC. However, older patients less frequently received adjuvant radiotherapy and chemotherapy compared with younger patients, and future studies should be conducted to examine the impact on long-term survival.
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Affiliation(s)
- Andrea Costantino
- Department of Otolaryngology–Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida
| | - Bruce Haughey
- Department of Otolaryngology–Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida
- Department of Otolaryngology–Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa
- Department of Surgery, University of Auckland School of Medicine and Allied Health Sciences, Auckland, New Zealand
| | - Uthman Alamoudi
- Department of Otolaryngology–Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida
| | - Mathew Biskup
- Department of Otolaryngology–Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida
| | - Jeffery Scott Magnuson
- Department of Otolaryngology–Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida
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Margalit DN, Anker CJ, Aristophanous M, Awan M, Bajaj GK, Bradfield L, Califano J, Caudell JJ, Chapman CH, Garden AS, Harari PM, Helms A, Lin A, Maghami E, Mehra R, Parker L, Shnayder Y, Spencer S, Swiecicki PL, Tsai JC, Sher DJ. Radiation Therapy for HPV-Positive Oropharyngeal Squamous Cell Carcinoma: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2024; 14:398-425. [PMID: 39078350 DOI: 10.1016/j.prro.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/06/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Human Papilloma Virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is a distinct disease from other head and neck tumors. This guideline provides evidence-based recommendations on the critical decisions in its curative treatment, including both definitive and postoperative radiation therapy (RT) management. METHODS ASTRO convened a task force to address 5 key questions on the use of RT for management of HPV-associated OPSCC. These questions included indications for definitive and postoperative RT and chemoradiation; dose-fractionation regimens and treatment volumes; preferred RT techniques and normal tissue considerations; and posttreatment management decisions. The task force did not address indications for primary surgery versus RT. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS Concurrent cisplatin is recommended for patients receiving definitive RT with T3-4 disease and/or 1 node >3 cm, or multiple nodes. For similar patients who are ineligible for cisplatin, concurrent cetuximab, carboplatin/5-fluorouracil, or taxane-based systemic therapy are conditionally recommended. In the postoperative setting, RT with concurrent cisplatin (either schedule) is recommended for positive surgical margins or extranodal extension. Postoperative RT alone is recommended for pT3-4 disease, >2 nodes, or a single node >3 cm. Observation is conditionally recommended for pT1-2 disease and a single node ≤3 cm without other risk factors. For patients treated with definitive RT with concurrent systemic therapy, 7000 cGy in 33 to 35 fractions is recommended, and for patients receiving postoperative RT without positive surgical margins and extranodal extension, 5600 to 6000 cGy is recommended. For all patients receiving RT, intensity modulated RT over 3-dimensional techniques with reduction in dose to critical organs at risk (including salivary and swallowing structures) is recommended. Reassessment with positron emission tomography-computed tomography is recommended approximately 3 months after definitive RT/chemoradiation, and neck dissection is recommended for convincing evidence of residual disease; for equivocal positron emission tomography-computed tomography findings, either neck dissection or repeat imaging is recommended. CONCLUSIONS The role and practice of RT continues to evolve for HPV-associated OPSCC, and these guidelines inform best clinical practice based on the available evidence.
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Affiliation(s)
- Danielle N Margalit
- Department of Radiation Oncology, Brigham & Women's/Dana-Farber Cancer Center, Harvard Medical School, Boston, Massachusetts.
| | - Christopher J Anker
- Division of Radiation Oncology, University of Vermont Cancer Center, Burlington, Vermont
| | - Michalis Aristophanous
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Gopal K Bajaj
- Department of Advanced Radiation Oncology and Proton Therapy, Inova Schar Cancer Institute, Fairfax, Virginia
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Joseph Califano
- Department of Surgery, University of California San Diego Health, San Diego, California
| | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Christina H Chapman
- Department of Radiation Oncology, Baylor College of Medicine, Houston, Texas
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas - MD Anderson Cancer Center, Houston, Texas
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
| | - Amanda Helms
- American Society for Radiation Oncology, Arlington, Virginia
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellie Maghami
- Department of Surgery, City of Hope, Duarte, California
| | - Ranee Mehra
- Department of Medical Oncology, University of Maryland Medical School and Greenebaum Comprehensive Cancer Center, Baltimore, Maryland
| | | | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Sharon Spencer
- Department of Radiation Oncology, University of Alabama Heersink School of Medicine, Birmingham, Alabama
| | - Paul L Swiecicki
- Department of Medical Oncology, University of Michigan Rogel Cancer Center, Ann Arbor, Michigan
| | | | - David J Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
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Oka H, Kawahara D, Murakami Y. Radiomics-based prediction of recurrence for head and neck cancer patients using data imbalanced correction. Comput Biol Med 2024; 180:108879. [PMID: 39067154 DOI: 10.1016/j.compbiomed.2024.108879] [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: 11/16/2023] [Revised: 06/21/2024] [Accepted: 07/10/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVES To propose a radiomics-based prediction model for head and neck squamous cell carcinoma (HSNCC) recurrence after radiation therapy using a novel data imbalance correction method known as Gaussian noise upsampling (GNUS). MATERIALS AND METHODS The dataset includes 97 HNSCC patients treated with definitive radiotherapy alone or concurrent chemoradiotherapy at two institutions. We performed radiomics analysis using nine segmentations created on pretreatment positron emission tomography and computed tomography images. Feature selection was performed by the least absolute shrinkage and selection operator analysis via five-fold cross-validation. The proposed GNUS was compared with seven conventional data-imbalance correction methods. Classification models of HNSCC recurrence were constructed on oversampled features using the machine learning algorithms of linear regression. Their predictive performance was evaluated based on accuracy, sensitivity, specificity, and the area under the curve (AUC) of the receiver operating performance characteristic curve via five-fold cross-validation using the same combinations as for feature selection. RESULT The prediction model without data imbalance correction shows sensitivity, specificity, accuracy, and AUC values of 83 %, 96 %, 92 %, and 0.96, respectively. The conventional model with the best performance is the random over-sampler model, which shows sensitivity, specificity, accuracy, and AUC values of 93 %, 91 %, 92 %, 0.97, respectively, whereas the GNUS model shows values of 93 %, 94 %, 94 %, 0.98, respectively. CONCLUSION Oversampling methods can reduce sensitivity and specificity bias. The proposed GNUS can improve accuracy as well as reduce sensitivity and specificity bias.
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Affiliation(s)
- Hiroki Oka
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
| | - Daisuke Kawahara
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan.
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8551, Japan
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Simopoulou F, Kyrgias G, Georgakopoulos I, Avgousti R, Armpilia C, Skarlos P, Softa V, Theodorou K, Kouloulias V, Zygogianni A. Does adaptive radiotherapy for head and neck cancer favorably impact dosimetric, clinical, and toxicity outcomes?: A review. Medicine (Baltimore) 2024; 103:e38529. [PMID: 38941415 PMCID: PMC11466102 DOI: 10.1097/md.0000000000038529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/17/2024] [Indexed: 06/30/2024] Open
Abstract
PURPOSE The current review aims to summarize the international experience of the impact of adaptive radiotherapy on dosimetry and clinical and toxicity outcomes. Additionally, it might trigger Radiation Oncologists to use ART and evaluate whether ART improves target volume coverage and/or normal tissue sparing and, consequently, therapeutic results. MATERIALS AND METHODS We conducted an electronic literature search of PubMed/MEDLINE and ScienceDirect from January 2007 to January 2023. The search adhered to the PRISMA guidelines and employed keywords such as ART, HNC, parotid gland, and target volume. Furthermore, we examined the reference lists for studies pertinent to the present review. This study included both retrospective and prospective studies that were considered for inclusion. CONCLUSION ART replanning appears to be a sustainable strategy to minimize toxicity by improving normal tissue sparing. Furthermore, it can enhance target volume coverage by correctly determining the specific dose to be delivered to the tumor. In conclusion, this review confirmed that ART benefits dosimetric, clinical/therapeutic, and toxicity outcomes.
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Affiliation(s)
- Foteini Simopoulou
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - George Kyrgias
- Radiation Oncology Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioannis Georgakopoulos
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - Rafaela Avgousti
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - Christina Armpilia
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - Pantelis Skarlos
- Radiation Oncology Department, Metropolitan Hospital, Piraeus, Greece
| | - Vasiliki Softa
- Medical Physics Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Kiki Theodorou
- Medical Physics Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vassilis Kouloulias
- Radiation Oncology Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
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Ushiro K, Watanabe Y, Kishimoto Y, Kawai Y, Fujimura S, Asato R, Tsujimura T, Hori R, Kumabe Y, Yasuda K, Tamaki H, Iki T, Kitani Y, Kurata K, Kojima T, Takata K, Kada S, Takebayashi S, Shinohara S, Hamaguchi K, Miyazaki M, Ikenaga T, Maetani T, Harada H, Haji T, Omori K. Complications including dysphagia following transoral non-robotic surgery for pharyngeal and laryngeal squamous cell carcinoma: A retrospective multicenter study. Auris Nasus Larynx 2024; 51:575-582. [PMID: 38547566 DOI: 10.1016/j.anl.2024.03.005] [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: 10/20/2023] [Revised: 02/19/2024] [Accepted: 03/14/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Transoral surgery is a minimally invasive treatment but may cause severe dysphagia at a lower rate than chemoradiotherapy. METHODS We compared clinical information, surgical complications, and swallowing function in patients who underwent transoral nonrobotic surgery for laryngo-pharyngeal squamous cell carcinoma between 2015 and 2021 in a multicenter retrospective study. RESULTS Six hundred and forty patients were included. Postoperative bleeding was observed in 20 cases (3.1%), and the risk factor was advanced T category. Postoperative laryngeal edema was observed in 13 cases (2.0%), and the risk factors were prior radiotherapy, advanced T stage, and concurrent neck dissection in patients with resected HPC. Dysphagia requiring nutritional support was observed in 29 cases (4.5%) at 1 month postoperatively and in 19 cases (3.0%) at 1 year postoperatively, respectively. The risk factors for long-term dysphagia were prior radiotherapy and advanced T category. Short-term risk factors for dysphagia were prior radiotherapy, advanced T category, and concurrent neck dissection, while long-term risk factors for dysphagia were only prior radiotherapy and advanced T category. CONCLUSION Prior radiotherapy, advanced T stage, and concurrent neck dissection increased the incidence of postoperative laryngeal edema and short-term dysphagia, but concurrent neck dissection did not affect long-term dysphagia. Such features should be considered when considering the indication for transoral surgery and postoperative management.
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Affiliation(s)
- Koji Ushiro
- Department of Otolaryngology-Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
| | - Yoshiki Watanabe
- Department of Otolaryngology-Head & Neck Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Yo Kishimoto
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryo Asato
- Department of Otolaryngology-Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, 1-1 Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan
| | - Takashi Tsujimura
- Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Ryusuke Hori
- Department of Otolaryngology-Head and Neck Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan; Department of Otolaryngology-Head & Neck Surgery, Fujita Health University, Toyoake, Japan; Department of Otolaryngology-Head & Neck Surgery, Tenri Hospital, Tenri, Japan
| | - Yohei Kumabe
- Department of Otolaryngology-Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kaori Yasuda
- Department of Otolaryngology-Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Hisanobu Tamaki
- Department of Otolaryngology-Head & Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takehiro Iki
- Department of Otolaryngology-Head & Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Kitani
- Department of Otolaryngology-Head & Neck Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Keisuke Kurata
- Department of Otolaryngology-Head & Neck Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Otolaryngology-Head & Neck Surgery, Tenri Hospital, Tenri, Japan
| | - Kuniaki Takata
- Department of Otolaryngology-Head & Neck Surgery, Tenri Hospital, Tenri, Japan
| | - Shinpei Kada
- Department of Otolaryngology-Head & Neck Surgery, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Shinji Takebayashi
- Department of Otolaryngology-Head & Neck Surgery, Shiga General Hospital, Moriyama, Japan
| | - Shogo Shinohara
- Department of Otolaryngology-Head & Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kiyomi Hamaguchi
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan; Department of Otolaryngology-Head & Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masakazu Miyazaki
- Department of Otolaryngology-Head & Neck Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Tadashi Ikenaga
- Department of Otolaryngology-Head & Neck Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Toshiki Maetani
- Department of Otolaryngology-Head & Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Hiroyuki Harada
- Department of Otolaryngology-Head & Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tomoyuki Haji
- Department of Otolaryngology-Head & Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Hu Q, Li F, Yang K. Systematic evaluation and meta-analysis of the prognosis of down-staging human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma using cetuximab combined with radiotherapy instead of cisplatin combined with radiotherapy. PeerJ 2024; 12:e17391. [PMID: 38784388 PMCID: PMC11114112 DOI: 10.7717/peerj.17391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To evaluate the efficacy and safety of cetuximab instead of cisplatin in combination with downstaging radiotherapy for papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC). Design Meta-analysis and systematic evaluation. Data sources The PubMed, Embase, Web of Science, and Cochrane library databases were searched up to June 8, 2023, as well as Clinicaltrials.gov Clinical Trials Registry, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Wiprojournal.com. Eligibility criteria for selecting studies Randomized controlled trials reporting results of standard regimens of cetuximab + radiotherapy vs cisplatin + radiotherapy in treating HPV+ OPSCC were included. The primary outcomes of interest were overall survival (OS), progression-free survival (PFS), local regional failure rate (LRF), distant metastasis rate (DM), and adverse events (AE). Data extraction and synthesis Two reviewers independently extracted data and assessed the risk of bias of the included studies. The HR and its 95% CI were used as the effect analysis statistic for survival analysis, while the OR and its 95% CI were used as the effect analysis statistic for dichotomous variables. These statistics were extracted by the reviewers and aggregated using a fixed-effects model to synthesise the data. Results A total of 874 relevant papers were obtained from the initial search, and five papers that met the inclusion criteria were included; a total of 1,617 patients with HPV+ OPSCC were enrolled in these studies. Meta-analysis showed that OS and PFS were significantly shorter in the cetuximab + radiotherapy group of patients with HPV+ OPSCC compared with those in the conventional cisplatin + radiotherapy group (HR = 2.10, 95% CI [1.39-3.15], P = 0.0004; HR = 1.79, 95% CI [1.40-2.29], P < 0.0001); LRF and DM were significantly increased (HR = 2.22, 95% CI [1.58-3.11], P < 0.0001; HR = 1.66, 95% CI [1.07-2.58], P = 0.02), but there was no significant difference in overall grade 3 to 4, acute and late AE overall (OR = 0.86, 95% CI [0.65-1.13], P = 0.28). Conclusions Cisplatin + radiotherapy remains the standard treatment for HPV+ OPSCC. According to the 7th edition AJCC/UICC criteria, low-risk HPV+ OPSCC patients with a smoking history of ≤ 10 packs/year and non-pharyngeal tumors not involved in lymphatic metastasis had similar survival outcomes with cetuximab/cisplatin + radiotherapy. However, further clinical trials are necessary to determine whether cetuximab + radiotherapy can replace cisplatin + radiotherapy for degraded treatment in individuals who meet the aforementioned characteristics, particularly those with platinum drug allergies. Prospero registration number CRD42023445619.
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Affiliation(s)
- Qiong Hu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Yang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Nuyts S, Bollen H, Eisbruch A, Strojan P, Mendenhall WM, Ng SP, Ferlito A. Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view. Cancer Med 2024; 13:e7192. [PMID: 38650546 PMCID: PMC11036082 DOI: 10.1002/cam4.7192] [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: 01/11/2024] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) may experience substantial anatomical changes during the course of radiotherapy treatment. The implementation of adaptive radiotherapy (ART) proves effective in managing the consequent impact on the planned dose distribution. METHODS This narrative literature review comprehensively discusses the diverse strategies of ART in HNC and the documented dosimetric and clinical advantages associated with these approaches, while also addressing the current challenges for integration of ART into clinical practice. RESULTS AND CONCLUSION Although based on mainly non-randomized and retrospective trials, there is accumulating evidence that ART has the potential to reduce toxicity and improve quality of life and tumor control in HNC patients treated with RT. However, several questions remain regarding accurate patient selection, the ideal frequency and timing of replanning, and the appropriate way for image registration and dose calculation. Well-designed randomized prospective trials, with a predetermined protocol for both image registration and dose summation, are urgently needed to further investigate the dosimetric and clinical benefits of ART.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Avrahram Eisbruch
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Primoz Strojan
- Department of Radiation Oncology Institute of OncologyUniversity of LjubljanaLjubljanaSlovenia
| | - William M. Mendenhall
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Sweet Ping Ng
- Department of Radiation OncologyOlivia Newton‐John Cancer and Wellness Centre, Austin HealthMelbourneAustralia
| | - Alfio Ferlito
- Coordinator International Head and Neck Scientific GroupUdineItaly
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Kristensen MH, Sørensen MK, Tramm T, Alsner J, Sørensen BS, Maare C, Johansen J, Primdahl H, Bratland Å, Kristensen CA, Andersen M, Lilja-Fischer JK, Holm AIS, Samsøe E, Hansen CR, Zukauskaite R, Overgaard J, Eriksen JG. Tumor volume and cancer stem cell expression as prognostic markers for high-dose loco-regional failure in head and neck squamous cell carcinoma - A DAHANCA 19 study. Radiother Oncol 2024; 193:110149. [PMID: 38341096 DOI: 10.1016/j.radonc.2024.110149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND AND PURPOSE Reliable and accessible biomarkers for patients with Head and Neck Squamous Cell Carcinoma (HNSCC) are warranted for biologically driven radiotherapy (RT). This study aimed to investigate the prognostic value of putative cancer stem cell (CSC) markers, hypoxia, and tumor volume using loco-regional high-dose failure (HDF) as endpoint. MATERIALS AND METHODS Tumor tissue was retrieved from patients treated with primary chemo-(C-)RT and nimorazole for HNSCC in the Danish Head and Neck Cancer Study Group (DAHANCA) 19 study. Tumor volume, hypoxic classification, and expression of CSC markers CD44, SLC3A2, and MET were analyzed. For patients with eligible data on all parameters (n = 340), the risk of HDF following primary chemo-(C-)RT were analyzed by these biomarkers as a whole and stratified for p16-positive oropharynx (p16 + OPSCC) vs p16-negative (p16-) tumors (oral cavity, p16- oropharynx, hypopharynx and larynx). RESULTS Higher risk of HDF was seen for patients with larger primary and nodal volume (>25 cm3, Hazard Ratio (HR): 3.00 [95 % CI: 1.73-5.18]), high SLC3A2 (HR: 2.99 [1.28-6.99]), CD44 (>30 % positive, HR: 2.29 [1.05-5.00]), and p16- tumors (HR: 2.53 [1.05-6.11]). p16- tumors had a higher CSC marker expression than p16 + OPSCC. The factors associated with the highest risk of HDF were larger volume (HR: 3.29 [1.79-6.04]) for p16- tumors (n = 178) and high SLC3A2 (HR: 6.19 [1.58-24.23]) for p16 + OPSCC (n = 162). CONCLUSION Tumor volume, p16, and CSC markers are potential biomarkers for HDF for patients with HNSCC treated with (C-)RT. Lower expression of CSC in p16 + OPSCC may contribute to better tumor control.
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Affiliation(s)
| | - Mia Kristina Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Trine Tramm
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Jacob Kinggaard Lilja-Fischer
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Otolaryngology - Head & Neck Surgery, Aarhus University Hospital, Denmark
| | | | - Eva Samsøe
- Zealand University Hospital, Department of Oncology, Næstved, Denmark
| | - Christian Rønn Hansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Odense University Hospital, Laboratory of Radiation Physics, Odense, Denmark; University of Southern Denmark, Department of Clinical Research, Odense, Denmark
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Arora C, Sharma N, Kapoor A, Pandya TN. A comparative study of the treatment outcome of moderately accelerated radiation fractionation (with concurrent chemotherapy in daily dosing) to conventional chemo-radiotherapy in locally advanced head and neck cancers: Supportive in a resource constrained environment. Indian J Cancer 2024; 61:262-272. [PMID: 38090961 DOI: 10.4103/ijc.ijc_155_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/07/2021] [Indexed: 09/12/2024]
Abstract
BACKGROUND In our country, head and neck cancers account for about a third of all cancers. Moreover, the patients typically present in advanced stages, which entails intensive multimodality therapy; but there is not much scope for improved survival outcomes. In view of this, a study was conducted to know the effects of treatment intensification, wherein moderately accelerated fractionation radiotherapy was given to patients presenting with advanced cancer of head and neck. This treatment was further intensified by accompanying radiation with concurrent cisplatin chemotherapy in daily doses. The control arm received the current standard therapy of conventional fractionation radiotherapy with weekly cisplatin chemotherapy. METHODS The primary objective of the study was to determine the prospect of tumor control (TC), disease-free survival (DFS), and overall survival (OS). The secondary objective was to study acute toxicity and late toxicity of the highest grade in both treatment groups. The study was conducted on a total of 60 patients who presented with locally advanced squamous cell carcinoma of the head and neck. The 30 patients in the control group received conventional fractionated radiotherapy (five fractions per week) with weekly cisplatin chemotherapy (40 mg/m 2 ), whereas the remaining 30 in the study group received moderately accelerated radiotherapy (six fractions per week with same treatment field) along with daily cisplatin chemotherapy (6 mg/m 2 ) with a reduction in treatment time by 1 week. RESULTS The overall response to therapy assessed as TC, DFS, and OS was compared, and no statistically significant difference between the two treatment arms was observed. However, the mean overall treatment time was reduced in the study group to 45 days as compared with 49 days in the control group ( P = 0.001). The acute toxicities of xerostomia ( P = 0.057) and skin ( P = 0.052) and late toxicity of aspiration/laryngeal toxicity ( P = 0.002) were higher in grade and number in the study group with accelerated fractionation. CONCLUSIONS Hence, the study results suggest that it is a feasible option to combine the therapeutic benefits of accelerated fractionation radiotherapy with concurrent chemotherapy in patients with locally advanced head and neck carcinomas. There is a significant decrease in the overall treatment time and a considerable reduction in the load on the resource-constrained healthcare system. It would be equitable to point out that higher grade of few toxicities in the acceleration arm are likely due to doses to organs at risk being intensified with accelerated fractionation, which can now be delivered in a controlled manner with the latest high precision techniques, resulting in improved toxicity profile and quality of life which is the way forward for future studies.
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Affiliation(s)
- Chhavi Arora
- Department of Radiation Oncology, Army Hospital R and R, New Delhi, India
| | - Neelam Sharma
- Department of Radiation Oncology, Army Hospital R and R, New Delhi, India
- Commanding Officer, Military Hospital Abohar, Punjab, India
| | - Amul Kapoor
- Department of Medical Oncology, Army Hospital R and R, New Delhi, India
- Commandant Military Hospital Bareilly, Uttar Pradesh, India
| | - Tejas N Pandya
- Department of Radiation Oncology, Army Hospital R and R, New Delhi, India
- Department of Radiation Oncology, Command Hospital (Eastern Command), Kolkata, West Bengal, India
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10
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Blumenfeld P, Arbit E, Den R, Salhab A, Falick Michaeli T, Wygoda M, Hillman Y, Pfeffer RM, Fang M, Misrati Y, Weizman N, Feldman J, Popovtzer A. Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer. Radiat Oncol 2024; 19:43. [PMID: 38555453 PMCID: PMC10981810 DOI: 10.1186/s13014-024-02436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Philip Blumenfeld
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel.
| | - Eduard Arbit
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Robert Den
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Israel
| | - Ayman Salhab
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Tal Falick Michaeli
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Marc Wygoda
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Yair Hillman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Raphael M Pfeffer
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Marcel Fang
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Yael Misrati
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Noam Weizman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Jon Feldman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
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11
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Yarbrough WG, Schrank TP, Burtness BA, Issaeva N. De-Escalated Therapy and Early Treatment of Recurrences in HPV-Associated Head and Neck Cancer: The Potential for Biomarkers to Revolutionize Personalized Therapy. Viruses 2024; 16:536. [PMID: 38675879 PMCID: PMC11053602 DOI: 10.3390/v16040536] [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: 02/19/2024] [Revised: 03/22/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
Human papillomavirus-associated (HPV+) head and neck squamous cell carcinoma (HNSCC) is the most common HPV-associated cancer in the United States, with a rapid increase in incidence over the last two decades. The burden of HPV+ HNSCC is likely to continue to rise, and given the long latency between infection and the development of HPV+ HNSCC, it is estimated that the effect of the HPV vaccine will not be reflected in HNSCC prevalence until 2060. Efforts have begun to decrease morbidity of standard therapies for this disease, and its improved characterization is being leveraged to identify and target molecular vulnerabilities. Companion biomarkers for new therapies will identify responsive tumors. A more basic understanding of two mechanisms of HPV carcinogenesis in the head and neck has identified subtypes of HPV+ HNSCC that correlate with different carcinogenic programs and that identify tumors with good or poor prognosis. Current development of biomarkers that reliably identify these two subtypes, as well as biomarkers that can detect recurrent disease at an earlier time, will have immediate clinical application.
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Affiliation(s)
- Wendell G. Yarbrough
- Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine, Chapel Hill, NC 27599, USA; (T.P.S.); (N.I.)
- Department of Pathology and Lab Medicine, UNC School of Medicine, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, NC 27599, USA
| | - Travis P. Schrank
- Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine, Chapel Hill, NC 27599, USA; (T.P.S.); (N.I.)
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, NC 27599, USA
| | - Barbara A. Burtness
- Department of Medicine, Medical Oncology, Yale School of Medicine, New Haven, CT 06510, USA;
- Yale Cancer Center, Yale School of Medicine, New Haven, CT 06510, USA
| | - Natalia Issaeva
- Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine, Chapel Hill, NC 27599, USA; (T.P.S.); (N.I.)
- Department of Pathology and Lab Medicine, UNC School of Medicine, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, NC 27599, USA
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12
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Fahrzadeh N, Tunca M. Evaluation of the shear bond strength of various adhesives on the surface of enamel irradiated with various doses of radiotherapy. Am J Orthod Dentofacial Orthop 2024; 165:285-293. [PMID: 37897485 DOI: 10.1016/j.ajodo.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 10/30/2023]
Abstract
INTRODUCTION We aimed to compare the shear bond strength (SBS) forces on the enamel surface with 2 adhesives after treatment with various radiation doses. METHODS A total of 120 premolars were included in the study. The teeth were randomly divided into 5 main groups (n = 24): negative control (without aging), positive control (with aging), 40 Gy, 60 Gy, and 70 Gy radiation. The 40 Gy, 60 Gy, and 70 Gy groups underwent conventional radiotherapy 5 days a week with a dose of 2 Gy each day. After the radiotherapy, all samples except the negative control group were subjected to thermal cycle aging. In all 5 groups, the specimens were divided into 2 subgroups, and half were bonded using 2 adhesives. After bonding, the universal Shimadzu test device was used to analyze the SBS. After the test, the tooth surfaces were examined under a stereomicroscope to determine the adhesive remnant index. RESULTS When adhesives were compared, Biofix adhesive's bond strength value was statistically higher in the 40 Gy group than in the Transbond XT group (P = 0.001). The SBS value was higher in all irradiated groups than in nonirradiated groups (P = 0.001). When the adhesive remnant index score was analyzed, no significant difference was found among the groups. CONCLUSIONS The SBS increased in irradiated teeth compared with unirradiated teeth, and the SBS values of both adhesives were within the acceptable limits in all radiation groups.
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Affiliation(s)
- Nihal Fahrzadeh
- Department of Orthodontics, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey
| | - Murat Tunca
- Department of Orthodontics, Faculty of Dentistry, Van Yüzüncü Yıl University, Van, Turkey.
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13
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Li CX, Tan XR, Wei W, Li MQ, Zhang WN, Gong ZC, Zhang Y, Zhao HR. A radiobiological perspective on radioresistance or/and radiosensitivity of head and neck squamous cell carcinoma. Rep Pract Oncol Radiother 2024; 28:809-822. [PMID: 38515813 PMCID: PMC10954264 DOI: 10.5603/rpor.99355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/11/2023] [Indexed: 03/23/2024] Open
Abstract
Background This article aimed to compile and summarize clinically relevant literature in radiation therapy, and to discuss the potential in radioresistant and radiosensitive head and neck cancer. Study Design Narrative review. Materials and methods Google Scholar, PubMed and the Cochrane Library were retrieved using combined key words such as "radiotherapy" and "head and neck cancer". Search strings additionally queried were "radioresistant", "radiosensitive", "head and neck region", "squamous cell carcinoma", in combination with Boolean Operators 'AND' and 'OR'. Subsequently, the resulting publications were included for review of the full text. Results Radiotherapeutic response currently in clinical observation referred to HNSCC scoping were selected into this review. The compiled mechanisms were then detailed concerning on the clinical significance, biological characteristics, and molecular function. Conclusions Brachytherapy or/and external-beam radiotherapy are crucial for treating HNSCC, especially the early stage patients, but in patients with locally advanced tumors, their outcome with radiation therapy is poor due to obvious radioresistance. The curative effects mainly depend on the response of radiation therapy, so an updated review is needed to optimize further applications in HNSCC radiotherapy.
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Affiliation(s)
- Chen-xi Li
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
- Hubei Province Key Laboratory of Oral and Maxillofacial Development and Regeneration, School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao-rong Tan
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wei Wei
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Mu-qiu Li
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wei-na Zhang
- Ear, Nose & Throat Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zhong-cheng Gong
- Department of Oral and Maxillofacial Oncology & Surgery, School/Hospital of Stomatology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Stomatological Research Institute of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yang Zhang
- The First Ward of Oncological Department, Cancer Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Hua-rong Zhao
- The First Ward of Oncological Department, Cancer Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
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14
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Agheli R, Siavashpour Z, Reiazi R, Azghandi S, Cheraghi S, Paydar R. Predicting severe radiation-induced oral mucositis in head and neck cancer patients using integrated baseline CT radiomic, dosimetry, and clinical features: A machine learning approach. Heliyon 2024; 10:e24866. [PMID: 38317933 PMCID: PMC10839875 DOI: 10.1016/j.heliyon.2024.e24866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose To establish the early prediction models of radiation-induced oral mucositis (RIOM) based on baseline CT-based radiomic features (RFs), dosimetric data, and clinical features by machine learning models for head and neck cancer (HNC) patients. Methods In this single-center prospective study, 49 HNCs treated with curative intensity modulated radiotherapy (IMRT) were enrolled. Baseline CT images (i.e., CT simulation), dosimetric, and clinical features were collected. RIOM was assessed using CTCAE v.5.0. RFs were extracted from manually-contoured oral mucosa structures. Minimum-redundancy-maximum-relevance (mRMR) method was applied to select the most informative radiomics, dosimetric, and clinical features. Then, binary prediction models were constructed for predicting acute RIOM based on the top mRMR-ranked radiomics, dosimetric, and clinical features alone or in combination, using random forest classifier algorithm. The predictive performance of models was assessed using the area under the receiver operating curve (AUC), accuracy, weighted-average based sensitivity, precision, and F1-measure. Results Among extracted features, the top 10 RFs, the top 5 dose-volume features, and the top 5 clinical features were selected using mRMR method. The model exploiting the integrated features (10-radiomics + 5-dosimetric + 5-clinical) achieved the best prediction with AUC, accuracy, sensitivity, precision, and F1-measure values of 91.7 %, 90.0 %, 83.0 % 100.0 %, and 91.0 %, respectively. The model developed using baseline CT RFs alone provided the best performance compared to dose-volume features or clinical features alone, with an AUC of 87.0 %. Conclusion Our results suggest that the integration of baseline CT radiomic features with dosimetric and clinical features showed promising potential to improve the performance of machine learning models in early prediction of RIOM. The ultimate goal is to personalize radiotherapy for HNC patients.
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Affiliation(s)
- Razieh Agheli
- Radiation Sciences Department, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Siavashpour
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Reiazi
- Department of Radiation Physics, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Samira Azghandi
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Susan Cheraghi
- Radiation Sciences Department, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Paydar
- Radiation Sciences Department, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
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15
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Huang Y, Zhou H, Zhao G, Wang M, Luo J, Liu J. Immune Checkpoint Inhibitors Serve as the First-Line Treatment for Advanced Head and Neck Cancer. Laryngoscope 2024; 134:749-761. [PMID: 37610169 DOI: 10.1002/lary.30971] [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: 03/04/2023] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Immune checkpoint inhibitor (ICI) therapy has demonstrated substantial benefits for certain patients. We try to evaluate the merits and demerits of each immunotherapy to aid clinical treatment. METHODS We conducted a comprehensive search of the PubMed, Embase, and Cochrane databases for randomized clinical trials published as of June 10, 2023. Our study included published clinical trials of ICI monotherapy or combination therapy, along with data on treatment-related adverse events (TRAE). Data regarding survival efficacy and adverse events of each randomized controlled trial (RCT) were collected. The Bayesian random effects model was utilized for the network meta-analysis (NMA). RESULTS This study incorporated 19 RCTs, involving 5900 patients. Among 14 treatment regimens, Pembrolizumab combined with chemotherapy emerged as the most promising primary treatment for overall survival (OS) and objective response rate (ORR). Toripalimab combined with chemotherapy exhibited the highest likelihood of becoming the primary treatment for extending progression-free survival (PFS). Durvalumab showed the lowest probability of adverse events, suggesting a safer profile compared with other drugs. Camrelizumab combined with chemotherapy demonstrated a heightened risk of adverse events. Dual ICI Nivolumab/Ipilimumab surpassed Durvalumab/Tremelimumab in terms of ORR and adverse events. The standard of care (SOC) regimen did not exhibit strong performance across the four outcome indicators. CONCLUSION Our analysis suggests that the integration of chemotherapy agents with ICIs enhances its efficacy as a first-line treatment for patients with advanced head and neck cancer (HNC). LEVEL OF EVIDENCE 1 Laryngoscope, 134:749-761, 2024.
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Affiliation(s)
- Yan Huang
- Department of Radiotherapy, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Hong Zhou
- Department of Otolaryngology, Shidong Hospital, Yangpu District, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
| | - Guangyong Zhao
- Department of Thoracic Surgery, The Affiliated Taian City Central Hospital of Qingdao University, Taian, China
| | - Meihua Wang
- Department of Pathology, Changzhou Tumor Hospital, Changzhou, China
| | - Judong Luo
- Department of Radiotherapy, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou, China
| | - Jun Liu
- Department of Radiotherapy, Changzhou Fourth People's Hospital, Changzhou, China
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Ushiro K, Watanabe Y, Kishimoto Y, Kawai Y, Fujimura S, Asato R, Tsujimura T, Hori R, Kumabe Y, Yasuda K, Tamaki H, Iki T, Kitani Y, Kurata K, Kojima T, Takata K, Kada S, Takebayashi S, Shinohara S, Hamaguchi K, Miyazaki M, Ikenaga T, Maetani T, Harada H, Haji T, Omori K. Local recurrence and metachronous multiple cancers after transoral nonrobotic surgery for pharyngeal and laryngeal squamous cell carcinoma: A retrospective multicenter study. Head Neck 2024; 46:118-128. [PMID: 37897205 DOI: 10.1002/hed.27564] [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: 08/08/2023] [Revised: 09/25/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Late laryngopharyngeal cancers after transoral surgery include not only local recurrences but also metachronous multiple cancers. METHODS We compared clinical information, surgical outcomes, and late laryngopharyngeal cancers in patients who underwent transoral nonrobotic surgery for laryngopharyngeal squamous cell carcinoma without lymph node metastases between 2015 and 2021 in a multicenter retrospective study. RESULTS Four hundred and fifty-seven patients were included. Positive surgical margins were found in 121 patients (26.5%). Twenty-two patients (4.8%) received additional treatment. Positive horizontal margins of invasive carcinoma (p = 0.003) and positive horizontal margins of carcinoma in situ only (p = 0.032) were independent risk factors for local recurrence, and prior radiotherapy (p = 0.001) for metachronous multiple cancers. Local control was significantly worse without additional treatment (p = 0.049), but there was no significant difference in survival. CONCLUSIONS Patients with positive margins had an increased frequency of local recurrence, but salvage therapy was effective.
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Affiliation(s)
- Koji Ushiro
- Department of Otolaryngology - Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Yoshiki Watanabe
- Department of Otolaryngology - Head & Neck Surgery, Japanese Red Cross Osaka Hospital, Osaka, Japan
| | - Yo Kishimoto
- Department of Otolaryngology - Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoshitaka Kawai
- Department of Otolaryngology - Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology - Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryo Asato
- Department of Otolaryngology - Head & Neck Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Tsujimura
- Department of Otolaryngology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Ryusuke Hori
- Department of Otolaryngology - Head and Neck Surgery, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Otolaryngology - Head & Neck Surgery, Fujita Health University, Toyoake, Japan
- Department of Otolaryngology - Head & Neck Surgery, Tenri Hospital, Tenri, Japan
| | - Yohei Kumabe
- Department of Otolaryngology - Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Kaori Yasuda
- Department of Otolaryngology - Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Hisanobu Tamaki
- Department of Otolaryngology - Head & Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takehiro Iki
- Department of Otolaryngology - Head & Neck Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yoshiharu Kitani
- Department of Otolaryngology - Head & Neck Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Keisuke Kurata
- Department of Otolaryngology - Head & Neck Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Tsuyoshi Kojima
- Department of Otolaryngology - Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Otolaryngology - Head & Neck Surgery, Tenri Hospital, Tenri, Japan
| | - Kuniaki Takata
- Department of Otolaryngology - Head & Neck Surgery, Tenri Hospital, Tenri, Japan
| | - Shinpei Kada
- Department of Otolaryngology - Head & Neck Surgery, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Shinji Takebayashi
- Department of Otolaryngology - Head & Neck Surgery, Shiga General Hospital, Moriyama, Japan
| | - Shogo Shinohara
- Department of Otolaryngology - Head & Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kiyomi Hamaguchi
- Department of Otolaryngology - Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Otolaryngology - Head & Neck Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Masakazu Miyazaki
- Department of Otolaryngology - Head & Neck Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Tadashi Ikenaga
- Department of Otolaryngology - Head & Neck Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Toshiki Maetani
- Department of Otolaryngology - Head & Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Hiroyuki Harada
- Department of Otolaryngology - Head & Neck Surgery, Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tomoyuki Haji
- Department of Otolaryngology - Head & Neck Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Koichi Omori
- Department of Otolaryngology - Head & Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Limkin E, Blanchard P, Lacas B, Bourhis J, Parmar M, Licitra L, Le QT, Yom SS, Fortpied C, Langendijk J, Vermorken JB, Bernier J, Overgaard J, Harris J, Pignon JP, Auperin A. Season of radiotherapy and outcomes of head & neck cancer patients in the MACH-NC & MARCH meta-analyses. Radiother Oncol 2024; 190:110011. [PMID: 37956890 PMCID: PMC11253287 DOI: 10.1016/j.radonc.2023.110011] [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: 08/25/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND A single institution retrospective study suggested that head and neck squamous cell cancer (HNSCC) patients receiving radiotherapy (RT) during "dark" season (fall/winter) may have better outcomes than those treated during "light" season (spring/summer), possibly secondary to seasonal variations in cell cycle progression. We investigated the impact of season of RT in two large, multi-institutional, prospective datasets of randomized trials. METHODS Individual patient data from the MACH-NC and MARCH meta-analyses were analyzed. Dark season was defined as mid-radiotherapy date during fall or winter and light the reverse, using equinoxes to separate the two periods. Primary endpoint was progression-free survival (PFS) and secondary endpoint was locoregional failure (LRF). The effect of season was estimated with a Cox model stratified by trial and adjusted on sex, tumor site, stage, and treatment. Planned sensitivity analyses were performed on patients treated around solstices, who received "complete radiotherapy", patients treated with concomitant radio-chemotherapy and on trials performed in Northern countries. RESULTS 11320 patients from 33 trials of MARCH and 6276 patients from 29 trials of MACH-NC were included. RT during dark season had no benefit on PFS in the MARCH (hazard ratio[HR]: 1.01 [95%CI 0.97;1.05],p=0.72) or MACH-NC dataset (HR:1.00 [95%CI 0.94;1.06],p=1.0. No difference in LRF was observed in the MARCH (HR:1.00 [95%CI 0.94;1.06,p=0.95) or MACH-NC dataset (HR:0.99 [95%CI 0.91; 1.07],p=0.77). Sensitivity analyses showed similar results. CONCLUSION Season of RT had no impact on PFS or LRF in two large databases of HNSCC.
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Affiliation(s)
- Elaine Limkin
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave-Roussy, Villejuif, France
| | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave-Roussy, Villejuif, France; Oncostat U1018 INSERM, Labeled Ligue Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France.
| | - Benjamin Lacas
- Oncostat U1018 INSERM, Labeled Ligue Contre le Cancer, Villejuif, France; Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave-Roussy, Villejuif, France
| | - Jean Bourhis
- Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France; CHUV, Lausanne, Switzerland
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Lisa Licitra
- Fondazione IRCCS Istituto Tumori Milan and University of Milan, Italy
| | - Quynh-Thu Le
- Stanford University School of Medicine, Stanford, CA, USA; NRG Oncology, Philadelphia, PA, USA
| | | | | | | | | | | | | | | | - Jean-Pierre Pignon
- Oncostat U1018 INSERM, Labeled Ligue Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France; Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave-Roussy, Villejuif, France
| | - Anne Auperin
- Oncostat U1018 INSERM, Labeled Ligue Contre le Cancer, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France; Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, Université Paris-Saclay, Gustave-Roussy, Villejuif, France
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18
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Macchia G, Lancellotta V, Ferioli M, Casà C, Pezzulla D, Pappalardi B, Laliscia C, Ippolito E, Di Muzio J, Huscher A, Tortoreto F, Boccardi M, Lazzari R, Perrone AM, Raspagliesi F, Gadducci A, Garganese G, Fragomeni SM, Ferrandina G, Morganti AG, Gambacorta MA, Tagliaferri L. Definitive chemoradiation in vulvar squamous cell carcinoma: outcome and toxicity from an observational multicenter Italian study on vulvar cancer (OLDLADY 1.1). LA RADIOLOGIA MEDICA 2024; 129:152-159. [PMID: 37700153 PMCID: PMC10808465 DOI: 10.1007/s11547-023-01712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Vulvar carcinoma is a rather uncommon gynecological malignancy affecting elderly women and the treatment of loco-regional advanced carcinoma of the vulva (LAVC) is a challenge for both gynecologic and radiation oncologists. Definitive chemoradiation (CRT) is the treatment of choice, but with disappointing results. In this multicenter study (OLDLADY-1.1), several institutions have combined their retrospective data on LAVC patients to produce a real-world dataset aimed at collecting data on efficacy and safety of CRT. METHODS The primary study end-point was 2-year-local control (LC), secondary end-points were 2-year-metastasis free-survival (MFS), 2-year-overall survival (OS) and the rate and severity of acute and late toxicities. Participating centers were required to fill data sets including age, stage, histology, grading as well as technical/dosimetric details of CRT. Data about response, local and regional recurrence, acute and late toxicities, follow-up and outcome measures were also collected. The toxicity was a posteriori documented through the Common Terminology Criteria for Adverse Events version 5 scale. RESULTS Retrospective analysis was performed on 65 patients with primary or recurrent LAVC treated at five different radiation oncology institutions covering 11-year time interval (February 2010-November 2021). Median age at diagnosis was 72 years (range 32-89). With a median follow-up of 19 months (range 1-114 months), 2-year actuarial LC, MFS and OS rate were 43.2%, 84.9% and 59.7%, respectively. In 29 patients (44%), CRT was temporarily stopped (median 5 days, range 1-53 days) due to toxicity. The treatment interruption was statistically significant at univariate analysis of factors predicting LC (p: 0.05) and OS rate (p: 0.011), and it was confirmed at the multivariate analysis for LC rate (p: 0.032). In terms of toxicity profile, no G4 event was recorded. Most adverse events were reported as grade 1 or 2. Only 14 acute G3 toxicities, all cutaneous, and 7 late G3 events (3 genitourinary, 3 cutaneous, and 1 vaginal stenosis) were recorded. CONCLUSION In the context of CRT for LAVC, the present study reports encouraging results even if there is clearly room for further improvements, in terms of both treatment outcomes, toxicity and treatment interruption management.
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Affiliation(s)
- Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Valentina Lancellotta
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy.
| | - Martina Ferioli
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Calogero Casà
- UOC Di Radioterapia Fatebenefratelli Isola Tiberina. Gemelli Isola, Rome, Italy
| | - Donato Pezzulla
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Brigida Pappalardi
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Concetta Laliscia
- Division of Radiation Oncology, Department of New Technologies and Translational Research, University of Pisa, Pisa, Italy
| | - Edy Ippolito
- Radiation Oncology, Università Campus Bio-Medico, Rome, Italy
| | - Jacopo Di Muzio
- Dipartimento Di Oncologia P.O. S. Anna - SS Radioterapia, A.O.U "Città Della Salute E Della Scienza", Turin, Italy
| | - Alessandra Huscher
- Fondazione Poliambulanza, U.O. Di Radioterapia Oncologica "Guido Berlucchi", Brescia, Italy
| | - Francesca Tortoreto
- UOC Di Radioterapia Fatebenefratelli Isola Tiberina. Gemelli Isola, Rome, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100, Campobasso, Italy
| | - Roberta Lazzari
- Division of Radiotherapy, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Anna Myriam Perrone
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | | | - Angiolo Gadducci
- Division of Gynecology and Obstetrics, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgia Garganese
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
- Dipartimento Scienze Della Vita E Sanità Pubblica, Sezione Di Ginecologia Ed Ostetricia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Simona Maria Fragomeni
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Gabriella Ferrandina
- Dipartimento Scienze Della Salute Della Donna, del bambino e Di Sanità Pubblica, UOC Ginecologia Oncologica,, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Maria Antonietta Gambacorta
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore Sede Di Roma, 00168, Rome, Italy
| | - Luca Tagliaferri
- Dipartimento Di Diagnostica Per Immagini, Radioterapia Oncologica Ed Ematologia, UOC Radioterapia Oncologica, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168, Rome, Italy
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19
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Agarwal S, Jaiswal I, Shahi UP, Mandal A, Aggarwal LM, Singh A, Jaiswal A, Yadawa N. Accelerated hypofractionated chemoradiation for locally advanced head and neck cancer during COVID 19 pandemic: A tertiary care experience. J Cancer Res Ther 2024; 20:404-409. [PMID: 38554353 DOI: 10.4103/jcrt.jcrt_1747_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 12/08/2022] [Indexed: 04/01/2024]
Abstract
PURPOSE To assess the role of Accelerated Hypofractionated Chemoradiation for Locally Advanced Head & Neck squamous cell cancer (HNSCC) during COVID 19 pandemic. MATERIALS AND METHODS Previously untreated 20 patients with locally advanced HNSCC (Oral cavity/oropharynx/larynx/hypopharynx) were treated with definitive hypofractionated radiotherapy of 60Gy in 25 fractions with concurrent cisplatin @35 mg/m2 once weekly for 5 weeks from March 2020 to November 2021. The patients were treated on 6MV LINAC with Volumetric modulated arc therapy (VMAT) by the Sequential boost technique and concurrent chemotherapy @35 mg/m2. All the patients received 48Gy in 20 fractions to low-risk volume (CTV LR) in Phase I followed by 12Gy in 5 fractions boost to High-risk volume (CTV HR) in Phase II. The organs at risk (OARs) were contoured and appropriate constraints were given considering the hypofractionated regimen. RESULTS Out of 20 patients, most of the patients were Stage IV (15;75%) & stage III 20%, out of which (55%) 11 were of the oral cavity, (40%) 8 were of the oropharynx, and (5%) 1 of larynx. All patients were treated with 60Gy/25#/5 weeks with the majority of the patients (17;85%) completing their treatment in less than 45 days. The Median follow-up was of 214 days. The locoregional control at 6 Months was 55%. Maximum acute toxicity was grade 3 mucositis which was observed in 18 (90%) patients. Ryle's tube feeding was needed in 11 (55%) patient. Out of 20 patients, 5 patients did not receive concurrent chemotherapy, and 8 (40%) patients received all 5 cycles of chemotherapy. 7, 35% of the patients could not complete all 5 cycles of concurrent chemotherapy due to grade 3 mucositis. CONCLUSION During a pandemic crisis with limited manpower & technical resources accelerated hypofractionated radiotherapy with concurrent chemotherapy can be considered a feasible therapeutic option for HNSCC which can significantly reduce the overall Treatment Time (OTT) with comparable local control and manageable toxicities.
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Affiliation(s)
- Sumit Agarwal
- Department of Radiotherapy, AIIMS, Patna, Bihar, India
| | - Isha Jaiswal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Uday P Shahi
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Abhijit Mandal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Lalit M Aggarwal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ankita Singh
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anil Jaiswal
- Department of Radiotherapy and Radiation Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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20
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Bollen H, Gulyban A, Nuyts S. Impact of consensus guidelines on delineation of primary tumor clinical target volume (CTVp) for head and neck cancer: Results of a national review project. Radiother Oncol 2023; 189:109915. [PMID: 37739317 DOI: 10.1016/j.radonc.2023.109915] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/31/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE A significant interobserver variability (IOV) for clinical target volume of the primary tumor (CTVp) delineation was shown in a previous national review project. Since then, international expert consensus guidelines (CG) for the delineation of CTVp were published. The aim of this follow-up study was to 1) objectify the extent of implementation of the CG, 2) assess its impact on delineation quality and consistency, 3) identify any remaining ambiguities. MATERIALS AND METHODS All Belgian RT departments were invited to complete an online survey and submit CTVp for 5 reference cases. Organs at risk and GTV of the primary tumor were predefined. Margins, volumes, IOV between all participating centers (IOVall) and IOV compared to a reference consensus delineation (IOVref) were calculated and compared to the previous analysis. A qualitative analysis was performed assessing the correct interpretation of the CG for each case. RESULTS 17 RT centers completed both survey and delineations, of which 88% had implemented CG. Median DSCref for CTVp_total was 0.80-0.92. IOVall and IOVref improved significantly for the centers following CG (p = 0.005). IOVref for CTVp_high was small with a DSC higher than 0.90 for all cases. A significant volume decrease for the CTVp receiving 70 Gy was observed. Interpretation of CG was more accurate for (supra)glottic carcinoma. 60% of the radiation oncologists thinks clarification of CG is indicated. CONCLUSION Implementation of consensus guidelines for CTVp delineation is already fairly advanced on a national level, resulting in significantly increased delineation uniformity. The accompanying substantial decrease of CTV receiving high dose RT calls for caution and correct interpretation of CG. Clarification of the existing guidelines seems appropriate especially for oropharyngeal and hypopharyngeal carcinoma.
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Affiliation(s)
- Heleen Bollen
- KU Leuven, Dept. Oncology, Laboratory of Experimental Radiotherapy, & UZ Leuven, Radiation Oncology, B-3000, Leuven, Belgium.
| | - Akos Gulyban
- Medical Physics department, Institut Jules Bordet, Brussels, Belgium; Radiophysics and MRI physics laboratory, Faculty of Medicine, Free University of Bruxelles (ULB), Brussels, Belgium
| | - Sandra Nuyts
- KU Leuven, Dept. Oncology, Laboratory of Experimental Radiotherapy, & UZ Leuven, Radiation Oncology, B-3000, Leuven, Belgium
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21
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Balchander D, Shorbaji K, Cabrera CI, Hoying D, Clancy K, Fowler N, Thuener JE, Lavertu P, Pan Q, Teknos TN, Rezaee RP, Li S, Tamaki A. Prognostic significance of time trends in treatment of head and neck squamous cell carcinoma. Am J Otolaryngol 2023; 44:103966. [PMID: 37481899 DOI: 10.1016/j.amjoto.2023.103966] [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: 03/10/2023] [Revised: 06/19/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To analyze the impact of demographic, clinical, and management variables on time to treatment initiation (TTI) and overall survival (OS). STUDY DESIGN Retrospective chart review. MATERIALS AND METHODS Medical records of patients diagnosed with head and neck cancer from 2018 to 2020 were reviewed. Univariate linear and Cox-regressions identified predictors of TTI and OS. Kaplan Meier (KM) curves assessed the difference in survival by diagnostic year and TTI. RESULTS 381 patients met eligibility criteria. Median TTI was 35.0 days (IQR: 25.0-49.0). Only 10.8 % of all patients reported any treatment delay, with TTI exceeding 90 days found in 3.7 % of patients. TTI increased with African American race (p = 0.02), ED referrals (p = 0.02), and direct admission status (p = 0.01). When compared to treatment with surgery alone, TTI was shorter in patients undergoing surgery with adjuvant radiation (p = 0.02), adjuvant chemoradiation (p = 0.04), and salvage surgery (p = 0.04). Univariate Cox-regressions found smoking (p = 0.01), direct admission status (p = 0.02), increased duration of symptoms (p = 0.02), placement of PEG tubes (p < 0.01) and tracheostomies (p < 0.01), combination treatment (p < 0.01), and surgery with adjuvant chemoradiation treatment (p = 0.01) to increase mortality risk. Disease characteristics, including tumor size (p < 0.01), presence of nodal disease (p = 0.02), and late-stage disease (p < 0.01), increased mortality risk. TTI and diagnostic year did not impact survival. CONCLUSIONS Our analysis determined several demographic, referral, and treatment factors impacted TTI. However, increased TTI did not impact survival. Characteristics consistent with advanced disease worsened OS. Despite the pandemic burden, patients diagnosed in 2020 showed no difference in short-term survival compared to prior years.
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Affiliation(s)
| | - Khaled Shorbaji
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Claudia I Cabrera
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Hoying
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kate Clancy
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicole Fowler
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jason E Thuener
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Pierre Lavertu
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Quintin Pan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Theodoros N Teknos
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rod P Rezaee
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Shawn Li
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Akina Tamaki
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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22
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Babu G, Ravikumar R, Rafi M, Sharafuddin Z, Shankar SA, George PS, Kainickal CT, Kunnambath R. Carcinoma buccal mucosa treated with definitive hypofractionated accelerated radiotherapy: a retrospective analysis of treatment outcomes. Singapore Med J 2023:384047. [PMID: 37675674 DOI: 10.4103/singaporemedj.smj-2021-282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Introduction Oral cancer is a major public health concern in India. Both conventional and altered fractionation radiotherapy schedules have been used in curative treatment of oral cancer. This study aimed to retrospectively evaluate the clinical profile and treatment outcomes of patients with carcinoma buccal mucosa who underwent treatment with definitive hypofractionated accelerated radiotherapy. Methods A total of 517 patients treated from January 2011 to December 2016 were eligible for the analysis. All patients were treated with definitive hypofractionated accelerated radiotherapy schedule of 5,250 cGy in 15 fractions over 3 weeks. Survival estimates were generated using the Kaplan-Meier method. Results At a median follow-up of 77.4 months, 473 (91.5%) patients attained complete remission with radiation therapy. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 69% and 80.5%, respectively. The 5-year OS for stage I, II, III and IVa tumours was 80.3%, 84.4%, 81.4% and 73.7%, respectively, and the DFS was 75.7%, 73.2%, 69.6% and 60.2%, respectively. Age >50 years was found to be a significant factor affecting DFS (P = 0.026) and OS (P = 0.048) in multivariate analysis. Fifty-three (10.3%) patients developed osteoradionecrosis of the mandible. Conclusion Excellent outcome could be achieved in less-aggressive, low-volume carcinoma of the buccal mucosa with radical accelerated hypofractionated radiotherapy. A radiotherapy schedule over a 3-week period is useful in high-volume centres.
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Affiliation(s)
- Geethu Babu
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Rejnish Ravikumar
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Zuzaki Sharafuddin
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - S Arun Shankar
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Preethi Sara George
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India
| | | | - Ramadas Kunnambath
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
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23
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Huang CH, Peng TC, Chou YF, Peng YH. Investigating sarcopenia, physical activity, and inflammation biomarkers in newly diagnosed oral cancer patients during curative treatment: A prospective longitudinal study. Asia Pac J Oncol Nurs 2023; 10:100261. [PMID: 37497155 PMCID: PMC10365980 DOI: 10.1016/j.apjon.2023.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/07/2023] [Indexed: 07/28/2023] Open
Abstract
Objective This prospective longitudinal study aimed to investigate changes in sarcopenia, physical activity, and inflammation biomarkers in patients with oral cavity cancer during curative treatment and explore their association with treatment outcomes. Methods Patients newly diagnosed with oral cavity cancer who underwent primary surgery with (chemo)radiation therapy were included. Along with physical activity and inflammatory markers, sarcopenia was assessed using a 5-time chair stand test, hand grip strength, and skeletal muscle index (SMI). Data were collected before operation and after 3 months (T2) and 6 months after operation. Logistic regression and Cox proportional hazards models were used to identify predictors of treatment outcomes. Results Out of 56 patients, 21 (37.5%) had sarcopenia. SMI score, physical activity, and neutrophil-to-lymphocyte ratio (NLR) showed significant changes after surgery, with exacerbation at T2. Patients with sarcopenia exhibited a significant decrease in SMI scores at T2. Advanced cancer stage and sarcopenia were associated with treatment-related dysphagia (odds ratio [OR] = 3.01, P = 0.034; OR = 7.62, P = 0.018). Sarcopenia (OR = 3.02, P = 0.002) and NLR (OR = 5.38, P < 0.001) were significantly associated with infections. Pretreatment SMI independently predicted poor survival outcomes (hazard ratio = 7.00, P = 0.005). Conclusions Identifying patients with oral cavity cancer, sarcopenia, and high NLR levels can ensure prompt education and vigilant monitoring, potentially improving treatment outcomes and patient well-being during curative treatment.
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Affiliation(s)
- Chun-Hou Huang
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
| | - Tai-Chu Peng
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
| | - Yu-Fu Chou
- Department of Otolaryngology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yun-Hsin Peng
- Department of Nursing, Tzu Chi University, Hualien, Taiwan
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24
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Rades D, Zwaan I, Idel C, Pries R, Bruchhage KL, Hakim SG, Yu NY, Soror T. A New Prognostic Instrument for Predicting the Probability of Completion of Cisplatin during Chemoradiation for Head and Neck Cancer. J Pers Med 2023; 13:1120. [PMID: 37511733 PMCID: PMC10381843 DOI: 10.3390/jpm13071120] [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: 06/21/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Many head and neck cancer patients assigned to definitive or adjuvant chemoradiation treatment do not complete the concurrent cisplatin dose. We determined corresponding risk factors and developed a prognostic instrument to help identify these patients. Ten pre-treatment characteristics were retrospectively analyzed in 154 patients with head and neck cancer who were treated via chemoradiation with cisplatin. These pre-treatment characteristics included age, sex, Karnofsky performance score, tumor site, primary tumor stage, nodal stage, histologic grade, upfront surgery, human papilloma virus status, and history of smoking. The characteristics significantly associated with the completion of cisplatin-based treatment, the receipt of ≥80% cisplatin, or showing a strong trend of association after multivariate analyses were used for the prognostic instrument. For each characteristic, 0 points were assigned for worse outcomes, and 1 point was assigned for better outcomes. Patients' scores were calculated by adding these points. Age ≤ 60 years and a Karnofsky performance score of 90-100 were significantly associated with both endpoints after multivariate analysis, and male gender showed a trend for association with the receipt of ≥80% cisplatin. Patient scores were 0, 1, 2, and 3 points. The corresponding rates of completion of cisplatin-based treatment were 14%, 41%, 62%, and 72%, respectively (p = 0.004). The rates of receipt of ≥80% cisplatin were 29%, 54%, 72%, and 94%, respectively (p < 0.001). This new prognostic instrument helps to predict whether head and neck cancer patients scheduled for chemoradiation will receive cisplatin as planned.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Inga Zwaan
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Christian Idel
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Ralph Pries
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Karl L Bruchhage
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, University of Lubeck, 23562 Lubeck, Germany
| | - Samer G Hakim
- Department of Oral and Maxillofacial Surgery, University of Lubeck, 23562 Lubeck, Germany
- Department of Oral and Maxillofacial Surgery, MSH Medical School Hamburg, Schwerin Campus, 19055 Schwerin, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ 85054, USA
| | - Tamer Soror
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
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Das SM, Roy N, Singh D, Sardar PK, Das S. A Comparative Prospective Study Between Conventional Chemo-Radiotherapy and Pure Accelerated Radiotherapy With Concurrent Chemotherapy for the Treatment of Locally Advanced Head and Neck Cancer. Cureus 2023; 15:e42206. [PMID: 37602000 PMCID: PMC10439807 DOI: 10.7759/cureus.42206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND The established standard treatment for locally advanced head and neck squamous cell carcinoma is concurrent chemoradiotherapy, but the optimum radiotherapy schedule for best disease control and acceptable toxicity is still evolving. Tumor control probability decreases with each day's prolongation of treatment time. Shortening the overall treatment time of radiation by pure accelerated radiotherapy may be a good option. MATERIAL AND METHODS One hundred and sixty-five patients with histopathologically proven squamous cell carcinoma of the head and neck were included in the study and were assigned into two groups from January 2017 to June 2019. The total dose of 70 Gy was given, 2 Gy/fraction/day. Treatment was given five days a week (conventional radiotherapy) and six days a week (pure accelerated radiotherapy). Both groups received weekly concurrent injections of cisplatin. RESULTS The stage (p=0.006) and fractionation of radiation (p=0.018) were the independent factors affecting disease-free survival (DFS). There was a statistically significant difference (p=0.019) in the recurrence of patients in different fractionation schedules. The median DFS was 39 months with a 95% CI of 31.44 - 46.55. One- and three-year DFS was 51% and 8.5% respectively in the five fractions/week schedule arm while 54.5% and 9.5% respectively in the six fractions/week schedule group. CONCLUSION Pure accelerated radiotherapy is more efficacious in terms of disease control with comparable mildly increased acute side effects.
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Affiliation(s)
- Sumana M Das
- Department of Radiotherapy, Radha Gobinda (RG) Kar Medical College and Hospital, Kolkata, IND
| | - Niladri Roy
- Department of Radiotherapy, Medical College and Hospital, Kolkata, IND
| | - Dharmendra Singh
- Department of Radiotherapy, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | | | - Siddhartha Das
- Department of Physiology, Diamond Harbour Government Medical College, Diamond Harbour, IND
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Sutera P, Skinner H, Witek M, Mishra M, Kwok Y, Davicioni E, Feng F, Song D, Nichols E, Tran PT, Bergom C. Histology Specific Molecular Biomarkers: Ushering in a New Era of Precision Radiation Oncology. Semin Radiat Oncol 2023; 33:232-242. [PMID: 37331778 PMCID: PMC10446901 DOI: 10.1016/j.semradonc.2023.03.001] [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] [Indexed: 06/20/2023]
Abstract
Histopathology and clinical staging have historically formed the backbone for allocation of treatment decisions in oncology. Although this has provided an extremely practical and fruitful approach for decades, it has long been evident that these data alone do not adequately capture the heterogeneity and breadth of disease trajectories experienced by patients. As efficient and affordable DNA and RNA sequencing have become available, the ability to provide precision therapy has become within grasp. This has been realized with systemic oncologic therapy, as targeted therapies have demonstrated immense promise for subsets of patients with oncogene-driver mutations. Further, several studies have evaluated predictive biomarkers for response to systemic therapy within a variety of malignancies. Within radiation oncology, the use of genomics/transcriptomics to guide the use, dose, and fractionation of radiation therapy is rapidly evolving but still in its infancy. The genomic adjusted radiation dose/radiation sensitivity index is one such early and exciting effort to provide genomically guided radiation dosing with a pan-cancer approach. In addition to this broad method, a histology specific approach to precision radiation therapy is also underway. Herein we review select literature surrounding the use of histology specific, molecular biomarkers to allow for precision radiotherapy with the greatest emphasis on commercially available and prospectively validated biomarkers.
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Affiliation(s)
- Philip Sutera
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Heath Skinner
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew Witek
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Mark Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Young Kwok
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Felix Feng
- Departments of Radiation Oncology, Medicine and Urology, UCSF, San Francisco, CA, USA
| | - Daniel Song
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth Nichols
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Phuoc T. Tran
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA
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Xu Q, Huang S, Yang K. Combination immunochemotherapy for recurrent or metastatic head and neck squamous cell carcinoma: a systematic review and meta-analysis. BMJ Open 2023; 13:e069047. [PMID: 37311638 DOI: 10.1136/bmjopen-2022-069047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of combination immunochemotherapy regimens for the treatment of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC). DESIGN Meta-analysis and systematic review. DATA SOURCES PubMed, Embase, Web of Science and Cochrane library and the Clinicaltrials.gov clinical trials registry were searched up to 14 March 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trials that compared combination immunochemotherapy with conventional chemotherapy for R/M HNSCC. Primary outcomes of interest were overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and adverse effects (AEs). DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed the risk of bias of the included studies. The HR and its 95% CI were used as the effect analysis statistic for survival analysis, while the OR and its 95% CI were used as the effect analysis statistic for dichotomous variables. These statistics were extracted by the reviewers and aggregated using a fixed-effects model to synthesise the data. RESULTS A total of 1214 relevant papers were obtained after the initial search, and five papers that met the inclusion criteria were included; these studies included a total of 1856 patients with R/M HNSCC. Meta-analysis showed that the OS and PFS of patients with R/M HNSCC in the combination immunochemotherapy group were significantly longer than those in the conventional chemotherapy group (HR=0.84; 95% CI 0.76, 0.94; p=0.002; HR=0.67; 95% CI 0.61, 0.75; p<0.0001), and the ORR was significantly higher (OR=1.90; 95% CI 1.54, 2.34; p<0.00001). The analysis of AEs showed that there was no significant difference in the overall incidence rate of AEs between two groups (OR=0.80; 95% CI 0.18, 3.58; p=0.77), but the rate of grade III and IV AEs was significantly higher in patients in the combination immunochemotherapy group (OR=1.39; 95% CI 1.12, 1.73; p=0.003). CONCLUSIONS Combination immunochemotherapy prolonged OS and PFS in patients with R/M HNSCC and improved the ORR; while this approach did not increase the overall incidence of AEs in patients, it increased the rate of grade III and IV AEs. PROSPERO REGISTRATION NUMBER CRD42022344166.
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Affiliation(s)
- Qiudong Xu
- Department of Oral and Maxillofacial Surgery, Wuxi Stomatology Hospital, Wuxi, China
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shuang Huang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Yang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Choi JC, Kang JH, Kim DW, Park CW. Preparation and Evaluation of Inhalable Amifostine Microparticles Using Wet Ball Milling. Pharmaceutics 2023; 15:1696. [PMID: 37376145 DOI: 10.3390/pharmaceutics15061696] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/21/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The conventional dosage form of Ethyol® (amifostine), a sterile lyophilized powder, involves reconstituting it with 9.7 mL of sterile 0.9% sodium chloride in accordance with the United States Pharmacopeia specifications for intravenous infusion. The purpose of this study was to develop inhalable microparticles of amifostine (AMF) and compare the physicochemical properties and inhalation efficiency of AMF microparticles prepared by different methods (jet milling and wet ball milling) and different solvents (methanol, ethanol, chloroform, and toluene). Inhalable microparticles of AMF dry powder were prepared using a wet ball-milling process with polar and non-polar solvents to improve their efficacy when delivered through the pulmonary route. The wet ball-milling process was performed as follows: AMF (10 g), zirconia balls (50 g), and solvent (20 mL) were mixed and placed in a cylindrical stainless-steel jar. Wet ball milling was performed at 400 rpm for 15 min. The physicochemical properties and aerodynamic characteristics of the prepared samples were evaluated. The physicochemical properties of wet-ball-milled microparticles (WBM-M and WBM-E) using polar solvents were confirmed. Aerodynamic characterization was not used to measure the % fine particle fraction (% FPF) value in the raw AMF. The % FPF value of JM was 26.9 ± 5.8%. The % FPF values of the wet-ball-milled microparticles WBM-M and WBM-E prepared using polar solvents were 34.5 ± 0.2% and 27.9 ± 0.7%, respectively; while the % FPF values of the wet-ball-milled microparticles WBM-C and WBM-T prepared using non-polar solvents were 45.5 ± 0.6% and 44.7 ± 0.3%, respectively. Using a non-polar solvent in the wet ball-milling process resulted in a more homogeneous and stable crystal form of the fine AMF powder than using a polar solvent.
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Affiliation(s)
- Jae-Cheol Choi
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea
| | - Ji-Hyun Kang
- School of Pharmacy, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Dong-Wook Kim
- College of Pharmacy, Wonkwang University, Iksan 54538, Republic of Korea
| | - Chun-Woong Park
- College of Pharmacy, Chungbuk National University, Cheongju 28160, Republic of Korea
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Abdelhafiz N, Mahmoud D, Gad M, Essa H, Morsy A. Effect of definitive hypo-fractionated radiotherapy concurrent with weekly cisplatin in locally advanced squamous cell carcinoma of the head and neck. J Med Life 2023; 16:743-750. [PMID: 37520484 PMCID: PMC10375354 DOI: 10.25122/jml-2023-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 04/11/2023] [Indexed: 08/01/2023] Open
Abstract
To mitigate the risk of COVID-19 infection in cancer patients, it is recommended to utilize hypo-fractionated treatment schedules that aim to minimize the overall duration of treatment. In this study, we aimed to determine whether hypo-fractionated intensity-modulated radiotherapy (hypo-IMRT) with concurrent chemotherapy was practical, effective, and could achieve acceptable tumor control rates for squamous cell carcinoma of the head and neck (SCCHN). We enrolled 62 patients with high-risk stage II, stage III, and IVA SCCHN who received hypo-IMRT (62.5 Gy in 25 fractions over 5 weeks 2.5Gy/fraction with weekly cisplatin 40 mg/m2). Our primary endpoint was to assess acute toxicity, while our secondary endpoints were late toxicity, loco-regional control, disease-free survival, and overall survival. The percentages of grade 3 acute pain, dermatitis, mucositis, and dysphagia were 71%, 19.4%, 72.6%, and 41.9%, respectively. The rates of late xerostomia, dysphagia, dental complications, grade 3 pain, and grade 3 weight loss were 72.6%, 62.9%, 27.4%, 4.8%, and 4.3%, respectively. At a median follow-up time of 24 months, 2-year loco-regional control and overall survival were 87.1% and 83.9%, respectively. Disease-free survival was 100%, 89.5%, and 69% in stages II, III, and IV%, respectively, with a significant p-value of 0.024. This regimen was effective and relatively safe, with acceptable and tolerable acute and late toxicity. Given the reduced need for hospital visits, hypo-fractionated schedules may represent an alternative treatment during the COVID-19 outbreak.
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Affiliation(s)
- Nora Abdelhafiz
- Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Doaa Mahmoud
- Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Clinical Oncology, Saudi German Hospital Aseer, Khamis Mushait, Saudi Arabia
| | - Mohamed Gad
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hoda Essa
- Department of Clinical Oncology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Aiat Morsy
- Department of Radiotherapy and Nuclear Medicine, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
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30
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Morris BB, Hughes R, Fields EC, Sabo RT, Weaver KE, Fuemmeler BF. Sociodemographic and Clinical Factors Associated With Radiation Treatment Nonadherence and Survival Among Rural and Nonrural Patients With Cancer. Int J Radiat Oncol Biol Phys 2023; 116:28-38. [PMID: 35777674 PMCID: PMC9797617 DOI: 10.1016/j.ijrobp.2022.06.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 06/02/2022] [Accepted: 06/10/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Cancer treatment nonadherence is associated with higher rates of cancer recurrence and decreased survival. Rural patients with cancer experience a 10% higher mortality rate compared with their nonrural counterparts; geographic differences in nonadherence may contribute to this increased mortality. The goal of this study was to assess for geographic disparities and determine sociodemographic and clinical factors associated with radiation therapy (RT) nonadherence and survival among rural and nonrural patients with cancer. METHODS AND MATERIALS We examined cancer registry, medical records, and billing claims data at a safety net academic medical center. Geographic residence was defined as rural versus nonrural by US Department of Agriculture 2013 Rural-Urban Continuum Codes. Other factors assessed were age, sex, race, marital status, insurance type, employment, area median household income, residential distance to cancer treatment center, clinical stage, cancer type, treatment modality, total radiation dose received, and radiation dose per fraction. We used Cox proportional hazards modeling to examine 7 ways of operationalizing nonadherence and selected the definition that resulted in the best model fit statistics and prediction of mortality. Overall survival rates were estimated with the Kaplan-Meier method. We then examined nonadherence as the main exposure along with additional covariates in least absolute shrinkage and selection operator penalized survival analyses and as the outcome in our multivariable generalized linear regression analyses predicting nonadherence. We considered 2-way interaction terms with the main exposure, geographic residence. RESULTS We identified 3,077 patients with cancer who averaged 62 years old, were 59% female, 34% Black, and 14% rural. Twenty-two percent of patients missed at least 2 fractions and missed an average of 10% of their treatment plan. Rural patients experienced a higher mortality rate than nonrural patients (53% vs 42%, P < .0001). Survival was assessed through December 31, 2021, with a mean follow-up of 4.5 years. Proportion of missed fractions as the indicator of nonadherence provided the best model fit statistics and prediction of survival. Marital status, employment status, tumor, nodes, metastases stage, cancer type, and age at diagnosis significantly affected survival, in addition to a treatment delay by geographic residence interaction effect. Specifically, patients residing in rural areas who experienced a treatment delay were more than twice as likely to die as nonrural residents who also experienced a treatment delay, and nearly twice as likely to die as rural residents who did not experience a treatment delay. The 2-year survival rate was 76% for nonrural residents who did not experience a treatment delay versus 27% for rural residents who experienced a treatment delay. Patients who were widowed, had stage 4 cancer, or lung cancer were more likely to be nonadherent. Finally, patients residing in rural areas who experienced a treatment delay were more likely to subsequently be nonadherent. CONCLUSIONS In a geographically and racially diverse population, RT nonadherence is a significant concern that affects survival, yet it is a modifiable risk factor. We demonstrated that rural residence was associated with both RT nonadherence and poorer overall survival. Rural patients with a treatment delay had the lowest overall survival, compared with both nonrural survivors and rural survivors without delay. Rural residents who are delayed in starting treatment are at heightened risk for poor outcomes and should receive targeted support to mitigate the observed disparities. Additional patient populations that may benefit from targeted treatment adherence support include widowed patients and those with stage 4 cancer or lung cancer.
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Affiliation(s)
- Bonny B Morris
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, Virginia.
| | - Ryan Hughes
- Wake Forest School of Medicine, Department of Radiation Oncology, Winston-Salem, North Carolina
| | - Emma C Fields
- Virginia Commonwealth University School of Medicine, Department of Radiation Oncology, Richmond, Virginia
| | - Roy T Sabo
- Virginia Commonwealth University School of Medicine, Department of Biostatistics, Richmond, Virginia
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Departments of Social Sciences and Health Policy & Implementation Science, Winston-Salem, North Carolina
| | - Bernard F Fuemmeler
- Virginia Commonwealth University School of Medicine, Department of Health Behavior and Policy, Richmond, Virginia
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31
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Hallemeier CL, Moughan J, Haddock MG, Herskovic AM, Minsky BD, Suntharalingam M, Zeitzer KL, Garg MK, Greenwald BD, Komaki RU, Puckett LL, Kim H, Lloyd S, Bush DA, Kim HE, Lad TE, Meyer JE, Okawara GS, Raben A, Schefter TE, Barker JL, Falkson CI, Videtic GMM, Jacob R, Winter KA, Crane CH. Association of Radiotherapy Duration With Clinical Outcomes in Patients With Esophageal Cancer Treated in NRG Oncology Trials: A Secondary Analysis of NRG Oncology Randomized Clinical Trials. JAMA Netw Open 2023; 6:e238504. [PMID: 37083668 PMCID: PMC10122174 DOI: 10.1001/jamanetworkopen.2023.8504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/02/2023] [Indexed: 04/22/2023] Open
Abstract
Importance For many types of epithelial malignant neoplasms that are treated with definitive radiotherapy (RT), treatment prolongation and interruptions have an adverse effect on outcomes. Objective To analyze the association between RT duration and outcomes in patients with esophageal cancer who were treated with definitive chemoradiotherapy (CRT). Design, Setting, and Participants This study was an unplanned, post hoc secondary analysis of 3 prospective, multi-institutional phase 3 randomized clinical trials (Radiation Therapy Oncology Group [RTOG] 8501, RTOG 9405, and RTOG 0436) of the National Cancer Institute-sponsored NRG Oncology (formerly the National Surgical Adjuvant Breast and Bowel Project, RTOG, and Gynecologic Oncology Group). Enrolled patients with nonmetastatic esophageal cancer underwent definitive CRT in the trials between 1986 and 2013, with follow-up occurring through 2014. Data analyses were conducted between March 2022 to February 2023. Exposures Treatment groups in the trials used standard-dose RT (50 Gy) and concurrent chemotherapy. Main Outcomes and Measures The outcomes were local-regional failure (LRF), distant failure, disease-free survival (DFS), and overall survival (OS). Multivariable models were used to examine the associations between these outcomes and both RT duration and interruptions. Radiotherapy duration was analyzed as a dichotomized variable using an X-Tile software to choose a cut point and its median value as a cut point, as well as a continuous variable. Results The analysis included 509 patients (median [IQR] age, 64 [57-70] years; 418 males [82%]; and 376 White individuals [74%]). The median (IQR) follow-up was 4.01 (2.93-4.92) years for surviving patients. The median cut point of RT duration was 39 days or less in 271 patients (53%) vs more than 39 days in 238 patients (47%), and the X-Tile software cut point was 45 days or less in 446 patients (88%) vs more than 45 days in 63 patients (12%). Radiotherapy interruptions occurred in 207 patients (41%). Female (vs male) sex and other (vs White) race and ethnicity were associated with longer RT duration and RT interruptions. In the multivariable models, RT duration longer than 45 days was associated with inferior DFS (hazard ratio [HR], 1.34; 95% CI, 1.01-1.77; P = .04). The HR for OS was 1.33, but the results were not statistically significant (95% CI, 0.99-1.77; P = .05). Radiotherapy duration longer than 39 days (vs ≤39 days) was associated with a higher risk of LRF (HR, 1.32; 95% CI, 1.06-1.65; P = .01). As a continuous variable, RT duration (per 1 week increase) was associated with DFS failure (HR, 1.14; 95% CI, 1.01-1.28; P = .03). The HR for LRF 1.13, but the result was not statistically significant (95% CI, 0.99-1.28; P = .07). Conclusions and Relevance Results of this study indicated that in patients with esophageal cancer receiving definitive CRT, prolonged RT duration was associated with inferior outcomes; female patients and those with other (vs White) race and ethnicity were more likely to have longer RT duration and experience RT interruptions. Radiotherapy interruptions should be minimized to optimize outcomes.
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Affiliation(s)
| | - Jennifer Moughan
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | | | - Arnold M. Herskovic
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Bruce D. Minsky
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston
| | - Mohan Suntharalingam
- Department of Radiation Oncology, University of Maryland and Greenebaum Comprehensive Cancer Center, Baltimore
| | - Kenneth L. Zeitzer
- Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Madhur K. Garg
- Department of Radiation Oncology, Montefiore Medical Center–Moses Campus, Bronx, New York
| | - Bruce D. Greenwald
- Department of Gastroenterology and Hepatology, University of Maryland and Greenebaum Cancer Center, Baltimore
| | - Ritsuko U. Komaki
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston
| | - Lindsay L. Puckett
- Department of Radiation Oncology, Medical College of Wisconsin and Zablocki Veterans' Administration Medical Center, Milwaukee
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah Health Science Center, Salt Lake City
| | - David A. Bush
- Department of Radiation Oncology, Loma Linda University Cancer Institute, Loma Linda, California
| | - Harold E. Kim
- Department of Radiation Oncology, Wayne State University/Karmanos Cancer Institute, Detroit, Michigan
| | - Thomas E. Lad
- Department of Medical Oncology, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | - Joshua E. Meyer
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Gordon S. Okawara
- Department of Radiation Oncology, McMaster University, Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Adam Raben
- Department of Radiation Oncology, Christiana Care Health Services Inc Community Clinical Oncology Program, Newark, Delaware
| | | | - Jerry L. Barker
- Department of Radiation Oncology, US Oncology Texas Oncology-Sugar Land, Fort Worth
| | - Carla I. Falkson
- Department of Medicine, Hematology/Oncology, University of Rochester, Rochester, New York
| | | | - Rojymon Jacob
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham
| | - Kathryn A. Winter
- NRG Oncology Statistics and Data Management Center/American College of Radiology, Philadelphia, Pennsylvania
| | - Christopher H. Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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32
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Sharma R, Vats S, Seam R, Gupta M, Negi RR, Fotedar V, Singh K. A Comparison of the Toxicities in Patients With Locally Advanced Head and Neck Cancers Treated With Concomitant Boost Radiotherapy Versus Conventional Chemoradiation. Cureus 2023; 15:e38362. [PMID: 37266055 PMCID: PMC10230179 DOI: 10.7759/cureus.38362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE To compare the objective and patient-reported toxicities of concomitant boost radiotherapy (CBRT) and concurrent chemoradiation (CRT) in patients with locally advanced head and neck cancers. METHODS AND MATERIAL In this prospective study, 46 patients with histologically proven stage III-IVA head and neck cancer were randomly assigned to receive either concurrent chemoradiation to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (40 mg/m2 IV weekly; control arm) or accelerated radiotherapy with concomitant boost radiotherapy (study arm) to a dose of 67.5 Gy in 40 fractions in five weeks. Acute toxicity was evaluated using RTOG toxicity criteria. The assessment was done weekly after initiation of treatment, at the first follow-up (six weeks), and at three months. The four main patient-reported symptoms of pain, hoarseness of voice, dryness of mouth, and loss of taste were also compared between the two groups to assess patient quality of life during treatment. RESULTS The mean treatment duration was 37 days in the CBRT arm and 49 days in the CRT arm. Treatment-related interruptions were less in the study group,17.3% in the study, and 27.2% in the control with insignificant P-value. Grade III laryngeal toxicity was significantly higher in the study group (P=0.029). Other acute grade I-III toxicities (pharyngeal, skin, mucositis, and salivary) were comparable in both CRT and CBRT arms. Grade IV toxicities were seen only in the CBRT arm but were resolved at the first follow-up. Haematological toxicities and renal toxicities were significantly higher in the CRT arm, with significant P-values of 0.0004 and 0.018, respectively. CONCLUSION In patients with locally advanced head and neck cancer, concomitant boost radiotherapy is well tolerated with acceptable local toxicity and minimal systemic toxicity as compared to conventional chemoradiation. It is a feasible option for patients with locally advanced head and neck cancer not fit for concurrent chemoradiation.
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Affiliation(s)
- Ritu Sharma
- Department of Radiotherapy, Shri Lal Bahadur Shastri Government Medical College and Hospital, Mandi, IND
| | - Siddharth Vats
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, IND
| | - Rajeev Seam
- Department of Radiotherapy, Maharishi Markandeshwar Institiute of Medical Sciences and Research, Ambala, IND
| | - Manish Gupta
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, IND
| | - Ratti R Negi
- Department of Radiotherapy, Shri Lal Bahadur Shastri Government Medical College and Hospital, Mandi, IND
| | - Vikas Fotedar
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, IND
| | - Kaalindi Singh
- Department of Radiotherapy, Shri Lal Bahadur Shastri Government Medical College and Hospital, Mandi, IND
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Eggmann F, Hwang JD, Ayub JM, Mante FK. Impact of Irradiation on the Adhesive Performance of Resin-Based Dental Biomaterials: A Systematic Review of Laboratory Studies. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2580. [PMID: 37048873 PMCID: PMC10095157 DOI: 10.3390/ma16072580] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
Head and neck cancers are a significant global health burden, with radiation therapy being a frequently utilized treatment. The aim of this systematic review was to provide a critical appraisal of laboratory studies that assessed the effect of irradiation on the adhesive performance of resin-based biomaterials. The analysis included 23 laboratory studies obtained from five databases, with most studies using human enamel, dentin, or both, and bonding procedures involving the fabrication of direct restorations, standardized specimens, bonding of orthodontic brackets, and luting of endodontic fiber posts. The protocols used for irradiation varied, with most studies exposing specimens made from extracted teeth to irradiation using cabinet irradiators to simulate treatment of head and neck cancer. The findings indicate that irradiation reduces the bond strength of dental adhesives and resin-based composites on flat, ground enamel and dentin specimens, with different adhesives and timing of irradiation having a significant impact on adhesive performance. Irradiation also increased microleakage in most studies. The effect of irradiation on marginal adaptation of direct resin-based composite restorations was inconclusive. This systematic review indicates that irradiation has detrimental effects on the adhesive performance of resin-based biomaterials and highlights the need for further clinical and laboratory studies evaluating the performance of adhesive materials and approaches to improve it.
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Affiliation(s)
- Florin Eggmann
- Department of Preventive and Restorative Sciences, Robert Schattner Center, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Periodontology, Endodontology, and Cariology, University Center for Dental Medicine Basel UZB, University of Basel, CH-4058 Basel, Switzerland
| | - Jonathan D. Hwang
- Department of Preventive and Restorative Sciences, Robert Schattner Center, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jose M. Ayub
- Department of Preventive and Restorative Sciences, Robert Schattner Center, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Francis K. Mante
- Department of Preventive and Restorative Sciences, Robert Schattner Center, Penn Dental Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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You R, Liu YP, Xie YL, Lin C, Duan CY, Chen DP, Pan Y, Qi B, Zou X, Guo L, Cao JY, Zhang YN, Wang ZQ, Liu YL, Ouyang YF, Wen K, Yang Q, Xie RQ, Li HF, Duan XT, Ding X, Peng L, Chen SY, Liang JL, Feng ZK, Xia TL, Xie RL, Jiang R, Gu CM, Liu RZ, Sun R, Yang X, Liu LZ, Ling L, Liu Q, Ng WT, Hua YJ, Huang PY, Chen MY. Hyperfractionation compared with standard fractionation in intensity-modulated radiotherapy for patients with locally advanced recurrent nasopharyngeal carcinoma: a multicentre, randomised, open-label, phase 3 trial. Lancet 2023; 401:917-927. [PMID: 36842439 DOI: 10.1016/s0140-6736(23)00269-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Reirradiation in standard fractionation for locally advanced recurrent nasopharyngeal carcinoma after a previous course of high-dose radiotherapy is often associated with substantial late toxicity, negating its overall benefit. We therefore aimed to investigate the efficacy and safety of hyperfractionation compared with standard fractionation in intensity-modulated radiotherapy. METHODS This multicentre, randomised, open-label, phase 3 trial was done in three centres in Guangzhou, China. Eligible patients were aged 18-65 years with histopathologically confirmed undifferentiated or differentiated, non-keratinising, advanced locally recurrent nasopharyngeal carcinoma. Participants were randomly assigned (1:1) to either receive hyperfractionation (65 Gy in 54 fractions, given twice daily with an interfractional time interval of at least 6 h) or standard fractionation (60 Gy in 27 fractions, given once a day). Intensity-modulated radiotherapy was used in both groups. A computer program generated the assignment sequence and randomisation was stratified by treatment centre, recurrent tumour stage (T2-T3 vs T4), and recurrent nodal stage (N0 vs N1-N2), determined at the time of randomisation. The two primary endpoints were the incidence of severe late complications defined as the incidence of grade 3 or worse late radiation-induced complications occurring 3 months after the completion of radiotherapy until the latest follow-up in the safety population, and overall survival defined as the time interval from randomisation to death due to any cause in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT02456506. FINDINGS Between July 10, 2015, and Dec 23, 2019, 178 patients were screened for eligibility, 144 of whom were enrolled and randomly assigned to hyperfractionation or standard fractionation (n=72 in each group). 35 (24%) participants were women and 109 (76%) were men. After a median follow-up of 45·0 months (IQR 37·3-53·3), there was a significantly lower incidence of grade 3 or worse late radiation-induced toxicity in the hyperfractionation group (23 [34%] of 68 patients) versus the standard fractionation group (39 [57%] of 68 patients; between-group difference -23% [95% CI -39 to -7]; p=0·023). Patients in the hyperfractionation group had better 3-year overall survival than those in the standard fractionation group (74·6% [95% CI 64·4 to 84·8] vs 55·0% [43·4 to 66·6]; hazard ratio for death 0·54 [95% CI 0·33 to 0·88]; p=0·014). There were fewer grade 5 late complications in the hyperfractionation group (five [7%] nasal haemorrhage) than in the standard fractionation group (16 [24%], including two [3%] nasopharyngeal necrosis, 11 [16%] nasal haemorrhage, and three [4%] temporal lobe necrosis). INTERPRETATION Hyperfractionated intensity-modulated radiotherapy could significantly decrease the rate of severe late complications and improve overall survival among patients with locally advanced recurrent nasopharyngeal carcinoma. Our findings suggest that hyperfractionated intensity-modulated radiotherapy could be used as the standard of care for these patients. FUNDING Key-Area Research and Development of Guangdong Province, the National Natural Science Foundation of China, the Special Support Program for High-level Talents in Sun Yat-sen University Cancer Center, the Guangzhou Science and Technology Plan Project, and the National Ten Thousand Talents Program Science and Technology Innovation Leading Talents, Sun Yat-Sen University Clinical Research 5010 Program.
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Affiliation(s)
- Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - You-Ping Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yu-Long Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chao Lin
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chong-Yang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Dong-Ping Chen
- Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Yi Pan
- Department of Radiation Oncology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Bin Qi
- Department of Radiation Oncology, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Xiong Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Cooperative Surgical Ward of Nasopharyngeal Carcinoma, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ling Guo
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jing-Yu Cao
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yi-Nuan Zhang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Zhi-Qiang Wang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yong-Long Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yan-Feng Ouyang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Kai Wen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Qi Yang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ruo-Qi Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Hui-Feng Li
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiao-Tong Duan
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xi Ding
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Lan Peng
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Si-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Jiong-Lin Liang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Zheng-Kai Feng
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Tian-Liang Xia
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rui-Ling Xie
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rou Jiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Chen-Mei Gu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rong-Zeng Liu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Rui Sun
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xin Yang
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li-Zhi Liu
- Department of Medical Imaging, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Qing Liu
- Department of Medical Statistics and Epidemiology, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yi-Jun Hua
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Pei-Yu Huang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, Guangzhou, China; State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China; Cooperative Surgical Ward of Nasopharyngeal Carcinoma, Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
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Dickstein DR, Powers AE, Vujovic D, Roof S, Bakst RL. Clinical and Therapeutic Considerations for Older Adults with Head and Neck Cancer. Clin Interv Aging 2023; 18:409-422. [PMID: 36959837 PMCID: PMC10029371 DOI: 10.2147/cia.s366155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/04/2023] [Indexed: 03/18/2023] Open
Abstract
Approximately 30% of patients with head and neck squamous cell carcinoma (HNSCC) are at least 70 years of age, and this percentage is expected to increase as the population increases and lives longer. Elderly patients are underrepresented in head and neck oncology clinical trials, and there is minimal evidence on the management of HNSCC for this population. Subsequently, despite their best intentions, physicians may unknowingly recommend an ill-suited course of therapy, which may result in suboptimal oncological or functional outcomes or adverse events. Surgical approaches have the potential to carry a higher risk of morbidity and mortality in older adults, especially in patients with multiple comorbidities. Definitive radiation therapy treatment in patients with HNSCC frequently involves 7 weeks of daily radiation, sometimes with concurrent chemotherapy, and this demanding treatment can be difficult for older adult patients, which may lead to treatment interruptions, potential removal of concurrent systemic therapy, compromised outcomes, and diminished quality of life. There are clinical trials currently underway investigating altered fractionation regimens and novel, less toxic systemic treatments in this population. This review provides an overview of how best to approach an older adult with HNSCC, from initial work-up to treatment selection.
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Affiliation(s)
- Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ann E Powers
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Dragan Vujovic
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Scott Roof
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Bouleftour W, Guy JB, Moreno-Acosta P, Rodriguez Lafrasse C, Sargos P, Magné N. Challenges in radiobiology - technology duality as a key for a risk-free α/β ratio. Bull Cancer 2023:S0007-4551(23)00091-7. [PMID: 36872128 DOI: 10.1016/j.bulcan.2023.02.006] [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: 10/12/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 03/06/2023]
Abstract
Since radiotherapy discovery, prediction of biological response to ionizing radiation remains a major challenge. Indeed, several radiobiological models appeared through radiotherapy history. Nominal single dose so popular in the 1970s, was tragically linked to the dark years in radiobiology by underestimating the late toxicity of the high-dose fractions. The actual prominent linear-quadratic model continues to prove to be an effective tool in radiobiology. Mainly with its pivotal α/β ratio, which gives a reliable estimate of tissues sensitivity to fractions. Despite these arguments, this model experiences limitations with substantial doubts of α/β ratio values. Interestingly, the story of radiobiology since X-ray discovery is truly instructive and teaches modern clinicians to refine fractionation schemes. Many fractionation schemes have been tested with successes or dramas. This review retraces radiobiological models' history, and confronts these models to new fractionation schemes, drawing a preventive message.
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Affiliation(s)
- Wafa Bouleftour
- University Hospital of Saint-Etienne, North Hospital, Medical oncology department, 42270 Saint-Priest-en-Jarez, France.
| | - Jean-Baptiste Guy
- Centre Marie-Curie, Radiotherapy department, 159, boulevard Maréchal-Juin, 26000 Valence, France
| | - Pablo Moreno-Acosta
- Clinical, Molecular and Cellular Radiobiology Research Group, Instituto Nacional de Cancerología, Calle 1 # 9-85, Bogotá, Colombia
| | - Claire Rodriguez Lafrasse
- Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, UMR CNRS5822/IP2I, Université de Lyon, Lyon 1 University, 69921 Oullins, France; Université de Lyon, Lyon 1 University, UMR CNRS5822/IP2I, 69100 Villeurbanne, France
| | - Paul Sargos
- Institut Bergonié, Department of Radiation Oncology, 33076 Bordeaux, France
| | - Nicolas Magné
- Cellular and Molecular Radiobiology Laboratory, Lyon-Sud Medical School, UMR CNRS5822/IP2I, Université de Lyon, Lyon 1 University, 69921 Oullins, France; Université de Lyon, Lyon 1 University, UMR CNRS5822/IP2I, 69100 Villeurbanne, France; Institut Bergonié, Department of Radiation Oncology, 33076 Bordeaux, France
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Laskar SG, Chaukar D, Deshpande M, Chatterjee A, Sinha S, Chakraborty S, Agarwal JP, Gupta T, Budrukkar A, Murthy V, Pai P, Chaturvedi P, Pantvaidya G, Deshmukh A, Nair D, Nair S, Prabhash K, Swain M, Kumar A, Noronha V, Patil V, Joshi A, DCruz A. Oral cavity adjuvant therapy (OCAT) -a phase III, randomized controlled trial of surgery followed by conventional RT (5 fr/wk) versus concurrent CT-RT versus accelerated RT (6fr/wk) in locally advanced, resectable, squamous cell carcinoma of oral cavity. Eur J Cancer 2023; 181:179-187. [PMID: 36669426 DOI: 10.1016/j.ejca.2022.12.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/14/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Limited data exists regarding the impact of intensification of adjuvant therapy in resected Oral Cavity Squamous Cell Carcinomas (OCSCC) with adverse prognostic features on histopathology. PATIENTS AND METHODS This was a three-arm phase III, randomised trial including patients with resected advanced OCSCC. Randomisation was done in a 1:1:1 ratio: Arm-A- standard adjuvant radiation therapy (RT) 60Gy/30 fractions over 6 weeks versus Arm-B-concurrent chemoradiation versus Arm-C-accelerated radiation therapy (6 d a week). The trial was powered to detect an absolute difference of 10% in 5-year Locoregional Control (LRC). RESULTS The trial was conducted between June 2005 and March 2013. Majority of the patients were males, had T3-T4 disease, had N2-N3 nodal status and had Extra-Capsular Extension (ECE) in nodes. The median follow-up was 95.9 months. There was no difference between the three arms (A versus B versus C) for 10-year locoregional control (LRC): 60.2% versus 61.4% versus 65.7%, p = 0.57; disease free survival (DFS): 37.4% versus 43.9% versus 39.6%, p = 0.40; or Overall Survival (OS): 39.7% versus 46.6% versus 40.4%, p = 0.40. There was no benefit of intensification with either modality in patients with any single adverse pathological factor. A benefit of intensification could be seen in patients with a combination of high-risk features: T3-T4 primary tumours with N2-N3 nodes along with ECE for DFS (Arm B versus Arm A HR) = 0.53, Arm C versus Arm A HR = 0.63) and OS (Arm B versus Arm A HR = 0.58, Arm C versus Arm A HR = 0.60). CONCLUSIONS All optimally resected OCSCC with adverse features did not benefit from intensification of adjuvant therapy. Only a cohort of patients with a combination of high-risk features are likely candidates for intensification. CLINICAL TRIAL REGISTRATION NCT00193843.
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Affiliation(s)
- Sarbani G Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India.
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Mandar Deshpande
- Department of Surgical Oncology, Kokilaben Dhirubai Ambani Hospital, Mumbai, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Jai P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Gouri Pantvaidya
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuja Deshmukh
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Deepa Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Amit Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anil DCruz
- Director Oncology Services and Head Neck Cancer Surgeon, Apollo Hospitals, Mumbai, India
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Le Reun E, Foray N. Low-Dose Radiation Therapy (LDRT) against Cancer and Inflammatory or Degenerative Diseases: Three Parallel Stories with a Common Molecular Mechanism Involving the Nucleoshuttling of the ATM Protein? Cancers (Basel) 2023; 15:1482. [PMID: 36900274 PMCID: PMC10000719 DOI: 10.3390/cancers15051482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Very early after their discovery, X-rays were used in multiple medical applications, such as treatments against cancer, inflammation and pain. Because of technological constraints, such applications involved X-ray doses lower than 1 Gy per session. Progressively, notably in oncology, the dose per session increased. However, the approach of delivering less than 1 Gy per session, now called low-dose radiation therapy (LDRT), was preserved and is still applied in very specific cases. More recently, LDRT has also been applied in some trials to protect against lung inflammation after COVID-19 infection or to treat degenerative syndromes such as Alzheimer's disease. LDRT illustrates well the discontinuity of the dose-response curve and the counterintuitive observation that a low dose may produce a biological effect higher than a certain higher dose. Even if further investigations are needed to document and optimize LDRT, the apparent paradox of some radiobiological effects specific to low dose may be explained by the same mechanistic model based on the radiation-induced nucleoshuttling of the ATM kinase, a protein involved in various stress response pathways.
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Affiliation(s)
| | - Nicolas Foray
- Inserm, U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon-Bérard, 28 rue Laennec, 69008 Lyon, France
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Kuznetsov M, Kolobov A. Optimization of antitumor radiotherapy fractionation via mathematical modeling with account of 4 R's of radiobiology. J Theor Biol 2023; 558:111371. [PMID: 36462667 DOI: 10.1016/j.jtbi.2022.111371] [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: 04/29/2022] [Revised: 07/26/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
A spatially-distributed continuous mathematical model of solid tumor growth and treatment by fractionated radiotherapy is presented. The model explicitly accounts for the factors, widely referred to as 4 R's of radiobiology, which influence the efficacy of radiotherapy fractionation protocols: tumor cell repopulation, their redistribution in cell cycle, reoxygenation and repair of sublethal damage of both tumor and normal tissues. With the use of special algorithm the fractionation protocols that provide increased tumor control probability, compared to standard clinical protocol, are found for various physiologically-based values of model parameters under the constraints of fixed overall normal tissue damage and maximum admissible fractional dose. In particular, it is shown that significant gain in treatment efficacy can be achieved for tumors of low malignancy by the use of protracted hyperfractionated protocols. The optimized non-uniform protocols are characterized by gradual escalation of fractional doses in their last parts, which start after the levels of oxygen and nutrients significantly elevate throughout the tumor and accelerated tumor proliferation manifests itself, which is a well-known experimental phenomenon.
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Affiliation(s)
- Maxim Kuznetsov
- P.N. Lebedev Physical Institute of the Russian Academy of Sciences, 53 Leninskiy Prospekt, Moscow 119991, Russia; Peoples' Friendship University of Russia (RUDN University), 6 Miklukho-Maklaya Street, Moscow 117198, Russia.
| | - Andrey Kolobov
- P.N. Lebedev Physical Institute of the Russian Academy of Sciences, 53 Leninskiy Prospekt, Moscow 119991, Russia
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Ferris RL, Westra W. Oropharyngeal Carcinoma with a Special Focus on HPV-Related Squamous Cell Carcinoma. ANNUAL REVIEW OF PATHOLOGY 2023; 18:515-535. [PMID: 36693202 PMCID: PMC11227657 DOI: 10.1146/annurev-pathmechdis-031521-041424] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV-OPSCC) has one of the most rapidly increasing incidences of any cancer in high-income countries. The most recent (8th) edition of the Union for International Cancer Control/American Joint Committee on Cancer staging system separates HPV-OPSCC from its HPV-negative counterpart to account for the improved prognosis seen in the former. Indeed, owing to its improved prognosis and greater prevalence in younger individuals, numerous ongoing trials are examining the potential for treatment deintensification as a means to improve quality of life while maintaining acceptable survival outcomes. Owing to the distinct biology of HPV-OPSCCs, targeted therapies and immunotherapies have become an area of particular interest. Importantly, OPSCC is often detected at an advanced stage, highlighting the need for diagnostic biomarkers to aid in earlier detection. In this review, we highlight important advances in the epidemiology, pathology, diagnosis, and clinical management of HPV-OPSCC and underscore the need for a progressive understanding of the molecular basis of this disease toward early detection and precision care.
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Affiliation(s)
| | - William Westra
- Department of Pathology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
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Lalu MM, Kekre N, Montroy J, Ghiasi M, Hay K, McComb S, Weeratna R, Atkins H, Hutton B, Yahya A, Masurekar A, Sobh M, Fergusson DA. Identifying effect modifiers of CAR-T cell therapeutic efficacy: a systematic review and individual patient data meta-analysis protocol. Syst Rev 2023; 12:9. [PMID: 36653879 PMCID: PMC9850506 DOI: 10.1186/s13643-022-02158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Chimeric antigen receptor T cell therapy (CAR-T) represents a promising and exciting new therapy for hematologic malignancies, where prognosis for relapsed/refractory patients remains poor. Encouraging results from clinical trials have often been tempered by heterogeneity in response to treatment among patients, as well as safety concerns including cytokine release syndrome. The identification of specific patient or treatment-specific factors underlying this heterogeneity may provide the key to the long-term sustainability of this complex and expensive therapy. An individual patient data meta-analysis (IPMDA) may provide potential explanations for the high degree of heterogeneity. Therefore, our objective is to perform a systematic review and IPDMA of CAR-T cell therapy in patients with hematologic malignancies to explore potential effect modifiers of CAR-T cell therapy. METHODS AND ANALYSIS We will search MEDLINE, Embase, and the Cochrane Central Register of Controlled Clinical Trials. Studies will be screened in duplicate at the abstract level, then at the full-text level by two independent reviewers. We will include any prospective clinical trial of CAR-T cell therapy in patients with hematologic malignancies. Our primary outcome is complete response, while secondary outcomes of interest include overall response, progression-free survival, overall survival, and safety. IPD will be collected from each included trial and, in the case of missing data, corresponding authors/study sponsors will be contacted. Standard aggregate meta-analyses will be performed, followed by the IPD meta-analysis using a one-stage approach. A modified Institute of Health Economics tool will be used to evaluate the risk of bias of included studies. ETHICS AND DISSEMINATION Identifying characteristics that may act as modifiers of CAR-T cell efficacy is of paramount importance and can help shape future clinical trials in the field. Results from this study will be submitted for publication in a peer-reviewed scientific journal, presented at relevant conferences and shared with relevant stakeholders.
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Affiliation(s)
- Manoj M Lalu
- Centre for Practice-Changing Research, Office L1298a, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario, K1H 8L6, Canada
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada
| | - Natasha Kekre
- Centre for Practice-Changing Research, Office L1298a, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario, K1H 8L6, Canada
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Joshua Montroy
- Centre for Practice-Changing Research, Office L1298a, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario, K1H 8L6, Canada
| | - Maryam Ghiasi
- Centre for Practice-Changing Research, Office L1298a, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario, K1H 8L6, Canada
| | - Kevin Hay
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Scott McComb
- National Research Council of Canada, Ottawa, Canada
| | | | - Harold Atkins
- Blood and Marrow Transplant Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Hutton
- Centre for Practice-Changing Research, Office L1298a, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario, K1H 8L6, Canada
| | - Ayel Yahya
- Division of Medicine, Department of Hematology, University of Ottawa, Ottawa, Canada
| | - Ashish Masurekar
- Division of Medicine, Department of Hematology, University of Ottawa, Ottawa, Canada
| | - Mohamad Sobh
- Centre for Practice-Changing Research, Office L1298a, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario, K1H 8L6, Canada
| | - Dean A Fergusson
- Centre for Practice-Changing Research, Office L1298a, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, Ontario, K1H 8L6, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.
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Dhara V, Shetty SS, de Arruda JAA, Silva TA, Russo RC, Shetty NJ, Pidaparthi M, Wollenberg B, Rao VUS, Gopinath TPS. Decoding the influence of the immune system and immunotherapy targets on carcinomas: A hidden prism in oral cancer therapy. Dis Mon 2023; 69:101353. [PMID: 35311656 DOI: 10.1016/j.disamonth.2022.101353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In recent decades, understanding tumorigenesis and the complex interaction between the host and the immune system has been the pillar for significant advances in anticancer therapy. Conventional anticancer therapy (e.g., cut, burn, and cytotoxic drugs) involves multiple targeting of tumor cells. However, the tumor tissue microenvironment can present a dysregulated, stimulating, or subverted immune response which, in turn, reveals pro-tumor activities favoring tumor expansion and progression. Recently, new potential targets have been identified based on immunomodulatory therapies, which are crafted to re-establish the host anti-tumoral immune response. Clinicians should fully understand the intricate interactions between carcinogens, the tumor milieu, the immune system, and traditional anticancer therapies in order to progress and to overcome the refractory/recurrent challenges and morbidity of the disease. Thus, in this article, we highlight the complex milieu of the oral cancer immune response, pointing out potential therapeutic immunotargets for oral squamous cell carcinomas. The impact of traditional anticancer therapy on the immune system is also outlined.
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Affiliation(s)
- Vasantha Dhara
- Consultant Maxillofacial Surgeon, Hyderabad, Telangana, India
| | - Sameep S Shetty
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, A constituent of MAHE, Manipal, Karnataka, India.
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Remo Castro Russo
- Laboratory of Pulmonary Immunology and Mechanics, Department of Physiology and Biophysics, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Neetha J Shetty
- Department of Periodontology, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education, A constituent of MAHE, Mangalore, Karnataka, India
| | | | - Barbara Wollenberg
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum rechts der Isar der TU München, Ismaningerstraße 22, 81675 München, Germany
| | - Vishal U S Rao
- Department of Head and Neck Surgical Oncology, HealthCare Global Enterprises Ltd., Bangalore, Karnataka, India
| | - Thilak P S Gopinath
- Nitte (Deemed to be University) , AB Shetty Memorial Institute of Dental Sciences (ABSMIDS) , Department of Oral and Maxillofacial Surgery, Mangalore, India
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van Dijk LV, Mohamed AS, Ahmed S, Nipu N, Marai GE, Wahid K, Sijtsema NM, Gunn B, Garden AS, Moreno A, Hope AJ, Langendijk JA, Fuller CD. Head and neck cancer predictive risk estimator to determine control and therapeutic outcomes of radiotherapy (HNC-PREDICTOR): development, international multi-institutional validation, and web implementation of clinic-ready model-based risk stratification for head and neck cancer. Eur J Cancer 2023; 178:150-161. [PMID: 36442460 PMCID: PMC9853413 DOI: 10.1016/j.ejca.2022.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Personalised radiotherapy can improve treatment outcomes of patients with head and neck cancer (HNC), where currently a 'one-dose-fits-all' approach is the standard. The aim was to establish individualised outcome prediction based on multi-institutional international 'big-data' to facilitate risk-based stratification of patients with HNC. METHODS The data of 4611 HNC radiotherapy patients from three academic cancer centres were split into four cohorts: a training (n = 2241), independent test (n = 786), and external validation cohorts 1 (n = 1087) and 2 (n = 497). Tumour- and patient-related clinical variables were considered in a machine learning pipeline to predict overall survival (primary end-point) and local and regional tumour control (secondary end-points); serially, imaging features were considered for optional model improvement. Finally, patients were stratified into high-, intermediate-, and low-risk groups. RESULTS Performance score, AJCC8thstage, pack-years, and Age were identified as predictors for overall survival, demonstrating good performance in both the training cohort (c-index = 0.72 [95% CI, 0.66-0.77]) and in all three validation cohorts (c-indices: 0.76 [0.69-0.83], 0.73 [0.68-0.77], and 0.75 [0.68-0.80]). Excellent stratification of patients with HNC into high, intermediate, and low mortality risk was achieved; with 5-year overall survival rates of 17-46% for the high-risk group compared to 92-98% for the low-risk group. The addition of morphological image feature further improved the performance (c-index = 0.73 [0.64-0.81]). These models are integrated in a clinic-ready interactive web interface: https://uic-evl.github.io/hnc-predictor/ CONCLUSIONS: Robust model-based prediction was able to stratify patients with HNC in distinct high, intermediate, and low mortality risk groups. This can effectively be capitalised for personalised radiotherapy, e.g., for tumour radiation dose escalation/de-escalation.
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Affiliation(s)
- Lisanne V van Dijk
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Abdallah Sr Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sara Ahmed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nafiul Nipu
- Department of Computer Science, The University of Illinois Chicago, Chicago, USA
| | - G Elisabeta Marai
- Department of Computer Science, The University of Illinois Chicago, Chicago, USA
| | - Kareem Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; MD Anderson Stiefel Center for Oropharyngeal Cancer Research and Education (MDA-SCORE), Houston, TX, USA
| | - Andrew J Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; MD Anderson Stiefel Center for Oropharyngeal Cancer Research and Education (MDA-SCORE), Houston, TX, USA
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Uttam AK, Yadav AK, Jalota S, Singh R, Malik S, Arya AK. A prospective randomized comparative study to evaluate the effect of palliative hypo-fractionated radiotherapy with concurrent chemotherapy versus hypo-fractionated radiotherapy alone in advanced and unresectable head and neck cancer with no metastasis. Ecancermedicalscience 2023; 17:1541. [PMID: 37138956 PMCID: PMC10151081 DOI: 10.3332/ecancer.2023.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction A short duration, palliative radiotherapy schedule for locally advanced and unresectable head and neck cancer (LAUHNC) was evaluated in terms of palliation of cancer-related symptoms and acute toxicities. Aims and objectives The aim of the study was to compare the role and feasibility of hypo-fractionated radiotherapy with concurrent chemotherapy and hypo-fractionated radiotherapy in LAUHNC. Materials and methods All the patients included in this study of LAUHNC were not fit for curative treatment. These patients are assessed on the basis of quality of life (QOL), tumour response, toxicities, and relief in symptoms. QOL was assessed on the basis of University of Washington QOL questionnaire version 4 before and after treatment. Patients are divided into two arms, Arm A patients received 40 Gy in ten fractions concurrent cisplatin 50 mg/m2 with weekly and Arm B patients received 40 Gy in ten fractions. To assess the tumour response response evaluation criteria in solid tumours criteria were used. Results A total of 40 patients were enrolled in this study, with 20 patents in both arms. Three patients defaulted during treatment and one patient died during treatment. A total of 36 patients completed treatment. Before treatment common complaints was distressing pain in primary site, and difficulty in chewing and swallowing. After treatment there was reduction of pain and improvement in swallowing in both arms. Overall QOL improvement in Arm A (28.89 ± 18.44 to 46.67 ± 15.34) and in Arm B (31.11 ± 15.68 to 43.33 ± 15.72). Neither of the arms experienced grade IV mucositis and skin reaction. Conclusion Toxicity in the form of mucositis and dermatitis was higher in the concurrent hypo-fractioned arm compared to the only hypo-fractionated radiotherapy arm during the treatment and in follow up period. The QOL in both individual arms showed statistically significant results, however when the QOL of both the arms was compared, the results were not statistically significant.
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Affiliation(s)
| | - Arun Kumar Yadav
- Sarojini Naidu Medical College, Agra 282003, Uttar Pradesh, India
| | - Shreya Jalota
- Sarojini Naidu Medical College, Agra 282003, Uttar Pradesh, India
| | - Renu Singh
- Sarojini Naidu Medical College, Agra 282003, Uttar Pradesh, India
| | - Shivani Malik
- Sarojini Naidu Medical College, Agra 282003, Uttar Pradesh, India
| | - Ashok Kumar Arya
- Sarojini Naidu Medical College, Agra 282003, Uttar Pradesh, India
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Zhao J, Wu L, Hu C, Bi N, Wang L. Radiotherapy Fraction in Limited-Stage Small Cell Lung Cancer in the Modern Era: A Systematic Review and Meta-Analysis of 8006 Reconstructed Individual Patient Data. Cancers (Basel) 2022; 15:277. [PMID: 36612272 PMCID: PMC9818135 DOI: 10.3390/cancers15010277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/25/2022] [Accepted: 12/25/2022] [Indexed: 01/03/2023] Open
Abstract
The optimal thoracic radiotherapy (TRT) dose and fractionation for limited-stage small cell lung cancer (LS-SCLC) using modern techniques remain unclear. We conducted systematic review and meta-analyses of the efficacy and safety differences between definitive hypofractionated TRT (HypoTRT), conventional TRT (ConvTRT) and hyperfractionated TRT (HyperTRT), especially in the modern era. Eligible randomized controlled trials (RCTs), real-world cohorts, and single-arm trials published between 1990 and 2021 were identified. Two meta-analyses of overall survival (OS) were conducted: (i) a random-effects meta-analysis based on reconstructed individual-patient data (IPD) of all studies; and (ii) a Bayesian network meta-analysis based on study-level aggregated data (AD) of RCTs. The incidences of severe radiation-related toxicities were compared using the random-effects meta-regression model. Overall, 53 of the 30,031 publications met the inclusion criteria, and a total of 8006 IPD were reconstructed. After adjusting for key treatment variables and stratification by study type, there were no significant differences in the OS rates between the altered fractionation regimens (HypoTRT vs. HyperTRT, aHR [adjusted HR] = 1.05, 95% CI 0.93-1.19; ConvTRT vs. HyperTRT, aHR = 1.00, 95% CI 0·90-1.11; HypoTRT vs. ConvTRT, aHR = 1.05, 95% CI 0.91-1.20). In the modern era, the survival outcomes of all three schedules, while remaining comparable, have improved significantly. Results of the AD-based network meta-analysis were consistent with those of IPD analysis, and HypoTRT was ranked as the best regimen (SUCRA = 81%). There were no significant differences in toxicities between groups when using modern radiation techniques. In the modern era, no significant differences in OS or severe radiation-related toxicities were observed between altered schedules in LS-SCLC. HypoTRT may be associated with moderate and non-significant OS improvements, which should be further confirmed in prospective randomized phase III trials.
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Affiliation(s)
- Jingjing Zhao
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Linfang Wu
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
- Cancer Research UK Cambridge Institute, University of Cambridge Li Ka Shing Center, Cambridge CB2 0RE, UK
| | - Chen Hu
- Division of Quantitative Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Luhua Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
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Santos M, Chavez-Nogueda J, Galvis JC, Merino T, Oliveira e Silva L, Rico M, Sarria G, Sisamon I, Garay O. Hypofractionation as a solution to radiotherapy access in latin america: expert perspective. Rep Pract Oncol Radiother 2022; 27:1094-1105. [PMID: 36632306 PMCID: PMC9826647 DOI: 10.5603/rpor.a2022.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background Limited radiation therapy resources have resulted in an interest in developing time and cost-saving innovations to expand access to cancer treatment, in Latin America. Therefore, hypofractionated radiotherapy (HRT) is a possible solution, as this modality delivers radiation over a shorter period of time. Materials and methods A selected panel of Latin American (LA) experts in fields related to HRT were provided with a series of relevant questions to address, prior to the multi-day conference. Within this meeting, each narrative was discussed and edited, through numerous rounds of discussion, until agreement was achieved. Results The challenges identified in increasing the adoption of HRT in LA include a lack of national and regional clinical practice guidelines and cancer registries; a lack of qualified human resources and personnel education; high up-front costs of equipment; disparate resource distribution and scarce HRT research. An analysis for these overarching challenges was developed and answered with recommendations. Conclusion Extending the adoption of HRT in LA can provide a path forward to increase access to radiotherapy and overcome the shortage of equipment. HRT has the potential to improve population health outcomes and patient centered care, while offering comparable local control, toxicity, palliation, and late effects for multiple indications, when compared to conventional RT. Concerted efforts from all involved stakeholders are needed to overcome the barriers in adopting this strategy in LA countries. The recommendations presented in this article can serve as a plan of action for HRT adoption in other countries in a similar situation.
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Affiliation(s)
- Marcos Santos
- ALATRO — Latin America Society of Therapeutic Radiation Oncology, Goiânia, Brasil
| | - Jessica Chavez-Nogueda
- Radiation Oncology Department, Hospital de Oncología, Centro Médico Nacional Siglo XXI, IMSS, México City, México
| | - Juan Carlos Galvis
- Division of Radiation Oncology, Clinica Los Nogales, Division of Clinical Research Clinica Los Nogales, Bogota, Colombia
| | - Tomas Merino
- Hemato-Oncology Department, Pontifícia Universidad Católica de Chile, Santiago, Chile
| | - Luis Oliveira e Silva
- Brasilia University Hospital (Hospital Universitário de Brasília — HUB), Brasília, Brasil
| | - Mariana Rico
- Americas Health Foundation (AHF), Washington, United States
| | - Gustavo Sarria
- Radiation Therapy Department, Oncosalud — AUNA, Lima, Peru
| | - Ignacio Sisamon
- Centro de Oncologia y Radioterapia and Hospital Privado de Comunidad, Mar del Plata, Argentina,School of Medicine, FASTA University, Mar del Plata, Argentina
| | - Onix Garay
- National Autonomous University of Mexico (UNAM)/Mexican Social Security Institute (IMSS), México City, Mexico
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Yang Z, Zhong W, Yang L, Wen P, Luo Y, Wu C. The emerging role of exosomes in radiotherapy. Cell Commun Signal 2022; 20:171. [PMCID: PMC9620591 DOI: 10.1186/s12964-022-00986-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/01/2022] [Indexed: 11/10/2022] Open
Abstract
Presently, more than half of cancer patients receive radiotherapy to cure localized cancer, palliate symptoms, or control the progression of cancer. However, radioresistance and radiation-induced bystander effects (RIBEs) are still challenging problems in cancer treatment. Exosomes, as a kind of extracellular vesicle, have a significant function in mediating and regulating intercellular signaling pathways. An increasing number of studies have shown that radiotherapy can increase exosome secretion and alter exosome cargo. Furthermore, radiation-induced exosomes are involved in the mechanism of radioresistance and RIBEs. Therefore, exosomes hold great promise for clinical application in radiotherapy. In this review, we not only focus on the influence of radiation on exosome biogenesis, secretion and cargoes but also on the mechanism of radiation-induced exosomes in radioresistance and RIBEs, which may expand our insight into the cooperative function of exosomes in radiotherapy.
Video abstract
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Affiliation(s)
- Zhenyi Yang
- grid.412644.10000 0004 5909 0696Fourth Affiliated Hospital of China Medical University, Liaoning, China
| | - Wen Zhong
- grid.412644.10000 0004 5909 0696Fourth Affiliated Hospital of China Medical University, Liaoning, China
| | - Liang Yang
- grid.412644.10000 0004 5909 0696Fourth Affiliated Hospital of China Medical University, Liaoning, China
| | - Ping Wen
- grid.412644.10000 0004 5909 0696Fourth Affiliated Hospital of China Medical University, Liaoning, China
| | - Yixuan Luo
- grid.412644.10000 0004 5909 0696Fourth Affiliated Hospital of China Medical University, Liaoning, China
| | - Chunli Wu
- grid.412644.10000 0004 5909 0696Fourth Affiliated Hospital of China Medical University, Liaoning, China
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Munjal M, Kaur R, Kaur R, Munjal S, Chopra P, Verma H, Chopra H. Therapeutic Modalities in Head-Neck Neoplasia and Prognostication: A Review. Indian J Otolaryngol Head Neck Surg 2022; 74:2445-2457. [PMID: 36452817 PMCID: PMC9702289 DOI: 10.1007/s12070-020-02200-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022] Open
Abstract
Neoplasia of the head and the neck necessitates intervention, surgical or otherwise, as the site and stage of the pathology may dictate. The various therapeutic modalities employed and prognosis has been reviewed.
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Affiliation(s)
- Manish Munjal
- Oto-Rhino-Laryngologology and Head Neck Services, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Ramanpreet Kaur
- Oto-Rhino-Laryngologology and Head Neck Services, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Raminderjit Kaur
- Oto-Rhino-Laryngologology and Head Neck Services, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Shubham Munjal
- Oto-Rhino-Laryngologology and Head Neck Services, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Parth Chopra
- Oto-Rhino-Laryngologology and Head Neck Services, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Hitesh Verma
- Oto-Rhino-Laryngologology and Head Neck Services, Dayanand Medical College and Hospital, Ludhiana, Punjab India
| | - Hemant Chopra
- Oto-Rhino-Laryngologology and Head Neck Services, Dayanand Medical College and Hospital, Ludhiana, Punjab India
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Zhang Q, Wang K, Zhou Z, Qin G, Wang L, Li P, Sher D, Jiang S, Wang J. Predicting local persistence/recurrence after radiation therapy for head and neck cancer from PET/CT using a multi-objective, multi-classifier radiomics model. Front Oncol 2022; 12:955712. [PMID: 36248979 PMCID: PMC9557184 DOI: 10.3389/fonc.2022.955712] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/05/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Accurate identifying head and neck squamous cell cancer (HNSCC) patients at high risk of local persistence/recurrence (P/R) is of importance for personalized patient management. Here we developed a multi-objective, multi-classifier radiomics model for early HNSCC local P/R prediction based on post-treatment PET/CT scans and clinical data. Materials and methods We retrospectively identified 328 individuals (69 patients have local P/R) with HNSCC treated with definitive radiation therapy at our institution. The median follow-up from treatment completion to the first surveillance PET/CT imaging was 114 days (range: 82-159 days). Post-treatment PET/CT scans were reviewed and contoured for all patients. For each imaging modality, we extracted 257 radiomic features to build a multi-objective radiomics model with sensitivity, specificity, and feature sparsity as objectives for model training. Multiple representative classifiers were combined to construct the predictive model. The output probabilities of models built with features from various modalities were fused together to make the final prediction. Results We built and evaluated three single-modality models and two multi-modality models. The combination of PET, CT, and clinical data in the multi-objective, multi-classifier radiomics model trended towards the best prediction performance, with a sensitivity of 93%, specificity of 83%, accuracy of 85%, and AUC of 0.94. Conclusion Our study demonstrates the feasibility of employing a multi-objective, multi-classifier radiomics model with PET/CT radiomic features and clinical data to predict outcomes for patients with HNSCC after radiation therapy. The proposed prediction model shows the potential to detect cancer local P/R early after radiation therapy.
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Affiliation(s)
- Qiongwen Zhang
- Department of Head and Neck Oncology, Department of Radiation Oncology, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Kai Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Zhiguo Zhou
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Genggeng Qin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Lei Wang
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Ping Li
- Department of Head and Neck Oncology, Department of Radiation Oncology, Cancer Center, and State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - David Sher
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jing Wang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, United States
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Escalating a Biological Dose of Radiation in the Target Volume Applying Stereotactic Radiosurgery in Patients with Head and Neck Region Tumours. Biomedicines 2022; 10:biomedicines10071484. [PMID: 35884789 PMCID: PMC9313164 DOI: 10.3390/biomedicines10071484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The treatment of head and neck tumours is a complicated process usually involving surgery, radiation therapy, and systemic treatment. Despite the multidisciplinary approach, treatment outcomes are still unsatisfactory, especially considering malignant tumours such as squamous cell carcinoma or sarcoma, where the frequency of recurrence has reached 50% of cases. The implementation of modern and precise methods of radiotherapy, such as a radiosurgery boost, may allow for the escalation of the biologically effective dose in the gross tumour volume and improve the results of treatment. Methods: The administration of a stereotactic radiotherapy boost can be done in two ways: an upfront boost followed by conventional radio(chemo)therapy or a direct boost after conventional radio(chemo)therapy. The boost dose depends on the primary or nodal tumour volume and localization regarding the organs at risk. It falls within the range of 10–18 Gy. Discussion: The collection of detailed data on the response of the disease to the radiosurgery boost combined with conventional radiotherapy as well as an assessment of early and late toxicities will contribute crucial information to the prospective modification of fractionated radiotherapy. In the case of beneficial findings, the stereotactic radiosurgery boost in the course of radio(chemo)therapy in patients with head and neck tumours will be able to replace traditional techniques of radiation, and radical schemes of treatment will be possible for future development.
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