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Danishuddin, Haque MA, Malik MZ, Arya R, Singh P, Lee JS, Kim JJ, Lee KW, Jung TS. Unveiling the Mechanisms Underlying the Immunotherapeutic Potential of Gene-miRNA and Drugs in Head and Neck Cancer. Pharmaceuticals (Basel) 2024; 17:921. [PMID: 39065771 PMCID: PMC11280033 DOI: 10.3390/ph17070921] [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: 06/17/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Head and neck cancer ranks as the sixth-most common malignancy worldwide, characterized by high mortality and recurrence rates. Research studies indicate that molecular diagnostics play a crucial role in the early detection and prognostic evaluation of these diseases. This study aimed to identify potential biomarkers for head and neck cancer and elucidate their interactions with miRNAs and possible therapeutic drugs. Four drivers, namely, FN1, IL1A, COL1A1, and MMP9, were identified using network biology and machine learning approaches. Gene set variation analysis (GSVA) showed that these genes were significantly involved in different biological processes and pathways, including coagulation, UV-response-down, apoptosis, NOTCH signaling, Wnt-beta catenin, and other signal pathways. The diagnostic value of these hub genes was validated using receiver operating characteristic (ROC) curves. The top interactive miRNAs, including miR-128-3p, miR-218-5p, miR-214-3p, miR-124-3p, miR-129-2-3p, and miR-1-3p, targeted the key genes. Furthermore, the interaction between the key genes and drugs was also identified. In summary, the key genes and miRNAs or drugs reported in this study might provide valuable information for potential biomarkers to increase the prognosis and diagnosis of head and neck cancer.
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Affiliation(s)
- Danishuddin
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea; (D.); (M.A.H.); (R.A.)
| | - Md Azizul Haque
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea; (D.); (M.A.H.); (R.A.)
| | - Md. Zubbair Malik
- Department of Genetics and Bioinformatics, Dasman Diabetes Institute (DDI), Dasman 15462, Kuwait;
| | - Rakesh Arya
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea; (D.); (M.A.H.); (R.A.)
| | - Pooja Singh
- Division of Applied Life Science (BK21 Four), Plant Molecular Biology and Biotechnology Research Center (PMBBRC), Gyeongsang National University (GNU), Jinju 52828, Republic of Korea;
| | - Jeong-Sang Lee
- GSCRO, Research Spin-Off Company, Innopolis Jeonbuk, Jeonju 55069, Republic of Korea;
- Department of Food and Nutrition, College of Medical Science, Jeonju University, Jeonju 55069, Republic of Korea
| | - Jong-Joo Kim
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea; (D.); (M.A.H.); (R.A.)
| | - Keun-Woo Lee
- Korea Quantum Computing (KQC), Busan 48058, Republic of Korea
- Angel i-Drug Design (AiDD), Jinju 52650, Republic of Korea
| | - Tae-Sung Jung
- Laboratory of Aquatic Animal Diseases, Research Institute of Natural Science, College of Veterinary Medicine, Gyeongsang National University (GNU), Jinju 52828, Republic of Korea
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Rades D, Zwaan I, Soror T, Idel C, Pries R, Bruchhage KL, Hakim SG, Yu NY. Chemoradiation with Cisplatin vs. Carboplatin for Squamous Cell Carcinoma of the Head and Neck (SCCHN). Cancers (Basel) 2023; 15:3278. [PMID: 37444388 DOI: 10.3390/cancers15133278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
Cisplatin is the standard for the chemoradiation of squamous cell carcinoma of the head and neck (HNSCC). Many patients cannot receive cisplatin due to impaired renal function. This study investigated carboplatin as an alternative option. In total, 131 patients assigned to two courses of cisplatin (20 mg/m2/d1--5 or 25 mg/m2/d1-4) were matched to 45 patients not suitable for cisplatin and receiving carboplatin (AUC 1.0/d1-5 or AUC 1.5/d1-4). The endpoints included loco-regional control (LRC), metastases-free survival (MFS), overall survival (OS), toxicities, and the completion of chemotherapy. The patients in the carboplatin group were significantly older and had more G3 tumors. Otherwise, the baseline characteristics were balanced. The LRC rates at 2 and 3 years were 77% and 76% in the cisplatin group vs. 69% and 65% in the carboplatin group (p = 0.21). The MFS rates were 83% and 78% vs. 78% and 74% (p = 0.34) and the OS rates 83% and 79% vs. 83% and 75% (p = 0.64), respectively. The outcomes were not significantly different in the subgroups receiving definitive or adjuvant chemoradiation. No significant differences were found regarding toxicities. Non-significantly more patients in the carboplatin group completed their chemotherapy (78% vs. 66%, p = 0.15). Carboplatin was associated with similar outcomes and toxicities as cisplatin, although these patients had worse renal function, more aggressive tumors, and were older. Given the limitations of this study, carboplatin appears an option for patients not suitable for cisplatin.
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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
| | - Tamer Soror
- 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
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Embring A, Onjukka E, Mercke C, Lax I, Berglund A, Friesland S. Dose Escalation of Oropharyngeal Cancer: Long-Time Follow-Up and Side Effects. Cancers (Basel) 2023; 15:cancers15092580. [PMID: 37174046 PMCID: PMC10177133 DOI: 10.3390/cancers15092580] [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: 02/04/2023] [Revised: 04/13/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Previous studies on dose-escalated radiotherapy in head and neck cancer have shown mixed results, and it is not established which patients would benefit from dose escalation. Further, while dose escalation does not appear to increase late toxicity, this needs to be confirmed with longer follow-up. In this study, we analysed treatment outcome and toxicity in 215 patients with oropharyngeal cancer treated with dose-escalated radiotherapy (>72 Gy, EQD2, α/β = 10 Gy, boost by brachytherapy or simultaneous integrated boost) and a matched cohort of 215 patients treated with standard dose external-beam radiotherapy (68 Gy) between 2011 and 2018 at our institution. The 5-year overall survival (OS) was 77.8% (72.4-83.6) and 73.7% (67.8-80.1) in the dose-escalated and standard dose group, respectively (p = 0.24). Median follow-up was 78.1 (49.2-98.4) and 60.2 (38.9-89.4) months in the dose-escalated and standard dose groups, respectively. Grade ≥3 osteoradionecrosis (ORN) and late dysphagia were more common in the dose-escalated group compared to the standard dose group, with 19 (8.8%) vs. 4 (1.9%) patients developing grade ≥3 ORN (p = 0.001), and 39 (18.1%) vs. 21 (9.8%) patients developing grade ≥3 dysphagia (p = 0.01). No predictive factors to help select patients for dose-escalated radiotherapy were found. However, the remarkably good OS in the dose-escalated cohort, despite a predominance of advanced tumour stages, encourages further attempts to identify such factors.
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Affiliation(s)
- Anna Embring
- Department of Oncology, Karolinska University Hospital, 17176 Stockholm, Sweden
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
| | - Eva Onjukka
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Claes Mercke
- Department of Oncology, Karolinska University Hospital, 17176 Stockholm, Sweden
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
| | - Ingmar Lax
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Anders Berglund
- Epistat Epidemiology and Statistics Consulting, 75655 Uppsala, Sweden
| | - Signe Friesland
- Department of Oncology, Karolinska University Hospital, 17176 Stockholm, Sweden
- Karolinska Institute, Department of Oncology-Pathology, 17176 Stockholm, Sweden
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Embring A, Onjukka E, Mercke C, Lax I, Berglund A, Friesland S. Dose escalation in oropharyngeal cancer: a comparison of simultaneous integrated boost and brachytherapy boost. Radiat Oncol 2023; 18:65. [PMID: 37029424 PMCID: PMC10082532 DOI: 10.1186/s13014-023-02256-x] [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: 10/21/2022] [Accepted: 04/03/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND Local recurrence is the most common pattern of failure in head and neck cancer. It can therefore be hypothesised that some of these patients would benefit from an intensified local treatment, such as radiation dose escalation of the primary tumour. This study compares treatment and toxicity outcomes from two different boost modalities in oropharyngeal cancer: simultaneous integrated boost (SIB) and brachytherapy boost. METHODS Two hundred and forty-four consecutive patients treated with > 72 Gy for oropharyngeal squamous cell carcinoma between 2011 and 2018 at our institution were retrospectively analysed. Data on side effects were collected from a local quality registry and supplemented with a review of medical records. Patients receiving a brachytherapy boost first had external beam radiotherapy consisting of 68 Gy in 2 Gy fractions to the gross tumour volume (GTV), and elective radiotherapy to the neck bilaterally. The brachytherapy boost was typically given using pulsed dose rate, 15 fractions and 0.56-0.66 Gy per fraction [total dose in EQD2 = 75.4-76.8 Gy (α/β = 10)]. The typical dose escalated radiotherapy with external beam radiotherapy only, was delivered using SIB with 74,8 Gy in 2.2 Gy fractions [EQD2 = 76.0 Gy (α/β = 10)] to the primary tumour, 68 Gy in 2 Gy fractions to GTV + 10 mm margin and elective radiotherapy to the neck bilaterally. RESULTS Dose escalation by SIB was given to 111 patients and brachytherapy boost to 134 patients. The most common type of cancer was base of tongue (55%), followed by tonsillar cancer (42%). The majority of patients had T3- or T4-tumours and 84% were HPV-positive. The 5-year OS was 72,4% (95% CI 66.9-78.3) and the median follow-up was 6.1 years. Comparing the two different dose escalation modalities we found no significant differences in OS or PFS and these results remained after a propensity-score matched analysis was performed. The analysis of grade ≥ 3 side effects showed no significant differences between the two different dose escalation techniques. CONCLUSIONS We found no significant differences in survival or grade ≥ 3 side effects comparing simultaneous integrated boost and brachytherapy boost as alternative dose escalation modalities in the treatment of oropharyngeal cancer.
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Affiliation(s)
- Anna Embring
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
- Department of Oncology, Karolinska University Hospital, Anna Steckséns Gata 41, 171 76, Solna, Stockholm, Sweden.
| | - Eva Onjukka
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Claes Mercke
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Anna Steckséns Gata 41, 171 76, Solna, Stockholm, Sweden
| | - Ingmar Lax
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Berglund
- Epistat Epidemiology and Statistics Consulting, Uppsala, Sweden
| | - Signe Friesland
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Anna Steckséns Gata 41, 171 76, Solna, Stockholm, Sweden
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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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Gupta S, Srivastava S, Singh N, Ghosh A. Volumetric and Dosimetric Inconstancy of Parotid Glands and Tumor in Head and Neck Cancer during IMRT. Radiat Oncol 2022. [DOI: 10.5772/intechopen.104745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The treatment of head and neck cancer using external beam radiotherapy is commonly done with three field techniques, which involves bilateral parallel opposed beams and one anterior lower neck field. Conventional treatment is based on 2D fluoroscopic images where there is no facility to shield the organs at risk like parotid. The most common side effect of such conventional radiotherapy treatment is xerostomia. The incidence of radiotherapy-related xerostomia varies depending on the specific radiotherapy technique used and the dose delivered to the parotid glands. Dosimetric variation in the tumor and normal tissue including parotid glands due to volume shrinkage during intensity modulated radiotherapy is the leading challenges in radiotherapy delivery in head and neck malignancy in terms of acute and late radiation related toxicities. Therefore if the planning target volume and normal tissue anatomy are changing with time during intensity modulated radiotherapy, it would be beneficial and acceptable to adapt our treatment delivery to minimize normal tissue toxicities where it really matters.
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Khattar H, Kumar P, S N. Delineation of Oral Mucosa as a Pseudo-Organ-at-Risk May Lead to a Decrease in the Incidence of Oral Mucositis: A Dosimetric Analysis of Intensity-Modulated Radiation Therapy Plans in Head and Neck Cancers. Cureus 2022; 14:e23716. [PMID: 35505730 PMCID: PMC9056708 DOI: 10.7759/cureus.23716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Oral mucositis is a common and potentially serious complication of radiation in head and neck cancer treatment. Severe mucositis causes pain, difficulty in chewing and swallowing that can cause treatment breaks and can cause treatment failures leading to local recurrence or a decrease in overall survival. The contouring of the planning target volume (PTV) and organ at risk (OAR) leaves some undefined regions on computed tomography imaging. The treatment planning system uses these regions as dumping sites for the dose in order to achieve the optimum plan. The present study was done to assess the dose going to these unspecified regions termed as pseudo-OARs and whether delineation of these structures and prescribing a dose constraint will reduce the dose to the oral mucosa without compromising the quality of the treatment plan. Methods Twenty patients of head and neck cancer were selected and were randomly placed in two arms. One was intensity-modulated radiation therapy (IMRT) arm I, which included the initial plans with which the patients were treated where the pseudo-OAR was not delineated and hence was not considered in the planning process. After giving treatment, the pseudo-OAR was delineated to see the dose dumped into the area outside the PTV. The other was IMRT arm II, where another virtual plan of the same patients of arm I was made wherein the delineation of the pseudo-OAR was done before planning and dose constraint prescribed. The pseudo-OAR consisted of anterior oral mucosa, part of mandible and maxilla, which was adjacent to the PTV in oropharynx and contralateral buccal mucosa patients. The dose constraint given to the pseudo-OAR was Dmean ≤30 Gy. Statistical significance was calculated by using a paired t-test. A p-value of <0.05 was considered as statistically significant. Results The dosimetric parameters of PTV were comparable in both the IMRT arms. The pre-specified objective was fulfilled with both the study arms. The dose homogeneity and conformity was also similar. The dosimetric parameters of other OARs were within the prescribed dose constraints. The Dmean value of the pseudo-OAR in arm I was 31.28 Gy ± 3.55 Gy and 7.87 Gy ± 9.11 Gy in arm II and the p-value was significant (p=0.001), whereas the Dmax in arm I was 61.82 Gy ± 5.91 Gy and 61.23 Gy ± 5.54 Gy in arm II (p=0.6). The dose to the pseudo-OAR in IMRT arm II was reduced drastically by 75%, which was statistically significant. Conclusion The delineation of oral mucosa as a pseudo-OAR should routinely be done. The dose constraints need to be optimized by clinical studies, which might probably decrease the incidence and severity of oral mucositis.
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Parmar A, Macluskey M, Mc Goldrick N, Conway DI, Glenny AM, Clarkson JE, Worthington HV, Chan KK. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database Syst Rev 2021; 12:CD006386. [PMID: 34929047 PMCID: PMC8687638 DOI: 10.1002/14651858.cd006386.pub4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Oral cavity and oropharyngeal cancers are the most common cancers arising in the head and neck. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients. This review updates one last published in 2011. OBJECTIVES To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal squamous cell carcinoma results in improved overall survival, improved disease-free survival and/or improved locoregional control, when incorporated as either induction therapy given prior to locoregional treatment (i.e. radiotherapy or surgery), concurrent with radiotherapy or in the adjuvant (i.e. after locoregional treatment with radiotherapy or surgery) setting. SEARCH METHODS An information specialist searched 4 bibliographic databases up to 15 September 2021 and used additional search methods to identify published, unpublished and ongoing studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and that evaluated the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration. DATA COLLECTION AND ANALYSIS For this update, we assessed the new included trials for their risk of bias and at least two authors extracted data from them. Our primary outcome was overall survival (time to death from any cause). Secondary outcomes were disease-free survival (time to disease recurrence or death from any cause) and locoregional control (response to primary treatment). We contacted trial authors for additional information or clarification when necessary. MAIN RESULTS We included 100 studies with 18,813 participants. None of the included trials were at low risk of bias. For induction chemotherapy, we reported the results for contemporary regimens that will be of interest to clinicians and people being treated for oral cavity and oropharyngeal cancers. Overall, there is insufficient evidence to clearly demonstrate a survival benefit from induction chemotherapy with platinum plus 5-fluorouracil prior to radiotherapy (hazard ratio (HR) for death 0.85, 95% confidence interval (CI) 0.70 to 1.04, P = 0.11; 7427 participants, 5 studies; moderate-certainty evidence), prior to surgery (HR for death 1.06, 95% CI 0.71 to 1.60, P = 0.77; 198 participants, 1 study; low-certainty evidence) or prior to concurrent chemoradiation (CRT) with cisplatin (HR for death 0.71, 95% CI 0.37 to 1.35, P = 0.30; 389 participants, 2 studies; low-certainty evidence). There is insufficient evidence to support the use of an induction chemotherapy regimen with cisplatin plus 5-fluorouracil plus docetaxel prior to CRT with cisplatin (HR for death 1.08, 95% CI 0.80 to 1.44, P = 0.63; 760 participants, 3 studies; low-certainty evidence). There is insufficient evidence to support the use of adjuvant chemotherapy over observation only following surgery (HR for death 0.95, 95% CI 0.73 to 1.22, P = 0.67; 353 participants, 5 studies; moderate-certainty evidence). Among studies that compared post-surgical adjuvant CRT, as compared to post-surgical RT, adjuvant CRT showed a survival benefit (HR 0.84, 95% CI 0.72 to 0.98, P = 0.03; 1097 participants, 4 studies; moderate-certainty evidence). Primary treatment with CRT, as compared to radiotherapy alone, was associated with a reduction in the risk of death (HR for death 0.74, 95% CI 0.67 to 0.83, P < 0.00001; 2852 participants, 24 studies; moderate-certainty evidence). AUTHORS' CONCLUSIONS: The results of this review demonstrate that chemotherapy in the curative-intent treatment of oral cavity and oropharyngeal cancers only seems to be of benefit when used in specific circumstances together with locoregional treatment. The evidence does not show a clear survival benefit from the use of induction chemotherapy prior to radiotherapy, surgery or CRT. Adjuvant CRT reduces the risk of death by 16%, as compared to radiotherapy alone. Concurrent chemoradiation as compared to radiation alone is associated with a greater than 20% improvement in overall survival; however, additional research is required to inform how the specific chemotherapy regimen may influence this benefit.
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Affiliation(s)
- Ambika Parmar
- Medical Oncology, Sunnybrook Odette Cancer Center, Toronto, Canada
| | | | | | - David I Conway
- Glasgow Dental School, University of Glasgow, Glasgow, UK
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Division of Oral Health Sciences, School of Dentistry, University of Dundee, Dundee, UK
| | - Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Kelvin Kw Chan
- Sunnybrook Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
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Baijens LWJ, Walshe M, Aaltonen LM, Arens C, Cordier R, Cras P, Crevier-Buchman L, Curtis C, Golusinski W, Govender R, Eriksen JG, Hansen K, Heathcote K, Hess MM, Hosal S, Klussmann JP, Leemans CR, MacCarthy D, Manduchi B, Marie JP, Nouraei R, Parkes C, Pflug C, Pilz W, Regan J, Rommel N, Schindler A, Schols AMWJ, Speyer R, Succo G, Wessel I, Willemsen ACH, Yilmaz T, Clavé P. European white paper: oropharyngeal dysphagia in head and neck cancer. Eur Arch Otorhinolaryngol 2021; 278:577-616. [PMID: 33341909 PMCID: PMC7826315 DOI: 10.1007/s00405-020-06507-5] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. METHODS Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. RESULTS Twenty-four sections on HNC-specific OD topics. CONCLUSION This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.
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Affiliation(s)
- Laura W J Baijens
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Christoph Arens
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Magdeburg, Otto-von-Guericke University, Magdeburg, Germany
| | - Reinie Cordier
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Patrick Cras
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Lise Crevier-Buchman
- Voice, Speech, Swallowing Lab, Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital UVSQ and Research lab CNRS-UMR7018, Hôpital Foch, Suresnes, France
| | - Chris Curtis
- Swallows Head and Neck Cancer Charity, Blackpool, UK
| | - Wojciech Golusinski
- Department of Head and Neck Surgery, The Greater Poland Cancer Centre, Poznan University of Medical Sciences, Poznan, Poland
| | - Roganie Govender
- Head and Neck Cancer Centre, University College London Hospital, London, UK
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kate Heathcote
- Robert White Centre for Airway, Voice and Swallow, Poole Hospital NHS Foundation Trust, Dorset, UK
| | - Markus M Hess
- Deutsche Stimmklinik, Hamburg, Germany
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sefik Hosal
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Atılım University, Medicana International Ankara, Ankara, Turkey
| | - Jens Peter Klussmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
| | - C René Leemans
- Department of Otolaryngology, Head and Neck Surgery, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, The Netherlands
| | - Denise MacCarthy
- Division of Restorative Dentistry and Periodontology, Faculty of Health Sciences, Trinity College Dublin, Dublin Dental University Hospital, Dublin, Ireland
| | - Beatrice Manduchi
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Jean-Paul Marie
- Department of Otorhinolaryngology, Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Reza Nouraei
- Department of Ear Nose and Throat Surgery, The Robert White Centre for Airway Voice and Swallowing, Poole Hospital NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Claire Parkes
- Department of Speech and Language Therapy, St. James's Hospital, Dublin, Ireland
| | - Christina Pflug
- Departement of Voice, Speech and Hearing Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Walmari Pilz
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Dublin, Ireland
| | - Nathalie Rommel
- Department Neurosciences, Experimental Otorhinolaryngology, Deglutology, University of Leuven, Leuven, Belgium
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Renee Speyer
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, The Netherlands
- Faculty of Health, School of Health and Social Development, Victoria, Australia
| | - Giovanni Succo
- Head and Neck Oncology Service, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Orbassano, TO, Italy
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna C H Willemsen
- GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
- Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Taner Yilmaz
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Pere Clavé
- Gastrointestinal Physiology Laboratory, Hospital de Mataró, Universitat Autònoma de Barcelona, Mataró, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
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10
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Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, Burtness B, Ghi MG, Cohen EEW, Grau C, Wolf G, Hitt R, Corvò R, Budach V, Kumar S, Laskar SG, Mazeron JJ, Zhong LP, Dobrowsky W, Ghadjar P, Fallai C, Zakotnik B, Sharma A, Bensadoun RJ, Ruo Redda MG, Racadot S, Fountzilas G, Brizel D, Rovea P, Argiris A, Nagy ZT, Lee JW, Fortpied C, Harris J, Bourhis J, Aupérin A, Blanchard P, Pignon JP. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol 2021; 156:281-293. [PMID: 33515668 DOI: 10.1016/j.radonc.2021.01.013] [Citation(s) in RCA: 148] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results. MATERIALS AND METHODS Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint. RESULTS For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005). CONCLUSION The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
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Affiliation(s)
- Benjamin Lacas
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | | | | | | | | | | | | | | | | | - Cai Grau
- H. Lee Moffitt Cancer Center & Research Institute, USA
| | | | | | - Renzo Corvò
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer, India
| | - Volker Budach
- State University of New York Downstate Medical Center, USA
| | | | | | | | | | | | - Pirus Ghadjar
- Johns Hopkins Univ/Sidney Kimmel Cancer Center, MD, USA
| | - Carlo Fallai
- Centre Hospitalier Universitaire de Tours, France
| | | | - Atul Sharma
- Cancer Research UK & UCL Cancer Trials Centre, UK
| | | | | | - Séverine Racadot
- Princess Margaret Cancer Centre/University of Toronto, Ontario, Canada
| | | | | | - Paolo Rovea
- Kragulevac University Hospital, Yugoslavia, Serbia
| | | | | | | | | | | | - Jean Bourhis
- Institut Saint Catherine, France; Stanford University School of Medicine, CA, USA
| | - Anne Aupérin
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | - Pierre Blanchard
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France; University of Texas-MD Anderson Cancer Center, USA.
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11
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Christopherson KM, Moreno AC, Elgohari B, Gross N, Ferrarotto R, Mohamed ASR, Brandon Gunn G, Goepfert RP, Mott FE, Shah SJ, David Fuller C, Reddy JP, Frank SJ, Morrison WH, Phan J, Rosenthal DI, Garden AS. Outcomes after salvage for HPV-positive recurrent oropharyngeal cancer treated with primary radiation. Oral Oncol 2020; 113:105125. [PMID: 33360375 DOI: 10.1016/j.oraloncology.2020.105125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/20/2020] [Accepted: 11/28/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) carries a favorable prognosis for patients, yet nearly 30% of patients will experience disease relapse. We sought to detail patterns of failure, associated salvage therapy, and outcomes for patients with recurrent HPV-positive OPSCC. METHODS AND MATERIALS This is a single institution retrospective study of patients with recurrent HPV-positive OPSCC irradiated from 2002 to 2014. The primary study outcome was overall survival (OS, calculated using the Kaplan-Meier method). Secondary aims included patterns of first failure with descriptive details of salvage therapy. Solitary recurrences were defined as initial presentation of recurrence in a single site (primary, neck or oligometastatic), and multi-site was defined as local and regional and/or multiple sites of distant recurrence. Survival outcomes were compared using the log-rank test. RESULTS The cohort consisted of 132 patients. The median follow-up was 59 months for surviving patients. Estimated 2-year and 5-year OS rates were 47% and 32%, respectively. Comparative 2-year and 5-year OS rates were 65% and 46% versus 19% and 9% for the solitary group and multi-site group, respectively (p < .001). CONCLUSIONS Patients with recurrent HPV-positive OPSCC experience 5-year survival of approximately 32%. However, patients with a "solitary" recurrence including disease at the primary site, neck or oligometastatic site have more favorable long-term outcomes.
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Affiliation(s)
- Kaitlin M Christopherson
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy C Moreno
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Baher Elgohari
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neil Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Renata Ferrarotto
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdallah Sherif Radwan Mohamed
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Clinical Oncology, University of Alexandria, Alexandria, Egypt
| | - G Brandon Gunn
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ryan P Goepfert
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frank E Mott
- Department of Thoracic and Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Shalin J Shah
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C David Fuller
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jay P Reddy
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William H Morrison
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I Rosenthal
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S Garden
- Departments of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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12
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Accelerated Hyperfractionated Radiotherapy versus Conventional Fractionation Radiotherapy for Head and Neck Cancer: A Meta-Analysis of Randomized Controlled Trials. JOURNAL OF ONCOLOGY 2019; 2019:7634746. [PMID: 31885584 PMCID: PMC6914880 DOI: 10.1155/2019/7634746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/08/2019] [Indexed: 12/25/2022]
Abstract
Objective The benefits of accelerated hyperfractionated radiotherapy (HART) and conventional fractionation radiotherapy (CFRT) in the treatment of head and neck cancer (HNC) remain controversial. In this study, we analyzed the therapeutic effects of these two treatment regimens to explore whether HART can improve the overall survival (OS) rate and locoregional control (LRC) rate in patients with HNC. Methods The PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for eligible studies. The OS rate and LRC rate were considered as the efficacy outcomes. I2 was used to test the heterogeneity among studies with a cutoff value of 50%. Potential publication bias was assessed by funnel plots and Egger's test. We also performed a sensitivity analysis to assess the stability of the results. In this meta-analysis, all analyses were performed using R 3.5.3 software. Results Twelve qualified articles including a total of 2,935 patients were identified. HART had a significant beneficial effect on OS rate (HR = 0.80, 95% CI: 0.65–0.98). Compared with CFRT, HART demonstrated a significantly higher LRC rate (HR = 0.82, 95% CI: 0.71–0.96). Conclusion Our meta-analysis showed that HART can significantly improve OS and LRC compared with CFRT in patients with HNC.
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13
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Antognoni P, Corvò R, Zerini D, Orecchia R. Altered Fractionation Radiotherapy in Head and Neck Cancer: Clinical Issues and Pitfalls of “Evidence-Based Medicine”. TUMORI JOURNAL 2019; 91:30-9. [PMID: 15850002 DOI: 10.1177/030089160509100107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors present a critical appraisal of the biological bases of altered fractionation and a brief overview of published randomized trials with conventional fractionation as the control arm, reviews and meta-analysis on altered fractionation radiotherapy in head and neck cancer. The major controversial issues emerging from these studies are reviewed and the limiting factors which so far have prevented the widespread use of altered fractionation regimens in current clinical practice are analyzed. Future perspectives regarding predictive biological assays for patient selection and the integration of altered fractionation regimens with radiochemotherapy protocols, biomodulators and novel radiotherapy techniques are also reviewed and summarized.
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Affiliation(s)
- Paolo Antognoni
- Servizio di Radioterapia, CdC Santa Maria-Multimedica Hospitals, Castellanza, VA, Italy.
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14
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Bossi P, Miceli R, Benasso M, Corvò R, Bacigalupo A, Sanguineti G, Fallai C, Merlano MC, Infante G, Dani C, Di Giannantonio V, Licitra L. Impact of treatment expertise on the outcome of patients with head and neck cancer treated within 6 randomized trials. Head Neck 2018; 40:2648-2656. [PMID: 30447127 DOI: 10.1002/hed.25389] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 04/14/2018] [Accepted: 05/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated the impact of center expertise, in terms of number of patients treated, on the overall survival (OS) and progression-free survival (PFS) of patients with head and neck squamous cell carcinoma (SCC). METHODS We performed a pooled analysis including data from 6 randomized trials in head and neck SCC conducted in Italy. We evaluated the association between OS or PFS and the number of patients recruited by the center. RESULTS The outcome of 903 patients who had received radiotherapy (RT) was analyzed (median follow-up 76 months). The hazard ratio (HR) comparing the third and the first quartiles of the distribution of number of patients per center showed an advantage in PFS (HR 0.59, range 0.53-0.65, P < .0001) and in OS (HR 0.70, 0.60-0.81, P < .0001) for centers with a higher number of patients recruited. A similar benefit was observed in PFS (HR 0.63, 0.60-0.66) and OS (HR 0.74, 0.69-0.79) considering the mean number of patients per year. CONCLUSIONS The PFS and OS were longer for patients treated in high-case-volume centers.
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Affiliation(s)
- Paolo Bossi
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
| | - Rosalba Miceli
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
| | - Marco Benasso
- Ospedale San Paolo Savona and Ospedale Santa Corona Pietra Ligure, Savona, Italy
| | - Renzo Corvò
- AOU IRCCS San Martino-IST National Cancer Research Institute and University, Genoa, Italy
| | - Andrea Bacigalupo
- AOU IRCCS San Martino-IST National Cancer Research Institute and University, Genoa, Italy
| | | | - Carlo Fallai
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
| | | | - Gabriele Infante
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
| | - Carla Dani
- AOU IRCCS San Martino-IST National Cancer Research Institute and University, Genoa, Italy
| | | | - Lisa Licitra
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milano and University of Milano, Italy
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15
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Liu Y, Kou C, Bai W, Liu X, Song Y, Zhang L, Wang M, Zhang Y, You Y, Yin Y, Jiang X, Xin Y. Altered fractionation radiotherapy with or without chemotherapy in the treatment of head and neck cancer: a network meta-analysis. Onco Targets Ther 2018; 11:5465-5483. [PMID: 30233208 PMCID: PMC6129020 DOI: 10.2147/ott.s172018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objectives A Bayesian network meta-analysis (NMA) was conducted in patients with head and neck cancers (HNCs) to estimate the efficacy and safety of treatment with conventional fractionation radiotherapy (CF), conventional fractionation chemoradiotherapy (CF_CRT), hyperfractionated radiotherapy (HF), hyperfractionated chemoradiotherapy (HF_CRT), accelerated fractionation radiotherapy, accelerated fractionation chemoradiotherapy, accelerated hyperfractionated radiotherapy (HART) or accelerated hyperfractionated chemoradiotherapy (HACRT) to identify superior treatments to aid in clinical decisions. Methods PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for potentially eligible randomized controlled trials up to December 2016. Overall survival (OS), disease-free survival (DFS) and locoregional control (LRC) were considered efficacy outcomes, whereas acute toxicity and late toxicity on skin and mucosa were considered safety outcomes. The surface under the cumulative ranking curve (SUCRA) was calculated to rank each treatment in each index. Results Data from 72 trials with 21,868 participants were included in the analysis. Concerning OS, all treatments were associated with a significant advantage compared to CF alone, with HR effect sizes ranging from 0.64 to 0.83, and HACRT was significantly more effective than all the other treatments. The network comparisons of both HACRT vs HART and HF_CRT vs HF demonstrated a higher OS benefit, with an HR of 0.78 (95% credible interval [CrI]: 0.64–0.95) and 0.78 (95% CrI: 0.61–0.99), respectively. The results of SUCRA indicated that HACRT had the best ranking for OS and LRC, HF_CRT for DFS, HART for acute and late skin toxicity, CF_CRT for acute mucosal toxicity and HF_CRT for late mucosal toxicity. Conclusion The NMA results support the notion that HACRT is the preferable treatment modality for HNCs because it has better rankings in all three efficacy indexes, although it does present a high risk of acute mucosal toxicity.
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Affiliation(s)
- Yingyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Wei Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yan Song
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lili Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Mohan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yangyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yueyue You
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yue Yin
- Department of Radiation Oncology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xin Jiang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, Jilin, China,
| | - Ying Xin
- Department of Pathology, School of Basic Medicine, Jilin University, Changchun, Jilin, China,
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16
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Fallai C, Bolner A, Signor M, Gava A, Franchin G, Ponticelli P, Taino R, Rossi F, Ardizzoia A, Oggionni M, Crispino S, Olmi P. Long-Term Results of Conventional Radiotherapy versus Accelerated Hyperfractionated Radiotherapy versus Concomitant Radiotherapy and Chemotherapy in Locoregionally Advanced Carcinoma of the Oropharynx. TUMORI JOURNAL 2018; 92:41-54. [PMID: 16683383 DOI: 10.1177/030089160609200108] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS AND BACKGROUND To compare conventional fractionation (CF) radiation therapy (RT), arm A, versus a split-course accelerated hyperfractionated schedule (S-AHF), arm B, versus CFRT plus concomitant chemotherapy (CT), arm C, in terms of five-year survival and toxicity for squamous cell tumors of the oropharynx. METHODS AND STUDY DESIGN Between January 1993 and June 1998, 192 previously untreated patients with stage III and IV oropharyngeal carcinoma (excluding T1N1 and T2N1) were enrolled in a multicenter randomized phase III trial (ORO 93-01). In arms A and C, 66 to 70 Gy in 33 to 35 fractions was administered five days a week for six and a half to seven weeks. In arm B, the dose delivered was 64 to 67.2 Gy in two fractions of 1.6 Gy every day, five days a week, with a planned two-week split at 38.4 Gy. In arm C the CT regimen consisted of three cycles of carboplatin and 5-fluorouracil (CBDCA 75 mg/m2 on days 1 to 4 and 5-FU 1000 mg/m2 i.v. on days 1 to 4 every 28 days). RESULTS No statistically significant difference was found in five-year overall survival (P = 0.39): 21% for arm A, 21% for arm B, and 40% for arm C. Similarly, there was no statistically significant difference in terms of five-year relapse-free survival: 15% for arm A, 17% for arm B, and 36% for arm C. There was a slight trend towards better five-year locoregional control (P = 0.07) for the combined arm: patients without locoregional relapse were 48% in arm C, 21% in arm A and 18% in arm B. Locoregional control was significantly better when arm C was compared with arms A and B combined (P = 0.02; arm A+B 20%; arm C 48%). Distant metastases were fairly balanced in the three arms (A: 14; B: 9; C: 11), with a tendency towards more frequent isolated distant metastasis development in arm C (8 of 11 [72%] versus 7 of 23 [30%] in arms A+B). Five-year second-tumor-free survival was 85%. The 13 second tumors were equally distributed and were mainly correlated with tobacco and alcohol consumption (five lung, two esophagus, two oral cavity, one larynx, one pancreas, one hepatocarcinoma, one myeloma). Arm C showed slightly more G3+ late side effects involving subcutaneous tissues and mucosa, although significant late sequelae were relatively uncommon and the mucosal side effects were mostly transient. The occurrence of persistent G3 xerostomia was comparable in the three treatment arms. CONCLUSIONS The results obtained with the combination of CT and RT compared with RT alone did not reach statistical significance, but combined treatment almost doubled the five-year overall survival, relapse-free survival and locoregional control rate. Patients with advanced squamous cell carcinomas of the oropharynx who are medically suitable for the combined approach should be treated with a combination of radiotherapy and chemotherapy. The occurrence of second tumors is relatively common in these patients and may contribute substantially to the causes of death.
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MESH Headings
- Aged
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biomarkers, Tumor/analysis
- Carboplatin/administration & dosage
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Chemotherapy, Adjuvant/adverse effects
- Dose Fractionation, Radiation
- Female
- Fluorouracil/administration & dosage
- Humans
- Male
- Middle Aged
- Neoplasm Staging
- Neoplasms, Second Primary/drug therapy
- Neoplasms, Second Primary/radiotherapy
- Oropharyngeal Neoplasms/drug therapy
- Oropharyngeal Neoplasms/pathology
- Oropharyngeal Neoplasms/radiotherapy
- Radiotherapy, Adjuvant/adverse effects
- Radiotherapy, Adjuvant/methods
- Risk Factors
- Salvage Therapy
- Survival Analysis
- Time Factors
- Treatment Failure
- Treatment Outcome
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Affiliation(s)
- Carlo Fallai
- Radioterapia 2, Istituto Nazionale Tumori, Milan, Italy.
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17
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De La Torre A, Romero J, Montero A, Garcia-Berrocal MI, Valcarcel FJ, Cordoba S, Magallon R. Radiochemotherapy with Cisplatin and Oral Tegafur in Advanced Head and Neck Cancer: Long-Term Results of a Phase II Study. TUMORI JOURNAL 2018; 94:453-8. [DOI: 10.1177/030089160809400402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and Background To evaluate the tolerance and efficacy of an original concurrent radiochemotherapy regimen in locally advanced head and neck cancer. Methods Sixty-four patients with stage III or IV squamous cell carcinoma arising from a head and neck mucosal site were eligible. Simultaneous radiochemotherapy consisted of two courses of continuous infusional cisplatin (20 mg/m2/d, days 1–4 and 29–32) and oral tegafur (1200 mg/d, days 1–14 and 29–43), together with conventional radiation therapy up to a total dose of 70–75 Gy over nine weeks. Results All the patients were evaluated for toxicity and response. Acute mucositis was the most prevalent complication. Grade 3 toxicities were mucositis (44%), skin toxicity (10%), leukopenia (8%), and thrombocytopenia (1%). No toxic death was observed. Complete response to treatment was observed in 72% of patients. With a median follow-up of 48.5 months (range, 27–84), 5-year actuarial rate of local-regional control, disease-free survival, overall survival and disease-specific survival were 60% (95% confidence interval [CI], 40–70%), 55% (95% CI, 45–65%), 51% (95% CI, 43–59%) and 61% (95% CI, 53–69%), respectively. Conclusions Response, local-regional control and survival rates are equivalent to those reported from other concomitant radiochemotherapy combinations. However, the regimen offers the advantage of its tolerance and toxicity profile.
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Affiliation(s)
- Alejandro De La Torre
- Department of Radiation Oncology, University Hospital “Clínica Puerta de Hierro”, Madrid, Spain
| | - Jesus Romero
- Department of Radiation Oncology, University Hospital “Clínica Puerta de Hierro”, Madrid, Spain
| | - Angel Montero
- Department of Radiation Oncology, University Hospital “Clínica Puerta de Hierro”, Madrid, Spain
| | | | - Francisco J Valcarcel
- Department of Radiation Oncology, University Hospital “Clínica Puerta de Hierro”, Madrid, Spain
| | - Sofia Cordoba
- Department of Radiation Oncology, University Hospital “Clínica Puerta de Hierro”, Madrid, Spain
| | - Rosa Magallon
- Department of Radiation Oncology, University Hospital “Clínica Puerta de Hierro”, Madrid, Spain
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Lassen P, Lacas B, Pignon JP, Trotti A, Zackrisson B, Zhang Q, Overgaard J, Blanchard P. Prognostic impact of HPV-associated p16-expression and smoking status on outcomes following radiotherapy for oropharyngeal cancer: The MARCH-HPV project. Radiother Oncol 2018; 126:107-115. [DOI: 10.1016/j.radonc.2017.10.018] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 11/30/2022]
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Baine MJ, Dorius T, Bennion N, Smith L, Zhen W, Ganti AK. Weight Loss and Percutaneous Endoscopic Gastrostomy Tube Placement during Chemoradiotherapy for Locally Advanced Cancer of the Oropharynx Do Not Negatively Impact Outcomes. Front Oncol 2017; 7:299. [PMID: 29379770 PMCID: PMC5770811 DOI: 10.3389/fonc.2017.00299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/20/2017] [Indexed: 01/27/2023] Open
Abstract
Objectives Concurrent chemoradiotherapy is standard of care in locally advanced oropharyngeal cancer (LA-OPC). This treatment regimen results in significant acute toxicities. This study investigates the effect of treatment-related toxicity on patient outcomes. Methods Patient information was retrospectively collected for patients treated for LA-OPC between 2007 and 2014. Factors analyzed included age, gender, pretreatment ECOG performance status, smoking history, patient BMI prior to and following treatment, tumor histology, disease stage, disease recurrence, incidence, and timing of feeding tube placement, radiation dose received, chemotherapy regimen used and if it was completed, and patient survival. All statistical analysis was provided through the University of Nebraska Medical Center Department of Biostatistics. Results 74 patients were identified with a median follow-up of 3.4 years and a median age of 58.5. Most patients were male (87.8%) and had squamous cell histology (98.7%). Most patients underwent chemoradiotherapy alone (98.6%) and received concurrent cisplatin (78.4%) with approximately half (53.4%) receiving all planned chemotherapy. Upon multivariate analysis, both disease-free (DFS) and overall survival (OS) rates were improved by lower pretreatment BMI, increased weight lost during treatment, and lack of percutaneous endoscopic gastrostomy (PEG) tube placement prior to treatment initiation. Neither DFS nor OS was impacted by placement of a PEG tube during active treatment. Conclusion These data suggest that weight loss and PEG tube placement during chemoradiotherapy for LA-OPC, presumably due to treatment-associated mucositis and xerostomia, are not associated with worse outcomes.
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Affiliation(s)
- Michael J Baine
- Department of Radiation Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Timothy Dorius
- Department of Medical Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Nathan Bennion
- Department of Radiation Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Lynette Smith
- Center for Collaboration on Research Design and Analysis, Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, United States
| | - Weining Zhen
- Department of Radiation Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
| | - Apar Kishor Ganti
- Department of Medical Oncology, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, United States
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Park YM, Keum KC, Kim HR, Cho BC, Kim DH, Cho NH, Kim SH. A Clinical Trial of Combination Neoadjuvant Chemotherapy and Transoral Robotic Surgery in Patients with T3 and T4 Laryngo-Hypopharyngeal Cancer. Ann Surg Oncol 2017; 25:864-871. [DOI: 10.1245/s10434-017-6208-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Indexed: 11/18/2022]
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Baine M, Dorius T, Bennion N, Alam M, Smith L, Zhen W, Ganti A. Chemoradiotherapy for locally advanced squamous cell carcinoma of the oropharynx: Does completion of systemic therapy affect outcomes? Oral Oncol 2017; 73:105-110. [DOI: 10.1016/j.oraloncology.2017.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/31/2017] [Accepted: 08/27/2017] [Indexed: 10/18/2022]
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22
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Lacas B, Bourhis J, Overgaard J, Zhang Q, Grégoire V, Nankivell M, Zackrisson B, Szutkowski Z, Suwiński R, Poulsen M, O'Sullivan B, Corvò R, Laskar SG, Fallai C, Yamazaki H, Dobrowsky W, Cho KH, Beadle B, Langendijk JA, Viegas CMP, Hay J, Lotayef M, Parmar MKB, Aupérin A, van Herpen C, Maingon P, Trotti AM, Grau C, Pignon JP, Blanchard P. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol 2017; 18:1221-1237. [PMID: 28757375 PMCID: PMC5737765 DOI: 10.1016/s1470-2045(17)30458-8] [Citation(s) in RCA: 190] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND The Meta-Analysis of Radiotherapy in squamous cell Carcinomas of Head and neck (MARCH) showed that altered fractionation radiotherapy is associated with improved overall and progression-free survival compared with conventional radiotherapy, with hyperfractionated radiotherapy showing the greatest benefit. This update aims to confirm and explain the superiority of hyperfractionated radiotherapy over other altered fractionation radiotherapy regimens and to assess the benefit of altered fractionation within the context of concomitant chemotherapy with the inclusion of new trials. METHODS For this updated meta-analysis, we searched bibliography databases, trials registries, and meeting proceedings for published or unpublished randomised trials done between Jan 1, 2009, and July 15, 2015, comparing primary or postoperative conventional fractionation radiotherapy versus altered fractionation radiotherapy (comparison 1) or conventional fractionation radiotherapy plus concomitant chemotherapy versus altered fractionation radiotherapy alone (comparison 2). Eligible trials had to start randomisation on or after Jan 1, 1970, and completed accrual before Dec 31, 2010; had to have been randomised in a way that precluded prior knowledge of treatment assignment; and had to include patients with non-metastatic squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx undergoing first-line curative treatment. Trials including a non-conventional radiotherapy control group, investigating hypofractionated radiotherapy, or including mostly nasopharyngeal carcinomas were excluded. Trials were grouped in three types of altered fractionation: hyperfractionated, moderately accelerated, and very accelerated. Individual patient data were collected and combined with a fixed-effects model based on the intention-to-treat principle. The primary endpoint was overall survival. FINDINGS Comparison 1 (conventional fractionation radiotherapy vs altered fractionation radiotherapy) included 33 trials and 11 423 patients. Altered fractionation radiotherapy was associated with a significant benefit on overall survival (hazard ratio [HR] 0·94, 95% CI 0·90-0·98; p=0·0033), with an absolute difference at 5 years of 3·1% (95% CI 1·3-4·9) and at 10 years of 1·2% (-0·8 to 3·2). We found a significant interaction (p=0·051) between type of fractionation and treatment effect, the overall survival benefit being restricted to the hyperfractionated group (HR 0·83, 0·74-0·92), with absolute differences at 5 years of 8·1% (3·4 to 12·8) and at 10 years of 3·9% (-0·6 to 8·4). Comparison 2 (conventional fractionation radiotherapy plus concomitant chemotherapy versus altered fractionation radiotherapy alone) included five trials and 986 patients. Overall survival was significantly worse with altered fractionation radiotherapy compared with concomitant chemoradiotherapy (HR 1·22, 1·05-1·42; p=0·0098), with absolute differences at 5 years of -5·8% (-11·9 to 0·3) and at 10 years of -5·1% (-13·0 to 2·8). INTERPRETATION This update confirms, with more patients and a longer follow-up than the first version of MARCH, that hyperfractionated radiotherapy is, along with concomitant chemoradiotherapy, a standard of care for the treatment of locally advanced head and neck squamous cell cancers. The comparison between hyperfractionated radiotherapy and concomitant chemoradiotherapy remains to be specifically tested. FUNDING Institut National du Cancer; and Ligue Nationale Contre le Cancer.
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Affiliation(s)
- Benjamin Lacas
- Ligue Nationale Contre le Cancer Meta-Analysis Platform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Jean Bourhis
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus, Denmark
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center (formerly RTOG), Philadelphia, PA, USA
| | - Vincent Grégoire
- Radiation Oncology Department, UCL-Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Matthew Nankivell
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Björn Zackrisson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Zbigniew Szutkowski
- Department of Radiotherapy, Cancer Center, Marie Curie-Sklodowska Memorial Institute, Warsaw, Poland
| | - Rafał Suwiński
- Radiotherapy and Chemotherapy Clinic and Teaching Hospital, Marie Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Michael Poulsen
- Radiation Oncology Services, Mater Centre, Brisbane, QLD, Australia
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Carlo Fallai
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Hideya Yamazaki
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan
| | - Werner Dobrowsky
- Department of Clinical Oncology, Freeman Hospital, Newcastle, UK
| | - Kwan Ho Cho
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Beth Beadle
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Celia Maria Pais Viegas
- Radiation Oncology Department, Instituto Nacional de Cancer, Brasil National Cancer Institute, Rio de Janeiro, Brazil
| | - John Hay
- Division of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Mohamed Lotayef
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Anne Aupérin
- Ligue Nationale Contre le Cancer Meta-Analysis Platform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Carla van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Philippe Maingon
- European Organisation for Research and Treatment of Cancer, Radiation Oncology Group, Brussels, Belgium; Service d'Oncologie, Radiothérapie, Hôpitaux Universitaires Pitié Salpêtrière, Charles Foix, Paris, France
| | - Andy M Trotti
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Cai Grau
- Department of Experimental Clinical Oncology, Aarhus, Denmark
| | - Jean-Pierre Pignon
- Ligue Nationale Contre le Cancer Meta-Analysis Platform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
| | - Pierre Blanchard
- Department of Radiation Therapy, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
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Hickman M, Meade S, Fong C, Sanghera P, Good J, Hartley A. A prospective comparison of common toxicity criteria adverse events Version 3 and 4 in assessing oral mucositis for oral and oropharyngeal carcinoma. Tech Innov Patient Support Radiat Oncol 2017; 1:18-21. [PMID: 32095539 PMCID: PMC7033787 DOI: 10.1016/j.tipsro.2017.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/17/2017] [Accepted: 02/06/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND AND PURPOSE Oral mucositis is an expected complication of radiotherapy in the management of carcinoma of the head and neck. The Common Terminology Criteria for Adverse Events (CTCAE) Version 3 (V3) and related systems based on mucosal appearance have been used in clinical trials historically. More recently, Version 4 (V4) which is based on patient symptoms has been employed. This study compares the use of V3 and V4 in the grading of mucositis in patients undergoing radiotherapy with or without concurrent systemic therapy for carcinoma of the oral cavity and oropharynx. METHODS Oral mucositis was graded prospectively in patients receiving radiotherapy with or without concurrent systemic therapy using both V3 and V4. Grading was recorded during and after completion of therapy. RESULTS Between November 2014 and November 2015, 555 measurements were taken from 73 patients. Mucositis scores were equal in both versions in 327 (59%) measurements. Significant differences between V3 and V4 were seen in patients receiving cetuximab-based concurrent therapy (p < 0.001) and beyond 8 weeks from the start of radiotherapy (p = 0.004). CONCLUSION Differences in grading of mucositis scored by V3 and V4 are frequent. Relationships between biologically effective dose and rates of grade 3 mucositis have historically been based on mucosal appearances. It is not known whether the same relationships apply when mucositis is graded based on symptomatic grading systems. Both V3 and V4 should be used in clinical trials to improve understanding of mucositis and its relationship to quality of life and late mucosal toxicity.
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Affiliation(s)
| | | | | | | | | | - A. Hartley
- Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
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Nyqvist J, Fransson P, Laurell G, Hammerlid E, Kjellén E, Franzén L, Söderström K, Wickart-Johansson G, Friesland S, Sjödin H, Brun E, Ask A, Nilsson P, Ekberg L, Björk-Eriksson T, Nyman J, Lödén B, Lewin F, Reizenstein J, Lundin E, Zackrisson B. Differences in health related quality of life in the randomised ARTSCAN study; accelerated vs. conventional radiotherapy for head and neck cancer. A five year follow up. Radiother Oncol 2016; 118:335-41. [PMID: 26777124 DOI: 10.1016/j.radonc.2015.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/22/2015] [Accepted: 12/27/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE Health related quality of life (HRQoL) was assessed in the randomised, prospective ARTSCAN study comparing conventional radiotherapy (CF) with accelerated radiotherapy (AF) for head and neck cancer. MATERIAL AND METHODS 750 patients with squamous cell carcinoma (of any grade and stage) in the oral cavity, oro-, or hypopharynx or larynx (except T1-2, N0 glottic carcinoma) without distant metastases were randomised to either conventional fractionation (2 Gy/day, 5 days/week in 49 days, total dose 68 Gy) or accelerated fractionation (1.1+2.0 Gy/day, 5 days/week in 35 days, total dose 68 Gy). HRQoL was assessed with EORTC QLQ-C30, QLQ-H&N35 and HADS at baseline, at end of radiotherapy (eRT) and at 3 and 6 months and 1, 2 and 5 years after start of treatment. RESULTS The AF group reported HRQoL was significantly lower at eRT and at 3 months for most symptoms, scales and functions. Few significant differences were noted between the groups at 6 months and 5 years. Scores related to functional oral intake never reached baseline. CONCLUSION In comparison to CF, AF has a stronger adverse effect on HRQoL in the acute phase.
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Affiliation(s)
- Johanna Nyqvist
- Department of Otolaryngology and Head and Neck Surgery, Skåne University Hospital, Lund, Sweden; Department of Clinical Science Otolaryngology and Head and Neck Surgery, Umeå University, Sweden.
| | | | - Göran Laurell
- Department of Clinical Science Otolaryngology and Head and Neck Surgery, Umeå University, Sweden; Department of Otolaryngology and Head and Neck Surgery, Uppsala University Hospital, Sweden
| | - Eva Hammerlid
- Department of Otolaryngology and Head and Neck Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elisabeth Kjellén
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | - Lars Franzén
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - Karin Söderström
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | | | - Signe Friesland
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Helena Sjödin
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Eva Brun
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | - Anders Ask
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | - Per Nilsson
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | - Lars Ekberg
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden
| | | | - Jan Nyman
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Britta Lödén
- Department of Clinical Oncology, Karlstad Central Hospital, Sweden
| | - Freddi Lewin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | | | - Erik Lundin
- Department of Oncology, Ryhov County Hospital, Jönköping, Sweden
| | - Björn Zackrisson
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
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Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma. Clin Oncol (R Coll Radiol) 2015; 28:50-61. [PMID: 26454839 DOI: 10.1016/j.clon.2015.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 07/27/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022]
Abstract
AIMS Treatment intensification either by using concurrent chemoradiotherapy (CCRT) or altered fractionation radiotherapy (AFRT) improves outcomes of locoregionally advanced head and neck squamous cell carcinoma (HNSCC). The superiority of one approach over the other, however, remains to be firmly established. The aim of the present study was to compare outcomes of CCRT versus AFRT in the definitive non-surgical management of locoregionally advanced HNSCC for evidence-based decision making. MATERIALS AND METHODS An electronic search of Medline via PubMed was conducted with no language, year, or publication status restrictions. The Cochrane Central Register of Controlled Trials (CENTRAL) and Database of Abstracts of Reviews of Effectiveness (DARE) were also searched electronically. Only randomised controlled trials assigning HNSCC patients randomly to conventionally fractionated CCRT or AFRT alone were included. Data were extracted independently by two reviewers and pooled using the Cochrane methodology for meta-analysis and expressed as a hazard ratio with 95% confidence intervals. Overall survival was the primary outcome of interest, whereas disease-free survival, locoregional control and toxicity were secondary end points. RESULTS Five randomised controlled trials (involving 1117 patients and 627 deaths) directly comparing conventionally fractionated CCRT with AFRT alone were included. The risk of bias in included studies was low for efficacy outcomes, but high for toxicity outcomes. The overall pooled hazard ratio of death was 0.73 (95% confidence interval = 0.62-0.86), which significantly favoured conventionally fractionated CCRT over AFRT alone (P < 0.0001). Similarly, disease-free survival (hazard ratio = 0.79, 95% confidence interval = 0.68-0.92; P = 0.002) and locoregional control (hazard ratio = 0.71, 95% confidence interval = 0.59-0.84; P < 0.0001) were significantly improved with CCRT. There were no significant differences in the incidence of severe acute toxicity (dermatitis and mucositis) between the two approaches of treatment intensification. Late xerostomia was significantly increased with CCRT. Significant haematological toxicity and nephrotoxicity were seen exclusively with chemotherapy. CONCLUSION There is moderate quality evidence that conventionally fractionated CCRT improves survival outcomes compared with AFRT alone in the definitive radiotherapeutic management of locoregionally advanced HNSCC. No form of acceleration can potentially compensate fully for the lack of concurrent chemotherapy.
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Mature results from a Swedish comparison study of conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma - The ARTSCAN trial. Radiother Oncol 2015; 117:99-105. [PMID: 26427805 DOI: 10.1016/j.radonc.2015.09.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/10/2015] [Accepted: 09/18/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE This report contains the mature five-year data from the Swedish ARTSCAN trial including information on the influence of p16 positivity (p16+) for oropharyngeal cancers. MATERIAL AND METHODS Patients with previously untreated squamous cell carcinoma without distant metastases of the oral cavity, oropharynx, larynx (except T1-2, N0 glottic cancers) and hypopharynx were included. Patients were randomised between accelerated fractionation (AF) (1.1Gy+2Gy per day, 5days/week for 4.5weeks, total dose 68Gy) and conventional fractionation (CF) (2Gy per day, 5days/week for 7weeks, total dose 68Gy). Human papillomavirus (HPV)-associated p16-expression was assessed retrospectively in tumour tissues from patients with oropharyngeal carcinoma. RESULTS There was no significant difference in loco-regional control (LRC) between AF and CF (log-rank test p=0.75). LRC at 5years was 65.5% for AF and 64.9% for CF. Overall survival (OS) was similar in both arms (p=0.99). The estimated cancer specific survival (CSS) at 5years was 62.2% (AF) and 63.3% (CF) (p=0.99). 206 specimens were analysed for p16 with 153 specimens (74%) identified as p16+. P16 status did not discriminate for response to AF vs. CF with regard to LRC, OS or CSS. Patients with p16+ tumours had a statistically significant better overall prognosis compared with p16- tumours. CONCLUSION This update confirms the results of the 2-year report. We failed to identify a positive effect resulting from AF with regards to LRC, OS and CSS. The addition of information on the HPV-associated p16 overexpression did not explain this lack of effect.
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Lyhne NM, Primdahl H, Kristensen CA, Andersen E, Johansen J, Andersen LJ, Evensen J, Mortensen HR, Overgaard J. The DAHANCA 6 randomized trial: Effect of 6 vs 5 weekly fractions of radiotherapy in patients with glottic squamous cell carcinoma. Radiother Oncol 2015; 117:91-8. [PMID: 26255764 DOI: 10.1016/j.radonc.2015.07.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The DAHANCA 6 trial evaluated tumor response and morbidity after moderate accelerated radiotherapy compared to conventional fractionated radiotherapy in patients treated for glottic squamous cell carcinoma (SCC). Further, the failure pattern and incidence of new primary tumors were explored. PATIENTS AND METHODS Six hundred and ninety-four patients with non-metastatic glottic SCC were randomized between six or five weekly fractions (fx/w) of radiotherapy to the same total dose. The median treatment time was 38 and 46days, respectively. The primary endpoint was loco-regional failure. RESULTS Median follow-up time was 14.5years. Of the 177 failures, 167 involved T-site. The cumulative incidence of loco-regional failure (LRF) was 21.6% in the 6fx/w group and 29.3% in the 5fx/w group and the corresponding hazard rate (HR) of LRF was 0.72 (CI: 0.53-0.97, p=0.04). The effect of acceleration on LRF was especially evident in well differentiated tumors (HR=0.42 (CI: 0.23-0.75) and in T1-2 tumors (HR=0.60 (CI: 0.41-0.89)). The HR of laryngectomy was 0.72 (CI: 0.50-1.04) in the 6fx/w group compared to the 5fx/w group. The hazards of disease-specific death, event-free survival, and overall survival were comparable between the two groups. Significantly more patients experienced severe acute mucositis in the 6fx/w group but the incidence of late morbidity was comparable between the groups. New primary tumors occurred in 22.5% of the patients. CONCLUSION Moderate accelerated radiotherapy significantly improved loco-regional control in patients with glottic SCC.
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Affiliation(s)
- Nina M Lyhne
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | - Elo Andersen
- Department of Oncology, Herlev Hospital, Copenhagen, Denmark
| | | | | | | | - Hanna R Mortensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
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Ghosh-Laskar S, Kalyani N, Gupta T, Budrukkar A, Murthy V, Sengar M, Chaukar D, Pai P, Chaturvedi P, D'Cruz A, Agarwal J. Conventional radiotherapy versus concurrent chemoradiotherapy versus accelerated radiotherapy in locoregionally advanced carcinoma of head and neck: Results of a prospective randomized trial. Head Neck 2015; 38:202-7. [PMID: 25224814 DOI: 10.1002/hed.23865] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to report the results of a phase III, 3-arm, randomized trial comparing conventional radiotherapy (RT) to concurrent chemoradiotherapy (CRT) and accelerated RT in advanced head and neck squamous cell carcinoma (HNSCC). METHODS One hundred eighty-six of 750 planned patients were randomized to receive one of the following treatment plans: RT (66-70 Gy/2 Gy fraction/5 fractions weekly; CRT of weekly cisplatin (30 mg/m(2) ) with the same RT dose; or accelerated RT alone of 66 to 70 Gy/2 Gy fraction/6 fractions weekly were available for analysis. The primary endpoint was locoregional control at 5 years. RESULTS The mean follow-up was 54 months. Among the 3 arms, CRT showed superior locoregional control (49%; p = .049). RT had lower grade ≥3 mucositis and late toxicity. CONCLUSION CRT is associated with significantly better locoregional control as compared to RT and accelerated RT with higher but acceptable acute and late toxicities.
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Affiliation(s)
- Sarbani Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Nikhil Kalyani
- Department of Radiation Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Anil D'Cruz
- Department of Head and Neck Surgical Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
| | - Jaiprakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital Centre, Parel, Mumbai, India
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Kawaguchi Y, Nishiyama K, Hirata T, Konishi K, Otozai S, Suzuki M, Yoshii T, Fujii T, Teshima T. Treatment outcomes of external-beam radiotherapy for squamous cell carcinoma of the base of the tongue. Int J Clin Oncol 2015; 20:891-6. [PMID: 25732609 DOI: 10.1007/s10147-015-0805-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate definitive external-beam radiotherapy (EBRT) for patients with base of the tongue (BOT) cancers. METHODS We reviewed results for 26 patients with BOT cancers who were treated with EBRT. Clinical stages T1, T2, T3, and T4a were observed for 10, 7, 4, and 5 patients, respectively, and stages N0, N1, N2a, N2b, N2c, and N3 were observed for 4, 2, 5, 6, 8, and 1 patients, respectively. More than half of the patients (n = 19) were stage IVA. Standard total delivered doses were 70 Gy to primary tumors and cervical lymph node (CLN) metastases and 40-46 Gy to elective nodal regions. Eleven patients with advanced loco-regional disease received concurrent or neoadjuvant chemotherapy. Four T3 patients and one T2 patient received 2 or 3 cycles of concurrent intra-arterial cisplatin with EBRT (RADPLAT). RESULTS Three-year overall survival was 69 % (95 % CI 47-83 %), with a median follow-up period of 33 months. Three-year local control was 100, 86, 100, and 20 % for T1, T2, T3, and T4 patients, respectively. Three-year regional control was 100 % for N0, N1, and N2a, 83 % for N2b, 75 % for N2c, and 0 % for N3 patients. Treatment failed for 7 patients. All 5 patients undergoing RADPLAT achieved complete responses and did not develop local recurrence. CONCLUSIONS We achieved favorable outcomes for patients with T1-T3 BOT cancers by use of definitive EBRT with or without chemotherapy.
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Affiliation(s)
- Yoshifumi Kawaguchi
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3, Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan.
| | - Kinji Nishiyama
- Department of Radiology, Yao Municipal Hospital, Osaka, Japan
| | - Takerou Hirata
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3, Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan
| | - Kouji Konishi
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3, Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan
| | - Shinji Otozai
- Department of Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Motoyuki Suzuki
- Department of Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Tadashi Yoshii
- Department of Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 3-3, Nakamichi 1-chome, Higashinari-ku, Osaka, 537-8511, Japan
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Hall SF, O'Sullivan B, Irish JC, Meyer RM, Gregg R, Groome P. Impact of the addition of chemotherapy to radiotherapy for oropharyngeal cancer in 2003-2004: Population-based study from the Province of Ontario, Canada. Head Neck 2014; 37:1461-9. [PMID: 24844415 DOI: 10.1002/hed.23777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Concurrent chemoradiotherapy (CRT) became the standard of care for locoregionally advanced head and neck cancers based on clinical trials but its effectiveness at the community level is not reported. METHODS We conducted a population-based comparative effectiveness study of all 571 patients with oropharyngeal cancer in Ontario Canada (2003-2004) that describes the patients and the treatments and compares concurrent CRT to radiotherapy (RT) alone. RESULTS When comparing the outcomes (CRT vs RT) for all patients or patients eligible for either treatment, for patients of centers with the "higher use" of CRT to patients of the 'lower use' centers and comparing all centers, we found no overall or disease-specific advantage to CRT over RT alone. There was also no difference in recurrence-free survival, pattern of recurrences, or distant control. CONCLUSION In Ontario (2003-2004), in daily clinical practice, the addition of concurrent CRT to RT had little impact on survival in patients with oropharyngeal carcinoma.
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Affiliation(s)
- Stephen F Hall
- Department of Otolaryngology and Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology, University of Toronto, Toronto, Ontario, Canada
| | - Ralph M Meyer
- Juravinski Hospital and Cancer Center, Hamilton, Ontario, Canada
| | - Richard Gregg
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Patti Groome
- Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen's University, Kingston, Ontario, Canada
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Laskar SG, Agarwal JP, Srinivas C, Dinshaw KA. Radiotherapeutic management of locally advanced head and neck cancer. Expert Rev Anticancer Ther 2014; 6:405-17. [PMID: 16503857 DOI: 10.1586/14737140.6.3.405] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Head and neck cancer management has undergone several paradigm shifts for several relevant reasons. From the dismal experience with the use of radiotherapy as the sole modality in the treatment of this group of patients with advanced disease, radiotherapy has been evaluated as an adjuvant for the same group of patients who had undergone successful surgery. Although there is no level 1 evidence to support postoperative adjuvant radiation, several studies have demonstrated that adjuvant radiotherapy reduces the local failures and, thereby, improves survival. Predictors of recurrence after surgical resection are: positive margins of resection; extranodal spread in involved nodes; perineural invasion; and presence of two or more involved regional lymph nodes. Realization of the advantages of a combination of chemotherapy with radiotherapy has had a major impact on the management of these cancers. There is emerging evidence for the use of adjuvant concurrent chemoradiotherapy in the group with high-risk features. Multiple organ conservation strategies in the management of locally advanced head and neck cancers have evolved over the years. However, the meta-analyses of impact of chemotherapy in various settings reveal that concomitant chemoradiotherapy is superior to any of the other regimens. Increasing use of computed tomography, magnetic resonance imaging and positron emission tomography scan images has resulted in better visualization of target volumes and critical structures. Delineation of these structures is of paramount importance and has resulted in a profound change in conformal treatment planning. Better understanding of the physical aspects of delivery of radiotherapy and the advent of modern treatment planning systems have led to the development of conformal techniques. Although the benefit of these techniques on survival have yet to be demonstrated, there is evidence to suggest that they reduce treatment-related toxicities significantly and facilitate dose escalation. Increased knowledge of radiobiology has led to the development of various altered fractionation regimens in the management of locally advanced head and neck cancers. Discovery of cell-cycle kinetics and signal transduction pathways has led to the unearthing of several potential targets for targeted therapy. The epidermal growth factor receptor gene has emerged as the most promising target. The role of biological radiation response modifiers is evolving. All of these approaches to improve the therapeutic gain would be incomplete without evaluating their effect on the quality of life of these patients.
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Affiliation(s)
- S Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, Maharashtra, 400012, India.
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Meade S, McConkey C, Sanghera P, Mehanna H, Hartley A. Revised radiobiological modelling of the contribution of synchronous chemotherapy to the rate of grades 3-4 mucositis in head and neck cancer. J Med Imaging Radiat Oncol 2013; 57:733-8; quiz 739-40. [DOI: 10.1111/1754-9485.12096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/07/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Sara Meade
- Hall-Edwards Radiotherapy Research Group; Queen Elizabeth Hospital
| | | | - Paul Sanghera
- Hall-Edwards Radiotherapy Research Group; Queen Elizabeth Hospital
- Institute of Head and Neck Surgery and Education (InHANSE); University of Birmingham; Birmingham
| | - Hisham Mehanna
- Institute of Head and Neck Surgery and Education (InHANSE); University of Birmingham; Birmingham
| | - Andrew Hartley
- Hall-Edwards Radiotherapy Research Group; Queen Elizabeth Hospital
- Institute of Head and Neck Surgery and Education (InHANSE); University of Birmingham; Birmingham
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Revising the Radiobiological Model of Synchronous Chemotherapy in Head-and-Neck Cancer: A New Analysis Examining Reduced Weighting of Accelerated Repopulation. Int J Radiat Oncol Biol Phys 2013; 86:157-63. [DOI: 10.1016/j.ijrobp.2012.11.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 10/11/2012] [Accepted: 11/13/2012] [Indexed: 11/22/2022]
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Bütof R, Baumann M. Time in radiation oncology – Keep it short! Radiother Oncol 2013; 106:271-5. [DOI: 10.1016/j.radonc.2013.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/04/2013] [Indexed: 12/25/2022]
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Harada H, Omura K, Tomioka H, Nakayama H, Hiraki A, Shinohara M, Yoshihama Y, Shintani S. Multicenter phase II trial of preoperative chemoradiotherapy with S-1 for locally advanced oral squamous cell carcinoma. Cancer Chemother Pharmacol 2013; 71:1059-64. [PMID: 23377375 PMCID: PMC3607732 DOI: 10.1007/s00280-013-2101-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 01/19/2013] [Indexed: 11/10/2022]
Abstract
Purpose We evaluated whether preoperative chemotherapy with S-1 and concurrent radiotherapy is feasible and efficacious in the treatment of advanced oral squamous cell carcinoma. Methods Participants comprised 39 patients with oral carcinoma (stage III, n = 15; stage IVA, n = 24). All patients received a total radiation dose of 40 Gy, in once-daily 2-Gy fractions, and received S-1 at 65 mg/m2/day for 5 consecutive days, over 4 consecutive weeks with concurrent radiotherapy. Results Hematological toxicity was mild and reversible. The most common non-hematological toxicity was grade 3 mucositis, but this was transient and tolerable. Radical surgery was performed for 37 patients, with the remaining 2 patients declining the surgery. Postoperatively, local failure developed in 1 patient, and neck failure in 2 patients. Distant metastases were identified in 4 patients. At a median follow-up of 38.0 months (range 23–88 months), locoregional control, disease-specific survival, and overall survival rates at 3 years were 91.5, 83.8, and 83.8 %, respectively. Conclusion Concurrent administration of S-1 and radiotherapy combined with surgery offers a well-tolerated method of successfully treating advanced oral squamous cell carcinoma. The locoregional control rate remains high even at 3 years of follow-up, and no serious adverse effects have been encountered.
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Affiliation(s)
- Hiroyuki Harada
- Department of Oral Surgery, Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8549, Japan.
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Machtay M, Moughan J, Farach A, Martin-O'Meara E, Galvin J, Garden AS, Weber RS, Cooper JS, Forastiere A, Ang KK. Hypopharyngeal dose is associated with severe late toxicity in locally advanced head-and-neck cancer: an RTOG analysis. Int J Radiat Oncol Biol Phys 2013; 84:983-9. [PMID: 23078898 DOI: 10.1016/j.ijrobp.2012.03.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/01/2012] [Accepted: 03/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. METHODS AND MATERIALS This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube≥2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. RESULTS A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving ≤60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. CONCLUSIONS Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.
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Affiliation(s)
- Mitchell Machtay
- University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
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Kano S, Homma A, Hayashi R, Kawabata K, Yoshino K, Iwae S, Hasegawa Y, Nibu K, Kato T, Shiga K, Matsuura K, Monden N, Fujii M. Matched-Pair Analysis in Patients with Advanced Oropharyngeal Cancer: Surgery versus Concurrent Chemoradiotherapy. Oncology 2013; 84:290-8. [DOI: 10.1159/000346908] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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Abstract
Treatment for patients with head and neck cancer requires a multidisciplinary approach. Radiotherapy is employed as a primary treatment or as an adjuvant to surgery. Each specific subsite dictates the appropriate radiotherapy techniques, fields, dose, and fractionation scheme. Quality of life is also an important issue in the management of head and neck cancer. The radiation-related complications have a tremendous impact on the quality of life. Modern radiotherapy techniques, such as intensity-modulated radiotherapy and image-guided radiotherapy, can offer precise radiation delivery and reduce the dose to the surrounding normal tissues without compromise of target coverage. In the future, efforts should be made in the exploration of novel strategies to improve treatment outcome in patients with head and neck cancer.
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Affiliation(s)
- Shyh-An Yeh
- Department of Radiation Oncology, E-Da Hospital, Kaohsiung, Taiwan
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Haisfield-Wolfe ME, McGuire DB, Krumm S. Perspectives on coping among patients with head and neck cancer receiving radiation. Oncol Nurs Forum 2012; 39:E249-57. [PMID: 22543396 DOI: 10.1188/12.onf.e249-e257] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe coping among patients with laryngeal and oropharyngeal cancer during definitive radiation with or without chemotherapy. RESEARCH APPROACH Qualitative content analysis conducted within a larger study. SETTING Two radiation oncology outpatient clinics in Baltimore, MD. PARTICIPANTS 21 patients with oropharyngeal or laryngeal cancer. METHODOLOGIC APPROACH Interviews with open-ended questions were conducted during treatment. Questions covered topics such as coping during treatment, treatment-related issues, and resources. MAIN RESEARCH VARIABLES Coping, treatment, and coping resources. FINDINGS Patients' self-assessments suggested they were coping or that coping was rough or upsetting. Issues that required coping varied over four time points. Physical side effects were problematic during and one month after treatment completion. Patients used coping to manage the uncertainties of physical and psychological aspects of their experience. Family and friend support was a common coping strategy used by patients, with the intensity of side effects corresponding with the support provided across time points. CONCLUSIONS Findings confirm previous research, but also provide new information about ways in which patients with head and neck cancer cope with their illness experience. Emergent themes provide insight into patients' feelings, issues, and assistance received with coping. INTERPRETATION Patients with head and neck cancer need education on the amount and severity of side effects and should be appraised of potential difficulties with scheduling, driving, and other logistic issues. Patients also should be informed of helpful types of support and coping strategies. Additional research is needed to expand the findings related to patients' coping with treatment and to explore the experiences of family and friends who provide social support.
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The Role of Chemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma. Semin Radiat Oncol 2012; 22:198-206. [DOI: 10.1016/j.semradonc.2012.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Krstevska V, Stojkovski I, Zafirova-Ivanovska B. Concurrent radiochemotherapy in locally-regionally advanced oropharyngeal squamous cell carcinoma: analysis of treatment results and prognostic factors. Radiat Oncol 2012; 7:78. [PMID: 22640662 PMCID: PMC3404949 DOI: 10.1186/1748-717x-7-78] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 05/28/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Concurrent radiochemotherapy is a recommended treatment option for patients with locally advanced squamous cell head and neck carcinomas with recent data showing the most significant absolute overall and event-free survival benefit achieved in patients with oropharyngeal tumours. The aim of this study was to analyse the results of three-dimensional conformal radiotherapy given with concomitant weekly cisplatin in patients with advanced oropharyngeal carcinoma and to identify prognostic factors influencing outcomes of this patients category. METHODS Sixty-five patients with stage III or IV squamous cell carcinoma of the oropharynx who underwent concurrent radiochemotherapy between January 2005 and December 2010 were retrospectively analyzed. All patients received radiotherapy to 70 Gy/35 fractions/2 Gy per fraction/5 fractions per week. Concurrent chemotherapy consisted of weekly cisplatin (30 mg/m(2)) started at the first day of radiotherapy. RESULTS Median age was 57 years (range, 36 to 69 years) and 59 (90.8%) patients were male. Complete composite response was achieved in 47 patients (72.3%). Local and/or regional recurrence was the most frequent treatment failure present in 19 out of 25 patients (76.0%). At a median follow-up of 14 months (range, 5 to 72 months), 2-year local relapse-free, regional relapse-free, locoregional relapse-free, disease-free, and overall survival rates were 48.8%, 57.8%, 41.7%, 33.2% and 49.7%, respectively.On multivariate analysis the only significant factor for inferior regional relapse-free survival was the advanced N stage (p = 0.048). Higher overall stage was independent prognostic factor for poorer local relapse-free survival, locoregional relapse-free survival and disease-free survival (p = 0.022, p = 0.003 and p = 0.003, respectively). Pre-treatment haemoglobin concentration was an independent prognostic factor for local relapse-free survival, regional relapse-free survival, locoregional relapse-free survival, disease-free survival, and overall survival (p = 0.002, p = 0.021, p = 0.001, p = 0.002 and p = 0.002, respectively). CONCLUSIONS Poor treatments results of this study suggested that introduction of intensity-modulated radiotherapy, use of induction chemotherapy followed by concurrent radiochemotherapy, accelerated radiotherapy regimens, and molecular targeted therapies could positively influence treatment outcomes. The incorporation of reversal of anaemia should be also expected to provide further improvement in locoregional control and survival in patients with advanced squamous cell carcinoma of the oropharynx.
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Affiliation(s)
- Valentina Krstevska
- Department of Head and Neck Cancer, University Clinic of Radiotherapy and Oncology, Skopje, Macedonia
| | - Igor Stojkovski
- Department of Head and Neck Cancer, University Clinic of Radiotherapy and Oncology, Skopje, Macedonia
| | - Beti Zafirova-Ivanovska
- Institute of Epidemiology, Statistics and Informatics, Faculty of Medicine, Skopje, Macedonia
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Deboni ALDS, Giordani AJ, Lopes NNF, Dias RS, Segreto RA, Jensen SB, Segreto HRC. Long-term oral effects in patients treated with radiochemotherapy for head and neck cancer. Support Care Cancer 2012; 20:2903-11. [DOI: 10.1007/s00520-012-1418-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Accepted: 02/14/2012] [Indexed: 11/24/2022]
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Two-year results from a Swedish study on conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma – The ARTSCAN study. Radiother Oncol 2011; 100:41-8. [DOI: 10.1016/j.radonc.2010.12.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 12/27/2010] [Accepted: 12/30/2010] [Indexed: 11/20/2022]
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Furness S, Glenny AM, Worthington HV, Pavitt S, Oliver R, Clarkson JE, Macluskey M, Chan KK, Conway DI. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database Syst Rev 2011:CD006386. [PMID: 21491393 DOI: 10.1002/14651858.cd006386.pub3] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients. OBJECTIVES To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes. SEARCH STRATEGY Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 1st December 2010. Reference lists of recent reviews and included studies were also searched to identify further trials. SELECTION CRITERIA Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included. DATA COLLECTION AND ANALYSIS Eighty-nine trials which met the inclusion criteria were assessed for risk of bias and data were extracted by two or more review authors. The primary outcome was total mortality. Trial authors were contacted for additional information or for clarification. MAIN RESULTS There is evidence of a small increase in overall survival associated with induction chemotherapy compared to locoregional treatment alone (25 trials), hazard ratio (HR) of mortality 0.92 (95% confidence interval (CI) 0.84 to 1.00, P = 0.06). Post-surgery adjuvant chemotherapy is associated with improved overall survival compared to surgery ± radiotherapy alone (10 trials), HR of mortality 0.88 (95% CI 0.79 to 0.99, P = 0.03), and there is some evidence that this improvement may be greater with concomitant adjuvant chemoradiotherapy (4 trials), HR of mortality 0.84 (95% CI 0.72 to 0.98, P = 0.03). In patients with unresectable tumours, there is evidence that concomitant or alternating chemoradiotherapy is associated with improved survival compared to radiotherapy alone (26 trials), HR of mortality 0.78 (95% CI 0.73 to 0.83, P < 0.00001). These findings are confirmed by sensitivity analyses based on studies assessed at low risk of bias. There is insufficient evidence to identify which agent(s) and/or regimen(s) are the most effective. The additional toxicity attributable to chemotherapy in the combined regimens remains unquantified. AUTHORS' CONCLUSIONS Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy may prolong survival by 8 to 20% and adjuvant concomitant chemoradiotherapy may prolong survival by up to 16%. In patients with unresectable tumours, concomitant or alternating chemoradiotherapy may prolong survival by 10 to 22%. There is insufficient evidence as to which agent or regimen is most effective and the additional toxicity associated with chemotherapy given in addition to radiotherapy and/or surgery cannot be quantified.
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Affiliation(s)
- Susan Furness
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Building, Oxford Rd, Manchester, UK, M13 9PL
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Baujat B, Bourhis J, Blanchard P, Overgaard J, Ang KK, Saunders M, Le Maître A, Bernier J, Horiot JC, Maillard E, Pajak TF, Poulsen MG, Bourredjem A, O'Sullivan B, Dobrowsky W, Andrzej H, Skladowski K, Hay JH, Pinto LHJ, Fu KK, Fallai C, Sylvester R, Pignon JP. Hyperfractionated or accelerated radiotherapy for head and neck cancer. Cochrane Database Syst Rev 2010; 2010:CD002026. [PMID: 21154350 PMCID: PMC8407183 DOI: 10.1002/14651858.cd002026.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Several trials have studied the role of altered fractionation radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. OBJECTIVES The aim of this individual patient data (IPD) meta-analysis was to assess whether this type of radiotherapy could improve survival. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL (2010, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 8 August 2010. SELECTION CRITERIA We identified randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic head and neck squamous cell carcinomas and grouped trials into three pre-specified treatment categories: hyperfractionated, accelerated and accelerated with total dose reduction. Trials were eligible if they began recruitment after 1969 and ended before 1998. DATA COLLECTION AND ANALYSIS We obtained updated individual patient data. Overall survival was the main outcome measure. The secondary outcome measures were local or regional control rates (or both), distant control rates and cause-specific mortality. MAIN RESULTS We included 15 trials with 6515 patients. The median follow up was six years. Tumour sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (UICC 2002). There was a significant survival benefit with altered fractionation radiotherapy, corresponding to an absolute benefit of 3.4% at five years (hazard ratio (HR) 0.92, 95% CI 0.86 to 0.97; P = 0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at five years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at five years, P = 0.02). There was a benefit in locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at five years; P < 0.0001), which was particularly efficient in reducing local failure, whereas the benefit on nodal control was less pronounced. The benefit was significantly higher in the youngest patients (under 50 year old) (HR 0.78, 95% CI 0.65 to 0.94), 0.95 (95% CI 0.83 to 1.09) for 51 to 60 year olds, 0.92 (95% CI 0.81 to 1.06) for 61 to 70 year olds, and 1.08 (95% CI 0.89 to 1.30) for those over 70 years old; test for trends P = 0.007). AUTHORS' CONCLUSIONS Altered fractionation radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation provides the greatest benefit. An update of this IPD meta-analysis (MARCH 2), which will increase the power of this analysis and allow for other comparisons, is currently in progress.
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Affiliation(s)
- Bertrand Baujat
- Hôpital TenonService ORL‐CCF4 rue de la ChineParisFrance75020
| | - Jean Bourhis
- Institut Gustave RoussyDépartement de Radiothérapie39 rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Pierre Blanchard
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Jens Overgaard
- Aarhus University HospitalDepartment of Experimental Clinical OncologyNorrebrogade 44 Bldg 5AarhusDenmarkC DK‐8000
| | - Kian K Ang
- MD Anderson Cancer CenterRadiation Oncology Department1515 Holcombe Blvd Box 97HoustonTexasUSA77030
| | - Michelle Saunders
- Marie Curie Research Wing for OncologyRadiation Oncology DepartmentMount Vernon Centre for Cancer TreatmentRickmansworth RoadNorthwoodMiddlesexUKHA6 2RN
| | - Aurélie Le Maître
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Jacques Bernier
- Clinique de GenoliaService de Radio‐OncologieGenolierSwitzerlandCH‐1272
| | | | - Emilie Maillard
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Thomas F Pajak
- RTOGStatistical Headquarters1818 Market Street, Suite 1600PhiladelphiaPAUSA19103
| | - Michael G Poulsen
- Mater Queensland Radium InstituteRaymond Terrace, South BrisbaneBrisbaneAustralia4101
| | - Abderrahmane Bourredjem
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Brian O'Sullivan
- Princess Margaret HospitalRadiation Oncology Department610 University AvenueTorontoONCanadaM5G 2M9
| | - Werner Dobrowsky
- Northern Centre for Cancer TreatmentNewcastle General HospitalWestgate roadNewcastle upon TyneUKNE4 6BE
| | | | - Krzystof Skladowski
- Centrum Onkologii‐Inst. M. CurieRadiotherapy ClinicWybrzeze Armii Krajowej 15GliwicePoland44‐101
| | - John H Hay
- Vancouver Cancer CenterDepartment of Radiation Oncology600 W, 10th AvenueVancouverBCCanadaV5Z 4E6
| | - Luiz HJ Pinto
- Instituto Nacional de CancerDepartamento de RadioterapiaRio de JaneiroBrazil20230
| | - Karen K Fu
- University of California San Francisco555 Laurel Ave Apt 508San MateoCAUSA94401‐4153
| | - Carlo Fallai
- Instituto Nazionale dei TumoriDipartimento di RadiotherapiaVia Venezian 1MilanoItaly20133
| | - Richard Sylvester
- European Organisation for Research and Treatment of CancerData CenterAvenue E Mounier 83 ‐ Bte 11BrusselsBelgium1200
| | - Jean Pierre Pignon
- Gustave Roussy Cancer CampusPlateforme LNCC de Méta‐analyse en Oncologie et Service de Biostatistique et d’EpidémiologieVillejuifFrance
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Glenny A, Furness S, Worthington HV, Conway DI, Oliver R, Clarkson JE, Macluskey M, Pavitt S, Chan KKW, Brocklehurst P, The CSROC Expert Panel. Interventions for the treatment of oral cavity and oropharyngeal cancer: radiotherapy. Cochrane Database Syst Rev 2010; 2010:CD006387. [PMID: 21154367 PMCID: PMC10749265 DOI: 10.1002/14651858.cd006387.pub2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The management of advanced oral cavity and oropharyngeal cancers is problematic and has traditionally relied on surgery and radiotherapy, both of which are associated with substantial adverse effects. Radiotherapy has been in use since the 1950s and has traditionally been given as single daily doses. This method of dividing up the total dose, or fractionation, has been modified over the years and a variety of approaches have been developed with the aim of improving survival whilst maintaining acceptable toxicity. OBJECTIVES To determine which radiotherapy regimens for oral cavity and oropharyngeal cancers result in increased overall survival, disease free survival, progression free survival and locoregional control. SEARCH STRATEGY The following electronic databases were searched: the Cochrane Oral Health Group's Trials Register (to 28 July 2010), CENTRAL (The Cochrane Library 2010, Issue 3), MEDLINE via OVID (1950 to 28 July 2010) and EMBASE via OVID (1980 to 28 July 2010). There were no restrictions regarding language or date of publication. SELECTION CRITERIA Randomised controlled trials where more than 50% of participants had primary tumours of the oral cavity or oropharynx, and which compared two or more radiotherapy regimens, radiotherapy versus other treatment modality, or the addition of radiotherapy to other treatment modalities. DATA COLLECTION AND ANALYSIS Data extraction and assessment of risk of bias was undertaken independently by two or more authors. Study authors were contacted for additional information as required. Adverse events data were collected from published trials. MAIN RESULTS 30 trials involving 6535 participants were included. Seventeen trials compared some form of altered fractionation (hyperfractionation/accelerated) radiotherapy with conventional radiotherapy; three trials compared different altered fractionation regimens; one trial compared timing of radiotherapy, five trials evaluated neutron therapy and four trials evaluated the addition of pre-operative radiotherapy. Pooling trials of any altered fractionation radiotherapy compared to a conventional schedule showed a statistically significant reduction in total mortality (hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76 to 0.98). In addition, a statistically significant difference in favour of the altered fractionation was shown for the outcome of locoregional control (HR 0.79, 95% CI 0.70 to 0.89). No statistically significant difference was shown for disease free survival.No statistically significant difference was shown for any other comparison. AUTHORS' CONCLUSIONS Altered fractionation radiotherapy is associated with an improvement in overall survival and locoregional control in patients with oral cavity and oropharyngeal cancers. More accurate methods of reporting adverse events are needed in order to truly assess the clinical performance of different radiotherapy regimens.
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Affiliation(s)
- Anne‐Marie Glenny
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - Susan Furness
- The University of ManchesterCochrane Oral Health Group, School of DentistryCoupland III Bldg, Oxford RdManchesterUKM13 9PL
| | - Helen V Worthington
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
| | - David I Conway
- University of GlasgowGlasgow Dental School378 Sauchiehall StreetGlasgowUKG2 3JZ
| | - Richard Oliver
- RED (Research and Education in Dentistry)10 Longbow Close, Harlescott LaneShrewsburyUKSY1 3GZ
| | - Jan E Clarkson
- Cochrane Oral Health Group, The University of ManchesterDental Health Services & Research Unit, University of Dundee, DundeeManchesterUK
| | - Michaelina Macluskey
- University of DundeeUnit of Oral Surgery and MedicineUniversity of Dundee Dental Hospital and SchoolPark PlaceDundeeScotlandUKDD1 4NR
| | - Sue Pavitt
- University of LeedsClinical Trials Research UnitClinical Trials Research House71‐75 Clarendon RoadLeedsUKLS2 9NP
| | - Kelvin KW Chan
- Princess Margaret Hospital610 University AvenueTorontoOntarioCanadaM5G 2M9
| | - Paul Brocklehurst
- School of Dentistry, The University of ManchesterCoupland III BuildingOxford RoadManchesterUKM13 9PL
| | - The CSROC Expert Panel
- School of Dentistry, The University of ManchesterCochrane Oral Health GroupCoupland III Building, Oxford RoadManchesterUKM13 9PL
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Boscolo-Rizzo P, Gava A, Baggio V, Marchiori C, Stellin M, Fuson R, Lamon S, Da Mosto MC. Matched survival analysis in patients with locoregionally advanced resectable oropharyngeal carcinoma: platinum-based induction and concurrent chemoradiotherapy versus primary surgical resection. Int J Radiat Oncol Biol Phys 2010; 80:154-60. [PMID: 20864267 DOI: 10.1016/j.ijrobp.2010.01.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Revised: 01/20/2010] [Accepted: 01/20/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE The outcome of a prospective case series of 47 patients with newly diagnosed resectable locoregionally advanced oropharyngeal squamous cell carcinoma treated with platinum-based induction-concurrent chemoradiotherapy (IC/CCRT) was compared with the outcome of 47 matched historical control patients treated with surgery and postoperative RT. METHODS AND MATERIALS A total of 47 control patients with locoregionally advanced oropharyngeal squamous cell carcinoma were identified from review of a prospectively compiled comprehensive computerized head-and-neck cancer database and were matched with a prospective case series of patients undergoing IC/CCRT by disease stage, nodal status, gender, and age (± 5 years). The IC/CCRT regimen consisted of one cycle of induction chemotherapy followed by conventionally fractionated RT to a total dose of 66-70 Gy concomitantly with two cycles of chemotherapy. Each cycle of chemotherapy consisted of cisplatinum, 100 mg/m(2), and a continuous infusion of 5-fluorouracil, 1,000 mg/m(2)/d for 5 days. The survival analysis was performed using Kaplan-Meier estimates. Matched-pair survival was compared using the Cox proportional hazards model. RESULTS No significant difference was found in the overall survival or progression-free survival rates between the two groups. The matched analysis of survival did not show a statistically significant greater hazard ratio for overall death (hazard ratio, 1.35; 95% confidence interval, 0.65-2.80; p = .415) or progression (hazard ratio, 1.44; 95% confidence interval, 0.72-2.87; p = .301) for patients undergoing IC/CCRT. CONCLUSION Although the sample size was small and not randomized, this matched-pair comparison between a prospective case series and a historical cohort treated at the same institution showed that the efficacy of IC/CCRT with salvage surgery is as good as primary surgical resection and postoperative RT.
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Affiliation(s)
- Paolo Boscolo-Rizzo
- Department of Medical and Surgical Specialties, Otolaryngology Clinic, Regional Center for Head and Neck Cancer, University of Padua School of Medicine, Treviso Regional Hospital, Treviso, Italy.
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Furness S, Glenny AM, Worthington HV, Pavitt S, Oliver R, Clarkson JE, Macluskey M, Chan KK, Conway DI. Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy. Cochrane Database Syst Rev 2010:CD006386. [PMID: 20824847 DOI: 10.1002/14651858.cd006386.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Oral cavity and oropharyngeal cancers are frequently described as part of a group of oral cancers or head and neck cancer. Treatment of oral cavity cancer is generally surgery followed by radiotherapy, whereas oropharyngeal cancers, which are more likely to be advanced at the time of diagnosis, are managed with radiotherapy or chemoradiation. Surgery for oral cancers can be disfiguring and both surgery and radiotherapy have significant functional side effects, notably impaired ability to eat, drink and talk. The development of new chemotherapy agents, new combinations of agents and changes in the relative timing of surgery, radiotherapy, and chemotherapy treatments may potentially bring about increases in both survival and quality of life for this group of patients. OBJECTIVES To determine whether chemotherapy, in addition to radiotherapy and/or surgery for oral cavity and oropharyngeal cancer results in improved survival, disease free survival, progression free survival, locoregional control and reduced recurrence of disease. To determine which regimen and time of administration (induction, concomitant or adjuvant) is associated with better outcomes. SEARCH STRATEGY Electronic searches of the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE, EMBASE, AMED were undertaken on 28th July 2010. Reference lists of recent reviews and included studies were also searched to identify further trials. SELECTION CRITERIA Randomised controlled trials where more than 50% of participants had primary tumours in the oral cavity or oropharynx, and which compared the addition of chemotherapy to other treatments such as radiotherapy and/or surgery, or compared two or more chemotherapy regimens or modes of administration, were included. DATA COLLECTION AND ANALYSIS Trials which met the inclusion criteria were assessed for risk of bias using six domains: sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting and other possible sources of bias. Data were extracted using a specially designed form and entered into the characteristics of included studies table and the analysis sections of the review. The proportion of participants in each trial with oral cavity and oropharyngeal cancers are recorded in Additional Table 1. MAIN RESULTS There was no statistically significant improvement in overall survival associated with induction chemotherapy compared to locoregional treatment alone in 25 trials (hazard ratio (HR) of mortality 0.92, 95% confidence interval (CI) 0.84 to 1.00). Post-surgery adjuvant chemotherapy was associated with improved overall survival compared to surgery +/- radiotherapy alone in 10 trials (HR of mortality 0.88, 95% CI 0.79 to 0.99), and there was an additional benefit of adjuvant concomitant chemoradiotherapy compared to radiotherapy in 4 of these trials (HR of mortality 0.84, 95% CI 0.72 to 0.98). Concomitant chemoradiotherapy resulted in improved survival compared to radiotherapy alone in patients whose tumours were considered unresectable in 25 trials (HR of mortality 0.79, 95% CI 0.74 to 0.84). However, the additional toxicity attributable to chemotherapy in the combined regimens remains unquantified. AUTHORS' CONCLUSIONS Chemotherapy, in addition to radiotherapy and surgery, is associated with improved overall survival in patients with oral cavity and oropharyngeal cancers. Induction chemotherapy is associated with a 9% increase in survival and adjuvant concomitant chemoradiotherapy is associated with a 16% increase in overall survival following surgery. In patients with unresectable tumours, concomitant chemoradiotherapy showed a 22% benefit in overall survival compared with radiotherapy alone.
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Affiliation(s)
- Susan Furness
- Cochrane Oral Health Group, School of Dentistry, The University of Manchester, Coupland III Bldg, Oxford Rd, Manchester, UK, M13 9PL
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Treatment outcomes of locally advanced oropharyngeal cancer: a comparison between combined modality radio-chemotherapy and two variants of single modality altered fractionation radiotherapy. Int J Radiat Oncol Biol Phys 2010; 80:1030-6. [PMID: 20675071 DOI: 10.1016/j.ijrobp.2010.03.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 03/24/2010] [Accepted: 03/31/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE To compare outcomes in patients with locally advanced oropharyngeal cancer treated with radio-chemotherapy (RT-CT), accelerated fractionation radiotherapy (AccRT), or hypofractionated radiotherapy (HypoRT). METHODS AND MATERIALS Subjects were 321 consecutive patients with newly diagnosed oropharyngeal cancer, Stage III or IVA/B, treated between January 2001 and December 2005 at the BC Cancer Agency with RT-CT (n = 157), AccRT (n = 57), or HypoRT (n = 107). Outcomes examined were disease-specific survival (DSS), locoregional control (LRC), overall survival (OS), rate of G-tube use, and rate of hospitalization for acute complications. RESULTS Median follow-up was 3.4 years. Three-year Kaplan-Meier DSS with RT-CT, AccRT, and HypoRT were 80%, 81%, and 74%, respectively (p = 0.219). Cox regression analysis identified treatment modality as a significant factor affecting DSS (p = 0.038). Compared with RT-CT, the hazard ratio (HR) for DSS was 1.0 with AccRT and 2.0 with HypoRT (p = 0.021). Kaplan-Meier pairwise comparisons found no significant difference in LRC and OS between RT-CT and AccRT. HypoRT was associated with significantly lower LRC (p = 0.005) and OS (p = 0.008) compared with RT-CT. There were significant differences in the rates of G-tube use (p < 0.001) and of hospitalization (p = 0.036) among the three treatment groups, with the most frequent rates observed in the RT-CT group. CONCLUSIONS In patients with locally advanced oropharyngeal cancer, AccRT conferred DSS, LRC, and OS comparable to that of RT-CT. Patients treated with RT-CT experienced higher rates of treatment-related acute toxicities. HypoRT was associated with the least favorable outcomes.
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