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Afify AY, Ashry MH. Exploring the risk of second primary malignancies in laryngeal cancer survivors: insights from the SEER database. Eur Arch Otorhinolaryngol 2024; 281:4409-4417. [PMID: 38775833 PMCID: PMC11266365 DOI: 10.1007/s00405-024-08731-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/09/2024] [Indexed: 07/24/2024]
Abstract
PURPOSE We intended to investigate the risk for second primary malignancy (SPM) development in Laryngeal Cancer (LC) survivors. We conducted a population-based analysis of SPM risk using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) database. METHODS Data of selected LC survivors from the SEER database between 2000 and 2020 were examined. Standardized Incidence ratios (SIRs) for SPM development were calculated, followed by detailed stratification according to anatomical site and different latency periods. RESULTS A total of 8413 SPMs were observed in our extracted cohort. The collective standardized incidence of SPMs was 2.12 (95% CI 2.07-2.17) compared to the US population, with an absolute excess risk (AER) of 201.73 per 10,000 individuals. The highest SPM risks were observed in patients with young age at diagnosis, females, and American Indians/Alaska natives. Increased SPM risks were reported in patients receiving all modalities of treatment including surgery, chemotherapy, and radiotherapy. Most SPMs were detected in solid organs such as the lungs and bronchus, oral cavity and pharynx, and prostate. The highest increased risks of developing SPMs were observed in Trachea, larynx, oral cavity and pharynx, lung and bronchus, and esophagus. CONCLUSIONS The risk of SPMs in LC survivors was significantly increased compared to the general US population. Accordingly, a more impactful cancer surveillance strategy for LC patients should be implemented.
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Affiliation(s)
| | - Mohamed Hady Ashry
- School of Medicine, New Giza University (NGU), Giza, Egypt
- Medical Research Platform, Cairo, Egypt
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2
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Nobacht A, Meijer TWH, Oosting SF, van der Vegt B, Wedman J, Halmos GB, Plaat BEC. Oncological and functional outcomes in T3 and T4 laryngeal cancer patients: choice for larynx preservation or total laryngectomy based on expected laryngeal function. J Laryngol Otol 2024; 138:672-678. [PMID: 38235588 PMCID: PMC11096834 DOI: 10.1017/s0022215124000112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/26/2023] [Accepted: 11/02/2023] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To determine oncological and functional outcomes in patients with T3 and T4 laryngeal carcinoma, in which choice of treatment was based on expected laryngeal function and not T classification. METHODS Oncological outcomes (disease-specific survival and overall survival) as well as functional outcomes (larynx preservation and functional larynx preservation) were analysed. RESULTS In 130 T3 and 59 T4 patients, there was no difference in disease-specific survival or overall survival rates after radiotherapy (RT) (107 patients), chemoradiotherapy (36 patients) and total laryngectomy (46 patients). The five-year disease-specific survival rates were 83 per cent after RT, 78 per cent after chemoradiotherapy and 69 per cent after total laryngectomy, whereas overall survival rates were 62, 54 and 60 per cent, respectively. Five-year larynx preservation and functional larynx preservation rates were comparable for RT (79 and 66 per cent, respectively) and chemoradiotherapy (86 and 62 per cent, respectively). CONCLUSION There is no difference in oncological outcome after (chemo)radiotherapy or total laryngectomy in T3 and T4 laryngeal carcinoma patients whose choice of treatment was based on expected laryngeal function.
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Affiliation(s)
- Arman Nobacht
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tineke W H Meijer
- Department of Radiotherapy, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bert van der Vegt
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan Wedman
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - György B Halmos
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Boudewijn E C Plaat
- Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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3
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van de Weerd C, Geurts SME, Vercoulen RJMT, van Veggel IHF, Brands MT, Marres HAM, Hermens RPMG, van Tol-Geerdink JJ, Kaanders JHAM, Takes RP. Value of routine follow-up for recurrence detection after treatment with curative intent for laryngeal squamous cell carcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107304. [PMID: 38043360 DOI: 10.1016/j.ejso.2023.107304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/30/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION The benefits of routine follow-up after treatment of primary laryngeal squamous cell carcinoma (LSCC) remain disputed. Guidelines worldwide are consensus-based, and evidence for specific subgroups is lacking. This study evaluates routine LSCC follow-up including flexible endoscopy for detecting locoregional recurrence (LRR). METHODS A retrospective cohort of 413 LSCC patients treated between 2006 and 2012 was analysed. The cumulative risk of LRR was calculated. Routine follow-up was evaluated by follow-up visit (routine or interval) at which LRR was detected, LRR treatment intent, and overall survival (OS). Analyses were stratified by early (I-II) and advanced (III-IV) TNM-stage. RESULTS There were 263 (64 %) patients with early-stage and 132 (32 %) patients with advanced-stage LSCC. One-, two- and five-year cumulative risks for LRR after early-stage LSCC were 8 %, 18 %, and 26 %. For advanced-stage LSCC, cumulative risks of LRR were 20 %, 30 %, and 35 %. Of all 69 LRRs after early-stage LSCC, 72 % were routine-detected, 81 % were symptomatic, and 90 % received curative-intent treatment. Of all 45 LRRs following advanced-stage LSCC, 42 % were routine-detected, 84 % were symptomatic, and 62 % received curative-intent treatment. Five-year OS of early-stage LSCC with routine-detected LRR was 70 %, and 72 % for interval-detection (log-rank-p = 0.91). Five-year OS of advanced-stage LSCC with routine-detected LRR was 37 %, and 18 % for interval-detection (log-rank-p = 0.06). CONCLUSIONS Routine follow-up for detecting asymptomatic recurrences seems redundant for early-stage LSCC. After advanced-stage LSCC, no asymptomatic recurrences were detected beyond one year posttreatment despite regular follow-up. Emphasis should be on other follow-up aspects, such as psychosocial support, especially after one year posttreatment.
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Affiliation(s)
- Cecile van de Weerd
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands.
| | - Sandra M E Geurts
- Maastricht University Medical Center, Department of Medical Oncology, GROW School for Oncology and Reproduction, Maastricht, the Netherlands
| | - Richard J M T Vercoulen
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
| | - Inge H F van Veggel
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
| | - Maria T Brands
- Hospital Network Antwerp, Middelheim Medical Center, Department of Oral and Maxillofacial Surgery, Antwerp, Belgium
| | - Henri A M Marres
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
| | - Rosella P M G Hermens
- Radboud University Medical Center, Department of IQ Healthcare, Nijmegen, the Netherlands
| | | | - Johannes H A M Kaanders
- Radboud University Medical Center, Department of Radiation Oncology, Nijmegen, the Netherlands
| | - Robert P Takes
- Radboud University Medical Center, Department of Otorhinolaryngology and Head and Neck Surgery, Nijmegen, the Netherlands
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Svärd F, Alabi RO, Leivo I, Mäkitie AA, Almangush A. The risk of second primary cancer after nasopharyngeal cancer: a systematic review. Eur Arch Otorhinolaryngol 2023; 280:4775-4781. [PMID: 37495725 PMCID: PMC10562268 DOI: 10.1007/s00405-023-08144-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/18/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Second primary cancers (SPCs) after nasopharyngeal cancer (NPC) are rare, but have an impact on the follow-up of this patient population. The aim of this study is to systematically review the literature to determine the prevalence and most typical sites of SPCs after NPC. METHODS We searched the databases of PubMed, Web of Science, and Scopus for articles on SPCs after NPC. The Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed. RESULTS This review includes data on 89 168 patients with NPC from 21 articles. The mean occurrence for SPCs was 6.6% and varied from 4.9% in endemic areas to 8.7% in non-endemic areas. The most frequent locations of SPCs were oral cavity, pharynx, nose and paranasal sinuses, esophagus and lung. CONCLUSION There is an increased risk for a SPC after NPC management, especially in non-endemic areas. However, their mean rate is lower than after other head and neck carcinomas.
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Affiliation(s)
- Fanni Svärd
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - Rasheed Omobolaji Alabi
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ilmo Leivo
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
| | - Antti A Mäkitie
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Department of Otorhinolaryngology, Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Alhadi Almangush
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Pathology, University of Helsinki, P.O. Box 21, 00014, Helsinki, Finland
- Institute of Biomedicine, Pathology, University of Turku, Turku, Finland
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5
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Nikkilä R, Hirvonen E, Haapaniemi A, Tapiovaara L, Pitkäniemi J, Malila N, Mäkitie A. Significant risk of second primary cancer among laryngeal squamous cell carcinoma patients even after 20 years. Acta Oncol 2023; 62:1322-1330. [PMID: 37672344 DOI: 10.1080/0284186x.2023.2254482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Evidence on the risk of second primary cancer (SPC) following primary laryngeal squamous cell carcinoma (LSCC) is limited, especially in Europe. METHODS Patients diagnosed with primary LSCC from 1953-2018 were retrieved from the Finnish Cancer Registry. A total of 6241 LSCC patients were identified adding to 49,393 person-years (PY) of follow-up until the end of 2019. Only one patient emigrated and was lost to follow-up. Both standardized incidence ratios (SIR) and excess absolute risk (EAR) per 1000 person-years at risk (PYR) of second primary cancer (SPC) were calculated relative to the general population. Only non-laryngeal SPCs diagnosed six months after diagnosis of primary LSCC were included. RESULTS A SPC was diagnosed in 1244 LSCC patients (20% of all LSCC patients) over the 65-year period, predominantly in men (92%, n = 1170). Out of all SPCs, 34% were diagnosed within 0.5 to 5 years and 66% after 5 years from primary LSCC. Among male patients, the overall SIR for SPC at any location was 1.61 (95% CI: 1.52-1.71), corresponding to 9.49 excess SPCs per 1000 PYR (95% CI: 8.19-11). The corresponding SIR for women was 1.47 (95% CI: 1.15-1.84), yielding 4.82 excess SPCs per 1000 PYR (95% CI: 2.36-9.84). The risk remained significant even after 20 years of follow-up (SIR for all 1.73, 95% CI: 1.49-2.01 and EAR 16.8 per 1000 PY, 11.88-23.75). The risk for SPC was also significantly elevated in all age groups, except <40. The highest SIRs were for SPCs arising in the mouth/pharynx (SIR for all 3.08, 95% CI: 2.36-3.95 and EAR 0.80 per 1000 PY, 0.55-1.15) and lungs (3.02, 2.75-3.30 and 5.90 per 1000, 5.13-6.78). CONCLUSION Patients with LSCC as primary cancer have a 60% excess risk for an SPC, especially for tobacco-associated cancers, remaining significantly elevated even decades after treatment.
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Affiliation(s)
- Rayan Nikkilä
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Elli Hirvonen
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Tapiovaara
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Janne Pitkäniemi
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Nea Malila
- Finnish Cancer Registry, Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
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Marijić B, Tudor F, Janik S, Grasl S, Frommlet F, Maržić D, Hadžisejdić I, Vukelić J, Braut T, Velepič M, Erovic BM. Long-Term Care and Follow-Up in Laryngeal Cancer Patients: A Multicenter Retrospective Analysis. J Pers Med 2023; 13:927. [PMID: 37373916 DOI: 10.3390/jpm13060927] [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: 05/14/2023] [Revised: 05/29/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE We conducted an outcome analysis on surgically treated laryngeal squamous cell carcinoma (LSCC) patients. METHODS A multicenter retrospective study with 352 patients was analyzed. A new nomogram that incorporates age, T- and N-classification, and treatment was created. RESULTS Recurrence was observed in 65 (18.5%) patients after a mean time of 16.5 months. After 60 months, 91 (25.9%) of patients developed secondary primary tumors (SPT), most commonly in the lungs (n = 29; 8.2%) followed by other head and neck cancers (n = 21; 6.0%). Notably, the mean time to occurrence of secondary head and neck cancers was twice that of lung cancer (101.1 vs. 47.5 months). CONCLUSION Recurrent disease is less common in LSCC patients and appears much earlier than SPT. Because one in every four laryngeal cancer patients develops SPTs within 5-10 years, long-term care and follow-up, including imaging studies, are highly recommended. The nomogram was useful for estimating survival.
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Affiliation(s)
- Blažen Marijić
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Filip Tudor
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Stefan Janik
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, 1090 Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University Vienna, 1090 Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Section for Medical Statistics, Medical University Vienna, 1090 Vienna, Austria
| | - Diana Maržić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Audiology and Phoniatrics, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
| | - Ita Hadžisejdić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Clinical Department of Pathology and Cytology, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Jelena Vukelić
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Audiology and Phoniatrics, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia
| | - Tamara Braut
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Marko Velepič
- Department of Otorhinolaryngology, Head and Neck Surgery, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Boban M Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, 1180 Vienna, Austria
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7
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Genc S, Yagci T, Vageli DP, Dundar R, Doukas PG, Doukas SG, Tolia M, Chatzakis N, Tsatsakis A, Taghizadehghalehjoughi A. Exosomal MicroRNA-223, MicroRNA-146, and MicroRNA-21 Profiles and Biochemical Changes in Laryngeal Cancer. ACS Pharmacol Transl Sci 2023; 6:820-828. [PMID: 37200807 PMCID: PMC10186621 DOI: 10.1021/acsptsci.3c00038] [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: 02/23/2023] [Indexed: 05/20/2023]
Abstract
Laryngeal squamous cell carcinoma (LSCC) is one of the most aggressive cancers, and its early diagnosis is urgent. Exosomes are believed to have diagnostic significance in cancer. However, the role of serum exosomal microRNAs, miR-223, miR-146, and miR-21, and phosphatase and tensin homologue (PTEN) and hemoglobin subunit delta (HBD) mRNAs in LSCC is unclear. Exosomes were isolated from the blood serum of 10 LSCC patients and 10 healthy controls to perform scanning electron microscopy and liquid chromatography quadrupole time-of-flight mass spectrometry analyses to characterize them and to undergo reverse transcription polymerase chain reaction to identify miR-223, miR-146, miR-21, and PTEN and HBD mRNA expression phenotypes. Biochemical parameters, including serum C-reactive protein (CRP) and vitamin B12, were also obtained. Serum exosomes of 10-140 nm were isolated from LSCC and controls. Serum exosomal miR-223, miR-146, and PTEN were found to be significantly decreased (p < 0.05), in contrast to serum exosomal miRNA-21 (p < 0.01), and serum vitamin B12 and CRP (p < 0.05) were found to be significantly increased, in LSCC vs controls. Our novel data show that the combination of reduced serum exosomal miR-223, miR-146, and miR-21 profiles and biochemical alterations in CRP and vitamin B12 levels may be useful indicators of LSCC that could be validated by large studies. Our findings also suggest a possible negative regulatory effect of miR-21 on PTEN in LSCC, encouraging a more extensive investigation of its role.
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Affiliation(s)
- Sidika Genc
- Faculty
of Medicine, Department of Medical Pharmacology, Bilecik Seyh Edebali University, Bilecik 11230, Turkey
| | - Tarik Yagci
- Faculty
of Medicine, Department of ENT, Bilecik
Seyh Edebali University, Bilecik 11230, Turkey
| | - Dimitra P. Vageli
- Yale
Larynx Laboratory, Department of Surgery (Otolaryngology), Yale School of Medicine, New Haven, Connecticut 06510, United States
| | - Riza Dundar
- Faculty
of Medicine, Department of ENT, Bilecik
Seyh Edebali University, Bilecik 11230, Turkey
| | - Panagiotis G. Doukas
- Yale
Larynx Laboratory, Department of Surgery (Otolaryngology), Yale School of Medicine, New Haven, Connecticut 06510, United States
| | - Sotirios G. Doukas
- Department
of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Peter University Hospital, New Brunswick New Jersey 08901-1780, United States
- Department
of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Maria Tolia
- Department
of Radiology, Faculty of Medicine, University
of Crete, 71003 Heraklion, Greece
| | - Nikolaos Chatzakis
- Otorhinolaryngologist
Consultant, ENT Department of University
Hospital of Crete, 71003 Heraklion, Greece
| | - Aristidis Tsatsakis
- Department
of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Ali Taghizadehghalehjoughi
- Faculty
of Medicine, Department of Medical Pharmacology, Bilecik Seyh Edebali University, Bilecik 11230, Turkey
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8
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He D, Zhang J, Xiang Y, Wu P, Li G, Chang H, Wang Q, Shao Q, Zhu S. Association between radiotherapy for surgically treated oral cavity cancer and secondary lung cancer. Front Public Health 2023; 11:1120671. [PMID: 37033050 PMCID: PMC10073750 DOI: 10.3389/fpubh.2023.1120671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/03/2023] [Indexed: 04/11/2023] Open
Abstract
Background There is limited research on the incidence of secondary lung cancer (SLC) after radiotherapy (RT) for oral cavity cancer (OCC). Therefore, we investigated the association between RT for OCC and the risk of SLC and the overall survival of these patients. Methods Patients diagnosed with OCC between 1975 and 2015 were selected from the Surveillance, Epidemiology, and End Results database. The cumulative incidence of SLC, relative risk (RR) of RT vs. no RT (NRT), standardized incidence ratios (SIR), and survival outcomes were assessed. Results A total of 10,936 patients with OCC were included. Of these, 429 (3.92%) patients developed SLC, where 136 (5.02%) received RT and 293 (3.56%) did not. The cumulative incidence of SLC during follow-up was 6.89% and 4.84% in the RT and NRT patients, respectively. RT was associated with a higher risk of SLC. In the subset analysis, the results showed that a higher risk of developing SLC among patients with index OCC in most subgroups. Dynamic RR and SIR revealed a decreased risk of SLC with increasing latency time. No difference was observed in the 10-year survival rates for patients with SLC who received RT or not or compared with primary lung cancer. Conclusion RT was associated with a higher risk of SLC, and patients diagnosed with OCC could be followed for 5-10 years after diagnosis.
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Affiliation(s)
- Dongjie He
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Jun Zhang
- Department of Otolaryngology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Ying Xiang
- Department of Traditional Chinese Medicine, The Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Peiwen Wu
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Gaiyan Li
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Hao Chang
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiming Wang
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Qiuju Shao
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
| | - Siying Zhu
- Department of Radiation Oncology, Tangdu Hospital, The Second Affiliated Hospital of Air Force Military Medical University, Xi'an, China
- *Correspondence: Siying Zhu
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9
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Luo X, Huang X, Luo J, Xiao J, Wang K, Qu Y, Chen X, Zhang Y, Wu R, Wang J, Zhang J, Xu G, Gao L, Liu S, Wang X, He X, Luo D, Yi J. Induction TPF followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in locally advanced hypopharyngeal cancer: a preliminary analysis of a randomized phase 2 trial. BMC Cancer 2022; 22:1235. [PMID: 36447152 PMCID: PMC9706919 DOI: 10.1186/s12885-022-10306-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Concurrent chemoradiotherapy (CCRT) is a standard treatment choice for locally advanced hypopharyngeal carcinoma. The aim of this study was to investigate whether induction chemotherapy (IC) followed by CCRT is superior to CCRT alone to treat locally advanced hypopharyngeal carcinoma. METHODS AND MATERIALS Patients (n = 142) were randomized to receive two cycles of paclitaxel/cisplatin/5-fluorouracil (TPF) IC followed by CCRT or CCRT alone. The primary end point was overall survival (OS). The secondary end points included the larynx-preservation rate, progression-free survival (PFS), distant metastasis-free survival (DMFS), and toxicities. RESULTS Ultimately, 113 of the 142 patients were analyzed. With a median follow-up of 45.6 months (interquartile range 26.8-57.8 months), the 3-year OS was 53.1% in the IC + CCRT group compared with 54.8% in the CCRT group (hazard ratio, 1.004; 95% confidence interval, 0.573-1.761; P = 0.988). There were no statistically significant differences in PFS, DMFS, and the larynx-preservation rate between the two groups. The incidence of grade 3-4 hematological toxicity was much higher in the IC+ CCRT group than in the CCRT group (54.7% vs. 10%, P < 0.001). CONCLUSIONS Adding induction TPF to CCRT did not improve survival and the larynx-preservation rate in locally advanced hypopharyngeal cancer, but caused a higher incidence of acute hematological toxicities. TRIAL REGISTRATION ClinicalTrials.gov , number NCT03558035. Date of first registration, 15/06/2018.
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Affiliation(s)
- Xi Luo
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Xiaodong Huang
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Jingwei Luo
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Jianping Xiao
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Kai Wang
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Yuan Qu
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Xuesong Chen
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Ye Zhang
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Runye Wu
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Jingbo Wang
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Jianghu Zhang
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Guozhen Xu
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Li Gao
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Shaoyan Liu
- grid.506261.60000 0001 0706 7839Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Xiaolei Wang
- grid.506261.60000 0001 0706 7839Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Xiaohui He
- grid.506261.60000 0001 0706 7839Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Dehong Luo
- grid.506261.60000 0001 0706 7839Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China
| | - Junlin Yi
- grid.506261.60000 0001 0706 7839Department of Radiation Oncology, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021 China ,grid.506261.60000 0001 0706 7839National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001 China
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10
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Wang WL, Zheng HW, Zhang LH, Yu LS. Effect of treatment modality on the long-term survival of patients with early glottic squamous cancer: a retrospective cohort study based on the SEER database. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:440. [PMID: 35571433 PMCID: PMC9096410 DOI: 10.21037/atm-21-5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/14/2022] [Indexed: 11/06/2022]
Abstract
Background The optimal treatment strategy for patients with early glottic (T1-2N0M0) squamous cancer remains unclear. Methods A retrospective population-based analysis was performed using the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was used to balance treatment arms, and Cox regression analysis was used to determine prognostic factors for survival. Kaplan-Meier analysis, log-rank tests, and competing risk analysis were used to compare survival outcomes between treatment modalities (surgery vs. radiotherapy). Results Among the 3,994 eligible patients in this study, surgery was associated with improved cancer-specific survival (CSS) and overall survival (OS) compared with radiotherapy (log-rank test, P<0.05). This survival trend favoring surgery was consistent in the T1a, well/moderately differentiated grade, male, and all age subgroups. However, after the baseline characteristics were balanced with PSM, the survival outcomes (CSS and OS) did not differ significantly between the surgery and radiotherapy groups. Interestingly, surgery was associated with a 39% reduced risk of cancer-related death compared with radiotherapy in patients aged ≥70 years (hazard ratio 0.61; 95% CI: 0.43-0.87; P=0.006). However, this survival trend favoring surgery was not observed in younger patients (age <70 years), T stage subgroups, male or female subgroups, or in any of the pathological grade subgroups. Conclusions In patients with early glottic squamous cell carcinoma undergoing surgery or radiotherapy, there is no sufficient evidence favoring one method over another in terms of survival. However, surgery is recommended in patients aged ≥70 years because, in this group, it was associated with improved survival outcomes compared with radiotherapy.
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Affiliation(s)
- Wen-Lun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Hong-Wei Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Li-Hong Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
| | - Li-Sheng Yu
- Department of Otorhinolaryngology-Head and Neck Surgery, Peking University People's Hospital, Beijing, China
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11
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Chang CC, Huang TH, Shueng PW, Chen SH, Chen CC, Lu CJ, Tseng YJ. Developing a Stacked Ensemble-Based Classification Scheme to Predict Second Primary Cancers in Head and Neck Cancer Survivors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12499. [PMID: 34886225 PMCID: PMC8657249 DOI: 10.3390/ijerph182312499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 12/16/2022]
Abstract
Despite a considerable expansion in the present therapeutic repertoire for other malignancy managements, mortality from head and neck cancer (HNC) has not significantly improved in recent decades. Moreover, the second primary cancer (SPC) diagnoses increased in patients with HNC, but studies providing evidence to support SPCs prediction in HNC are lacking. Several base classifiers are integrated forming an ensemble meta-classifier using a stacked ensemble method to predict SPCs and find out relevant risk features in patients with HNC. The balanced accuracy and area under the curve (AUC) are over 0.761 and 0.847, with an approximately 2% and 3% increase, respectively, compared to the best individual base classifier. Our study found the top six ensemble risk features, such as body mass index, primary site of HNC, clinical nodal (N) status, primary site surgical margins, sex, and pathologic nodal (N) status. This will help clinicians screen HNC survivors before SPCs occur.
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Affiliation(s)
- Chi-Chang Chang
- School of Medical Informatics, Chung Shan Medical University & IT Office, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Department of Information Management, Ming Chuan University, Taoyuan 33300, Taiwan
| | - Tse-Hung Huang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- School of Traditional Chinese Medicine, Chang Gung University, Taoyuan 33300, Taiwan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11200, Taiwan
- Graduate Institute of Health Industry Technology, Chang Gung University of Science and Technology, Taoyuan 33300, Taiwan
| | - Pei-Wei Shueng
- Department of Radiology, Division of Radiation Oncology, Far Eastern Memorial Hospital, New Taipei 22060, Taiwan;
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 22060, Taiwan
| | - Ssu-Han Chen
- Department of Industrial Engineering and Management, Ming Chi University of Technology, New Taipei 24330, Taiwan
- Center for Artificial Intelligence & Data Science, Ming Chi University of Technology, New Taipei 24330, Taiwan
| | - Chun-Chia Chen
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Surgery, Division of Plastic Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Chi-Jie Lu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei 242062, Taiwan;
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei 242062, Taiwan
- Department of Information Management, Fu Jen Catholic University, New Taipei 242062, Taiwan
| | - Yi-Ju Tseng
- Department of Information Management, National Central University, Taoyuan 32031, Taiwan;
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12
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Convolutional neural network for human cancer types prediction by integrating protein interaction networks and omics data. Sci Rep 2021; 11:20691. [PMID: 34667236 PMCID: PMC8526703 DOI: 10.1038/s41598-021-98814-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 09/14/2021] [Indexed: 02/07/2023] Open
Abstract
Many studies have proven the power of gene expression profile in cancer identification, however, the explosive growth of genomics data increasing needs of tools for cancer diagnosis and prognosis in high accuracy and short times. Here, we collected 6136 human samples from 11 cancer types, and integrated their gene expression profiles and protein-protein interaction (PPI) network to generate 2D images with spectral clustering method. To predict normal samples and 11 cancer tumor types, the images of these 6136 human cancer network were separated into training and validation dataset to develop convolutional neural network (CNN). Our model showed 97.4% and 95.4% accuracies in identification of normal versus tumors and 11 cancer types, respectively. We also provided the results that tumors located in neighboring tissues or in the same cell types, would induce machine make error classification due to the similar gene expression profiles. Furthermore, we observed some patients may exhibit better prognosis if their tumors often misjudged into normal samples. As far as we know, we are the first to generate thousands of cancer networks to predict and classify multiple cancer types with CNN architecture. We believe that our model not only can be applied to cancer diagnosis and prognosis, but also promote the discovery of multiple cancer biomarkers.
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13
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Outcomes after pulmonary lobectomy in patients with history of head and neck carcinoma. Respir Med Res 2021; 80:100857. [PMID: 34488047 DOI: 10.1016/j.resmer.2021.100857] [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: 05/08/2021] [Revised: 07/02/2021] [Accepted: 08/15/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND We aimed to determine whether video assisted thoracic surgery (VATS) was associated with better short-term outcomes compared to open approach and to determine factors affecting long term survival after lobectomy in patients with history of head and neck carcinoma (HNC). METHODS We performed a retrospective monocentric analysis of consecutive standard lobectomies performed for lung cancer in patients with history of HNC between 2010 and 2017. Patients' characteristics, surgical approach, lung tumor histology, in-hospital and 90-days morbi-mortality and long term survival were analyzed; VATS and open lobectomy groups were compared. RESULTS Among 85 patients, 52 underwent an open lobectomy and 33 a VATS lobectomy. There was no significant difference between the two groups regarding age, preoperative characteristics, pathology and stage of lung cancer (All p = NS). In the VATS group, there was a significant decrease in proportion of in-hospital postoperative life-threatening complications requiring hospitalization in intensive care unit (12/52 vs. 1/33, p = 0.01). The 90-days postoperative comprehensive complication index was significantly increased in the open thoracotomy group (median (interquartile range):33.5 (0-53.5) vs. 8.7 (0-34.1), p = 0.018). Long term survival was not significantly different between the 2 groups - Log-rank test comparison, p = NS). Patients with squamous cell histology presented a significantly poorer survival (both Log-rank test comparison, p < 0.01). CONCLUSIONS Minimally invasive approach improved in-hospital and 90-days outcomes compared to open surgery for lung cancer resection in patients with history of HNC. The poor long-term results in patients with squamous cell carcinoma highlight the need to improve therapeutic strategies for this subset of patients.
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14
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Bugter O, van Iwaarden DLP, van Leeuwen N, Nieboer D, Dronkers EAC, Hardillo JAU, Baatenburg de Jong RJ. A cause-specific Cox model for second primary tumors in patients with head and neck cancer: A RONCDOC study. Head Neck 2021; 43:1881-1889. [PMID: 33655596 PMCID: PMC8247881 DOI: 10.1002/hed.26666] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/12/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
Background The aim of this study was to identify risk factors for the development of second primary tumors (SPTs) in the head and neck region, lungs, and esophagus in patients with head and neck cancer. Methods We collected data from 1581 patients. A cause‐specific Cox model for the development of an SPT was fitted, accounting for the competing risks residual/recurrent tumor and mortality. Results Of all patients, 246 (15.6%) developed SPTs. Analysis showed that tobacco and alcohol use, comorbidity, and the oral cavity subsite were risk factors for SPTs. The C‐index, the discriminative accuracy, of the model for SPT was 0.65 (95% confidence interval, 0.61–0.68). Conclusions Our results show that there is potential to identify patients who have an increased risk to develop an SPT. This might increase their survival chances and quality of life. More research is needed to provide head and neck clinicians with definitive recommendations.
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Affiliation(s)
- Oisín Bugter
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk L P van Iwaarden
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Medical Decision Making, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Center for Medical Decision Making, Rotterdam, The Netherlands
| | - Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - José A U Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Caulley L, Hunink MG, Randolph GW, Shin JJ. Evidence-Based Medicine in Otolaryngology, Part XI: Modeling and Analysis to Support Decisions. Otolaryngol Head Neck Surg 2020; 164:462-472. [PMID: 32838658 DOI: 10.1177/0194599820948827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To provide a resource to educate clinical decision makers about the analyses and models that can be employed to support data-driven choices. DATA SOURCES Published studies and literature regarding decision analysis, decision trees, and models used to support clinical decisions. REVIEW METHODS Decision models provide insights into the evidence and its implications for those who make choices about clinical care and resource allocation. Decision models are designed to further our understanding and allow exploration of the common problems that we face, with parameters derived from the best available evidence. Analysis of these models demonstrates critical insights and uncertainties surrounding key problems via a readily interpretable yet quantitative format. This 11th installment of the Evidence-Based Medicine in Otolaryngology series thus provides a step-by-step introduction to decision models, their typical framework, and favored approaches to inform data-driven practice for patient-level decisions, as well as comparative assessments of proposed health interventions for larger populations. CONCLUSIONS Information to support decisions may arise from tools such as decision trees, Markov models, microsimulation models, and dynamic transmission models. These data can help guide choices about competing or alternative approaches to health care. IMPLICATIONS FOR PRACTICE Methods have been developed to support decisions based on data. Understanding the related techniques may help promote an evidence-based approach to clinical management and policy.
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Affiliation(s)
- Lisa Caulley
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Myriam G Hunink
- Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, the Netherlands.,Center for Health Decision Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
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16
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Jurmeister P, Bockmayr M, Seegerer P, Bockmayr T, Treue D, Montavon G, Vollbrecht C, Arnold A, Teichmann D, Bressem K, Schüller U, von Laffert M, Müller KR, Capper D, Klauschen F. Machine learning analysis of DNA methylation profiles distinguishes primary lung squamous cell carcinomas from head and neck metastases. Sci Transl Med 2020; 11:11/509/eaaw8513. [PMID: 31511427 DOI: 10.1126/scitranslmed.aaw8513] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
Abstract
Head and neck squamous cell carcinoma (HNSC) patients are at risk of suffering from both pulmonary metastases or a second squamous cell carcinoma of the lung (LUSC). Differentiating pulmonary metastases from primary lung cancers is of high clinical importance, but not possible in most cases with current diagnostics. To address this, we performed DNA methylation profiling of primary tumors and trained three different machine learning methods to distinguish metastatic HNSC from primary LUSC. We developed an artificial neural network that correctly classified 96.4% of the cases in a validation cohort of 279 patients with HNSC and LUSC as well as normal lung controls, outperforming support vector machines (95.7%) and random forests (87.8%). Prediction accuracies of more than 99% were achieved for 92.1% (neural network), 90% (support vector machine), and 43% (random forest) of these cases by applying thresholds to the resulting probability scores and excluding samples with low confidence. As independent clinical validation of the approach, we analyzed a series of 51 patients with a history of HNSC and a second lung tumor, demonstrating the correct classifications based on clinicopathological properties. In summary, our approach may facilitate the reliable diagnostic differentiation of pulmonary metastases of HNSC from primary LUSC to guide therapeutic decisions.
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Affiliation(s)
- Philipp Jurmeister
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.,Charité Comprehensive Cancer Center, 10117 Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69210 Heidelberg, Germany
| | - Michael Bockmayr
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.,Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, 20251 Hamburg, Germany
| | - Philipp Seegerer
- Machine-Learning Group, Department of Software Engineering and Theoretical Computer Science, Technical University of Berlin, 10623 Berlin, Germany
| | - Teresa Bockmayr
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Denise Treue
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Grégoire Montavon
- Machine-Learning Group, Department of Software Engineering and Theoretical Computer Science, Technical University of Berlin, 10623 Berlin, Germany
| | - Claudia Vollbrecht
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany.,German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69210 Heidelberg, Germany.,German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Alexander Arnold
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Daniel Teichmann
- Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Keno Bressem
- Department of Radiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Ulrich Schüller
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.,Research Institute Children's Cancer Center Hamburg, 20251 Hamburg, Germany.,Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Maximilian von Laffert
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Klaus-Robert Müller
- Machine-Learning Group, Department of Software Engineering and Theoretical Computer Science, Technical University of Berlin, 10623 Berlin, Germany.,Department of Brain and Cognitive Engineering, Korea University, 136-713 Seoul, South Korea.,Max-Planck-Institute for Informatics, 66123 Saarbrücken, Germany
| | - David Capper
- German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69210 Heidelberg, Germany. .,Department of Neuropathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany
| | - Frederick Klauschen
- Institute of Pathology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 10117 Berlin, Germany. .,German Cancer Consortium (DKTK), Partner Site Berlin, and German Cancer Research Center (DKFZ), 69210 Heidelberg, Germany
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17
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Budnik J, DeNunzio NJ, Singh DP, Milano MT. Second Primary Non–Small-Cell Lung Cancer After Head and Neck Cancer: A Population-Based Study of Clinical and Pathologic Characteristics and Survival Outcomes in 3597 Patients. Clin Lung Cancer 2020; 21:195-203. [DOI: 10.1016/j.cllc.2019.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
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18
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Riesgo de aparición de segundas neoplasias y neoplasias sucesivas en pacientes con un tumor índice de cabeza y cuello. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:9-15. [DOI: 10.1016/j.otorri.2018.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 10/29/2018] [Accepted: 11/04/2018] [Indexed: 10/27/2022]
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19
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León X, García J, López M, Rodriguez C, Gutierrez A, Quer M. Risk of Onset of Second Neoplasms and Successive Neoplasms in Patients With a Head and Neck Index Tumour. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2018.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Awan MJ, Nedzi L, Wang D, Tumati V, Sumer B, Xie XJ, Smith I, Truelson J, Hughes R, Myers LL, Lavertu P, Wong S, Yao M. Final results of a multi-institutional phase II trial of reirradiation with concurrent weekly cisplatin and cetuximab for recurrent or second primary squamous cell carcinoma of the head and neck. Ann Oncol 2019; 29:998-1003. [PMID: 29346519 DOI: 10.1093/annonc/mdy018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The optimal regimen of chemotherapy and reirradiation (re-XRT) for recurrent head and neck squamous cell carcinoma (HNSCC) is controversial. We report the final outcomes of a multicenter phase II trial evaluating cetuximab and cisplatin-based chemotherapy concurrent with re-XRT for patients with recurrent HNSCC. Materials and methods Patients with unresectable recurrent disease or positive margins after salvage surgery arising within a previously irradiated field with KPS ≥ 70 were eligible for this trial. Cetuximab 400 mg/m2 was delivered as a loading dose in week 1 followed by weekly cetuximab 250 mg/m2 and cisplatin 30 mg/m2 concurrent with 6 weeks of intensity-modulated radiotherapy to a dose of 60-66 Gy in 30 daily fractions. Patients who previously received both concurrent cetuximab and cisplatin with radiation or who received radiotherapy less than 6 months prior were ineligible. Results From 2009 to 2013, 48 patients enrolled on this trial, 2 did not receive any protocol treatment. Of the remaining 46 patients, 34 were male and 12 female, with a median age of 62 years (range 36-85). Treatment was feasible and only 1 patient did not complete the treatment course. Common grade 3 or higher acute toxicities were lymphopenia (46%), pain (22%), dysphagia (13%), radiation dermatitis (13%), mucositis (11%) and anorexia (11%). There were no grade 5 acute toxicities. Eight grade 3 late toxicities were observed, four of which were swallowing related. With a median follow-up of 1.38 years, the 1-year overall survival (OS) was 60.4% and 1-year recurrence-free survival was 34.1%. On univariate analysis, OS was significantly improved with young age (P = 0.01). OS was not associated with radiation dose, surgery before re-XRT or interval from prior XRT. Conclusions Concurrent cisplatin and cetuximab with re-XRT is feasible and offers good treatment outcomes for patients with high-risk features. Younger patients had significantly improved OS. ClinicalTrials.Gov Identifier NCT00833261.
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Affiliation(s)
- M J Awan
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA; University Hospitals of Cleveland, Cleveland, USA
| | - L Nedzi
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, USA
| | - D Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, USA
| | - V Tumati
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, USA
| | - B Sumer
- Department of Otolaryngology Head and Neck Surgery, USA
| | - X-J Xie
- Department of Clinical Sciences, University of Texas Southwestern, Dallas, USA
| | - I Smith
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, USA
| | - J Truelson
- Department of Otolaryngology Head and Neck Surgery, USA
| | - R Hughes
- Internal Medicine - Medical Oncology, University of Texas Southwestern, Dallas, USA
| | - L L Myers
- Department of Otolaryngology Head and Neck Surgery, USA
| | - P Lavertu
- University Hospitals of Cleveland, Cleveland, USA; Department of Otolaryngology Head and Neck Surgery, Case Western Reserve University; Cleveland, USA
| | - S Wong
- Department of Internal Medicine - Medical Oncology, Medical College of Wisconsin, Milwaukee, USA
| | - M Yao
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA; University Hospitals of Cleveland, Cleveland, USA.
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21
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Coca-Pelaz A, Rodrigo JP, Suárez C, Nixon IJ, Mäkitie A, Sanabria A, Quer M, Strojan P, Bradford CR, Kowalski LP, Shaha AR, de Bree R, Hartl DM, Rinaldo A, Takes RP, Ferlito A. The risk of second primary tumors in head and neck cancer: A systematic review. Head Neck 2019; 42:456-466. [PMID: 31750595 DOI: 10.1002/hed.26016] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 10/22/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Second primary tumors (SPTs) are a common cause of reduced life expectancy in patients treated for head and neck cancer (HNC). This phenomenon forms an area to be addressed during posttreatment follow-up. METHODS We conducted a systematic review of literature following PRISMA guidelines, from 1979 to 2019, to investigate incidence of SPTs, synchronous, and metachronous, in HNC population. RESULTS Our review includes data of 456 130 patients from 61 articles. With a minimum follow-up of 22 months, mean incidence of SPTs was 13.2% (95% CI: 11.56-14.84): 5.3% (95% CI: 4.24-6.36) for synchronous SPTs and 9.4% (95% CI: 7.9-10.9) for metachronous SPTs. The most frequent site for SPTs was head and neck area, followed by the lungs and esophagus. CONCLUSION Although with wide variations between studies, the rate of SPTs in HNC patients is high. Given the impact in the prognosis, we must develop strategies for the early diagnosis of SPTs.
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Affiliation(s)
- Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Iain J Nixon
- Ear, Nose and Throat Department, NHS Lothian, University of Edinburgh, Edinburgh, UK
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, CEXCA. Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
| | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Second primary lung cancer following laryngeal cancer: retrospective study of incidence and multivariate analysis of risk factors in 209 patients. The Journal of Laryngology & Otology 2019; 133:974-979. [PMID: 31668148 DOI: 10.1017/s0022215119002147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To analyse the incidence of second primary lung cancer following treatment for laryngeal cancer and to identify risk factors for its development. METHOD Retrospective case series. RESULTS The five-year actuarial incidence of second primary lung cancer was 8 per cent (1.6 per cent per year). This was associated with a very poor median survival of seven months following diagnosis. Supraglottic tumours were associated with an increased risk of second primary lung cancer compared to glottic tumours in both univariate (hazard ratio = 4.32, p = 0.005) and multivariate analyses (hazard ratio = 4.14, p = 0.03). CONCLUSION Second primary lung cancer occurs at a rate of 1.6 per cent per year following a diagnosis of laryngeal cancer, and this is associated in a statistically significant manner with supraglottic primary tumour. The recent National Lung Cancer Screening Trial suggests a survival advantage of 20 per cent at five years with annual screening using low-dose computed tomography scanning of the chest in a comparable cohort to ours. These findings have the potential to inform post-treatment surveillance protocols in the future.
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23
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Ng SP, Pollard C, Kamal M, Ayoub Z, Garden AS, Bahig H, Gunn GB, Frank SJ, Skinner HD, Phan J, Berends J, Morrison WH, Johnson JM, Ferrarotto R, Sturgis EM, Mohamed ASR, Lai SY, Fuller CD, Rosenthal DI. Risk of second primary malignancies in head and neck cancer patients treated with definitive radiotherapy. NPJ Precis Oncol 2019; 3:22. [PMID: 31583278 PMCID: PMC6764977 DOI: 10.1038/s41698-019-0097-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 09/10/2019] [Indexed: 12/31/2022] Open
Abstract
Second primary malignancy (SPM) may occur after index head and neck cancer (HNC) treatment. This study evaluated the prevalence and outcome of SPM in patients with HNC treated with definitive radiotherapy. Eligible patients include those with index mucosal HNC treated with definitive radiotherapy between 2000 and 2010. SPM was defined as an invasive cancer at a noncontiguous site diagnosed at least 6 months after completion of radiotherapy. Clinical data were collected, and the Kaplan–Meier method was used to estimate overall survival. In total, 1512 patients were studied. The majority of patients had index oropharyngeal cancer (86%). In all, 130 (9%) patients developed a SPM. The risk of SPM increased exponentially with time with 5-, 10-, and 15-year rates of 4, 10, and 25%. Half of SPMs were within the head and neck or thoracic regions. SPM rates were significantly higher (p < 0.0001) in current smokers and former smokers than never smokers with 5-, 10-, and 15-year risk being: never smoker (2, 4, 14%), former smokers with <10-pack year (5, 10, 23%), former smokers with ≥10-pack year (5, 14, 35%), and current smokers (6, 18, 32%). In total, 102 (78%) had subsequent curative-intent therapy. The 5-year overall survival from SPM was 44%. The majority of SPMs were in those with significant smoking history reflecting the same risk factor as for the index mucosal HNC. Nearly one in two patients with SPMs were salvaged underscoring the importance of regular surveillance for SPMs.
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Affiliation(s)
- Sweet Ping Ng
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA.,2Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria Australia
| | - Courtney Pollard
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Mona Kamal
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Zeina Ayoub
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Adam S Garden
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Houda Bahig
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - G Brandon Gunn
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Steven J Frank
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Heath D Skinner
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Jack Phan
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Joel Berends
- 3The University of Texas Health Science Center, San Antonio, TX USA
| | - William H Morrison
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Jason M Johnson
- 4Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Renata Ferrarotto
- 5Department of Thoracic Head and Neck Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Erich M Sturgis
- 6Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Abdallah S R Mohamed
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Stephen Y Lai
- 6Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Clifton D Fuller
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - David I Rosenthal
- 1Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
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Albertson M, Chandra S, Sayed Z, Johnson C. PET/CT Evaluation of Head and Neck Cancer of Unknown Primary. Semin Ultrasound CT MR 2019; 40:414-423. [PMID: 31635768 DOI: 10.1053/j.sult.2019.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The diagnosis of carcinoma of unknown primary in the head and neck is made when there is a metastasis but no primary lesion is identified after physical exam and diagnostic CT or MR imaging. PET/CT is the first step in searching for a primary lesion, followed by more invasive techniques such as endoscopy and surgery. Knowledge of the different tumor histologic types, preferential locations of nodal spread, imaging pitfalls, and other special considerations such as cystic metastases can be helpful in the ultimate identification of primary tumors, which leads to improved overall patient survival.
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Affiliation(s)
- Megan Albertson
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE.
| | - Srinivasa Chandra
- Division of Oral & Maxillofacial Surgery, Department of Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE
| | - Zafar Sayed
- Department of Otolaryngology - Head and Neck Oncology, University of Nebraska Medical Center, Omaha, NE
| | - Craig Johnson
- Department of Radiology, University of Nebraska Medical Center, Omaha, NE
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25
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Haremza C, Baert M, Pascual C, Biet-Hornstein A, Page C. Head and neck squamous cell carcinoma and metachronous second primaries. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:367-372. [PMID: 31208879 DOI: 10.1016/j.anorl.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To assess the rate of second (or more) primaries after treatment for head and neck squamous cell carcinoma (HNSCC), and survival compared to patients with a single head and neck cancer. MATERIAL AND METHOD A single-center retrospective study was performed in a University Hospital Center in 541 patients between 2002 and 2010. RESULTS One hundred and forty-one patients (26.06%) presented 172 metachronous cancers. Overall 5-year survival was 20.3% with and 38.1% without metachronous cancer. Median and mean survival were respectively 21.9 and 51 months in patients with a single cancer, versus 13.9 and 26.5 months in case of metachronous cancer. Specific survival was comparable to overall survival. All-cause and specific survival were significantly poorer in metachronous cancer (P=0.001; log-rank α=0.05). CONCLUSION At least a quarter of HNSCC patients go on to develop a metachronous second primary. These are of poor prognosis, whatever their location.
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Affiliation(s)
- C Haremza
- ENT and Head & Neck Surgery Department, University Hospital Centre, 80054 Amiens cedex 1, France
| | - M Baert
- ENT and Head & Neck Surgery Department, University Hospital Centre, 80054 Amiens cedex 1, France
| | - C Pascual
- ENT and Head & Neck Surgery Department, University Hospital Centre, 80054 Amiens cedex 1, France
| | - A Biet-Hornstein
- ENT and Head & Neck Surgery Department, University Hospital Centre, 80054 Amiens cedex 1, France
| | - C Page
- ENT and Head & Neck Surgery Department, University Hospital Centre, 80054 Amiens cedex 1, France.
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26
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Rivera MP, Henderson LM. Lung cancer screening and shared decision making in cancer survivors: the long and winding road. Transl Lung Cancer Res 2019; 8:119-123. [PMID: 31106122 DOI: 10.21037/tlcr.2018.12.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- M Patricia Rivera
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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27
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Silén S, Haapaniemi A, Dickinson A, Rönn K, Mäkitie A. Presentation of second primary cancers in young laryngeal carcinoma patients. Acta Otolaryngol 2019; 139:85-89. [PMID: 30712430 DOI: 10.1080/00016489.2018.1527037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laryngeal squamous cell carcinoma (LSCC) is rare in the young. OBJECTIVES We characterized the clinical behavior of LSCC and assessed the presentation of second primary tumors (SPCs) in this patient population. MATERIALS AND METHODS Data from the Finnish Cancer Registry (FCR) were used to identify an epidemiological series of LSCC patients diagnosed at the age of 40 years or under, during 1953-2012 in Finland. Data regarding primary treatment, survival, and SPCs were available. To further characterize the comorbidity and lifestyle factors of young patients with LSCC, institutional data were collected of patients treated at the Helsinki University Hospital during 1967-2012. RESULTS We identified 151 patients, with a mean follow-up of 252 months. The 10-year overall survival (OS) was 75% and the disease-specific survival was 84%. SPCs were diagnosed in 26% (n = 39), with a median delay of 28 years. Of the 35 patients in the institutional series from Helsinki, 22 (63%) were current or former smokers. LSCC recurred in 28% of patients. CONCLUSIONS AND SIGNIFICANCE The delay to SPCs in young patients was significantly longer compared with the general LSCC population. As factors underlying this phenomenon cannot be identified by this retrospective study, further studies are warranted.
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Affiliation(s)
- Suvi Silén
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Aaro Haapaniemi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Amy Dickinson
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karin Rönn
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Jin F, Luo HL, Zhou J, He YN, Liu XF, Zhong MS, Yang H, Li C, Li QC, Huang X, Tian XM, Qiu D, He GL, Yin L, Wang Y. Cancer risk assessment in modern radiotherapy workflow with medical big data. Cancer Manag Res 2018; 10:1665-1675. [PMID: 29970965 PMCID: PMC6021004 DOI: 10.2147/cmar.s164980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Modern radiotherapy (RT) is being enriched by big digital data and intensive technology. Multimodality image registration, intelligence-guided planning, real-time tracking, image-guided RT (IGRT), and automatic follow-up surveys are the products of the digital era. Enormous digital data are created in the process of treatment, including benefits and risks. Generally, decision making in RT tries to balance these two aspects, which is based on the archival and retrieving of data from various platforms. However, modern risk-based analysis shows that many errors that occur in radiation oncology are due to failures in workflow. These errors can lead to imbalance between benefits and risks. In addition, the exact mechanism and dose-response relationship for radiation-induced malignancy are not well understood. The cancer risk in modern RT workflow continues to be a problem. Therefore, in this review, we develop risk assessments based on our current knowledge of IGRT and provide strategies for cancer risk reduction. Artificial intelligence (AI) such as machine learning is also discussed because big data are transforming RT via AI.
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Affiliation(s)
- Fu Jin
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Huan-Li Luo
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Juan Zhou
- Forensic Identification Center, College of Criminal Investigation, Southwest University of Political Science and Law, Chongqing, People’s Republic of China
| | - Ya-Nan He
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xian-Feng Liu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Ming-Song Zhong
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Han Yang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Chao Li
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Qi-Cheng Li
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xia Huang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Xiu-Mei Tian
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Da Qiu
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Guang-Lei He
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Li Yin
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing, People’s Republic of China
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Phosphorylation of gH2AX as a novel prognostic biomarker for laryngoesophageal dysfunction-free survival. Oncotarget 2017; 7:31723-37. [PMID: 27166270 PMCID: PMC5077972 DOI: 10.18632/oncotarget.9172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 04/22/2016] [Indexed: 01/13/2023] Open
Abstract
Current larynx preservation treatments have achieved an improvement of laryngoesophageal dysfunction-free survival (LDS) but lead to significant toxicities and recurrences. At present, there is no evidence to select the group of patients that may benefit from preservation approaches instead of surgery. Therefore, laryngeal biomarkers could facilitate pretreatment identification of patients who could respond to chemoradiation-based therapy. In this study, we evaluated retrospectively 53 patients with larynx cancer to determine whether gH2AX phosphorylation (pH2AX) alone or in combination with the membrane protein MAP17 (PDZK1IP1) could be used as prognostic biomarkers. We also evaluated whether the completion of cisplatin treatment and radiotherapy could predict survival in combination with pH2AX. We found that the dose of cisplatin received but not the length of the radiotherapy influenced LDS. High-pH2AX expression was associated with prolonged LDS (HR 0.26, p = 0.02) while MAP17 correlated with overall survival (OS) (HR 0.98, p = 0.05). High-MAP17 and high-pH2AX combined analysis showed improved LDS (with 61.35 months vs 32.2 months, p = 0.05) and OS (with 66.6 months vs 39.8 months, p = 0.01). Furthermore, the subgroup of high-pH2AX and optimal dose of cisplatin was also associated with OS (72 months vs 38.6 months, p = 0.03) and LDS (66.9 months vs 27 months, p = 0.017). These findings suggest that pH2AX alone or better in combination with MAP17 may become a novel and valuable prognostic biomarker for patients with laryngeal carcinoma treated with preservation approaches.
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Kitani Y, Kubota A, Furukawa M, Hori Y, Nakayama Y, Nonaka T, Mizoguchi N, Kitani Y, Hatakeyama H, Oridate N. Impact of combined modality treatment with radiotherapy and S-1 on T2N0 laryngeal cancer: Possible improvement in survival through the prevention of second primary cancer and distant metastasis. Oral Oncol 2017; 71:54-59. [PMID: 28688691 DOI: 10.1016/j.oraloncology.2017.05.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/20/2017] [Accepted: 05/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND In patients with head and neck cancer, the management of second primary cancer (SPC) is particularly important for improving survival because of its high incidence and associated mortality. We evaluated the impact of combination chemotherapy on survival and SPC. METHOD We retrospectively analyzed data from 49 patients treated with definitive radiation therapy (RT) for T2N0M0 laryngeal squamous cell carcinoma between 2003 and 2011. Among them, 22 patients received combined modality treatment with radiotherapy and S-1 (RT+CT group). RESULTS The median follow-up period was 71months (32-111months). A significant difference in overall survival (OS, P<0.01) was observed between the RT+CT group (n=22) and the RT alone group (n=27) though no significant differences were observed in local control and disease specific survival. Univariate analyses showed that an older age (P<0.05) and a higher grade (P<0.05) were associated with OS. Multivariate analysis identified chemotherapy as the most significant predictor of survival (OR, 0.056; 95% CI, 0.008-0.353, P<0.01). A significantly lower incidence of distant metastasis (DM)+SPC (5-year incidence: 5% vs. 19%, P<0.05) and fewer deaths from these causes (1 vs. 8: P<0.05) were observed in the RT+CT group. Multivariate analysis showed that chemotherapy was the most significant factor for the incidence of DM+SPC (OR, 0.074; 95% CI, 0.0065-0.84; P<0.05). CONCLUSION The findings of this study suggest the possibility that combined modality treatment with radiotherapy and S-1 improve survival by preventing distant metastasis and second primary cancer.
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Affiliation(s)
- Yosuke Kitani
- Department of Otorhinolaryngology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan.
| | - Akira Kubota
- Department of Head and Neck Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Madoka Furukawa
- Department of Head and Neck Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Yukiko Hori
- Department of Head and Neck Surgery, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Tetsuo Nonaka
- Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Nobutaka Mizoguchi
- Department of Radiation Oncology, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Yuka Kitani
- Department of Otorhinolaryngology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Hiromitsu Hatakeyama
- Department of Otorhinolaryngology, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama 232-0024, Japan
| | - Nobuhiko Oridate
- Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan
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Metastatic squamous cell carcinoma of colon from esophageal cancer. Exp Hematol Oncol 2017; 6:11. [PMID: 28428908 PMCID: PMC5395791 DOI: 10.1186/s40164-017-0069-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 04/01/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Esophageal cancer including squamous cell carcinoma (SCC) and adenocarcinoma represents 4% of all cancers in the United States. Patients with esophageal cancer frequently present with locally advanced disease, and about 40% of patients have evidence of metastatic disease on presentation. Common sites of metastasis include liver, lung and bone. Here, we present a rare case of colonic metastasis from primary esophageal SCC. CASE PRESENTATION A 60-year-old Caucasian male with a history of 20-pack-year cigarette smoking received surgery and adjuvant chemoradiotherapy for locally advanced SCC of larynx. Approximately 9 months later, he developed dysphagia, and found to have a esophageal SCC in the mid-esophagus with regional lymph node involvement. He underwent chemoradiation treatment with good response and improved symptoms but declined subsequent surgical resection for esophageal cancer. About 1 year after the diagnosis of esophageal cancer, he developed blood streaked bowel movement and severe anemia. Colonoscopy showed a 3-cm mass in the proximal ascending colon; biopsy showed metastatic SCC, consistent with metastasis from esophageal primary. He subsequently received palliative radiation to the ascending colon metastatic tumor with improvement of anemia, and remained transfusion independent for more than 3 months. CONCLUSIONS Colonic metastasis from esophageal SCC is rare, and associated with poor prognosis. There are no definite features in terms of location, histological differentiation etc. that contribute to colonic metastasis from primary esophageal SCC. The goal of treatment is palliative and data from our and other case reports support the use of chemotherapy and radiation for symptom improvement and disease control.
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Louie AV, Damhuis RA, Haasbeek CJ, Warner A, Rodin D, Slotman BJ, Leemans C, Senan S. Treatment and survival of second primary early-stage lung cancer, following treatment of head and neck cancer in the Netherlands. Lung Cancer 2016; 94:54-60. [DOI: 10.1016/j.lungcan.2016.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/26/2016] [Accepted: 01/30/2016] [Indexed: 01/10/2023]
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de Miguel-Luken MJ, Chaves-Conde M, de Miguel-Luken V, Muñoz-Galván S, López-Guerra JL, Mateos JC, Pachón J, Chinchón D, Suarez V, Carnero A. MAP17 (PDZKIP1) as a novel prognostic biomarker for laryngeal cancer. Oncotarget 2016; 6:12625-36. [PMID: 25788275 PMCID: PMC4494962 DOI: 10.18632/oncotarget.3470] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 01/20/2015] [Indexed: 11/25/2022] Open
Abstract
Larynx cancer organ preservation treatments with chemo and radiotherapy have substantially improved laryngoesophageal dysfunction-free survival. However, both of them lead to a high incidence of acute and chronic toxicities and a significant number of patients relapse. To date, there is no evidence available to establish the group of patients that may benefit from preservation approaches and clinical criteria such as primary tumor extension or pretreatment tracheotomy are not validated. MAP17 is a small non-glycosylated membrane protein overexpressed in carcinomas. The tumoral behavior induced by MAP17 is associated with reactive oxygen species production in which SGLT1 seems involved. In this study we found that the levels of MAP17 were related to clinical findings and survival in a cohort of 58 patients with larynx cancer. MAP17 expression is associated with overall survival (p<0.001) and laryngoesophageal dysfunction-free survival (p=0.002). Locoregional control in patients with high MAP17 showed better outcomes than those with low MAP17 (p=0.016). Besides, a positive correlation was observed between MAP17 expression and SGLT (p=0.022) and the combination of high levels of MAP17/SGLT also led to an increased overall survival (p=0,028). These findings suggest that MAP17, alone or in combination with SGLT1, may become a novel predictive biomarker for laryngeal carcinoma.
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Affiliation(s)
| | - Manuel Chaves-Conde
- Department of Medical Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | | | - Sandra Muñoz-Galván
- Instituto de Biomedicina de Sevilla, IBIS, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas, Seville, Spain
| | - José Luis López-Guerra
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Juan C Mateos
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Jerónimo Pachón
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - David Chinchón
- Department of Pathology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Vladimir Suarez
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Amancio Carnero
- Instituto de Biomedicina de Sevilla, IBIS, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas, Seville, Spain
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de Miguel-Luken MJ, Chaves-Conde M, Carnero A. A genetic view of laryngeal cancer heterogeneity. Cell Cycle 2016; 15:1202-12. [PMID: 26940775 DOI: 10.1080/15384101.2016.1156275] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
During the recent decades significant improvements in the understanding of laryngeal molecular biology allowed a better characterization of the tumor. However, despite increased molecular knowledge and clinical efforts, survival of patients with laryngeal cancer remains the same as 30 years ago. Although this result may not make major conclusions as preservation approaches were not broadly used until the time of database collection, it seems to be clear that there is still window for improvement. Although the cornerstone for laryngeal cancer eradication is to implement smoking cessation programs, survival progresses will be hopefully seen in the future. Introducing molecular biomarkers as predictive factors to determine which patients will benefit of preservation treatments may become one of the next steps to improve survival. Furthermore, the development of new therapeutic modalities joint to biomarkers to selectively apply such new therapy in these patients may help to define new modalities with improved survival. New inhibitors against Notch pathway, EGFR, VRK1 or DNA damage repair may become gold standard if we are able to identify patients that may benefit from them, either on survival or functional larynx preservation. It is the moment for an inflexion point on the way laryngeal cancer is clinically managed.
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Affiliation(s)
- María José de Miguel-Luken
- a Instituto de Biomedicina de Sevilla, IBIS/Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas , Seville , Spain.,b Department of Medical Oncology , Virgen del Rocío University Hospital , Seville , Spain
| | - Manuel Chaves-Conde
- a Instituto de Biomedicina de Sevilla, IBIS/Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas , Seville , Spain.,b Department of Medical Oncology , Virgen del Rocío University Hospital , Seville , Spain
| | - Amancio Carnero
- a Instituto de Biomedicina de Sevilla, IBIS/Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Consejo Superior de Investigaciones Científicas , Seville , Spain
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Tolisano AM, Klem C, Lustik MB, Sniezek JC, Golden JB. Effect of a second primary thyroid carcinoma on patients with head and neck squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E890-4. [PMID: 25965105 DOI: 10.1002/hed.24121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The purpose of this study was to characterize the timing, histology, and behavior of second primary thyroid carcinoma (SPTC) developing after a diagnosis of head and neck squamous cell carcinoma (HNSCC). METHODS We conducted a retrospective review of the Surveillance, Epidemiology, and End Results (SEER) 9 database. RESULTS Patients with HNSCC who develop SPTC die 1.6 times sooner than those without SPTC. This effect is only seen if SPTC presents >6 months after diagnosis of HNSCC. Models were adjusted for age, sex, year of diagnosis, and location of HNSCC. There was no effect of prior radiation therapy on either mortality rates or time to development of thyroid cancer in patients with SPTC. The type of thyroid carcinoma that developed was similar between cohorts. CONCLUSION The development of SPTC in patients with HNSCC results in decreased overall length of survival. © 2015 Wiley Periodicals, Inc. Head Neck 38: E890-E894, 2016.
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Affiliation(s)
- Anthony M Tolisano
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Christopher Klem
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, Hawaii
| | - Michael B Lustik
- Department of Clinical Investigations, Tripler Army Medical Center, Honolulu, Hawaii
| | - Joseph C Sniezek
- Division of Head and Neck Surgery, Swedish Cancer Institute, Seattle, Washington
| | - J Blake Golden
- Department of Otolaryngology, Tripler Army Medical Center, Honolulu, Hawaii
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Pagedar NA, Jayawardena A, Charlton ME, Hoffman HT. Second Primary Lung Cancer After Head and Neck Cancer: Implications for Screening Computed Tomography. Ann Otol Rhinol Laryngol 2015; 124:765-9. [PMID: 25881583 DOI: 10.1177/0003489415582259] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Recent guidelines recommend chest computed tomography (CT) for smokers based on studies of individuals aged 55 to 74 years with 30-pack year smoking to detect lung cancers. Some have postulated that a prior diagnosis of head and neck cancer (HNC) should also warrant lung cancer screening with CT, but no studies have demonstrated benefit in this population. Our goal was to compare survival of HNC patients with second primary lung cancers (SPLCs) with survival of lung cancer-only patients to determine if detecting early stage lung cancer in those with prior HNC could lead to similar survival benefits. METHODS Survival estimates for patients with early stage SPLC diagnosed between ages 55 and 74 at least 1 year after HNC diagnosis were compared with patients with early stage lung cancer and no other cancers. RESULTS Median survival of patients with lung cancer only was 38 months. Median survival after SPLC was 22 months. History of head and neck cancer predicted poorer survival after lung cancer diagnosis, P<.0001. CONCLUSIONS Survival outcomes after early lung cancer are worse after HNC. This finding diminishes the effectiveness of chest CT as a screening modality for HNC survivors, and further study should be undertaken prior to its routine use.
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Affiliation(s)
- Nitin A Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
| | - Asitha Jayawardena
- Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Mary E Charlton
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Henry T Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA
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Xi M, Liu SL, Zhao L, Shen JX, Zhang L, Zhang P, Liu MZ. Prognostic factors and survival in patients with radiation-related second malignant neoplasms following radiotherapy for nasopharyngeal carcinoma. PLoS One 2013; 8:e84586. [PMID: 24367679 PMCID: PMC3867505 DOI: 10.1371/journal.pone.0084586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 11/15/2013] [Indexed: 12/13/2022] Open
Abstract
Purpose To analyze the clinicopathological characteristics, treatment modalities, and potential prognostic factors of radiation-related second malignant neoplasms (SMNs) in a large group of nasopharyngeal carcinoma (NPC) cases. Methods and Materials Institutional electronic medical records of 39,118 patients with NPC treated by definitive radiotherapy between February 1964 and December 2003 were reviewed. A total of 247 patients with confirmed SMN attributable to radiotherapy were included. Results Median latency between radiotherapy for NPC and the diagnosis of SMN was 9.5 years (range, 3.1–36.8 years). Squamous cell carcinoma was the most common histologic type, followed by fibrosarcoma and adenocarcinoma. Median progression-free survival and overall survival (OS) of the 235 patients who underwent treatment were 17.3 months and 28.5 months, respectively. The 5-year OS rates were 42.9%, 23.7%, and 0% for the surgery, radiotherapy, and chemotherapy groups, respectively. The independent prognostic factors associated with survival were sex, histologic type, and treatment modality in both the early stage subgroup and the advanced stage subgroup of SMN. Conclusions Sex, histologic type, and treatment modality were the significant prognostic factors for SMN. Complete resection offers the best chance for long-term survival. In select patients with locally advanced and unresectable SMN, reirradiation should be strongly considered as a curative option.
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Affiliation(s)
- Mian Xi
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Shi-Liang Liu
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Lei Zhao
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Jing-Xian Shen
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- Imaging Diagnosis and Interventional Center, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Li Zhang
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Peng Zhang
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
| | - Meng-Zhong Liu
- State Key Laboratory of Oncology in Southern China, Guangzhou, China
- Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China
- Collaborative Innovation Center of Cancer Medicine, Guangzhou, China
- * E-mail:
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Löhler J, Gerstner AOH, Bootz F, Walther LE. Incidence and localization of abnormal mucosa findings in patients consulting ENT outpatient clinics and data analysis of a cancer registry. Eur Arch Otorhinolaryngol 2013; 271:1289-97. [PMID: 24114062 DOI: 10.1007/s00405-013-2738-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/24/2013] [Indexed: 11/29/2022]
Abstract
For patients without symptoms and at risk, there is no established early detection program to discover carcinomas of the upper aerodigestive tract in the sense of secondary prevention. Such type of prevention seems even more desirable because the chances for a cure and the quality of life are strongly dependent on the stage of the tumor and the time of the initial diagnosis. Six hundred and eight patients without symptoms but at least one of the self-reported risk factors "smoking", "alcohol consumption" or "reflux" were examined with an endoscope or an optical microscope for pathological findings in the upper aerodigestive tract once a year. In addition, the incidence of malignancies of the upper aerodigestive tract between 2001 and 2010 was determined through the Cancer Registry of Schleswig-Holstein. Tissue samples were taken from 18 of the 608 patients. Eleven patients (1.8%) had a squamous cell carcinoma. Another patient suffered from non-Hodgkin's lymphoma and one from larynx tuberculosis. The ratio of detected malignancies in the oral cavity and the oropharynx on the one hand and the hypopharynx and larynx, which can only be examined by endoscopes, on the other hand were in our cohorts and in our survey according to the cancer registry was 5/6. The above-described methods allow examining risk patients easily and safely. According to current publications, the ratio of the found malignancies exceeds the expected ratio significantly, which presumably was caused by the examination targeting patients at risk. Due to the expanded examination area using optical instruments more than doubles the rate of discoverable malignancies compared to the limitations posed by the examination of directly visible areas of the oral cavity of the oropharynx.
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Affiliation(s)
- J Löhler
- Research Institute for Applied Otolaryngology (WIAHNO) of the German Professional Association of Otolaryngologists e. V., Maienbeeck 1, 24576, Bad Bramstedt, Germany,
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Lai WM, Chen CC, Lee JH, Chen CJ, Wang JS, Hou YY, Liou HH, Chen HC, Fu TY, Lee YC, Ger LP. Second primary tumors and myeloperoxidase expression in buccal mucosal squamous cell carcinoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116:464-73. [DOI: 10.1016/j.oooo.2013.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Revised: 06/04/2013] [Accepted: 06/14/2013] [Indexed: 11/16/2022]
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Chromosomal imbalances exclusively detected in invasive front area are associated with poor outcome in laryngeal carcinomas from different anatomical sites. Tumour Biol 2013; 34:3015-26. [PMID: 23749487 DOI: 10.1007/s13277-013-0866-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022] Open
Abstract
Laryngeal squamous cell carcinoma (LSCC) is a malignant neoplasm exhibiting aggressive phenotype, high recurrence rate, and risk of developing second primary tumors. Current evidence suggests that cells in the invasive front of carcinomas have different molecular profiles compared to those in superficial areas. This study aimed to identify candidate genes in the invasive front and superficial cells from laryngeal carcinomas that would be useful as molecular markers. Invasive front and tumor surface cells of 32 LSCC were evaluated by high-resolution comparative genomic hybridization. Both CCND1 copy number gains and cyclin D1 protein expression were evaluated to confirm gains of 11q13.3. Losses of 3q26.2-q29 and 18q23 were confirmed by loss of heterozygosity analysis. The most frequent chromosomal alterations observed only in invasive front cells involved gains of 1p, 4q, and 9p and losses of 3p, 11p, 12p, 13q, 17q, 18p, 19q, 20q, 21q, and Xp. Gains of 11q13 were detected in both components from glottis and supraglottis but only in invasive front cells from transglottic tumors. Fluorescence in situ hybridization confirmed gains of CCND1/CPE11 in a subset of cases. In supraglottic tumors, cyclin D1 positivity was associated with distant metastasis (P = 0.0018) and with decreased disease-free survival (P = 0.042). Loss of heterozygosity at 3q26.2 and 18q23 were associated with lymph node involvement (P = 0.055) and worsened prognosis, respectively. In conclusion, this study revealed regions that could be targeted in the search for molecular markers in LSCC. Cyclin D1 may be useful as a prognostic marker in supraglottic tumors.
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Atienza JAS, Dasanu CA. Incidence of second primary malignancies in patients with treated head and neck cancer: a comprehensive review of literature. Curr Med Res Opin 2012; 28:1899-909. [PMID: 23121148 DOI: 10.1185/03007995.2012.746218] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Increased incidence of a second primary aero-digestive malignancy after an index head and neck cancer (HNC) is well-documented. Furthermore, a clear set of surveillance strategies for second primary aero-digestive cancers in these patients exists. METHODS The goal of this article is to review the published literature on risk of second primary malignancies (SPMs) (including aero-digestive malignancies) after a treated index HNC as well as its associated predictors, prognosis and surveillance. Most relevant publications were identified through searching the PubMed database for articles published up to July 2012; epidemiologic evidence was synthesized and thoroughly analyzed. FINDINGS Data from randomized controlled trials, meta-analyses, population-based and cohort group studies, prior reviews, and case reports indicate an increased incidence of various SPMs after occurrence of a HNC. These cancers are not limited to upper aero-digestive sites. Common risk factors including environmental, genetic and immune factors may explain the increased incidence of second cancers in this patient population. In addition, site of the index HNC may predict the site of a future SPM. CONCLUSIONS As a general rule, oral cavity and oropharyngeal squamous cell cancers are associated more with head and neck region SPM, while laryngeal and hypopharyngeal cancers - with that of the lung. As these cancers confer dismal prognosis and shorter survival in patients with HNCs, several literature sources recommend close surveillance for and an aggressive therapy of SPM. Notwithstanding, their optimal management and follow-up schedule remains to be established.
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Affiliation(s)
- Jonessa Ann S Atienza
- University of Connecticut, Department of Internal Medicine, Farmington, CT 06030, USA.
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Bornstein S, Wax M, Holland J. Surveillance low-dose chest computed tomography for head and neck cancer patients. Otolaryngol Head Neck Surg 2012; 147:401-3. [PMID: 22581639 DOI: 10.1177/0194599812447167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Based on the recent results of the National Lung Cancer Screening Trial, the National Comprehensive Cancer Network now recommends annual screening with low-dose computed tomography for high-risk individuals (generally defined as 45- to 60-year-old current or former smokers). As head and neck cancer patients are at a high risk for (second) lung cancers, annual surveillance computed tomography should be considered for head and neck cancer patients.
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Affiliation(s)
- Sophia Bornstein
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA
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Nakayama M, Laccourreye O, Holsinger FC, Okamoto M, Hayakawa K. Functional organ preservation for laryngeal cancer: past, present and future. Jpn J Clin Oncol 2012; 42:155-60. [PMID: 22223858 DOI: 10.1093/jjco/hyr190] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Management of laryngeal cancer has focused on improving survival while preserving function. Over the past 20 years, the trends have shifted from surgery to chemoradiotherapy and presently we are facing various challenges. It is imperative to re-examine what has happened and what can be done. METHODS Review of the literature along with our experience in the management of functional organ preservation for laryngeal cancer. RESULTS There was an increasing use of chemoradiotherapy with a decreasing use of surgery. Inappropriate patient selection along with inability to properly apply salvage surgeries have been presumed to be responsible for survival deterioration in laryngeal cancer. Reports concerning late adverse events after chemoradiotherapy are also increasing. Reconfirmation of the multidisciplinary team approach is imperative. Transoral laser microsurgery can be used for early laryngeal cancer and, in some experienced institutes, for advanced-stage cancers. Supracricoid laryngectomy demonstrated satisfactory oncologic and functional outcomes, based on our experience. CONCLUSIONS Treatment selection for larynx preservation should not merely be decided by guidelines but considering each patient's individual condition. Head and neck surgeons are encouraged to take reasonable risks in performing salvage larynx preservation surgery when it is the only option to save a functioning larynx.
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Affiliation(s)
- Meijin Nakayama
- Department of Otorhinolaryngology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa, Japan.
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Jayaprakash V, Cheng C, Reid M, Dexter EU, Nwogu CE, Hicks W, Sullivan M, Demmy TL, Yendamuri S. Previous head and neck cancers portend poor prognoses in lung cancer patients. Ann Thorac Surg 2011; 92:1056-60; discussion 1060-1. [PMID: 21871300 DOI: 10.1016/j.athoracsur.2011.03.146] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/22/2011] [Accepted: 03/28/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Although a common clinical pairing, the epidemiology and prognosis of lung cancer (LC) after head and neck cancer (HNC) is not well described. METHODS Data from the database of the Surveillance, Epidemiology and End Results (SEER) Program were used to study the epidemiology and survival of patients with LC after HNC. These data were compared with those from our institutional cancer registry. RESULTS Of all patients with a history of HNC in the SEER database, 8,225 (5%) patients went on to develop LC. This was more than three times the incidence of second primary lung cancers (1.5%). Subsequent LCs in patients with a history of HNC were more common among those with hypopharyngeal and laryngeal cancer and those with localized HNC. Patients with HNC followed by LC had poorer overall survival than did the overall population of patients with LCs in the SEER database. Overall survival after the onset of LC was dismal (median survival, 8 months). Survival was not affected by histologic concordance between HNC and LC. An analysis of 72 patients with LC after HNC reported in our institutional tumor registry over the past 37 years yielded similar results. CONCLUSIONS Of patients who survive LC or HNC, the latter are much more likely to develop a new pulmonary malignancy. Lung cancers that develop after HNC have a poor prognosis. This phenomenon is not explained by misclassified metastases, because histologically discordant cases behave just as poorly. Enhanced surveillance and chemoprevention strategies are needed to detect and prevent subsequent primary LC in survivors of HNC.
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Affiliation(s)
- Vijayvel Jayaprakash
- Department of Dentistry and Maxillofacial Prosthetics, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Löhler J, Gerstner AOH, Bootz F, Heinritz H, Fryen A, Fryen G, Holstein N, Lingg A, Kleeberg J, Langhoff W, Rösch G, Hanisch A, Schneeberg E, Heinrich D, Walther LE. [Prevalence of abnormal mucosal findings in patients in HNO practices]. HNO 2011; 60:240-8. [PMID: 22037968 DOI: 10.1007/s00106-011-2381-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To date, no secondary prevention program is in place for patients carrying an increased risk for developing head and neck cancer (HNSCC). In terms of successful, long-term curative therapy and increased quality of life, it would be useful to detect such diseases at an early stage. PATIENTS AND METHODS A total of 370 patients with at least one risk factor such as "smoking", "alcohol", or "reflux disease" and without any symptoms were examined during a 1-year period using standard HNO methods (e. g. endoscopy) for suspicious alterations of the mucosa of the upper aerodigestive tract. RESULTS In 13 (3.5%) of all 370 cases a biopsy was taken for further diagnosis. Squamous cell carcinoma was found in eight cases, while one further patient was suffering from non-Hodgkin lymphoma. CONCLUSIONS It is simple and safe to examine patients at risk of developing HNSCC by standard HNO methods. The rate of detected carcinomas is much higher than in former investigations, likely because our survey focused only on patients with specific risk factors.
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Affiliation(s)
- J Löhler
- Wissenschaftliches Institut für angewandte HNO-Heilkunde des Deutschen Berufsverbandes der HNO-Ärzte e. V., Maienbeeck 1, 24576, Bad Bramstedt, Deutschland.
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Schultz P. Vocal fold cancer. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128:301-8. [PMID: 21959270 DOI: 10.1016/j.anorl.2011.04.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Revised: 04/03/2011] [Accepted: 04/16/2011] [Indexed: 11/17/2022]
Abstract
Ninety percent of vocal fold cancers take the form of squamous cell carcinoma. Since the 1980s, incidence in France has been constantly falling in males while increasing in females. The main risk factor is smoking, alcohol being less implicated than in other laryngeal or extralaryngeal locations. Vocal fold squamous cell carcinoma generally develops on healthy mucosa, although primary precancerous lesions such as leukoplakia or papillomatous keratosis are also frequent. The tumor usually originates in the non-lymphophilic mucosal free edge of the vocal fold then invades the various anatomic subunits of the larynx, acquiring lymph-node metastatic potential. Dysphonia is the first presenting symptom, initially caused by defective mucosal vibration and then by impaired mobility and finally fixation of the vocal fold. Extension, risk factor and pretreatment assessments are as in other upper-aerodigestive-tract cancer locations. The possibilities of laryngoscopic exposure and the tumor limits, however, need to be precisely determined if transoral resection is to be considered. For small tumors, surgery or exclusive radiation therapy can be suggested to the patient as part of an individual treatment plan, each having its advantages and drawbacks. Cutting-edge teams report 5-year local control rates of 85-95% in T1-class tumor and 60-90% in T2. Whatever the treatment option, smoking cessation, close surveillance and cardiovascular prevention enable screening of other oncologic locations and limit onset of the other pathologies implicated in most deaths.
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Affiliation(s)
- P Schultz
- Service d'ORL et de chirurgie cervicofaciale, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, avenue Molière, 67098 Strasbourg cedex, France.
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Abstract
OBJECTIVE To identify factors that predict for occult malignancy or high-risk lesions (HRL) in the contralateral breast among women undergoing contralateral prophylactic mastectomy (CPM). BACKGROUND A growing number of women are choosing to undergo CPM, yet the benefit of this procedure for the average woman with breast cancer remains uncertain. The identification of reliable predictors of occult malignancy or HRL in the contralateral breast may aid in selecting patients most likely to benefit from CPM. METHODS Patients undergoing mastectomy with CPM for their first diagnosis of unilateral stage 0 to III breast cancer were retrospectively identified (1997-2005). Univariate and multivariate logistic regression was used to identify factors predictive of HRL and/or occult contralateral breast cancer (CBC). RESULTS Among 2965 patients, 407 (13%) underwent CPM. Occult CBC was identified in 24 (6%) patients, and 114 (28%) had an HRL. On univariate analysis, multifocality/multicentricity of the index cancer was the only factor associated with occult malignancy in the CPM (OR 2.88, P = 0.04). On multivariate analysis, patient age and progesterone receptor positivity of the index cancer were associated with finding either malignancy or a HRL in the CPM. CONCLUSIONS The diagnosis of multifocality/multicentricity invasive index cancer was associated with occult malignancy in the CPM; however, lack of standardized definitions and differences in pathologic evaluation limit the application of this finding in the preoperative setting. Until reliable predictors for occult disease are identified, the low rates of occult CBC do not support the use of CPM in average-risk women with newly diagnosed breast cancer.
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Postoperative Follow-Up Strategy in Patients With Oral Squamous Cell Carcinoma. J Oral Maxillofac Surg 2011; 69:e105-11. [DOI: 10.1016/j.joms.2010.11.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 10/12/2010] [Accepted: 11/23/2010] [Indexed: 01/20/2023]
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Berrington de Gonzalez A, Curtis RE, Kry SF, Gilbert E, Lamart S, Berg CD, Stovall M, Ron E. Proportion of second cancers attributable to radiotherapy treatment in adults: a cohort study in the US SEER cancer registries. Lancet Oncol 2011; 12:353-60. [PMID: 21454129 PMCID: PMC3086738 DOI: 10.1016/s1470-2045(11)70061-4] [Citation(s) in RCA: 327] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Improvements in cancer survival have made the long-term risks from treatments more important, including the risk of developing a second cancer after radiotherapy. We aimed to estimate the proportion of second cancers attributable to radiotherapy in adults with data from the US Surveillance, Epidemiology and End Results (SEER) cancer registries. METHODS We used nine of the SEER registries to systematically analyse 15 cancer sites that are routinely treated with radiotherapy (oral and pharynx, salivary gland, rectum, anus, larynx, lung, soft tissue, female breast, cervix, endometrial, prostate, testes, eye and orbit, brain and CNS, and thyroid). The cohort we studied was composed of patients aged 20 years or older who were diagnosed with a first primary invasive solid cancer reported in the SEER registries between Jan 1, 1973, and Dec 31, 2002. Relative risks (RRs) for second cancer in patients treated with radiotherapy versus patients not treated with radiotherapy were estimated with Poisson regression adjusted for age, stage, and other potential confounders. FINDINGS 647,672 cancer patients who were 5-year survivors were followed up for a mean 12 years (SD 4.5, range 5-34); 60,271 (9%) developed a second solid cancer. For each of the first cancer sites the RR of developing a second cancer associated with radiotherapy exceeded 1, and varied from 1.08 (95% CI 0.79-1.46) after cancers of the eye and orbit to 1.43 (1.13-1.84) after cancer of the testes. In general, the RR was highest for organs that typically received greater than 5 Gy, decreased with increasing age at diagnosis, and increased with time since diagnosis. We estimated a total of 3266 (2862-3670) excess second solid cancers that could be related to radiotherapy, that is 8% (7-9) of the total in all radiotherapy patients (≥1 year survivors) and five excess cancers per 1000 patients treated with radiotherapy by 15 years after diagnosis. INTERPRETATION A relatively small proportion of second cancers are related to radiotherapy in adults, suggesting that most are due to other factors, such as lifestyle or genetics. FUNDING US National Cancer Institute.
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Rahman MA, Amin ARMR, Shin DM. Chemopreventive potential of natural compounds in head and neck cancer. Nutr Cancer 2011; 62:973-87. [PMID: 20924973 DOI: 10.1080/01635581.2010.509538] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is one of the most fatal cancers worldwide. Despite advances in the management of HNSCC, the overall survival for patients has not improved significantly due to advanced stages at diagnosis, high recurrence rate after surgical removal, and second primary tumor development, which underscore the importance of novel strategies for cancer prevention. Cancer chemoprevention, the use of natural or synthetic compounds to prevent, arrest, or reverse the process of carcinogenesis at its earliest stages, aims to reverse premalignancies and prevent second primary tumors. Genomics and proteomics information including initial mutation, cancer promotion, progression, and susceptibility has brought molecularly targeted therapies for drug development. The development of preventive approaches using specific natural or synthetic compounds, or both, requires a depth of understanding of the cross-talk between cancer signaling pathways and networks to retain or enhance chemopreventive activity while reducing known toxic effects. Many natural dietary compounds have been identified with multiple molecular targets, effective in the prevention and treatment of cancer. This review describes recent advances in the understanding of the complex signaling networks driving cancer progression and of molecularly targeted natural compounds under preclinical and clinical investigation.
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Affiliation(s)
- Mohammad Aminur Rahman
- Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia 30322, USA
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