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Rohrmeier C, Salloum H, Keerl R, Bohr C, Mueller S. Tobacco use in patients with ENT tumours: Deficits in the provision of education and smoking cessation support. EAR, NOSE & THROAT JOURNAL 2024; 103:580-587. [PMID: 35037507 DOI: 10.1177/01455613211070899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Smoking is not only one of the main risk factors for the development of most malignant and numerous benign ENT tumours but also has an important influence on therapy and prognosis. Even quitting smoking at the time of diagnosis significantly reduces mortality. Patients have a particularly strong desire to stop smoking when they are diagnosed. The present study investigated to what extent patients were aware of the relationships between smoking and the development and prognosis of tumours and how much information and smoking cessation support they were offered by physicians. METHODS A total of 194 patients (74.7% male, 62.0 ±10.6 a) with malignant primary ENT tumours, pre-cancerous tumours, Reinke's oedema and salivary gland tumours were interviewed. RESULTS 22.7% were nonsmokers, 49.5% were cigarette smokers and 27.8% were ex-smokers. A total of 57.0% of the smokers said they would have quit before the onset of the disease if they had known about the association. Forty-one percent did not receive information about the association between smoking and the development of their disease, while 45.5% did not receive information about the relationship with their prognosis. The provision of information lasted less than 5 min for 40.4% of the patients and more than 10 min for only 13.5%. In total, 50.7% of the patients were directly requested not to smoke. A total of 7.7% received offers of smoking cessation support from otolaryngologists and 18.2% received such offers from family physicians. CONCLUSIONS There is a pronounced need for improvements in the provision of medical information about the health risks associated with smoking and offers to support patient efforts to stop smoking. In particular, the appointment during which the diagnosis is communicated to the patient should be considered a 'teachable moment' that can lead to smoking cessation.
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Affiliation(s)
| | - Hazem Salloum
- Department of Otorhinolaryngology, St. Elisabeth Hospital, Straubing, Germany
| | - Rainer Keerl
- Department of Otorhinolaryngology, St. Elisabeth Hospital, Straubing, Germany
| | - Christopher Bohr
- Department of Otorhinolaryngology, University of Regensburg, Regensburg, Germany
| | - Steffen Mueller
- Department of Oral and Maxillofacial Surgery, University of Regensburg, Regensburg, Germany
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Victor MT, Faraji F, Voora R, Kalavacherla S, Mell LK, Rose BS, Guo TW. Factors associated with total laryngectomy following organ-preserving treatment of laryngeal SCC. Laryngoscope Investig Otolaryngol 2024; 9:e1317. [PMID: 39108948 PMCID: PMC11301822 DOI: 10.1002/lio2.1317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/25/2024] [Accepted: 07/20/2024] [Indexed: 09/12/2024] Open
Abstract
Objectives A subset of laryngeal squamous cell carcinoma (LSCC) patients undergoing larynx preserving treatment ultimately require total laryngectomy (TL) for oncologic or functional reasons. This study aims to identify TL risk factors in these patients. Methods Retrospective cohort study using Veterans Affairs (VA) database. T1-T4 LSCC cases treated with primary radiotherapy (XRT) or chemoradiotherapy (CRT) were assessed for TL and recurrence. Binary logistic and Cox regression and Kaplan-Meier analyses were implemented. Results Of 5390 cases, 863 (16.0%) underwent TL. On multivariable analysis, age (adjusted odds ratio: 0.97 [0.96-0.98]; p < .001) and N3 disease (0.42 [0.18-1.00]; p = .050) were associated with reduced risk of TL, whereas current alcohol use (1.22 [1.04-1.43]; p = .015) and >T1 disease (T2, 1.76 [1.44-2.17]; p < .001; T3, 2.06 [1.58-2.68]; p < .001; T4, 1.79 [1.26-2.53]; p = .001) were associated with increased risk of TL. However, N2 (adjusted hazard ratio: 1.30 [1.10-1.55]; p = .003) and N3 (2.02 [1.25-3.26]; p = .004) disease were associated with an increased risk for local recurrence. Compared to XRT, treatment with CRT was associated with reduced risk for local recurrence after adjusting for other factors (0.84 [0.70-0.99]; p = .044). Those who do not receive TL following local recurrence have poorer disease-specific survival (log-rank, p < .001). In patients without local recurrence, N2 disease was associated with a fourfold increase in risk of TL (4.24 [1.83-9.82]; p < .001). Conclusion Advanced nodal stage was associated with reduced rates of salvage TL in the setting of local recurrence, and subsequent worse prognosis after recurrence. Conversely, advanced nodal stage may increase the risk for functional salvage TL in patients without recurrence. Level of Evidence Level 3.
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Affiliation(s)
- Mitchell T. Victor
- University of California San Diego School of MedicineSan DiegoCaliforniaUSA
- Northwestern University, Feinberg School of MedicineChicagoIllinoisUSA
| | - Farhoud Faraji
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San Diego HealthLa JollaCaliforniaUSA
- Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer CenterUniversity of California San Diego HealthLa JollaCaliforniaUSA
| | - Rohith Voora
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San Diego HealthLa JollaCaliforniaUSA
| | | | - Loren K. Mell
- Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer CenterUniversity of California San Diego HealthLa JollaCaliforniaUSA
- Department of Radiation Medicine and Applied SciencesUniversity of California San Diego HealthLa JollaCaliforniaUSA
| | - Brent S. Rose
- Department of Radiation Medicine and Applied SciencesUniversity of California San Diego HealthLa JollaCaliforniaUSA
- Department of Radiation OncologyVeterans Affairs San Diego Healthcare SystemSan DiegoCaliforniaUSA
| | - Theresa W. Guo
- Department of Otolaryngology‐Head and Neck SurgeryUniversity of California San Diego HealthLa JollaCaliforniaUSA
- Hanna and Mark Gleiberman Head and Neck Cancer Center, Moores Cancer CenterUniversity of California San Diego HealthLa JollaCaliforniaUSA
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Haghparast M, Evazi MR, Darvish L. Tobacco smoking influences the side effects of radiation therapy-managed patients with various malignancies: A systematic review. J Med Imaging Radiat Sci 2024; 55:101430. [PMID: 38870612 DOI: 10.1016/j.jmir.2024.05.003] [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: 02/07/2024] [Revised: 04/30/2024] [Accepted: 05/08/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Tobacco smoking may decrease the effectiveness of radiation therapy. This is because tobacco smoking can cause inflammation and damage to surrounding tissues, which may interfere with radiation delivery to the tumor. Our aim of this study is to investigate the effect of tobacco smoking use on complications in radiotherapy as a systematic review. METHOD The articles searched from the MEDLINE, PubMed, EMBASE, and Web of Science databases. The search terms used were "radiotherapy", "outcome", "radiation therapy", "tobacco", "smoking", "complications", "side effects", "cancer", and "malignancy". PRISMA check list was used to assess the overall quality of evidence for each outcome. RESULT The outcomes of radiotherapy-inducing tobacco smoking in smokers are more than non-smokers including; high SPC (second primary cancer), decreased median overall survival, higher infections during treatment, increased fatigue (p = 0.027), increased pain (p = 0.009), poorer cognitive function (0.041), affected mouth opening (0.049), more speech disturbances (p = 0.017), higher metastasis risk (p = 0.031 and 0.019), higher locoregional recurrence risk (p = 0.027), oral mucositis (p = 0.03), mucositis severity related to higher tobacco exposure (p = 0.008), severe acute radiation skin reactions, and myocardial infarction. DISCUSSION Tobacco smoking appears to be the most significant modifiable factor influencing cancer treatment outcomes. As such, healthcare providers should take detailed notes on patients' smoking histories during both routine and future clinical studies. Beyond immediate cessation, cancer patients should undertake comprehensive smoking cessation programs. These programs can significantly boost the efficacy of radiotherapy and enhance overall patient outcomes.
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Affiliation(s)
- Mohammad Haghparast
- Department of Radiology, Faculty of ParaMedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran; Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mohammad Reza Evazi
- Hematologist and Medical Oncologist, Hormozgan University of Medical Science, Bandar Abbas, Iran
| | - Leili Darvish
- Department of Radiology, Faculty of ParaMedicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran; Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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Invernizzi C, Da Silva Ribeiro Mota A, Barbe C, Bouazzi L, Marques O, Munschi L, Marchand-Crety C, Jacquin N, Dubernard X, Beddok A, Lasset C, Assouly N, Vignot S, Brenet E. Prospective comparison of acute severe toxicities between smokers and non-smokers during radiotherapy for head and neck cancers. Oral Oncol 2024; 153:106833. [PMID: 38729039 DOI: 10.1016/j.oraloncology.2024.106833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 04/09/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND AND PURPOSE The association between smoking and acute radiation toxicities of head and neck cancer (HNC) is currently unproven. The aim of the study was to compare the occurrence of acute severe toxicity between active and non-active smokers treated for HNC by radiotherapy. MATERIALS AND METHODS A prospective monocentric cohort study included patients treated by (chemo)radiotherapy for HNC from January 2021 to January 2023. Smoking status was recorded. Patients underwent a medical exam weekly during the radiotherapy to report acute toxicities according to the Common Terminology Criteria for Adverse Effects system version 5.0. Primary endpoint was the occurrence of at least one grade ≥ 3 acute toxicity among mucositis, dysphagia and dermatitis. RESULTS Among the 102 patients included, 27.4 % were active smokers, 58.8 % were former smokers and 13.7 % had never smoked. Regarding toxicity, 23.5 % (n = 24) patients experienced severe mucositis, 37.2 % (n = 38) severe dysphagia, 13.7 % (n = 14) severe dermatitis and 54.9 % (n = 56) experienced at least one of them. Occurrence of severe acute toxicity was not statistically associated with smoking during radiotherapy (64.3 % among active smokers versus 51.3 % among non-active smokers; p = 0.24). On multivariate analysis, concurrent chemotherapy (87.5 % vs 65.2 %; OR = 5.04 [1.64-15.52]; p = 0.004) and 2.12 Gy versus 2 Gy fractionation schedule (64.3 % vs 41.3 %; OR = 2.53 [1.09-5.90]; p = 0.03) were significantly associated with severe acute toxicity. CONCLUSION This study did not find an association between smoking during radiotherapy for HNC and occurrence of severe acute toxicities.
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Affiliation(s)
- C Invernizzi
- Department of Onco-Radiotherapy, Institut Godinot, 51100 Reims, France; Health Division, University of Reims Champagne-Ardenne, 51100 Reims, France
| | | | - C Barbe
- Department of Biostatistics and Health Economics, University of Reims Champagne-Ardenne, CURRS, 51100 Reims, France
| | - L Bouazzi
- Department of Biostatistics and Health Economics, University of Reims Champagne-Ardenne, CURRS, 51100 Reims, France
| | - O Marques
- Department of Onco-Radiotherapy, Institut Godinot, 51100 Reims, France
| | - L Munschi
- Department of Onco-Radiotherapy, Institut Godinot, 51100 Reims, France
| | - C Marchand-Crety
- Department of Onco-Radiotherapy, Institut Godinot, 51100 Reims, France
| | - N Jacquin
- Department of Onco-Radiotherapy, Institut Godinot, 51100 Reims, France; Health Division, University of Reims Champagne-Ardenne, 51100 Reims, France
| | - X Dubernard
- Health Division, University of Reims Champagne-Ardenne, 51100 Reims, France; Department of Otorhinolaryngology Head and Neck Surgery, Robert Debré University Hospital Center, 51100 Reims, France
| | - A Beddok
- Department of Onco-Radiotherapy, Institut Godinot, 51100 Reims, France; Health Division, University of Reims Champagne-Ardenne, 51100 Reims, France
| | - C Lasset
- Department of Prevention and Genetic Epidemiology, Léon Bérard Center, 69 373 Lyon Cedex 08, France
| | - N Assouly
- Department of Surgery, Institut Godinot, 51100 Reims, France
| | - S Vignot
- Department of Onco-Radiotherapy, Institut Godinot, 51100 Reims, France; Health Division, University of Reims Champagne-Ardenne, 51100 Reims, France
| | - E Brenet
- Health Division, University of Reims Champagne-Ardenne, 51100 Reims, France; Department of Otorhinolaryngology Head and Neck Surgery, Robert Debré University Hospital Center, 51100 Reims, France.
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Krutz M, Acharya P, Elliott J, Zhao D, Mhawej R, Queimado L. Tobacco Cessation Following Laryngeal Cancer Diagnosis Predicts Response to Treatment and Laryngectomy-Free Survival. Otolaryngol Head Neck Surg 2024; 170:438-446. [PMID: 37890055 PMCID: PMC10872773 DOI: 10.1002/ohn.567] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVE To determine the effect of tobacco cessation following laryngeal cancer diagnosis on response to first-line therapy, laryngectomy-free survival, and overall survival in patients who were current smokers at the time of diagnosis. STUDY DESIGN Retrospective, case-control study. SETTING OU Stephenson Cancer Center, National Cancer Institute-Designated Cancer Center. METHODS We included 140 patients diagnosed with laryngeal squamous cell carcinoma, who were current smokers at the time of diagnosis, and were treated with first-line definitive radiation or chemo/radiation with the intent to cure. The association between patient characteristics and treatment response was assessed using the χ2 test and logistic regression analysis. Survival outcomes were analyzed using Kaplan-Meier methods and Cox proportional-hazards models. RESULTS Of the 140 current smokers, 61 patients (45%) quit smoking prior to treatment initiation. In adjusted logistic regression analysis, quitters had 3.7 times higher odds of achieving a complete response to first-line therapy than active smokers (odds ratio: 3.694 [1.575-8.661]; P = .003). In the adjusted Cox proportional-hazards model, quitters were 54% less likely to require salvage laryngectomy within 7 years of diagnosis than active smokers (hazard ratio: 0.456 [0.246-0.848]; P = .013). Quitters had a statistically significant increase in 7-year overall survival compared to active smokers (P = .02). CONCLUSION This is the first study to show that in newly diagnosed laryngeal cancer patients who are current smokers at the time of diagnosis, tobacco cessation significantly increases therapy response, laryngectomy-free survival, and overall survival. These data stress the importance of systematically incorporating tobacco cessation programs into laryngeal cancer treatment plans.
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Affiliation(s)
- Matthew Krutz
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City OK, USA
| | - Pawan Acharya
- Department of Biostatistics & Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City OK, USA
| | - Jacey Elliott
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City OK, USA
| | - Daniel Zhao
- Department of Biostatistics & Epidemiology, The University of Oklahoma Health Sciences Center, Oklahoma City OK, USA
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rachad Mhawej
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City OK, USA
| | - Lurdes Queimado
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City OK, USA
- Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Cell Biology, The University of Oklahoma Health Sciences Center, Oklahoma City OK, USA
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Sadhasivam B, Manyanga J, Ganapathy V, Acharya P, Bouharati C, Chinnaiyan M, Mehta T, Mathews B, Castles S, Rubenstein DA, Tackett AP, Zhao YD, Ramachandran I, Queimado L. Exposure to Secondhand Smoke Extract Increases Cisplatin Resistance in Head and Neck Cancer Cells. Int J Mol Sci 2024; 25:1032. [PMID: 38256106 PMCID: PMC10816441 DOI: 10.3390/ijms25021032] [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: 11/30/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
Chemotherapy and radiotherapy resistance are major obstacles in the long-term efficacy of head and neck squamous cell carcinoma (HNSCC) treatment. Secondhand smoke (SHS) exposure is common and has been proposed as an independent predictor of HNSCC recurrence and disease-free survival. However, the underlying mechanisms responsible for these negative patient outcomes are unknown. To assess the effects of SHS exposure on cisplatin efficacy in cancer cells, three distinct HNSCC cell lines were exposed to sidestream (SS) smoke, the main component of SHS, at concentrations mimicking the nicotine level seen in passive smokers' saliva and treated with cisplatin (0.01-100 µM) for 48 h. Compared to cisplatin treatment alone, cancer cells exposed to both cisplatin and SS smoke extract showed significantly lower cisplatin-induced cell death and higher cell viability, IC50, and indefinite survival capacity. However, SS smoke extract exposure alone did not change cancer cell viability, cell death, or cell proliferation compared to unexposed control cancer cells. Mechanistically, exposure to SS smoke extract significantly reduced the expression of cisplatin influx transporter CTR1, and increased the expression of multidrug-resistant proteins ABCG2 and ATP7A. Our study is the first to document that exposure to SHS can increase cisplatin resistance by altering the expression of several proteins involved in multidrug resistance, thus increasing the cells' capability to evade cisplatin-induced cell death. These findings emphasize the urgent need for clinicians to consider the potential role of SHS on treatment outcomes and to advise cancer patients and caregivers on the potential benefits of avoiding SHS exposure.
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Affiliation(s)
- Balaji Sadhasivam
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
- Department of Occupational and Environmental Health, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Jimmy Manyanga
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
- Department of Cell Biology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Vengatesh Ganapathy
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Pawan Acharya
- Department of Biostatistics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.A.); (Y.D.Z.)
| | - Célia Bouharati
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Mayilvanan Chinnaiyan
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Toral Mehta
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Basil Mathews
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - Samuel Castles
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
| | - David A. Rubenstein
- Department of Biomedical Engineering, Stony Brook University, New York City, NY 11794, USA;
| | - Alayna P. Tackett
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
- Division of Medical Oncology, The Ohio State University, Columbus, OH 43210, USA
| | - Yan D. Zhao
- Department of Biostatistics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.A.); (Y.D.Z.)
| | - Ilangovan Ramachandran
- Department of Endocrinology, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai, TN 600113, India;
| | - Lurdes Queimado
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (B.S.); (J.M.); (V.G.); (M.C.); (T.M.); (B.M.); (S.C.)
- Department of Cell Biology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
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Leonhardt CS, Pils D, Qadan M, Gustorff C, Sahora K, Klaiber U, Warshaw AL, Prager G, Ferrone CR, Lillemoe KD, Schindl M, Strobel O, Castillo CFD, Hank T. Smoking impairs the effect of neoadjuvant FOLFIRINOX on postresection survival in pancreatic cancer. Eur J Cancer 2023; 193:113293. [PMID: 37713740 DOI: 10.1016/j.ejca.2023.113293] [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: 08/05/2023] [Accepted: 08/10/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Smoking plays an important role in carcinogenesis, including pancreatic ductal adenocarcinoma (PDAC). However, little is known about the association between smoking status and prognosis in resected PDAC. METHODS All patients who underwent resection for PDAC were identified from two prospective institutional databases. Clinicopathologic data as well as demographics including smoking status were extracted. Survival analysis and multivariable Cox regression modelling was performed. Restricted cubic splines were used for linear data to define cut-off points. RESULTS Out of 848 patients, 357 (42.1%) received neoadjuvant treatment (NAT), 491 upfront resection (57.9%), and 475 (56%) adjuvant therapy. The median overall survival (OS) was 27.8 months, 36.1 months, and 23.0 months for the entire cohort, after NAT and upfront resection. 464 patients were never smokers (54.7%), 250 former smokers (29.5%), and 134 active smokers (15.8%). In the multivariable model, the interaction of neoadjuvant FOLFIRINOX and active smoking was associated with the highest risk for decreased OS (harzard ratio (HR) 2.35; 95% confidence interval 1.13-4.90) and strongly mitigated the benefit of FOLFIRNOX (HR 0.40; 95% CI 0.25-0.63). Adjusted median OS in NAT patients with FOLFIRINOX was not reached for never and former smokers, compared to 26.2 months in active smokers. Based on the model, a nomogram was generated to illustrate the probability of 5-year survival after PDAC resection. CONCLUSION The present study confirms that neoadjuvant FOLFIRINOX is associated with excellent survival and demonstrates that active smoking reduces its benefit. The nomogram can assist in daily clinical practice and emphasises the importance of smoking cessation in patients with PDAC, especially prior to NAT with FOLFIRINOX.
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Affiliation(s)
- Carl-Stephan Leonhardt
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Dietmar Pils
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Charlotte Gustorff
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Klaus Sahora
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Ulla Klaiber
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gerald Prager
- Department of Medicine I, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin Schindl
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | - Oliver Strobel
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Thomas Hank
- Department of General Surgery, Division of Visceral Surgery, Medical University of Vienna, Vienna, Austria; Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Fares AF, Li Y, Jiang M, Brown MC, Lam ACL, Aggarwal R, Schmid S, Leighl NB, Shepherd FA, Wang Z, Diao N, Wenzlaff AS, Xie J, Kohno T, Caporaso NE, Harris C, Ma H, Barnett MJ, Leal LF, Fernandez-Tardon G, Pérez-Ríos M, Davies MPA, Taylor F, Schöttker B, Brennan P, Zaridze D, Holcatova I, Lissowska J, Świątkowska B, Mates D, Savic M, Brenner H, Andrew A, Cox A, Field JK, Ruano-Ravina A, Shete SS, Tardon A, Wang Y, Le Marchand L, Reis RM, Schabath MB, Chen C, Shen H, Ryan BM, Landi MT, Shiraishi K, Zhang J, Schwartz AG, Tsao MS, Christiani DC, Yang P, Hung RJ, Xu W, Liu G. Association between duration of smoking abstinence before non-small-cell lung cancer diagnosis and survival: a retrospective, pooled analysis of cohort studies. Lancet Public Health 2023; 8:e691-e700. [PMID: 37633678 PMCID: PMC10540150 DOI: 10.1016/s2468-2667(23)00131-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The association between duration of smoking abstinence before non-small-cell lung cancer (NSCLC) diagnosis and subsequent survival can influence public health messaging delivered in lung-cancer screening. We aimed to assess whether the duration of smoking abstinence before diagnosis of NSCLC is associated with improved survival. METHODS In this retrospective, pooled analysis of cohort studies, we used 26 cohorts participating in Clinical Outcomes Studies of the International Lung Cancer Consortium (COS-ILCCO) at 23 hospitals. 16 (62%) were from North America, six (23%) were from Europe, three (12%) were from Asia, and one (4%) was from South America. Patients enrolled were diagnosed between June 1, 1983, and Dec 31, 2019. Eligible patients had smoking data before NSCLC diagnosis, epidemiological data at diagnosis (obtained largely from patient questionnaires), and clinical information (retrieved from medical records). Kaplan-Meier curves and multivariable Cox models (ie, adjusted hazard ratios [aHRs]) were generated with individual, harmonised patient data from the consortium database. We estimated overall survival for all causes, measured in years from diagnosis date until the date of the last follow-up or death due to any cause and NSCLC-specific survival. FINDINGS Of 42 087 patients with NSCLC in the COS-ILCCO database, 21 893 (52·0%) of whom were male and 20 194 (48·0%) of whom were female, we excluded 4474 (10·6%) with missing data. Compared with current smokers (15 036 [40·0%] of 37 613), patients with 1-3 years of smoking abstinence before NSCLC diagnosis (2890 [7·7%]) had an overall survival aHR of 0·92 (95% CI 0·87-0·97), patients with 3-5 years of smoking abstinence (1114 [3·0%]) had an overall survival aHR of 0·90 (0·83-0·97), and patients with more than 5 years of smoking abstinence (10 841 [28·8%]) had an overall survival aHR of 0·90 (0·87-0·93). Improved NSCLC-specific survival was observed in 4301 (44%) of 9727 patients who had quit cigarette smoking and was significant at abstinence durations of more than 5 years (aHR 0·87, 95% CI 0·81-0·93). Results were consistent across age, sex, histology, and disease-stage distributions. INTERPRETATION In this large, pooled analysis of cohort studies across Asia, Europe, North America, and South America, overall survival was improved in patients with NSCLC whose duration of smoking abstinence before diagnosis was as short as 1 year. These findings suggest that quitting smoking can improve overall survival, even if NSCLC is diagnosed at a later lung-cancer screening visit. These findings also support the implementation of public health smoking cessation strategies at any time. FUNDING The Alan B Brown Chair, The Posluns Family Fund, The Lusi Wong Fund, and the Princess Margaret Cancer Foundation.
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Affiliation(s)
- Aline F Fares
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Division of Medical Oncology, Faculty of Medicine of São José do Rio Preto, São Paulo, Brazil
| | - Yao Li
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Mei Jiang
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - M Catherine Brown
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew C L Lam
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Reenika Aggarwal
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Sabine Schmid
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Universitätsklinik für Medizinische Onkologie, Inselspital Bern, Bern, Switzerland
| | - Natasha B Leighl
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Frances A Shepherd
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - Zhichao Wang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Nancy Diao
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Angela S Wenzlaff
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Juntao Xie
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Takashi Kohno
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan
| | - Neil E Caporaso
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Curtis Harris
- Laboratory of Human Carcinogenesis, Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Hongxia Ma
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Matthew J Barnett
- Public Health Sciences, Biostatistics Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Leticia Ferro Leal
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil
| | - G Fernandez-Tardon
- University Institute of Oncology of Asturias-Cajastur Social Programme, University of Oviedo, Oviedo, Spain; Health Research Institute of Asturias, Oviedo, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Oviedo, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Michael P A Davies
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Fiona Taylor
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Weston Park Cancer Centre, Sheffield Teaching Hospital Foundation Trust, Sheffield, UK
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Network of Aging Research, Heidelberg University, Heidelberg, Germany
| | - Paul Brennan
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - David Zaridze
- N N Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - Ivana Holcatova
- Institute of Public Health and Preventive Medicine and Department of Oncology, Second Faculty of Medicine and University Hospital Motol, Charles University, Prague, Czech Republic
| | - Jolanta Lissowska
- Department of Cancer Epidemiology and Prevention, M Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Dana Mates
- National Institute of Public Health, Bucharest, Romania
| | - Milan Savic
- Department of Thoracic Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany; National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | - Angela Cox
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - John K Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Alberto Ruano-Ravina
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Sanjay S Shete
- M D Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Adonina Tardon
- University Institute of Oncology of Asturias-Cajastur Social Programme, University of Oviedo, Oviedo, Spain; Health Research Institute of Asturias, Oviedo, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública, Oviedo, Spain
| | - Ying Wang
- American Cancer Society, Atlanta, GA, USA
| | - Loic Le Marchand
- University of Hawai'i Cancer Centre, University of Hawai'i, Honolulu, HI, USA
| | - Rui Manuel Reis
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, Brazil; Life and Health Sciences Research Institute, Medical School, University of Minho, Braga, Portugal; Life and Health Sciences Research Institute-Biomaterials, Biodegradables and Biomimetics Research Group Associate Laboratory, Braga, Portugal
| | | | - Chu Chen
- Program in Epidemiology, Cancer Prevention Program, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Hongbing Shen
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Brid M Ryan
- Laboratory of Human Carcinogenesis, Centre for Cancer Research, National Institutes of Health, Bethesda, MD, USA
| | - Maria Teresa Landi
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kouya Shiraishi
- Division of Genome Biology, National Cancer Center Research Institute, Tokyo, Japan; Department of Clinical Genomics, National Cancer Center Research Institute, Tokyo, Japan
| | - Jie Zhang
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Ann G Schwartz
- Barbara Ann Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA
| | - Ming S Tsao
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
| | - David C Christiani
- Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ping Yang
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Rayjean J Hung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Sinai Health Systems, Toronto, ON, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Geoffrey Liu
- Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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9
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Price SN, Palmer AM, Fucito LM, Graboyes EM, Baker NL, Rojewski AM, Toll BA. Tobacco use and cancer-related symptom burden: Analysis of the US Population Assessment of Tobacco and Health Study. Cancer 2023; 129:2385-2394. [PMID: 37211959 PMCID: PMC10593116 DOI: 10.1002/cncr.34746] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/03/2023] [Accepted: 02/22/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Understanding the relationship between tobacco use and symptom burden may inform tobacco treatment interventions tailored to the needs of individuals with cancer. METHODS The study included 1409 adult cancer survivors from Wave 5 of the US Food and Drug Administration Population Assessment of Tobacco and Health (PATH) Study. A multivariate analysis of variance controlling for age, sex, and race/ethnicity assessed the association of cigarette smoking and vaping on cancer-related symptom burden (fatigue, pain, emotional problems) and quality of life (QoL). Generalized linear mixed models controlling for the same factors were used to assess associations among symptom burden, QoL, and quit-smoking intentions, quit-smoking likelihood, and past 12-month smoking quit attempts. RESULTS Weighted rates of current cigarette smoking and vaping were 14.21% and 2.88%, respectively. Current smoking was associated with greater fatigue (p < .0001; partial η 2 = .02), pain (p < .0001; partial η 2 = .08), emotional problems (p < .0001; partial η 2 = .02), and worse QoL (p < .0001; partial η 2 = .08). Current vaping was associated with greater fatigue (p = .001; partial η 2 = .008), pain (p = .009; partial η 2 = .005), and emotional problems (p = .04; partial η 2 = .003), but not worse QoL (p = .17). Higher cancer symptom burden was not associated with reduced interest in quitting, likelihood of quitting, or odds of past year quit attempts (p > .05 for each). CONCLUSIONS Among adults with cancer, current smoking and vaping were associated with greater symptom burden. Survivors' interest in and intentions to quit smoking were not related to symptom burden. Future research should examine the role of tobacco cessation in improving symptom burden and QoL.
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Affiliation(s)
- Sarah N. Price
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amanda M. Palmer
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa M. Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Cancer Center, New Haven, Connecticut, USA
| | - Evan M. Graboyes
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nathaniel L. Baker
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alana M. Rojewski
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Benjamin A. Toll
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
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10
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Yingst JM, Carrillo M, Chan KH, Choi K, Dao J, Kulkarni P, Bordner C, Goyal N, Foulds J, Bascom R. Effectiveness of smoking cessation interventions among persons with cancer: A systematic review. Psychooncology 2023; 32:1147-1162. [PMID: 37226331 DOI: 10.1002/pon.6171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Continued smoking after cancer diagnosis is associated with worse outcomes, however, many persons diagnosed with cancer who smoke are unable to quit successfully. Effective interventions are needed to promote quitting in this population. The purpose of this systematic review is to understand the most effective interventions for smoking cessation among persons with cancer and to identify gaps in knowledge and methodology to suggest directions for future research. METHODS Three electronic databases (The Cochrane Central Register of Controlled trials, MEDLINE, and EMBASE) were searched for studies of smoking cessation interventions among persons with cancer, published up to 1 July 2021. Title and abstract screening, full-text review, and data extraction was completed by two independent reviewers, via Covalence software, with any discordance resolved by a third reviewer. A quality assessment was completed using the Cochrane Risk of Bias Tool Version 2. RESULTS Thirty-six articles were included in the review, including 17 randomized-controlled trials (RCTs) and 19 non-RCT studies. Of the 36 studies, 28 (77.8%) utilized an intervention that included both counseling and medication, with 24 (85.7%) providing medication to participants at no cost. Abstinence rates in the RCT intervention groups (n = 17) ranged from 5.2% to 75%, while the non-RCTs found abstinence rates ranging from 15% to 46%. Overall, studies met a mean of 2.28 out of seven quality items, ranging from 0 to 6. CONCLUSIONS Our study highlights the importance of utilizing intensive combined behavioral and pharmacological interventions for persons with cancer. While combined therapy interventions seem to be the most effective, more research is needed, as current studies have several quality issues, including the lack of biochemical verification for abstinence.
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Affiliation(s)
- Jessica M Yingst
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Matthew Carrillo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Karen Choi
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Joseph Dao
- Penn State College of Medicine, Hershey, Pennsylvania, USA
| | | | - Candace Bordner
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Neerav Goyal
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Otolaryngology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Jonathan Foulds
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
| | - Rebecca Bascom
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
- Penn State Cancer Institute, Hershey, Pennsylvania, USA
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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11
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Bricker JB, Westmaas JL, Ostroff JS, Mull KE, Sullivan BM, Santiago-Torres M. Efficacy of smartphone applications to help cancer patients quit smoking: Protocol of the Quit2Heal randomized controlled trial. Contemp Clin Trials 2023; 129:107180. [PMID: 37040817 PMCID: PMC10283347 DOI: 10.1016/j.cct.2023.107180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/13/2023]
Abstract
Cigarette smoking is highly prevalent among cancer patients in the United States (US), with up to half of cancer patients smoking at the time of their initial cancer diagnosis. However, evidence-based cessation programs are rarely implemented in oncology care, and smoking is not consistently treated in cancer treatment settings. Consequently, there is an urgent need for accessible and efficacious cessation treatments that are uniquely tailored to the needs of cancer patients. Here we describe the design and implementation of a randomized controlled trial (RCT) testing the efficacy of a smartphone app (Quit2Heal) versus a US Clinical Practice Guidelines-based app (QuitGuide) for smoking cessation among a planned sample of 422 cancer patients. Quit2Heal is designed to address cancer-related shame, stigma, depression, anxiety, and knowledge about the consequences of smoking/quitting. Quit2Heal is based on the principles of Acceptance and Commitment Therapy, a behavioral therapy that teaches skills for accepting cravings to smoke without smoking, values-driven motivation to quit, and preventing relapse. The primary aim of the RCT is to determine whether Quit2Heal has significantly higher self-reported 30-day point prevalence abstinence at 12 months relative to QuitGuide. The trial will also determine whether Quit2Heal's effect on cessation is (1) mediated by improvements in cancer-related shame, stigma, depression, anxiety, and knowledge about the consequences of smoking/quitting; and (2) moderated by baseline factors (e.g., cancer type, stage, time since diagnosis). If successful, Quit2Heal will offer a more efficacious, broadly scalable smoking cessation treatment that could be implemented alongside existing oncology care, thereby improving cancer outcomes.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | | | - Jamie S Ostroff
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering, New York City, NY, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
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12
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Chaudhary R, Slebos RJ, Noel LC, Song F, Poole MI, Hoening DS, Hernandez-Prera JC, Conejo-Garcia JR, Guevara-Patino JA, Wang X, Xie M, Tan AC, Chung CH. EGFR Inhibition by Cetuximab Modulates Hypoxia and IFN Response Genes in Head and Neck Squamous Cell Carcinoma. CANCER RESEARCH COMMUNICATIONS 2023; 3:896-907. [PMID: 37377902 PMCID: PMC10202124 DOI: 10.1158/2767-9764.crc-22-0443] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/01/2023] [Accepted: 05/02/2023] [Indexed: 06/29/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) has one of the most hypoxic and immunosuppressive tumor microenvironments (TME) among solid tumors. However, there is no proven therapeutic strategy to remodel the TME to be less hypoxic and proinflammatory. In this study, we classified tumors according to a Hypoxia-Immune signature, characterized the immune cells in each subgroup, and analyzed the signaling pathways to identify a potential therapeutic target that can remodel the TME. We confirmed that hypoxic tumors had significantly higher numbers of immunosuppressive cells, as evidenced by a lower ratio of CD8+ T cells to FOXP3+ regulatory T cells, compared with nonhypoxic tumors. Patients with hypoxic tumors had worse outcomes after treatment with pembrolizumab or nivolumab, anti-programmed cell death-1 inhibitors. Our expression analysis also indicated that hypoxic tumors predominantly increased the expression of the EGFR and TGFβ pathway genes. Cetuximab, an anti-EGFR inhibitor, decreased the expression of hypoxia signature genes, suggesting that it may alleviate the effects of hypoxia and remodel the TME to become more proinflammatory. Our study provides a rationale for treatment strategies combining EGFR-targeted agents and immunotherapy in the management of hypoxic HNSCC. Significance While the hypoxic and immunosuppressive TME of HNSCC has been well described, comprehensive evaluation of the immune cell components and signaling pathways contributing to immunotherapy resistance has been poorly characterized. We further identified additional molecular determinants and potential therapeutic targets of the hypoxic TME to fully leverage currently available targeted therapies that can be administered with immunotherapy.
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Affiliation(s)
- Ritu Chaudhary
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Robbert J.C. Slebos
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Leenil C. Noel
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Feifei Song
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Maria I. Poole
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Dirk S. Hoening
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | | | | | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Mengyu Xie
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Aik Choon Tan
- Department of Oncological Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Christine H. Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
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13
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Bokemeyer F, Lebherz L, Schulz H, Bokemeyer C, Gali K, Bleich C. Smoking patterns and the intention to quit in German patients with cancer: study protocol for a cross-sectional observational study. BMJ Open 2023; 13:e069570. [PMID: 37055212 PMCID: PMC10106069 DOI: 10.1136/bmjopen-2022-069570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Patients who continue to smoke cigarettes after a cancer diagnosis can experience poorer treatment tolerance and outcomes than those who quit immediately. Identifying risk factors specific to patients with cancer who smoke, as well as their smoking behaviours (eg, frequency of use, types of tobacco products), dependency level and quit intentions, is necessary to better inform patients and encourage quitting smoking after a cancer diagnosis. This study aims to examine the occurrence of smoking in patients with cancer treated at specialised oncology departments and outpatient clinics based within the metropolitan region of Hamburg, Germany, and presents an analysis of their smoking patterns. This understanding is the first step in developing an adequate smoking cessation intervention and shall contribute to a sustainable improvement in the treatment results, long-term survival and quality of life of patients with cancer. METHODS AND ANALYSIS A questionnaire will be administered to patients with cancer (N=865) aged 18 years and above in the catchment area of Hamburg, Germany. Data acquisition includes sociodemographic, medical and psychosocial data as well as information on current smoking patterns. To identify the associations between smoking patterns and sociodemographic characteristics, disease-related variables, and psychological risk factors, descriptive statistics and multiple logistic as well as multinomial regressions will be performed. ETHICS AND DISSEMINATION This study was registered at Open Science Framework (https://doi.org/10.17605/OSF.IO/PGBY8). It was approved by the ethics committee of the local psychological Ethic committee at the centre of psychosocial medicine Hamburg, Germany (LPEK) (tracking number: LPEK-0212). The study will be carried out in accordance with the Code of Ethics of the Declaration of Helsinki. The results will be published in peer-reviewed scientific journals.
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Affiliation(s)
- Frederike Bokemeyer
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- II. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Lebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medical Clinic and Polyclinic, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kathleen Gali
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
| | - Christiane Bleich
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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Are we ready for deintensification in human papillomavirus-positive oropharyngeal carcinomas? Curr Opin Otolaryngol Head Neck Surg 2023; 31:118-128. [PMID: 36912224 DOI: 10.1097/moo.0000000000000871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW Excellent outcomes following contemporary treatment of human papillomavirus (HPV)-positive oropharyngeal carcinoma (HPV+ OPC) have prompted the exploration of deintensification approaches to minimize treatment-related toxicities. This review describes the landscape of deintensification to date (up to November 2022). RECENT FINDINGS Although several deintensification trials have been published, none are practice changing. Three phase III randomized-controlled trials studying cetuximab and radiation therapy vs. standard chemoradiotherapy all showed inferior outcomes. Although some phase II trials reported favourable outcomes, they are often single-arm trials without an adequate control arm, thereby limiting the ability to modify practice. SUMMARY Substantial effort has been expended to explore deintensification options for selected HPV+ OPC patients aiming to avoid unnecessary toxicity. Strategies have included replacing cisplatin with cetuximab, reduced chemotherapy or radiotherapy intensity, reduction of radiotherapy volumes and risk stratification after trans-oral surgery or following induction chemotherapy. Challenges remain in the current deintensification landscape, including identifying the most suitable candidates along with a choice of most appropriate deintensification strategies. Promising selection criteria included either static baseline features or kinetic characteristics of clinical-biological parameters. Practice-changing trials remain elusive, and the search continues to attempt optimization of the therapeutic ratio for these patients.
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15
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McDermott JD, Amini A, Molina E, Stokes WA, Karam SD. Treatment outcomes and cost comparisons for older adults with T4 laryngeal squamous cell cancer. Head Neck 2023; 45:664-674. [PMID: 36563300 PMCID: PMC10626713 DOI: 10.1002/hed.27284] [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: 05/12/2021] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate treatment modalities of T4 larynx cancer in older adults using SEER-Medicare. METHODS The database was queried for patients aged 66 and older with nonmetastatic T4 laryngeal squamous cell cancer from 2006 to 2015. Treatment modalities compared were surgery plus chemoradiation (SCR), surgery plus radiation (SR), chemoradiation (CR), surgery (S), and radiation (R). Multivariate analysis and Kaplan-Meier methods were used to explore the relationship of treatment modality and survival. Total cancer-related costs were calculated. RESULTS A total of 438 patients met inclusion criteria. Patients receiving CR or SR had similar CSS to SCR (HR 1.36 and HR 1.24, respectively). Those receiving S (HR 2.00) or R (HR 2.41) had significantly worse CSS. Similar findings were observed for OS. Cancer care-related costs were not significantly different but highest in SCR ($162215) and lowest in R ($121421). CONCLUSION Older patients with T4 larynx cancer had similar survival rates when treated with CR, SR, and SCR. Average total health care costs were not significantly different between modalities. Patients not eligible for triple-modality could consider these other treatment options.
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Affiliation(s)
- Jessica D McDermott
- Department of Medical Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope, Duarte, California, USA
| | - Elizabeth Molina
- Department of Health Systems, Management, and Policy, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - William A Stokes
- Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Anschutz School of Medicine, Aurora, Colorado, USA
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16
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Haist M, Kaufmann J, Kur IM, Zimmer S, Grabbe S, Schmidberger H, Weigert A, Mayer A. Response to primary chemoradiotherapy of locally advanced oropharyngeal carcinoma is determined by the degree of cytotoxic T cell infiltration within tumor cell aggregates. Front Immunol 2023; 14:1070203. [PMID: 37187729 PMCID: PMC10175951 DOI: 10.3389/fimmu.2023.1070203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Background Effective anti-tumor immune responses are mediated by T cells and require organized, spatially coordinated interactions within the tumor microenvironment (TME). Understanding coordinated T-cell-behavior and deciphering mechanisms of radiotherapy resistance mediated by tumor stem cells will advance risk stratification of oropharyngeal cancer (OPSCC) patients treated with primary chemoradiotherapy (RCTx). Methods To determine the role of CD8 T cells (CTL) and tumor stem cells for response to RCTx, we employed multiplex immunofluorescence stains on pre-treatment biopsy specimens from 86 advanced OPSCC patients and correlated these quantitative data with clinical parameters. Multiplex stains were analyzed at the single-cell level using QuPath and spatial coordination of immune cells within the TME was explored using the R-package Spatstat. Results Our observations demonstrate that a strong CTL-infiltration into the epithelial tumor compartment (HR for overall survival, OS: 0.35; p<0.001) and the expression of PD-L1 on CTL (HR: 0.36; p<0.001) were both associated with a significantly better response and survival upon RCTx. As expected, p16 expression was a strong predictor of improved OS (HR: 0.38; p=0.002) and correlated with overall CTL infiltration (r: 0.358, p<0.001). By contrast, tumor cell proliferative activity, expression of the tumor stem cell marker CD271 and overall CTL infiltration, regardless of the affected compartment, were not associated with response or survival. Conclusion In this study, we could demonstrate the clinical relevance of the spatial organization and the phenotype of CD8 T cells within the TME. In particular, we found that the infiltration of CD8 T cells specifically into the tumor cell compartment was an independent predictive marker for response to chemoradiotherapy, which was strongly associated with p16 expression. Meanwhile, tumor cell proliferation and the expression of stem cell markers showed no independent prognostic effect for patients with primary RCTx and thus requires further study.
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Affiliation(s)
- Maximilian Haist
- Department of Dermatology, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, United States
- Department of Microbiology & Immunology, Stanford University School of Medicine, Stanford, CA, United States
- *Correspondence: Maximilian Haist,
| | - Justus Kaufmann
- Department of Radiation Oncology and Radiotherapy, University Medical Center, Mainz, Germany
| | - Ivan-Maximiliano Kur
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Stefanie Zimmer
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiotherapy, University Medical Center, Mainz, Germany
| | - Andreas Weigert
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, Frankfurt, Germany
| | - Arnulf Mayer
- Institute of Pathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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17
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Chellappan S. Smoking Cessation after Cancer Diagnosis and Enhanced Therapy Response: Mechanisms and Significance. Curr Oncol 2022; 29:9956-9969. [PMID: 36547196 PMCID: PMC9776692 DOI: 10.3390/curroncol29120782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The adverse effects of smoking on human health have been recognized for several decades, especially in the context of cancer. The ability of tobacco smoke components, including tobacco-specific carcinogens and additive compounds such as nicotine, to initiate or promote tumor growth have been described in hundreds of studies. These investigations have revealed the tumor-promoting activities of nicotine and other tobacco smoke components and have also recognized the ability of these agents to suppress the efficacy of cancer therapy; it is now clear that smoking can reduce the efficacy of most of the widely used therapeutic modalities, including immunotherapy, radiation therapy, and chemotherapy. Several studies examined if continued smoking after cancer diagnosis affected therapy response; it was found that while never smokers or non-smokers had the best response to therapy, those who quit smoking at the time of diagnosis had higher overall survival and reduced side-effects than those who continued to smoke. These studies also revealed the multiple mechanisms via which smoking enhances the growth and survival of tumors while suppressing therapy-induced cell death. In conclusion, smoking cessation during the course of cancer therapy markedly increases the chances of survival and the quality of life.
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Affiliation(s)
- Srikumar Chellappan
- Department of Tumor Biology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Drive, Tampa, FL 33612, USA
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18
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Ma SJ, Yu H, Yu B, Waldman O, Khan M, Chatterjee U, Santhosh S, Gill J, Iovoli AJ, Farrugia M, Shevorykin A, Carl E, Wooten K, Gupta V, McSpadden R, Kuriakose MA, Markiewicz MR, Al-Afif A, Hicks WL, Platek ME, Seshadri M, Sheffer C, Warren GW, Singh AK. Association of Pack-Years of Cigarette Smoking With Survival and Tumor Progression Among Patients Treated With Chemoradiation for Head and Neck Cancer. JAMA Netw Open 2022; 5:e2245818. [PMID: 36480200 PMCID: PMC9856262 DOI: 10.1001/jamanetworkopen.2022.45818] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE After 10 pack-years of smoking was initially established as a threshold for risk stratification, subsequent clinical trials incorporated it to identify candidates for treatment deintensification. However, several recent studies were unable to validate this threshold externally, and the threshold for smoking exposure remains unclear. OBJECTIVE To estimate the threshold of pack-years of smoking associated with survival and tumor recurrence among patients with head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS This single-institution, cohort study included patients with nonmetastatic head and neck cancer receiving chemoradiation from January 2005 to April 2021. Data were analyzed from January to April 2022. EXPOSURES Heavy vs light smoking using 22 pack-years as a threshold based on maximizing log-rank test statistic. MAIN OUTCOMES AND MEASURES Overall survival (OS), progression-free survival (PFS), locoregional failure (LRF), and distant failure (DF). RESULTS A total of 518 patients (427 male [82.4%]; median [IQR] age, 61 [55-66] years) were included. Median (IQR) follow-up was 44.1 (22.3-72.8) months. A nonlinear Cox regression model using restricted cubic splines showed continuous worsening of OS and PFS outcomes as pack-years of smoking increased. The threshold of pack-years to estimate OS and PFS was 22. Cox multivariable analysis (MVA) showed that more than 22 pack-years was associated with worse OS (adjusted hazard ratio [aHR] 1.57; 95% CI, 1.11-2.22; P = .01) and PFS (aHR, 1.38; 95% CI, 1.00-1.89; P = .048). On Fine-Gray MVA, heavy smokers were associated with DF (aHR, 1.71; 95% CI, 1.02-2.88; P = .04), but not LRF (aHR, 1.07; 95% CI, 0.61-1.87; P = .82). When 10 pack-years of smoking were used as a threshold, there was no association for OS (aHR, 1.23; 95% CI, 0.83-1.81; P = .30), PFS (aHR, 1.11; 95% CI, 0.78-1.57; P = .56), LRF (aHR, 1.19; 95% CI, 0.64-2.21; P = .58), and DF (aHR, 1.45; 95% CI, 0.82-2.56; P = .20). Current smoking was associated with worse OS and PFS only among human papillomavirus (HPV)-positive tumors (OS: aHR, 2.81; 95% CI, 1.26-6.29; P = .01; PFS: aHR, 2.51; 95% CI, 1.22-5.14; P = .01). CONCLUSIONS AND RELEVANCE In this cohort study of patients treated with definitive chemoradiation, 22 pack-years of smoking was associated with survival and distant metastasis outcomes. Current smoking status was associated with adverse outcomes only among patients with HPV-associated head and neck cancer.
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Affiliation(s)
- Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Han Yu
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Brian Yu
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Olivia Waldman
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Michael Khan
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Udit Chatterjee
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sharon Santhosh
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Jasmin Gill
- University at Buffalo, The State University of New York, Buffalo
| | - Austin J. Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Mark Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kimberly Wooten
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Vishal Gupta
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Ryan McSpadden
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Moni A. Kuriakose
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Michael R. Markiewicz
- Department of Oral and Maxillofacial Surgery, School of Dental Medicine, University at Buffalo, The State University of New York, Buffalo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo
| | - Ayham Al-Afif
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Wesley L. Hicks
- Department of Head and Neck Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Mary E. Platek
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- Department of Nutrition and Dietetics, D’Youville University, Buffalo, New York
| | - Mukund Seshadri
- Department of Oral Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Christine Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Graham W. Warren
- Hollings Cancer Center, Department of Radiation Oncology, Medical University of South Carolina, Charleston
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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19
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Hughes RT, Ip EH, Urbanic JJ, Hu JJ, Weaver KE, Lively MO, Winkfield KM, Shaw EG, Diaz LB, Brown DR, Strasser J, Sears JD, Lesser GJ. Smoking and Radiation-induced Skin Injury: Analysis of a Multiracial, Multiethnic Prospective Clinical Trial. Clin Breast Cancer 2022; 22:762-770. [PMID: 36216768 PMCID: PMC10003823 DOI: 10.1016/j.clbc.2022.09.003] [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: 07/12/2022] [Revised: 08/30/2022] [Accepted: 09/13/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Smoking during breast radiotherapy (RT) may be associated with radiation-induced skin injury (RISI). We aimed to determine if a urinary biomarker of tobacco smoke exposure is associated with increased rates of RISI during and after breast RT. PATIENTS AND METHODS Women with Stage 0-IIIA breast cancer treated with breast-conserving surgery or mastectomy followed by RT to the breast or chest wall with or without regional nodal irradiation were prospectively enrolled on a multicenter study assessing acute/late RISI. 980 patients with urinary cotinine (UCot) measurements (baseline and end-RT) were categorized into three groups. Acute and late RISI was assessed using the ONS Acute Skin Reaction scale and the LENT-SOMA Criteria. RESULTS Late Grade 2+ and Grade 3+ RISI occurred in 18.2% and 1.9% of patients, respectively-primarily fibrosis, pain, edema, and hyperpigmentation. Grade 2+ late RISI was associated with UCot group (P= 006). Multivariable analysis identified UCot-based light smoker/secondhand smoke exposure (HR 1.79, P= .10) and smoking (HR 1.60, p = .06) as non-significantly associated with an increased risk of late RISI. Hypofractionated breast RT was associated with decreased risk of late RISI (HR 0.51, P=.03). UCot was not associated with acute RISI, multivariable analysis identified race, obesity, RT site/fractionation, and bra size to be associated with acute RISI. CONCLUSIONS Tobacco exposure during breast RT may be associated with an increased risk of late RISI without an effect on acute toxicity. Smoking cessation should be encouraged prior to radiotherapy to minimize these and other ill effects of smoking.
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Affiliation(s)
- Ryan T Hughes
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Edward H Ip
- Department of Biostatistics & Data Science, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States; Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - James J Urbanic
- Department of Radiation Medicine and Applied Sciences, UC San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, United States.
| | - Jennifer J Hu
- Department of Public Health Sciences, Sylvester Comprehensive Cancer Center, University of Miami School of Medicine, 1600 NW 10th Ave #1140, Miami, FL 33136.
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | | | - Karen M Winkfield
- Meharry-Vanderbilt Alliance, Vanderbilt University Medical Center, 1005 Dr DB Todd Jr Blvd, Nashville, TN 37208, United States.
| | | | - Luis Baez Diaz
- Puerto Rico Minority Underserved NCI Community Oncology Research Program, 89 De Diego Avenue, PMB #711, Suite 105, San Juan, Puerto Rico 00927.
| | - Doris R Brown
- Department of Radiation Oncology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Jon Strasser
- Helen F Graham Cancer Center, 4701 Ogletown Stanton Rd, Newark, DE 19713, United States.
| | - Judith D Sears
- Piedmont Radiation Oncology, 1010 Bethesda Court, Winston-Salem, NC 27103, United States.
| | - Glenn J Lesser
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest University School of Medicine.
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20
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Fasaludeen A, Kumar RR, Rafi M, Nazeer F, Prakasan AM, Kumar N, George P, Ramadas K, Thommachan KC. Outcomes of organ preservation treatment in advanced laryngeal carcinoma: A retrospective analysis from a single institution. Mol Clin Oncol 2022; 18:1. [PMID: 36545209 PMCID: PMC9756020 DOI: 10.3892/mco.2022.2597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
Abstract
Chemoradiation is the standard treatment for patients with locally advanced laryngeal carcinoma with intact cartilage and functional larynx. The aim of this retrospective study was to assess overall survival (OS) and disease-free survival (DFS) of patients with locally advanced (stage III and stage IV) squamous cell carcinoma of the larynx who have been treated with definitive radical radiotherapy (RT) with or without chemotherapy in a tertiary cancer center in India between January 1, 2006 and December 31, 2015. Data were collected using structured proforma. The patients were treated with RT alone, induction chemotherapy (IC) followed by RT, concurrent chemoradiation therapy (CCRT) or IC followed by CCRT. Response assessment was conducted at 3-4 months post-treatment. Patient-, tumor- and treatment-related factors were documented and were associated with DFS and OS. Survival curves were generated using the Kaplan-Meier method and the statistical significance of survival curves was assessed using the log-rank test. Prognostic factors were assessed using the Cox proportional hazards regression model. A total of 630 patients were included in the present study. The most common age group at presentation was 50-70 years (n=477; 75.7%) and 95.4% (n=601) patients were male. The most common stage at presentation was stage III (n=367, 58.1%). The median follow-up period for the entire group of was 59 months (range, 2-175 months). A complete response after treatment was seen in 549 patients (87.1%). Salvage surgery was performed for 11 patients with residual disease. A total of 134 patients (21.3%) had developed locoregional and distant relapses, and salvage surgery was performed for 31 out of 102 patients with locoregional relapse. The 5-year OS was 48.7% and the 5-year DFS was 45.7%. The stage-wise OS rates were 58.9, 34.9 and 30.4% (P=0.001) and the stage-wise DFS rates were 56.3, 32.0 and 21.7 (P=0.001) for stage III, IVa and IVb, respectively. Results from the present study demonstrated the feasibility of delivery of chemoradiation protocols with good results in a developing country.
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Affiliation(s)
- Afsar Fasaludeen
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Rejnish Ravi Kumar
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Farida Nazeer
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | | | - Naveen Kumar
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Preethi George
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Kunnambath Ramadas
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India
| | - Kainickal Cessal Thommachan
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram 695011, India,Correspondence to: Dr Kainickal Cessal Thommachan, Department of Radiation Oncology, Regional Cancer Centre, Medical College Campus, Thiruvananthapuram 695011, India
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21
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Caini S, Del Riccio M, Vettori V, D'Ecclesiis O, Bonomo P, Locatello LG, Salvestrini V, Gallo O, Tagliabue M, Raimondi S, Saieva C, Cozzolino F, Bendinelli B, Gandini S. Post-diagnosis smoking cessation and survival of patients with head and neck cancer: a systematic review and meta-analysis. Br J Cancer 2022; 127:1907-1915. [PMID: 35999273 PMCID: PMC9681856 DOI: 10.1038/s41416-022-01945-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/22/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Cigarette smoking is the main risk factor for head and neck cancer (HNC) and many HNC patients are active smokers at diagnosis. We conducted a systematic literature review and meta-analysis to quantify the survival impact of smoking cessation at or around the time of HNC diagnosis. We searched studies published until December 31, 2021, and used random-effects meta-analysis to pool study-specific estimates into summary hazard ratio (SHR) and corresponding 95% confidence intervals (CI). Sixteen studies were published between 1983 and 2021, and over 2300 HNC patients were included. Studies were diverse in terms of design, patients, tumours and treatment characteristics, and criteria used to discriminate quitters from continued smokers. HNC patients who quit smoking at or around diagnosis had significantly better overall survival than continued smokers (SHR 0.80, 95% CI 0.70-0.91, n studies = 10). A beneficial effect of post-diagnosis smoking cessation was suggested for other survival endpoints as well, but the results were based on fewer studies (n = 5) and affected by publication bias. Cessation counselling should be offered to all smokers who start a diagnostic workup for HNC and should be considered standard multidisciplinary oncological care for HNC patients. PROSPERO registration number CRD42021245560.
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Affiliation(s)
- Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy.
| | - Marco Del Riccio
- Postgraduate School in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Virginia Vettori
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Oriana D'Ecclesiis
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Careggi University Hospital, Florence, Italy
| | | | | | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marta Tagliabue
- Department of Otolaryngology and Head and Neck Surgery, European Institute of Oncology (IEO), IRCCS, Milan, Italy
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Sara Raimondi
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Calogero Saieva
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Flavia Cozzolino
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Benedetta Bendinelli
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Sara Gandini
- Department of Experimental Oncology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
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22
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Krutz M, Acharya P, Chissoe G, Raj V, Driskill L, Krempl G, Zhao D, Mhawej R, Queimado L. Tobacco cessation after head and neck cancer diagnosis is an independent predictor of treatment response and long-term survival. Oral Oncol 2022; 134:106072. [PMID: 35995005 PMCID: PMC10427030 DOI: 10.1016/j.oraloncology.2022.106072] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 10/31/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) patients who are current smokers when diagnosed have inferior clinical outcomes compared to never-smokers or previous smokers. However, the impact of quitting after HNSCC diagnosis has not been quantified. In this retrospective, case-control study (n = 134), the odds of complete response to first-line therapy were 3.7 times higher among smokers at diagnosis who quit before treatment initiation (quitters; n = 55) than among those continuing to smoke (p = 0.03). Disease-free survival was also higher among quitters (aHR, 0.33; 95 % CI, 0.12-0.90; p = 0.029). Quitters were 67 % less likely to die of all causes than active smokers (aHR, 0.33; 95 % CI, 0.15-0.71; p = 0.004). These data show for the first time that, smoking cessation after HNSCC diagnosis is predictive of higher therapy efficacy and long-term survival.
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Affiliation(s)
- Matthew Krutz
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Pawan Acharya
- Department of Biostatistics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Geraldine Chissoe
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Vijay Raj
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Lane Driskill
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Greg Krempl
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Daniel Zhao
- Department of Biostatistics, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Rachad Mhawej
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Lurdes Queimado
- Department of Otolaryngology Head and Neck Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Cell Biology, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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23
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Schlafstein AJ, Goyal S, Amini A, Karam SD, Saba NF, Kaka AS, Aiken AH, Beitler JJ, Stokes WA. The impact of operability status on outcomes in patients with T4 larynx cancer undergoing larynx preservation. Head Neck 2022; 44:2854-2864. [PMID: 36196859 DOI: 10.1002/hed.27204] [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: 05/27/2022] [Revised: 08/18/2022] [Accepted: 09/09/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Large analyses of T4 larynx cancer (LC) have raised concerns that larynx preservation (LP) contributes to reduced survival compared with laryngectomy (LGX). The role of operability has not been previously considered as a confounder. METHODS We queried the National Cancer Database for T4M0 LC diagnosed 2004-2015. Patients were categorized as undergoing LGX, chemoradiotherapy but operable (LP-operable), and chemoradiotherapy inoperable (LP-inoperable). Overall survival (OS) was estimated by Kaplan-Meier. Cox multivariate analysis (MVA) identified variables associated with OS. RESULTS We identified 1405 LGX, 164 LP-operable and 1969 LP-inoperable patients. Compared with LGX, MVA demonstrated worse OS among LP-inoperable (HR 1.28 95%CI 1.17-1.40, p < 0.01) but not LP-operable patients (HR 1.12 95%CI 0.91-1.39, p = 0.28). CONCLUSIONS LP-operable patients did not have significantly worse OS than those undergoing LGX.
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Affiliation(s)
- Ashley J Schlafstein
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Subir Goyal
- Biostatistics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado school of Medicine, Aurora, Colorado, USA
| | - Nabil F Saba
- Department of Medical Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Azeem S Kaka
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ashley H Aiken
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - William A Stokes
- Department of Radiation Oncology, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia, USA
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Feuer Z, Michael J, Morton E, Matulewicz RS, Sheeran P, Shoenbill K, Goldstein A, Sherman S, Bjurlin MA. Systematic review of smoking relapse rates among cancer survivors who quit at the time of cancer diagnosis. Cancer Epidemiol 2022; 80:102237. [PMID: 35988307 PMCID: PMC10363369 DOI: 10.1016/j.canep.2022.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/30/2022] [Accepted: 08/06/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Tobacco cessation, at the time of cancer diagnosis, has been associated with better oncologic outcomes. Cancer diagnosis has been shown to serves as a "teachable moment," inspiring tobacco cessation. However, the sustainability of abstinence from smoking is understudied. Similarly, there is a paucity of data regarding the utility of behavioral/pharmacologic intervention to support continued smoking cessation. METHODS A systematic literature review was conducted in August 2021 with no date limits. Relevant studies that reported tobacco smoking relapse rates for patients who quit at the time of cancer diagnosis were included. Our literature search identified 1620 articles and 29 met inclusion criteria. The primary endpoint of the study was smoking relapse rate. Secondary outcome was a descriptive assessment of behavioral and pharmacologic interventions to promote continued cessation. Exploratory outcomes included a regression analysis to examine associations between study factors and relapse rates. RESULTS There were 3021 smokers who quit at the time of cancer diagnosis. Weighted overall relapse rate for the study population was 44 % (range 5-57 %). Interventions to support smoking cessation were employed in 17 of the 29 included studies and protocols were heterogenous, including behavioral, pharmacologic, or mixed intervention strategies. Exploratory analysis demonstrated no association between relapse rates and publication year, gender, or study type. Relapse rates were indirectly associated with age (p = .003), suggesting that younger patients were more likely to relapse. CONCLUSION The sustainability of smoking cessation after a cancer diagnosis is understudied, and existing literature is difficult to interpret due to heterogeneity. Relapse rates remain significant and, although many studies have included the employment of an intervention to promote continued cessation, few studies have measured the effect of a protocolized intervention to support abstinence.
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Affiliation(s)
- Zachary Feuer
- Department of Urology, NYU Langone Health, New York, NY, United States
| | - Jamie Michael
- School of Medicine, University of North Carolina at Chapel Hill, NC, United States
| | - Elizabeth Morton
- Health Sciences Library, University of North Carolina at Chapel Hill, NC, United States
| | - Richard S Matulewicz
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, United States; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, United States
| | - Kimberly Shoenbill
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, United States; Department of Family Medicine, University of North Carolina at Chapel Hill, NC, United States; Program on Health and Clinical Informatics, University of North Carolina at Chapel Hill, NC, United States
| | - Adam Goldstein
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, United States; Department of Family Medicine, University of North Carolina at Chapel Hill, NC, United States
| | - Scott Sherman
- Section on Tobacco, Alcohol and Drug Use, Department of Population Health, NYU School of Medicine, New York, NY, United States
| | - Marc A Bjurlin
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, United States; Department of Urology, University of North Carolina at Chapel Hill, NC, United States.
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Kashyap B, Mikkonen JJW, Bhardwaj T, Dekker H, Schulten EAJM, Bloemena E, Kullaa AM. Effect of smoking on MUC1 expression in oral epithelial dysplasia, oral cancer, and irradiated oral epithelium. Arch Oral Biol 2022; 142:105525. [PMID: 36027639 DOI: 10.1016/j.archoralbio.2022.105525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/01/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study was to assess the MUC1 expression in the oral epithelium of normal, oral epithelial dysplasia (OED), oral squamous cell carcinoma (OSCC), and irradiated oral epithelium (IROE) and its association with smoking habits in non-smokers and smokers. DESIGN Oral mucosal biopsies from controls, OED, OSCC, and IROE groups were obtained and categorized based on the smoking history as non-smokers, smoker I (25 pack-years), and smoker II (>25 pack-years). Immunohistochemical staining of MUC1 using human milk fat globule 1 (HMFG 1) antibody was performed, and the MUC1 score was calculated. The relation between MUC1 expression and clinicopathological findings was examined. RESULTS MUC1 staining of superficial oral epithelial cells with mild MUC1 score was detected in all control samples. The MUC1 staining extended from superficial to basal cell layer of oral epithelium with the increase in MUC1 score from moderate to strong in OED, OSCC, and IROE, and the difference was significant (p < 0.004, p < 0.002 and p < 0.004, respectively) compared to controls. A positive association between smoking and MUC1 score was observed within groups (p < 0.05). CONCLUSION The depolarization of MUC1 protein expression is associated with smoking habits in OED and OSCC. In the IROE, the radiation causes subcellular and molecular changes, observed as altered MUC1 expression and accelerated by smoking, furthermore, complicating the oral mucosal adaptation and progress to radiation-induced lesions as a delayed effect.
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Affiliation(s)
- Bina Kashyap
- Institute of Dentistry, University of Eastern Finland, Kuopio campus, Kuopio P.O. Box 1627, Kuopio 70211, Finland.
| | - Jopi J W Mikkonen
- Institute of Dentistry, University of Eastern Finland, Kuopio campus, Kuopio P.O. Box 1627, Kuopio 70211, Finland.
| | - Tulika Bhardwaj
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio campus, P.O. Box 1627, Kuopio 70211, Finland.
| | - Hannah Dekker
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Engelbert A J M Schulten
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Elisabeth Bloemena
- Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Oral Pathology, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Arja M Kullaa
- Institute of Dentistry, University of Eastern Finland, Kuopio campus, Kuopio P.O. Box 1627, Kuopio 70211, Finland.
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26
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Taniguchi C, Narisada A, Tanaka H, Iida H, Iida M, Mori R, Nakayama A, Suzuki K. Smoking cessation after cancer diagnosis reduces the risk of severe cancer pain: A longitudinal cohort study. PLoS One 2022; 17:e0272779. [PMID: 35944029 PMCID: PMC9362951 DOI: 10.1371/journal.pone.0272779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022] Open
Abstract
Background Whether abstinence from smoking among cancer patients reduces cancer pain is still unclear. Opioids can act as a surrogate index for evaluating the incidence of severe cancer pain in countries where opioid abuse is infrequent. This study aimed to investigate whether changed smoking behavior after cancer diagnosis influences the incidence of severe cancer pain as determined by strong opioid use. Methods Using a large Japanese insurance claims database (n = 4,797,329), we selected 794,702 insured employees whose annual health checkup data could be confirmed ≥6 times between January 2009 and December 2018. We selected 591 study subjects from 3,256 employees who were diagnosed with cancer pain and had health checkup data at the year of cancer pain diagnosis. Results A significantly greater proportion of patients who continued smoking after cancer diagnosis (“current smoker”, n = 133) received strong opioids (36.8%) compared with patients who had never smoked or had stopped before cancer diagnosis (“non-smoker”, n = 383, 20.6%; p<0.05) but also compared with patients who had quit smoking after cancer diagnosis (“abstainer:”, n = 75, 24.0%; p<0.05). In multivariable Cox proportional hazards regression analysis, abstainers had a significantly lower risk of receiving strong opioids than current smokers (hazard ratio: 0.57, 95% CI: 0.328 to 0.997). These findings were consistent across multiple sensitivity analyses. Conclusion Our study demonstrated that patients who quit smoking after cancer diagnosis have a lower risk of severe cancer pain. This information adds clinical incentives for improving quality of life among those who smoked at the time of cancer diagnosis.
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Affiliation(s)
- Chie Taniguchi
- College of Nursing, Aichi Medical University, Nagakute, Aichi, Japan
- * E-mail:
| | - Akihiko Narisada
- Institute for Occupational Health Science, Aichi Medical University, Nagakute, Aichi, Japan
| | - Hideo Tanaka
- Public Health Center of Neyagawa City, Neyagawa, Osaka, Japan
- Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Hiroki Iida
- Department of Anesthesiology and Pain Medicine, Central Japan International Medical Center, Minokamo, Gifu, Japan
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center, Gifu, Gifu, Japan
| | - Rina Mori
- College of Nursing, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ayako Nakayama
- College of Nursing, Aichi Medical University, Nagakute, Aichi, Japan
| | - Kohta Suzuki
- Institute for Occupational Health Science, Aichi Medical University, Nagakute, Aichi, Japan
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
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27
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Schostag K, Lynch P, Leavitt T, Sumer B, Yang A, Shah A, Emmet T, Sher DJ, Day AT. Smoking and other patient factors in HPV-mediated oropharynx cancer: A retrospective cohort study. Am J Otolaryngol 2022; 43:103555. [DOI: 10.1016/j.amjoto.2022.103555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 11/01/2022]
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Clinical impact of cigarette smoking on the outcomes of allogeneic hematopoietic stem cell transplantation: a multicenter retrospective study. Bone Marrow Transplant 2022; 57:1124-1132. [PMID: 35505096 DOI: 10.1038/s41409-022-01678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/28/2022] [Accepted: 04/05/2022] [Indexed: 11/08/2022]
Abstract
Smoking is associated with a high risk for different diseases including respiratory tract infections in immunocompetent patients. However, data about the effects of cigarette smoking on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are limited. Therefore, we retrospectively investigated 608 patients aged ≥20 years with hematological disorders who received their first allo-HSCT at our group of hospitals between 2000 and 2015, and evaluated the impact of cigarette smoking before allo-HSCT on clinical outcomes by dividing patients into two groups according to the Brinkman index (BI) (nonsmokers or light smokers [BI: 0-500] and heavy smokers [BI: ≥ 500]). Multivariate analyses showed that heavy smoking was associated with a high 5-year cumulative incidence of chronic graft-versus-host disease (cGVHD) (hazard ratio [HR]: 1.73, 95% confidence interval [CI]: 1.15-2.61, p < 0.01). The 5-year overall survival (HR: 1.16, 95% CI: 0.86-1.58, p = 0.33) and disease-free survival (HR: 1.12, 95% CI: 0.83-1.52, p = 0.45) were similar between the two groups. Hence, cigarette smoking is correlated with cGVHD, although prospective studies must be conducted to further verify this result.
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29
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François C, Maud V, Frederique B, Alison J, Solem Laviec H, Audrey R. Impact of Early Supportive Care Assessment on treatment decision in head and neck cancer before concomitant chemoradiotherapy. Support Care Cancer 2022; 30:6545-6553. [PMID: 35477810 DOI: 10.1007/s00520-022-07078-3] [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: 02/09/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the impact of a global pretherapeutic comprehensive supportive care assessment performed in an outpatient supportive care clinic (OSCC) and early supportive care interventions on oncological treatment choice in patients with chemoradiation (CRT) indication for head and neck cancer (HNC). METHODS In this monocentric prospective observational study, we included all patients considered for CRT (exclusive or post-operative) for HNC from February 2019 to March 2020. The following frailty indicators were assessed: comorbidities (Charlson index), nutritional status, altered functional ability (ADL and IADL), social precarity (EPICES score), cognitive impairment (MoCA score), addictive habits and pain. RESULTS OSCC led to a change in treatment for 13.7% of patients, mainly de-escalations. Ninety-three percent of patients had at least one altered domain, including 50% with three or more altered domains. Cognitive function was the most frequently altered domain (66.7%). Altered functional ability was significantly associated with treatment de-escalation after OSCC. Treatment interruptions were significantly associated with treatment de-escalation and social precarity. De-escalation was also associated with a significantly poorer PFS (median of 23.2 mos. vs 8.8 mos., HR = 2.18 95%IC[1.02-4.63] p = 0.037)) and a non-significant trend towards worse OS (median 23.3mos. vs not reached (HR = 2.16 95%CI[0.88-5.31] p = 0.0836). CONCLUSION We strongly encourage the creation of OSCC for patients treated with chemoradiation for HNC. This practice, through an exhaustive assessment, favours therapeutic adaptation, personalized follow-up and optimization of supportive care.
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Affiliation(s)
- Cherifi François
- Medical Oncology Department, Centre François Baclesse, Caen, France.
| | - Villemin Maud
- Medical Oncology Department, Centre François Baclesse, Caen, France.,Medical Oncology Department, Centre Hospitalier Memorial, Saint-Lô, France
| | - Bisiaux Frederique
- Supportive Care Department, Centre François Baclesse, Baclesse, Caen, France
| | - Johnson Alison
- Medical Oncology Department, Centre Hospitalier Memorial, Saint-Lô, France
| | - Heidi Solem Laviec
- Supportive Care Department, Centre François Baclesse, Baclesse, Caen, France
| | - Rambeau Audrey
- Medical Oncology Department, Centre Hospitalier Memorial, Saint-Lô, France.,Supportive Care Department, Centre François Baclesse, Baclesse, Caen, France
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30
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Smoking-, Alcohol-, and Age-Related Alterations of Blood Monocyte Subsets and Circulating CD4/CD8 T Cells in Head and Neck Cancer. BIOLOGY 2022; 11:biology11050658. [PMID: 35625386 PMCID: PMC9138171 DOI: 10.3390/biology11050658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
Head and neck squamous cell carcinoma (HNSCC) represents a heterogeneous malignant disease of the oral cavity, pharynx, and larynx. Although cigarette smoking, alcohol abuse, and aging are well-established associated factors for HNSCC, their respective influence on immunologic alterations of monocyte subsets or T-cell compositions in the peripheral blood has not yet been fully unveiled. Using flow cytometry, whole blood measurements of CD14/CD16 monocyte subsets and analyses of T-cell subsets in isolated PBMC fractions were carried out in 64 HNSCC patients in view of their tobacco and alcohol consumption, as well as their age, in comparison to healthy volunteers. Flow cytometric analysis revealed significantly increased expression of monocytic CD11b, as well as significantly decreased expression levels of CX3CR1 on classical and intermediate monocyte subsets in smoking-related and in alcohol-related HNSCC patients compared to healthy donors. Peripheral monocytes revealed an age-correlated significant decrease in PD-L1 within the entirety of the HNSCC cohort. Furthermore, we observed significantly decreased abundances of CD8+ effector memory T cells in active-smoking HNSCC patients and significantly increased percentages of CD8+ effector T cells in alcohol-abusing patients compared to the non-smoking/non-drinking patient cohort. Our data indicate an enhanced influence of smoking and alcohol abuse on the dynamics and characteristics of circulating monocyte subsets and CD4/CD8 T-cell subset proportions, as well as an age-related weakened immunosuppression in head and neck cancer patients.
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31
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Di Meglio A, Havas J, Gbenou AS, Martin E, El-Mouhebb M, Pistilli B, Menvielle G, Dumas A, Everhard S, Martin AL, Cottu PH, Lerebours F, Coutant C, Lesur A, Tredan O, Soulie P, Vanlemmens L, Joly F, Delaloge S, Ganz PA, André F, Partridge AH, Jones LW, Michiels S, Vaz-Luis I. Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy. J Clin Oncol 2022; 40:3190-3204. [PMID: 35446677 PMCID: PMC9509127 DOI: 10.1200/jco.21.00277] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors.
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Affiliation(s)
- Antonio Di Meglio
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Julie Havas
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Arnauld S Gbenou
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Elise Martin
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Mayssam El-Mouhebb
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Barbara Pistilli
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Agnes Dumas
- Université de Paris, ECEVE UMR 1123, INSERM, Paris, France
| | | | | | | | | | | | - Anne Lesur
- Institut de Cancérologie de Lorraine, Nancy, France
| | | | | | | | | | | | | | - Fabrice André
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | | | - Lee W Jones
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Oncostat Inserm U1018, Université Paris- Saclay, Equipe labellisée Ligue Contre le Cancer, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Medical Oncology, Gustave Roussy, Villejuif, France.,INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
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32
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Hong JH, Tong ZJ, Wei TE, Lu YC, Huang CY, Huang CY, Chiang CH, Jaw FS, Cheng HW, Wang HT. Cigarette smoke containing acrolein contributes to cisplatin resistance in human bladder cancers through the regulation of HER2 pathway or FGFR3 pathway. Mol Cancer Ther 2022; 21:1010-1019. [PMID: 35312783 DOI: 10.1158/1535-7163.mct-21-0725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/03/2021] [Accepted: 03/11/2022] [Indexed: 11/16/2022]
Abstract
Cisplatin-based chemotherapy is the first-line therapy for bladder cancer (BC). However, cisplatin resistance has been associated with the recurrence of BC. Previous studies have shown that activation of fibroblast growth factor receptor (FGFR) and HER2 signaling are involved in BC cell proliferation and drug resistance. Smoking is the most common etiologic risk factor for BC, and there is emerging evidence that smoking is associated with cisplatin resistance. However, the underlying mechanism remains elusive. Acrolein, a highly reactive aldehyde, is abundant in tobacco smoke, cooking fumes, and automobile exhaust fumes. Our previous studies have shown that acrolein contributes to bladder carcinogenesis through the induction of DNA damage and inhibition of DNA repair. In this study, we found that acrolein induced cisplatin resistance and tumor progression in both non-muscle invasive BC (NMIBC) and muscle invasive BC (MIBC) cell lines RT4 and T24, respectively. Activation of HER2 and FGFR3 signaling contributes to acrolein-induced cisplatin resistance in RT4 and T24 cells, respectively. Furthermore, trastuzumab, an anti-HER2 antibody, and PD173074, a FGFR inhibitor, reversed cisplatin resistance in RT4 and T24 cells, respectively. Using a xenograft mouse model with acrolein-induced cisplatin-resistant T24 clones, we found that cisplatin combined with PD173074 significantly reduced tumor size compared to cisplatin alone. These results indicate that differential molecular alterations behind cisplatin resistance in NMIBC and MIBC significantly alter the effectiveness of targeted therapy combined with chemotherapy. This study provides valuable insights into therapeutic strategies for cisplatin-resistant bladder cancer.
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Affiliation(s)
- Jian-Hua Hong
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, Taipei City, Taiwan
| | - Zhen-Jie Tong
- National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tung-En Wei
- National Yang Ming Chiao Tung University, Taiwan
| | - Yu-Chuan Lu
- National Taiwan University Hospital, Taipei City, Taiwan
| | | | | | | | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, Taipei, Taiwan
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33
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Goyal N, Day A, Epstein J, Goodman J, Graboyes E, Jalisi S, Kiess AP, Ku JA, Miller MC, Panwar A, Patel VA, Sacco A, Sandulache V, Williams AM, Deschler D, Farwell DG, Nathan C, Fakhry C, Agrawal N. Head and neck cancer survivorship consensus statement from the American Head and Neck Society. Laryngoscope Investig Otolaryngol 2022; 7:70-92. [PMID: 35155786 PMCID: PMC8823162 DOI: 10.1002/lio2.702] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2021] [Accepted: 11/10/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To provide a consensus statement describing best practices and evidence regarding head and neck cancer survivorship. METHODS Key topics regarding head and neck cancer survivorship were identified by the multidisciplinary membership of the American Head and Neck Society Survivorship, Supportive Care & Rehabilitation Service. Guidelines were generated by combining expert opinion and a review of the literature and categorized by level of evidence. RESULTS Several areas regarding survivorship including dysphonia, dysphagia, fatigue, chronic pain, intimacy, the ability to return to work, financial toxicity, lymphedema, psycho-oncology, physical activity, and substance abuse were identified and discussed. Additionally, the group identified and described the role of key clinicians in survivorship including surgical, medical and radiation oncologists; dentists; primary care physicians; psychotherapists; as well as physical, occupational, speech, and respiratory therapists. CONCLUSION Head and neck cancer survivorship is complex and requires a multidisciplinary approach centered around patients and their caregivers. As survival related to head and neck cancer treatment improves, addressing post-treatment concerns appropriately is critically important to our patient's quality of life. There continues to be a need to define effective and efficient programs that can coordinate this multidisciplinary effort toward survivorship.
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Affiliation(s)
- Neerav Goyal
- Department of Otolaryngology—Head and Neck SurgeryThe Pennsylvania State University, College of MedicineHersheyPennsylvaniaUSA
| | - Andrew Day
- Department of Otolaryngology—Head and Neck SurgeryUniversity of Texas Southwestern Medical CenterDallasTexasUSA
| | - Joel Epstein
- Department of SurgeryCedars SinaiLos AngelesCaliforniaUSA
- City of HopeCaliforniaDuarteUSA
| | - Joseph Goodman
- Ear, Nose and Throat CenterGeorge Washington UniversityWashingtonDistrict of ColumbiaUSA
| | - Evan Graboyes
- Department of Otolaryngology—Head and Neck SurgeryMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Scharukh Jalisi
- Department of OtolaryngologyBeth Israel DeaconessBostonMassachusettsUSA
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins MedicineBaltimoreMarylandUSA
| | - Jamie A. Ku
- Head and Neck InstituteCleveland ClinicClevelandOhioUSA
| | - Matthew C. Miller
- Department of OtolaryngologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
| | - Aru Panwar
- Department of Head and Neck Surgical Oncology, Methodist Estabrook Cancer CenterNebraska Methodist HospitalOmahaNebraskaUSA
| | - Vijay A. Patel
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Assuntina Sacco
- Department of Medical OncologyUniversity of California San DiegoLa JollaCaliforniaUSA
| | - Vlad Sandulache
- Department of Otolaryngology—Head and Neck SurgeryBaylor College of MedicineHoustonTexasUSA
| | - Amy M. Williams
- Department of Otolaryngology—Head and Neck SurgeryHenry Ford Health SystemDetroitMichiganUSA
| | - Daniel Deschler
- Department of Otolaryngology–Head and Neck SurgeryMassachusetts Eye and EarBostonMassachusettsUSA
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California DavisDavisCaliforniaUSA
| | - Cherie‐Ann Nathan
- Department of Otolaryngology—Head and Neck SurgeryLouisiana State UniversityShreveportLouisianaUSA
| | - Carole Fakhry
- Department of Otolaryngology—Head and Neck SurgeryJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Nishant Agrawal
- Department of Surgery, Section of Otolaryngology—Head and Neck SurgeryUniversity of Chicago Pritzker School of MedicineChicagoIllinoisUSA
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Pilar A, O’Sullivan B, Huang SH. Risk Stratification of HPV-Associated Oropharyngeal Squamous Cell Carcinoma: Are All Tumors Created Equally? CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-021-00382-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kachhwaha A, Jakhar SL, Syiem T, Sharma N, Kumar HS, Sharma A. Hypofractionated radiotherapy versus conventional radiotherapy in early glottic cancer T1-2N0M0: A randomized study. J Cancer Res Ther 2021; 17:1499-1502. [PMID: 34916384 DOI: 10.4103/jcrt.jcrt_867_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective Glottic cancer has an excellent probability of cure. The early glottic cancer is usually treated by radiotherapy with different fractionation schedules. The aim of this study was to compare conventional versus hypofractionated radiotherapy with respect to overall survival and disease-free survival. Materials and Methods A total of fifty patients with T1-2N0M0 glottic cancer with no previous treatment history were prospectively randomized into two arms. In Arm A (Study), patients received a total of 55 Gy in 20# at 2.75 Gy/#, 5 days a week. In Arm B (Control), patients received a total of 66 Gy in 33# at 2 Gy/#, 5 days a week. Disease response was evaluated by the WHO criteria at the end of treatment, then at 1, 2, and 3 months to complete their 6-month follow-up. Overall survival and disease-free survival were evaluated at 1, 2, and 3 years. Results Overall, 100% of patients in the study arm and 96% of patients in the control arm had complete response after 6 months. Overall survival rates at 1, 2, and 3 years were 96%, 96%, and 88%, respectively, in the study arm, while in the control arm, these values were 92%, 84%, and 80%, respectively, and the difference was not statistically significant (P > 0.05). Disease-free survival at 3 years was 88% in the study arm and 80% in the control arm. Conclusion The study suggests that hypofractionated regimen may be better in local control and symptomatic relief with the added advantage of shorter treatment time, which offers better patient compliance and advantageous in busy setups where there is heavy patient load.
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Affiliation(s)
- Avni Kachhwaha
- Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, S. P. Medical College, Bikaner, Rajasthan, India
| | - Shankar Lal Jakhar
- Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, S. P. Medical College, Bikaner, Rajasthan, India
| | - Tanya Syiem
- Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, S. P. Medical College, Bikaner, Rajasthan, India
| | - Neeti Sharma
- Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, S. P. Medical College, Bikaner, Rajasthan, India
| | - Harvinder Singh Kumar
- Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, S. P. Medical College, Bikaner, Rajasthan, India
| | - Ajay Sharma
- Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, Bikaner, Rajasthan, India
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Survival Impact of Current-Smoking-Related COPD or COPD with Acute Exacerbation on Bladder Preservation through Concurrent Chemoradiotherapy for Muscle-Invasive Bladder Urothelial Carcinoma. J Pers Med 2021; 11:jpm11100958. [PMID: 34683099 PMCID: PMC8539205 DOI: 10.3390/jpm11100958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE: The survival effect of smoking-related chronic obstructive pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) on patients with muscle-invasive bladder urothelial carcinoma (MIBUC) receiving concurrent chemoradiotherapy (CCRT) for bladder preservation is unclear. METHODS: We recruited patients with MIBUC, clinical stages IIA-IVB, who had received maximal transurethral resection of bladder tumor (TURBT) followed by CCRT from the Taiwan Cancer Registry Database. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into two groups by using propensity score matching based on the preexisting COPD status (within 1 year before CCRT) to compare overall survival outcomes: Group 1 (never smokers without COPD) and Group 2 (current smokers with COPD). RESULTS: In multivariate Cox regression analyses, the adjusted hazard ratio (aHR; 95% confidence interval (CI)) of all-cause mortality in Group 2 compared with Group 1 was 1.89 (1.12-3.18), p = 0.017. The aHRs (95% CIs) of all-cause mortality for ≥1 and ≥2 hospitalizations for COPDAE within 1 year before CCRT for bladder preservation were 3.26 (1.95-5.46) and 6.33 (3.55-11.281) compared with non-COPDAE patients with MIBUC undergoing CCRT for bladder preservation. CONCLUSIONS: Among patients with MIBUC undergoing TURBT followed by CCRT for bladder preservation, current smokers with smoking-related COPD had worse survival outcomes than did nonsmokers without COPD. CONDENSED ABSTRACT: This was the first study to estimate the survival impact of smoking-related chronic obstructive pulmonary disease (COPD) on patients with muscle-invasive bladder urothelial carcinoma (MIBUC) receiving maximal transurethral resection of bladder tumor (TURBT) followed by concurrent chemoradiotherapy (CCRT) for bladder preservation. Smoking-related COPD was a significant independent risk factor for all-cause mortality in patients with clinical stages IIA-IVB receiving TURBT followed by CCRT. Hospitalization frequency for COPD with at least one acute exacerbation within 1 year before CCRT was highly associated with high mortality for patients with MIBUC receiving CCRT for bladder preservation. Not only all-cause death but also bladder cancer death and COPD death were significantly higher in the current-smoking COPD group than in the never-smoking non-COPD group.
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Twenty-year experience with salvage total laryngectomy: lessons learned. The Journal of Laryngology & Otology 2021; 135:729-736. [PMID: 34219631 DOI: 10.1017/s0022215121001687] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the outcome of salvage total laryngectomy and identify areas for further improvement. METHOD A retrospective analysis of all patients who underwent salvage total laryngectomy between January 1999 and December 2018 was performed. RESULTS Thirty-one patients were identified. The most common primary tumour site was the glottis (83.8 per cent). Early stage (T1-T2) disease was identified in 83.9 per cent of cases. Overall survival at 2 and 5 years post-salvage total laryngectomy was 71 per cent and 45 per cent, respectively. Disease-free survival at 2 and 5 years post-salvage total laryngectomy was 65 per cent and 42 per cent, respectively. The rate of post-salvage total laryngectomy pharyngocutaneous fistula was 29 per cent. CONCLUSION More than half of patients will not survive beyond five years after salvage total laryngectomy. Regional recurrence was the most common form of failure and death. From this study, elective lateral and central neck dissection is advocated in patients with early laryngeal cancer who present with an advanced recurrence.
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Rojewski AM, Fucito LM, Baker NL, Palmer AM, Foster MG, Warren GW, Bernstein SL, Toll BA. Preoperative contingency management intervention for smoking abstinence in cancer patients: trial protocol for a multisite randomised controlled trial. BMJ Open 2021; 11:e051226. [PMID: 34187835 PMCID: PMC8245459 DOI: 10.1136/bmjopen-2021-051226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Continued smoking following a cancer diagnosis has substantial health risks including increased overall and cancer-specific mortality, risk of secondary malignancies, cancer treatment toxicity and risk of surgical complications. These risks can be mitigated by quitting smoking. The preoperative period represents a prime opportunity in which to administer robust smoking cessation treatment to both improve health and support and improve surgical outcomes. We will conduct a randomised clinical trial to evaluate the effectiveness of financial incentives delivered contingent on biochemically verified smoking abstinence (contingency management (CM)) in patients with cancer undergoing surgery. METHODS AND ANALYSIS The study will take place across two study sites, and participants (N=282) who smoke, are diagnosed with or suspected to have any type of operable cancer and have a surgical procedure scheduled in the next 10 days to 5 weeks will be randomised to receive standard care plus Monitoring Only or CM prior to surgery. All patients will receive breath carbon monoxide (CO) tests three times per week, nicotine replacement therapy and counselling. The CM group will also earn payments for self-reported smoking abstinence confirmed by CO breath test ≤4 ppm on an escalating schedule of reinforcement (with a reset if they smoked). Point prevalence abstinence (PPA) outcomes (self-report of 7-day abstinence confirmed by CO≤4 ppm and/or anabasine ≤2 ng/mL) will be assessed on the day of surgery and 6 months after surgery. The effect of CM on 7-day PPA at the time of surgery and 6-month follow-up will be modelled using generalised linear mixed effects models. ETHICS AND DISSEMINATION This study has been reviewed and approved by the Medical University of South Carolina Institutional Review Board. We will disseminate our scientific results through traditional research-oriented outlets such as presentations at scientific meetings and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04605458.
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Affiliation(s)
- Alana M Rojewski
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
| | - Lisa M Fucito
- Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Nathaniel L Baker
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Amanda M Palmer
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Pulmonary, Critical Care, Allergy, and Sleep Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Madeline G Foster
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Graham W Warren
- Hollings Cancer Center, Charleston, South Carolina, USA
- Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Steven L Bernstein
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Benjamin A Toll
- Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
- Hollings Cancer Center, Charleston, South Carolina, USA
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
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Fazel A, Quabius ES, Fabian A, Gonzales Donate M, Schleicher T, Kress K, Laudien M, Huber K, Hoffmann M. [The impact of smoking habit alteration on prognosis of head and neck cancer patients]. Laryngorhinootologie 2021; 100:634-643. [PMID: 34139775 DOI: 10.1055/a-1509-8851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The influence of smoking on survival in patients with HNSCC is well documented in the literature. There is little data on changes in smoking habits after diagnosis. Here, the effect on survival of the reduction of smoking compared to full smoking cessation is investigated. PATIENTS AND METHODS Patient records and tumor documentation of 643 consecutive HNSCC cases of the Head and Neck Tumor Center of the University Hospital Kiel are evaluated retrospectively: smoking habits before and after treatment and survival are evaluated. RESULTS Change in smoking behavior at the initial diagnosis of HNSCC leads to a significant positive effect on the prognosis compared to continued smoking. There is no difference between smoke reduction and weaning. This effect is based solely on those patients who are treated exclusively by surgery. Lifelong non-smokers have a significant survival advantage over active and ex-smokers, with no difference between the latter two groups. CONCLUSIONS The positive influence of changed smoking habits on the prognosis runs parallel to the negative direct effect of active smoking on therapy, which is attributed to peritumoral hypoxia with a negative effect on the effectiveness of R(C)T. The positive effect of the change in smoking behaviour during surgery alone is most likely due to reduced peri-operative complications. Patients should be encouraged to at least minimize smoking with the cancer diagnosis. In addition, former smokers should be considered active smokers for survival estimates and therapy planning.
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Affiliation(s)
- Asita Fazel
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Alexander Fabian
- Klinik für Strahlentherapie, Christian-Albrechts-Universität zu Kiel, Germany
| | - Mireia Gonzales Donate
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Thilo Schleicher
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Konstantin Kress
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Martin Laudien
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karen Huber
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Markus Hoffmann
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Bhat GR, Hyole RG, Li J. Head and neck cancer: Current challenges and future perspectives. Adv Cancer Res 2021; 152:67-102. [PMID: 34353444 DOI: 10.1016/bs.acr.2021.05.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Head and neck cancers are a heterogeneous, aggressive and genetically complex collection of malignancies of the oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, paranasal sinuses and salivary glands, which are difficult to treat. About 90% of all head and neck cancers are squamous cell carcinomas (HNSCC). Larynx and Oral cavity carcinomas are generally related with tobacco consumption, alcohol abuse (or both), but pharynx carcinomas are generally associated with infection of human papillomavirus (HPV), especially HPV-16 subtype. Thus, usually HNSCC can be separated into HPV-negative and HPV-positive categories. Despite substantial efforts invested into therapeutic development of HNSCC, the 5-year survival rate of patients with HNSCC still remains dismal. The primary reason being late diagnosis, recurrent metastasis, relapse and resistance to therapies. Currently surgery and radiotherapy represent the baseline treatment options for most initial stage HNSCC patients, but these treatments are associated with significant morbidity and poor prognosis. Moreover, the issue of resistance to both radiotherapy/chemotherapy and recurrent relapse are common in HNSCC. Elucidation of the genetic landscape, tumor microenvironment and aberrant signaling pathways have generated new insights into the molecular pathogenesis of this disease. Thus, the scientific research has therefore been focused on the understanding of HNSCC biology and immunobiology to identification of predictive/prognostic biomarkers, which will be key to develop more effective targeted therapies with less toxicity and high specificity.
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Affiliation(s)
- Gh Rasool Bhat
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, United States
| | - Rosalie G Hyole
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, United States
| | - Jiong Li
- Department of Medicinal Chemistry, School of Pharmacy, Virginia Commonwealth University, Richmond, VA, United States; Institute for Structural Biology, Drug Discovery and Development, Virginia Commonwealth University, Richmond, VA, United States; Massey Cancer Center, Virginia Commonwealth University, Richmond, VA, United States; Department of Oral and Craniofacial Molecular Biology, School of Dentistry, Virginia Commonwealth University, Richmond, VA, United States; Philips Institute for Oral Health Research, Virginia Commonwealth University, Richmond, VA, United States.
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Magnes T, Wagner S, Kiem D, Weiss L, Rinnerthaler G, Greil R, Melchardt T. Prognostic and Predictive Factors in Advanced Head and Neck Squamous Cell Carcinoma. Int J Mol Sci 2021; 22:4981. [PMID: 34067112 PMCID: PMC8125786 DOI: 10.3390/ijms22094981] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/11/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a heterogeneous disease arising from the mucosa of the upper aerodigestive tract. Despite multimodality treatments approximately half of all patients with locally advanced disease relapse and the prognosis of patients with recurrent or metastatic HNSCC is dismal. The introduction of checkpoint inhibitors improved the treatment options for these patients and pembrolizumab alone or in combination with a platinum and fluorouracil is now the standard of care for first-line therapy. However, approximately only one third of unselected patients respond to this combination and the response rate to checkpoint inhibitors alone is even lower. This shows that there is an urgent need to improve prognostication and prediction of treatment benefits in patients with HNSCC. In this review, we summarize the most relevant risk factors in the field and discuss their roles and limitations. The human papilloma virus (HPV) status for patients with oropharyngeal cancer and the combined positive score are the only biomarkers consistently used in clinical routine. Other factors, such as the tumor mutational burden and the immune microenvironment have been highly studied and are promising but need validation in prospective trials.
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Affiliation(s)
- Teresa Magnes
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
| | - Sandro Wagner
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
| | - Dominik Kiem
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
| | - Lukas Weiss
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
| | - Gabriel Rinnerthaler
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
| | - Richard Greil
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
- Cancer Cluster Salzburg, 5020 Salzburg, Austria
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
| | - Thomas Melchardt
- Oncologic Center, Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Paracelsus Medical University, 5020 Salzburg, Austria; (T.M.); (S.W.); (D.K.); (L.W.); (G.R.); (R.G.)
- Salzburg Cancer Research Institute-Laboratory for Immunological and Molecular Cancer Research (SCRI-LIMCR), 5020 Salzburg, Austria
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Tatekawa S, Shimamoto S, Miyata Y, Yoshino Y, Hirata T, Tamari K, Seo Y, Isohashi F, Yamamoto Y, Uno A, Inohara H, Ogawa K. Monitoring expiratory carbon monoxide to study the effect of complete smoking cessation on definitive radiation therapy for early stage glottic carcinoma. Acta Oncol 2021; 60:582-588. [PMID: 33406970 DOI: 10.1080/0284186x.2020.1865563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies reported that cigarette smoking during radiation therapy was associated with unfavorable outcomes in various cancers using medical interviewing or monitoring of cotinine. Here, we evaluated the effect of smoking cessation on definitive radiation therapy for early stage glottic carcinoma by monitoring expiratory carbon monoxide (CO). MATERIAL AND METHODS We enrolled 103 patients with early glottic carcinoma (T1N0/T2N0 = 79/24) who underwent conventional radiotherapy between 2005 and 2016. The median age was 70 years. Pathologically, all patients had squamous cell carcinoma. Since 2009, we confirmed smoking cessation before radiation therapy by medical interviews. Since 2014, we measured expiratory CO to strictly monitor smoking cessation. The patients were divided according to diagnosis years: 'no cessation' (2005-2008), 'incomplete cessation' (2009-2013), and 'complete cessation' (2014-2016). We retrospectively analyzed the local recurrence rate and disease-free survival (DFS). RESULTS The median follow-up period was 60.1 months (range, 1.9-110.0 months). The 2-year local recurrence rate in the 'complete cessation' group was 5.3% and tended to be lower than that in the 'incomplete cessation' group (13.7%) and 'no cessation' group (21.2%). Multivariate analysis revealed that 'no cessation' was a risk factor for DFS (hazard ratio [HR] = 4.25) and local recurrence rate (HR = 16.5, p < .05) compared to 'complete cessation.' DISCUSSION We confirmed that the 'complete cessation' group had better prognosis than the 'no cessation' group by monitoring expiratory CO during radiation therapy for early stage glottic carcinoma. Moreover, monitoring expiratory CO was easier and more suitable than conventional methods for evaluating smoking cessation because it provided real-time measurements.
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Affiliation(s)
- Shotaro Tatekawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Radiation Oncology, Osaka General Medical Center, Osaka, Japan
| | | | - Yoshiaki Miyata
- Department of Radiation Oncology, Saito Yukoukai Hospital, Osaka, Japan
| | - Yutaro Yoshino
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takero Hirata
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Tamari
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yoshifumi Yamamoto
- Department of Otorhinolaryngology-Head and Neck surgery, Osaka General Medical Center, Osaka, Japan
| | - Atsuhiko Uno
- Department of Otorhinolaryngology-Head and Neck surgery, Osaka General Medical Center, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
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20 pack-year smoking history as strongest smoking metric predictive of HPV-positive oropharyngeal cancer outcomes. Am J Otolaryngol 2021; 42:102915. [PMID: 33482566 DOI: 10.1016/j.amjoto.2021.102915] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES While smoking is associated with worse outcomes in HPV-positive oropharyngeal squamous cell carcinoma (OPSCC), the magnitude of this association is unclear given the heterogenous smoking definitions and outcomes. Our objective was to investigate the association between smoking, survival, and recurrence in HPV-related OPSCC using multiple smoking metrics reported in the literature. MATERIALS AND METHODS This was a retrospective cohort study of 375 adults with p16+ OPSCC undergoing surgical resection (n = 272) or definitive chemoradiation (n = 103) at a tertiary academic institution from 2006 to 2017. The primary outcome was overall survival (OS). Secondary outcomes included disease-free survival (DFS), disease-specific survival (DSS), and recurrence. We used multiple smoking metrics commonly cited in previous studies, including ever versus never smokers, current versus former/never smokers, ≤10 versus >10 pack-year, ≤20 versus >20 pack-year, and continuous pack-year. RESULTS There were 375 patients, median age 58 years, with 326 (87%) males, and median follow-up of 52 months. Of all smoking metrics, >20 pack-year history was the strongest predictor of both OS (HR 2.24, 95% CI: 1.19-4.20) and DFS (HR 1.67, 95% CI: 1.04-2.66) on univariable and multivariable analysis after adjusting for age, overall stage, and comorbidities. Patients with >20 pack-year smoking history were also more likely to have recurrence (HR 1.59, 95% CI: 0.95-2.67) after adjusting for overall stage. CONCLUSION Heavier smoking >20 pack-years was the strongest smoking metric associated with 2-times worse survival and recurrence. Our findings suggest that >20 pack-year smoking history may be a more useful cutoff for risk stratification models but requires further validation.
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Reiner AS, Watt GP, John EM, Lynch CF, Brooks JD, Mellemkjær L, Boice JD, Knight JA, Concannon P, Smith SA, Liang X, Woods M, Shore R, Malone KE, Bernstein L, Bernstein JL. Smoking, Radiation Therapy, and Contralateral Breast Cancer Risk in Young Women. J Natl Cancer Inst 2021; 114:631-634. [PMID: 33779721 DOI: 10.1093/jnci/djab047] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 03/19/2021] [Indexed: 12/19/2022] Open
Abstract
Evidence is mounting that cigarette smoking contributes to second primary contralateral breast cancer (CBC) risk. Whether radiation therapy (RT) interacts with smoking to modify this risk is unknown. In this multicenter, individually-matched case-control study, we examined the association between RT, smoking, and CBC risk. The study included 1,521 CBC cases and 2,212 controls with unilateral breast cancer, all diagnosed with first invasive breast cancer between 1985-2008 at age <55 years. Absorbed radiation doses to contralateral breast regions were estimated with thermoluminescent dosimeters in tissue-equivalent anthropomorphic phantoms and smoking history was collected by interview. Rate ratios (RRs) and 95% confidence intervals (CIs) for CBC risk were estimated by multivariable conditional logistic regression. There was no interaction between any measure of smoking with RT to increase CBC risk (eg, the interaction of continuous RT dose with smoking at first breast cancer diagnosis [ever/never]: RR = 1.00, 95% CI = 0.89-1.14; continuous RT dose with years smoked: RR = 1.00, 95% CI = 0.99-1.01; and continuous RT dose with lifetime pack-years: RR = 1.00, 95% CI = 0.99-1.01). There was no evidence that RT further increased CBC risk in young women with first primary breast cancer who were current smokers or had smoking history.
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Affiliation(s)
- Anne S Reiner
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gordon P Watt
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Jennifer D Brooks
- University of Toronto, Dalla Lana School of Public Health Science, Toronto, Canada
| | | | - John D Boice
- Vanderbilt University Medical Center and the Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Julia A Knight
- University of Toronto, Dalla Lana School of Public Health Science, Toronto, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Patrick Concannon
- Genetics Institute and Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Susan A Smith
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiaolin Liang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Meghan Woods
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Roy Shore
- NYU School of Medicine, New York, NY
| | | | - Leslie Bernstein
- Beckman Research Institute, City of Hope National Medical Center, Duarte, CA
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Miranda-Galvis M, Loveless R, Kowalski LP, Teng Y. Impacts of Environmental Factors on Head and Neck Cancer Pathogenesis and Progression. Cells 2021; 10:cells10020389. [PMID: 33668576 PMCID: PMC7917998 DOI: 10.3390/cells10020389] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 02/08/2023] Open
Abstract
Epidemiological and clinical studies over the past two decades have provided strong evidence that genetic elements interacting with environmental components can individually and collectively influence one’s susceptibility to cancer. In addition to tumorigenic properties, numerous environmental factors, such as nutrition, chemical carcinogens, and tobacco/alcohol consumption, possess pro-invasive and pro-metastatic cancer features. In contrast to traditional cancer treatment, modern therapeutics not only take into account an individual’s genetic makeup but also consider gene–environment interactions. The current review sharpens the focus by elaborating on the impact that environmental factors have on the pathogenesis and progression of head and neck cancer and the underlying molecular mechanisms involved. Recent advances, challenges, and future perspectives in this area of research are also discussed. Inhibiting key environmental drivers of tumor progression should yield survival benefits for patients at any stage of head and neck cancer.
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Affiliation(s)
- Marisol Miranda-Galvis
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (M.M.-G.); (R.L.)
| | - Reid Loveless
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (M.M.-G.); (R.L.)
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo 01509, Brazil;
- Head and Neck Surgery Department, Medical School, University of São Paulo, São Paulo 01509, Brazil
| | - Yong Teng
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, Augusta, GA 30912, USA; (M.M.-G.); (R.L.)
- Georgia Cancer Center, Department of Biochemistry and Molecular Biology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Department of Medical Laboratory, Imaging and Radiologic Sciences, College of Allied Health, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-70-6446-5611; Fax: +1-70-6721-9415
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Electronic cigarette aerosols alter the expression of cisplatin transporters and increase drug resistance in oral cancer cells. Sci Rep 2021; 11:1821. [PMID: 33469038 PMCID: PMC7815770 DOI: 10.1038/s41598-021-81148-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/29/2020] [Indexed: 11/26/2022] Open
Abstract
Tobacco smoking is the leading preventable cause of cancer. Moreover, continued smoking during cancer therapy reduces overall survival. Aware of the negative consequences of tobacco smoking and the challenges of smoking cessation, cancer patients are inquiring whether they should switch to electronic cigarettes (e-cigarettes). To obtain evidence-based data to inform this decision, we examined the effects of e-cigarette aerosol exposure on cisplatin resistance in head and neck cancer cells. Our results show that cancer cells exposed to e-cigarette aerosol extracts and treated with cisplatin have a significant decrease in cell death, increase in viability, and increase in clonogenic survival when compared to non-exposed cells. Moreover, exposure to e-cigarette aerosol extracts increased the concentration of cisplatin needed to induce a 50% reduction in cell growth (IC50) in a nicotine-independent manner. Tobacco smoke extracts induced similar increases in cisplatin resistance. Changes in the expression of drug influx and efflux transporters, rather than activation of cell growth-promoting pathways or DNA damage repair, contribute to e-cigarette induced cisplatin resistance. These results suggest that like combustible tobacco, e-cigarette use might increase chemotherapy resistance, and emphasize the urgent need for rigorous evaluation of e-cigarettes health effects to ensure evidence-based public health policies.
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Smaily H, Khalaf M, Melkane AE, Helou D, Richa T, Khoury C, Azoury F, Farha G, Haddad A, Matar N. Smoking cessation intervention for patients with head and neck cancer: A prospective randomized controlled trial. Am J Otolaryngol 2021; 42:102832. [PMID: 33221636 DOI: 10.1016/j.amjoto.2020.102832] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/07/2020] [Indexed: 10/23/2022]
Abstract
AIMS To evaluate the effectiveness of a brief smoking cessation intervention in head and neck cancer patients (HNCP). STUDY DESIGN A prospective randomized controlled trial that randomly assigns participants in two groups: a usual care group (UCG), and a standardized intervention group (SIG). MATERIAL AND METHODS Patients with a confirmed diagnosis of head and neck squamous cell carcinoma (HNSCC) and who are active smokers were prospectively approached by one of 4 trained Ear-nose-throat (ENT) residents. Participants were randomized into a UCG, and a SIG consisting of a brief perioperative smoking cessation intervention based on National Institute of Health (NIH) "5A's" model along with an informative motivational document and nicotine patch therapy (NPT) offered for 8 weeks in gradually decreasing doses. OBJECTIVE The evaluation of abstinence at 3, 6 and 12 months after enrollment. RESULTS 56 subjects were randomized into the UCG (N = 29, 52%), and the SIG (N = 27, 48%). The overall smoking cessation rates were not statistically different between the two groups; we observed at 3 months cessation rates of 57.1% vs. 57.7% (p = 0.96); at 6 months, 42.9% vs. 24% (p = 0.148); and at 12 months, 33.3% vs. 20.8% (p = 0.318), for the UCG and the SIG respectively. CONCLUSION This study failed to show the effectiveness of a combined brief smoking cessation approach led by and ENT resident in HNSCC patients. A multifaceted approach addressing different pharmacological treatments, factors contributing to smoking maintenance, mainly alcohol dependence and mood disturbances and dealing with relapse risks through close face-to-face or phone call follow-ups may have better outcomes and should be evaluated in upcoming trials.
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Radiation Therapy Alone for Human Papillomavirus-Related Squamous Cell Carcinoma of the Oropharynx: A Single-Arm, Phase 2 Study. Int J Radiat Oncol Biol Phys 2020; 110:403-411. [PMID: 33373656 DOI: 10.1016/j.ijrobp.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/01/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Human papillomavirus (HPV)-related squamous cell carcinoma of the oropharynx (OPSCC) is extremely radiosensitive. Radiation therapy plus high-dose cisplatin remains the standard of care but causes long-term toxicity. Treatment deintensification approaches that reduce toxicity while maintaining survival are desirable for HPV-related OPSCC. METHODS AND MATERIALS We conducted a single-arm, multicenter, phase 2 trial. Patients with newly diagnosed, biopsy-proven, American Joint Committee on Cancer (seventh edition) stage III or IV OPSCC positive for both p16 and HPV DNA were eligible. Patients with T4, N3, or T1N1 disease were excluded. Smoking history was not included in eligibility criteria. Patients received intensity modulated radiation therapy (IMRT) of 70 Gy in 35 fractions or 70.4 Gy in 32 fractions without chemotherapy. The primary endpoint was complete response or complete metabolic response 10 weeks after IMRT completion. RESULTS Between September 13, 2013, and November 15, 2016, 39 patients were enrolled according to a 2-stage Simon design. Twenty-three patients (59%) had smoked for more than10 pack-years. Thirty-six patients (92%) had tumors genotyped as HPV16. Thirty-seven patients (95%) received full-dose radiation therapy and 35 (90%) had complete response or complete metabolic response. Median follow-up was 51 months (interquartile range, 41-63 months). One patient (3%) had regional recurrence and 3 (8%) had distant metastasis. One patient died of disease. The 2-year progression-free survival rate was 94% (95% CI, 81%-99%), and the 2-year overall survival rate was 100%. Common grade 3 adverse events during IMRT included mucositis in 10 patients (26%) and dysphagia in 7 patients (18%). No patients were dependent on a feeding tube at 1 month after IMRT completion. No grade 3 or 4 late adverse events were observed. CONCLUSIONS IMRT alone is associated with excellent response as well as reduced toxicity and could be a treatment option for carefully selected patients with locally advanced "true" HPV-related OPSCC. Further studies are warranted.
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Delago D, Knittelfelder O, Jakse G, Lukasiak K, Reinisch S, Renner W, Stranzl-Lawatsch H, Partl R, Langsenlehner T. The decreased mean platelet volume is associated with poor prognosis in patients with oropharyngeal cancer treated with radiotherapy. Radiat Oncol 2020; 15:259. [PMID: 33160368 PMCID: PMC7648964 DOI: 10.1186/s13014-020-01702-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/29/2020] [Indexed: 01/23/2023] Open
Abstract
Background There is considerable evidence that platelets contribute to cancer growth and metastatic dissemination. In recent studies, altered mean platelet volume (MPV) has been associated with prognosis in different types of cancer. However, the prognostic role of the MPV in head and neck squamous cell cancer (HNSCC) is currently discussed controversially. The present study was performed to analyze and further elucidate the prognostic significance of the MPV in HNSCC. Methods A total of 319 oropharyngeal squamous cell cancer (OPSCC) patients treated with radiotherapy at a tertiary academic center were enrolled in the present study. Kaplan–Meier method as well as uni- and multivariate Cox proportional hazards were used to evaluate the impact of MPV on cancer-specific survival (CSS), locoregional control (LC) and recurrence-free survival (RFS). Results The median MPV was 10.30 fL (mean 10.26 ± 1.17fL). Univariate analyses showed a significant association of the MPV with CSS (HR 0.85, 95% CI 0.74–0.98, p = 0.025), LC (HR 0.86, 95% CI 0.74–0.99, p = 0.034) and RFS (HR 0.87, 95% CI 0.76–0.996; p = 0.043). In multivariate analysis, the MPV remained an independent prognostic factor for CSS (HR 0.77, 95% CI 0.63–0.93, p = 0.008), LC (HR 0.80, 95% CI 0.65–0.98, p = 0.030), and RFS (HR 0.83, 95% CI 0.685–0.999, p = 0.049). Conclusions Our findings indicate that the MPV is a prognostic marker in OPSCC patients and may contribute to future individual risk assessment.
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Affiliation(s)
- Daniela Delago
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Olivia Knittelfelder
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Gabriele Jakse
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Katarzyna Lukasiak
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Sabine Reinisch
- Department of Otorhinolaryngology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 26, 8036, Graz, Austria
| | - Wilfried Renner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria
| | - Heidi Stranzl-Lawatsch
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
| | - Richard Partl
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria.
| | - Tanja Langsenlehner
- Department of Therapeutic Radiology and Oncology, Comprehensive Cancer Center, Medical University of Graz, Auenbruggerplatz 32, 8036, Graz, Austria
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50
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Simon V, Laot L, Laas E, Rozette S, Guerin J, Balezeau T, Nicolas M, Pierga JY, Coussy F, Laé M, De Croze D, Grandal B, Abecassis J, Dumas E, Lerebours F, Reyal F, Hamy AS. No Impact of Smoking Status on Breast Cancer Tumor Infiltrating Lymphocytes, Response to Neoadjuvant Chemotherapy and Prognosis. Cancers (Basel) 2020; 12:cancers12102943. [PMID: 33053866 PMCID: PMC7601636 DOI: 10.3390/cancers12102943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/28/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
Simple Summary Tobacco use is associated with an increase in breast cancer mortality. Pathologic complete response (pCR) rate to neoadjuvant chemotherapy is influenced by tumor-infiltrating lymphocyte (TIL) levels and is associated with a better long-term survival outcome. The aim of this study was to evaluate the impact of smoking status on TIL levels, response to neoadjuvant chemotherapy and prognosis for breast cancer patients. We retrospectively assessed pre- and post-neoadjuvant chemotherapy tumor infiltrating lymphocyte (TILs) levels and pathological complete response (pCR) rates in a cohort of 956 specimens of breast cancer (BC) patients treated with neoadjuvant chemotherapy, according to their smoking status. To our knowledge, this is the largest cohort of BC patients used to study this topic so far. We found no impact of smoking status on tumor infiltrating lymphocyte levels, response to neoadjuvant chemotherapy and prognosis in the whole population and within each BC subtype. Abstract Tobacco use is associated with an increase in breast cancer (BC) mortality. Pathologic complete response (pCR) rate to neoadjuvant chemotherapy (NAC) is influenced by tumor-infiltrating lymphocyte (TIL) levels and is associated with a better long-term survival outcome. The aim of our study is to evaluate the impact of smoking status on TIL levels, response to NAC and prognosis for BC patients. We retrospectively evaluated pre- and post-NAC stromal and intra tumoral TIL levels and pCR rates on a cohort of T1-T3NxM0 BC patients treated with NAC between 2002 and 2012 at Institut Curie. Smoking status (current, ever, never smokers) was collected in clinical records. We analyzed the association between smoking status, TIL levels, pCR rates and survival outcomes among the whole population, and according to BC subtype. Nine hundred and fifty-six BC patients with available smoking status information were included in our analysis (current smokers, n = 179 (18.7%); ever smokers, n = 154 (16.1%) and never smokers, n = 623 (65.2%)). Median pre-NAC TIL levels, pCR rates, or median post-NAC TIL levels were not significantly different according to smoking status, neither in the whole population, nor in any BC subtype group. With a median follow-up of 101.4 months, relapse-free survival (RFS) and overall survival (OS) were not significantly different by smoking status. We did not find any significant effect of tobacco use on pre- and post-NAC TILs nor response to NAC. Though our data seem reassuring, BC treatment should still be considered as a window of opportunity to offer BC patients accurate smoking cessation interventions.
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Affiliation(s)
- Vanille Simon
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Lucie Laot
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Enora Laas
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Sonia Rozette
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Julien Guerin
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France; (J.G.); (T.B.)
| | - Thomas Balezeau
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France; (J.G.); (T.B.)
| | - Marion Nicolas
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Marick Laé
- Department of Tumor Biology, Institut Curie, 75005 Paris, France; (M.L.); (D.D.C.)
| | - Diane De Croze
- Department of Tumor Biology, Institut Curie, 75005 Paris, France; (M.L.); (D.D.C.)
| | - Beatriz Grandal
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Judith Abecassis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
| | - Florence Lerebours
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
| | - Fabien Reyal
- Department of Surgical Oncology, Institut Curie, University Paris, 75005 Paris, France; (V.S.); (L.L.); (E.L.); (M.N.); (B.G.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
- Correspondence: ; Tel.: +33-144-324-087 or +33-615-271-980
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, University Paris, 75005 Paris, France; (S.R.); (J.-Y.P.); (F.C.); (F.L.); (A.-S.H.)
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, 75005 Paris, France; (J.A.); (E.D.)
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