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Uchinami Y, Yasuda K, Kano S, Otsuka M, Hamada S, Suzuki T, Tsushima N, Takahashi S, Fujita Y, Miyazaki T, Higaki H, Taguchi J, Shimizu Y, Sakashita T, Homma A, Aoyama H. Treatment outcomes of radiotherapy with concurrent weekly cisplatin in older patients with locally advanced head and neck squamous cell carcinoma. Discov Oncol 2023; 14:226. [PMID: 38063923 PMCID: PMC10709267 DOI: 10.1007/s12672-023-00844-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Tri-weekly cisplatin and radiotherapy (CDDP + RT) is a standard of care for locally advanced head and neck squamous cell carcinoma (LA-HNSCC) but is sometimes challenging to complete in older patients. Weekly CDDP + RT has shown mild toxicity compared to tri-weekly CDDP + RT for LA-HNSCC and is a promising option for older adults. We aimed to report the treatment outcomes and prognostic factors in patients with LA-HNSCC treated with weekly CDDP + RT. METHODS We analyzed patients aged ≥ 70 years who started weekly CDDP + RT for LA-HNSCC between July 2006 and October 2022. LA-HNSCC includes cancer in the oropharynx, hypopharynx, or larynx with a clinical stage of 3 or 4 without distant metastases based on the Union for International Cancer Control staging system 8th edition. The radiation dose of 70 Gy was delivered in 35 fractions by 3-dimensional conformal radiotherapy, intensity-modulated radiotherapy, or proton beam therapy. The primary endpoint was the 3-year overall survival (OS), and the secondary endpoints were the 3-year progression-free survival (PFS) and 3-year cause-specific survival (CSS). The Kaplan-Meier method was used to calculate survival rates, and the log-rank test was used to evaluate statistical significance. A Cox proportional hazards model was used for the multivariate analysis of prognostic factors. RESULTS The median age of the 49 patients was 72 (range: 70-78) years. The median CDDP dose was 200 (40-280) mg/ m2, and 47 patients completed scheduled radiotherapy. Forty-eight patients (98.0%) had a performance status of ≥ 1 at the initial visit. The 3-year OS, PFS, and CSS were 80.9% (95% confidence interval [CI]: 64.8-90.7), 68.3% (95% CI 51.8-81.2), and 85.0% (95% CI 68.7-93.4), respectively. In the multivariate analysis, the cumulative CDDP dose (< 200 or ≥ 200 mg/m2) was a significant factor for OS (hazard ratio: 0.29 [95% CI 0.08-0.97], p = 0.044). There was one case of early mortality. Grade 3 or higher late adverse events were observed in four patients (8.2%). CONCLUSIONS Weekly CDDP + RT in older patients led to good survival outcomes with an acceptable rate of adverse events. CDDP should be administered at a dose of at least 200 mg/m2 in older patients. Trial registration Retrospectively registered.
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Affiliation(s)
- Yusuke Uchinami
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, North 14 West 5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Manami Otsuka
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Seijiro Hamada
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Takayoshi Suzuki
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Nayuta Tsushima
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Shuhei Takahashi
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshihiro Fujita
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomohiko Miyazaki
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hajime Higaki
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Jun Taguchi
- Department of Medical Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Yasushi Shimizu
- Department of Medical Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Tomohiro Sakashita
- Department of Otolaryngology-Head and Neck Surgery, Kushiro City General Hospital, Syunkodai 1-12, Kushiro, Hokkaido, 085-0822, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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Krishna A, Jayachandran M, Sacheendran D, George T, Palatty PL, Baliga MS. Pharmacoeconomic Appraisal of Treating Head and Neck Cancer with Various Chemotherapy and Chemoirradiation Regimens Using Branded and Jan-aushadhi Drugs in India. Indian J Otolaryngol Head Neck Surg 2023; 75:1782-1791. [PMID: 37636797 PMCID: PMC10447740 DOI: 10.1007/s12070-023-03753-x] [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: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 08/29/2023] Open
Abstract
According to recent studies, head and neck cancers (HNC) make up a substantial proportion of all cancers in India and are proportionately high in the lower socioeconomic people practising tobacco and alcohol. Chemotherapy is a crucial component of treating HNC, and this study was carried out to determine the Cost Minimization Analysis (CMA) by comparing the price of the high and least expensive branded drugs marketed in India. This study was performed to understand the cost difference (CD), Cost ratio (CR) and percentage of cost variation (PCV) of both individual drugs and the standard anticancer regimens. The Current Index of Medical Stores was used to determine the costs of the most and least expensive branded medications and analysed. The results indicated that Paclitaxel-Cisplatin-5 Fluoruracil chemotherapy regimen exhibited the greatest variance in cost, with the Jan Aushadhi brand of medicine costing 8.1 times and 4.3 times less than the most expensive and cheapest branded drugs, respectively. The cost of the concurrent cisplatin regimen with Jan Aushadi Medicine was Rs 1764, Rs 3489.64 with the lowest branded drug, and Rs 8477 with the most expensive branded drug. Also when compared to Jan Aushadhi medication, the cost of Ciplatin was 4.8 times higher with the most expensive branded drug and 2 times higher with the least expensive branded drug. As far as the authors are aware of this is the first study that addresses the pharmacoeconomic appraisal of treating HNC with various chemotherapy and chemoirradiation regimens. This study will help oncologists, pharmacists, and healthcare workers comprehend the financial advantages of treating breast cancer with less expensive chemotherapeutic agents instead of brand-name medications.
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Affiliation(s)
- Abhishek Krishna
- Department of Radiation Oncology, Mysore Medical College and Research Institute, Irwin Road, Mysuru, Karnataka India
| | - Mamatha Jayachandran
- Department of Pharmacology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala 682041 India
| | - Dhanya Sacheendran
- Department of Pharmacology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala 682041 India
| | - Thomas George
- Internal Medicine, Coney Island Hospital, Ocean Pkwy, Brooklyn, NY 2601 USA
| | - Princy Louis Palatty
- Department of Pharmacology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala 682041 India
- The Bioethics SAARC Nodal Centre, International Network Bioethics at Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala India
| | - Manjeshwar Shrinath Baliga
- The Bioethics SAARC Nodal Centre, International Network Bioethics at Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala India
- Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka India
- Bioethics Education & Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka India
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Rao S, Kini V, Hegde SK, Meera S, Rao P, George T, Baliga MS. Ayurvedic Drug Triphala in Combination with Providone Iodine Mitigates Radiation-Induced Mucositis in Head and Neck Cancer Patients without Affecting the Tumor Response. Indian J Otolaryngol Head Neck Surg 2023; 75:1480-1489. [PMID: 37636651 PMCID: PMC10447701 DOI: 10.1007/s12070-023-03516-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/19/2023] [Indexed: 03/06/2023] Open
Abstract
Radiation-induced mucositis is a dose-limiting concern in the treatment of head and neck cancers (HNC). This study was conducted to determine the effectiveness of the Ayurvedic drug Triphala in reducing radiation-induced mucositis and influencing tumour control when combined with providone iodine. Data from patient files of HNC patients who received Triphala in conjunction with iodine or iodine alone over the course of curative radiotherapy (> 60 Gy) from May 2013 to February 2015 were extracted for this retrospective chart based study. Data was subjected to statistical analysis, X2 and unpaired t test using the Statistical Package for Social Sciences (SPSS), version 17 (IBM, Chicago, USA). When compared to iodine alone, the group that utilised Triphala gargling was very efficient in delaying mucositis, the extent of weight loss (p = 0.038), the incidence (p = 0.03), and the number (p = 0.02) of treatment breaks. However, it had no influence on the radiation-induced tumour response. According to the observations, Triphala coupled with iodine was more successful in preventing radiation mucositis, and without affecting the killing of tumour cells than iodine gargle alone. According to the authors, this is the first observation to demonstrate the value of combining providone iodine with Triphala in preventing radiation-induced oral mucositis.
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Affiliation(s)
- Suresh Rao
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Venkataraman Kini
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Sanath Kumar Hegde
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, 575002 India
| | | | - Pratima Rao
- Department of Dentistry, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Thomas George
- Research Unit, Mangalore Institute of Oncology, Mangalore, 575002 India
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Mireștean CC, Iancu RI, Iancu DPT. p53 Modulates Radiosensitivity in Head and Neck Cancers-From Classic to Future Horizons. Diagnostics (Basel) 2022; 12:3052. [PMID: 36553058 PMCID: PMC9777383 DOI: 10.3390/diagnostics12123052] [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: 09/22/2022] [Revised: 11/08/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
p53, initially considered a tumor suppressor, has been the subject of research related to cancer treatment resistance in the last 30 years. The unfavorable response to multimodal therapy and the higher recurrence rate, despite an aggressive approach, make HNSCC a research topic of interest for improving therapeutic outcomes, even if it is only the sixth most common malignancy worldwide. New advances in molecular biology and genetics include the involvement of miRNA in the control of the p53 pathway, the understanding of mechanisms such as gain/loss of function, and the development of different methods to restore p53 function, especially for HPV-negative cases. The different ratio between mutant p53 status in the primary tumor and distant metastasis originating HNSCC may serve to select the best therapeutic target for activating an abscopal effect by radiotherapy as a "booster" of the immune system. P53 may also be a key player in choosing radiotherapy fractionation regimens. Targeting any pathway involving p53, including tumor metabolism, in particular the Warburg effect, could modulate the radiosensitivity and chemo-sensitivity of head and neck cancers.
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Affiliation(s)
- Camil Ciprian Mireștean
- Department of Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, 200349 Craiova, Romania
- Department of Surgery, Railways Clinical Hospital Iasi, 700506 Iași, Romania
| | - Roxana Irina Iancu
- Oral Pathology Department, Faculty of Dental Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Clinical Laboratory, “St. Spiridon” Emergency Universitary Hospital, 700111 Iași, Romania
| | - Dragoș Petru Teodor Iancu
- Oncology and Radiotherapy Department, Faculty of Medicine, “Gr. T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Department of Radiation Oncology, Regional Institute of Oncology, 700483 Iași, Romania
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Hegde SK, Rao S, Rao P, Raghu SV, Meera S, Baliga MS. Aqueous Extract of Emblica officinalis Linn (Indian gooseberry) in Combination with Iodine is More Efficacious than Iodine Alone in Mitigating Mucositis in Head and Neck Cancer Patients Undergoing Curative Radiotherapy: Retrospective Observations. Indian J Otolaryngol Head Neck Surg 2022; 74:6330-6338. [PMID: 36742808 PMCID: PMC9895700 DOI: 10.1007/s12070-021-03059-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
Mucositis is a very painful unavoidable and common side effect in head and neck cancer patients undergoing curative radiotherapy and can affect the planned treatment. In this study, attempt is made at understanding the efficacy of Emblica officinalis Linn (amla) when combined with providone iodine in mitigating radiation-induced mucositis, weight loss and tumor control. This was a retrospective chart based study and was carried out by extracting the data from the files of patients with cancer of head and neck who used amla in combination with iodine or iodine alone during the course of the curative radiotherapy (> 60 Gy). The data was entered in to Microsoft excel and subjected to statistical analysis using SPSS 17 software. The results indicate that when compared with iodine alone, the group where iodine and amla gargling were used was very effective in delaying mucositis, reduced incidence of intolerable mucositis (P = 0.027), quantitative grade of weight loss (P = 0.016), incidence of severe weight loss (P = 0.03) without affecting tumor response. The results suggest that when compared with iodine alone, amla when combined with iodine was more effective in mitigating radiation mucositis and by not interfering with the tumor cell kill. As far as the authors are aware of this is the first study that shows the usefulness of combining iodine with Amla in mitigating radiation-induced mucositis.
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Affiliation(s)
- Sanath Kumar Hegde
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Suresh Rao
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Pratima Rao
- Department of Dentistry, Mangalore Institute of Oncology, Mangalore, 575002 India
| | - Shamprasad Varija Raghu
- Neurogenetics Laboratory, Department of Applied Zoology, Mangalore University, Mangalagangotri, Karnataka 574199 India
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Hegde S, Rao S, D'souza RK, Baliga MS. Supplementation with Cod Liver Oil Capsules Reduces Weight Loss and Mucositis in Head and Neck Cancer Patients Undergoing Curative Radiotherapy without Affecting the Treatment Response. ASIAN JOURNAL OF ONCOLOGY 2022. [DOI: 10.1055/s-0042-1750019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Background Weight loss is a common observation in head and neck cancer (HNC) patients and the severity depends on the modalities used. The purpose of this study was to evaluate the effectiveness of providing two capsules of fish oil supplement each day during the course of curative radiotherapy for HNC patients.
Materials and Methods This was a retrospective single-center study, and files of HNC patients treated with radiotherapy between the months of January 2015 and March 2015 were evaluated. Data on gender, age, tumor, treatment details, adverse effects, weight before and at the end of the treatment, and treatment response were obtained from the patient files. The data collected were entered into Excel sheet and subjected to statistical analysis using chi-square tests, unpaired t-test, and analysis of variance with post hoc Tukey test. A p-value of <0.05 was considered significant.
Results Records of 68 patients treated during the study period with radiation for HNC and admitted to the inpatient facility throughout the treatment period were retrospectively reviewed. Majority of the patients had advanced stage tumors. There was no difference in the initial weight of the patients in the two groups while a significant difference was seen in the final weight (p = 0.007). The number of patients with severe weight loss (>5 kg) was more in the control than in the fish oil cohort (68.89 vs. 43.48) and was significant (p = 0.042). In addition to this, the incidence of mucositis was delayed and also lesser in severity in the cohorts that had received fish oil. At the dose used, fish oil capsules did not have any adverse effects and importantly there was no significant difference in treatment response.
Conclusion The results of the study indicate that administering fish oil capsules was effective in arresting weight loss and delaying and mitigating mucositis in HNC patients undergoing curative radiotherapy. Fish oil capsule has good safety profile, was devoid of any toxic effects, and has a good clinical application value.
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Affiliation(s)
- Sanath Hegde
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Suresh Rao
- Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka, India
| | - Rhea Katherine D'souza
- Clinical Nutrition, Mangalore Institute of Oncology, Mangalore, Karnataka, India
- Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka, India
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Kiyota N, Tahara M, Mizusawa J, Kodaira T, Fujii H, Yamazaki T, Mitani H, Iwae S, Fujimoto Y, Onozawa Y, Hanai N, Ogawa T, Hara H, Monden N, Shimura E, Minami S, Fujii T, Tanaka K, Homma A, Yoshimoto S, Oridate N, Omori K, Ueda T, Okami K, Ota I, Shiga K, Sugasawa M, Asakage T, Saito Y, Murono S, Nishimura Y, Nakamura K, Hayashi R. Weekly Cisplatin Plus Radiation for Postoperative Head and Neck Cancer (JCOG1008): A Multicenter, Noninferiority, Phase II/III Randomized Controlled Trial. J Clin Oncol 2022; 40:1980-1990. [PMID: 35230884 PMCID: PMC9197353 DOI: 10.1200/jco.21.01293] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The standard treatment for postoperative high-risk locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) is chemoradiotherapy with 3-weekly cisplatin (100 mg/m2). However, whether chemoradiotherapy with weekly cisplatin (40 mg/m2) yields comparable efficacy with 3-weekly cisplatin in postoperative high-risk LA-SCCHN is unknown. PATIENTS AND METHODS In this multi-institutional open-label phase II/III trial, patients with postoperative high-risk LA-SCCHN were randomly assigned to receive either chemoradiotherapy with 3-weekly cisplatin (100 mg/m2) or with weekly cisplatin (40 mg/m2) to confirm the noninferiority of weekly cisplatin. The primary end point of phase II was the proportion of treatment completion, and that of phase III was overall survival. A noninferiority margin of hazard ratio was set at 1.32. RESULTS Between October 2012 and December 2018, a total of 261 patients were enrolled (3-weekly cisplatin, 132 patients; weekly cisplatin, 129 patients). At the planned third interim analysis in the phase III part, after a median follow-up of 2.2 (interquartile range 1.19-3.56) years, chemoradiotherapy with weekly cisplatin was noninferior to 3-weekly cisplatin in terms of overall survival, with a hazard ratio of 0.69 (99.1% CI, 0.374 to 1.273 [< 1.32], one-sided P for noninferiority = .0027 < .0043). Grade 3 or more neutropenia and infection were less frequent in the weekly arm (3-weekly v weekly, 49% v 35% and 12% v 7%, respectively), as were renal impairment and hearing impairment. No treatment-related death was reported in the 3-weekly arm, and two (1.6%) in the weekly arm. CONCLUSION Chemoradiotherapy with weekly cisplatin is noninferior to 3-weekly cisplatin for patients with postoperative high-risk LA-SCCHN. These findings suggest that chemoradiotherapy with weekly cisplatin can be a possible treatment option for these patients.
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Affiliation(s)
- Naomi Kiyota
- Kobe University Hospital, Cancer Center, Kobe, Japan
| | - Makoto Tahara
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo
| | | | | | | | | | | | | | | | | | | | | | | | | | - Shujiro Minami
- National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | | | | | | | | | | | | | | | - Kenji Okami
- Tokai University School of Medicine, Isehara, Japan
| | - Ichiro Ota
- Nara Medical University, Kashihara, Japan
| | | | - Masashi Sugasawa
- Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Yuki Saito
- The University of Tokyo Hospital, Tokyo, Japan
| | | | | | - Kenichi Nakamura
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo
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Buglione M, Alterio D, Maddalo M, Greco D, Gerardi MA, Tomasini D, Pegurri L, Augugliaro M, Marvaso G, Turturici I, Guerini A, Ansarin M, Spiazzi L, Costa L, Cossu Rocca M, Magrini SM, Jereczek-Fossa BA. Three weekly versus weekly concurrent cisplatin: safety propensity score analysis on 166 head and neck cancer patients. Radiat Oncol 2021; 16:239. [PMID: 34930353 PMCID: PMC8686550 DOI: 10.1186/s13014-021-01966-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Radio-chemotherapy with CDDP is the standard for H&N squamous cell cancer. CDDP 100 mg/m2/q3 is the standard; alternative schedules are used to reduce toxicity, mostly 40 mg/m2/q1.
Methods Patients were treated from 1/2010 to 1/2017 in two Radiation Oncology Centres. Propensity score analysis (PS) was retrospectively used to compare these two schedules. Results Patients analyzed were 166. Most (114/166) had 1w-CDDP while 52 had 3w-CDDP. In the 3w-CDDP group, patients were younger, with better performance status, smaller disease extent and a more common nodal involvement than in the 1w-CDDP. Acute toxicity was similar in the groups. Treatment compliance was lower in the w-CCDP. Overall survival before PS was better for female, for oropharyngeal disease and for 3w-CDDP group. After PS, survival was not related to the CDDP schedule. Conclusions 3w-CDDP remains the standard for fit patients, weekly schedule could be safely used in selected patients.
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Affiliation(s)
- Michela Buglione
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Daniela Alterio
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Marta Maddalo
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Diana Greco
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Marianna Alessandra Gerardi
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Davide Tomasini
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Ludovica Pegurri
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Matteo Augugliaro
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Irene Turturici
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - Andrea Guerini
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Mohssen Ansarin
- Division of Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Luigi Spiazzi
- Medical Physics, ASST Spedali Civili, Brescia, Italy
| | - Loredana Costa
- Radiation Oncology Department, University and ASST Spedali Civili, Brescia, Italy
| | - Maria Cossu Rocca
- Division of Medical Oncology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Barbara Alicja Jereczek-Fossa
- Division of Radiotherapy, Radiation Oncology Department, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Araújo RS, Cristina Oliveira M, Cardoso VN, Keefe DMK, Stringer AM. The effect of free and encapsulated cisplatin into long-circulating and pH-sensitive liposomes on IEC-6 cells during wound healing in the presence of host-microbiota. J Pharm Pharmacol 2021; 74:711-717. [PMID: 34791381 DOI: 10.1093/jpp/rgab156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/18/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To circumvent cisplatin (CDDP) toxic effects and improve the antitumoural effect, our research group developed long-circulating and pH-sensitive liposomes containing CDDP (SpHL-CDDP). This study aimed to evaluate whether SpHL-CDDP is associated with intestinal protection under in-vitro conditions in the presence of host-microbiota, compared with free CDDP. METHODS The cytotoxicity of CDDP and SpHL-CDDP were evaluated by colorimetric MTT and sulforhodamine B (SRB) assays. Epithelial proliferation was assessed by using an in-vitro wounding model in the presence of host-microbiota with intestinal epithelial cell line 6 (IEC-6) monolayers. Cytokines were determined by ELISA. KEY FINDINGS Reduced cytotoxicity of SpHL-CDDP in IEC-6 cells (minimum of 1.3-fold according to the IC50 values) was observed when compared with CDDP. The presence of microbiota or CDDP reduced the wound healing. The association of microbiota and SpHL-CDDP improved the wound healing and cell number in IEC-6 cells when compared with control. These beneficial results can be associated with increased IL-6 and IL-10 levels induced by SpHL-CDDP which were affected by the presence of microbiota. CONCLUSIONS These results indicate that the presence of microbiota associated with SpHL-CDDP provided less intestinal cellular damages compared with CDDP and constitutes a promising candidate for clinical use.
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Affiliation(s)
- Raquel Silva Araújo
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Mônica Cristina Oliveira
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Valbert Nascimento Cardoso
- Department of Clinical and Toxicological Analysis, Faculty of Pharmacy, Federal Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Dorothy M K Keefe
- Department of Medicine, Mucositis Research Group, The University of Adelaide, Adelaide, SA, Australia
| | - Andrea M Stringer
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
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10
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Babar A, Woody NM, Ghanem AI, Tsai J, Dunlap NE, Schymick M, Liu HY, Burkey BB, Lamarre ED, Ku JA, Scharpf J, Prendes BL, Joshi NP, Caudell JJ, Siddiqui F, Porceddu SV, Lee N, Schwartzman L, Koyfman SA, Adelstein DJ, Geiger JL. Outcomes of Post-Operative Treatment with Concurrent Chemoradiotherapy (CRT) in High-Risk Resected Oral Cavity Squamous Cell Carcinoma (OCSCC): A Multi-Institutional Collaboration. ACTA ACUST UNITED AC 2021; 28:2409-2419. [PMID: 34209302 PMCID: PMC8293216 DOI: 10.3390/curroncol28040221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/13/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
Adjuvant chemoradiation (CRT), with high-dose cisplatin remains standard treatment for oral cavity squamous cell carcinoma (OCSCC) with high-risk pathologic features. We evaluated outcomes associated with different cisplatin dosing and schedules, concurrent with radiation (RT), and the effect of cumulative dosing of cisplatin. An IRB-approved collaborative database of patients (pts) with primary OCSCC (Stage I–IVB AJCC 7th edition) treated with primary surgical resection between January 2005 and January 2015, with or without adjuvant therapy, was established from six academic institutions. Patients were categorized by cisplatin dose and schedule, and resultant groups compared for demographic data, pathologic features, and outcomes by statistical analysis to determine disease free survival (DFS) and freedom from metastatic disease (DM). From a total sample size of 1282 pts, 196 pts were identified with high-risk features who were treated with adjuvant CRT. Administration schedule of cisplatin was not significantly associated with DFS. On multivariate (MVA), DFS was significantly better in patients without perineural invasion (PNI) and in those receiving ≥200 mg/m2 cisplatin dose (p < 0.001 and 0.007). Median DFS, by cisplatin dose, was 10.5 (<200 mg/m2) vs. 20.8 months (≥200 mg/m2). Our analysis demonstrated cumulative cisplatin dose ≥200 mg/m2 was associated with improved DFS in high-risk resected OCSCC pts.
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Affiliation(s)
- Arslan Babar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Neil M. Woody
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (N.M.W.); (N.P.J.); (S.A.K.)
| | - Ahmed I. Ghanem
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI 48202, USA; (A.I.G.); (M.S.); (F.S.)
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 00203, Egypt
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.T.); (N.L.)
| | - Neal E. Dunlap
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY 40202, USA; (N.E.D.); (S.V.P.)
| | - Matthew Schymick
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI 48202, USA; (A.I.G.); (M.S.); (F.S.)
| | - Howard Y. Liu
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia;
| | - Brian B. Burkey
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Eric D. Lamarre
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Jamie A. Ku
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Brandon L. Prendes
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Nikhil P. Joshi
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (N.M.W.); (N.P.J.); (S.A.K.)
| | - Jimmy J. Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI 48202, USA; (A.I.G.); (M.S.); (F.S.)
| | - Sandro V. Porceddu
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY 40202, USA; (N.E.D.); (S.V.P.)
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.T.); (N.L.)
| | - Larisa Schwartzman
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (L.S.); (D.J.A.)
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (N.M.W.); (N.P.J.); (S.A.K.)
| | - David J. Adelstein
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (L.S.); (D.J.A.)
| | - Jessica L. Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (L.S.); (D.J.A.)
- Correspondence:
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11
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Nair LM, Kumar RR, Thomachan KC, Rafi M, George PS, Krishna KMJ, Ramadas K. Phase IIb trial comparing two concurrent cisplatin schedules in locally advanced head and neck cancer. South Asian J Cancer 2020; 6:64-68. [PMID: 28702409 PMCID: PMC5506812 DOI: 10.4103/2278-330x.208840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: Concurrent chemoradiation with 3 weekly cisplatin (100 mg/m2) is the standard of care for locally advanced head and neck cancer. However, this regimen has been shown to be associated with lesser compliance and higher toxicities. Hence, there is a need to explore alternative concurrent cisplatin regimens. Objectives: The objective of this study was to compare the efficacy and toxicities of 3 weekly cisplatin (100 mg/m2) with weekly cisplatin (40 mg/m2) concurrently with radiation in patients with locally advanced head and neck cancer. Patients and Methods: This phase IIb trial randomized 56 patients with Stage III and IV squamous cell carcinoma of oropharynx, hypopharynx, and larynx to Arm A or Arm B. Arm A received cisplatin 100 mg/m2 3 weekly and Arm B received cisplatin 40 mg/m2 weekly concurrently with radiation. The primary end point was disease-free survival (DFS) and secondary end points were overall survival (OS) and acute toxicity. DFS and OS were estimated using Kaplan–Meier method, and log-rank test was used to assess the difference in these distributions with respect to treatment. Results: The 2-year DFS in Arm A and Arm B was 64.5% and 52.8%, respectively (P = 0.67). The OS at 2 years was 71% and 61.1% in Arm A and Arm B, respectively (P = 0.61). There were no significant differences in acute hematological, renal, or mucosal toxicities between the two arms. Conclusion: This study showed a nonsignificant improvement in DFS and OS in the 3 weekly cisplatin arm over the weekly arm with comparable toxicities. The trial is registered with Clinical Trial Registry of India (CTRI registration number: CTRI/2013/05/003703, URL-http://ctri.nic.in).
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Affiliation(s)
- Lekha Madhavan Nair
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - R Rejnish Kumar
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | | | - Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Preethi Sara George
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India
| | - K M Jagathnath Krishna
- Department of Cancer Epidemiology and Biostatistics, Regional Cancer Centre, Trivandrum, Kerala, India
| | - Kunnambath Ramadas
- Department of Radiation Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
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12
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Chou FJ, Lin C, Tian H, Lin W, You B, Lu J, Sahasrabudhe D, Huang CP, Yang V, Yeh S, Niu Y, Chang C. Preclinical studies using cisplatin/carboplatin to restore the Enzalutamide sensitivity via degrading the androgen receptor splicing variant 7 (ARv7) to further suppress Enzalutamide resistant prostate cancer. Cell Death Dis 2020; 11:942. [PMID: 33139720 PMCID: PMC7606511 DOI: 10.1038/s41419-020-02970-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 08/07/2020] [Accepted: 08/21/2020] [Indexed: 12/21/2022]
Abstract
The FDA-approved anti-androgen Enzalutamide (Enz) has been used successfully as the last line therapy to extend castration-resistant prostate cancer (CRPC) patients’ survival by an extra 4.8 months. However, CRPC patients eventually develop Enz-resistance that may involve the induction of the androgen receptor (AR) splicing variant ARv7. Here we found that Cisplatin (Cis) or Carboplatin, currently used in chemotherapy/radiation therapy to suppress tumor progression, could restore the Enz sensitivity in multiple Enz-resistant (EnzR) CRPC cells via directly degrading/suppressing the ARv7. Combining Cis or Carboplatin with Enz therapy can also delay the development of Enz-resistance in CRPC C4-2 cells. Mechanism dissection found that Cis or Carboplatin might decrease the ARv7 expression via multiple mechanisms including targeting the lncRNA-Malat1/SF2 RNA splicing complex and increasing ARv7 degradation via altering ubiquitination. Preclinical studies using in vivo mouse model with implanted EnzR1-C4-2 cells also demonstrated that Cis plus Enz therapy resulted in better suppression of EnzR CRPC progression than Enz treatment alone. These results not only unveil the previously unrecognized Cis mechanism to degrade ARv7 via targeting the Malat1/SF2 complex and ubiquitination signals, it may also provide a novel and ready therapy to further suppress the EnzR CRPC progression in the near future.
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Affiliation(s)
- Fu-Ju Chou
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - ChangYi Lin
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Hao Tian
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA.,Tianjin Institute of Urology, Tianjin Medical University, Tianjin, 300211, China
| | - WanYing Lin
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Bosen You
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA.,Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Jieyang Lu
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Deepak Sahasrabudhe
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Chi-Ping Huang
- Sex Hormone Research Center and Department of Urology, China Medical University and Hospital, Taichung, 404, Taiwan
| | - Vanessa Yang
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Shuyuan Yeh
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Yuanjie Niu
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA.,Tianjin Institute of Urology, Tianjin Medical University, Tianjin, 300211, China
| | - Chawnshang Chang
- George Whipple Lab for Cancer Research, Departments of Pathology, Urology, Radiation Oncology and The Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, NY, 14642, USA. .,Department of Urology, The 4th Affiliated Hospital of Harbin Medical University, Harbin, 150001, China.
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13
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Kitano M, Kojima T, Okanoue Y, Fujimura S, Oyagi S, Shoji K, Hori R. Concurrent chemoradiotherapy with low-dose weekly platinum agent for head and neck carcinoma. Clin Otolaryngol 2020; 45:952-955. [PMID: 32741125 DOI: 10.1111/coa.13623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/13/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Masayuki Kitano
- Department of Otolaryngology, Tenri Hospital, Nara, Japan.,Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | - Yusuke Okanoue
- Department of Otolaryngology, Tenri Hospital, Nara, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Seiji Oyagi
- Department of Otolaryngology-Head & Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiko Shoji
- Department of Otolaryngology, Tenri Hospital, Nara, Japan
| | - Ryusuke Hori
- Department of Otolaryngology, Tenri Hospital, Nara, Japan
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14
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The role of endoscopic resection for selected patients with sinonasal squamous cell carcinoma. Auris Nasus Larynx 2020; 48:131-137. [PMID: 32723597 DOI: 10.1016/j.anl.2020.06.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/16/2020] [Accepted: 07/01/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Despite of rapid advances in endoscopic surgery, the gold standard for sinonasal squamous cell carcinoma (SNSCC) surgery has remained the open approach with en-block resection due to the aggressive nature of SNSCC, including frequent recurrence and high mortality rate. For that reason, few studies have focused on SNSCC treated by endoscopic surgery alone. The objective of this study was to evaluate the usefulness of endoscopic surgery for patients with SNSCC. METHODS A retrospective analysis was performed for 15 consecutive SNSCC patients who underwent endoscopic surgery without an open approach. We carefully selected patients whose tumor attachment sites could be fully visualized and completely resected through an endonasal approach. RESULTS Of the fifteen patients, 4 patients (27%) were diagnosed with T1, 7 (47%) with T2, 4 (27%) with T3, and no patients with T4a or T4b disease. Four of the 15 (27%) patients showed positive surgical margins. The 5-yr overall survival, disease-specific survival, and local control rate was 72.4%, 79.6%, and 92.9%, respectively. The 5-yr disease-specific survival for T1, T2, and T3 disease was 100% and 75% and 75%, respectively. Patients with negative surgical margins had a better disease-specific survival rate than did those with positive surgical margins (p = 0.0253). CONCLUSION Endoscopic surgery for patients with SNSCC appears to afford an effective method in selected cases. The achievement of negative surgical margins with a good view of the tumor attachment site was considered to be critical to the management of SNSCC.
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15
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Hiramatsu SI, Ikemura K, Fujisawa Y, Iwamoto T, Okuda M. Concomitant lansoprazole ameliorates cisplatin-induced nephrotoxicity by inhibiting renal organic cation transporter 2 in rats. Biopharm Drug Dispos 2020; 41:239-247. [PMID: 32473602 DOI: 10.1002/bdd.2242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/20/2020] [Accepted: 05/27/2020] [Indexed: 12/12/2022]
Abstract
Cisplatin is used widely for the treatment of multiple solid tumors. Cisplatin-induced nephrotoxicity is caused by renal accumulation of cisplatin via human organic cation transporter 2 (hOCT2). As lansoprazole, a proton pump inhibitor, is known to inhibit hOCT2 activity, lansoprazole might ameliorate cisplatin-induced nephrotoxicity. A previous study showed that concomitant lansoprazole administration ameliorated nephrotoxicity in patients receiving cisplatin. However, the detailed mechanism remains to be clarified. In the present study, the drug-drug interaction between lansoprazole and cisplatin was examined using hOCT2-expressing cultured cells and rat renal slices. Moreover, the effect of lansoprazole on cisplatin-induced nephrotoxicity and the pharmacokinetics of cisplatin in rats was investigated. In the uptake study, lansoprazole potently inhibited the uptake of cisplatin in hOCT2-expressing cultured cells and rat renal slices. The in vivo rat study showed that concomitant lansoprazole significantly ameliorated cisplatin-induced nephrotoxicity and reduced the renal accumulation of platinum up to approximately 60% of cisplatin alone at 72 h after cisplatin intraperitoneal administration. Furthermore, the renal uptake of platinum at 3 min after intravenous cisplatin administration in rats with cisplatin and lansoprazole decreased to 78% of rats with cisplatin alone. In addition, there was no significant difference in the plasma platinum concentration between rats treated with and without lansoprazole at 3 min after cisplatin intravenous administration. These findings suggested that concomitant lansoprazole ameliorated cisplatin-induced nephrotoxicity by inhibiting rOCT2-mediated cisplatin uptake in rats, thus decreasing cisplatin accumulation in the kidney. The present findings provided important information for the establishment of novel protective approaches to minimize cisplatin-induced nephrotoxicity.
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Affiliation(s)
- Shun-Ichi Hiramatsu
- Department of Clinical Pharmacy and Biopharmaceutics, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kenji Ikemura
- Department of Pharmacy, Osaka University Hospital, Suita, Osaka, Japan
| | - Yutaka Fujisawa
- Faculty of Pharmaceutical Sciences, Suzuka University of Medical Science, Suzuka, Mie, Japan
| | - Takuya Iwamoto
- Department of Pharmacy, Mie University Hospital, Tsu, Mie, Japan
| | - Masahiro Okuda
- Department of Pharmacy, Osaka University Hospital, Suita, Osaka, Japan
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16
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Kong A, Good J, Kirkham A, Savage J, Mant R, Llewellyn L, Parish J, Spruce R, Forster M, Schipani S, Harrington K, Sacco J, Murray P, Middleton G, Yap C, Mehanna H. Phase I trial of WEE1 inhibition with chemotherapy and radiotherapy as adjuvant treatment, and a window of opportunity trial with cisplatin in patients with head and neck cancer: the WISTERIA trial protocol. BMJ Open 2020; 10:e033009. [PMID: 32184305 PMCID: PMC7076237 DOI: 10.1136/bmjopen-2019-033009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 01/15/2020] [Accepted: 01/30/2020] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Patients with head and neck squamous cell carcinoma with locally advanced disease often require multimodality treatment with surgery, radiotherapy and/or chemotherapy. Adjuvant radiotherapy with concurrent chemotherapy is offered to patients with high-risk pathological features postsurgery. While cure rates are improved, overall survival remains suboptimal and treatment has a significant negative impact on quality of life.Cell cycle checkpoint kinase inhibition is a promising method to selectively potentiate the therapeutic effects of chemoradiation. Our hypothesis is that combining chemoradiation with a WEE1 inhibitor will affect the biological response to DNA damage caused by cisplatin and radiation, thereby enhancing clinical outcomes, without increased toxicity. This trial explores the associated effect of WEE1 kinase inhibitor adavosertib (AZD1775). METHODS AND ANALYSIS This phase I dose-finding, open-label, multicentre trial aims to determine the highest safe dose of AZD1775 in combination with cisplatin chemotherapy preoperatively (group A) as a window of opportunity trial, and in combination with postoperative cisplatin-based chemoradiation (group B).Modified time-to-event continual reassessment method will determine the recommended dose, recruiting up to 21 patients per group. Primary outcomes are recommended doses with predefined target dose-limiting toxicity probabilities of 25% monitored up to 42 days (group A), and 30% monitored up to 12 weeks (group B). Secondary outcomes are disease-free survival times (groups A and B). Exploratory objectives are evaluation of pharmacodynamic (PD) effects, identification and correlation of potential biomarkers with PD markers of DNA damage, determine rate of resection status and surgical complications for group A; and quality of life in group B. ETHICS AND DISSEMINATION Research Ethics Committee, Edgbaston, West Midlands (REC reference 16/WM/0501) initial approval received on 18/01/2017. Results will be disseminated via peer-reviewed publication and presentation at international conferences. TRIAL REGISTRATION NUMBER ISRCTN76291951 and NCT03028766.
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Affiliation(s)
- Anthony Kong
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - James Good
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Amanda Kirkham
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Joshua Savage
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Rhys Mant
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Joanna Parish
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Rachel Spruce
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | | | - Stefano Schipani
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, Glasgow, UK
| | | | - Joseph Sacco
- Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, Wirral, UK
| | | | - Gary Middleton
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Christina Yap
- Cancer Research UK Clinical Trials Unit, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Hisham Mehanna
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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Porceddu SV, Scotté F, Aapro M, Salmio S, Castro A, Launay-Vacher V, Licitra L. Treating Patients With Locally Advanced Squamous Cell Carcinoma of the Head and Neck Unsuitable to Receive Cisplatin-Based Therapy. Front Oncol 2020; 9:1522. [PMID: 32039012 PMCID: PMC6987395 DOI: 10.3389/fonc.2019.01522] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
Concurrent chemoradiotherapy with high-dose cisplatin (100 mg/m2 every 3 weeks) is the preferred regimen with curative intent for patients with unresected locally advanced squamous cell carcinoma of the head and neck (LA SCCHN). This treatment is associated with acute and late toxicities, including myelosuppression, severe nausea/vomiting, irreversible renal failure, hearing loss, and neurotoxicity. Because of cisplatin's safety profile, treatment adherence to high-dose cisplatin can be suboptimal. Patients commonly receive less than the total cumulative target dose of 300 mg/m2 or the minimum recommended dose of 200 mg/m2, which can have a negative impact on locoregional control and survival. Alternatively, cetuximab plus radiotherapy may be most suitable for patients at high risk of non-adherence to high-dose cisplatin. We discuss the baseline characteristics dictating the unsuitability/borderline unsuitability of cisplatin and the available alternative evidence-based treatment regimens for patients with LA SCCHN. We non-systematically reviewed published phase II and III trials and retrospective analyses of high-dose cisplatin-based chemoradiation in LA SCCHN conducted between 1987 and 2018, focusing on recent key phase III studies. We defined the baseline characteristics and associated prescreening tests to determine unsuitability and borderline unsuitability for high-dose cisplatin in combination with radiotherapy in patients with LA SCCHN. Patients with any pre-existing comorbidities that may be exacerbated by high-dose cisplatin treatment can be redirected to a non-cisplatin-based option to minimize the risk of treatment non-adherence. High-dose cisplatin plus radiotherapy remains the preferred treatment for fit patients with unresected LA SCCHN; patients who are unsuitable or borderline unsuitable for high-dose cisplatin could be identified using available tests for potential comorbidities and should be offered alternative treatments, such as cetuximab plus radiotherapy.
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Affiliation(s)
- Sandro V Porceddu
- University of Queensland, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Florian Scotté
- Department of Medical Oncology and Supportive Care, Hôpital Foch, Suresnes, France
| | - Matti Aapro
- Genolier Cancer Center, Genolier, Switzerland
| | | | - Ana Castro
- Lenitudes Medical Center & Research, Santa Maria da Feira, Portugal
| | | | - Lisa Licitra
- Fondazione IRCCS Istituto Nazionale Tumori and University of Milan, Milan, Italy
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Nanda R, Katke A, Suneetha N, Thejaswini B, Pasha T, Jagannath KP, Giri GV, Babu KG. A prospective randomized study comparing concurrent chemoradiation with weekly and 3 weekly cisplatin in locally advanced oropharyngeal carcinoma. South Asian J Cancer 2019; 8:178-182. [PMID: 31489293 PMCID: PMC6699241 DOI: 10.4103/sajc.sajc_270_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The chemotherapy schedules with cytotoxic dose or weekly regimes are still challenging, weighing the benefits versus toxicities. This prospective randomized study is an attempt to assess the efficacy of two schedules of cisplatin in management of locally advanced HNSCC. OBJECTIVES The objectives of this study was to evaluate tolerance, tumour response and toxicities of concurrent chemoradiation with cisplatin in weekly and three weekly regimes. METHODS Locally advanced oropharyngeal squamous cell carcinoma patients fit for concurrent chemoradiation with cisplatin 40 mg/m2 (weekly) and 100 mg/m2 (3 weekly) were randomized to Arm A and B concurrently with radiotherapy of 70Gy/35frs/7 weeks. STATISTICAL ANALYSIS Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between the groups. The statistical software SPSS 15.0 was used. RESULTS Between December 2010 and January 2013, 60 patients were enrolled. The median cycles of cisplatin in Arm-A was 5 and 2 in Arm-B. The complete response of 80.9% vs 75% and partial response of 14.3% vs 12.5% was observed in both arms respectively. There was no statistical difference in acute radiation and hematological toxicities between the two groups. With median follow up of 28 months, the 2 and 5 years overall survival was 55% and 58%; 41.6% and 32.3% in arms A and B respectively. CONCLUSION In our study of locally advanced oropharyngeal carcinoma treated with radical radiotherapy comparing concurrent chemotherapy with cisplatin weekly vs 3 weekly had no significant difference in overall response, complete response and acute toxicities.
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Affiliation(s)
- R. Nanda
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Aradhana Katke
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - N. Suneetha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - B. Thejaswini
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - Tanvir Pasha
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K. P. Jagannath
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - G. V. Giri
- Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
| | - K. Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India
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Morse RT, Ganju RG, TenNapel MJ, Neupane P, Kakarala K, Shnayder Y, Chen AM, Lominska CE. Weekly cisplatin chemotherapy dosing versus triweekly chemotherapy with concurrent radiation for head and neck squamous cell carcinoma. Head Neck 2019; 41:2492-2499. [DOI: 10.1002/hed.25717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/23/2019] [Accepted: 02/05/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ryan T. Morse
- Department of Radiation Oncology; University of Kansas Cancer Center, Kansas University Medical Center; Kansas City Kansas
| | - Rohit G. Ganju
- Department of Radiation Oncology; University of Kansas Cancer Center, Kansas University Medical Center; Kansas City Kansas
| | - Mindi J. TenNapel
- Department of Radiation Oncology; University of Kansas Cancer Center, Kansas University Medical Center; Kansas City Kansas
| | - Prakash Neupane
- Department of Medical Oncology; University of Kansas Cancer Center, Kansas University Medical Center; Kansas City Kansas
| | - Kiran Kakarala
- Department of Otolaryngology; University of Kansas Cancer Center, Kansas University Medical Center; Kansas City Kansas
| | - Yelizaveta Shnayder
- Department of Otolaryngology; University of Kansas Cancer Center, Kansas University Medical Center; Kansas City Kansas
| | - Allen M. Chen
- Department of Radiation Oncology; University of California, Irvine, UC Irvine School of Medicine, Orange; California
| | - Christopher E. Lominska
- Department of Radiation Oncology; University of Kansas Cancer Center, Kansas University Medical Center; Kansas City Kansas
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20
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Helfenstein S, Riesterer O, Meier UR, Papachristofilou A, Kasenda B, Pless M, Rothschild SI. 3-weekly or weekly cisplatin concurrently with radiotherapy for patients with squamous cell carcinoma of the head and neck - a multicentre, retrospective analysis. Radiat Oncol 2019; 14:32. [PMID: 30744643 PMCID: PMC6371614 DOI: 10.1186/s13014-019-1235-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/04/2019] [Indexed: 12/20/2022] Open
Abstract
Background Concurrent chemoradiotherapy with cisplatin is standard for patients (pts) with loco-regionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) and for patients with resected SCCHN with high-risk features. The standard regimen includes 3-weekly cisplatin, but weekly regimens are often used to lower toxicity. Reaching a cumulative dose of ≥200 mg/m2 cisplatin was shown being associated with improved outcome. We herein investigated cumulative dose reached and toxicities between the 3-weekly and weekly cisplatin regimens with concurrent radiotherapy. Methods Multicentre, retrospective analysis of all patients undergoing combined RCT with cisplatin treated at 3 centres in Switzerland between 06/2008 and 12/2015. Results Three hundred fourteen pts. were included (3-weekly, N = 127; weekly, N = 187). Median cumulative cisplatin dose was 200 mg/m2 (IQR 150–300) for pts. treated with a 3-weekly schedule and 160 mg/m2 (120–240) for the weekly schedule, consequently more pts. treated with a 3-weekly schedule reached a cumulative dose ≥200 mg/m2 (75.6% vs. 47.1%, p < 0.001). This association was also observed in multivariable analysis adjusted for age and sex (OR 3.46, 95% confidence interval [CI], 2.1–5.7). The 3-weekly regimen led to a higher rate of acute renal toxicity (33.1% vs. 20.9%, p = 0.022). In the landmark analysis, we could not confirm that a cisplatin dose ≥200 mg/m2 is associated with better survival (HR 1.3, 95% CI 0.8–1.9). Conclusions Significantly more patients receive a cumulative cisplatin dose of ≥200 mg/m2, when treated with a 3-weekly schedule compared to weekly dosing. The previously reported association between a cumulative cisplatin dose ≥200 mg/m2 and improved outcome could not be shown in our study.
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Affiliation(s)
- Seth Helfenstein
- Department Internal Medicine, University Hospital Basel, Medical Oncology, Petersgraben 4, 4031, Basel, Switzerland
| | - Oliver Riesterer
- Clinic for Radiation Oncology, University Hospital and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Urs R Meier
- Cantonal Hospital Winterthur, Clinic for Radiation Oncology, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Alexandros Papachristofilou
- Clinic for Radiotherapy and Radio-Oncology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Benjamin Kasenda
- Department Internal Medicine, University Hospital Basel, Medical Oncology, Petersgraben 4, 4031, Basel, Switzerland
| | - Miklos Pless
- Medical Oncology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Sacha I Rothschild
- Department Internal Medicine, University Hospital Basel, Medical Oncology, Petersgraben 4, 4031, Basel, Switzerland.
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Use of 18F-FDG PET/CT Imaging for Radiotherapy Target Volume Delineation after Induction Chemotherapy and for Prognosis of Locally Advanced Squamous Cell Carcinoma of the Head and Neck. ACTA ACUST UNITED AC 2018; 54:medicina54060107. [PMID: 30544718 PMCID: PMC6306774 DOI: 10.3390/medicina54060107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/23/2018] [Accepted: 11/29/2018] [Indexed: 12/12/2022]
Abstract
Background and objectives: Induction chemotherapy (ICT) before definitive chemoradiation (CRT) gives high response rates in locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). However, pre-ICT gross tumor volume (GTV) for radiotherapy (RT) planning is still recommended. As 18F-FDG PET/CT has an advantage of biological tumor information comparing to standard imaging methods, we aimed to evaluate the feasibility of 18F-FDG PET/CT-based post-ICT GTV delineation for RT planning in LA-SCCHN and to assess the prognostic value of PET parameters: maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG). Methods: 47 LA-SCCHN patients were treated with 3 cycles of ICT (docetaxel, cisplatin, and 5-fluorouracil) followed by CRT (70 Gy in 35 fractions with weekly cisplatin). Pre- and post-ICT PET/CT examinations were acquired. Planning CT was co-registered with post-ICT PET/CT and RT target volumes were contoured according to post-ICT PET. Post-ICT percentage decrease of SUVmax, MTV and TLG in primary tumor and metastatic regional lymphnodes (LN) was counted. Loco-regional failure patterns, 3-year progression free (PFS) and overall survival (OS) were evaluated. Results: 3-year PFS and OS rates for study population were 67% and 61% respectively. 31.9% of patients progressed loco-regionally. All progress was localized in high-to-intermediate dose (60⁻70 Gy) RT volumes and none in low dose (50 Gy) volumes. Decrease of SUVmax ≥ 74% (p = 0.04), MTV ≥ 68% (p = 0.03), TLG ≥ 76% (p = 0.03) in primary tumor, and LN TLG decrease ≥ 74% (p = 0.03) were associated with PFS. Decrease of primary tumor SUVmax ≥ 74% (p = 0.04), MTV ≥ 69% (p = 0.03), TLG ≥ 74% (p = 0.02) and LN TLG ≥ 73% (p = 0.02) were prognostic factors for OS. Conclusions: According to our results, 18F-FDG PET/CT-based post-ICT GTV delineation is feasible strategy without negative impacts on loco-regional control and survival. Percentage decrease of metabolic PET parameters SUVmax, MTV and TLG has a prognostic value in LA-SCCHN.
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Hayashi Y, Minamiyama S, Ohya T, Iida M, Iwai T, Koizumi T, Oguri S, Hirota M, Kioi M, Hata M, Taguri M, Mitsudo K. Daily Cisplatin and Weekly Docetaxel versus Weekly Cisplatin Intra-Arterial Chemoradiotherapy for Late T2-3 Tongue Cancer: A Pilot and Feasibility Trial. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E52. [PMID: 30344283 PMCID: PMC6174343 DOI: 10.3390/medicina54040052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022]
Abstract
Background and objectives: The aim of present study was to compare the treatment results of daily cisplatin (CDDP), weekly docetaxel (DOC) intra-arterial infusion chemotherapy combined with radiotherapy (DIACRT) regimen and weekly CDDP intra-arterial infusion chemotherapy combined with radiotherapy (WIACRT) for patients with tongue cancer. Materials and Methods: Between January 2007 and December 2016, a total of 11 patients treated with WIACRT and 45 patients treated with DIACRT were enrolled in the present study. In the DIACRT group, 25 patients had late T2, and 20 patients had T3. A total of nine patients had late T2 and two had T3 in WIACRT (p = NS). In DIACRT, the treatment schedule consisted of intra-arterial chemotherapy (DOC, total 60 mg/m²; CDDP, total 150 mg/m²) and daily concurrent radiotherapy (RT) (total, 60 Gy). In WIACRT, the treatment schedule consisted of intra-arterial chemotherapy (CDDP, total 360 mg/m²) and daily concurrent RT (total, 60 Gy). Results: The median follow-up periods for DIACRT and WIACRT were 61 and 66 months, respectively. The five-year local control (LC) and overall survival (OS) rate were 94.5% and 89.6% for the DIACRT group, and 60.6% and 63.6% for the WIACRT group, respectively. The LC rate and OS of the DIACRT group were significantly higher than those of the WIACRT group. As regards toxicities, no treatment-related deaths were observed during the follow-up periods in both groups. Conclusions: DIACRT was found to be feasible and effective for patients with tongue cancer and could become a new treatment modality.
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Affiliation(s)
- Yuichiro Hayashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Shuhei Minamiyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Takashi Ohya
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masaki Iida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Toshiyuki Koizumi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Makoto Hirota
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Mitomu Kioi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masaharu Hata
- Department of Radiation Oncology, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masataka Taguri
- Department of Biostatistics, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
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23
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Carlsson L, Bratman SV, Siu LL, Spreafico A. The Cisplatin Total Dose and Concomitant Radiation in Locoregionally Advanced Head and Neck Cancer: Any Recent Evidence for Dose Efficacy? Curr Treat Options Oncol 2018; 18:39. [PMID: 28555374 DOI: 10.1007/s11864-017-0482-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OPINION STATEMENT Concurrent chemoradiotherapy (CRT) with high-dose (100 mg/m2), single-agent cisplatin is considered the standard of care for locoregionally advanced head and neck cancer (LAHNC). Poor compliance often due to significant treatment-related toxicities observed during CRT regimen has stimulated research efforts to examine for evidence of the optimal cumulative cisplatin dose and schedule. The findings from this systematic literature review demonstrate that there are insufficient prospective, randomized controlled data to determine the optimal total dose (and schedule) of cisplatin to administer concomitantly with radiotherapy in the treatment of LAHNC. Given the clinical challenges associated with administering concurrent CRT with single-agent high-dose cisplatin, as well as the long-term toxicities accompanying this treatment, an examination of the available literature for evidence of dose efficacy is of continued clinical interest. Moving forward, it is critical that researchers include complete descriptions of key disease and treatment variables (i.e. treatment compliance and HPV status) to inform and strengthen clinical decisions. The substantial heterogeneity of LAHNC has led to the focus of recent research efforts to risk-stratify using a combination of clinical and molecular markers (e.g. HPV status). Thus, the optimal total dose (and schedule) of cisplatin may need to be modified to reflect the specific characteristics of the individual patient subpopulations being treated. At present, CRT remains the standard of care for LAHNC, but this field is rapidly evolving. National and international clinical trials are ongoing to evaluate treatment de-intensification in favourable risk patient subsets and treatment intensification in poor-risk patient subsets, these will provide evidence-based guidance to individualize therapy with the ultimate goal of improving patient outcomes.
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Affiliation(s)
- Lindsay Carlsson
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada.
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Matsuyama H, Yamazaki K, Okabe R, Ueki Y, Shodo R, Omata J, Sato Y, Ota H, Takahashi T, Tomita M, Yokoyama Y, Togashi T, Aoyama H, Abe E, Saijo Y, Katsura K, Soga M, Sugita T, Matsumoto Y, Tsuchida E, Horii A. Multicenter phase I/II study of chemoradiotherapy with high-dose CDDP for head and neck squamous cell carcinoma in Japan. Auris Nasus Larynx 2018; 45:1086-1092. [PMID: 29567334 DOI: 10.1016/j.anl.2018.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/05/2018] [Accepted: 02/27/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Recent data indicated that concurrent chemoradiotherapy (CCRT) using high dose cisplatin (CDDP) is the most useful treatment for advanced head and neck squamous cell carcinoma (SCC). Regarding the dose of CDDP, 100mg/m2 is most recommended in Western countries. However, in terms of a balance of efficacy and adverse events, appropriate dose of cytotoxic drugs such as CDDP may be different among the different ethnic groups. In this multicenter phase I/II study, we aimed to identify the optimal dose of CDDP in CCRT for patients with advanced head and neck SCC in the Japanese. METHODS Patients were eligible for inclusion if they had head and neck SCC that was treated with radical CCRT comprising whole-neck irradiation of the primary lesion and level II-IV lymph nodes on both sides. For the phase I study, a CDDP dose was 70mg/m2 for level 0, 80mg/m2 for level 1, and 100mg/m2 for level 2. Maximum tolerated dose (MTD) and dose-limiting toxicity (DLT) were examined by phase I trial, by which CDDP dose for phase II was determined. The primary endpoint for the phase II was CCRT completion rate, and the secondary endpoint was full-dose-CCRT completion rate, the percentage of patients receiving a total CDDP dose of ≥200mg/m2, response rate, and incidences of adverse events. RESULTS A CDDP dose of 100mg/m2 was the MTD for phase I, and the recommended dose for phase II was 80 mg/m2. Forty-seven patients were evaluated in the phase II trial. CCRT completion rate, full-dose-CCRT rate, and the percentage of patients receiving a total CDDP dose of ≥200mg/m2, were 93.6%, 78.7%, and 93.6%, respectively. One patient (2.1%) developed grade 2 renal dysfunction, and no patient developed febrile neutropenia or a grade 4 adverse event. CONCLUSION The present phase I study indicated that a CDDP dose of 80mg/m2 is the optimal dose in terms of safety. The phase II study revealed that CCRT completion rate, response rate, and rates of adverse events were not inferior for a CDDP dose of 80mg/m2 as compared with a dose of 100mg/m2, and a dose of 80mg/m2 is therefore recommended in CCRT for the Japanese. This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; identification No. UMIN000010369).
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Affiliation(s)
- Hiroshi Matsuyama
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Keisuke Yamazaki
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryuichi Okabe
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yushi Ueki
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ryusuke Shodo
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jo Omata
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuichiro Sato
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hisayuki Ota
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Takeshi Takahashi
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Masahiko Tomita
- Department of Otorhinolaryngology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Yusuke Yokoyama
- Department of Otorhinolaryngology, Nagaoka Red Cross Hospital, Niigata, Japan
| | - Takafumi Togashi
- Department of Otorhinolaryngology, Niigata City General Hospital, Niigata, Japan
| | - Hidefumi Aoyama
- Departments of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Eisuke Abe
- Departments of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuo Saijo
- Departments of Medical Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kouji Katsura
- Departments of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Marie Soga
- Departments of Oral and Maxillofacial Radiology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tadashi Sugita
- Department of Radiation Therapy, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yasuo Matsumoto
- Department of Radiation Therapy, Niigata Cancer Center Hospital, Niigata, Japan
| | - Emiko Tsuchida
- Department of Radiation Oncology, Niigata City General Hospital, Niigata, Japan
| | - Arata Horii
- Departments of Otolaryngology Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Mackiewicz J, Rybarczyk-Kasiuchnicz A, Łasińska I, Mazur-Roszak M, Świniuch D, Michalak M, Kaźmierska J, Studniarek A, Krokowicz Ł, Bajon T. The comparison of acute toxicity in 2 treatment courses: Three-weekly and weekly cisplatin treatment administered with radiotherapy in patients with head and neck squamous cell carcinoma. Medicine (Baltimore) 2017; 96:e9151. [PMID: 29390445 PMCID: PMC5758147 DOI: 10.1097/md.0000000000009151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
The most appropriate cisplatin treatment schedule delivered with radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) is unknown. The aim of this study was to compare the acute toxicity and its impact on the course of the treatment, administered cisplatin and radiation doses, the length of hospitalization and supportive drugs administration in patients with HNSCC receiving 2 different cisplatin treatment schedules administered with radiotherapy.In this retrospective analysis, 104 patients with HNSCC were enrolled. Patients received radiation concurrently with 100 mg/m cisplatin administered 3-weekly (n = 50; group A) or 35 to 40 mg/m cisplatin administered weekly (n = 54; group B). Chemoradiotherapy was performed in locally and/or regionally advanced disease (stage III-IV), in a definitive radical upfront setting (71.1%) or after surgical resection in patients with high-risk factors (28.8%).Both study groups were equally distributed in terms of age, gender, stage of the disease, Eastern Cooperative Oncology Group performance score, chronic diseases and primary tumor site. The schedule of cisplatin dosing did not influence the duration of hospitalization, the number of additional supportive drugs (antibiotics, opioids) administered or total doses of received radiotherapy. However, postponement of radiotherapy due to adverse events was significantly more frequent in patients treated with 35/40 mg/m (55.56% vs 32%; P = .015). Furthermore, patients treated with weekly treatment schedule received lower total cisplatin dose (160 mg/m) in comparison to those treated with the 3-weekly schedule (200 mg/m). Grade 3 and 4 mucositis occurred more frequently in patients treated in group A (70% vs 50%; P = .037). Leukopenia was also observed more frequently in group A (88% vs 72.2%; P = .04), however there was no difference in grade 3/4 leukopenia between both study arms. There was no statistically significant difference in any other adverse effects.These results do not demonstrate the advantage of modified weekly schedule over standard 3-weekly cisplatin treatment plan. However, severe mucositis occurred more frequently in patients receiving 3-weekly cisplatin, both chemotherapy schedules seemed to present similar toxicity. Due to conflicting efficacy and toxicity, the results and compliance of weekly and 3-weekly cisplatin schedules should be evaluated in further randomized, controlled trials and retrospective studies.
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Affiliation(s)
- Jacek Mackiewicz
- Department of Medical and Experimental Oncology, Heliodor Swiecicki Clinical, Hospital, Poznan University of Medical Sciences, Poland
- Department of Biology and Environmental Studies, University of Medical Sciences, Poznan, Poland
- Department of Diagnostics and Cancer Immunology, Greater Poland Cancer Centre, Poznan, Poland
- Department of Medical Oncology, Malgorzata Medical Center, Srem
| | | | - Izabela Łasińska
- Department of Medical and Experimental Oncology, Heliodor Swiecicki Clinical, Hospital, Poznan University of Medical Sciences, Poland
- Department of Medical Oncology, Malgorzata Medical Center, Srem
| | | | - Daria Świniuch
- Department of Medical Oncology, Malgorzata Medical Center, Srem
| | - Michał Michalak
- Department of Computer Sciences and Statistics Poznan University of Medical Sciences
| | - Joanna Kaźmierska
- Radiotherapy Department II Greater Poland Cancer Center
- Electroradiology Department, University of Medical Sciences, Poznan, Poland
| | - Adam Studniarek
- Department of General Surgery Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Łukasz Krokowicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poznan, Poland
| | - Tomasz Bajon
- Radiotherapy Department II Greater Poland Cancer Center
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26
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Jacinto JK, Co J, Mejia MB, Regala EE. The evidence on effectiveness of weekly vs triweekly cisplatin concurrent with radiotherapy in locally advanced head and neck squamous cell carcinoma (HNSCC): a systematic review and meta-analysis. Br J Radiol 2017; 90:20170442. [PMID: 29053029 DOI: 10.1259/bjr.20170442] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study aims to synthesize the current available evidences on the effectiveness of weekly vs triweekly cisplatin concurrent with radiotherapy in the primary and adjuvant treatment of locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS A systematic review and meta-analysis of literature were undertaken to assess the effectiveness of weekly vs triweekly schedule in primary and adjuvant treatment for HNSCC with adverse risk features. Search of relevant articles from electronic database from 2000 to March 2016 and appraisal of studies were done. RESULTS Only one randomized controlled trial (RCT) and six retrospective studies were included in this review. The RCT showed less severe mucositis (75 vs 38.5%, p = 0.012) and more patients receiving at least 200 mg/m2 (62.5% vs 88.5%, p = 0.047) of cisplatin in triweekly arm. There was no difference in 1-year progression-free survival (60% vs 71.1%, p = 0.806) and 1-year overall survival (OS) (71.6 vs 79.3%, p = 0.978) between the weekly and triweekly arm. Pooling of data from six studies showed no difference in 5-year progression-free survival (RR 0.84, 95%, CI 0.67-1.07), 5-year OS (RR 0.88, 95% CI 0.73-1.07), severe renal events (RR 0.66, 95% CI 0.42-1.04), severe mucositis (RR 0.92, 95% CI 0.71-1.21), severe dermatitis (RR 0.61, 95% CI 0.37-1.03), treatment interruptions (RR 1.06, 95% CI 0.74-1.52) and number of patients receiving at least 200 mg/m2 (RR 0.83, 95% CI 0.67-1.03). CONCLUSION The current evidence showed that weekly schedule is not superior to triweekly in improving oncological outcomes and decreasing early effects of treatment. In the absence of compelling data, triweekly schedule should remain the standard of care while more RCTs are warranted. Advances in knowledge: While some have proposed that low-dose weekly cisplatin is safer and less toxic, this study emphasized that there is no difference in acute toxicity of the two schedules and it is safe to utilize high-dose cisplatin every 3 weeks to reach the threshold dose of 200 mg/m2 faster. Uniquely, this study excluded nasopharyngeal cancer patients as the biology and treatment response are different with other HNSCC.
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Affiliation(s)
- Jc Kennetth Jacinto
- 1 Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Jayson Co
- 1 Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Michael Benedict Mejia
- 1 Department of Radiation Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
| | - Eugenio Emmanuel Regala
- 2 Department of Medicine, Section of Medical Oncology, Benavides Cancer Institute, University of Santo Tomas Hospital, Manila, Philippines
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Abstract
OBJECTIVE We aimed to evaluate the prognostic factors and efficacy of treatment modalities for patients with temporal bone cancer, and to determine if definitive chemoradiotherapy (CRT) for advanced-stage disease can provide a substitute for highly invasive surgeries. STUDY DESIGN Retrospective case series. SETTING Tertiary referral center. PATIENTS Sixty-six patients with previously untreated squamous cell carcinoma of the temporal bone treated with curative intent between April 1997 and March 2015. INTERVENTION Surgery alone, radiotherapy (RT) alone, surgery followed by RT or definitive CRT. MAIN OUTCOME MEASURE The overall survival (OS) rate. RESULTS The 5-year OS rate for each T classification was 100% for T1, 76.2% for T2, 55.6% for T3, and 36.7% for T4. Univariable and multivariable analysis showed that T classification was an independent predictor of the OS rate (hazard ratio 5.66; 95% confidence interval 1.51-27.0; p = 0.015). Analysis by treatment modality revealed that the 5-year OS rate for patients with T1-2 was 100% for surgery and 81.3% for RT alone. The rate for patients with T3-4 was 52.1% for definitive CRT and 55.6% for surgery followed by RT with or without chemotherapy. CONCLUSIONS Patients with T1-2 benefited from surgical intervention without significant morbidity or mortality. Our findings also suggested that definitive CRT might be appropriate as the first-line treatment for T3-4, especially in cases with unresectable tumors.
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Onseng K, Johns NP, Khuayjarernpanishk T, Subongkot S, Priprem A, Hurst C, Johns J. Beneficial Effects of Adjuvant Melatonin in Minimizing Oral Mucositis Complications in Head and Neck Cancer Patients Receiving Concurrent Chemoradiation. J Altern Complement Med 2017; 23:957-963. [PMID: 28657801 DOI: 10.1089/acm.2017.0081] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Oral mucositis is a major cause of pain and delayed cancer treatment leading to poor survival in head and neck cancer patients receiving concurrent chemoradiation. The study evaluated the effect of adjuvant melatonin on minimizing oral mucositis complications to reduce these treatment delays and interruptions. DESIGN A randomized, double-blind, double dummy, placebo-controlled clinical trial. SETTING Ubon Ratchathani Cancer Hospital, Thailand. PARTICIPANTS Thirty-nine head and neck cancer patients receiving concurrent chemoradiation (5 days/week of radiation plus chemotherapy three or six cycles). METHODS Patients were randomized to receive 20 mg melatonin gargle (or matched placebo) before each irradiation, and 20 mg melatonin capsules (or matched placebo) taken nightly during 7 weeks of concurrent chemoradiation. Endpoints were oral mucositis events (incidence and time to grade 3 mucositis or grade 2 xerostomia), pain medication consumption and quality of life (QOL). RESULTS Melatonin group reported lower incidence of grade 3 oral mucositis (42% vs. 55%) and grade 2 xerostomia (20% vs. 21%); no statistical significance was detected. Melatonin regimen delayed onset of grade 3 mucositis (median 34 days vs. 50 days; p = 0.0318), allowing median time of 16 more patient visits before its onset and fewer interrupted treatments due to oral mucositis were reported (n = 1 vs. n = 5). There was no difference of grade 2 xerostomia (median 32 days vs. 50 days; p = 0.624). Morphine consumption was also reduced (median 57 mg vs. 0 mg; p = 0.0342), while QOL was comparable during the study period. CONCLUSION Adjuvant melatonin delayed the onset of oral mucositis, which enables uninterrupted cancer treatment and reduced the amount of morphine used for pain treatment.
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Affiliation(s)
- Kittipong Onseng
- 1 Melatonin Research Group, Faculty of Pharmaceutical Sciences, Khon Kaen University , Khon Kaen, Thailand
| | | | | | - Suphat Subongkot
- 3 Faculty of Pharmaceutical Sciences, Khon Kaen University , Khon Kaen, Thailand
| | - Aroonsri Priprem
- 3 Faculty of Pharmaceutical Sciences, Khon Kaen University , Khon Kaen, Thailand
| | - Cameron Hurst
- 4 Faculty of Medicine, Biostatistics Center, Chulalongkorn University , Bangkok, Thailand
| | - Jeffrey Johns
- 1 Melatonin Research Group, Faculty of Pharmaceutical Sciences, Khon Kaen University , Khon Kaen, Thailand
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Perez CA, Wu X, Amsbaugh MJ, Gosain R, Claudino WM, Yusuf M, Roberts T, Jain D, Jenson A, Khanal S, Silverman CI, Tennant P, Bumpous JM, Dunlap NE, Rai SN, Redman RA. High-dose versus weekly cisplatin definitive chemoradiotherapy for HPV-related oropharyngeal squamous cell carcinoma of the head and neck. Oral Oncol 2017; 67:24-28. [DOI: 10.1016/j.oraloncology.2017.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/14/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
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Negi P, Kingsley PA, Srivastava H, Sharma SK. Three Weekly Versus Weekly Cisplatin as Radiosensitizer in Head and Neck Cancer: a Decision Dilemma. Asian Pac J Cancer Prev 2017; 17:1617-23. [PMID: 27221829 DOI: 10.7314/apjcp.2016.17.4.1617] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cisplatin-based concurrent chemoradiation plays an undisputed key role as definitive treatment in unresectable patients with locally advanced squamous cell carcinoma head and neck or as an organ preservation strategy. Treatment with 100 mg/m2 3-weekly cisplatin is considered the standard of care but is often associated with several adverse events. The optimum drug schedule of administration remains to be defined and presently, there is insufficient data limiting conclusions about the relative tolerability of one regimen over the other. This review addresses regarding the optimal dose schedule of cisplatin focusing mainly on three-weekly and weekly dose of cisplatin based concurrent chemoradiotherapy in locally advanced head and neck cancer with an emphasis on mucositis, dermatitis, systemic toxicity, compliance, and treatment interruptions. To derive a definitive conclusion, large prospective randomized trials are needed directly comparing standard 3-weekly cisplatin (100 mg/m2) with weekly schedule (30 - 40 mg/m2) of concurrent cisplatin based chemoradiotherapy in locally advanced squamous cell carcinoma head and neck.
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Affiliation(s)
- Preety Negi
- Radiation Oncology, Assistant Professor, 2Radiation Oncology, Professor, Christian Medical College and Hospital, Ludhiana , Ludhian, India E-mail :
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Sahoo TK, Samanta DR, Senapati SN, Parida K. A Comparative Study on Weekly Versus Three Weekly Cisplatinum Based Chemoradiation in Locally Advanced Head and Neck Cancers. J Clin Diagn Res 2017; 11:XC07-XC11. [PMID: 28274031 DOI: 10.7860/jcdr/2017/24765.9293] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/04/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Head and Neck Cancers constitute around 30% of cancers occurring in India and majority of cases present with locoregionally advanced disease. Cisplatin based concurrent chemoradiation is the most common modality of definitive treatment in these advanced cases. However, it is unclear regarding priority of weekly versus three weekly cisplatin based concurrent chemoradiation schedule in treatment of such advanced diseases. AIM To evaluate the efficacy in terms of response, locoregional control, and disease status in both the arms, and to compare the acute and late toxicity in both arms. MATERIALS AND METHODS Thirty untreated patients of locally advanced Squamous Cell Carcinoma of head and neck were randomized into two arms: Arm A (n=15) patients received injection cisplatin 30 mg/m2 weekly along with radiation; Arm B (n=15) patients received injection cisplatin 100 mg/m2 on a three weekly basis along with radiation. Radiotherapy was delivered to a total dose of 66 Gy in conventional fractionation schedule in telecobalt machine. RESULTS Major toxicities included mucositis, dermatitis, vomiting, neutropenia, and anaemia. There was a trend towards increase in grade-III leukopenia and grade-III dermatitis in arm A compared to arm B, and increase in grade-III mucositis and grade-III vomiting in arm B in comparison to arm A although statistically not significant. Within a median follow-up of seven months, in arm A complete response was 73.33% (11/15) and partial response was 26.67%; whereas in arm B complete response was 85.71% (12/14) and partial response was 14.29%, which was not statistically significant. However, there was a trend towards better efficacy in arm B. CONCLUSION We conclude that, weekly cisplatin arm is as good as three weekly cisplatin arms. But efficacy is not statistically significant. However, there was a trend of three weekly cisplatin arms towards better efficacy, with comparable haematological and mucosal toxicities.
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Affiliation(s)
- Tapan Kumar Sahoo
- Senior Resident, Department of Radiation Oncology, All India Institute of Medical Sciences , Bhubaneswar, Odisha, India
| | - Dipti Rani Samanta
- Assistant Professor, Department of Medical Oncology, Acharya Harihara Regional Cancer Centre , Cuttack, Odisha, India
| | - Surendra Nath Senapati
- Professor, Department of Radiation Oncology, Acharya Harihara Regional Cancer Centre , Cuttack, Odisha, India
| | - Karishma Parida
- Junior Resident, Department of Medicine, Institute of Medical Sciences, SUM Hospital , Bhubaneswar, Odisha, India
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Iqbal MS, Chaw C, Kovarik J, Aslam S, Jackson A, Kelly J, Dobrowsky W, Kelly C. Primary Concurrent Chemoradiation in Head and Neck Cancers with Weekly Cisplatin Chemotherapy: Analysis of Compliance, Toxicity and Survival. Int Arch Otorhinolaryngol 2016; 21:171-177. [PMID: 28382126 PMCID: PMC5375948 DOI: 10.1055/s-0036-1594020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 09/09/2016] [Indexed: 01/05/2023] Open
Abstract
Introduction Concurrent chemoradiation is the standard of care in inoperable locally advanced squamous cell head and neck cancers. The most widely accepted schedule of concomitant cisplatin is 100mg/m2 given on a 3 weekly basis but the optimal regime is unknown. Objective The objective of this study is to assess the tolerability, compliance, and clinical outcomes of weekly cisplatin (40mg/m2). Methods During the period of January 2007–December 2009, we analyzed retrospectively 122 patients with histologically proven squamous cell carcinoma of head and neck (nasopharynx, oropharynx, larynx, hypopharynx, and oral cavity) treated with definitive chemoradiation. All patients received 63 Gy in 30 daily fractions with concomitant weekly cisplatin 40mg/m2. We assessed treatment toxicities and patient compliance. We estimated overall survival using the Kaplan-Meier method. Results Sixty-eight percent of patients managed to complete all six cycles of chemotherapy while 87% of patients completed at least 5 cycles of weekly cisplatin. Incidence of grade 3/4 toxicity was as follows: mucositis 33%, dermatitis 41%, dysphagia 15%, mouth/neck pain 17%, neutropenia 2%, and renal impairment 3%. 53% patients required at least one hospital admission for symptom control. The 5-year overall survival rate was 60%. Conclusion Concurrent chemoradiotherapy using weekly cisplatin at 40mg/m2 per week is an effective, well tolerated regimen allowing most patients to receive at least 5 cycles of chemotherapy. However, a phase III randomized control trial comparing the standard dose of 100mg/m2 cisplatin tri-weekly with a weekly regimen is needed to establish the long term clinical outcome.
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Affiliation(s)
- Muhammad Shahid Iqbal
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Cheng Chaw
- Department of Clinical Oncology, Ninewells Hospital, Dundee, Dundee, United Kingdom of Great Britain and Northern Ireland
| | - Josef Kovarik
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Shahzeena Aslam
- Department of Clinical Oncology, Clinical Oncology, Addenbrookes Hospital, Cambridge, Cambridgeshire, United Kingdom of Great Britain and Northern Ireland
| | - Aaron Jackson
- Department of Research, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - John Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Werner Dobrowsky
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
| | - Charles Kelly
- Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
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Hasegawa T, Yanamoto S, Otsuru M, Yamada SI, Minamikawa T, Shigeta T, Naruse T, Suzuki T, Sasaki M, Ota Y, Umeda M, Komori T. Retrospective study of treatment outcomes after postoperative chemoradiotherapy in Japanese oral squamous cell carcinoma patients with risk factors of recurrence. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 123:524-530. [PMID: 28159586 DOI: 10.1016/j.oooo.2016.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/25/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the feasibility of postoperative concomitant chemoradiotherapy (CRT) with cisplatin (CDDP), and compare the prognosis in 3 groups-without postoperative therapy (S-only), with radiotherapy (RT) alone (S+RT), and with CRT (S+CRT)-in oral squamous cell carcinoma (OSCC) patients at high risk of recurrence. METHODS Clinicopathologic data and treatment modality were investigated. Endpoints evaluated were locoregional control (LRC), relapse-free survival, overall survival (OS), and type of recurrence. RESULTS The S+CRT group was associated with a better LRC rate than the S-only (P < .001) and S+RT groups (P = .044). However, there was no significant difference in OS rates between the S+RT and S+CRT groups. CONCLUSION The addition of concomitant CDDP to postoperative RT improved LRC. However, there may be no benefit from the addition of concomitant CDDP to postoperative RT for improvement of distant metastasis and OS rates in OSCC patients.
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Affiliation(s)
- Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Souichi Yanamoto
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Mitsunobu Otsuru
- Department of Oral and Maxillofacial Surgery, Division of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Shin-Ichi Yamada
- Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Shigeta
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomofumi Naruse
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takatsugu Suzuki
- Department of Oral and Maxillofacial Surgery, Division of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Masashi Sasaki
- Department of Oral and Maxillofacial Surgery, Division of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Yoshihide Ota
- Department of Oral and Maxillofacial Surgery, Division of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Masahiro Umeda
- Department of Clinical Oral Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Melotek JM, Cooper BT, Koshy M, Silverman JS, Spiotto MT. Weekly versus every-three-weeks platinum-based chemoradiation regimens for head and neck cancer. J Otolaryngol Head Neck Surg 2016; 45:62. [PMID: 27881143 PMCID: PMC5121964 DOI: 10.1186/s40463-016-0175-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 11/17/2016] [Indexed: 01/07/2023] Open
Abstract
Background The majority of chemoradiation (CRT) trials for locally advanced head and neck squamous cell carcinoma (HNSCC) have relied on platinum-based chemotherapy regimens administered every-3-weeks. However, given the increased utilization of weekly platinum regimens, it remains unclear how different chemotherapy schedules compare regarding efficacy and toxicity. Methods We retrospectively identified 212 patients with HNSCC who were treated at a single academic medical center with concurrent platinum-based CRT given weekly (N = 68) or every-three-weeks (N = 144). JMP version 10 (SAS Institute) was used for statistical analysis. Discrete variables were compared with the chi-square test and differences in the medians were assessed using the Wilcoxon test. Survival curves were constructed using the Kaplan-Meier method and significance was assessed using the log rank test. For univariate analysis and multivariate analysis, we used Cox proportional hazard or logistic regression models to compare differences in survival or differences in categorical variables, respectively. Results Patients receiving weekly platinum regimens were more likely to be older (median age 61.4 vs. 55.5 y; P < .001), have high or very high Charlson comorbidity index (45.6% vs. 27.8%; P = .01), and receive carboplatin-based chemotherapy (6.3% vs. 76.5%; P < .001). Weekly and every-3-week platinum regimens had similar locoregional control (HR 1.10; 95% CI 0.63–1.88; P = .72), progression-free survival (HR 1.13; 95% CI 0.75–1.69; P = .55), and overall survival (HR 1.11; 95% CI 0.64–1.86; P = .71). Every-3-weeks platinum regimens were associated with increased days of hospitalization (median: 3 days vs. 0 days; P = .03) and acute kidney injury (AKI) during radiotherapy (50.0% vs. 22.1%; P < .001). On multivariate analysis, AKI was significantly associated with every-3-weeks regimens (OR: 24.38; 95% CI 3.00–198.03; P = .003) and high comorbidity scores (OR: 2.74; 95% CI 2.15–5.99; P = .01). Conclusions Our results suggest that every-3-weeks and weekly platinum-containing CRT regimens have similar disease control but weekly platinum regimens are associated with less acute toxicity. Electronic supplementary material The online version of this article (doi:10.1186/s40463-016-0175-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- James M Melotek
- Department of Radiation and Cellular Oncology, University of Chicago, KCBD 6142, 900 E. 57th St, Chicago, IL, 60637, USA
| | - Benjamin T Cooper
- Department of Radiation Oncology, New York University, New York, NY, USA
| | - Matthew Koshy
- Department of Radiation and Cellular Oncology, University of Chicago, KCBD 6142, 900 E. 57th St, Chicago, IL, 60637, USA.,Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Joshua S Silverman
- Department of Radiation Oncology, New York University, New York, NY, USA
| | - Michael T Spiotto
- Department of Radiation and Cellular Oncology, University of Chicago, KCBD 6142, 900 E. 57th St, Chicago, IL, 60637, USA. .,Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL, USA.
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Impact of cisplatin dose intensity on human papillomavirus-related and -unrelated locally advanced head and neck squamous cell carcinoma. Eur J Cancer 2016; 67:174-182. [PMID: 27669504 DOI: 10.1016/j.ejca.2016.08.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/16/2016] [Accepted: 08/21/2016] [Indexed: 10/21/2022]
Abstract
AIM The aim is to evaluate the impact of cisplatin dose modification on outcomes of human papillomavirus (HPV)-related (HPV+) and HPV-unrelated (HPV-) locally advanced head and neck cancer (LAHNC) treated with chemoradiotherapy (CRT). PATIENTS AND METHODS A pooled analysis was conducted of stage III/IV oropharyngeal cancer (OPC), carcinoma of unknown primary (CUP) and laryngo-hypopharyngeal cancer (LHC) patients treated with single-agent cisplatin CRT in 2000-2012 from two tertiary academic cancer centres. HPV status was determined by p16 staining and/or in situ hybridisation. LHC was assumed to be HPV-. Unknown HPV status OPC/CUPs were excluded. Overall survival (OS) was calculated. Multivariable analysis (MVA) evaluated the impact of cisplatin dose intensity on survival for HPV+ and HPV- cohorts separately. RESULTS A total of 404 HPV+ and 255 HPV- LAHNC (481 OPC, 18 CUP, 160 LHC) patients were included. Median follow-up was 4.3 (0.5-11.9) years. Three-year OS for cisplatin <200, =200, and >200 mg/m2 subgroups were 52%, 60%, and 72% (P = 0.001) for the HPV- and 91%, 90%, and 91% (P = 0.30) for the HPV+ patients. MVA confirmed a survival benefit with cisplatin >200 mg/m2 for the HPV- (hazard ratio [HR] 0.5, 95% confidence interval [CI]: 0.3-0.7, P < 0.001) but not for HPV+ (HR 0.6, 95% CI: 0.4-1.1, P = 0.104). There was a superior OS trend in the HPV+ T4 or N3 high-risk subset (N = 107) with cisplatin >200 mg/m2 (HR 0.5, 95% CI: 0.2-1.1, P = 0.07). CONCLUSIONS A survival benefit of cisplatin dose >200 mg/m2 is evident for HPV- LAHNC patients, but not for HPV+ cohort overall, although the T4 or N3 subset may benefit from a higher cumulative cisplatin dose.
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Homma A, Hatakeyama H, Mizumachi T, Kano S, Sakashita T, Kuramoto R, Nakamaru Y, Onimaru R, Tsuchiya K, Yoshida D, Yasuda K, Shirato H, Fukuda S. A Retrospective Study of G-Tube Use in Japanese Patients Treated with Concurrent Chemoradiotherapy for Hypopharyngeal Cancer. PLoS One 2016; 11:e0161734. [PMID: 27556279 PMCID: PMC4996531 DOI: 10.1371/journal.pone.0161734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/10/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Late toxicity after concurrent chemoradiotherapy (CCRT), such as dysphagia, in patients with squamous cell carcinoma of the head and neck has received a good deal of attention recently. The gastrostomy tube (G-tube) dependence rate 1 year after CCRT was reported to be 16.7-42.9% in Western countries. We evaluated swallowing outcomes after CCRT in patients with hypopharyngeal cancer (HPC) treated in our hospital and compared them with previous reports. METHODS We reviewed 96 consecutive patients with a HPC treated by radiotherapy with intravenous or intra-arterial chemotherapy between 2006 and 2013 at Hokkaido University Hospital, Sapporo, Japan. RESULTS At 1 month after CCRT, 13 patients (13.7%) used a G-tube, whereas 5/91 (5.5%) and 4/81 (4.9%) used a G-tube at 3 and 6 months, respectively. Two patients used a G-tube at 12 and 24 months after CCRT (G-tube use rate: 2.8% at 12 months, and 3.2% at 24 months). The variables female, posterior wall primary, stage IV, ECOG performance status of 2, and smoking status were significantly associated with G-tube use at 12 months after CCRT, whereas the route of cisplatin administration was not related to G-tube use (p = 0.303). CONCLUSIONS The G-tube use rate up to 1year could be lower in Japanese patients than in Western patients according to previous reports. In particular, Japanese patients resume oral intake sooner than Western patients. Further study of the incidence of dysphagia after CCRT by ethnicity is required to clarify the differences in dysphagia after CCRT.
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Affiliation(s)
- Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- * E-mail:
| | - Hiromitsu Hatakeyama
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takatsugu Mizumachi
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomohiro Sakashita
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Rinnosuke Kuramoto
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Rikiya Onimaru
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiko Tsuchiya
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daisuke Yoshida
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koichi Yasuda
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Fukuda
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Fayette J, Molin Y, Lavergne E, Montbarbon X, Racadot S, Poupart M, Ramade A, Zrounba P, Ceruse P, Pommier P. Radiotherapy potentiation with weekly cisplatin compared to standard every 3 weeks cisplatin chemotherapy for locoregionally advanced head and neck squamous cell carcinoma. DRUG DESIGN DEVELOPMENT AND THERAPY 2015; 9:6203-10. [PMID: 26648696 PMCID: PMC4664534 DOI: 10.2147/dddt.s81488] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Despite its toxicity, cisplatin every 3 weeks (q3w) is the standard potentiation of chemo-radiotherapy for head and neck squamous cell carcinoma. This study aimed to determine whether weekly cisplatin (q1w) could be a safe and effective alternative. Patients and methods Two hundred and sixty-two patients with head and neck squamous cell carcinoma, irradiated in our institution with cisplatin (q1w or q3w) between January 2004 and December 2008, were retrospectively included. Overall survival (OS) and progression-free survival (PFS) were evaluated. Survival distributions were estimated by Kaplan–Meier method and compared using the log-rank test. Prognostic effect of chemo-radiotherapy was explored using Cox model. Results A total of 165 and 97 patients received q1w and q3w cisplatin, respectively. Median age, stage at diagnosis, alcohol consumption, intensity-modulated radiation therapy use, median weight, and renal failure before radiotherapy were significantly different, showing lower risk in the q3w group. Q3w cisplatin was found to be more toxic in terms of weight loss, renal failure, worse chemotherapy plan completion, and grade 3/4 mucositis and dermatitis, with more patients requiring analgesics, secondary hospitalization, and radiotherapy interruption (≥3 days), and patients affected by long-term toxicities. With a median follow-up of 73 months (95% confidence interval [CI] [68.9–76.2]), OS was found to be significantly better with q3w (5 years OS: 62.3%; 95% CI [51.6–71.3]) than with q1w cisplatin (5 years OS: 52.6%; 95% CI [44.5–60.0]) (log-rank P=0.0146). More number of patients treated according to the q1w schedule experienced a recurrence: 47.3% vs 30.9% (P=0.009). Thus, the PFS for q3w schedule was found to be globally better (5 years PFS: 55.8%; 95% CI [45.0–65.3]) than for q1w schedule (5 years PFS: 43.6%; 95% CI [35.9–51.0]) (log-rank P=0.0161). However, both multivariate analyses, OS and PFS, produce no significant hazard ratio for chemo-radiotherapy modality once adjusted on unbalanced covariates according to the descriptive analysis. Conclusion Though q1w seemed to be safer than q3w according to the descriptive analysis, multivariate analyses failed to conclude about its efficiency. Therefore, we conclude that the q3w schedule should remain the standard and prospective comparisons are needed.
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Affiliation(s)
| | - Yann Molin
- Department of Medicine, University of Lyon, France
| | | | - Xavier Montbarbon
- Department of Radiotherapy, Centre Léon Bérard, University of Lyon, France
| | - Séverine Racadot
- Department of Radiotherapy, Centre Léon Bérard, University of Lyon, France
| | - Marc Poupart
- Department of Surgery, Hôpital Croix-Rousse, University of Lyon, Lyon, France
| | - Antoine Ramade
- Department of Surgery, Hôpital Edouard Herriot, University of Lyon, Lyon, France
| | - Philippe Zrounba
- Department of Surgery, Centre Léon Bérard, University of Lyon, Lyon, France
| | - Philippe Ceruse
- Department of Surgery, Centre Hospitalier Lyon-Sud, Université de Lyon, Pierre-Bénite, France
| | - Pascal Pommier
- Department of Radiotherapy, Centre Léon Bérard, University of Lyon, France
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Sakashita T, Homma A, Hatakeyama H, Furusawa J, Kano S, Mizumachi T, Iizuka S, Onimaru R, Tsuchiya K, Yasuda K, Shirato H, Fukuda S. Comparison of acute toxicities associated with cetuximab-based bioradiotherapy and platinum-based chemoradiotherapy for head and neck squamous cell carcinomas: A single-institution retrospective study in Japan. Acta Otolaryngol 2015; 135:853-8. [PMID: 25814008 DOI: 10.3109/00016489.2015.1030772] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Grade ≥ 3 mucositis/stomatitis and inability to feed orally were problematic for patients undergoing cetuximab-based bioradiotherapy (BRT) as well as platinum-based chemoradiotherapy (CRT). Severe mucositis/stomatitis and radiation dermatitis should be addressed carefully in patients undergoing cetuximab-based BRT as well. OBJECTIVES The efficacy of cetuximab-based BRT in locally advanced head and neck squamous cell carcinomas has been established. However, the safety of cetuximab-based BRT in comparison with platinum-based CRT is currently under investigation. METHOD This study retrospectively analyzed 14 patients undergoing cetuximab-based BRT and 29 patients undergoing platinum-based CRT to compare the incidence of acute toxicities. In the BRT group, an initial cetuximab loading dose of 400 mg/m(2) was delivered 1 week before the start of radiotherapy. Seven weekly infusions of 250 mg/m(2) of cetuximab followed during the definitive radiotherapy. In the CRT group, cisplatin was administered at a dose of 40 mg/m(2) weekly during the definitive radiotherapy. RESULTS The BRT group had a higher incidence of Grade ≥ 3 radiation dermatitis than did the CRT group (43% vs 3%, respectively, p < 0.01). The incidence rate of Grade ≥ 3 mucositis/stomatitis was 64.3% and 41.4% in the BRT and CRT group, respectively (p = 0.1484), while the incidence rate of the inability to feed orally was 38.5% and 55.2%, respectively (p = 0.2053).
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Driessen CML, Janssens GO, van der Graaf WTA, Takes RP, Merkx TAW, Melchers WJG, Kaanders HAM, van Herpen CML. Toxicity and efficacy of accelerated radiotherapy with concurrent weekly cisplatin for locally advanced head and neck carcinoma. Head Neck 2015; 38 Suppl 1:E559-65. [DOI: 10.1002/hed.24039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chantal M. L. Driessen
- Department of Medical Oncology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Geert O. Janssens
- Department of Radiation Oncology; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Thijs A. W. Merkx
- Department of Oral and Maxillofacial Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Hans A. M. Kaanders
- Department of Radiation Oncology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Carla M. L. van Herpen
- Department of Medical Oncology; Radboud University Medical Center; Nijmegen The Netherlands
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Hassan Metwally MA, Ali R, Kuddu M, Shouman T, Strojan P, Iqbal K, Prasad R, Grau C, Overgaard J. IAEA-HypoX. A randomized multicenter study of the hypoxic radiosensitizer nimorazole concomitant with accelerated radiotherapy in head and neck squamous cell carcinoma. Radiother Oncol 2015; 116:15-20. [DOI: 10.1016/j.radonc.2015.04.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 11/26/2022]
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Shivakumar T, Nair S, Gupta T, Kannan S. Concurrent chemoradiotherapy with weekly versus three-weekly cisplatin in locally advanced head and neck squamous cell carcinoma. Hippokratia 2015. [DOI: 10.1002/14651858.cd010906.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Thiagarajan Shivakumar
- Advanced Centre for Treatment, Research & Education in Cancer (ACTREC), Tata Memorial Centre; Surgical Oncology (Head & Neck Services); Navi Mumbai India 410210
| | - Sudhir Nair
- Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Centre; Surgical Oncology; Kharghar Navi Mumbai India 410210
| | - Tejpal Gupta
- Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Centre; Radiation Oncology; Kharghar Navi Mumbai India 410210
| | - Sadhana Kannan
- Advanced Centre for Treatment Research & Education in Cancer (ACTREC), Tata Memorial Centre; Clinical Research Secretariat/Epidemiology & Clinical Trial Unit; Kharghar Navi Mumbai India 410210
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Hatakeyama H, Takahashi H, Oridate N, Kuramoto R, Fujiwara K, Homma A, Takeda H, Fukuda S. Hangeshashinto improves the completion rate of chemoradiotherapy and the nutritional status in patients with head and neck cancer. ORL J Otorhinolaryngol Relat Spec 2015; 77:100-8. [PMID: 25896416 DOI: 10.1159/000381026] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/16/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE Severe oral and pharyngeal mucositis is one of the most critical toxicities known to lead to the discontinuation of chemoradiotherapy (CRT) for head and neck cancer (HNC). Hangeshashinto (TJ-14) is a Kampo medicine that relieves chemotherapy-induced oral mucositis. We investigated the effect of TJ-14 on mucositis, nutritional status, and the completion rate of CRT. METHODS The study group comprised patients with advanced HNC who were treated with concomitant weekly cisplatin and 70 Gy of radiotherapy. The primary endpoint was the completion rate of chemotherapy, and the secondary endpoints were the grade of mucositis and the nutritional status. RESULTS A total of 57 patients were included in this study. The completion rate of CRT among patients who were treated with TJ-14 was 91.4%. There was a significant difference in the completion rate of CRT between the groups treated with and without TJ-14 (p = 0.0452). The reduction in body weight was significantly improved from 10.89 to 5.89% with TJ-14 administration (p = 0.003), and the reduction in serum albumin was also significantly decreased from 17.37 to 8.73%. (p = 0.024). CONCLUSION This therapy allowed a high completion rate of CRT as well as significant benefits in terms of nutritional status. We plan to carry out a further large-scale study of TJ-14.
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Affiliation(s)
- Hiromitsu Hatakeyama
- Department of Otolaryngology - Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Clinical outcomes of weekly cisplatin chemoradiotherapy for patients with pyriform sinus cancer. Int J Clin Oncol 2015; 20:1081-5. [DOI: 10.1007/s10147-015-0821-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
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Homma A, Nakamaru Y, Sakashita T, Onimaru R, Terasaka S, Tsuchiya K, Yoshida D, Yasuda K, Hatakeyama H, Furusawa J, Mizumachi T, Kano S, Shirato H, Fukuda S. Management for squamous cell carcinoma of the nasal cavity and ethmoid sinus: A single institution experience. Auris Nasus Larynx 2015; 42:377-81. [PMID: 25748513 DOI: 10.1016/j.anl.2015.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/29/2014] [Accepted: 02/02/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Here we report our experience of patients with squamous cell carcinoma (SCC) of the nasal cavity and ethmoid sinus (NC&ES) together with an analysis of treatment outcomes. METHODS A retrospective analysis was performed using data from 25 consecutive patients treated between 2000 and 2012. Four patients were diagnosed with T1, 3 with T2, 4 with T3, 7 with T4a, and 7 with T4b disease. No patient had lymph node metastasis. RESULTS Twelve patients were treated with surgery with/without radiotherapy and with/without chemotherapy. Of these, 4 underwent endoscopic surgery without an open approach and 3 required an anterior skull base approach. Thirteen were treated with radiotherapy; 1 with radiotherapy alone, and 4 and 8 with intravenous and intra-arterial chemotherapy, respectively. The 5-yr overall survival for T1-3, T4a, and T4b disease was 53.9%, 71.4%, and 29.0%, respectively. The 5-yr disease-specific survival for T1-3, T4a, and T4b disease was 74.1%, 71.4%, and 29.0%, respectively. CONCLUSION Our treatment policy for patients with SCC of NC&ES, which basically follows the NCCN guideline, was considered to be appropriate. However, several points in terms of surgery and non-surgical approach remain to be solved through further research.
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Affiliation(s)
- Akihiro Homma
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan.
| | - Yuji Nakamaru
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
| | - Tomohiro Sakashita
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
| | - Rikiya Onimaru
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shunsuke Terasaka
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhiko Tsuchiya
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Daisuke Yoshida
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koichi Yasuda
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiromitsu Hatakeyama
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
| | - Jun Furusawa
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
| | - Takatsugu Mizumachi
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
| | - Hiroki Shirato
- Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Fukuda
- Department of Otolaryngology-Head & Neck Surgery, Hokkaido University Graduate School of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo 060-8638, Japan
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Nyflot MJ, Kruser TJ, Traynor AM, Khuntia D, Yang DT, Hartig GK, McCulloch TM, Wiederholt PA, Gentry LR, Hoang T, Jeraj R, Harari PM. Phase 1 trial of bevacizumab with concurrent chemoradiation therapy for squamous cell carcinoma of the head and neck with exploratory functional imaging of tumor hypoxia, proliferation, and perfusion. Int J Radiat Oncol Biol Phys 2015; 91:942-51. [PMID: 25659884 DOI: 10.1016/j.ijrobp.2014.11.029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/12/2014] [Accepted: 11/18/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE A phase 1 trial was completed to examine the safety and feasibility of combining bevacizumab with radiation and cisplatin in patients with locoregionally advanced squamous cell carcinoma of the head and neck (HNSCC) treated with curative intent. Additionally, we assessed the capacity of bevacizumab to induce an early tumor response as measured by a series of biological imaging studies. METHODS AND MATERIALS All patients received a single induction dose of bevacizumab (15 mg/kg) delivered 3 weeks (±3 days) before the initiation of chemoradiation therapy. After the initial dose of bevacizumab, comprehensive head and neck chemoradiation therapy was delivered with curative intent to 70 Gy in 33 fractions with concurrent weekly cisplatin at 30 mg/m(2) and bevacizumab every 3 weeks (weeks 1, 4, 7) with dose escalation from 5 to 10 to 15 mg/kg. All patients underwent experimental imaging with [(18)F]fluorothymidine positron emission tomography (FLT-PET) (proliferation), [(61)Cu]Cu-diacetyl-bis(N4-methylthiosemicarbazone) PET (Cu-ATSM-PET) (hypoxia), and dynamic contrast-enhanced computed tomography (DCE-CT) (perfusion) at 3 time points: before bevacizumab monotherapy, after bevacizumab monotherapy, and during the combined therapy course. RESULTS Ten patients were enrolled. All had stage IV HNSCC, all achieved a complete response to treatment, and 9 of 10 remain alive, with a mean survival time of 61.3 months. All patients experienced grade 3 toxicity, but no dose-limiting toxicities or significant bleeding episodes were observed. Significant reductions were noted in tumor proliferation (FLT-PET), tumor hypoxia (Cu-ATSM-PET), and DCE-CT contrast enhancement after bevacizumab monotherapy, with further decreases in FLT-PET and Cu-ATSM-PET during the combined therapy course. CONCLUSIONS The incorporation of bevacizumab into comprehensive chemoradiation therapy regimens for patients with HNSCC appears safe and feasible. Experimental imaging demonstrates measureable changes in tumor proliferation, hypoxia, and perfusion after bevacizumab monotherapy and during chemoradiation therapy. These findings suggest opportunities to preview the clinical outcomes for individual patients and thereby design personalized therapy approaches in future trials.
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Affiliation(s)
- Matthew J Nyflot
- Department of Radiation Oncology, University of Washington, Seattle, Washington.
| | - Tim J Kruser
- Department of Radiation Oncology, Cadence Cancer Center at Delnor Hospital, Geneva, Illinois
| | - Anne M Traynor
- Department of Medicine, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
| | | | - David T Yang
- Departments of Pathology and Laboratory Medicine, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory K Hartig
- Department of Surgery-Otolaryngology, H&N Surgery Division, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
| | - Timothy M McCulloch
- Department of Surgery-Otolaryngology, H&N Surgery Division, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
| | - Peggy A Wiederholt
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
| | - Lindell R Gentry
- Department of Radiology, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
| | - Tien Hoang
- Department of Medicine, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
| | - Robert Jeraj
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin; Department of Radiology, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin; Department of Medical Physics, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin Carbone Cancer Center and School of Medicine and Public Health, Madison, Wisconsin
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Kang MH, Kang JH, Song HN, Jeong BK, Chai GY, Kang K, Woo SH, Park JJ, Kim JP. Concurrent Chemoradiation with Low-Dose Weekly Cisplatin in Locally Advanced Stage IV Head and Neck Squamous Cell Carcinoma. Cancer Res Treat 2014; 47:441-7. [PMID: 25672576 PMCID: PMC4506097 DOI: 10.4143/crt.2013.219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/11/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Concurrent chemoradiation (CRT) with 3-weekly doses of cisplatin is a standard treatment for loco-regionally advanced head and neck squamous cell carcinoma (HNSCC). However, treatment with 3-weekly doses of cisplatin is often associated with several adverse events. Therefore, we conducted this retrospective analysis to determine the efficacy and tolerance of CRT with a low weekly dose of cisplatin in stage IV HNSCC patients. MATERIALS AND METHODS Medical records of patients who were diagnosed with stage IV HNSCC and received concurrent CRT were analyzed. All patients were treated weekly with cisplatin at 20-30 mg/m(2) until radiotherapy was completed. RESULTS A total of 35 patients were reviewed. Median follow up was 10.7 months (range, 1.7 to 90.5 months), the median radiation dose was 7,040 cGy, and the median dose of cisplatin received was 157 mg/m(2). Eleven patients received docetaxel combination chemotherapy. Overall, 25 patients (71.4%) achieved complete response (CR), eight (22.9%) showed partial response. The median overall survival was 42.7 months, the 3-year survival rate was 51.2% and the 3 year disease-free survival rate was 72.8%. Overall survival was improved in patients who achieved CR relative to others (59.7 months vs. 13.4 months; p=0.008). There were significant differences in survival between patients who received docetaxel combination and cisplatin alone (51.8 months vs. 7.9 months; p=0.009). Grade 3-4 adverse events included stomatitis (82.9%), dermatitis (22.9%), infection (11.4%), dysphagia (8.6%), and neutropenia (5.7%). CONCLUSION CRT with low dose weekly cisplatin is likely effective and tolerable, even in patients with locally advanced-stage IV HNSCC.
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Affiliation(s)
- Myoung Hee Kang
- Departments of Internal Medicine, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Hun Kang
- Departments of Internal Medicine, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Haa-Na Song
- Departments of Internal Medicine, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Bae Kwon Jeong
- Departments of Radiation Oncology, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Gyu Young Chai
- Departments of Radiation Oncology, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Kimun Kang
- Departments of Radiation Oncology, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung Hoon Woo
- Departments of Otorhinolaryngology, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Je Park
- Departments of Otorhinolaryngology, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin Pyeong Kim
- Departments of Otorhinolaryngology, Institute of Health Science, Gyeongsang National University School of Medicine, Jinju, Korea
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Dimri K, Pandey AK, Trehan R, Rai B, Kumar A. Conventional radiotherapy with concurrent weekly Cisplatin in locally advanced head and neck cancers of squamous cell origin - a single institution experience. Asian Pac J Cancer Prev 2014; 14:6883-8. [PMID: 24377620 DOI: 10.7314/apjcp.2013.14.11.6883] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Platinum based concurrent chemo-radiation is the de-facto standard of care in the non-surgical management of locally-advanced head and neck cancer of squamous origin. Three-weekly single agent cisplatin at 100 mg/m2 concurrent with radical radiotherapy has demonstrated consistent improvement in loco-regional control and survival. This improvement is however at the cost of considerable hematologic toxicity and poor overall compliance. The routine use of this regime is improbable in developing countries with limited resources. We therefore aimed to determine the safety and efficacy of an alternative regime of weekly cisplatin and concurrent radiotherapy in such patients. MATERIALS AND METHODS January-05 and April-12, 188 patients of locally-advanced head and neck cancer of squamous origin were treated with concurrent weekly-cisplatin at 35 mg/m2 and conventional radiotherapy 60-66Gy/30-33 fractions/5 days per week. RESULTS Overall, 95% patients received planned doses of RT while 74% completed within the stipulated overall treatment time of <50 days. Eighty-two percent received at-least 5 weekly cycles. Grade-III/IV mucositis was seen in 58%/9% respectively, which resulted in mean weight loss of 9.2% from a pre-treatment mean of 54.5 kg. Grade-III hematologic toxicity-0.5%; grade II nephrotoxicity-2.5% and grade III emesis-3% were also seen. Grade-III/IV subcutaneous toxicity-10%/1% and grade-III/IV xerostomia-10%/0% were observed. Complete responses at the primary site, regional nodes and overall disease were seen in 86%, 89% and 83% patients respectively. The median and 5-years disease-free survival were 26 months and 39.4% respectively, while the median and overall survival were 27 months and 41.8% respectively. CONCLUSIONS Weekly-cisplatin at 35 mg /m2 when delivered concurrently with conventional radical RT (at-least 66y/33 fractions) in locally-advanced head and neck cancer is well tolerated with minimal hematologic and neprologic toxicity and can be routinely delivered on an out-patient basis. It is an effective alternative to the standard 3-weekly cisplatin especially in the context of developing countries.
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Affiliation(s)
- Kislay Dimri
- Department of Radiotherapy, Government Medical College, Chandigarh, India E-mail :
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Feasibility and efficacy of induction docetaxel, cisplatin, and 5-fluorouracil chemotherapy combined with concurrent weekly cisplatin chemoradiotherapy for locally advanced head and neck squamous cell carcinoma. Int J Clin Oncol 2014; 20:431-7. [PMID: 24993675 DOI: 10.1007/s10147-014-0726-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the feasibility of induction docetaxel, cisplatin, and 5-fluorouracil chemotherapy followed by concurrent weekly cisplatin chemoradiotherapy for patients with locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS Between 2010 and 2013, 30 patients with Stage IV HNSCC were treated in Hokkaido University Hospital with three cycles of induction chemotherapy (docetaxel 75 mg/m(2) and cisplatin 75 mg/m(2), day 1; and 5-fluorouracil 750 mg/m(2)/day 120 h continuous infusion, every 3 weeks) followed by concurrent weekly cisplatin (40 mg/m(2), on weeks 1, 2, 3, 5, 6 and 7) chemoradiotherapy. RESULTS Three courses of induction chemotherapy were performed in 25 patients (83%) with grade 3-4 toxicities during induction chemotherapy observed in 22 patients (73%). The major toxicities were hematologic, with 22 cases (73%) showing grade 3-4 neutropenia. Radiotherapy was completed (70 Gy) in 29 patients (97%), while a total of 19 patients (63%) completed five (13 patients) or six (6 patients) courses of chemotherapy. During concurrent chemoradiotherapy, no grade 4 hematological toxicities were observed. Grade 4 dermatitis was observed in one patient, and grade 3 mucositis was observed in 12 patients. There were no treatment-related deaths during the induction chemotherapy or concurrent chemoradiotherapy. The 1- and 2-year progression-free survival rates and the 1- and 2-year overall survival rates were 86%, 72%, and 89%, 81%, respectively. CONCLUSION Sequential therapy composed of induction chemotherapy followed by concurrent weekly cisplatin chemoradiotherapy is feasible, showing encouraging results in patients with locally advanced HNSCC. Concurrent weekly cisplatin chemoradiotherapy following induction chemotherapy appears to be a suitable alternative to three-weekly high-dose cisplatin therapy.
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Kunieda F, Kiyota N, Tahara M, Kodaira T, Hayashi R, Ishikura S, Mizusawa J, Nakamura K, Fukuda H, Fujii M. Randomized Phase II/III Trial of Post-operative Chemoradiotherapy Comparing 3-Weekly Cisplatin with Weekly Cisplatin in High-risk Patients with Squamous Cell Carcinoma of Head and Neck: Japan Clinical Oncology Group Study (JCOG1008). Jpn J Clin Oncol 2014; 44:770-4. [DOI: 10.1093/jjco/hyu067] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Metwally MAH, Frederiksen KD, Overgaard J. Compliance and toxicity of the hypoxic radiosensitizer nimorazole in the treatment of patients with head and neck squamous cell carcinoma (HNSCC). Acta Oncol 2014; 53:654-61. [PMID: 24328536 DOI: 10.3109/0284186x.2013.864050] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the compliance and toxicity of the hypoxic radiosensitizer nimorazole in head and neck cancer patients. METHODS A retrospective study of patients with head and neck squamous cell carcinoma (HNSCC), treated in Denmark between 1990 and 2013. All patients treated with radical radiotherapy (± chemotherapy) [66-70 Gy; 33-35 fractions; 2 Gy/fraction; 5-6 fractions/week] concomitant with the hypoxic radiosensitizer nimorazole. Nimorazole was administered as oral tablets in doses of approximately 1.2 g/m(2) body surface area in connection with the first of each daily radiation treatment. A second daily dose of 1 g was given in connection with the second radiotherapy fraction in the accelerated fractionation regimen. The compliance was estimated as the percentage of the initially prescribed dose, which was received by each patient. The main side effects were recorded. RESULTS A total of 1049 patients were investigated. The tolerance to nimorazole was fair: 58% of patients received the full prescribed total dose. Nausea and vomiting were the major complaints: among the 260 patients with dose reductions due to known side effects, (87%) were due to nausea/vomiting. All side effects ceased when treatment was interrupted, and neither severe nor long lasting side effects were observed. Female patients were significantly more likely to have dose reduction (OR 2.02; 95% CI 1.50-2.70), and nausea/vomiting. Patients aged more than 70 years were significantly more likely to have dose reduction. Patients who received less than 1100 mg/m(2) were significantly less likely to have dose reduction (OR 0.58; CI 0.44-0.78), and nausea/vomiting, compared to those who received 1100-1300 mg/m(2). The tolerance was also less in the group of patients received accelerated chemoradiotherapy (OR 1.70; CI 1.20-2.50) with more association with nausea/vomiting (OR 2.09; CI 1.40-3.10). CONCLUSION The compliance to nimorazole is fair, with tolerable acute, but neither persistent nor late, toxicity. It can be administered with chemotherapy and different radiotherapy fractionation schedules.
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