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Roof SA, Jabalee J, Rettig EM, Chennareddy S, Ferrandino RM, Chen S, Posner MR, Genden EM, Chai RL, Sims J, Thrash E, Stern SJ, Kalman NS, Yarlagadda S, Raben A, Clements L, Mendelsohn A, Kaczmar JM, Pandey Y, Bhayani M, Del Vecchio Fitz C, Hanna GJ. Utility of TTMV-HPV DNA in resolving indeterminate findings during oropharyngeal cancer surveillance. Oral Oncol 2024; 155:106874. [PMID: 38878355 DOI: 10.1016/j.oraloncology.2024.106874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVES Clinical and imaging examinations frequently have indeterminate results during cancer surveillance, which can lead to overtreatment and cause psychological and financial harm to the patient. This study addresses the critical need to enhance diagnostic precision and decision-making in the management of HPV-associated oropharyngeal cancer. This study evaluated the utility of tumor tissue-modified viral (TTMV)-HPV DNA to resolve indeterminate disease status following definitive treatment for HPV-associated oropharyngeal cancer. MATERIALS AND METHODS In this retrospective cohort, patients treated for HPV-associated oropharyngeal cancer at eight U.S. institutions and who received one or more TTMV-HPV DNA tests during post-treatment surveillance between February 2020 and January 2022 were included. RESULTS Among 543 patients, 210 patients (38.7%; 210/543) experienced one or more clinically indeterminate findings (CIFs) during surveillance, with 503 CIFs recorded. Of those patients with an "indeterminate" disease status at a point during surveillance, 79 were associated with contemporaneous TTMV-HPV DNA testing. TTMV-HPV DNA testing demonstrated high accuracy (97.5%; 77/79) in correctly determining recurrence status. Patients whose disease status was "indeterminate" at the time of a positive TTMV-HPV DNA test were clinically confirmed to recur faster than those whose disease status was "no evidence of disease." Only 3% of patients (17/543) experienced indeterminate TTMV-HPV DNA tests during surveillance. Discordance between TTMV-HPV DNA tests and clinical results was minimal, with only 0.6% (3/543) of patients showing positive tests without recurrence. CONCLUSION Our findings support the utility of circulating TTMV-HPV DNA in resolving indeterminate disease status and informing the subsequent clinical course.
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Affiliation(s)
- Scott A Roof
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | | | - Eleni M Rettig
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Susmita Chennareddy
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rocco M Ferrandino
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sida Chen
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marshall R Posner
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eric M Genden
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Raymond L Chai
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Sims
- CARTI Cancer Center, Little Rock, AR, USA
| | | | | | | | | | - Adam Raben
- Christiana Care, Helen F. Graham Cancer Center and Research Institute, Newark, DE, USA
| | | | - Abie Mendelsohn
- David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - John M Kaczmar
- Medical College of South Carolina Health-University Medical Center, Charleston, SC, USA
| | - Yadav Pandey
- Medical College of South Carolina Health-University Medical Center, Charleston, SC, USA
| | | | | | - Glenn J Hanna
- Center for Head & Neck Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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Wierzbicka M, Markowski J, Pietruszewska W, Burduk P, Mikaszewski B, Rogowski M, Składowski K, Milecki P, Fijuth J, Jurkiewicz D, Niemczyk K, Maciejczyk A. Algorithms of follow-up in patients with head and neck cancer in relation to primary location and advancement. Consensus of Polish ENT Society Board and Head Neck Experts. Front Oncol 2023; 13:1298541. [PMID: 38152365 PMCID: PMC10751934 DOI: 10.3389/fonc.2023.1298541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/31/2023] [Indexed: 12/29/2023] Open
Abstract
Summary The algorithm of follow-up in patients with head and neck cancer (HNC) has been prepared by a board of Polish Head Neck and Oncology Experts. The aim of this research is to focus on the specificity of HNC monitoring, to review the current trends in follow-up, and to adapt the evidence-based medicine international standards to the capabilities of the local healthcare service. Materials and methods The first methodological step was to categorize HNCs according to the estimated risk of failure after the adequate first-line treatment and according to the possibility of effective salvage treatment, resulting in improved overall survival. The final method used in this work was to prepare an authors' original monitoring algorithm for HNC groups with a high, moderate, and low risk of recurrence in combination with a high or low probability of using an effective salvage. Results Four categories were established: Ia. low risk of recurrence + effective organ preservation feasible; Ib. low risk of recurrence + effective salvage feasible; II. moderate risk of recurrence + effective salvage feasible; III. high risk of recurrence + effective salvage feasible; and IV. high risk of recurrence + no effective salvage feasible. Follow-up visit consisting of 1. ENT examination + neck ultrasound, 2. imaging HN tests, 3. chest imaging, 4. blood tests, and 5. rehabilitation (speech and swallowing) was scheduled with a very different frequency, at the proposed monthly intervals, tailored to the needs of the group. The number of visits for individual groups varies from 1 to 8 in the first 2 years and from 1 to 17 in the entire 5-year monitoring period. Group IV has not been included in regular follow-up, visits on own initiative of the patient if symptomatic, or supportive care needs, having in mind that third-line therapy and immune checkpoint inhibitors are available. Conclusion Universal monitoring algorithm for HNC four groups with a high, moderate, and low risk of recurrence after the adequate treatment in combination with a high or low probability of using an effective salvage is an innovative approach to redeploying system resources and ensuring maximum benefit for patients with HNC.
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Affiliation(s)
- Małgorzata Wierzbicka
- Department of Otolaryngology, Regional Specialist Hospital Wroclaw, Research & Development Centre, Wroclaw, Poland
- Faculty of Medicine, Wroclaw University of Science and Technology, Wroclaw, Poland
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Jarosław Markowski
- Department of Laryngology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Wioletta Pietruszewska
- Department of Otolaryngology Head Neck Oncology, Medical University of Lodz, Lodz, Poland
| | - Paweł Burduk
- Department of Otolaryngology Phoniatrics and Audiology, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Bogusław Mikaszewski
- Department of Otolaryngology, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Krzysztof Składowski
- Radiation and Clinical Oncology Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Piotr Milecki
- Department of Radiotherapy I, The Greater Poland Cancer Centre, Poznan, Poland
| | - Jacek Fijuth
- Department of Radiation Therapy, Oncology Chair, Medical University of Lodz, Lodz, Poland
| | - Dariusz Jurkiewicz
- Department of Otolaryngology and Laryngological Oncology with Clinical Department of Cranio-Maxillofacial Surgery, Military Institute of Medicine - National Research Institute, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Adam Maciejczyk
- Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
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Baliga MS, Lasrado S, Krishna A, George T, Madathil LP, D’souza RF, Palatty PL. Social, Ethical and Treatment Related Problems Faced by Healthcare Workers in the Care of Head and Neck Cancer Patients: A Narrative Review from the Bioethics Consortium from India. Indian J Otolaryngol Head Neck Surg 2023:1-11. [PMID: 37362104 PMCID: PMC10206566 DOI: 10.1007/s12070-023-03738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/26/2023] [Indexed: 06/28/2023] Open
Abstract
Head and neck cancer (HNC) presents a variety of ethical difficulties for an oncologist involved in screening, diagnosis, treatment, and rehabilitation that are challenging to address, especially for those professionals/people who are not trained in medical ethics. The bioethics department has spent the last ten years compiling information and rating the seriousness of numerous niche ethical concerns and their effects on healthcare professionals practising in India. Based on these findings, the current analysis makes an effort to outline the different challenges faced by oncologists when screening, diagnosing, treating, and rehabilitating people affected with HNC, particularly in a traditional nation like India. According to the authors, this is the first overview to address these issues from an Indian viewpoint, and it represents a small effort to document a crucial but unaddressed component of cancer treatment. It is hoped that these endeavours would aid in educating upcoming healthcare professionals on how to effectively handle the difficulties.
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Affiliation(s)
- Manjeshwar Shrinath Baliga
- Bioethics Education and Research Unit, Mangalore Institute of Oncology, Pumpwell, Mangalore, Karnataka 575002 India
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
- Member, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa) Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
| | - Savita Lasrado
- Department of Otorhinolaryngology, Father Muller Medical College, Kankanady, Mangalore, 575002 India
| | - Abhishek Krishna
- Department of Radiation Oncology, Kasturba Medical College, Mangalore, Karnataka 570001 India
| | - Thomas George
- Internal Medicine, Coney Island Hospital, 2601 Ocean Pkwy, Brooklyn, NY 11235 USA
| | - Lal P. Madathil
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
| | - Russell Franco D’souza
- Member, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa) Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
- Chair Department of Education, International Chair in Bioethics, University of Porto Portugal (Formerly UNESCO Chair in Bioethics, University of Haifa); Directorate of The Asia Pacific Division and Education Department, Cleeland Street, Melbourne, Australia
| | - Princy Louis Palatty
- The Bioethics SAARC Nodal Centre, International Network Bioethics, Amrita Institute of Medical Sciences, Kochi, Ernakulam, Kerala 682041 India
- Department of Pharmacology, Amrita School of Medicine, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Ernakulam, Kerala 682041 India
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Avery J, Thomas R, Howell D, Dubouloz Wilner CJ. Empowering Cancer Survivors in Managing Their Own Health: A Paradoxical Dynamic Process of Taking and Letting Go of Control. QUALITATIVE HEALTH RESEARCH 2023; 33:412-425. [PMID: 36825869 PMCID: PMC10126457 DOI: 10.1177/10497323231158629] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
In cancer care, gaps in support to help patients manage and live with the side-effects from cancer treatments have increased the emphasis on empowering patients to be more active and involved in managing their own health. However, empowerment in relation to promoting self-management behaviors is not well understood. Using the social constructivist grounded theory approach, our goal was to develop a theoretical understanding of this phenomenon in relation to the self-management behaviors of post-treatment cancer patients. Twenty-two post-treatment cancer patients participated in a semi-structured focused interview to co-construct with us how empowerment is defined, described, and experienced in relation to their capacity to self-manage. Through this co-construction, we defined empowerment as a process of personal growth, a display of fortitude and strength when participants confronted the impact of their illness that emerged in two dynamic and paradoxical ways: 1) establishing control over the impact of the illness as a means to maintain normalcy and to circumvent change over an eroding and changing sense of self and 2) relinquishing control over aspects of the illness deemed irrepressible and acknowledging and accepting change. When successful at establishing and/or relinquishing control, participants no longer viewed cancer as a threat, but re-interpreted their illness as also having a beneficial "empowering" experience and more capable of managing. Findings will guide the development of self-management interventions that use empowerment as a core construct.
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Affiliation(s)
- Jonathan Avery
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Roanne Thomas
- Department of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Doris Howell
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Mali SB. Surveillance of head neck cancer: Case for personalized and standardized surveillance. Oral Oncol 2023; 139:106354. [PMID: 36878144 DOI: 10.1016/j.oraloncology.2023.106354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
Although surgery, radiotherapy, chemotherapy, or combined treatment often elicits an initial satisfactory response, relapses are frequently observed within two years. Current surveillance methods, including clinical exams and imaging evaluations, have not unambiguously demonstrated a survival benefit, most probably due to a lack of sensitivity in detecting very early recurrence. Current guidelines advise post-treatment surveillance of head and neck cancer (HNC) patients should involve scheduled appointments with a variety of practitioners. The benefits of prolonged routine follow-up on survival have not been proven. Increasing numbers of HNC survivors raise the burden to provide efficient and effective care.
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Affiliation(s)
- Shrikant B Mali
- Mahatma Gandhi Vidya Mandir's Dental College and Hospital Nashik, India.
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Hanna GJ, Patel N, Tedla SG, Baugnon KL, Aiken A, Agrawal N. Personalizing Surveillance in Head and Neck Cancer. Am Soc Clin Oncol Educ Book 2023; 43:e389718. [PMID: 37079869 DOI: 10.1200/edbk_389718] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) encompasses a spectrum of heterogeneous diseases originating in the oral cavity, pharynx, and larynx. Within the United States, head and neck cancer (HNC) accounts for 66,470 new cases, or 3% of all malignancies, annually.1 The incidence of HNC is rising, largely driven by increases in oropharyngeal cancer.2-4 Recent molecular and clinical advancements, particularly with regard to molecular and tumor biology, reflect the heterogeneity of the subsites contained within the head and neck. Despite this, existing guidelines for post-treatment surveillance remain broad without much consideration given to different anatomic subsites and etiologic factors (such as human papillomavirus [HPV] status or tobacco exposure).5 Surveillance incorporating the physical examination, imaging, and emerging molecular biomarkers is an essential part of care for patients treated for HNC and allows for the detection of locoregional recurrence, distant metastases, and second primary malignancies aiming for better functional and survival outcomes. Additionally, it allows for evaluation and management of post-treatment complications.
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Affiliation(s)
- Glenn J Hanna
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Nirali Patel
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL
| | - Sara G Tedla
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Kristen L Baugnon
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ashley Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Nishant Agrawal
- Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL
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van de Weerd C, van Tol-Geerdink JJ, van den Broek GB, Kaanders JHAM, Marres HAM, Hermens RPMG, Takes RP. Individualised follow-up for head and neck cancer-design of a prospective cohort study to assess its feasibility. BMJ Open 2022; 12:e068750. [PMID: 36581428 PMCID: PMC9806091 DOI: 10.1136/bmjopen-2022-068750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION It is a common practice for many cancer types to monitor patients after treatment to detect new disease manifestations early. For head and neck cancer (HNC), however, long-term routine follow-up is up for debate for several reasons. The benefits of prolonged routine follow-up on survival have not been proven. Also, cancer follow-up is putting increasing pressure on healthcare resources due to rising incidence and survival rates. Therefore, this study investigates a novel follow-up approach among HNC patients, giving them the opportunity to choose their own follow-up programme. METHODS AND ANALYSIS HNC patients are offered a decision-aided choice between standardised or individualised follow-up after 1.5 years of uncomplicated guideline-prescribed follow-up. Standardised follow-up entails continuing the 5-year guideline-prescribed schedule. Individualised follow-up means the patient only attends the outpatient clinic on their own initiative in case of physical symptoms or supportive care needs. Patients are educated on self-examination and when a control visit is necessary. The primary outcome measure is the feasibility of offering patients this choice. Secondary outcome measures are quality of life, costs, productivity loss and detection of new disease. ETHICS AND DISSEMINATION We believe that it is essential to let patients determine their follow-up programme based on their own values and preferences. If this choice is feasible, it can be implemented and investigated in other HNC care centres. TRIAL REGISTRATION NUMBER NCT05386225.
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Affiliation(s)
- Cecile van de Weerd
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | | | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands
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Lee HI, Lee J, Lee JH, Wu HG, Kim JH, Kim Y, Eom KY. Evaluation of Optimal Assessment Schedules for Surveillance After Definitive Locoregional Treatment of Locally Advanced Head and Neck Cancer: A Retrospective Cohort Study With Parametric Modeling of Event-Free Survival. JAMA Otolaryngol Head Neck Surg 2022; 148:1059-1067. [PMID: 36173618 PMCID: PMC9523554 DOI: 10.1001/jamaoto.2022.2561] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/08/2022] [Indexed: 12/13/2022]
Abstract
Importance In clinical practice, assessment schedules are often arbitrarily determined after definitive treatment of head and neck cancer (HNC), producing heterogeneous and inconsistent surveillance plans. Objective To establish an optimal assessment schedule for patients with definitively treated locally advanced HNC, stratified by the primary subsite and HPV status, using a parametric model of standardized event-free survival curves. Design, Setting, and Participants This was a retrospective study including 2 tertiary referral hospitals and a total of 673 patients with definitive locoregional treatment of locally advanced HNC (227 patients with nasopharyngeal cancer [NPC]; 237 patients with human papillomavirus-positive oropharyngeal cancer [HPV+ OPC]; 47 patients with HPV-negative [HPV-] OPC; 65 patients with hypopharyngeal cancer [HPC]; and 97 patients with laryngeal cancer [LC]). Patients had received primary treatment in 2008 through 2019. The median (range) follow-up duration was 57.8 (6.4-158.1) months. Data analyses were performed from April to October 2021. Main Outcomes and Measures Tumor recurrence and secondary malignant neoplasms. Event-free survival was defined as the period from the end of treatment to occurrence of any event. Event-free survival curves were estimated using a piecewise exponential model and divided into 3 phases of regular follow-up. A 5% event rate criterion determined optimal follow-up time point and interval. Results The median (range) age of the 673 patients at HNC diagnosis was 58 (15-83) years; 555 (82.5%) were men; race and ethnicity were not considered. The event rates of NPC, HPV+ OPC, HPV- OPC, HPC, and LC were 18.9% (43 of 227), 14.8% (35 of 237), 36.2% (17 of 47), 44.6% (29 of 65), and 30.9% (30 of 97), respectively. Parametric modeling demonstrated optimal follow-up intervals for HPC, LC, and NPC, respectively, every 2.1, 3.2, and 6.1 months; 3.7, 5.6, and 10.8 months; and 9.1, 13.8, and 26.5 months until 16.5, 16.5 to 25.0, and 25.0 to 99.0 months posttreatment (open follow-up thereafter). For HPV- OPC, assessment was recommended every 2.7, 4.8, and 11.8 months until 16.5, 16.5 to 25.0, and 25 to 99 months posttreatment, respectively. In contrast, HPV+ OPC optimal intervals were every 7.7, 13.7, and 33.7 months until 16.5, 16.5 to 25.0, and 25 to 99 months posttreatment, respectively. Five, 4, 12, 15, and 10 follow-up visits were recommended for NPC, HPV+ OPC, HPV- OPC, HPC, and LC, respectively. Conclusions and Relevance This retrospective cohort study using parametric modeling suggests that the HNC assessment schedules should be patient tailored and evidence based to consider primary subsites and HPV status. Given limited health care resources and rising detection rates and costs of HNC, the guidelines offered by these findings could benefit patients and health systems and aid in developing future consensus guidelines.
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Affiliation(s)
- Hye In Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jongjin Lee
- Department of Statistics, Seoul National University, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yongdai Kim
- Department of Statistics, Seoul National University, Seoul, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Alnefaie M, Alamri A, Saeedi A, Althobaiti A, Alosaimi S, Alqurashi Y, Marzouki H, Merdad M. Pulmonary Screening Practices of Otolaryngology-Head and Neck Surgeons Across Saudi Arabia in the Posttreatment Surveillance of Squamous Cell Carcinoma: Cross-sectional Survey Study. Interact J Med Res 2022; 11:e24592. [PMID: 35302511 PMCID: PMC8976246 DOI: 10.2196/24592] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/07/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Background With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract. Objective Our cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology–head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC. Methods This nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out. Results This study included 22 participants and had a 78% (22/28) response rate. This study found that the majority of participants (9/22, 41%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32% (7/22) used low-dose computed tomography (CT; 7/22, 32%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77%) reported 5 years, and only 9% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77% (17/22) of participants conduct screening annually, 18% (4/22) conduct screening half-yearly, and 5% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36% (8/22) of participants believed them to be very effective or somewhat effective, 18% (4/22) did not know, and only 9% (2/22) believed that they were not effective. Conclusions The participants mainly used lung radiography (9/22, 41%), low-dose CT (7/22, 32%), or positron emission tomography/CT (6/22, 27%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77%) or 10 years (3/22, 14%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective.
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Affiliation(s)
- Majed Alnefaie
- King Fahad Armed Forces Hospital, Medical Services of The Armed Forces, Jeddah, Saudi Arabia
| | - Abdullah Alamri
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Asalh Saeedi
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Awwadh Althobaiti
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Shahad Alosaimi
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yousuf Alqurashi
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hani Marzouki
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mazin Merdad
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Posttreatment Magnetic Resonance Imaging Surveillance of Head and Neck Cancers. Magn Reson Imaging Clin N Am 2021; 30:109-120. [PMID: 34802574 DOI: 10.1016/j.mric.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Treatment strategies and recommended surveillance imaging differ for head and neck cancers depending on subsite and neoplasm type, and pose confusion for referring physicians and interpreting radiologists. The superior soft tissue resolution offered by magnetic resonance imaging is most useful in the surveillance of cancers with high propensities for intraorbital, intracranial, or perineural disease spread, which most commonly include those arising from the sinonasal cavities, nasopharynx, orbits, salivary glands, and the skin. This article discusses recommended surveillance protocoling and reviews treatment approaches, common posttreatment changes, and pearls for identifying disease recurrence in a subsite-based approach.
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Routine restaging after primary non-surgical treatment of laryngeal squamous cell carcinoma-a review. Strahlenther Onkol 2020; 197:167-176. [PMID: 33216194 PMCID: PMC7892687 DOI: 10.1007/s00066-020-01706-9] [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] [Received: 04/01/2020] [Accepted: 10/23/2020] [Indexed: 02/07/2023]
Abstract
Purpose Treatment of patients with laryngeal squamous cell carcinoma with radiotherapy or chemoradiation is an established alternative to laryngeal surgery in many cases, but particularly for advanced tumors without cartilage invasion. Imaging modalities face the challenge of distinguishing between posttherapeutic changes and residual disease in the complex anatomic subsite of the larynx. Guidelines concerning restaging of head and neck squamous cell carcinomas (HNSCC) are presented by the National Comprehensive Cancer Network (NCCN) and other national guidelines, but clearly defined recommendations for routine restaging particularly for laryngeal cancer are lacking. Methods A systematic search was carried out in PubMed to identify studies evaluating routine restaging methods after primary non-surgical treatment of laryngeal squamous cell carcinoma from 2009 to 2020. Results Only three studies were deemed eligible, as they included at least ≥50% patients with laryngeal squamous cell carcinoma and evaluated imaging modalities to detect residual cancer. The small number of studies in our review suggest restaging with fluoro-deoxy-glucose positron-emission tomography/computed tomography (FDG PET/CT) 3 months after initial treatment, followed by direct laryngoscopy with biopsy of the lesions identified by FDG PET/CT. Conclusion Studies evaluating restaging methods after organ-preserving non-surgical treatment of laryngeal carcinoma are limited. As radiotherapy (RT), chemoradiotherapy (CRT), systemic therapy followed by RT and radioimmunotherapy are established alternatives to surgical treatment, particularly in advanced laryngeal cancers, further studies are needed to assess and compare different imaging modalities (e.g. PET/CT, MRI, CT, ultrasound) and clinical diagnostic tools (e.g., video laryngoscopy, direct laryngoscopy) to offer patients safe and efficient restaging strategies. PET or PET/CT 3 months after initial treatment followed by direct laryngoscopy with biopsy of the identified lesions has the potential to reduce the number of unnecessary laryngoscopies.
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Gore A, Baugnon K, Beitler J, Saba NF, Patel MR, Wu X, Boyce BJ, Aiken AH. Posttreatment Imaging in Patients with Head and Neck Cancer without Clinical Evidence of Recurrence: Should Surveillance Imaging Extend Beyond 6 Months? AJNR Am J Neuroradiol 2020; 41:1238-1244. [PMID: 32554418 DOI: 10.3174/ajnr.a6614] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/18/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Early detection of residual or recurrent disease is important for effective salvage treatment in patients with head and neck cancer. Current National Comprehensive Cancer Network guidelines do not recommend standard surveillance imaging beyond 6 months unless there are worrisome signs or symptoms on clinical examination and offer vague guidelines for imaging of high-risk patients beyond that timeframe. Our goal was to evaluate the frequency of clinically occult recurrence in patients with head and neck squamous cell carcinoma with positive imaging findings (Neck Imaging Reporting and Data Systems scores of 2-4), especially after 6 months. MATERIALS AND METHODS This institutional review board-approved, retrospective data base search queried neck CT reports with Neck Imaging Reporting and Data Systems scores of 2-4 from June 2014 to March 2018. The electronic medical records were reviewed to determine outcomes of clinical and radiologic follow-up, including symptoms, physical examination findings, pathologic correlation, and clinical notes within 3 months of imaging. RESULTS A total of 255 cases, all with Neck Imaging Reporting and Data Systems scores of 2 or 3, met the inclusion criteria. Fifty-nine patients (23%) demonstrated recurrence (45 biopsy-proven, 14 based on clinical and imaging progression), and 21 patients (36%) had clinically occult recurrence (ie, no clinical evidence of disease at the time of the imaging examination). The median overall time to radiologically detected, clinically occult recurrence was 11.4 months from treatment completion. CONCLUSIONS Imaging surveillance beyond the first posttreatment baseline study was critical for detecting clinically occult recurrent disease in patients with head and neck squamous cell carcinoma. More than one-third of all recurrences were seen in patients without clinical evidence of disease; and 81% of clinically occult recurrences occurred beyond 6 months.
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Affiliation(s)
- A Gore
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | - K Baugnon
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | | | - N F Saba
- Hematology/Oncology (N.F.S.).,Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - M R Patel
- Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - X Wu
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.)
| | - B J Boyce
- Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- From the Departments of Radiology and Imaging Sciences (A.G., K.B., X.W., A.H.A.) .,Otolaryngology (N.F.S., M.R.P., B.J.B., A.H.A.), Emory University School of Medicine, Atlanta, Georgia
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13
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Høeg BL, Bidstrup PE, Karlsen RV, Friberg AS, Albieri V, Dalton SO, Saltbæk L, Andersen KK, Horsboel TA, Johansen C. Follow-up strategies following completion of primary cancer treatment in adult cancer survivors. Cochrane Database Syst Rev 2019; 2019:CD012425. [PMID: 31750936 PMCID: PMC6870787 DOI: 10.1002/14651858.cd012425.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most cancer survivors receive follow-up care after completion of treatment with the primary aim of detecting recurrence. Traditional follow-up consisting of fixed visits to a cancer specialist for examinations and tests are expensive and may be burdensome for the patient. Follow-up strategies involving non-specialist care providers, different intensity of procedures, or addition of survivorship care packages have been developed and tested, however their effectiveness remains unclear. OBJECTIVES The objective of this review is to compare the effect of different follow-up strategies in adult cancer survivors, following completion of primary cancer treatment, on the primary outcomes of overall survival and time to detection of recurrence. Secondary outcomes are health-related quality of life, anxiety (including fear of recurrence), depression and cost. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, four other databases and two trials registries on 11 December 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included all randomised trials comparing different follow-up strategies for adult cancer survivors following completion of curatively-intended primary cancer treatment, which included at least one of the outcomes listed above. We compared the effectiveness of: 1) non-specialist-led follow-up (i.e. general practitioner (GP)-led, nurse-led, patient-initiated or shared care) versus specialist-led follow-up; 2) less intensive versus more intensive follow-up (based on clinical visits, examinations and diagnostic procedures) and 3) follow-up integrating additional care components relevant for detection of recurrence (e.g. patient symptom education or monitoring, or survivorship care plans) versus usual care. DATA COLLECTION AND ANALYSIS We used the standard methodological guidelines by Cochrane and Cochrane Effective Practice and Organisation of Care (EPOC). We assessed the certainty of the evidence using the GRADE approach. For each comparison, we present synthesised findings for overall survival and time to detection of recurrence as hazard ratios (HR) and for health-related quality of life, anxiety and depression as mean differences (MD), with 95% confidence intervals (CI). When meta-analysis was not possible, we reported the results from individual studies. For survival and recurrence, we used meta-regression analysis where possible to investigate whether the effects varied with regards to cancer site, publication year and study quality. MAIN RESULTS We included 53 trials involving 20,832 participants across 12 cancer sites and 15 countries, mainly in Europe, North America and Australia. All the studies were carried out in either a hospital or general practice setting. Seventeen studies compared non-specialist-led follow-up with specialist-led follow-up, 24 studies compared intensity of follow-up and 12 studies compared patient symptom education or monitoring, or survivorship care plans with usual care. Risk of bias was generally low or unclear in most of the studies, with a higher risk of bias in the smaller trials. Non-specialist-led follow-up compared with specialist-led follow-up It is uncertain how this strategy affects overall survival (HR 1.21, 95% CI 0.68 to 2.15; 2 studies; 603 participants), time to detection of recurrence (4 studies, 1691 participants) or cost (8 studies, 1756 participants) because the certainty of the evidence is very low. Non-specialist- versus specialist-led follow up may make little or no difference to health-related quality of life at 12 months (MD 1.06, 95% CI -1.83 to 3.95; 4 studies; 605 participants; low-certainty evidence); and probably makes little or no difference to anxiety at 12 months (MD -0.03, 95% CI -0.73 to 0.67; 5 studies; 1266 participants; moderate-certainty evidence). We are more certain that it has little or no effect on depression at 12 months (MD 0.03, 95% CI -0.35 to 0.42; 5 studies; 1266 participants; high-certainty evidence). Less intensive follow-up compared with more intensive follow-up Less intensive versus more intensive follow-up may make little or no difference to overall survival (HR 1.05, 95% CI 0.96 to 1.14; 13 studies; 10,726 participants; low-certainty evidence) and probably increases time to detection of recurrence (HR 0.85, 95% CI 0.79 to 0.92; 12 studies; 11,276 participants; moderate-certainty evidence). Meta-regression analysis showed little or no difference in the intervention effects by cancer site, publication year or study quality. It is uncertain whether this strategy has an effect on health-related quality of life (3 studies, 2742 participants), anxiety (1 study, 180 participants) or cost (6 studies, 1412 participants) because the certainty of evidence is very low. None of the studies reported on depression. Follow-up strategies integrating additional patient symptom education or monitoring, or survivorship care plans compared with usual care: None of the studies reported on overall survival or time to detection of recurrence. It is uncertain whether this strategy makes a difference to health-related quality of life (12 studies, 2846 participants), anxiety (1 study, 470 participants), depression (8 studies, 2351 participants) or cost (1 studies, 408 participants), as the certainty of evidence is very low. AUTHORS' CONCLUSIONS Evidence regarding the effectiveness of the different follow-up strategies varies substantially. Less intensive follow-up may make little or no difference to overall survival but probably delays detection of recurrence. However, as we did not analyse the two outcomes together, we cannot make direct conclusions about the effect of interventions on survival after detection of recurrence. The effects of non-specialist-led follow-up on survival and detection of recurrence, and how intensity of follow-up affects health-related quality of life, anxiety and depression, are uncertain. There was little evidence for the effects of follow-up integrating additional patient symptom education/monitoring and survivorship care plans.
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Affiliation(s)
- Beverley L Høeg
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Pernille E Bidstrup
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Randi V Karlsen
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Anne Sofie Friberg
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Rigshospitalet, Copenhagen University HospitalDepartment of OncologyCopenhagenDenmark
| | - Vanna Albieri
- Danish Cancer Society Research CenterStatistics and Pharmaco‐Epidemiology UnitStrandboulevarden 49CopenhagenDenmark
| | - Susanne O Dalton
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Zealand University HospitalDepartment of OncologyNæstvedDenmark
| | - Lena Saltbæk
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Zealand University HospitalDepartment of OncologyNæstvedDenmark
| | - Klaus Kaae Andersen
- Danish Cancer Society Research CenterStatistics and Pharmaco‐Epidemiology UnitStrandboulevarden 49CopenhagenDenmark
| | - Trine Allerslev Horsboel
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
| | - Christoffer Johansen
- Danish Cancer Society Research CenterSurvivorship UnitStrandboulevarden 49CopenhagenCentral Denmark RegionDenmark2100
- Rigshospitalet, Copenhagen University HospitalDepartment of OncologyCopenhagenDenmark
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Baba A, Okuyama Y, Yamauchi H, Ogino N, Dorgu M, Kobashi Y, Yamazoe S, Munetomo Y, Mogami T, Ojiri H. Evaluation of Normal Epiglottis on Computed Tomography with Special Attention to Thickness. THE BULLETIN OF TOKYO DENTAL COLLEGE 2019; 60:11-16. [PMID: 30700641 DOI: 10.2209/tdcpublication.2017-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
To our knowledge, this is the first study to investigate the thickness of the normal epiglottis on computed tomography (CT) in a Japanese population. The focus was on determining the thickness of a normal epiglottis, which could then serve as a reference in detecting abnormalities. We believe that this would facilitate diagnosing and determining the extent of cancerous invasion of the supraglottis and secondary invasion of the epiglottis. This retrospective study was based on a review of radiographic data in patient charts. Cervical CT scans obtained from 79 Japanese patients (44 men [55.7%] and 35 women [44.3%]; age range, 28-85 years; mean, 58.9 years) showing a normal epiglottis under laryngoscopy were evaluated. The thickness of the epiglottis was measured on CT scans and the results analyzed with the Student's t-test, an analysis of variance, and the Tukey-Kramer test. The epiglottis in men was significantly thicker than that in women (p<0.05). A statistically significant difference was observed in thickness depending on longitudinal height (p=<0.001). The thickness at the median was larger than that bilaterally in all patients (p=<0.001). No statistically significant difference was observed in thickness depending on side or age. The thickness of the normal epiglottis was established at each level. We believe that these data could serve as a reference in diagnosing and detecting abnormalities of the epiglottis.
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Affiliation(s)
- Akira Baba
- Department of Radiology, Ichikawa General Hospital Tokyo Dental College
| | - Yumi Okuyama
- Department of Radiology, Ichikawa General Hospital Tokyo Dental College
| | | | - Nobuhiro Ogino
- Department of Radiology, Jikei University School of Medicine
| | - Murat Dorgu
- Department of Radiology, Ichikawa General Hospital Tokyo Dental College
| | - Yuko Kobashi
- Department of Radiology, Ichikawa General Hospital Tokyo Dental College
| | - Shinji Yamazoe
- Department of Radiology, Ichikawa General Hospital Tokyo Dental College
| | - Yohei Munetomo
- Department of Radiology, Ichikawa General Hospital Tokyo Dental College
| | - Takuji Mogami
- Department of Radiology, Ichikawa General Hospital Tokyo Dental College
| | - Hiroya Ojiri
- Department of Radiology, Jikei University School of Medicine
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15
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Bugter O, van Iwaarden DLP, Dronkers EAC, de Herdt MJ, Wieringa MH, Verduijn GM, Mureau MAM, Ten Hove I, van Meerten E, Hardillo JA, Baatenburg de Jong RJ. Survival of patients with head and neck cancer with metachronous multiple primary tumors is surprisingly favorable. Head Neck 2019; 41:1648-1655. [PMID: 30652377 PMCID: PMC6590295 DOI: 10.1002/hed.25595] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/24/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background The objectives of this study are to determine the incidence and survival rate of patients with head and neck squamous cell carcinoma (HNSCC) with multiple primary tumors (MPT) in the HN‐region, lung, or esophagus. Methods Patient and tumor specific data of 1372 patients with HNSCC were collected from both the national cancer registry and patient records to ensure high‐quality double‐checked data. Results The total incidence of MPTs in the HN‐region, lung, and esophagus in patients with HNSCC was 11% (149/1372). Patients with lung MPTs and esophageal MPTs had a significant worse 5‐year survival than patients with HN‐MPTs (29%, 14%, and 67%, respectively, P < 0.001). The 5‐year survival rate for synchronous HN MPTs was only 25%, whereas it was surprisingly high for patients with metachronous HN MPT (85%, P < 0.001). Conclusions One of 10 patients with HNSCC develop MPTs in the HN‐region, lung, or esophagus. The 5‐year survival of patients with metachronous HN MPTs was surprisingly favorable.
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Affiliation(s)
- Oisín Bugter
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Dirk L P van Iwaarden
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Emilie A C Dronkers
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Martine J de Herdt
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marjan H Wieringa
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Gerda M Verduijn
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marc A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ivo Ten Hove
- Department of Oral & Maxillofacial Surgery, Special Dental Care, and Orthodontics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Esther van Meerten
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - José A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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16
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Zhao X, Rao S. Surveillance imaging following treatment of head and neck cancer. Semin Oncol 2017; 44:323-329. [DOI: 10.1053/j.seminoncol.2018.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/03/2018] [Accepted: 01/31/2018] [Indexed: 11/11/2022]
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17
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Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017; 47:579-594. [PMID: 28969758 DOI: 10.1053/j.semnuclmed.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
FDG-PET/CT as a modality is increasingly used for detection of recurrence and for restaging in patients with clinical suspicion of malignancy, as well as in patients with elevated tumor markers. However, there are many pitfalls in the interpretation of these scans when the studies are performed after some treatment. Some of these are attributed to normal physiological distribution and are compounded when there are inflammatory changes occurring after surgery. The body's inherent response to the surgical insult results in this inflammation. In addition, there are also complications that can happen following surgery, causing increased FDG uptake. Despite various fallacies, FDG-PET/CT provides valuable information in evaluation of residual and recurrent malignant disease. In this article, we aim to describe some of these postsurgical changes secondary to inflammation, common surgical complications, and finally, the utility of FDG-PET/CT in these patients to detect recurrent disease, even in the background of postsurgical changes.
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Affiliation(s)
- Gunjan Garg
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Mohammed Taoudi Benchekroun
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Tony Abraham
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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18
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Meregaglia M, Cairns J, Alfieri S, Favales F, Mazzitelli D, Orlandi E, Licitra L, Bossi P. Eliciting Preferences for Clinical Follow-Up in Patients with Head and Neck Cancer Using Best-Worst Scaling. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2017; 20:799-808. [PMID: 28577698 DOI: 10.1016/j.jval.2017.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 11/07/2016] [Accepted: 01/27/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES There are no commonly accepted standards for monitoring patients treated for head and neck cancer. The aim of this study was to assess patients' preferences for different aspects of follow-up. METHODS A best-worst survey was conducted in a sample of head and neck cancer patients in clinical follow-up at the National Cancer Institute (Milan, Italy). Conditional logit regression with choice as the dependent variable was run to analyse the data. A covariate-adjusted analysis was performed in order to identify socio-demographic and clinical factors related to the selection of best-worst items. The participants were asked to report any difficulties encountered during the survey. RESULTS A total of 143 patients, predominantly male (74%) and with a mean age of 58 years were enrolled in the survey. The strongest positive preference was expressed for a hospital-based program of physical examinations with frequency decreasing over time. Conversely, the lowest valued item was not performing any positron emission tomography (PET) scan during follow-up. Patients with high educational levels were more likely to value attending a primary care-based program and undergoing intensive radiological investigations. Other patient-specific variables significantly associated with the choice of items were employment and living status, time already spent in follow-up and number of treatments received. CONCLUSIONS Overall, patients were more likely to choose an intensive follow-up scheme broadly consistent with the program currently administered by the hospital. There is little evidence of preference heterogeneity that might justify customized programs based on demographics. The best-worst scaling task appeared feasible for most participants.
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Affiliation(s)
- Michela Meregaglia
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy.
| | - John Cairns
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; CCBIO, University of Bergen, Bergen, Norway
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Department, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Federica Favales
- Head and Neck Medical Oncology Department, IRCCS Foundation National Cancer Institute, Milan, Italy
| | | | - Ester Orlandi
- Radiation Therapy Department, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Department, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - Paolo Bossi
- Head and Neck Medical Oncology Department, IRCCS Foundation National Cancer Institute, Milan, Italy
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Follow-up program in head and neck cancer. Crit Rev Oncol Hematol 2017; 113:151-155. [PMID: 28427504 DOI: 10.1016/j.critrevonc.2017.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 02/15/2017] [Accepted: 03/11/2017] [Indexed: 02/03/2023] Open
Abstract
Follow-up program in head and neck cancer (HNC) is an important issue in patients management. It represents the major dilemma in daily practice clinic. Many guidelines have been published in order to better define the best clinical protocol, but a consensus has not been attained yet. We constructed a follow-up program based on specific primary subsite, to standardize patients surveillance after treatment of HNC.
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Høeg BL, Bidstrup PE, Allerslev Horsboel T, Dalton SO, Saltbaek L, Karlsen RV, Andersen KK, Johansen C. Follow-up strategies following completion of primary cancer treatment in adult cancer survivors. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Beverley Lim Høeg
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Pernille Envold Bidstrup
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Trine Allerslev Horsboel
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Susanne Oksbjerg Dalton
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Lena Saltbaek
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Randi Valbjørn Karlsen
- Danish Cancer Society Research Center; Survivorship Unit; Strandboulevarden 49 Copenhagen Central Denmark Region Denmark 2100
| | - Klaus Kaae Andersen
- Danish Cancer Society Research Center; Statistics, Bioinformatics and Registry Unit; Copenhagen Denmark
| | - Christoffer Johansen
- Copenhagen University Hospital; Department of Oncology; Blegdamsvej 9 Copenhagen Central Denmark Region Denmark 2100
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Peisker A, Raschke GF, Guentsch A, Luepke P, Roshanghias K, Schultze-Mosgau S. Evaluation of a post-treatment follow-up program in patients with oral squamous cell carcinoma. Clin Oral Investig 2016; 21:135-141. [DOI: 10.1007/s00784-016-1764-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
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