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Fuentes JDB, Fouda S, Evans E, Palaniappan N, Rackley T, Chan P, Evans M, Webster R. High-grade neuroendocrine head and neck cancer: Case series and review of the literature. Curr Probl Cancer 2024; 51:101105. [PMID: 38823286 DOI: 10.1016/j.currproblcancer.2024.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 05/12/2024] [Accepted: 05/20/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND High-grade neuroendocrine cancers (NEC) of the head and neck (HN) are rare and aggressive, accounting for ≤1 % of all HN cancers, with a 5-year overall survival (OS) of ≤20 %. This case series examines clinical characteristics, treatments, and outcomes of patients diagnosed at a regional UK HN cancer centre over the last 23 years. METHODS A retrospective review of medical records was conducted for all patients diagnosed with NEC HN from 1st January 2000 until 1st March 2023 at Velindre Cancer Centre. RESULTS During the study period, 19 cases of NEC HN were identified, primarily affecting males (n = 15, 79 %). Median age of 67 years (range: 44-86). At diagnosis, 32 % of patients (n = 6) were smokers. The most common primary tumour sites were larynx (n = 5, 26.3 %) and sinonasal (n = 5, 26.3 %). Most patients presented with advanced loco-regional disease or distant metastasis, with stage IVA (n = 6, 32 %) and stage IVC (n = 6, 32 %) being the most common. The key pathology marker was synaptophysin, present in 100 % of the tested patients (n = 15). In the study, of the 12 patients with non-metastatic disease, 10 received a combination of treatments that included radiotherapy (RT). Some of these patients also received chemotherapy (CT) at the same time as their radiotherapy. Surgery alone was used in two patients with stage II disease. Seven subjects had complete responses, and one achieved a partial response. Among the seven metastatic patients, three received CT, and one underwent palliative RT, all achieving a partial response. In all cases, the CT used was carboplatin and etoposide. After a median follow-up of 11 months (range: 1-96), the median OS was 27 months for the overall population, 51 months for those treated radically, and three months for metastatic patients with palliative treatment. The 1-year OS for all patients was 54.3 %, the 2-year OS was 46.5 %, and the 5-year OS was 23.3 %. Among patients treated radically, these rates were 65.3 %, 52.2 %, and 26.1 %, respectively. For patients treated palliatively, the 1-year OS was 33.3 %. CONCLUSION This case series contributes preliminary observations on the characteristics and management of non-metastatic NEC HN, suggesting potential benefits from multimodality treatment strategies. Given the small cohort size, these observations should be interpreted cautiously and seen as a foundation for further research.
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Affiliation(s)
- Javier David Benitez Fuentes
- Velindre Cancer Centre, Cardiff, United Kingdom; Medical Oncology, Centro Integral Oncologico Clara Campal (CIOCC), Hospital Universitario HM Sanchinarro, Madrid, Spain.
| | - Sally Fouda
- Velindre Cancer Centre, Cardiff, United Kingdom.
| | - Elin Evans
- Velindre Cancer Centre, Cardiff, United Kingdom.
| | | | | | - Po Chan
- Velindre Cancer Centre, Cardiff, United Kingdom.
| | - Mererid Evans
- Velindre Cancer Centre, Cardiff, United Kingdom; Cardiff University, Wales, United Kingdom.
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Iyizoba-Ebozue Z, Prestwich R, Brown S, Hall E, Lilley J, Lowe M, Thomson DJ, Slevin F, Boele F, Murray L. Neurocognitive function following (chemo)radiotherapy for nasopharyngeal cancer and other head and neck cancers: A systematic review. Radiother Oncol 2023; 188:109863. [PMID: 37619657 DOI: 10.1016/j.radonc.2023.109863] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
When radiotherapy is used in the treatment of head and neck cancers, the brain commonly receives incidental doses of radiotherapy with potential for neurocognitive changes and subsequent impact on quality of life. This has not been widely investigated to date. A systematic search of MEDLINE, EMBASE, Psycinfo Info and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases was conducted. Of 2077 records screened, 20 were eligible comprising 1308 patients. There were no randomised studies and 73.3% of included patients were from single center studies. IMRT was delivered in 72.6% of patients, and chemotherapy used in 61%. There was considerable heterogeneity in methods. Narrative synthesis was therefore carried out. Most studies demonstrated inferior neurocognitive outcomes when compared to control groups at 12 months and beyond radiotherapy. Commonly affected neurocognitive domains were memory and language which appeared related to radiation dose to hippocampus, temporal lobe, and cerebellum. Magnetic Resonance Imaging could be valuable in the detection of early microstructural and functional changes, which could be indicative of future neurocognitive changes. In studies investigating quality of life, the presence of neurocognitive impairment was associated with inferior quality of life outcomes. (Chemo)radiotherapy for head and neck cancer appears to be associated with a risk of long-term neurocognitive impairment. Few studies were identified, with substantial variation in methodology, thus limiting conclusions. High quality large prospective head and neck cancer studies using standardised, sensitive, and reliable neurocognitive tests are needed.
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Affiliation(s)
| | - Robin Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Sarah Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - John Lilley
- Department of Radiotherapy Physics, Leeds Cancer Centre, Leeds, UK
| | - Matthew Lowe
- Department of Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Finbar Slevin
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Florien Boele
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Louise Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
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The Role of Stereotactic Ablative Radiotherapy in Oncological and Non-Oncological Clinical Settings: Highlights from the 7th Meeting of AIRO – Young Members Working Group (AIRO Giovani). TUMORI JOURNAL 2018. [DOI: 10.1177/1778.19280] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Franco P, Zeverino M, Migliaccio F, Torielli P, Angelini V, Sciacero P, Girelli G, Cante D, Arrichiello C, Borca VC, Numico G, La Porta MR, Tofani S, Ricardi U. Minimizing a Tricky Situation in Breast Irradiation with Helical Tomotherapy. TUMORI JOURNAL 2018; 100:e35-40. [DOI: 10.1177/030089161410000221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report on a patient with breast cancer undergoing adjuvant intensity-modulated whole breast and lymph node irradiation with static angle tomotherapy (TomoDirect), who experienced a traumatic ipsilateral humeral fracture and was able to continue radiotherapy with helical tomotherapy and daily dosimetric monitoring by means of the Planned Adaptive module.
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Affiliation(s)
- Pierfrancesco Franco
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Michele Zeverino
- Medical Physics Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Fernanda Migliaccio
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Paolo Torielli
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Veronica Angelini
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Piera Sciacero
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Giuseppe Girelli
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Domenico Cante
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Cecilia Arrichiello
- Medical Physics Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | | | - Gianmauro Numico
- Medical Oncology Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Maria Rosa La Porta
- Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Santi Tofani
- Medical Physics Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
| | - Umberto Ricardi
- Medical Physics Department, Ospedale Regionale “U Parini”, AUSL Valle d'Aosta, Aosta
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Jensen K, Sharma MB, Lenler-Eriksen S, Friis P, Holm AIS. Simultaneous integrated prophylactic cranial irradiation in sino-nasal cancer. Clin Transl Radiat Oncol 2017; 2:59-62. [PMID: 29658002 PMCID: PMC5893517 DOI: 10.1016/j.ctro.2017.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 11/28/2022] Open
Abstract
Therapy for small cell cancer and high grade neuroendocrine tumours of the paranasal sinuses is extrapolated from the treatment of small cell lung cancer and paranasal cancer of different histologies. Prophylactic cranial irradiation has proven survival benefit in small cell lung cancer. Two patients with aggressive cancer of the paranasal sinuses received radiotherapy with simultaneous integrated prophylactic brain irradiation, using two sequential plans. Chemotherapy was given before, during and after radiotherapy. None of the patients had intracranial recurrence. One patient experienced severe, but transient encephalitis-like symptoms that could only be attributed to radiotherapy. No long term side effects in the CNS were observed. The treatment was feasible, but with possible severe, but transient side effects. It should be considered in cases with head and neck cancer, with a high risk of intracerebral metastasis, as well as a significant overlap between the primary irradiated volume and the brain.
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Affiliation(s)
- Kenneth Jensen
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | | | - Per Friis
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Denmark
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De Felice F, Lei M, Guerrero Urbano T. Controversies in small cell carcinoma of the head and neck: Prophylactic cranial irradiation (PCI) after primary complete initial remission. Cancer Treat Rev 2015. [PMID: 26211602 DOI: 10.1016/j.ctrv.2015.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Small cell carcinoma of head and neck region (SmCCHN) represents a rare entity and its management remains a significant clinical challenge. Complete initial response to primary therapy poses a difficult and controversial scenario for radiation oncologists. Prophylactic cranial irradiation (PCI) has long been established in the management of small cell lung cancer; however, its role in SmCCHN is still called into question. The rationale behind PCI lies in the eradication of possible micro-metastatic brain disease, which is often documented in this type of cancer. No randomized trials on this topic are available. This review, based on 20 retrospective studies, addresses the controversies in the use of PCI in SmCCHN management.
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Affiliation(s)
- Francesca De Felice
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy.
| | - Mary Lei
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Bilateral Breast Radiation Delivered with Static Angle Tomotherapy (TomoDirect): Clinical Feasibility and Dosimetric Results of a Single Patient. TUMORI JOURNAL 2015; 101:e4-8. [DOI: 10.5301/tj.5000264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/20/2022]
Abstract
We herein report on a case of synchronous bilateral breast cancer patient undergoing adjuvant intensity-modulated whole breast with static angle tomotherapy (TomoDirect). The patient was treated with a hypofractionated schedule employing a simultaneous integrated boost approach. Radiotherapy schedule was 45 Gy/20 fractions (2.25 Gy daily) to the bilateral whole breast and 50 Gy/20 fractions (2.5 Gy daily) to the 2 lumpectomy cavities. Treatment was delivered over 4 weeks. Dosimetric results were robust with consistent target coverage and adequate normal tissue avoidance. Treatment was generally well-tolerated and acute toxicity profile was mild. The present report highlights the promising clinical feasibility of TomoDirect for bilateral breast irradiation.
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Franco P, Migliaccio F, Angelini V, Cante D, Sciacero P, Peruzzo Cornetto A, Casanova Borca V, Zeverino M, Torielli P, Arrichiello C, Girelli G, La Porta MR, Tofani S, Numico G, Ricardi U. Palliative radiotherapy for painful bone metastases from solid tumors delivered with static ports of tomotherapy (TomoDirect): feasibility and clinical results. Cancer Invest 2014; 32:458-63. [PMID: 25259607 DOI: 10.3109/07357907.2014.958495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the feasibility and response to palliative radiotherapy delivered with static ports of tomotherapy--TomoDirect (TD) in patients affected with painful bone metastases from solid tumors. METHODS A prospective cohort of 130 patients (185 osseous lesions) was treated between 2010 and 2013 with TD. Three fractionation schedules were employed according to clinical decision-making (3 Gy × 10; 4 Gy × 5; 8 Gy × 1). Pain response was investigated at 2 weeks and 2 months (for evaluable patients). The Numeric Rating Scale (NRS-11) was used to assess pain. Response rates to radiotherapy were calculated following the criteria of the International Bone Metastases Consensus Group (IBMCG), accounting for the use of concomitant analgesics (response: complete or partial; non-response: stable pain, pain progression or "other"). Analgesic consumption was recalculated into the daily oral morphine-equivalent dose (OMED). RESULTS Most of the patients had 1-2 bone metastases (91); those with multiple lesions mostly had a metachronous presentation (60%). Synchronous lesions were mainly approached with multiple plans (63%). Most treatments employed 3-4 fields (77%). Treatment times ranged from 255 to 939 s depending on fractionation, fields, and target lesions number. At 2 weeks, the median self-reported worst pain decreased significantly as median oral morphine-equivalent dose regardless of fractionation used. The response rate according to the IBMCG-based response categories ranged from 45 to 55%. Pain relief duration seems (response at 2 months) slightly inferior with the single fraction approach, with a higher re-treatment rate. At 2 weeks, the median self-reported worst pain and OMED significantly decreased regardless of fractionation (response rate: 49-55%). Pain relief decreased at 2 months, especially for single fraction (higher re-treatment rate). CONCLUSION TD is a valid option to deliver palliative radiotherapy for painful bone metastases from solid tumors.
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Tan W, Han G, Wei S, Hu D. Sparing functional anatomical structures during intensity-modulated radiotherapy: an old problem, a new solution. Future Oncol 2014; 10:1863-72. [PMID: 23987920 DOI: 10.2217/fon.13.172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ABSTRACT During intensity-modulated radiotherapy, an organ is usually assumed to be functionally homogeneous and, generally, its anatomical and spatial heterogeneity with respect to radiation response are not taken into consideration. However, advances in imaging and radiation techniques as well as an improved understanding of the radiobiological response of organs have raised the possibility of sparing the critical functional structures within various organs at risk during intensity-modulated radiotherapy. Here, we discuss these structures, which include the critical brain structure, or neural nuclei, and the nerve fiber tracts in the CNS, head and neck structures related to radiation-induced salivary and swallowing dysfunction, and functional structures in the heart and lung. We suggest that these structures can be used as potential surrogate organs at risk in order to minimize their radiation dose and/or irradiated volume without compromising the dose coverage of the target volume during radiation treatment.
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Affiliation(s)
- Wenyong Tan
- Department of Radiation Oncology, Hubei Cancer Hospital, 116 South Road, Zhuodaoquan, Wuhan 430079, China
| | - Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, 116 South Road, Zhuodaoquan, Wuhan 430079, China
| | - Shaozhong Wei
- Department of Gastrointestinal & Genitourinary Oncology, Hubei Cancer Hospital, 116 South Road, Zhuodaoquan, Wuhan 430079, China
| | - Desheng Hu
- Department of Radiation Oncology, Hubei Cancer Hospital, 116 South Road, Zhuodaoquan, Wuhan 430079, China
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Yazıcı O, Ozdemir NY, Sendur MAN, Aksoy S, Zengin N. Current approaches for prophylactic cranial irradiation in extrapulmonary small cell carcinoma. Curr Med Res Opin 2014; 30:1327-36. [PMID: 24628530 DOI: 10.1185/03007995.2014.904771] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Small cell lung cancer (SCLC) patients, who have achieved complete or partial response after chemotherapy, should be followed with prophylactic cranial irradiation (PCI). PCI for extrapulmonary small cell carcinoma (EPSCC) is not routinely recommended. The purpose of this review is to discuss all aspects of PCI in management of EPSCC. SCOPE The PubMed database and the database of online abstracts of the American Society of Oncology (ASCO), ASCO Genitourinary (GU) Cancers meetings and clinical trials were searched up to 15 October 2013 using the following search keywords: 'SCC or EPSCC of each organ site and prophylactic cranial radiotherapy'. The language of screened abstracts and manuscripts was limited to English. The papers which included the largest case series and data of cases about prophylactic cranial radiotherapy and/or were published in the last 10 years were selected. FINDINGS Many single center studies showed low incidence of brain metastasis in patients with esophageal small cell carcinoma (SCC). Due to the low incidence of brain metastasis, PCI is not recommended for esophageal SCC. Genitourinary, colorectal, small bowel and appendix cranial metastatic SCCs are extremely rare. Therefore, PCI is not recommended. The frequency of brain metastasis of prostate small cell carcinoma is much higher (16-19%) compared to other counterparts of EPSCC. PCI can be performed in selected cases of prostate SCC. High rates (41%) of brain metastasis develop in head and neck SCC. PCI should be considered for patients with head neck SCC. CONCLUSION In the literature, the brain metastasis incidence of EPSCC might vary from 1.7% up to 40%. In many patients with ESPCC, PCI is not recommended. However, we have to keep in mind that primary head and neck and prostate SCC are exceptions due to the high incidence of cranial metastasis; PCI should be recommended for these patients on an individual basis.
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Affiliation(s)
- Ozan Yazıcı
- Ankara Numune Education and Research Hospital , Ankara , Turkey
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Oskan F, Ganswindt U, Schwarz SB, Manapov F, Belka C, Niyazi M. Hippocampus sparing in whole-brain radiotherapy. A review. Strahlenther Onkol 2014; 190:337-41. [PMID: 24452816 DOI: 10.1007/s00066-013-0518-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 11/11/2013] [Indexed: 01/21/2023]
Abstract
Radiation treatment techniques for whole-brain radiation therapy (WBRT) have not changed significantly since development of the procedure. However, the recent development of novel techniques such as intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) and helical tomotherapy, as well as an increasing body of evidence concerning neural stem cells (NSCs) have altered the conventional WBRT treatment paradigm. In this regard, hippocampus-sparing WBRT is a novel technique that aims to spare critical hippocampus regions without compromising tumour control. Published data on this new technique are limited to planning and feasibility studies; data on patient outcome are still lacking. However, several prospective trials to analyse the feasibility of this technique and to document clinical outcome in terms of reduced neurotoxicity are ongoing.
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Affiliation(s)
- F Oskan
- Department of Radiation Oncology & CCC Neuro-Oncology, University of Munich, Marchioninistr. 15, 81377, Munich, Germany
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