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Slater NN, Farsi S, Rogers AL, Herberger L, Penagaricano J, McKee S, King D, Samanta S, Sunde J, Vural E, Moreno MA. Reirradiation in head and neck squamous cell carcinoma; prognostic indicators, oncologic and functional outcomes. Am J Otolaryngol 2024; 45:104482. [PMID: 39116720 DOI: 10.1016/j.amjoto.2024.104482] [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: 07/28/2024] [Accepted: 08/01/2024] [Indexed: 08/10/2024]
Abstract
OBJECTIVES Patients with recurrent squamous cell carcinoma of the head and neck (HNSCC) have a poor prognosis and limited therapeutic alternatives. While reirradiation is feasible, it is usually associated with high treatment toxicity and is not yet considered the standard of care. Based on current NCCN guidelines, in the context of very advanced head and neck cancer (recurrent and/or persistent disease), surgical intervention is explored initially with/without adjuvants while unresectable disease is approached with radiation and/or systemic therapies. Specific and reliable prognostic indicators for both -oncologic and functional outcomes- have yet to be defined for this population. METHODS Retrospective chart review of 54 patients treated with reirradiation at a tertiary academic institution between January of 1998 and January of 2024. Only patients with non-metastatic recurrent, and second primary HNSCC were included in the series. Demographics, staging, radiation dose and technique, additional therapy, histopathologic variables, EORTC toxicity, pre- and post-treatment PEG/tracheotomy dependency and oncologic outcomes were retrieved. RESULTS The study cohort consisted of 54 patients (37 males, 17 females) with HNSCC, averaging 62.7 years in age. Initial tumors were locally advanced in over 42 % of cases, with 58 % being node-negative. The head and cutaneous regions (24.5 %) and tongue (20.8 %) were the most common tumor sites. Primary surgical resection and adjuvant radiation were performed in 47.2 % of cases, and concurrent chemotherapy was used in 40.7 %. Reirradiation was mainly for local or regional recurrence (88.9 %), often following salvage surgery (68.5 %), with a mean dose of 5623 Gy over 52.5 fractions. Positive surgical margins were present in 29.4 % of cases, and extracapsular spread in 59.5 %. No significant differences were found between the salvage surgery and definitive reirradiation groups except for tumor site (P = 0.022). Median follow-up was 52.6 months, with 27 deaths reported. Lymphovascular invasion was significantly correlated with overall survival (P = 0.017), while initial tumor T-stage and neck disease involvement were linked to local-regional control (P = 0.030 and P = 0.033, respectively). Reirradiation increased tracheotomy and PEG-tube dependency by 20 % (P = 0.011) and 23 % (P = 0.003), respectively. CONCLUSIONS Reirradiation is a feasible therapeutic alternative in recurrent head and neck SCC. Oncologic outcomes observed in this series compare favorably to most published reports. Complete response and perineural invasion were independent prognostic factors for survival and locoregional control. While no mortality directly associated with treatment was observed in this series, reirradiation had a significant impact in functional outcomes in terms of increased risk of tracheotomy and peg tube dependency. Further studies are required to define the role of this treatment in head and neck cancer.
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Affiliation(s)
- Noah N Slater
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Soroush Farsi
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Ashton L Rogers
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Lindsey Herberger
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Jose Penagaricano
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Steven McKee
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Deanne King
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Santanu Samanta
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Jumin Sunde
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Emre Vural
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America
| | - Mauricio A Moreno
- Department of Otolaryngology, Head and Neck Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Street #543, Little Rock, AR 72205-1709, United States of America.
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Kil WJ, Eisaman S, Wilke C, Mowery Y, Smith W, Herndon C, Cousins D. Pharyngeal Constrictor-Sparing Salvage Stereotactic Body Radiation Therapy With Tongue-Out for In-Field Recurrence After Definitive Radiation Therapy for Head and Neck Cancer: Guide to Tongue-Out Radiation Therapy. Pract Radiat Oncol 2024:S1879-8500(24)00162-0. [PMID: 39047905 DOI: 10.1016/j.prro.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/12/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
This report details a pharyngeal constrictor muscle (PCM)-sparing stereotactic body radiation therapy (SBRT) using our institutional technique of "tongue-out" radiation therapy (TORT) for treating a local recurrent cancer in the uvula (GTVuvula) in a patient with history of a definitive chemotherapy with radiation therapy (70 Gy with weekly cisplatin) for a locally advanced laryngeal cancer 4 years ago. TORT includes optimizing the patients' reproducible tongue-out position using readily available medicine cup (30 cc) followed by sculping the thermoplastic mask with tongue-out, and real-time visual monitoring of the tongue position during the computed tomography simulation scan, cone beam computed tomography acquisition, and treatment. Between arcs during volumetric modulated arc therapy, time for tongue relaxation and saliva swallowing can be given to the patient. Without TORT, the patient's GTVuvula abutted the medial aspect of superior PCM (medial-sPCM) and a substantial volume of the previously irradiated superior PCM (sPCM) would have received high radiation dose from this salvage SBRT (32.5 Gy in 5 fractions). Comparing without TORT, the shortest distance between medial-sPCM-to-GTVuvula was increased by 13 mm with TORT, which reduced radiation dose to sPCM in the salvage SBRT plan. The mean dose to sPCM was decreased from 20.5 Gy without TORT to 12.7 Gy with TORT. With TORT, minimal sPCM volumes fell within higher isodose line: volume receiving ≥ 60% prescription dose (V60%Rx), V80%Rx, and V100%Rx to sPCM was, 4.8 versus 0.7 cc (without vs with TORT, respectively), 2.9 versus 0.19 cc, and 1.6 versus 0.04 cc, respectively. Maximum dose (Dmax) to medial-sPCM was 34.6 Gy without TORT versus 22.7 Gy with TORT. These high doses to the sPCM and intrafractional swallowing-related geographic misses of GTVuvula were avoided through the application of TORT in this salvage reirradiation setting. The patient successfully finished salvage SBRT with TORT resulting in no dysphagia or mucositis and maintained complete response at 12 months after treatment.
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Affiliation(s)
- Whoon Jong Kil
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Williamsport, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Subarna Eisaman
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center at John P. Murtha Pavilion, Johnstown, Pennsylvania
| | - Christopher Wilke
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Shadyside/Presbyterian, Pittsburgh, Pennsylvania
| | - Yvonne Mowery
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Shadyside/Presbyterian, Pittsburgh, Pennsylvania
| | - Wyatt Smith
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Williamsport, Pennsylvania
| | - Craig Herndon
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Williamsport, Pennsylvania
| | - David Cousins
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Williamsport, Pennsylvania
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Sarkar B, Biswal SS, Shahid T, Appunu K, Bhattacharya J, Ganesh T, Munshi A, Das A. A comparative dose-escalation analysis for reirradiated cancer patients with and without appropriate dose mapping. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2024; 63:71-80. [PMID: 38078988 DOI: 10.1007/s00411-023-01050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 11/14/2023] [Indexed: 03/09/2024]
Abstract
This study aims to compare dose escalation between two groups of reirradiated cancer patients, one with the previous contour and radiotherapy plan available on the treatment planning system and the other without. First group is identified as DICOM-group, while the other one is called non-DICOM group. The current study included 89 patients, 57 in the DICOM, and 32 in the non-DICOM group, who received reirradiation for recurrent or second primary tumours between 2019 and 2021. For the DICOM group, doses to 0.2cc volume for spine, brainstem, and optic apparatus from first radiation were converted into structures and transferred to reirradiation CT using deformable registration. First, one radiotherapy plan was created using the doctor prescribed dose (baseline prescription RxD_B); further an escalated dose (RxD_E) plan, taking into account all the dose volume parameters from previous radiation, was created only for DICOM group. In non-DICOM group patients were planned only for RxD_B. The maximum accepted dose escalation was 21 Gy. Radiotherapy prescription dose during earlier (first) treatment in DICOM and non-DICOM groups were 61 ± 5.6 Gy and 30-66 Gy, respectively. DICOM and non-DICOM groups had nearly identical baseline doses: 52.5 ± 10.7 Gy and 50.6 ± 6.9 Gy (difference 1.9 ± 12.7 Gy). Dose escalation was possible for 51 out of 57 patients in the DICOM-group. Average escalated dose in DICOM-group was 59.2 ± 6.2 Gy, with an incremental dose of 6.7 ± 12.4 Gy from the baseline prescription. No dose escalation was opted for in the non-DICOM group due to the unavailability of dose volume information from previous radiation. Reirradiation for head and neck cases allowed for a moderate to high dose escalation, facilitated by the presence of pertinent DICOM information from the initial radiotherapy.
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Affiliation(s)
- Biplab Sarkar
- Department of Radiotherapy, Apollo Multispecialty Hospitals, Calcutta, India.
| | | | - Tanweer Shahid
- Department of Radiotherapy, Apollo Multispecialty Hospitals, Calcutta, India
| | - Karthik Appunu
- Department of Radiotherapy, Apollo Multispecialty Hospitals, Calcutta, India
| | - Jibak Bhattacharya
- Department of Radiotherapy, Apollo Multispecialty Hospitals, Calcutta, India
| | | | - Anusheel Munshi
- Department of Radiotherapy, Manipal Hospitals, Dwarka, New Delhi, India
| | - Anindita Das
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, India
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Dietz A, Wiegand S, Bläker H, Budach W. [Therapy of tumor recurrences or secondary carcinomas in pretreated area is not compatible with the primary therapy in non-previously treated tissue - an overview]. Laryngorhinootologie 2023; 102:908-915. [PMID: 37696291 DOI: 10.1055/a-2161-2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
There are different initial situations in the treatment of local or locoregional recurrences, secondary carcinomas or residual squamous cell carcinomas of the head and neck region after primary therapy. The majority of patients with locoregional recurrences have had prior treatment consisting of surgery and/or postoperative radiotherapy or radiochemotherapy or primary radiotherapy or radiochemotherapy. In any case, it is a matter of new tumor growth in a previously treated area, which must be taken into account for the therapy decision. The biological backgrounds are diverse and are described in more detail and clinically classified in the present work.
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Affiliation(s)
| | - S Wiegand
- Hals-Nasen-Ohren-Universitätsklinik, Leipzig
| | - H Bläker
- Institut für Pathologie, Universität Leipzig
| | - W Budach
- Klinik für Strahlentherapie und Radioonkologie, Universität Düsseldorf
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Zhang S, Zeng N, Yang J, He J, Zhu F, Liao W, Xiong M, Li Y. Advancements of radiotherapy for recurrent head and neck cancer in modern era. Radiat Oncol 2023; 18:166. [PMID: 37803477 PMCID: PMC10559506 DOI: 10.1186/s13014-023-02342-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/31/2023] [Indexed: 10/08/2023] Open
Abstract
Head and neck cancer is a kind of cancer which can be eradicated from radical radiation therapy. However, with best efforts, nearly 40% patients will experience locoregional recurrence. Locoregional recurrence is the main cause of cancer-related death in head and neck cancers, so local treatments play a key role in improving progression free survival. In the last decades, radiation techniques have been tremendously developed, highly conformal radiation techniques such as intensity-modulated radiotherapy, stereotactic body radiation therapy, brachytherapy and proton or heavy ion radiation therapy have their unique radiobiological advances. Although reirradiation is widely used in clinical practice, but little is known when comparing the different techniques. In this review, we will provide a comprehensive overview of the role of reirradiation in recurrent head and neck cancers including radiation techniques, patient selection, overall clinical benefits, and toxicities.
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Affiliation(s)
- Shu Zhang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
- Department of Radiation Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Ni Zeng
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Jiangping Yang
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Jinlan He
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Fubin Zhu
- Department of Oncology, Chengdu Seventh People's Hospital (Affiliated Cancer Hospital of Chengdu Medical College), Chengdu, China
| | - Wenjun Liao
- Department of Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Center, Sichuan Cancer Hospital& Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Maoqi Xiong
- West China Clinical Skills Training Center, West China School of Medicine, West China Hospital, SCU, Chengdu, Sichuan, China
| | - Yan Li
- Department of Radiation Oncology, Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China.
- Lung Cancer Center, West China Hospital, SCU, Chengdu, Sichuan, China.
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Amdal CD, Moan JM, Dale E, Falk RS, Johansen S, Bjordal K. Impact of hyperfractionated re-irradiation on quality of life in patients with recurrent or second primary head and neck cancer, a prospective single institutional study. Clin Transl Radiat Oncol 2023; 42:100654. [PMID: 37415638 PMCID: PMC10319815 DOI: 10.1016/j.ctro.2023.100654] [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: 03/15/2023] [Revised: 05/19/2023] [Accepted: 06/17/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose Describe the clinical outcome of hyperfractionated re-irradiation (HFRT) in patients with recurrent or second primary (SP) head and neck cancer (HNC). Methods This prospective observational study included HNC patients eligible for HFRT. Inclusion criteria: age ≥18 years, recurrent or SP HNC, planned re-irradiation and ability to respond to questionnaires. Patients received 1.5 Gy twice daily, five days a week for three (palliative) or four (curative/local control) weeks, total dose 45/60 Gy. Toxicity was scored with CTCAE v3 at baseline, end of treatment, at three, six, 12 and 36 months follow-up. Health-related quality of life (HRQoL) was measured with EORTC QLQ-C30 and EORTC QLQ-H&N35, pre-treatment and eight times until 36 months. In the main outcome (Global quality of life and H&N Pain), a change score of ≥10 was considered clinically significant, and p-values < 0.05 (two-sided) statistically significant. The Kaplan-Meier method was used for survival analyses. Results Over four years from 2015, 58 patients were enrolled (37 recurrent and 21 SP). All, but two patients completed treatment as planned. Toxicity (≥grade 3) increased from pre-treatment to end of treatment with improvement in the follow-up period. The mean Global quality of life (QoL) and H&N Pain scores were stable from pre-treatment to three months. Maintained/ improved Global QoL was reported by 60% of patients at three months and 56% of patients at 12 months. For patients with curative, local control and palliative intent, the median survival (range) was 23 (2-53), 10 (1-66) and 14 (3-41) months respectively. Of those alive, the proportion of disease-free patients at 12 and 36 months, were 58% and 48%, respectively. Conclusion Most HNC patients reported maintained HRQoL at three and 12 months after HFRT despite serious toxicity observed in many patients. Long-term survival can be achieved in a limited proportion of the patients.
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Affiliation(s)
- Cecilie Delphin Amdal
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Jon Magne Moan
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Einar Dale
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Safora Johansen
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Faculty of Health Sciences, Oslo, Norway
| | - Kristin Bjordal
- Research Support Services, Oslo University Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
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Scolari C, Buchali A, Franzen A, Förster R, Windisch P, Bodis S, Zwahlen DR, Schröder C. Re-irradiation for head and neck cancer: outcome and toxicity analysis using a prospective single institution database. Front Oncol 2023; 13:1175609. [PMID: 37456239 PMCID: PMC10346436 DOI: 10.3389/fonc.2023.1175609] [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: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
Purpose Re-irradiation (re-RT) in head and neck cancer is challenging. This study prospectively explored the feasibility of re-RT in patients with loco-regionally recurrent or second primary head and neck cancer (LRR/SP HNC). Methods From 2004 to 2021, 61 LRR/SP HNC patients were treated with re-RT, defined as having a second course of RT with curative intent resulting in a cumulative dose of ≥100 Gy in an overlapping volume. Postoperative or definitive dynamic intensity-modulated and/or volumetric modulated re-RT was administered using twice daily hyperfractionation to 60 Gy combined with cisplatin or carboplatin/5-fluorouracil. Overall survival (OS), progression-free survival (PFS), locoregional control (LRC) and distant metastasis control (DMC) were analyzed and prognostic factors evaluated. Toxicity was prospectively recorded and graded. Results The median follow-up was 9.8 months. In 41 patients (67.1%), complete administration of the intended treatment was not feasible. In 9 patients (15%) re-RT was interrupted prematurely and in other 9, the complete re-RT dose was lower than 60 Gy, and 37 patients (61%) could not receive or complete chemotherapy. Two-year OS, PFS and LRC rates were 19%, 18% and 30%, respectively. 20 patients (33%) received the complete intended treatment, and 1- and 2-year OS rates were 70% and 47%, respectively. Charlson comorbidity index was an important predictor for treatment completion. Multivariate analysis revealed recurrent N stage 0-1, age, chemotherapy administration and re-RT dose of 60 Gy as prognostic factors for clinical outcomes. No grade 5 re-RT-related toxicity was observed. The most common new grade ≥3 acute toxicities were dysphagia (52%) and mucositis (46%). Late toxicity included grade ≥3 dysphagia in 5% and osteoradionecrosis in 10% of evaluable patients, respectively. 6 patients (10%) were alive after 9 years without progression and no late toxicity grade ≥3, except for 2 patients presenting with osteoradionecrosis. Conclusion Hyperfractionated re-RT with 60 Gy combined with platinum-based chemotherapy was a curative treatment option with acceptable toxicity in LRR/SP patients. Patients with higher comorbidity had a higher probability of failing to receive and complete the intended therapy. Consequently, they derived unsatisfactory benefits from re-RT, highlighting the importance of patient selection.
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Affiliation(s)
- Chiara Scolari
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - André Buchali
- Department of Radiation Oncology, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
| | - Achim Franzen
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital Ruppin-Brandenburg, Brandenburg Medical School Theodor Fontane (MHB), Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Joint Faculty of the University of Potsdam, Brandenburg university of Technology Cottbus-Senftenberg and Brandenburg Medical School, Potsdam, Germany
| | - Robert Förster
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Paul Windisch
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Stephan Bodis
- Center for Radiation Oncology, Cantonal Hospital Aarau and Baden (KSA-KSB), Aarau/Baden, Switzerland
| | - Daniel R. Zwahlen
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
| | - Christina Schröder
- Department of Radiation Oncology, Cantonal Hospital Winterthur (KSW), Winterthur, Switzerland
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Roesch J, Oertel M, Wegen S, Trommer M, Schleifenbaum J, Hering D, Mäurer M, Knippen S, Dobiasch S, Waltenberger M, von der Grün J, Medenwald D, Süß C, Hoeck M, Käsmann L, Fleischmann DF, Rühle A, Nicolay NH, Fabian A, Löser A, Heß S, Tamaskovics B, Vinsensia M, Hecht M. Dose-escalated re-irradiation improves outcome in locally recurrent head and neck cancer - Results of a large multicenter analysis. Radiother Oncol 2023; 181:109380. [PMID: 36273736 DOI: 10.1016/j.radonc.2022.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/21/2022] [Accepted: 10/11/2022] [Indexed: 11/07/2022]
Abstract
To determine efficacy and prognostic parameters of definitive re-irradiation of locoregionally recurrent squamous cell carcinoma of the head and neck (HNSCC). MATERIALS AND METHODS Patients with locoregionally recurrent or second primary HNSCC undergoing re-irradiation with modern radiotherapy technique were eligible for this multicentric retrospective analysis. Main endpoints were overall survival (OS), progression-free survival (PFS) and locoregional control (LC). Univariate analyses were performed using the Kaplan Meier Method (log-rank). For multivariable analysis, Cox regression was used. RESULTS A total of 253 patients treated between 2009 and 2020 at 16 university hospitals in Germany were included. The median follow up was 27.4 months (range 0.5-130). The median OS and PFS were 13.2 (CI: 10.7 - 15.7) months and 7.9 (CI: 6.7 - 9.1) months, respectively, corresponding to two-year OS and PFS rates of 29 % and 19 %. Rates of locoregional progression and "in-field-failure" were 62 % and 51 % after two years. Multivariable Cox regression analysis identified good ECOG performance status and high radiation dose as independent prognostic parameters for OS. Doses above 50 Gy (EQD2) achieved longer median OS of 17.8 months (vs 11.7 months, p < 0.01) and longer PFS of 9.6 months (vs 6.8 months, p < 0.01). In addition, there was a trend for worse survival in patients with tracheostomy (multivariable, p = 0.061). Concomitant systemic therapy did not significantly impact PFS or OS. CONCLUSION Re-irradiation of locally recurrent or second primary HNSCC is efficient, especially if doses above 50 Gy (EQD2) are delivered. ECOG performance score was the strongest prognostic parameter for OS and PFS.
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Affiliation(s)
- Johannes Roesch
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany; Deutsches Zentrum Immuntherapie, Erlangen, Germany.
| | - Michael Oertel
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Simone Wegen
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Maike Trommer
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Julia Schleifenbaum
- Department of Radiation Oncology, Cyberknife and Radiotherapy, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dominik Hering
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Matthias Mäurer
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Stefan Knippen
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
| | - Sophie Dobiasch
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maria Waltenberger
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jens von der Grün
- Department of Radiation Oncology, University Hospital Frankfurt, Frankfurt, Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, University Hospital Halle, Halle, Germany
| | - Christoph Süß
- Department of Radiation Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Michael Hoeck
- Department of Radiation Oncology, University Hospital Augsburg, Augsburg, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel F Fleischmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anastassia Löser
- Outpatient Center of the University Medical Hospital Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology) and Department of Oncology, Haematology and Bone Marrow Transplantation with the Section Pneumology (Centre for Oncology), University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Heß
- Department of Radiation Oncology, University Hospital Würzburg, Julius-Maximilians-University, Würzburg, Germany
| | - Bálint Tamaskovics
- Department of Radiation Oncology, Düsseldorf University Hospital, Heinrich Heine University, Düsseldorf, Germany
| | - Maria Vinsensia
- Department of Radiation Oncology, University Hospital Mannheim, Mannheim, Germany
| | - Markus Hecht
- Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg/Saar, Germany
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9
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Reirradiation for local recurrence of oral, pharyngeal, and laryngeal cancers: a multi-institutional study. Sci Rep 2023; 13:3062. [PMID: 36810749 PMCID: PMC9944926 DOI: 10.1038/s41598-023-29459-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
This study aimed to examine the efficacy and toxicity of reirradiation in patients with locally recurrent oral, pharyngeal, and laryngeal cancers. We conducted a retrospective, multi-institutional analysis of 129 patients with previously irradiated cancer. The most frequent primary sites were the nasopharynx (43.4%), oral cavity (24.8%), and oropharynx (18.6%). With a median follow-up duration of 10.6 months, the median overall survival was 14.4 months and the 2-year overall survival rate was 40.6%. For each primary site, the 2-year overall survival rates were 32.1%, 34.6%, 30%, 60.8%, and 5.7% for the hypopharynx, oral cavity, larynx, nasopharynx, and oropharynx, respectively. Prognostic factors for overall survival were primary site (nasopharynx versus other sites) and gross tumor volume (GTV) (≤ 25 cm3 versus > 25 cm3). The 2-year local control rate was 41.2%. Twenty-four patients (18.6%) presented with grade ≥ 3 toxicities, including nine with hemorrhages that led to grade 5 toxicities in seven patients. All nine tumors that caused hemorrhage showed tumor encasement of the carotid ≥ 180 degrees and eight of nine tumors had larger GTV > 25 cm3. Reirradiation is a feasible treatment option for small local recurrence of oral, pharyngeal, and laryngeal cancers, with the requirement of a strict eligibility assessment for large tumors with carotid encasement.
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10
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Nonsurgical Treatment Strategies for Elderly Head and Neck Cancer Patients: An Emerging Subject Worldwide. Cancers (Basel) 2022; 14:cancers14225689. [PMID: 36428780 PMCID: PMC9688456 DOI: 10.3390/cancers14225689] [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: 10/12/2022] [Revised: 11/12/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Consistent with the increasing rate of head and neck cancers among elderly adults, there has been an increase in the rate of those receiving nonsurgical treatments to maintain their function and quality of life. However, various problems, such as poor tolerance to chemoradiotherapy-related toxicity, are of greater concern in elderly adults than in younger individuals. In this review, we describe adverse events that should be particularly noted in elderly patients and provide an overview of countermeasures in nonsurgical treatments. We mainly focus on cisplatin-based chemoradiotherapy-the primary treatment for head and neck squamous cell carcinoma (HNSCC). Furthermore, we review the molecular targeted drugs and immune checkpoint inhibitors for elderly patients with HNSCC. Although the number of older patients is increasing worldwide, clinical trials aimed at determining the standard of care typically enroll younger or well-conditioned elderly patients. There is still very little evidence for treating elderly HNSCC older patients, and the question of optimal treatment needs to be explored.
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11
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Ahmed S, Liu C, LaHurd D, Murray E, Kolar M, Joshi N, Woody N, Koyfman S, Xia P. Using feasibility dose-volume histograms to reduce intercampus plan quality variability for head-and-neck cancer. J Appl Clin Med Phys 2022; 24:e13749. [PMID: 35962566 PMCID: PMC9859985 DOI: 10.1002/acm2.13749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/12/2022] [Accepted: 07/21/2022] [Indexed: 01/26/2023] Open
Abstract
The purpose of this work is to objectively assess variability of intercampus plan quality for head-and-neck (HN) cancer and to test utility of a priori feasibility dose-volume histograms (FDVHs) as planning dose goals. In this study, 109 plans treated from 2017 to 2019 were selected, with 52 from the main campus and 57 from various regional centers. For each patient, the planning computed tomography images and contours were imported into a commercial program to generate FDVHs with a feasibility value (f-value) ranging from 0.0 to 0.5. For 10 selected organs-at-risk (OARs), we used the Dice similarity coefficient (DSC) to quantify the overlaps between FDVH and clinically achieved DVH of each OAR and determined the f-value associated with the maximum DSC (labeled as f-max). Subsequently, 10 HN plans from the regional centers were replanned with planning dose goals guided by FDVHs. The clinical and feasibility-guided auto-planning (FgAP) plans were evaluated using our institutional criteria. Among plans from the main campus and regional centers, the median f-max values were statistically significantly different (p < 0.05) for all OARs except for the left parotid (p = 0.622), oral cavity (p = 0.057), and mandible (p = 0.237). For the 10 FgAP plans, the median values of f-max were 0.21, compared to 0.37 from the clinical plans. With comparable dose coverage to the tumor volumes, the significant differences (p < 0.05) in the median f-max and corresponding dose reduction (shown in parenthesis) for the spinal cord, larynx, supraglottis, trachea, and esophagus were 0.27 (8.5 Gy), 0.3 (7.6 Gy), 0.19 (5.9 Gy), 0.19 (8.9 Gy), and 0.12 (4.0 Gy), respectively. In conclusion, the FDVH prediction is an objective quality assurance tool to evaluate the intercampus plan variability. This tool can also provide guideline in planning dose goals to further improve plan quality.
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Affiliation(s)
- Saeed Ahmed
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Chieh‐Wen Liu
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Danielle LaHurd
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Eric Murray
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Matthew Kolar
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Nikhil Joshi
- Department of Radiation OncologyRush University Medical CenterChicagoIllinoisUSA
| | - Neil Woody
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Shlomo Koyfman
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer CenterCleveland Clinic FoundationClevelandOhioUSA
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12
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Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
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13
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Kreinbrink PJ, Lewis LM, Redmond KP, Takiar V. Reirradiation of Recurrent and Second Primary Cancers of the Head and Neck: a Review of the Contemporary Evidence. Curr Treat Options Oncol 2022; 23:295-310. [PMID: 35226310 DOI: 10.1007/s11864-021-00936-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 01/07/2023]
Abstract
OPINION STATEMENT Recurrent and second primary head and neck cancers represent a clinical challenge due to frequently unresectable and/or locally advanced disease. Given that many of these patients have received definitive doses of radiation previously, reirradiation is associated with significant morbidity. Use of modern approaches such as conformal photon-based planning and charged particle therapy using protons or carbon ions allows for greater sparing of normal tissues while maintaining or escalating doses to tumor volumes. While the reirradiation data has consistently shown benefits to local control and even survival from escalation of radiotherapy dose, excessive cumulative doses can result in severe toxicities, including fatal carotid blowout syndrome. For all modalities, appropriate patient selection is of utmost importance. Large-scale trials and multi-institutional registry data are needed to standardize treatment modalities, and to determine optimal doses and volumes for reirradiation.
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Affiliation(s)
- Paul J Kreinbrink
- University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA
| | - Luke M Lewis
- University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA
| | - Kevin P Redmond
- University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA
| | - Vinita Takiar
- University of Cincinnati Departments of Radiation Oncology, Cincinnati, OH, USA. .,Cincinnati VA Medical Center, Cincinnati, OH, USA. .,University of Cincinnati Medical Center, 234 Goodman Street, ML 0757, Cincinnati, OH, 45267, USA.
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14
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Lee HI, Kim JH, Ahn SH, Chung EJ, Keam B, Eom KY, Jeong WJ, Kim JW, Wee CW, Wu HG. Re-irradiation for recurrent or second primary head and neck cancer. Radiat Oncol J 2022; 39:279-287. [PMID: 34986549 PMCID: PMC8743457 DOI: 10.3857/roj.2021.00640] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/17/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose To investigate the efficacy and safety of intensity-modulated radiotherapy (IMRT)-based re-irradiation (reRT) for recurrent or second primary head and neck cancer (HNC). Materials and Methods Patients who underwent IMRT-based reRT for recurrent or second primary HNC between 2007 and 2019 at two institutions were included. Medical records and dosimetric data were retrospectively reviewed. Overall survival (OS), progression-free survival (PFS), severe late toxicities, and clinicopathological prognostic factors were analyzed. Results A total of 42 patients were analyzed. With a median follow-up of 15.1 months (range, 3.7 to 85.8 months), the median OS was 28.9 months with a 2-year OS rate of 54.6%. The median PFS and 2-year PFS rates were 10.0 months and 30.9%, respectively. Multivariate analysis showed that good performance (Eastern Cooperative Oncology Group [ECOG] 0 or 1), a longer time interval (≥24 months) between radiotherapy courses, and higher reRT dose (>60 Gy) were significantly favorable factors for OS (all p < 0.05). Higher reRT dose and salvage surgery were significantly associated with improved PFS (all p < 0.05). Regarding the Multi‐Institution Reirradiation (MIRI) Collaborative RPA classification, the 2-year OS rates of each class were 87.5% in class I, 51.8% in class II, and 0% in class III (p = 0.008). Grade ≥3 late toxicity was reported in 10 (23.8%) patients. There was no significant factor associated with increased late toxicities. Conclusion IMRT-based reRT should be considered as a treatment option for patients with recurrent or second primary HNC. Further trials are needed to establish a subset of patients who may benefit from reRT without severe late toxicity.
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Affiliation(s)
- Hye In Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Won Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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15
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Hernandez DJ, Alam B, Kemnade JO, Huang AT, Chen AC, Sandulache VC. Consistent multimodality approach to oral cavity and high-risk oropharyngeal cancer in veterans. Am J Otolaryngol 2021; 42:103166. [PMID: 34333218 DOI: 10.1016/j.amjoto.2021.103166] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/17/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE High-risk oropharyngeal squamous cell carcinoma (OPSCC) associated with tobacco exposure remains difficult to treat due to high rates of locoregional recurrence similar to oral cavity squamous cell carcinoma (OCSCC). Current NCCN guidelines allow for surgical management of this disease, but oncologic and functional data in the modern era remain scarce. We sought to compare and contrast oncologic and functional considerations for surgical management of OPSCC and OCSCC in a cohort of Veterans. MATERIALS AND METHODS We conducted a retrospective review of patients treated at the Michael E. DeBakey Veterans Affairs Medical Center between 2017 and 2020, treated using a homogenous, multi-modality algorithm. RESULTS OPSCC tumors presented with a higher rate of perineural invasion (p < 0.05) and extranodal extension (p = 0.02) compared to OCSCC tumors. Compliance with NCCN guidelines for adjuvant treatment were lower for OPSCC patients primarily due to a higher rate of previous irradiation; re-irradiation could be delivered in 75% of patients when recommended by NCCN guidelines. Total glossectomy was accompanied by concomitant total laryngectomy in 100% of OPSCC patients and 0% of OCSCC. CONCLUSION Surgical resection and free flap reconstruction of high-risk OPSCC generates oncologic outcomes comparable to OCSCC with comparable complication rates but a lower overall functional status. Reconstruction focused on rapid healing allows for high-rates of re-irradiation and minimal treatment delays. LEVEL OF EVIDENCE level 4.
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16
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Ionna F, Bossi P, Guida A, Alberti A, Muto P, Salzano G, Ottaiano A, Maglitto F, Leopardo D, De Felice M, Longo F, Tafuto S, Della Vittoria Scarpati G, Perri F. Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck: A Big and Intriguing Challenge Which May Be Resolved by Integrated Treatments Combining Locoregional and Systemic Therapies. Cancers (Basel) 2021; 13:2371. [PMID: 34069092 PMCID: PMC8155962 DOI: 10.3390/cancers13102371] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 12/12/2022] Open
Abstract
Squamous cell carcinoma of the head and neck (SCCHN) is a complex group of malignancies, posing several challenges to treating physicians. Most patients are diagnosed with a locally advanced disease and treated with strategies integrating surgery, chemotherapy, and radiotherapy. About 50% of these patients will experience a recurrence of disease. Recurrent/metastatic SCCHN have poor prognosis with a median survival of about 12 months despite treatments. In the last years, the strategy to manage recurrent/metastatic SCCHN has profoundly evolved. Salvage treatments (surgery or re-irradiation) are commonly employed in patients suffering from locoregional recurrences and their role has gained more and more importance in the last years. Re-irradiation, using some particularly fractionating schedules, has the dual task of reducing the tumor mass and eliciting an immune response against cancer (abscopal effect). In this review, we will analyze the main systemic and/or locoregional strategies aimed at facing the recurrent/metastatic disease, underlining the enormous importance of the multidisciplinary approach in these types of patients.
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Affiliation(s)
- Franco Ionna
- Otolaryngology Unit, INT IRCCS Foundation G. Pascale, Naples. Via M. Semmola, 80131 Naples, Italy; (F.I.); (G.S.); (F.M.)
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, 25123 Brescia, Italy; (P.B.); (A.A.)
| | - Agostino Guida
- U.O.C. Odontostomatologia, A.O.R.N. Cardarelli, 80131 Naples, Italy;
| | - Andrea Alberti
- Medical Oncology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University of Brescia, ASST-Spedali Civili, 25123 Brescia, Italy; (P.B.); (A.A.)
| | - Paolo Muto
- Radiation Therapy Unit, INT IRCCS Foundation G Pascale, Via M. Semmola, 80131 Naples, Italy;
| | - Giovanni Salzano
- Otolaryngology Unit, INT IRCCS Foundation G. Pascale, Naples. Via M. Semmola, 80131 Naples, Italy; (F.I.); (G.S.); (F.M.)
| | - Alessandro Ottaiano
- Department of Abdominal Oncology, SSD-Innovative Therapies for Abdominal Cancers, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale” Via M. Semmola, 80131 Naples, Italy;
| | - Fabio Maglitto
- Otolaryngology Unit, INT IRCCS Foundation G. Pascale, Naples. Via M. Semmola, 80131 Naples, Italy; (F.I.); (G.S.); (F.M.)
| | - Davide Leopardo
- Medical Oncology Unit, Azienda Ospedaliera S. Anna e S. Sebastiano, 81100 Caserta, Italy; (D.L.); (M.D.F.)
| | - Marco De Felice
- Medical Oncology Unit, Azienda Ospedaliera S. Anna e S. Sebastiano, 81100 Caserta, Italy; (D.L.); (M.D.F.)
| | - Francesco Longo
- Otolaryngology and Maxillo-Facial Surgery Unit, Ospedale Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy;
| | - Salvatore Tafuto
- Sarcoma and Rare Tumors Medical Oncology Unit, Istituto Nazionale Tumori di Napoli, IRCCS “G. Pascale” Via M. Semmola, 80131 Naples, Italy;
| | | | - Francesco Perri
- Medical and Experimental Head and Neck Oncology Unit, INT IRCCS Foundation G Pascale, Via M. Semmola, 80131 Naples, Italy
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17
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Bertone F, Robiolio E, Robiolio L, Liscia D, Gervasio CF. Three Synchronous Head and Neck Cancers: A Multidisciplinary and Surgical Challenge. EAR, NOSE & THROAT JOURNAL 2021; 102:NP294-NP297. [PMID: 33848206 DOI: 10.1177/01455613211007946] [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: 11/15/2022] Open
Abstract
Second primary cancer (SPC) is a term used to describe a new primary cancer occurring in patients who had formerly been diagnosed with tumor. Even though SPCs appear to be related to primary cancers, they are actually entities that have arisen independently and not as a result of recurrence. This report is of the first case in literature of a patient hospitalized for the surgical treatment of 3 synchronous Head and Neck Cancers. A 66-year-old male was admitted to our hospital (Ospedale Degli Infermi-Biella, Italy) complaining about pharyngodynia. Three different lesions were identified through endoscopic examination and narrow band imaging: the first one on left tonsil, the second one on epiglottis, and the third one on right aryepiglottic fold. The case was subject to a multidisciplinary team analysis due to its complexity, then the surgery consisted in (1) CO2 laser left tonsillectomy, associated with (2) CO2 laser excision of the lesion on epiglottis free edge, and (3) CO2 laser excision of right aryepiglottic fold lesion. Synchronous tumors are among the most defiant challenges for surgeons since no international guideline specifies differentiated strategies to be adopted in patients affected by synchronous Head and Neck Cancers, therefore surgical planning must be tailored differently from patient to patient, and many unsolved questions still concern clinical treatments to be adopted.
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Affiliation(s)
- Fabio Bertone
- ENT Department, 472601Degli Infermi Hospital, Biella, Italy
| | | | - Luca Robiolio
- ENT Department, 472601Degli Infermi Hospital, Biella, Italy
| | - Daniele Liscia
- Anatomic Pathology Department, 18506Degli Infermi Hospital, Biella, Italy
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18
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Yang X, Han B, Zhang R, Su Y, Hosseini DK, Wu H, Yang M, Sun H. Development and validation of a RNA binding protein-associated prognostic model for head and neck squamous cell carcinoma. Aging (Albany NY) 2021; 13:7975-7997. [PMID: 33758106 PMCID: PMC8034976 DOI: 10.18632/aging.202848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 03/13/2021] [Indexed: 12/13/2022]
Abstract
Evidence shows that defects in RNA-binding proteins (RBPs) are closely related to the occurrence and development of HNSCC. We obtained 502 tumors and 44 normal samples from the TCGA database, among which 190 differentially expressed RBPs were screened. Finally, a prognostic model containing nine RBPs (CELF2, CPEB1, DDX39B, EIF3L, EZH2, KHDRBS3, RNASE10, RNASE3 and SIDT1) was produced. Further analysis showed that the overall survival rate in the high-risk group was lower than that in the low-risk group. The area under the ROC curve (AUC) in the training and testing groups was significant (3-year AUC, 0.735 vs 0.796; 5-year AUC, 0.821 vs 0.804). In addition, a comprehensive analysis of nine identified RBPs showed that most of them were related to the OS of HNSCC patients, and three of them (CELF2, EZH2, and SIDT1) were differentially expressed in HNSCC and control tissues at the protein level. In addition, our data revealed that the identified RBPs are highly interconnected, with high frequency copy number changes in HNSCC samples. GSEA indicated that the abnormal biological processes related to RNA and the activation of some classical tumor signaling pathways were important driving forces for the development of HNSCC. Our results provide novel insights into the pathogenesis of HNSCC, among which nine RBP markers have potential application value in clinical decision-making and individualized treatment of HNSCC.
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Affiliation(s)
- Xiuping Yang
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Baoai Han
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Runshi Zhang
- Department of Clinical Laboratory, Xi'an No. 1 Hospital, Xi'an 710000, China
| | - Yuan Su
- Department of Clinical Laboratory, Xi'an Labor Union Hospital, Xi'an 710000, China
| | - Davood K Hosseini
- Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ 07601, USA
| | - Han Wu
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Minlan Yang
- Department of Otorhinolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Haiying Sun
- Department of Otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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19
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Electrochemotherapy in the Treatment of Head and Neck Cancer: Current Conditions and Future Directions. Cancers (Basel) 2021; 13:cancers13061418. [PMID: 33808884 PMCID: PMC8003720 DOI: 10.3390/cancers13061418] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Electrochemotherapy (ECT) was first introduced in the late 1980s and was initially used mainly on cutaneous tumors. It has now evolved into a clinically verified treatment approach. Thanks to its high feasibility, it has been extended to treating mucosal and deep-seated tumors, including head and neck cancer (HNC) and in heavily pretreated settings. This review describes current knowledge and data on the use of ECT in various forms of HNCs across different clinical settings, with attention to future clinical and research perspectives. Abstract Despite recent advances in the development of chemotherapeutic drug, treatment for advanced cancer of the head and neck cancer (HNC) is still challenging. Options are limited by multiple factors, such as a prior history of irradiation to the tumor site as well as functional limitations. Against this background, electrochemotherapy (ECT) is a new modality which combines administration of an antineoplastic agent with locally applied electric pulses. These pulses allow the chemotherapeutic drug to penetrate the intracellular space of the tumor cells and thereby increase its cytotoxicity. ECT has shown encouraging efficacy and a tolerable safety profile in many clinical studies, including in heavily pre-treated HNC patients, and is considered a promising strategy. Efforts to improve its efficacy and broaden its application are now ongoing. Moreover, the combination of ECT with recently developed novel therapies, including immunotherapy, represented by immune checkpoint inhibitor (ICI)s, has attracted attention for its potent theoretical rationale. More extensive, well-organized clinical studies and timely updating of consensus guidelines will bring this hopeful treatment to HNC patients under challenging situations.
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20
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The Value of Laboratory Parameters for Anemia, Renal Function, Systemic Inflammation and Nutritional Status as Predictors for Outcome in Elderly Patients with Head-and-Neck Cancers. Cancers (Basel) 2020; 12:cancers12061698. [PMID: 32604773 PMCID: PMC7352755 DOI: 10.3390/cancers12061698] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/05/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study was to evaluate the value of routine blood markers regarding their predictive potential for treatment outcomes of elderly head-and-neck squamous cell carcinoma (HNSCC) patients. In total, 246 elderly HNSCC patients (≥65 years) undergoing (chemo)radiotherapy from 2010 to 2018 were analyzed for treatment outcomes, depending on their hemoglobin, glomerular filtration rate (GFR), C-reactive protein (CRP) and albumin values, representing anemia, kidney function, inflammation and nutrition status, respectively. Local/locoregional control, progression-free and overall survival (OS) were calculated using the Kaplan–Meier method. Cox analyses were performed to examine the influence of blood parameters on oncological outcomes. In the univariate Cox regression analysis, hemoglobin ≤ 12 g/dL (HR = 1.536, p < 0.05), a GFR ≤ 60 mL/min/1.73 m2 (HR = 1.537, p < 0.05), a CRP concentration > 5 mg/L (HR = 1.991, p < 0.001) and albumin levels ≤ 4.2 g/dL (HR = 2.916, p < 0.001) were significant risk factors for OS. In the multivariate analysis including clinical risk factors, only performance status (HR = 2.460, p < 0.05) and baseline albumin (HR = 2.305, p < 0.05) remained significant prognosticators. Additionally, baseline anemia correlated with the prevalence of higher-grade chronic toxicities. We could show for the first time that laboratory parameters for anemia (and at least partly, tumor oxygenation), decreased renal function, inflammation and reduced nutrition status are associated with impaired survival in elderly HNSCC patients undergoing (chemo)radiotherapy.
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Embring A, Onjukka E, Mercke C, Lax I, Berglund A, Bornedal S, Wennberg B, Friesland S. Overlapping volumes in re-irradiation for head and neck cancer - an important factor for patient selection. Radiat Oncol 2020; 15:147. [PMID: 32513217 PMCID: PMC7278185 DOI: 10.1186/s13014-020-01587-3] [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: 04/06/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is a lack of consensus concerning the definition of re-irradiation and re-irradiation volumes in head and neck cancer (HNC). The aim of the present study is to introduce a more strict definition of the re-irradiated volume that might better predict the risk of serious side-effects from treatment. METHODS Fifty-four consecutive patients re-irradiated for HNC cancer were retrospectively analysed. CT images were deformably registered and the dose distributions accumulated after conversion to EQD2. Patients with a cumulative dose of ≥100 Gy in the overlapping volume (V100) were included in the study. Survival data and radiation-related acute and late toxicities were recorded. RESULTS The overall survival of all included patients at 2 and 5 years was 42.6 and 27.3% respectively and the progression free survival at 2 and 5 years was 32.5 and 28.5% respectively. The overall rate of any event of severe (grade ≥ 3) acute and late toxicity was 26 and 51%, respectively. We found that severe acute toxicity was more common in patients who had a larger overlapping volume (V100 > mean) where 43% of the patients experienced grade ≥ 3 acute toxicity, compared to the patients with smaller overlapping volumes (V100 < mean) where only 11% had severe toxicity (p = 0.02). The seemingly high rates of late toxicity in the present study could be due to the use of a more strict definition of re-irradiation. In previous studies also patients with low dose overlap are included and our results imply that there is a risk that previous studies might have overestimated the risk-benefit ratio in re-irradiation of HNC. CONCLUSIONS Our study describes the outcome of a patient material where a more strict definition of the re-irradiated volume is used. With this definition, which could better describe the volume of highest risk for serious complications, we found that larger such overlapping volumes result in an increase in severe acute side-effects. A clear definition of re-irradiation and re-irradiation volumes is of utmost importance for future studies of HNC to make results from different studies comparable.
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Affiliation(s)
- Anna Embring
- Department of Oncology, Karolinska University Hospital, Anna Steckséns gata 41, 171 76, Stockholm, Solna, Sweden. .,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
| | - Eva Onjukka
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.,Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Claes Mercke
- Department of Oncology, Karolinska University Hospital, Anna Steckséns gata 41, 171 76, Stockholm, Solna, Sweden.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Ingmar Lax
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Berglund
- Epistat Epidemiology and Statistics Consulting, Uppsala, Sweden
| | - Sara Bornedal
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Berit Wennberg
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Signe Friesland
- Department of Oncology, Karolinska University Hospital, Anna Steckséns gata 41, 171 76, Stockholm, Solna, Sweden.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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