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Subtil FSB, Gröbner C, Recknagel N, Parplys AC, Kohl S, Arenz A, Eberle F, Dikomey E, Engenhart-Cabillic R, Schötz U. Dual PI3K/mTOR Inhibitor NVP-BEZ235 Leads to a Synergistic Enhancement of Cisplatin and Radiation in Both HPV-Negative and -Positive HNSCC Cell Lines. Cancers (Basel) 2022; 14:cancers14133160. [PMID: 35804930 PMCID: PMC9265133 DOI: 10.3390/cancers14133160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Head and neck cancers (HNSCCs), especially in the advanced stages, are predominantly treated by radiochemotherapy, including cisplatin. The cure rates are clearly higher for HPV-positive HNSCCs when compared to HPV-negative HNSCCs. For both entities, this treatment is accompanied by serious adverse reactions, mainly due to cisplatin administration. We reported earlier that for both HPV-positive and negative HNSCC cells, the effect of radiotherapy was strongly enhanced when pretreated using the dual PI3K/mTOR inhibitor NVP-BEZ235 (BEZ235). The current study shows that for HPV-positive cells, BEZ235 will strongly enhance the effect of cisplatin alone. More important, preincubation with BEZ235 was found to alter the purely additive effect normally seen when cisplatin is combined with radiation into a strong synergistic enhancement. This tri-modal combination might allow for the enhancement of the effect of radiochemotherapy, even with reduced cisplatin. Abstract The standard of care for advanced head and neck cancers (HNSCCs) is radiochemotherapy, including cisplatin. This treatment results in a cure rate of approximately 85% for oropharyngeal HPV-positive HNSCCs, in contrast to only 50% for HPV-negative HNSCCs, and is accompanied by severe side effects for both entities. Therefore, innovative treatment modalities are required, resulting in a better outcome for HPV-negative HNSCCs, and lowering the adverse effects for both entities. The effect of the dual PI3K/mTOR inhibitor NVP-BEZ235 on a combined treatment with cisplatin and radiation was studied in six HPV-negative and six HPV-positive HNSCC cell lines. Cisplatin alone was slightly more effective in HPV-positive cells. This could be attributed to a defect in homologous recombination, as demonstrated by depleting RAD51. Solely for HPV-positive cells, pretreatment with BEZ235 resulted in enhanced cisplatin sensitivity. For the combination of cisplatin and radiation, additive effects were observed. However, when pretreated with BEZ235, this combination changed into a synergistic interaction, with a slightly stronger enhancement for HPV-positive cells. This increase could be attributed to a diminished degree of DSB repair in G1, as visualized via the detection of γH2AX/53BP1 foci. BEZ235 can be used to enhance the effect of combined treatment with cisplatin and radiation in both HPV-negative and -positive HNSCCs.
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Affiliation(s)
- Florentine S. B. Subtil
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
| | - Carolin Gröbner
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
| | - Niklas Recknagel
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
| | - Ann Christin Parplys
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
| | - Sibylla Kohl
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
| | - Andrea Arenz
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
| | - Fabian Eberle
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
| | - Ekkehard Dikomey
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
- Laboratory of Radiobiology & Experimental Radiooncology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
| | - Ulrike Schötz
- Department of Radiotherapy and Radiooncology, Philipps-University, 35043 Marburg, Germany; (F.S.B.S.); (C.G.); (N.R.); (A.C.P.); (S.K.); (A.A.); (F.E.); (E.D.); (R.E.-C.)
- Correspondence: ; Tel.: +49-6421-28-21978
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de Brito RV, Mancini MW, Palumbo MDN, de Moraes LHO, Rodrigues GJ, Cervantes O, Sercarz JA, Paiva MB. The Rationale for "Laser-Induced Thermal Therapy (LITT) and Intratumoral Cisplatin" Approach for Cancer Treatment. Int J Mol Sci 2022; 23:5934. [PMID: 35682611 PMCID: PMC9180481 DOI: 10.3390/ijms23115934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 01/27/2023] Open
Abstract
Cisplatin is one of the most widely used anticancer drugs in the treatment of various types of solid human cancers, as well as germ cell tumors, sarcomas, and lymphomas. Strong evidence from research has demonstrated higher efficacy of a combination of cisplatin and derivatives, together with hyperthermia and light, in overcoming drug resistance and improving tumoricidal efficacy. It is well known that the antioncogenic potential of CDDP is markedly enhanced by hyperthermia compared to drug treatment alone. However, more recently, accelerators of high energy particles, such as synchrotrons, have been used to produce powerful and monochromatizable radiation to induce an Auger electron cascade in cis-platinum molecules. This is the concept that makes photoactivation of cis-platinum theoretically possible. Both heat and light increase cisplatin anticancer activity via multiple mechanisms, generating DNA lesions by interacting with purine bases in DNA followed by activation of several signal transduction pathways which finally lead to apoptosis. For the past twenty-seven years, our group has developed infrared photo-thermal activation of cisplatin for cancer treatment from bench to bedside. The future development of photoactivatable prodrugs of platinum-based agents injected intratumorally will increase selectivity, lower toxicity and increase efficacy of this important class of antitumor drugs, particularly when treating tumors accessible to laser-based fiber-optic devices, as in head and neck cancer. In this article, the mechanistic rationale of combined intratumor injections of cisplatin and laser-induced thermal therapy (CDDP-LITT) and the clinical application of such minimally invasive treatment for cancer are reviewed.
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Affiliation(s)
- Renan Vieira de Brito
- Department of Otolaryngology and Head and Neck Surgery, Federal University of São Paulo (UNIFESP), Sao Paulo 04023-062, SP, Brazil; (R.V.d.B.); (M.d.N.P.); (O.C.)
| | - Marília Wellichan Mancini
- Biophotonics Department, Institute of Research and Education in the Health Area (NUPEN), Sao Carlos 13562-030, SP, Brazil;
| | - Marcel das Neves Palumbo
- Department of Otolaryngology and Head and Neck Surgery, Federal University of São Paulo (UNIFESP), Sao Paulo 04023-062, SP, Brazil; (R.V.d.B.); (M.d.N.P.); (O.C.)
| | - Luis Henrique Oliveira de Moraes
- Department of Physiological Sciences, Federal University of Sao Carlos (UFSCar), Sao Carlos 13565-905, SP, Brazil; (L.H.O.d.M.); (G.J.R.)
| | - Gerson Jhonatan Rodrigues
- Department of Physiological Sciences, Federal University of Sao Carlos (UFSCar), Sao Carlos 13565-905, SP, Brazil; (L.H.O.d.M.); (G.J.R.)
| | - Onivaldo Cervantes
- Department of Otolaryngology and Head and Neck Surgery, Federal University of São Paulo (UNIFESP), Sao Paulo 04023-062, SP, Brazil; (R.V.d.B.); (M.d.N.P.); (O.C.)
| | - Joel Avram Sercarz
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
| | - Marcos Bandiera Paiva
- Department of Otolaryngology and Head and Neck Surgery, Federal University of São Paulo (UNIFESP), Sao Paulo 04023-062, SP, Brazil; (R.V.d.B.); (M.d.N.P.); (O.C.)
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, CA 90095, USA;
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Comorbidity, Radiation Duration, and Pretreatment Body Muscle Mass Predict Early Treatment Failure in Taiwanese Patients with Locally Advanced Oral Cavity Squamous Cell Carcinoma after Completion of Adjuvant Concurrent Chemoradiotherapy. Diagnostics (Basel) 2021; 11:diagnostics11071203. [PMID: 34359287 PMCID: PMC8306647 DOI: 10.3390/diagnostics11071203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 12/26/2022] Open
Abstract
Few prospective cohort trials have evaluated the potential risk factors of early treatment failure of locally advanced oral cavity squamous cell carcinoma (LAOCSCC) patients following the completion of postoperative adjuvant concurrent chemoradiotherapy (CCRT). We collected clinicopathological variables, nutrition-inflammatory markers and total body composition data assessed by dual-energy X-ray absorptiometry (DXA) before and after CCRT. A factor analysis was used to reduce the number of DXA-derived parameters. Cox proportional hazard models were applied to determine the risk factors associated with early treatment failure defined as tumor progression or death within 180 days of CCRT completion. A total of 69 patients were eligible for analysis. After CCRT, the body weight, body mass index, nutritional markers, and muscle mass decreased, whereas C-reactive protein level increased. Five factors reflecting different body composition statuses were identified. A total of 21 patients (30.4%) developed early treatment failure. Comorbidities (hazard ratio ((HR)), 2.699; 95% confidence interval ((CI)), 1.005–7.913; p = 0.044), radiation duration (HR, 1.092; 95% CI, 1.015–1.174; p = 0.018) and the pretreatment body muscle mass (HR, 0.578; 95% CI, 0.345–0.957; p = 0.037) independently contributed to early treatment failure. Comorbidities, longer radiation duration, and lower pretreatment body muscle mass are predictive factors for early treatment failure in LAOCSCC patients following postoperative adjuvant CCRT completion.
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LoCastro E, Paudyal R, Mazaheri Y, Hatzoglou V, Oh JH, Lu Y, Konar AS, Vom Eigen K, Ho A, Ewing JR, Lee N, Deasy JO, Shukla-Dave A. Computational Modeling of Interstitial Fluid Pressure and Velocity in Head and Neck Cancer Based on Dynamic Contrast-Enhanced Magnetic Resonance Imaging: Feasibility Analysis. ACTA ACUST UNITED AC 2021; 6:129-138. [PMID: 32548289 PMCID: PMC7289251 DOI: 10.18383/j.tom.2020.00005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We developed and tested the feasibility of computational fluid modeling (CFM) based on dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) for quantitative estimation of interstitial fluid pressure (IFP) and velocity (IFV) in patients with head and neck (HN) cancer with locoregional lymph node metastases. Twenty-two patients with HN cancer, with 38 lymph nodes, underwent pretreatment standard MRI, including DCE-MRI, on a 3-Tesla scanner. CFM simulation was performed with the finite element method in COMSOL Multiphysics software. The model consisted of a partial differential equation (PDE) module to generate 3D parametric IFP and IFV maps, using the Darcy equation and Ktrans values (min−1, estimated from the extended Tofts model) to reflect fluid influx into tissue from the capillary microvasculature. The Spearman correlation (ρ) was calculated between total tumor volumes and CFM estimates of mean tumor IFP and IFV. CFM-estimated tumor IFP and IFV mean ± standard deviation for the neck nodal metastases were 1.73 ± 0.39 (kPa) and 1.82 ± 0.9 × (10−7 m/s), respectively. High IFP estimates corresponds to very low IFV throughout the tumor core, but IFV rises rapidly near the tumor boundary where the drop in IFP is precipitous. A significant correlation was found between pretreatment total tumor volume and CFM estimates of mean tumor IFP (ρ = 0.50, P = 0.004). Future studies can validate these initial findings in larger patients with HN cancer cohorts using CFM of the tumor in concert with DCE characterization, which holds promise in radiation oncology and drug-therapy clinical trials.
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Affiliation(s)
| | | | - Yousef Mazaheri
- Departments of Medical Physics and.,Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vaios Hatzoglou
- Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Yonggang Lu
- Department of Radiology, Medical College of Wisconsin, Milwaukee, WI
| | | | | | - Alan Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James R Ewing
- Departments of Neurology and.,Neurosurgery, Henry Ford Hospital, Detroit, MI; and
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Amita Shukla-Dave
- Departments of Medical Physics and.,Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Viet CT, Dierks EJ, Cheng AC, Patel AA, Chang SC, Couey MA, Watters AL, Hoang T, Xiao HD, Crittenden MR, Leidner RS, Seung SK, Young KH, Bell RB. Transoral robotic surgery and neck dissection for HPV-positive oropharyngeal carcinoma: Importance of nodal count in survival. Oral Oncol 2020; 109:104770. [PMID: 32599498 DOI: 10.1016/j.oraloncology.2020.104770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 04/02/2020] [Accepted: 04/30/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND In this study we determine the survival in patients with HPV-positive oropharyngeal carcinoma treated with transoral robotic surgery (TORS), neck dissection and risk-adapted adjuvant therapy. METHODS We retrospectively identified 122 patients with HPV-positive oropharyngeal carcinoma treated with TORS and neck dissection between 2011 and 2018. Survival probability was calculated. We determined the effect of the type of neck dissection performed (modified radical neck dissection-MRND vs. selective neck dissection - SND), extranodal extension (ENE), margin status, and presence of ≥ 5 metastatic nodes on survival. RESULTS Our patient population had a five-year overall survival of 91.0% (95% C.I. 85-97%). The five-year probability of recurrence or cancer-associated death was 0.0977 (95% C.I. 0.0927-0.1027). The five-year probability of cancer-associated death was 0.0528 (95% C.I. 0.048-0.0570). All patients who died of their disease had distant metastasis. Our PEG dependence rate was 0%. Patients with ENE and positive margins who underwent adjuvant chemoradiation did not have worse survival. Presence of ≥ 5 metastatic nodes portended worse survival after controlling for age, positive ENE and margins. Low yield (<18 nodes) on neck dissection worsened DFS on multivariable analysis. Furthermore, patients who underwent SND did not have worse OS than those who underwent MRND. CONCLUSION Our study demonstrates that surgery could be simplified by performing TORS with SND rather than MRND. The one true poor prognostic factor in HPV-positive oropharyngeal carcinoma patients who undergo surgery is high nodal burden. Patients with high nodal burden are much more likely to die from their disease.
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Affiliation(s)
- Chi T Viet
- Oral and Maxillofacial Surgery Department, Loma Linda University School of Dentistry, Loma Linda, CA, United States; Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Head and Neck Cancer Program, Legacy Cancer Center, Portland, OR, United States
| | - Eric J Dierks
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Head and Neck Cancer Program, Legacy Cancer Center, Portland, OR, United States
| | - Allen C Cheng
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Head and Neck Cancer Program, Legacy Cancer Center, Portland, OR, United States
| | - Ashish A Patel
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Head and Neck Cancer Program, Legacy Cancer Center, Portland, OR, United States
| | - Shu-Ching Chang
- Medical Data Research Center, Providence St. Joseph Health, Portland, OR, United States
| | - Marcus A Couey
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Head and Neck Cancer Program, Legacy Cancer Center, Portland, OR, United States
| | - Amber L Watters
- Oral Oncology and Medicine, Providence Cancer Institute, Portland, OR, United States
| | - Thien Hoang
- Oral Oncology and Medicine, Providence Cancer Institute, Portland, OR, United States
| | - Hong D Xiao
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States
| | - Marka R Crittenden
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Earle A. Chiles Research Institute at Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, United States; The Oregon Clinic, Portland, OR, United States
| | - Rom S Leidner
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Earle A. Chiles Research Institute at Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, United States
| | - Steven K Seung
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; The Oregon Clinic, Portland, OR, United States
| | - Kristina H Young
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Earle A. Chiles Research Institute at Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, United States; The Oregon Clinic, Portland, OR, United States
| | - R Bryan Bell
- Head and Neck Cancer Program, Providence Cancer Institute, Portland, OR, United States; Earle A. Chiles Research Institute at Robert W. Franz Cancer Center, Providence Cancer Institute, Portland, OR, United States.
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Iatì G, Parisi S, Santacaterina A, Pontoriero A, Cacciola A, Brogna A, Platania A, Palazzolo C, Cambareri D, Davì V, Napoli I, Lillo S, Severo C, Tamburella C, Vadalà R, Delia P, Pergolizzi S. Simultaneous Integrated Boost Radiotherapy in Unresectable Stage IV (M0) Head and Neck Squamous Cell Cancer Patients: Daily Clinical Practice. Rep Pract Oncol Radiother 2020; 25:399-404. [PMID: 32368191 PMCID: PMC7190747 DOI: 10.1016/j.rpor.2020.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 03/07/2020] [Accepted: 04/02/2020] [Indexed: 12/21/2022] Open
Abstract
AIM To evaluate clinical outcome in locally-advanced stage IV (M0) head and neck cancer patients treated using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in daily clinical practice. BACKGROUND Despite SIB-IMRT has been reported as a feasible and effective advanced head and neck cancer treatment, there are few data about its concurrent use with systemic therapies. MATERIAL AND METHODS We reviewed 41 staged IV (M0) head and neck cancer patients treated in two radiotherapy units in the city of Messina (Italy) during the last six years, using intensity modulated techniques-SIB. 22/41 patients had concomitant chemotherapy or cetuximab. Acute and late toxicities, objective response (OR) rate, local control (LC) and overall survival (OS) have been evaluated. RESULTS 37/41 patients received the planned doses of radiotherapy, 2 patients died during the therapy. The major acute regional toxicities were skin reaction and mucositis. A case of mandibular osteoradionecrosis was recorded. At completion of treatment, OR was evaluated in 38 patients: 32/38 patients (84.2%) had complete (55.3%) and partial (28.9%) response. The 1- and 5-year LC rates were 73.4% and 69.73%, respectively. The 1-, 3-, and 5-year OS rates were 85.93%, 51.49% and 44.14%, respectively. No statistically significant differences in outcomes have been observed in patients treated with radiotherapy alone vs. irradiation concomitant to chemo/biotherapy. The median OS was 45 months. CONCLUSION SIB-IMRT is safeand can be used with concomitant chemotherapy/biotherapy in real-life daily clinical practice. SIB-IMRT alone is a valid alternative in patients unfit for systemic therapies.
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Affiliation(s)
- Giuseppe Iatì
- Unit of Radiation Oncology - University Hospital “G. Martino”, Via Consolare Valeria, 1 – 98125 Messina, Italy
| | - Silvana Parisi
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | | | - Antonio Pontoriero
- Unit of Radiation Oncology - University Hospital “G. Martino”, Via Consolare Valeria, 1 – 98125 Messina, Italy
| | - Alberto Cacciola
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Anna Brogna
- Unit of Medical Physics, University Hospital “G. Martino”, Messina, Italy
| | - Angelo Platania
- Unit of Radiation Oncology - Papardo Hospital, Messina, Italy
| | | | - Domenico Cambareri
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Valerio Davì
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Ilenia Napoli
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Sara Lillo
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Cesare Severo
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Consuelo Tamburella
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Roberta Vadalà
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
| | - Pietro Delia
- Unit of Radiation Oncology - University Hospital “G. Martino”, Via Consolare Valeria, 1 – 98125 Messina, Italy
| | - Stefano Pergolizzi
- Unit of Radiation Oncology - University Hospital “G. Martino”, Via Consolare Valeria, 1 – 98125 Messina, Italy
- Department of Biomedical and Dental Sciences, and of Morphological and Functional Images, University of Messina, Italy
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Jackson JE, Anderson NJ, Wada M, Schneider M, Poulsen M, Rolfo M, Fahandej M, Gan H, Joon DL, Khoo V. Clinical and dosimetric risk stratification for patients at high-risk of feeding tube use during definitive IMRT for head and neck cancer. Tech Innov Patient Support Radiat Oncol 2020; 14:1-10. [PMID: 32154393 PMCID: PMC7052527 DOI: 10.1016/j.tipsro.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 11/29/2022] Open
Abstract
Understanding feeding tube risk is critical to optimal weight maintenance during radiotherapy. T-stage, Level II lymphadenopathy risk stratify feeding tube use into 4 groups. The addition of cervical oesophagus dose can further refine these risk stratified groups.
Introduction To identify organs to which dose limitation using intensity modulated radiotherapy (IMRT) can potentially modify the incidence and duration of feeding tube use, during and immediately following therapy for head and neck cancer. Materials and methods One hundred and fourteen patients treated with definitive IMRT (± concurrent chemotherapy) head and neck mucosal cancers were included. Patients received a prophylactic feeding tube and followed up by a dietician for at least eight weeks post-radiotherapy. Salivary and swallowing organs were delineated for each patient. Tumour and dosimetric variables were recorded for all patients and analysed for incidence and duration of feeding tube use for at least 25% of dietary requirements. Results Multivariate analysis showed T-classification ≥3 and level II lymphadenopathy as independent significant predictors of incidence and duration of feeding tube use in oral cavity, pharyngeal and supraglottic primaries. Mean dose deposited in the cervical oesophagus over 36Gy further increased the incidence and duration of feeding tube use. Mean dose deposited in the base of tongue and superior pharyngeal constrictor muscles affected incidence and duration of feeding tube use, respectively. Discussion In patients treated with definitive IMRT, T-classification and Level II lymphadenopathy, combined with a mean cervical oesophagus dose over 36Gy can a stratify patients into eight distinct risk groups for using feeding tubes for at least 25% of their dietary requirements.
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Affiliation(s)
- James E. Jackson
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
- School of Medicine, Griffith University, Gold Coast, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Sciences, Monash University, Victoria, Australia
- Icon Cancer Centres, Gold Coast University Hospital, Queensland, Australia
- Corresponding authors at: ICON Cancer Care Centre, Gold Coast University Hospital, I University Boulevard, LG Block C, Southport, QLD 4215, Australia (J.E. Jackson). Principal Research Radiation Therapist, 305 Grattan Street, Melbourne, Victoria 3000, Australia (N.J. Anderson).
| | - Nigel J. Anderson
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Sciences, Monash University, Victoria, Australia
- Corresponding authors at: ICON Cancer Care Centre, Gold Coast University Hospital, I University Boulevard, LG Block C, Southport, QLD 4215, Australia (J.E. Jackson). Principal Research Radiation Therapist, 305 Grattan Street, Melbourne, Victoria 3000, Australia (N.J. Anderson).
| | - Morikatsu Wada
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Sciences, Monash University, Victoria, Australia
| | - Michael Poulsen
- Icon Cancer Centres, Gold Coast University Hospital, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Maureen Rolfo
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Maziar Fahandej
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
- Department of Palliative Care, St Vincent’s Hospital, Fitzroy, Victoria, Australia
| | - Hui Gan
- Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
- Icon Cancer Centres, Gold Coast University Hospital, Queensland, Australia
| | - Vincent Khoo
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, Victoria, Australia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Sciences, Monash University, Victoria, Australia
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Chelsea, London, UK
- Department of Medicine, University of Melbourne, Victoria, Australia
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Schwartz DL, Hayes DN. The Evolving Role of Radiotherapy for Head and Neck Cancer. Hematol Oncol Clin North Am 2019; 34:91-108. [PMID: 31739954 DOI: 10.1016/j.hoc.2019.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The length and quality of head and neck cancer survivorship continues to meaningfully improve. Radiotherapy has been central to this process through advances in treatment delivery, fractionation schemas, radiosensitizing systemic therapy, and thoughtful interplay with technical surgical improvements. The future looks brighter still, with ongoing progress in targeted biologic therapy, immuno-oncology, and molecular-genetic tumor characterization for personalized treatment. Head and neck cancer, a disease once fraught with nihilism and failure, is evolving into a major success story of modern multidisciplinary cancer care.
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Affiliation(s)
- David L Schwartz
- Department of Radiation Oncology, UTHSC College of Medicine, 1265 Union Avenue, Memphis, TN 38104, USA; Department of Preventive Medicine, UTHSC College of Medicine, 1265 Union Avenue, Memphis, TN 38104, USA.
| | - D Neil Hayes
- Hematology/Oncology, Department of Medicine, UTHSC College of Medicine, 19 South Manassas Street, Cancer Research Building, 324, Memphis, TN 38103, USA; Department of Genetics/Genomics/Informatics, UTHSC College of Medicine, Memphis, TN, USA; Department of Preventive Medicine, UTHSC College of Medicine, Memphis, TN, USA; Department of Pathology, UTHSC College of Medicine, Memphis, TN, USA; Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
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9
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Mohamed A, Twardy B, Zordok MA, Ashraf K, Alkhoder A, Schrapp K, Steuer C, Chen Z, Pakkala S, Pillai R, Trad Wadsworth J, Higgins K, Beitler JJ, Ramalingam SS, Owonikoko TK, Khuri FR, Shin DM, Behera M, Saba NF. Concurrent chemoradiotherapy with weekly versus triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck: Comparative analysis. Head Neck 2019; 41:1490-1498. [PMID: 30835900 DOI: 10.1002/hed.25379] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/10/2018] [Accepted: 05/28/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cisplatin-based chemoradiotherapy is standard of care for locally advanced squamous cell carcinoma of the head and neck. This systemic review compared efficacy and safety of weekly vs triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck. METHODS Among 1500 prospective studies published from 1970 to 2015, 39 (18 weekly, 21 triweekly) including 3668 patients qualified for inclusion. Clinical outcomes were analyzed using weighted estimates and 2-tailed t test for comparisons; significance level was 0.05. RESULTS Locoregional control was 58% (CI 53%-63%) vs 61% (CI 56%-65%; P = .7). The 2-year overall survival (OS) was 74% (CI 66%-80%) for weekly vs 67% (64%-69%) triweekly groups (P = .67). The 2-year progression-free survival (PFS) was 69% (CI 59%-77%) for weekly vs 62% (CI 58%-65%) triweekly groups (P = .9). Grade 3 to 5 toxicities were 36% vs 40% (P = .37) in weekly vs triweekly groups. CONCLUSIONS Weekly cisplatin was comparable in efficacy and safety to the triweekly regimen. Our analysis supports the use of weekly or triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck, with tolerability being a key factor in selection.
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Affiliation(s)
- Amr Mohamed
- Department of Medical Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Brandon Twardy
- Department of Medical Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Magdi A Zordok
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Khuram Ashraf
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Ayman Alkhoder
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Kelly Schrapp
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Zhengjia Chen
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Suchita Pakkala
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rathi Pillai
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - J Trad Wadsworth
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | | | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
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10
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Nilsen ML, Mady LJ, Hodges J, Wasserman-Wincko T, Johnson JT. Burden of treatment: Reported outcomes in a head and neck cancer survivorship clinic. Laryngoscope 2019; 129:E437-E444. [PMID: 30648277 DOI: 10.1002/lary.27801] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE With the intensification and utilization of multimodal treatment, acute toxicities have increased; however, the frequency of treatment sequelae in long-term head and neck cancer (HNC) survivors are poorly described. The purpose of this analysis was to determine the prevalence and predictors of patient-reported late and long-term treatment-related sequelae in HNC survivors. METHODS We performed a cross-sectional analysis of patient-reported outcomes from 228 survivors attending a multidisciplinary HNC survivorship clinic. The primary outcomes comprised quality of life (QOL), symptoms of anxiety and depression, and swallowing dysfunction. RESULTS Male gender, tumor sites in the oropharynx and larynx, longer time since treatment, and treatment with surgery alone were associated with higher physical QOL (P < .05). Male gender, longer time since treatment, and treatment with surgery alone were associated with higher social-emotional QOL (P < .05). A reduction in anxiety symptoms and a higher QOL were related to longer time since treatment; however, a reduction in swallowing dysfunction symptoms was only related to longer time since treatment until approximately 6 years. After 6 years, survivors reported worse swallowing dysfunction (P < .05). One hundred thirty-two survivors (56%) reported at least three treatment-related effects that impacted their daily life. Finally, advanced stage disease at diagnosis (stage III-IV) was also associated with severe swallowing dysfunction (P = .004). CONCLUSION These data indicate the remarkable prevalence of treatment-related effects in HNC survivors. These results highlight the need for de-intensification of therapies, where appropriate, and for a better understanding of pathophysiology and new approaches to mitigating treatment effects. LEVEL OF EVIDENCE 4 Laryngoscope, 129:E437-E444, 2019.
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Affiliation(s)
- Marci Lee Nilsen
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A.,Department of Acute and Tertiary Care, Pittsburgh, Pennsylvania, U.S.A.,The University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jacob Hodges
- UPMC Wolff Center, Pittsburgh, Pennsylvania, U.S.A
| | - Tamara Wasserman-Wincko
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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11
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Jackson JE, Anderson NJ, Rolfo M, Wada M, Schneider M, Poulsen M, Fahandej M, Huynh A, Lee ST, Joon DL, Khoo V. 18F-FDG Metabolic Tumor Volume: Association with Short- and Long-Term Feeding Tube Use in Head and Neck IMRT. Dysphagia 2018; 34:341-349. [PMID: 30267142 DOI: 10.1007/s00455-018-9946-z] [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: 12/27/2017] [Accepted: 09/17/2018] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to investigate whether the metabolic tumor volume (MTV) of head and neck primary tumors may be a significant prognostic factor for feeding tube (FT) use and FT dependence. Seventy-nine patients with evaluable primary tumors, pre-therapy FDG-PET scans, treated with definitive intensity-modulated radiotherapy (IMRT) (± concurrent chemotherapy) for head and neck mucosal cancers were included. MTV was quantified and recorded for the primary lesion using a minimum standardized uptake value (SUV) threshold of 2.0. Patients were recommended prophylactic FT and followed up by a dietician for at least eight weeks of post-radiotherapy. Associations between MTV, dose to swallowing organs at risk, FT use, and FT dependence were analyzed. MTV was positively correlated with gross tumor volume (GTV) (r = 0.7357; p < 0.0001). MTVs larger than 17 cc were associated with higher rates of FT use (87.8% vs. 69.5%, p = 0.0067) and FT dependence at six weeks (76.7% vs. 41.7%, p = 0.0024) and six months (25.0% vs. 8.7%, p = 0.0088). Increasing MTV was associated with increasing mean dose to the oral cavity (p = < 0.0001), tongue base (p = 0.0009), and superior (SPCM) (p = 0.0001) and middle pharyngeal constrictor muscles (MPCM) (p = 0.0005). Increasing MTV was associated with increasing maximum dose to oral cavity (p = 0.0028), tongue base (p = 0.0056), SPCM (p = 0.0037), and MPCM (p = 0.0085). Pre-treatment MTV is a reproducible parameter that can be generated at or prior to a pre-treatment Multidisciplinary Tumor Board and may expedite decisions regarding placement of prophylactic FTs. Prospective evaluation in larger series is required to determine whether MTV is a more useful prognostic variable for FT use than clinical T-classification.
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Affiliation(s)
- James E Jackson
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia.
- Radiation Oncology Centres, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia.
- School of Medicine, Griffith University, Gold Coast, Australia.
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Nigel J Anderson
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Maureen Rolfo
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Morikatsu Wada
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia
| | - Michael Poulsen
- Radiation Oncology Centres, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Maziar Fahandej
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Anna Huynh
- Radiation Oncology Centres, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - Sze Ting Lee
- Centre for PET, Austin Health, Heidelberg, VIC, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Vincent Khoo
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness & Research Centre, Austin Health, Heidelberg, VIC, Australia
- Department of Medical Imaging and Radiation Sciences, Monash University, Clayton, VIC, Australia
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Chelsea, London, UK
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
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12
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Kim S, Oh S, Kim JS, Kim YK, Kim KH, Oh DH, Lee DH, Jeong WJ, Jung YH. Prognostic value of FDG PET/CT during radiotherapy in head and neck cancer patients. Radiat Oncol J 2018; 36:95-102. [PMID: 29983029 PMCID: PMC6074065 DOI: 10.3857/roj.2017.00577] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/14/2018] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To evaluate the prognostic value of 18F-fluorodeoxyglucose positron-emission tomography (FDG PET) with computed tomography (CT) before and during radiotherapy (RT) in patients with head and neck cancer. METHODS Twenty patients with primary head and neck squamous cell carcinoma were enrolled in this study, of whom 6 had oropharyngeal cancer, 10 had hypopharyngeal cancer, and 4 had laryngeal cancer. Fifteen patients received concurrent cisplatin and 2 received concurrent cetuximab chemotherapy. FDG PET/CT was performed before RT and in the 4th week of RT. The parameters of maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor were measured, and the prognostic significance of each was analyzed with the Cox proportional hazards model. RESULTS Higher TLG (>19.0) on FDG PET/CT during RT was a poor prognostic factor for overall survival (OS) (p = 0.001) and progression-free survival (PFS) (p = 0.007). In the multivariate analysis, TLG during RT as a continuous variable was significantly associated with OS and PFS rate (p = 0.023 and p = 0.016, respectively). Tumor response worse than partial remission at 1 month after RT was another independent prognostic factor for PFS (p = 0.024). Conclusions: Higher TLG of the primary tumor on FDG PET/CT during RT was a poor prognostic factor for OS and PFS in patients with head and neck cancer.
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Affiliation(s)
- Suzy Kim
- Department of Radiation Oncology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sowon Oh
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin Soo Kim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kwang Hyun Kim
- Department of Otolaryngology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Do Hoon Oh
- Department of Radiation Oncology, Chung-Ang University Hostpial, Seoul, Korea
| | - Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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13
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Anderson NJ, Jackson JE, Smith JG, Wada M, Schneider M, Poulsen M, Rolfo M, Fahandej M, Gan H, Joon DL, Khoo V. Pretreatment risk stratification of feeding tube use in patients treated with intensity-modulated radiotherapy for head and neck cancer. Head Neck 2018; 40:2181-2192. [PMID: 29756389 DOI: 10.1002/hed.25316] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 01/07/2018] [Accepted: 04/03/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The purpose of this study was to establish a risk stratification model for feeding tube use in patients who undergo intensity-modulated radiotherapy (IMRT) for head and neck cancers. METHODS One hundred thirty-nine patients treated with definitive IMRT (+/- concurrent chemotherapy) for head and neck mucosal cancers were included in this study. Patients were recommended a prophylactic feeding tube and followed up by a dietician for at least 8 weeks postradiotherapy (post-RT). Potential prognostic factors were analyzed for risk and duration of feeding tube use for at least 25% of dietary requirements. RESULTS Many variables had significant effects on risk and/or duration of feeding tube use in univariate analyses. Subsequent multivariable analysis showed that T classification ≥3 and level 2 lymphadenopathy were the best independent significant predictors of higher risk and duration of feeding tube use, respectively, in oral cavity, pharyngeal, and supraglottic primaries. CONCLUSION In patients treated with definitive IMRT, T classification ≥3 and level 2 lymphadenopathy can potentially stratify patients into 4 risk groups for developing severe dysphagia requiring feeding tube use.
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Affiliation(s)
- Nigel J Anderson
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - James E Jackson
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,School of Medicine, Griffith University, Gold Coast, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | | | - Morikatsu Wada
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Michal Schneider
- Department of Medical Imaging and Radiation Sciences, Monash University, Victoria, Australia
| | - Michael Poulsen
- Radiation Oncology Centres, Gold Coast University Hospital, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Maureen Rolfo
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Maziar Fahandej
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Palliative Care, St Vincent's Hospital, Fitzroy, Victoria, Australia
| | - Hui Gan
- Olivia Newton-John Cancer Research Institute, Austin Health, Heidelberg, Victoria, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Vincent Khoo
- Department of Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, Heidelberg, Victoria, Australia.,Department of Medical Imaging and Radiation Sciences, Monash University, Victoria, Australia.,Department of Clinical Oncology, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Chelsea, London, UK.,Department of Medicine, University of Melbourne, Victoria, Australia
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14
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Szturz P, Wouters K, Kiyota N, Tahara M, Prabhash K, Noronha V, Adelstein D, Vermorken JB. Altered fractionation radiotherapy combined with concurrent low-dose or high-dose cisplatin in head and neck cancer: A systematic review of literature and meta-analysis. Oral Oncol 2017; 76:52-60. [PMID: 29290286 DOI: 10.1016/j.oraloncology.2017.11.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/20/2017] [Accepted: 11/26/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Altered fractionation radiotherapy and concomitant chemoradiotherapy represent commonly used intensification strategies in the management of locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). This meta-analysis compares compliance, safety, and efficacy between two single-agent cisplatin schedules given concurrently with altered fractionation radiotherapy. METHODS We systematically searched for prospective trials of patients with LA-SCCHN who received post-operative or definitive altered fractionation concurrent chemoradiotherapy. High-dose cisplatin once every three to four weeks (100 mg/m2, 2 doses) was compared with a weekly low-dose protocol (≤50 mg/m2, ≥4 doses). The primary outcome was overall survival. The secondary endpoints comprised treatment adherence, acute and late toxicities, and objective response rate. RESULTS Twelve studies with 1373 patients treated with definitive chemoradiotherapy were included. Compared to the weekly low-dose cisplatin regimen, the three- to four-weekly high-dose cisplatin regimen improved overall survival (p=.0185), was more compliant with respect to receiving all planned cycles of cisplatin (71% versus 95%, p=.0353), and demonstrated less complications in terms of severe (grade 3-4) acute mucositis and/or stomatitis (75% versus 40%, p=.0202) and constipation (8% versus 1%, p=.0066), toxic deaths (4%, versus 1%, p=.0168), 30-day mortality (8% versus 3%, p=.0154), and severe late subcutaneous fibrosis (21% versus 2%, p<.0001). Overall and complete response rates were similar between both chemotherapy schedules. CONCLUSION In chemoradiotherapy incorporating altered fractionation, two cycles of high-dose cisplatin with a three to four week interval are superior to weekly low-dose schedules. Further studies should identify those who might derive the greatest benefit from this intensified approach.
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Affiliation(s)
- Petr Szturz
- Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno, Czech Republic; School of Medicine, Masaryk University, Brno, Czech Republic.
| | - Kristien Wouters
- Scientific Coordination and Biostatistics, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Naomi Kiyota
- Kobe University Hospital Cancer Center, Kobe, Hyogo, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - David Adelstein
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jan B Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
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15
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Acute toxicity of concomitant boost radiation therapy by volumetric-modulated arc therapy in head and neck cancers. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396917000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroductionVolumetric-modulated arc therapy (VMAT) is an advanced form of intensity-modulated radiation therapy that reduces treatment time without compromising plan quality. This study assessed acute toxicities in patients having carcinomas of oropharynx, larynx and hypopharynx treated with concomitant boost radiation therapy by VMAT.Materials and methodsIn this study, 30 patients of stages II–IVA disease were treated with concomitant boost radiation therapy using VMAT and those with stages III and IV also received concurrent chemotherapy with cisplatin 100 mg/m2 weekly thrice for two cycles. The total dose was 68·4 Gy/40 fractions/5.5 weeks (1·8 Gy/fraction/day to the large field for 28 fractions +1·5 Gy/fraction/day to boost field for the last 12 days of treatment). Radiation Therapy Oncology Group acute radiation morbidity scoring criteria was used to grade acute effects.ResultsAll patients completed scheduled treatment with median duration of 44 days. No grade 4 skin and mucosal toxicities were observed; grade 3 skin and mucosal toxicities seen in six (20%) and eight (26·67%) patients, respectively; grade 3 dysphagia and laryngeal toxicity in eight (26·67%) and three (10%) patients, respectively; two patients had grade 4 laryngeal toxicity. No grade 3 or grade 4 haematological toxicities were seen.ConclusionVMAT-based concomitant boost radiation therapy allows for dose escalation with good patient tolerance by limiting acute toxicities.
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16
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Chang PH, Yeh KY, Wang CH, Chen EYC, Yang SW, Huang JS, Chou WC, Hsieh JCH. Impact of the pretreatment Glasgow prognostic score on treatment tolerance, toxicities, and survival in patients with advanced head and neck cancer undergoing concurrent chemoradiotherapy. Head Neck 2017; 39:1990-1996. [PMID: 28688124 DOI: 10.1002/hed.24853] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 03/10/2017] [Accepted: 04/25/2017] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of the pretreatment Glasgow prognostic score on treatment-related toxicities, tolerance, and survival in patients with advanced head and neck cancers undergoing concurrent chemoradiotherapy (CRT). METHODS We retrospectively analyzed and compared the clinical characteristics, toxicities, and survival of 143 patients with stages III, IVA, and IVB head and neck cancer treated with concurrent CRT according to their Glasgow prognostic score between 2007 and 2010. RESULTS The Glasgow prognostic score was correlated with advanced tumor stage and T/N classification. Patients with a higher Glasgow prognostic score were less likely to tolerate concurrent CRT, experienced more weight loss, required tube feeding support more frequently, and had higher percentage of grade ≥3 hematological toxicities, sepsis, and toxic death. Patients with a Glasgow prognostic score of 0 had better overall and recurrence-free survival than those with a Glasgow prognostic score of 1 or 2. CONCLUSION Pretreatment Glasgow prognostic score predicts treatment tolerance, toxicity, and survival in patients with advanced head and neck cancer undergoing concurrent CRT.
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Affiliation(s)
- Pei-Hung Chang
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Taiwan, Republic of China.,Cancer Center, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Kun-Yun Yeh
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Taiwan, Republic of China.,Cancer Center, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Cheng-Hsu Wang
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Taiwan, Republic of China.,Cancer Center, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Eric Yen-Chao Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Taiwan, Republic of China
| | - Shih-Wei Yang
- Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Taiwan, Republic of China
| | - Jen-Seng Huang
- Division of Hemato-oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University, College of Medicine, Taiwan, Republic of China
| | - Wen-Chi Chou
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, Republic of China
| | - Jason Chia-Hsun Hsieh
- Circulating Tumor Cell Laboratory, Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, Republic of China.,Department of Chemical and Materials Engineering, Chang Gung University, Taoyuan, Taiwan, Republic of China
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17
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Gupta PK, Lal P, Bajpai R, Goel A, Yadav R, Verma M, Kumar S. Long term results of comparison of concurrent low-dose daily cisplatin versus the standard weekly cisplatin with six fractions per week radiotherapy in locally advanced head neck cancer. South Asian J Cancer 2016; 5:80-4. [PMID: 27275456 PMCID: PMC4873705 DOI: 10.4103/2278-330x.181647] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aim and Objective: Weekly administration of cisplatin (cis-diamminedichloroplatinum [CDDP]) appears more feasible and substantially more popular than the 3 weekly schedules due to better compliance. Different concurrent cisplatin schedules have been attempted including a daily schedule. We did a comparison of two consecutive single arm studies, i.e., use of weekly cisplatin versus daily cisplatin when used with concurrently with a moderately accelerated radiotherapy (RT) schedule. Patients and Methods: Two prospective feasibility, safety and efficacy studies were carried out consecutively within the department. The weekly CDDP study was done from August 2003 to August 2005 and daily CDDP study was conducted from November 2005 to June 2007. Both studies included locally advanced stage III and IV squamous cell carcinoma of the head and neck region with RT dose of 70 Gy. Concurrent single-agent cisplatin was administered weekly (35 mg/m2) in the first and daily (6 mg/m2) in the second study. Results: Weekly cisplatin study had 68 and daily CDDP study had 52 patients. The median follow-up in the two studies was 93 and 63 months, respectively. Compliance in the two studies was comparable. Acute Grade III/IV mucositis and dysphagia were significantly higher in weekly cisplatin study. Late Grade II/III toxicities such as xerostomia, dysphagia, ototoxicity and nephrotoxicity were similar. The 5 years locoregional control was 18% and 25% and 5 years overall survival rate was 32% and 31% in weekly and daily cisplatin studies, respectively. Conclusions: Modest acceleration along with either weekly or daily cisplatin, whichever is possible in one's setup, is do-able, provided due attention is paid to patient selection and supportive care.
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Affiliation(s)
- Pramod Kumar Gupta
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Punita Lal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ranjeet Bajpai
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anshu Goel
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajan Yadav
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Mranalini Verma
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Goguen LA, Posner MR, Norris CM, Tishler RB, Wirth LJ, Annino DJ, Gagne A, Sullivan CA, Sammartino DE, Haddad RI. Dysphagia after Sequential Chemoradiation Therapy for Advanced Head and Neck Cancer. Otolaryngol Head Neck Surg 2016; 134:916-22. [PMID: 16730530 DOI: 10.1016/j.otohns.2006.02.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2005] [Accepted: 02/01/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES: Assess impact of sequential chemoradiation therapy (SCRT) for advanced head and neck cancer (HNCA) on swallowing, nutrition, and quality of life. STUDY DESIGN: Prospective cohort study of 59 patients undergoing SCRT for advanced head and neck cancer. Follow-up median was 47.5 months. SETTING: Regional Cancer Center. RESULTS: Median time to gastrostomy tube removal was 21 weeks. Eighteen of 23 patients who underwent modified barium swallow demonstrated aspiration; none developed pneumonia. Six of 7 with pharyngoesophageal stricture underwent successful dilatation. Functional Assessment of Cancer Therapy—Head and Neck Scale questionnaires at median 6 months after treatment revealed “somewhat” satisfaction with swallowing. At the time of analysis, 97% have the gastronomy tube removed and take soft/regular diet. CONCLUSION: Early after treatment dysphagia adversely affected weight, modified barium swallow results, and quality of life. Diligent swallow therapy, and dilation as needed, allowed nearly all patients to have their gastronomy tubes removed and return to a soft/regular diet. SIGNIFICANCE: Dysphagia is significant after SCRT but generally slowly recovers 6 to 12 months after SCRT.
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Affiliation(s)
- Laura A Goguen
- Department of Surgery/Division of Otolaryngology, at the Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston, MA 02115, USA.
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19
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Potential Role of PET/MRI for Imaging Metastatic Lymph Nodes in Head and Neck Cancer. AJR Am J Roentgenol 2016; 207:248-56. [PMID: 27163282 DOI: 10.2214/ajr.16.16265] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE This article explores recent developments in PET and MRI, separately or combined, for assessing metastatic lymph nodes in patients with head and neck cancer. CONCLUSION The synergistic role of PET and MRI for imaging metastatic lymph nodes has not been fully explored. To facilitate the understanding of the areas that need further investigation, we discuss potential mechanisms and evidence reported so far, as well as future directions and challenges for continued development and clinical research.
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Bergamini C, Locati L, Bossi P, Granata R, Alfieri S, Resteghini C, Imbimbo M, Fallai C, Orlandi E, Tana S, Iacovelli NA, Guzzo M, Ibba T, Colombo S, Bianchi R, Pizzi N, Fontanella W, Licitra L. Does a multidisciplinary team approach in a tertiary referral centre impact on the initial management of head and neck cancer? Oral Oncol 2016; 54:54-7. [PMID: 26774920 DOI: 10.1016/j.oraloncology.2016.01.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 12/29/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES A multi-disciplinary team (MDT) is essential in the management of cancer. Head and neck cancer (HNC) is a rare, complex and heterogeneous group of malignancies for which different treatment options are available. However, the potential impact of MDT on the management of HNC has been only poorly evaluated to date. This study evaluates the impact of MDT on the management of HNC in a tertiary centre. METHODS We retrospectively analysed records of HNC patients referred to a MDT evaluation at the Istituto Nazionale Tumori of Milan, Italy, from May 2007 to January 2012. All cases were reviewed by a MDT consisting of a head and neck surgeon, a radiation oncologist, and a medical oncologist. RESULTS Data from 781 HNC patients were analysed. Approximately 70% of patients were referred to our Institution for a second opinion consultation. Following MDT evaluation, new staging examinations were requested in 49% of patients, and treatment plan was modified in 10%. CONCLUSIONS A MDT approach in a tertiary referral hospital leads to staging refinement of disease or changes in treatment plan in about 60% of patients.
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Affiliation(s)
| | - Laura Locati
- Head and Neck Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Paolo Bossi
- Head and Neck Unit, Istituto Nazionale Tumori, Milan, Italy
| | | | | | | | | | - Carlo Fallai
- Radiotherapy Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Ester Orlandi
- Radiotherapy Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Silvia Tana
- Radiotherapy Unit, Istituto Nazionale Tumori, Milan, Italy
| | | | - Marco Guzzo
- Otorinolaryngol Surgery Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Tullio Ibba
- Otorinolaryngol Surgery Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Sarah Colombo
- Otorinolaryngol Surgery Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Roberto Bianchi
- Otorinolaryngol Surgery Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Natalia Pizzi
- Otorinolaryngol Surgery Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Walter Fontanella
- Otorinolaryngol Surgery Unit, Istituto Nazionale Tumori, Milan, Italy
| | - Lisa Licitra
- Head and Neck Unit, Istituto Nazionale Tumori, Milan, Italy
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21
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Lim SH, Lee SJ, Ahn MJ, Park K, Sun JM. Different clinical outcomes between locally advanced hypopharyngeal and oropharyngeal cancer treated with definitive concurrent chemoradiotherapy: implication for subgroup selection for induction chemotherapy. Jpn J Clin Oncol 2015; 46:40-5. [PMID: 26561556 DOI: 10.1093/jjco/hyv163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 10/07/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study is to compare the long-term clinical outcome of hypopharynx cancer and oropharynx cancer treated with concurrent chemoradiotherapy. METHODS A total of 213 patients with locally advanced hypopharyngeal squamous cell carcinoma (n = 79) or oropharygeal squamous cell carcinoma (n = 134) were included. All patients were treated with upfront concurrent chemoradiotherapy between 1995 and 2012. RESULTS The median overall survival and progression-free survival differed significantly between the two groups (P < 0.05). Overall survival and progression-free survival rates at 3 years were 52% and 42% for hypopharynx cancer, and 75% and 72% for oropharynx cancer, respectively. There was no significant difference in the overall incidence of distant metastases but more locoregional recurrences occurred in patients with hypopharynx cancer compared with those with oropharynx cancer with a statistical significance (P < 0.001). CONCLUSIONS Patients diagnosed with locally advanced hypopharyngeal had relatively poor survival after upfront concurrent chemoradiotherapy. More intensive treatment such as induction chemotherapy before concurrent chemoradiotherapy might be needed to improve survival outcome in this subgroup of patients.
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Affiliation(s)
- Sung Hee Lim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Su Jin Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Keunchil Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong-Mu Sun
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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22
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Kimple RJ, Sher DJ. Human papillomavirus and head and neck cancer. Int J Radiat Oncol Biol Phys 2015; 92:196-9. [PMID: 25968816 DOI: 10.1016/j.ijrobp.2015.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 10/23/2022]
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23
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Driessen CML, Janssens GO, van der Graaf WTA, Takes RP, Merkx TAW, Melchers WJG, Kaanders HAM, van Herpen CML. Toxicity and efficacy of accelerated radiotherapy with concurrent weekly cisplatin for locally advanced head and neck carcinoma. Head Neck 2015; 38 Suppl 1:E559-65. [DOI: 10.1002/hed.24039] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/10/2022] Open
Affiliation(s)
- Chantal M. L. Driessen
- Department of Medical Oncology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Geert O. Janssens
- Department of Radiation Oncology; Radboud University Medical Center; Nijmegen The Netherlands
| | | | - Robert P. Takes
- Department of Otorhinolaryngology and Head and Neck Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Thijs A. W. Merkx
- Department of Oral and Maxillofacial Surgery; Radboud University Medical Center; Nijmegen The Netherlands
| | - Willem J. G. Melchers
- Department of Medical Microbiology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Hans A. M. Kaanders
- Department of Radiation Oncology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Carla M. L. van Herpen
- Department of Medical Oncology; Radboud University Medical Center; Nijmegen The Netherlands
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24
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Induction chemotherapy with concurrent chemoradiotherapy versus concurrent chemoradiotherapy for locally advanced squamous cell carcinoma of head and neck: a meta-analysis. Sci Rep 2015; 5:10798. [PMID: 26041604 PMCID: PMC4455182 DOI: 10.1038/srep10798] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 04/30/2015] [Indexed: 02/01/2023] Open
Abstract
Concurrent chemoradiotherapy (CCRT) has been considered to be the standard of care for locally advanced squamous cell carcinoma of head and neck (LA-SCCHN). Whether induction chemotherapy (IC) with CCRT will further improve the clinical outcomes or not is still unclear. We conducted a meta-analysis to compare the two regimens for LA-SCCHN. Literature searches were carried out in PubMed, Embase, Cochrane Library and Chinese Biology Medicine from inception to November 2014. Five prospective randomized controlled trials (RCTs) with 922 patients were included in meta-analysis. Results were expressed as hazard ratios (HRs) or relative risks (RRs) with 95% confidence intervals (CIs). Compared with CCRT, IC with CCRT showed no statistically significant differences in overall survival (OS), progression-free survival (PFS), overall response rate (ORR) or locoregional recurrence rate (LRR), but could increase risks of grade 3-4 febrile neutropenia (P = 0.0009) and leukopenia (P = 0.04). In contrast, distant metastasis rate (DMR) decreased (P = 0.006) and complete response rate (CR) improved (P = 0.010) for IC with CCRT. In conclusion, the current studies do not support the use of IC with CCRT over CCRT, and the further positioning of IC with CCRT as standard treatment for LA-SCCHN will come from more RCTs directly comparing IC followed by CCRT with CCRT.
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Desouky S, AboSeif S, Shama S, Gaafar A, Gamaleldin O. Role of dynamic contrast enhanced and diffusion weighted MRI in the differentiation between post treatment changes and recurrent laryngeal cancers. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by chemoradiotherapy or chemoradiotherapy alone in stage III–IV unresectable head and neck cancer. Strahlenther Onkol 2015; 191:635-41. [DOI: 10.1007/s00066-015-0829-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/19/2015] [Indexed: 11/26/2022]
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Hoshikawa H, Kishino T, Mori T, Indo K, Inamoto R, Akiyama K, Miyashita T, Mori N. Clinical outcomes of nedaplatin and S-1 treatment with concurrent radiotherapy in advanced head and neck cancer. Acta Otolaryngol 2015; 135:103-8. [PMID: 25496182 DOI: 10.3109/00016489.2014.952046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Nedaplatin and S-1 treatment with concurrent radiotherapy was effective, with acceptable toxicities. This regimen does not require extensive intravenous hydration and continuous infusion. Nedaplatin and S-1 may contribute to better clinical outcomes and improve quality of life for patients. OBJECTIVES We retrospectively analyzed the clinical efficacy and toxicity of concurrent chemoradiotherapy with nedaplatin and S-1 for head and neck squamous cell cancer. METHODS Forty-six patients with oropharyngeal, hypopharyngeal, and laryngeal cancer were treated with S-1 on days 1 through 14 and nedaplatin on day 1 every 4 weeks for two cycles of radiotherapy. Therapeutic responses and adverse events were assessed. RESULTS Primary site tumors and neck lymph nodes exhibited complete response rates of 91% and 64.3%, respectively. The 4-year relapse-free survival and overall survival rates were 76.2% and 85.3%, respectively. The main grade 3 and 4 toxicities were mucositis (30%), leukopenia (30%), anorexia (22%), dermatitis (15%), and thrombocytopenia (9%).
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Affiliation(s)
- Hiroshi Hoshikawa
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa , Japan
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28
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Nguyen-Tan PF, Zhang Q, Ang KK, Weber RS, Rosenthal DI, Soulieres D, Kim H, Silverman C, Raben A, Galloway TJ, Fortin A, Gore E, Westra WH, Chung CH, Jordan RC, Gillison ML, List M, Le QT. Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the Radiation Therapy Oncology Group 0129 trial: long-term report of efficacy and toxicity. J Clin Oncol 2014; 32:3858-66. [PMID: 25366680 PMCID: PMC4239304 DOI: 10.1200/jco.2014.55.3925] [Citation(s) in RCA: 308] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We tested the efficacy and toxicity of cisplatin plus accelerated fractionation with a concomitant boost (AFX-C) versus standard fractionation (SFX) in locally advanced head and neck carcinoma (LA-HNC). PATIENTS AND METHODS Patients had stage III to IV carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Radiation therapy schedules were 70 Gy in 35 fractions over 7 weeks (SFX) or 72 Gy in 42 fractions over 6 weeks (AFX-C). Cisplatin doses were 100 mg/m(2) once every 3 weeks for two (AFX-C) or three (SFX) cycles. Toxicities were scored by using National Cancer Institute Common Toxicity Criteria 2.0 and the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria. Overall survival (OS) and progression-free survival (PFS) rates were estimated by using the Kaplan-Meier method and were compared by using the one-sided log-rank test. Locoregional failure (LRF) and distant metastasis (DM) rates were estimated by using the cumulative incidence method and Gray's test. RESULTS In all, 721 of 743 patients were analyzable (361, SFX; 360, AFX-C). At a median follow-up of 7.9 years (range, 0.3 to 10.1 years) for 355 surviving patients, no differences were observed in OS (hazard ratio [HR], 0.96; 95% CI, 0.79 to 1.18; P = .37; 8-year survival, 48% v 48%), PFS (HR, 1.02; 95% CI, 0.84 to 1.24; P = .52; 8-year estimate, 42% v 41%), LRF (HR, 1.08; 95% CI, 0.84 to 1.38; P = .78; 8-year estimate, 37% v 39%), or DM (HR, 0.83; 95% CI, 0.56 to 1.24; P = .16; 8-year estimate, 15% v 13%). For oropharyngeal cancer, p16-positive patients had better OS than p16-negative patients (HR, 0.30; 95% CI, 0.21 to 0.42; P < .001; 8-year survival, 70.9% v 30.2%). There were no statistically significant differences in the grade 3 to 5 acute or late toxicities between the two arms and p-16 status. CONCLUSION When combined with cisplatin, AFX-C neither improved outcome nor increased late toxicity in patients with LA-HNC. Long-term high survival rates in p16-positive patients with oropharyngeal cancer support the ongoing efforts to explore deintensification.
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Affiliation(s)
- Phuc Felix Nguyen-Tan
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL.
| | - Qiang Zhang
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - K Kian Ang
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Randal S Weber
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - David I Rosenthal
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Denis Soulieres
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Harold Kim
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Craig Silverman
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Adam Raben
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Thomas J Galloway
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - André Fortin
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Elizabeth Gore
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - William H Westra
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Christine H Chung
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Richard C Jordan
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Maura L Gillison
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Marcie List
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
| | - Quynh-Thu Le
- Phuc Felix Nguyen-Tan and Denis Soulieres, Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montreal; André Fortin, Centre Hospitalier Universitaire Hôtel-Dieu de Québec, Quebec City, Quebec, Canada; Qiang Zhang, NRG Oncology Statistics and Data Management Center; Thomas J. Galloway, Fox Chase Cancer Center, Philadelphia, PA; K. Kian Ang, Randal S. Weber, and David I. Rosenthal, University of Texas MD Anderson Cancer Center, Houston, TX; Harold Kim, Wayne State University, Detroit, MI; Craig Silverman, James Graham Brown Cancer Center, Louisville, KY; Adam Raben, Christiana Care Community Clinical Oncology Program, Newark, DE; Elizabeth Gore, Medical College of Wisconsin, Milwaukee, WI; William H. Westra and Christine H. Chung, Johns Hopkins University, Baltimore, MD; Richard C. Jordan, University of California at San Francisco, San Francisco; Quynh-Thu Le, Stanford University, Stanford, CA; Maura L. Gillison, Ohio State University Comprehensive Cancer Center, Columbus, OH; and Marcy List, University of Chicago Medicine Comprehensive Cancer Research Center, Chicago, IL
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Rodriguez CP, Adelstein DJ, Rybicki LA, Savvides P, Saxton JP, Koyfman SA, Greskovich JF, Yao M, Scharpf J, Lavertu P, Wood BG, Burkey BB, Lorenz RR, Rezaee RP, Zender CA, Ives DI. Randomized phase III study of 2 cisplatin-based chemoradiation regimens in locally advanced head and neck squamous cell carcinoma: Impact of changing disease epidemiology on contemporary trial design. Head Neck 2014; 37:1583-9. [DOI: 10.1002/hed.23794] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2014] [Indexed: 01/25/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Min Yao
- Case Western Reserve University, Seidman Cancer Institute; Cleveland Ohio
| | | | - Pierre Lavertu
- Case Western Reserve University, Seidman Cancer Institute; Cleveland Ohio
| | | | | | | | - Rod P. Rezaee
- Case Western Reserve University, Seidman Cancer Institute; Cleveland Ohio
| | - Chad A. Zender
- Case Western Reserve University, Seidman Cancer Institute; Cleveland Ohio
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Wopken K, Bijl HP, van der Schaaf A, van der Laan HP, Chouvalova O, Steenbakkers RJHM, Doornaert P, Slotman BJ, Oosting SF, Christianen MEMC, van der Laan BFAM, Roodenburg JLN, Leemans CR, Verdonck-de Leeuw IM, Langendijk JA. Development of a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence after curative radiotherapy/chemo-radiotherapy in head and neck cancer. Radiother Oncol 2014; 113:95-101. [PMID: 25443500 DOI: 10.1016/j.radonc.2014.09.013] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/16/2014] [Accepted: 09/22/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Curative radiotherapy/chemo-radiotherapy for head and neck cancer (HNC) may result in severe acute and late side effects, including tube feeding dependence. The purpose of this prospective cohort study was to develop a multivariable normal tissue complication probability (NTCP) model for tube feeding dependence 6 months (TUBEM6) after definitive radiotherapy, radiotherapy plus cetuximab or concurrent chemoradiation based on pre-treatment and treatment characteristics. MATERIALS AND METHODS The study included 355 patients with HNC. TUBEM6 was scored prospectively in a standard follow-up program. To design the prediction model, the penalized learning method LASSO was used, with TUBEM6 as the endpoint. RESULTS The prevalence of TUBEM6 was 10.7%. The multivariable model with the best performance consisted of the variables: advanced T-stage, moderate to severe weight loss at baseline, accelerated radiotherapy, chemoradiation, radiotherapy plus cetuximab, the mean dose to the superior and inferior pharyngeal constrictor muscle, to the contralateral parotid gland and to the cricopharyngeal muscle. CONCLUSIONS We developed a multivariable NTCP model for TUBEM6 to identify patients at risk for tube feeding dependence. The dosimetric variables can be used to optimize radiotherapy treatment planning aiming at prevention of tube feeding dependence and to estimate the benefit of new radiation technologies.
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Affiliation(s)
- Kim Wopken
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
| | - Hendrik P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Hans Paul van der Laan
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Olga Chouvalova
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Miranda E M C Christianen
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otolaryngology/Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
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Development and validation of a prediction model for tube feeding dependence after curative (chemo-) radiation in head and neck cancer. PLoS One 2014; 9:e94879. [PMID: 24736318 PMCID: PMC3988098 DOI: 10.1371/journal.pone.0094879] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/14/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Curative radiotherapy or chemoradiation for head and neck cancer (HNC) may result in severe acute and late side effects, including tube feeding dependence. The purpose of this prospective cohort study was to develop a prediction model for tube feeding dependence 6 months (TUBEM6) after curative (chemo-) radiotherapy in HNC patients. PATIENTS AND METHODS Tube feeding dependence was scored prospectively. To develop the multivariable model, a group LASSO analysis was carried out, with TUBEM6 as the primary endpoint (n = 427). The model was then validated in a test cohort (n = 183). The training cohort was divided into three groups based on the risk of TUBEM6 to test whether the model could be extrapolated to later time points (12, 18 and 24 months). RESULTS Most important predictors for TUBEM6 were weight loss prior to treatment, advanced T-stage, positive N-stage, bilateral neck irradiation, accelerated radiotherapy and chemoradiation. Model performance was good, with an Area under the Curve of 0.86 in the training cohort and 0.82 in the test cohort. The TUBEM6-based risk groups were significantly associated with tube feeding dependence at later time points (p<0.001). CONCLUSION We established an externally validated predictive model for tube feeding dependence after curative radiotherapy or chemoradiation, which can be used to predict TUBEM6.
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32
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Functional outcomes after TORS for oropharyngeal cancer: a systematic review. Eur Arch Otorhinolaryngol 2014; 272:463-71. [PMID: 24643851 DOI: 10.1007/s00405-014-2985-7] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/24/2014] [Indexed: 01/16/2023]
Abstract
Summarize functional outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal cancer (OPC). A systematic review was conducted. The MEDLINE database was searched (MeSH terms: TORS, pharyngeal neoplasms, oropharyngeal neoplasms). Peer-reviewed human subject papers published through December 2013 were included. Exclusion criteria were as follows: (1) case report design (n < 10), (2) review article, or (3) technical, animal, or cadaver studies. Functional outcomes extracted included feeding tube dependence, swallow examination findings, speech ratings, velopharyngeal insufficiency, pneumonia, and oral intake measures. Twelve papers comprising 441 patients with OPC treated with TORS ± adjuvant therapy were included. Feeding tube rates were the most commonly reported functional outcome. Excluding prophylactic placement, 18-39% of patients required gastrostomy placement, typically during adjuvant therapy. Chronic gastrostomy dependence ranged from 0 to 7% (mean follow-up 11-26 months), regardless of disease stage. Composite MD Anderson Dysphagia Inventory (MDADI) scores ranged from 65.2 to 78 (89 patients, 3 series, mean follow-up 12-13 months). Videofluoroscopic swallowing studies were not systematically reported. Incidence of postoperative pneumonia was 0-7%. Predictors of swallowing function included baseline function, T-stage, N-stage, tongue base primary tumors, and adjuvant chemoradiation. Rates of transient hypernasality were 4-9%. A single study suggested dose-dependent effects of adjuvant therapy (none, radiation alone, chemoradiation) on diet scores at 6 and 12 months. Crude end points of functional recovery after TORS ± adjuvant therapy suggest promising swallowing outcomes, depending on the functional measure reported.
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33
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Urban D, Corry J, Rischin D. What is the best treatment for patients with human papillomavirus-positive and -negative oropharyngeal cancer? Cancer 2014; 120:1462-70. [PMID: 24578320 DOI: 10.1002/cncr.28595] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/17/2013] [Accepted: 12/20/2013] [Indexed: 12/21/2022]
Abstract
The discovery that the human papilloma virus (HPV) is associated with a high and increasing percentage of oropharyngeal squamous cell carcinomas (SCCs) is among the most significant advances in the field of head and neck oncology. HPV-positive oropharyngeal cancer (HPVOPC) has clinical, etiologic, pathologic, and molecular features that distinguish it from HPV-negative disease. Increasingly, HPVOPC is being diagnosed in clinical practice because of the easy availability of p16 immunohistochemistry, a surrogate marker of HPV. The superior prognosis of HPVOPC has led to a reexamination of treatment approaches, and clinical trials are currently investigating strategies to deintensify treatment to reduce acute and late toxicity while preserving efficacy. This is of particular interest in low-risk patients. Unfortunately, patients with HPV-negative tumors still have high rates of locoregional failure and more efficacious treatments are required. This review of oropharyngeal SCC focuses on current and investigational treatment strategies in patients with both HPV-positive and HPV-negative oropharyngeal SCC.
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Affiliation(s)
- Damien Urban
- Department of Medical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia; Head and Neck Service, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Lewis SL, Brody R, Touger-Decker R, Parrott JS, Epstein J. Feeding tube use in patients with head and neck cancer. Head Neck 2014; 36:1789-95. [DOI: 10.1002/hed.23538] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Sherri L. Lewis
- James A. Haley Veteran's Affairs Hospital; Tampa Florida
- University of Medicine and Dentistry of New Jersey; Newark New Jersey
| | - Rebecca Brody
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - Riva Touger-Decker
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - James S. Parrott
- University of Medicine and Dentistry of New Jersey; School of Health Related Professions; Newark New Jersey
| | - Joel Epstein
- City of Hope; Oral Medicine Division of Otolaryngology and Head and Neck Surgery; Duarte California
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Jackson W, Alexander N, Schipper M, Fig L, Feng F, Jolly S. Characterization of changes in total body composition for patients with head and neck cancer undergoing chemoradiotherapy using dual-energy x-ray absorptiometry. Head Neck 2013; 36:1356-62. [DOI: 10.1002/hed.23461] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 05/28/2013] [Accepted: 08/13/2013] [Indexed: 11/11/2022] Open
Affiliation(s)
- William Jackson
- Department of Radiation Oncology; University of Michigan; Ann Arbor Michigan
| | - Neil Alexander
- Department of Internal Medicine; University of Michigan; Ann Arbor Michigan
- Division of Geriatric and Palliative Medicine; University of Michigan; Ann Arbor Michigan
- Mobility Research Center; University of Michigan; Ann Arbor Michigan
- Institute of Gerontology; University of Michigan; Ann Arbor Michigan
- Geriatric Research; Education; and Clinical Center (GRECC); VA Medical Center; Ann Arbor Michigan
| | - Matthew Schipper
- Department of Radiation Oncology; University of Michigan; Ann Arbor Michigan
| | - Lorraine Fig
- Department of Nuclear Medicine; VA Medical Center; Ann Arbor Michigan
| | - Felix Feng
- Department of Radiation Oncology; University of Michigan; Ann Arbor Michigan
| | - Shruti Jolly
- Department of Radiation Oncology; University of Michigan; Ann Arbor Michigan
- Department of Radiation Oncology; VA Medical Center; Ann Arbor Michigan
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36
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Dobrosotskaya IY, Bellile E, Spector ME, Kumar B, Feng F, Eisbruch A, Wolf GT, Prince MEP, Moyer JS, Teknos T, Chepeha DB, Walline HM, McHugh JB, Cordell KG, Ward PD, Byrd S, Maxwell JH, Urba S, Bradford CR, Carey TE, Worden FP. Weekly chemotherapy with radiation versus high-dose cisplatin with radiation as organ preservation for patients with HPV-positive and HPV-negative locally advanced squamous cell carcinoma of the oropharynx. Head Neck 2013; 36:617-23. [PMID: 23596055 DOI: 10.1002/hed.23339] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 01/18/2013] [Accepted: 04/05/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Optimal treatment for locally advanced squamous cell carcinoma of the oropharynx (SCCOP) is not well defined. Here we retrospectively compare survival and toxicities from 2 different organ preservation protocols. METHODS The matched dataset consisted of 35 patients from each trial matched for age, stage, smoking, and tumor human papillomavirus (HPV) status. Patients in the University of Michigan Cancer Center (UMCC) trial 9921 were treated with induction chemotherapy (IC) followed by high-dose cisplatin and radiation in responders or surgery in nonresponders. Patients in the UMCC trial 0221 were treated with weekly carboplatin and paclitaxel and radiation. RESULTS Survival was comparable for both studies and did not differ significantly across each trial after stratifying by HPV status. Grade 3 and 4 toxicities were more frequent in UMCC 9921. At 6 months posttreatment, gastrostomy tube (G-tube) dependence was not statistically different. CONCLUSION These data suggest that survival outcomes in patients with locally advanced SCCOP are not compromised with weekly chemotherapy and radiation therapy, and such treatment is generally more tolerable.
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37
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Hwang I, Choi SH, Kim YJ, Kim KG, Lee AL, Yun TJ, Kim JH, Sohn CH. Differentiation of recurrent tumor and posttreatment changes in head and neck squamous cell carcinoma: application of high b-value diffusion-weighted imaging. AJNR Am J Neuroradiol 2013; 34:2343-8. [PMID: 23811978 DOI: 10.3174/ajnr.a3603] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE High b-value DWI has been expected to have an additional diagnostic role and demonstrated some promising results in head and neck cancer. The aim of this study was to evaluate the diagnostic performance of DWI at a high b-value (b=2000 s/mm(2)) compared with a standard b-value (b=1000 s/mm(2)) and the ratio of ADC values of high and standard b-values for their ability to differentiate between recurrent tumor and posttreatment changes after the treatment of head and neck squamous cell carcinoma. MATERIALS AND METHODS A total of 33 patients diagnosed with head and neck squamous cell carcinoma were enrolled in the present study; all had contrast-enhancing lesions on follow-up MR imaging. All patients underwent single-shot echo-planar DWI at b=1000 s/mm(2) and b=2000 s/mm(2), and corresponding ADC maps were generated (ADC1000 and ADC2000, respectively). The mean ADC1000, ADC2000, and ADCratio (ADCratio = ADC2000/ADC1000 × 100) values were evaluated within a manually placed ROI with contrast-enhanced T1-weighted images as references. For the statistical analysis, we performed a Student t test and multivariate logistic regression. RESULTS The mean ADC1000 in recurrent tumor was significantly lower than that in posttreatment changes (P < .001), whereas the mean ADC2000 resulted in no significant difference (P = .365). The mean ADCratio was significantly higher in recurrent tumor than that in posttreatment changes (73.5 ± 7.2% vs 56.9 ± 8.8%, respectively; P < .001). Multivariate logistic regression analysis revealed that the ADCratio was the only independently differentiating variable (P = .024). The sensitivity, specificity, and accuracy of ADCratio were 95.0%, 69.2%, and 84.8%, respectively, by use of the optimal cutoff value of 62.6%. CONCLUSIONS We suggest that the ADCratio calculated from the ADC1000 and ADC2000 is a promising value for the differentiation of recurrent tumor and posttreatment changes in head and neck squamous cell carcinoma.
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Affiliation(s)
- I Hwang
- Department of Radiology Seoul National University College of Medicine, Seoul, Korea
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38
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Haddad R, O'Neill A, Rabinowits G, Tishler R, Khuri F, Adkins D, Clark J, Sarlis N, Lorch J, Beitler JJ, Limaye S, Riley S, Posner M. Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial. Lancet Oncol 2013; 14:257-64. [PMID: 23414589 DOI: 10.1016/s1470-2045(13)70011-1] [Citation(s) in RCA: 462] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The relative efficacy of the addition of induction chemotherapy to chemoradiotherapy compared with chemoradiotherapy alone for patients with head and neck cancer is unclear. The PARADIGM study is a multicentre open-label phase 3 study comparing the use of docetaxel, cisplatin, and fluorouracil (TPF) induction chemotherapy followed by concurrent chemoradiotherapy with cisplatin-based concurrent chemoradiotherapy alone in patients with locally advanced head and neck cancer. METHODS Adult patients with previously untreated, non-metastatic, newly diagnosed head and neck cancer were eligible. Patients were eligible if their tumour was either unresectable or of low surgical curability on the basis of advanced tumour stage (3 or 4) or regional-node stage (2 or 3, except T1N2), or if they were a candidate for organ preservation. Patients were randomly assigned (in a 1:1 ratio) to receive either induction chemotherapy with three cycles of TPF followed by concurrent chemoradiotherapy with either docetaxel or carboplatin or concurrent chemoradiotherapy alone with two cycles of bolus cisplatin. A computer-generated randomisation schedule using minimisation was prepared and the treatment assignment was done centrally at one of the study sites. Patients, study staff, and investigators were not masked to group assignment. Stratification factors were WHO performance status, primary disease site, and stage. The primary endpoint was overall survival. Analysis was by intention to treat. Patient accrual was terminated in December, 2008, because of slow enrolment. The trial is registered with ClinicalTrials.gov, number NCT00095875. FINDINGS Between Aug 24, 2004, and Dec 29, 2008, we enrolled 145 patients across 16 sites. After a median follow-up of 49 months (IQR 39-63), 41 patients had died-20 in the induction chemotherapy followed by chemoradiotherapy group and 21 in the chemoradiotherapy alone group. 3-year overall survival was 73% (95% CI 60-82) in the induction therapy followed by chemoradiotherapy group and 78% (66-86) in the chemoradiotherapy alone group (hazard ratio 1·09, 95% CI 0·59-2·03; p=0·77). More patients had febrile neutropenia in the induction chemotherapy followed by chemoradiotherapy group (16 patients) than in the chemoradiotherapy alone group (one patient). INTERPRETATION Although survival results were good in both groups there was no difference noted between those patients treated with induction chemotherapy followed by chemoradiotherapy and those who received chemoradiotherapy alone. We cannot rule out the possibility of a difference in survival going undetected due to early termination of the trial. Clinicians should still use their best judgment, based on the available data, in the decision of how to best treat patients. The addition of induction chemotherapy remains an appropriate approach for advanced disease with high risk for local or distant failure. FUNDING Sanofi-Aventis.
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Affiliation(s)
- Robert Haddad
- Department of Medicine, Brigham and Women's Hospital, and Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Machtay M, Moughan J, Farach A, Martin-O'Meara E, Galvin J, Garden AS, Weber RS, Cooper JS, Forastiere A, Ang KK. Hypopharyngeal dose is associated with severe late toxicity in locally advanced head-and-neck cancer: an RTOG analysis. Int J Radiat Oncol Biol Phys 2013; 84:983-9. [PMID: 23078898 DOI: 10.1016/j.ijrobp.2012.03.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 03/01/2012] [Accepted: 03/02/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. METHODS AND MATERIALS This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube≥2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. RESULTS A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving ≤60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. CONCLUSIONS Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.
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Affiliation(s)
- Mitchell Machtay
- University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, Ohio 44106, USA.
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Allen CT, Law JH, Dunn GP, Uppaluri R. Emerging insights into head and neck cancer metastasis. Head Neck 2012; 35:1669-78. [PMID: 23280716 DOI: 10.1002/hed.23202] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2012] [Indexed: 01/09/2023] Open
Abstract
The purpose of this review was to provide biological concepts of head and neck cancer metastasis. To attain this goal, we analyzed peer-reviewed articles related to head and neck cancer metastasis obtained though PubMed and archived articles. Articles related to the biologic principles of head and neck cancer metastasis were reviewed and summarized. As locoregional control has improved for patients with head and neck cancer, rates of distant metastasis have not decreased. As patients live longer, many will die of complications related to the development of disease at sites below the clavicles. Emerging evidence now suggests a more complicated framework of metastatic behavior for head and neck cancer. Here, we review the role of regional lymph nodes in containing advanced head and neck cancer, evidence for active as opposed to passive tumor cell metastasis, and clinical implications these concepts have on both treatment of head and neck cancer and future research.
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Affiliation(s)
- Clint T Allen
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, Missouri
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Chang PH, Yeh KY, Huang JS, Lai CH, Wu TH, Lan YJ, Tsai JCS, Chen EYC, Yang SW, Wang CH. Pretreatment performance status and nutrition are associated with early mortality of locally advanced head and neck cancer patients undergoing concurrent chemoradiation. Eur Arch Otorhinolaryngol 2012. [DOI: 10.1007/s00405-012-2290-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kim JW, Cho JH, Keum KC, Kim JH, Kim GE, Lee JY, Kim SK, Lee CG. IMRT with Simultaneous Integrated Boost and Concurrent Chemotherapy for Nasopharyngeal Cancer: Plan Evaluation and Treatment Outcome. Jpn J Clin Oncol 2012; 42:1152-60. [DOI: 10.1093/jjco/hys169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Treatment of hypopharyngeal carcinoma with primary chemoradiotherapy: functional morbidity. Curr Opin Otolaryngol Head Neck Surg 2012; 20:89-96. [PMID: 22249169 DOI: 10.1097/moo.0b013e32834fa72c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review aims at unravelling the medical literature which has reported on the treatment of 'larynx preserving' chemoradiotherapy strategies and separating the treatment sites, larynx and hypopharynx, from each other and reporting on the adverse effects and functional outcomes of patients with hypopharyngeal cancer. RECENT FINDINGS The literature reports on the treatment of advanced laryngeal and hypopharyngeal cancer with chemoradiotherapy together as a 'common cancer site'. Although the chemotherapeutic drugs affect the tumour and the normal tissues similarly in both the larynx and hypopharynx, their effects on the patient groups are different, mainly affecting swallow, airway protection mechanisms and voice/speech to a greater or lesser extent. Pretreatment symptoms and function should be documented subjectively and objectively prior to commencing nonsurgical treatment. Hypopharyngeal cancer should be reported separately, and preferably stratified into the three subsites, according to the T stage of disease rather than TNM stage. Equipment for such testing and the process for such documentation are available in most clinical areas, worldwide. SUMMARY Future analysis relies on the conscientious monitoring of adverse effects of all treatment modalities and an assessment of function as well as quality of life impact on the patient. Thus, the specialty can make informed decisions on the most appropriate and most suitable mode of treatment for individual patients based upon their tumour, their preoperative organ function, their likely future organ function and the likelihood of cure.
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Gómez-Millán J, Toledo MD, Lupiañez Y, Rueda A, Trigo JM, Sachetti A, Medina JA. Competing causes of death in patients with locoregionally advanced head and neck cancer treated with concomitant boost radiation plus concurrent weekly cisplatin. Clin Transl Oncol 2012; 15:321-6. [PMID: 22911552 DOI: 10.1007/s12094-012-0925-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 07/24/2012] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study analyzes the morbidity and the contribution of different causes of death to the outcome of patients with locally advanced head and- neck cancer after weekly cisplatin plus concomitant boost accelerated radiation treated in our center. MATERIALS AND METHODS Ninety-four patients with locally advanced head and neck carcinoma were included in this phase II trial consisting of concomitant boost radiation plus concurrent weekly cisplatin. The 43 patients treated in our centered with long-term follow-up were analyzed. Patients received radiotherapy with a concomitant boost scheme (1.8 Gy on days 1-40 and 1.5 Gy boost on days 25-40 with a total dose of 72 Gy) and concurrent cisplatin, 40 mg/m(2) weekly, for the first 4 weeks. RESULTS Most patients (93 %) received both radiation and complete chemotherapy according to protocol. Severe late toxicity presented were subcutaneous (5 %), larynx (2 %) and esophagous (5 %). Grade I-II late toxicity included mainly xerostomy (30 %), skin (16 %) and mucosal (16 %) toxicity. With a median follow-up of 95 months (9-135), the median overall survival and progression-free survival were 26 and 19 months, respectively (95 % CI 1-52; and 95 % CI 0-45); 60 % of the patients died because of head and neck cancer and 12 % of a second neoplasm, while 27 % of non-cancer patients died. CONCLUSIONS Patients with locoregionally advanced head and neck cancer treated with concomitant boost accelerated radiation plus chemotherapy show significant risks of mortality from causes other than disease progression.
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Affiliation(s)
- Jaime Gómez-Millán
- Radiation Oncology Department, Hospital Clinico Universitario Virgen de la Victoria, Campus Teatinos s/n, Málaga 29010, Spain.
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Jensen AD, Krauss J, Potthoff K, Simon C, Nikoghosyan AV, Lossner K, Debus J, Münter MW. Radiochemoimmunotherapy with intensity-modulated concomitant boost: interim analysis of the REACH trial. Radiat Oncol 2012; 7:57. [PMID: 22472064 PMCID: PMC3342898 DOI: 10.1186/1748-717x-7-57] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 04/02/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate efficacy and toxicity clinical in the intensified treatment of locally advanced squamous cell carcinoma of the head and neck (SCCHN) with the combination of chemotherapy, the EGFR antibody cetuximab, and intensity-modulated radiation therapy (IMRT) in a concomitant boost concept. METHODS REACH is a prospective, bi-centric phase II trial of carboplatin/5-FU and cetuximab weekly combined with IMRT. Primary endpoint is locoregional control, secondary endpoints include acute radiation effects and adverse events. Evaluation of disease response is carried out according to the Response Evaluation Criteria in Solid Tumors (RECIST); toxicity is assessed using NCI CTC v 3.0. RESULTS Treatment was tolerated moderately well, acneiforme erythema occurred in 74.1% (grade II/III), mucositis grade III in 28.6%, and radiation dermatitis grade III in 14.3%. Higher-grade side-effects resolved quickly until the first follow-up post treatment. Objective response rates were promising with 28.6% CR at first follow-up and 92.9% thereafter. CONCLUSION The combination of standard carboplatin/5-FU and cetuximab is feasible and results in promising objective response rates. The use of an IMRT concomitant boost is practicable in a routine clinical setting resulting in only moderate overall toxicity of the regimen. TRIAL REGISTRATION NUMBER ISRCTN87356938.
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Affiliation(s)
- Alexandra D Jensen
- Dept of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
- Dept of Head and Neck Surgery, INF 400, 69120 Heidelberg, Germany
| | - Jürgen Krauss
- Dept of Radiation Oncology, INF 400, 69120 Heidelberg, Germany
| | - Karin Potthoff
- Dept of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Christian Simon
- National Centre for Tumour Disease (NCT), INF 460, 69120 Heidelberg, Germany
| | - Anna V Nikoghosyan
- Dept of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Karen Lossner
- Dept of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Jürgen Debus
- Dept of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
| | - Marc W Münter
- Dept of Radiation Oncology, University of Heidelberg, INF 400, 69120 Heidelberg, Germany
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Montejo ME, Shrieve DC, Bentz BG, Hunt JP, Buchman LO, Agarwal N, Hitchcock YJ. IMRT With Simultaneous Integrated Boost and Concurrent Chemotherapy for Locoregionally Advanced Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2011; 81:e845-52. [DOI: 10.1016/j.ijrobp.2010.10.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Revised: 09/07/2010] [Accepted: 10/16/2010] [Indexed: 10/18/2022]
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Kawashima M, Hayashi R, Tahara M, Arahira S, Miyazaki M, Sakuraba M, Zenda S, Ogino T. Prospective trial of chemotherapy-enhanced accelerated radiotherapy for larynx preservation in patients with intermediate-volume hypopharyngeal cancer. Head Neck 2011; 34:1363-8. [DOI: 10.1002/hed.21934] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2011] [Indexed: 01/17/2023] Open
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Rütten H, Pop LA, Janssens GO, Takes RP, Knuijt S, Rooijakkers AF, van den Berg M, Merkx MA, van Herpen CM, Kaanders JH. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic. Int J Radiat Oncol Biol Phys 2011; 81:923-9. [DOI: 10.1016/j.ijrobp.2010.07.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 06/29/2010] [Accepted: 07/05/2010] [Indexed: 11/27/2022]
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Chapuy CI, Annino DJ, Snavely A, Li Y, Tishler RB, Norris CM, Haddad RI, Goguen LA. Swallowing function following postchemoradiotherapy neck dissection: review of findings and analysis of contributing factors. Otolaryngol Head Neck Surg 2011; 145:428-34. [PMID: 21493276 DOI: 10.1177/0194599811403075] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assesses swallowing function following chemoradiotherapy and neck dissection in head and neck cancer patients and investigates clinical, treatment, and neck dissection factors associated with dysphagia. STUDY DESIGN Case series with chart review. SETTING Tertiary care center. SUBJECTS AND METHODS Eighty-eight patients undergoing neck dissection after chemoradiotherapy for advanced head and neck cancer were reviewed. Dysphagia outcome measures included weight loss, diet, gastrostomy tube (GT) dependency,and video swallow findings of aspiration or stenosis. In addition,the researchers created a Diet/GT Scale, with scores ranging from 1 to 5. Univariate and multivariate analysis of clinical, treatment, or neck dissection factors potentially associated with dysphagia outcome measures was undertaken. RESULTS Peak mean weight loss was 17% at 6 months after chemoradiotherapy. At 12 months, a soft/regular diet was taken by 78 of 88 patients (89%), and only 1 of 88 patients (1%)was nil per os. Gastrostomy tube dependence at 6, 12, and 24 months was 53%, 25%, and 10%, respectively. The Diet/GT score was 5 (gastrostomy tube removed and soft/regular diet)for 47% at 6 months, 74% at 12 months, and 89% at 24 months.Multivariate analyses revealed that higher tumor stage was associated with a lower Diet/GT score at 12 months (P = .02)and gastrostomy dependence at 12 months (P = .01) and 24 months (P = .04). CONCLUSION Despite the addition of neck dissection to chemoradiotherapy,nearly all patients took a soft or regular diet and reached a Diet/GT score of 5, and only 1% remained nil per os. A higher tumor stage is associated with a lower Diet/GT score and gastrostomy tube dependency beyond 12 months.
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Affiliation(s)
- Claudia I Chapuy
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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50
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Jensen AD, Krauss J, Weichert W, Bergmann ZP, Freier K, Debus J, Münter MW. Disease control and functional outcome in three modern combined organ preserving regimens for locally advanced squamous cell carcinoma of the head and neck (SCCHN). Radiat Oncol 2011; 6:122. [PMID: 21942981 PMCID: PMC3195102 DOI: 10.1186/1748-717x-6-122] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 09/23/2011] [Indexed: 12/12/2022] Open
Abstract
Purpose To report our experience on disease control and functional outcome using three modern combined-modality approaches for definitive radiochemotherapy of locally advanced SCCHN with modern radiotherapy techniques: radiochemotherapy (RChT), radioimmunotherapy (RIT) with cetuximab, or induction chemotherapy with docetaxel, cisplatin, and 5-FU (TPF) combined with either RChT or RIT. Methods Toxicity and outcome was retrospectively analysed in patients receiving definitive RChT, RIT, or induction chemotherapy followed by RChT or RIT between 2006 and 2009. Outcome was estimated using Kaplan-Meier analyses, toxicity was analysed according to CTCAE v 3.0. Results Thirty-eight patients were treated with RChT, 38 patients with RIT, 16 patients received TPF followed by either RChT or RIT. Radiotherapy was mostly applied as IMRT (68%). Long-term toxicity was low, only one case of grad III dysphagia requiring oesophageal dilatation, no case of either xerostomia ≥ grade II or cervical plexopathy were observed. Median overall survival (OS) was 25.7 months (RChT) and 27.7 months (RIT), median locoregional progression-free survival (PFS) was not reached yet. Subgroup analysis showed no significant differences between TPF, RChT, and RIT despite higher age and co-morbidities in the RIT group. Results suggested improved OS, distant and overall PFS for the TPF regimen. Conclusion Late radiation effects in our cohort are rare. No significant differences in outcome between RChT and RIT were observed. Adding TPF suggests improved progression-free and overall survival, impact of TPF on locoregional PFS was marginal, therefore radiotherapeutic options for intensification of local treatment should be explored.
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