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Tang A, Li J, Scheff N, Johnson JT, Contrera KJ, Nilsen ML. Quality of Life Outcomes for Parotid Malignancies. Laryngoscope 2024; 134:4549-4556. [PMID: 38837232 PMCID: PMC11466688 DOI: 10.1002/lary.31554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/10/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND This study describes patient-reported outcome measures (PROMs) and associated factors in patients who underwent surgery for malignant parotid tumors (MPT). METHODS This is a retrospective study of all surgically treated MPT patients in a multidisciplinary head and neck cancer (HNC) survivorship clinic (2017-2023). PROMs included University of Washington Quality of Life Questionnaire (UW-QOL), Eating Assessment Tool (EAT-10), Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Neck Disability Index (NDI), and Insomnia Severity Index. Multivariable regression analysis was used to investigate clinical predictors associated with PROMs. RESULTS In 62 MPT patients, the prevalence of clinically relevant dysphagia symptoms (EAT-10), elevated symptoms of depression (PHQ-8), moderate/severe symptoms of anxiety (GAD-7), moderate/severe neck pain with activities of daily living (NDI), and moderate/severe symptoms of insomnia at last follow-up was 32.3%, 15.5%, 7.1%, 17.7%, and 7.2%, respectively. Nonparametric one-sided test revealed that patients treated with adjuvant CRT had significantly worse physical QOL, social-emotional QOL, and swallowing scores than patients treated with surgery alone (p = 0.01, p = 0.02, p = 0.03, respectively); that patients treated with surgery and adjuvant RT had significantly worse physical QOL and social-emotional QOL than patients treated with surgery alone (p < 0.01, p = 0.01, respectively) and that patients treated with surgery and adjuvant CRT had significantly worse swallowing and neck pain than patients treated with surgery and adjuvant RT (p = 0.03, p = 0.05, respectively). CONCLUSIONS In patients with surgically treated MPT, adjuvant CRT and RT were associated with worse PROMs. LEVEL OF EVIDENCE 4 Laryngoscope, 134:4549-4556, 2024.
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Affiliation(s)
- Anthony Tang
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jinhong Li
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, U.S.A
| | - Nicole Scheff
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Kevin J Contrera
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Marci L Nilsen
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, U.S.A
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2
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Ceremsak J, Ye W, Hicks M, Mannion K. Treatment De-escalation in Oropharyngeal Carcinoma and the Role of Robotic Surgery. Surg Oncol Clin N Am 2024; 33:697-709. [PMID: 39244288 DOI: 10.1016/j.soc.2024.07.001] [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] [Indexed: 09/09/2024]
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) related to human papillomavirus (HPV) infection has better survival outcomes compared to non-HPV-related OPSCC, leading to efforts to de-escalate the intensity of treatment to reduce associated morbidity. This article reviews recent clinical efforts to explore different de-escalation frameworks with a particular emphasis on the emergence of transoral robotic surgery and surgically driven de-escalation approaches. It discusses the current evidence for incorporating surgery into an evolving treatment paradigm for HPV-related OPSCC.
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Affiliation(s)
- John Ceremsak
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 Medical Center Drive, Nashville, TN 27232, USA.
| | - Wenda Ye
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 Medical Center Drive, Nashville, TN 27232, USA
| | - Melanie Hicks
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 Medical Center Drive, Nashville, TN 27232, USA
| | - Kyle Mannion
- Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, 1215 Medical Center Drive, Nashville, TN 27232, USA
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3
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Al-Zanoon N, Cummine J, Jeffery CC, Westover L, Aalto D. The effect of simulated radiation induced fibrosis on tongue protrusion. Biomech Model Mechanobiol 2024; 23:1649-1660. [PMID: 38869655 DOI: 10.1007/s10237-024-01860-4] [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: 01/25/2024] [Accepted: 05/14/2024] [Indexed: 06/14/2024]
Abstract
Radiation therapy (RT) is an important adjuvant and primary treatment modality for head and neck cancers. A severe side effect of RT is fibrosis or scarring of muscle tissues of the oral cavity including the tongue. Previous studies have demonstrated that increased radiation doses to the oral cavity structures have led to decrements in function, hypothesized to result from changes in muscle tissue properties that affect the tongue's function. To understand the complex relationship between tongue muscle fibrosis and tongue function, the current study used a virtual biomechanical model of the tongue. Fibrosis parameters including density (high, low), area (large, small) and location (946 node centres) were systematically varied in the model to test its impact on a target tongue tip motion (protrusion). The impact of fibrosis lesion parameters on three directional components of the tip (anterior-inferior, lateral-medial, and superior-inferior) were analyzed using multi linear regression models. Increases in density and area of fibrosis significantly predicted tongue protrusion movements compared to baseline. In the anterior-posterior direction, reductions in the tongue protrusion were observed. In the inferior-superior direction, the tongue height remained above baseline for the majority of cases. In the lateral-medial direction, ipsilateral deviations were observed. The location of fibrosis modulated these three main effects by either amplifying the observed effect or minimizing it. The findings support the hypothesis that changes in muscle tissue properties because of fibrosis impact tongue function. Increases in density and area of fibrosis impact key muscles in the target motion. The range of modulating effects of the lesion location (i.e., either amplifying or minimizing certain impact patterns) highlights the intricacy of tongue anatomy/soft tissue biomechanics and may suggest that lesions in any location will compromise the tongue's movement.
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Affiliation(s)
- Noor Al-Zanoon
- Department of Communication Sciences and Disorders, University of Alberta, Rehabilitation Medicine, Edmonton, AB, Canada.
| | - Jacqueline Cummine
- Department of Communication Sciences and Disorders, University of Alberta, Rehabilitation Medicine, Edmonton, AB, Canada
| | - Caroline C Jeffery
- Department of Communication Sciences and Disorders, University of Alberta, Rehabilitation Medicine, Edmonton, AB, Canada
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lindsey Westover
- Department of Biomedical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
- Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton, AB, Canada
| | - Daniel Aalto
- Department of Communication Sciences and Disorders, University of Alberta, Rehabilitation Medicine, Edmonton, AB, Canada
- Institute for Reconstructive Sciences in Medicine (iRSM), Misericordia Community Hospital, Edmonton, AB, Canada
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4
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Spinato G, Schiavon V, Torvilli S, Carraro S, Amato F, Daloiso A, Di Fiore A, Favero V, Franz L, Marioni G, de Filippis C, Fabbris C, Emanuelli E, Nicolai P. Oral Care in Head and Neck Radiotherapy: Proposal for an Oral Hygiene Protocol. J Pers Med 2024; 14:1013. [PMID: 39338267 PMCID: PMC11433007 DOI: 10.3390/jpm14091013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 09/18/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
This review aims to provide a comprehensive overview of the literature on the oral side effects caused by radiotherapy for head and neck cancers. Various treatments are examined to mitigate these sequelae, and a protocol is proposed for dentists and dental hygienists to manage oncological patients. A literature search was conducted to select relevant articles addressing the effects of radiotherapy treatments on the oral cavity, with a particular focus on the development of mucositis, candidiasis, changes in salivary pH, trismus, fibrosis, and alterations in the oral biofilm. PubMed and MedLine were used as search engines, with keyword combinations including: head and neck cancer, mucositis, candida, dental care, dental hygiene, epidemiology, oral microbiome, biofilm, trismus, fibrosis, and salivary pH. A total of 226 articles were identified, spanning the period from 1998 to 2023. Articles deemed inappropriate or in languages other than English or Italian were excluded. A management protocol for oncological patients was proposed, divided into two phases: home-based and professional. Despite the advancements in intensity-modulated radiation therapy, it is impossible to completely avoid damage to healthy tissues. Preventive education and counseling in the dental chair, ongoing motivation, and education about oral hygiene are crucial to combine a good therapeutic outcome with an improved quality of life for the patient.
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Affiliation(s)
- Giacomo Spinato
- Department of Neuroscience, Section of Otolaryngology, University of Padova, 35121 Padova, Italy
| | - Valentina Schiavon
- Department of Neuroscience, School of Dentistry, University of Padova, 35121 Padova, Italy
| | - Sara Torvilli
- Department of Neuroscience, School of Dentistry, University of Padova, 35121 Padova, Italy
| | - Stefano Carraro
- Department of Neuroscience, Section of Otolaryngology, University of Padova, 35121 Padova, Italy
| | - Federica Amato
- Department of Neuroscience, Section of Otolaryngology, University of Padova, 35121 Padova, Italy
| | - Antonio Daloiso
- Department of Neuroscience, Section of Otolaryngology, University of Padova, 35121 Padova, Italy
| | - Adolfo Di Fiore
- Department of Neuroscience, School of Dentistry, University of Padova, 35121 Padova, Italy
| | - Vittorio Favero
- Department of Neuroscience, Section of Maxillofacial Surgery, University of Padova, 35121 Padova, Italy
| | - Leonardo Franz
- Department of Neuroscience, Section of Audiology and Phoniatry, University of Padova, Treviso Hospital, 31100 Treviso, Italy
| | - Gino Marioni
- Department of Neuroscience, Section of Audiology and Phoniatry, University of Padova, Treviso Hospital, 31100 Treviso, Italy
| | - Cosimo de Filippis
- Department of Neuroscience, Section of Audiology and Phoniatry, University of Padova, Treviso Hospital, 31100 Treviso, Italy
| | - Cristoforo Fabbris
- Department of Medicine DIMED, University of Padova, 35122 Padova, Italy
- ENT Unit, Department of Surgery, South Padova United Hospitals, 35043 Padova, Italy
| | - Enzo Emanuelli
- AULSS 2 Marca Trevigiana, Section of Otolaryngology, Treviso Hospital, 31100 Treviso, Italy
| | - Piero Nicolai
- Department of Neuroscience, Section of Otolaryngology, University of Padova, 35121 Padova, Italy
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5
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Nichols AC, Theurer J, Prisman E, Read N, Berthelet E, Tran E, Fung K, de Almeida JR, Bayley A, Goldstein DP, Hier M, Sultanem K, Richardson K, Mlynarek A, Krishnan S, Le H, Yoo J, MacNeil SD, Winquist E, Hammond JA, Venkatesan V, Kuruvilla S, Warner A, Mitchell S, Chen J, Johnson-Obaseki S, Odell M, Corsten M, Parker C, Wehrli B, Kwan K, Palma DA. Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Final Results of the ORATOR Randomized Trial. J Clin Oncol 2024:JCO2400119. [PMID: 39303189 DOI: 10.1200/jco.24.00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/20/2024] [Accepted: 08/27/2024] [Indexed: 09/22/2024] Open
Abstract
Radiotherapy (RT) and transoral robotic surgery (TORS) are both curative-intent treatment options for oropharyngeal squamous cell carcinoma (OPSCC). Herein, we report the final outcomes of the ORATOR trial comparing these modalities, 5 years after enrollment completion. We randomly assigned 68 patients with T1-2N0-2 OPSCC to RT (with chemotherapy if node-positive) versus TORS plus neck dissection (± adjuvant RT/chemoradiation). The primary end point was swallowing quality of life (QOL) assessed with the MD Anderson Dysphagia Inventory (MDADI). Secondary end points included overall and progression-free survival (OS, PFS), adverse events (AEs), and other QOL metrics. The primary end point has been previously reported (Nichols 2019). In this report, the median follow-up was 5.1 years (IQR, 5.0-5.3 years). MDADI total scores converged by 5 years and were not significantly different across the follow-up period (P = .11). EORTC QLQ-C30 and H&N35 scores demonstrated differing profiles, including worse dry mouth in the RT arm (P = .032) and worse pain in the TORS arm (P = .002). Grade 2-5 AE rates did not differ between arms (91% [n = 31] v 97% [n = 33] respectively, P = .61), with more neutropenia and hearing loss in the RT arm, and more dysphagia and other pain in the TORS arm based on grades 2-5 (all P < .05). There were no differences in OS or PFS. In conclusion, toxicity and QOL profiles differ in some domains between RT and TORS, but oncologic outcomes were excellent in both arms. Choice of treatment should remain a shared decision between the patient and their providers.
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Affiliation(s)
- Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Julie Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - Eitan Prisman
- Department of Otolaryngology, University of British Columbia, Vancouver, BC, Canada
| | - Nancy Read
- Division of Radiation Oncology, Western University, London, ON, Canada
| | - Eric Berthelet
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Eric Tran
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Eric Winquist
- Department of Medical Oncology, Western University, London, ON, Canada
| | - J Alex Hammond
- Division of Radiation Oncology, Western University, London, ON, Canada
| | | | - Sara Kuruvilla
- Department of Medical Oncology, Western University, London, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, Western University, London, ON, Canada
| | - Sylvia Mitchell
- Division of Radiation Oncology, Western University, London, ON, Canada
| | - Jeff Chen
- Division of Radiation Oncology, Western University, London, ON, Canada
| | | | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Martin Corsten
- Division of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Christina Parker
- Department of Audiology, London Health Sciences Centre, London, ON, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, ON, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, ON, Canada
| | - David A Palma
- Division of Radiation Oncology, Western University, London, ON, Canada
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6
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Navran A, Kayembe MT, Gouw ZAR, Vogel WV, Karssemakers L, Paul de Boer J, Donswijk ML, Schreuder WH, Owers E, van den Brekel M, Al-Mamgani A. FGD-PET/CT three months after (chemo)radiotherapy for head and neck squamous cell carcinoma spares considerable number of patients from a salvage neck dissection. Radiother Oncol 2024; 198:110407. [PMID: 38942119 DOI: 10.1016/j.radonc.2024.110407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 06/12/2024] [Accepted: 06/17/2024] [Indexed: 06/30/2024]
Abstract
PURPOSE In the last decades FDG-PET/CT is increasingly used in combination with the standard diagnostic modalities (MRI + US-FNA) to identify residual neck disease (RND) after (chemo)radiotherapy for head-and-neck squamous cell carcinoma (HNSCC). The purpose of the current study is to identify the impact of increasing use of FDG-PET/CT on the accuracy of patient selection for salvage neck dissection (SND). MATERIALS AND METHODS Between 2008 and 2022, 908 consecutive patients with node-positive HNSCC were treated with (chemo)radiotherapy in our institution. PRIMARY ENDPOINT positive predictive value (PPV) of FDG-PET/CT for pathologic-confirmed RND (pRND) after SND, compared to the standard of care; MRI + US-FNA. Secondary endpoints: oncologic outcomes. RESULTS Of the entire group, 130 patients (14 %) received SND. Of them only 53 patients (41 %) had pRND at the SND-specimens. The PPV of FDG-PET/CT for the detection of pRND was considerably better, compared to MRI + US-FNA; 89 % and 65 %, respectively. If FDG-PET/CT showed metabolic CR, these patients did not undergo SND. The NPV was 97.5 %, as only 2.5 % of these patients developed delayed regional failure. FDG-PET/CT considerably improved the accuracy of patient selection for SND, as significantly more patients treated in the second period, compared to first period of the study (n = 454 each) still had vital tumor at SND-specimen (53 % and 31 %, p = 0.008). Regional recurrence free-survival, DFS, OS and HNSCC-death were significantly worse in patients with pRND (p < 0.05) CONCLUSIONS: Incorporating FDG-PET/CT into the diagnostic pathway for the response evaluation after (chemo)radiotherapy significantly improved the accuracy of patient selection for SND and spared considerable number of patients (>20 %) from unnecessary SND. For patients with metabolic CR, SND can safely be omitted while for patients with no metabolic CR, SND is strongly advocated.
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Affiliation(s)
- Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands.
| | - Mutamba T Kayembe
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Zeno A R Gouw
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Wouter V Vogel
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Luc Karssemakers
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Willem H Schreuder
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Emilia Owers
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michiel van den Brekel
- Department of Head and Neck Surgery, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Oral and Maxillo-Facial Surgery, Amsterdam University medical Center, Amsterdam, the Netherlands
| | - Abrahim Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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7
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Vasudevan SS, Zulli A, Olinde L, Pang J, Nathan CAO, Asarkar AA. Survival Outcomes of Transoral Microsurgery in T3/T4a Laryngeal Tumors: Systematic Review and Meta-Analysis. Laryngoscope 2024. [PMID: 39140205 DOI: 10.1002/lary.31695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 08/15/2024]
Abstract
OBJECTIVE To critically evaluate oncological and functional outcomes following transoral laser microsurgery (TLM) in patients with T3/T4a glottic and supraglottic squamous cell carcinoma (SCC). DATA SOURCES A comprehensive search of five major databases-PubMed, Embase, Scopus, ScienceDirect, and Web of Science-was conducted using a combination of relevant keywords and MeSH terms. REVIEW METHODS Systematic review and meta-analysis of odds ratio (OR), hazards ratio (HR), and proportion, focusing on oncological and functional outcomes of TLM in advanced T3/T4a glottic and supraglottic tumors. A random-effects meta-analysis model was employed. RESULTS The review incorporated 29 cohort studies, representing a total of 1,897 patients undergoing TLM for T3/T4a glottic and supraglottic SCC. The cumulative 5-year disease-free survival (DFS) rate for T3 glottic and supraglottic tumors was 44.4% (95% CI: 47-66%) and 62.8% (95% CI: 63-81%), while the 5-year DFS for T4 glottic and supraglottic tumors was 41.1% (95% CI: 33.4-49.2%) and 32.9% (95% CI: 19.3-50.1%), respectively. T3 glottic tumors exhibited a 2.5-fold significantly higher odds of local recurrence post-TLM compared to their T3 supraglottic tumors (95% CI: 1.6-3.9, p < 0.0001). Laryngeal preservation rates for T3glottic and supraglottic tumors were 68.9% (95% CI: 48.7-83.8%) and 88.4% (95% CI: 79.4-93.8%), respectively. Both groups showed comparable rates of tracheostomy (p = 0.48) and gastrostomy performed (p = 0.17). CONCLUSIONS This meta-analysis suggests that TLM is a viable larynx preservation approach in select patients with T3/T4a glottic and supraglottic tumors. However, glottic tumors may have less favorable outcomes after TLM compared to those with advanced supraglottic tumors. LEVEL OF EVIDENCE N/A Laryngoscope, 2024 Laryngoscope, 2024.
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Affiliation(s)
- Srivatsa Surya Vasudevan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Adam Zulli
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Lindsay Olinde
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - John Pang
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Cherie-Ann O Nathan
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
- Department of Surgery, Overton Brooks Veterans Administration Medical Center, Shreveport, Louisiana, USA
| | - Ameya A Asarkar
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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8
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Ishii R, Ohkoshi A, Katori Y. Treatment of elderly patients with head and neck cancer in an aging society: Focus on geriatric assessment and surgical treatment. Auris Nasus Larynx 2024; 51:647-658. [PMID: 38631257 DOI: 10.1016/j.anl.2024.04.005] [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: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Previous studies of the treatment of elderly head and neck cancer (HNC) patients were very limited and sometimes controversial. Although conclusions differ across various reports, it is often concluded that advanced chronological age does not directly affect prognosis, but that comorbidities and declines in physical and cognitive functions promote the occurrence of adverse events, especially with surgical treatment. Geriatric assessment (GA) and its screening tools are keys to help us understand overall health status and problems, predict life expectancy and treatment tolerance, and to influence treatment choices and interventions to improve treatment compliance. In addition, personal beliefs and values play a large role in determining policies for HNC treatment for elderly patients, and a multidisciplinary approach is important to support this. In this review, past research on HNC in older adults is presented, and the current evidence is explained, focusing on the management of elderly HNC patients, with an emphasis on the existing reports on each treatment stage and modality, especially the surgical procedures.
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Affiliation(s)
- Ryo Ishii
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan.
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
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9
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Sampieri C, Cioccoloni E, Costantino A, Kim D, Lee K, Meccariello G, Cammaroto G, Vicini C, Kim SH. Neoadjuvant chemotherapy followed by transoral robotic surgery versus upfront surgery for locoregionally advanced oropharyngeal carcinoma: A propensity score matched analysis. Head Neck 2024. [PMID: 39087607 DOI: 10.1002/hed.27904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 06/09/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Transoral robotic surgery (TORS) performed after neoadjuvant chemotherapy (NAC) is a promising treatment for advanced-stage oropharyngeal carcinoma (OPSCC) able to reduce the adjuvant therapy administration rate. METHODS A retrospective bi-centric study was conducted to analyze NAC + TORS versus upfront TORS patients. A 1:1 propensity score matching was used to compare the two groups. RESULTS Among the 300 patients with stage III-IV OPSCC, 204 patients were matched for comparing NAC + TORS versus upfront TORS. Between the two groups, no significant difference was observed in recurrences and in survival for RFS, OS, and DSS. In the NAC + TORS p16-positive population, adjuvant therapy could be spared in 51% versus 16% in the upfront surgery cohort (p < 0.001) due to the lower frequency of pathological risk factors after NAC. CONCLUSIONS NAC followed by TORS for locoregionally advanced OPSCC demonstrated to achieve non-inferior survival outcomes to upfront surgery, while in the p16-positive population allowed to significantly spare adjuvant therapy.
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Affiliation(s)
- Claudio Sampieri
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
- Department of Otorhinolaryngology, Hospital Clínic, Barcelona, Spain
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eleonora Cioccoloni
- Unit of Otolaryngology, Head-Neck and Oral Surgery, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Andrea Costantino
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Dahee Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyuin Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Giuseppe Meccariello
- Unit of Otolaryngology, Head-Neck and Oral Surgery, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Unit of Otolaryngology, Head-Neck and Oral Surgery, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Claudio Vicini
- Unit of Otolaryngology, Head-Neck and Oral Surgery, Department of Head-Neck Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Se-Heon Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
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10
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Wu C, Kuzmin P, Julian R. De-Escalation Strategies in HPV-Associated Oropharynx Cancer: A Historical Perspective with Future Direction. Cancers (Basel) 2024; 16:2733. [PMID: 39123461 PMCID: PMC11311653 DOI: 10.3390/cancers16152733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/26/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
The incidence of HPV-related oropharyngeal cancers has increased in recent decades. While cure rates exceed those of HPV-negative head and neck cancers, both acute and long-term sequelae of chemotherapy, radiation and surgery have led to clinical investigation into de-escalation of treatment. De-escalation trials have sought to reduce long-term treatment-related morbidity by altering or omitting chemotherapy, reducing radiation, or incorporating less invasive surgical resection through transoral surgery. More recent approaches include the use of novel agents such as immunotherapy in place of cisplatin. With the advent of tumor-tissue-modified HPV DNA detection and monitoring in blood, new strategies incorporating this biomarker are being developed.
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Affiliation(s)
- Clinton Wu
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85719, USA
| | - Paulina Kuzmin
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85719, USA
| | - Ricklie Julian
- Department of Internal Medicine, University of Arizona, Tucson, AZ 85719, USA
- Department of Hematology and Oncology, University of Arizona, Tucson, AZ 85719, USA
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11
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Ebisumoto K, Sakai A, Iijima H, Maki D, Yamauchi M, Saito K, Kaneda S, Teramura T, Watanabe T, Inagi T, Yanagiya R, Yamazaki A, Ashida H, Ota Y, Sato Y, Yamamoto A, Kobayashi N, Okami K. Safety and outcome of three-dimensional transoral videolaryngoscopic surgery. Head Neck 2024; 46:1873-1880. [PMID: 38268328 DOI: 10.1002/hed.27657] [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: 08/27/2023] [Revised: 12/07/2023] [Accepted: 01/15/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Transoral videolaryngoscopic surgery (TOVS) is widely used in Japan, and conventional two-dimensional (2D) endoscopic methods have been established. Three-dimensional (3D) endoscopic surgery offers superior distance perception because it provides stereoscopic views. Recently, we have developed 3D endoscopy for TOVS (3D TOVS). METHODS This study included 46 patients with pharyngeal cancer who underwent 3D TOVS. The perioperative complications and survival curves were retrospectively analyzed. RESULTS One patient with oropharyngeal cancer who underwent neck dissection and transoral resection simultaneously experienced postoperative hemorrhage of the neck. Another patient with oropharyngeal cancer underwent hemostasis for postoperative pharyngeal hemorrhage. There was one case of aspiration pneumonia. One patient developed cervical lymph node recurrence; however, there was no local recurrence or primary mortality. The 2-year overall survival, disease-specific survival, local control rates, locoregional control rate, and invasive disease-free survival were 90.9%, 100%, 100%, 97.4%, and 79.9%, respectively. CONCLUSIONS Three-dimensional endoscopy can be safely applied to TOVS.
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Affiliation(s)
- Koji Ebisumoto
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Akihiro Sakai
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Hiroaki Iijima
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Daisuke Maki
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Mayu Yamauchi
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Kosuke Saito
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Shoji Kaneda
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Takanobu Teramura
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Takane Watanabe
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Toshihide Inagi
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Ryoko Yanagiya
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Aritomo Yamazaki
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Hiroshi Ashida
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Yoshiyuki Ota
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Yurina Sato
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Ai Yamamoto
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Naoya Kobayashi
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
| | - Kenji Okami
- Department of Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, Japan
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12
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Chang CF, Wang LW, Yang MH, Chu PY. Induction chemotherapy followed by transoral laser microsurgery with or without adjuvant therapy for advanced hypopharyngeal cancer patients: A preliminary result. J Chin Med Assoc 2024; 87:803-808. [PMID: 38904335 DOI: 10.1097/jcma.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Hypopharyngeal squamous cell carcinoma (HPSCC) has the poorest prognosis among head and neck cancers. Its treatment may significantly affect breathing, speaking, and swallowing. Induction chemotherapy (ICT) followed by transoral laser microsurgery (TLM) could reduce these adverse effects and achieve good outcomes. METHODS This was a retrospective study of 11 patients with advanced HPSCC. All patients underwent ICT and TLM alongside tailor-made adjuvant therapy based on the pathological features. RESULTS Adjuvant therapy was done in seven of 11 patients (64%). The 3-year disease-free survival and laryngeal preservation rates were 78% and 91%, respectively. At the last follow-up, 10 of 11 patients (91%) had no tracheostomy or feeding tube. CONCLUSION ICT followed by TLM is an appropriate treatment for good tumor control in select patients with advanced HPSCC while preserving laryngeal function.
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Affiliation(s)
- Chia-Fan Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ling-Wei Wang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Heavy Particles and Radiation Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Muh-Hwa Yang
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pen-Yuan Chu
- Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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13
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Aristophanous M, Aliotta E, Lichtenwalner P, Abraham S, Nehmeh M, Caringi A, Zhang P, Hu YC, Zhang P, Cervino L, Gelblum D, McBride S, Riaz N, Chen L, Yu Y, Zakeri K, Lee N. Clinical Experience With an Offline Adaptive Radiation Therapy Head and Neck Program: Dosimetric Benefits and Opportunities for Patient Selection. Int J Radiat Oncol Biol Phys 2024; 119:1557-1568. [PMID: 38373657 DOI: 10.1016/j.ijrobp.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 01/26/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE The objective of this study was to develop a linear accelerator (LINAC)-based adaptive radiation therapy (ART) workflow for the head and neck that is informed by automated image tracking to identify major anatomic changes warranting adaptation. In this study, we report our initial clinical experience with the program and an investigation into potential trigger signals for ART. METHODS AND MATERIALS Offline ART was systematically performed on patients receiving radiation therapy for head and neck cancer on C-arm LINACs. Adaptations were performed at a single time point during treatment with resimulation approximately 3 weeks into treatment. Throughout treatment, all patients were tracked using an automated image tracking system called the Automated Watchdog for Adaptive Radiotherapy Environment (AWARE). AWARE measures volumetric changes in gross tumor volumes (GTVs) and selected normal tissues via cone beam computed tomography scans and deformable registration. The benefit of ART was determined by comparing adaptive plan dosimetry and normal tissue complication probabilities against the initial plans recalculated on resimulation computed tomography scans. Dosimetric differences were then correlated with AWARE-measured volume changes to identify patient-specific triggers for ART. Candidate trigger variables were evaluated using receiver operator characteristic analysis. RESULTS In total, 46 patients received ART in this study. Among these patients, we observed a significant decrease in dose to the submandibular glands (mean ± standard deviation: -219.2 ± 291.2 cGy, P < 10-5), parotids (-68.2 ± 197.7 cGy, P = .001), and oral cavity (-238.7 ± 206.7 cGy, P < 10-5) with the adaptive plan. Normal tissue complication probabilities for xerostomia computed from mean parotid doses also decreased significantly with the adaptive plans (P = .008). We also observed systematic intratreatment volume reductions (ΔV) for GTVs and normal tissues. Candidate triggers were identified that predicted significant improvement with ART, including parotid ΔV = 7%, neck ΔV = 2%, and nodal GTV ΔV = 29%. CONCLUSIONS Systematic offline head and neck ART was successfully deployed on conventional LINACs and reduced doses to critical salivary structures and the oral cavity. Automated cone beam computed tomography tracking provided information regarding anatomic changes that may aid patient-specific triggering for ART.
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Affiliation(s)
- Michalis Aristophanous
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Eric Aliotta
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Phillip Lichtenwalner
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shira Abraham
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mohammad Nehmeh
- Department of Applied Physics, Columbia University, New York, New York
| | - Amanda Caringi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Peng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yu-Chi Hu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Cervino
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daphna Gelblum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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14
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Abou Kors T, Meier M, Mühlenbruch L, Betzler AC, Oliveri F, Bens M, Thomas J, Kraus JM, Doescher J, von Witzleben A, Hofmann L, Ezic J, Huber D, Benckendorff J, Barth TFE, Greve J, Schuler PJ, Brunner C, Blackburn JM, Hoffmann TK, Ottensmeier C, Kestler HA, Rammensee HG, Walz JS, Laban S. Multi-omics analysis of overexpressed tumor-associated proteins: gene expression, immunopeptide presentation, and antibody response in oropharyngeal squamous cell carcinoma, with a focus on cancer-testis antigens. Front Immunol 2024; 15:1408173. [PMID: 39136024 PMCID: PMC11317303 DOI: 10.3389/fimmu.2024.1408173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 07/15/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction The human leukocyte antigen complex (HLA) is essential for inducing specific immune responses to cancer by presenting tumor-associated peptides (TAP) to T cells. Overexpressed tumor associated antigens, mainly cancer-testis antigens (CTA), are outlined as essential targets for immunotherapy in oropharyngeal squamous cell carcinoma (OPSCC). This study assessed the degree to which presentation, gene expression, and antibody response (AR) of TAP, mainly CTA, are correlated in OPSCC patients to evaluate their potential as immunotherapy targets. Materials and methods Snap-frozen tumor (NLigand/RNA=40), healthy mucosa (NRNA=6), and healthy tonsils (NLigand=5) samples were obtained. RNA-Seq was performed using Illumina HiSeq 2500/NovaSeq 6000 and whole exome sequencing (WES) utilizing NextSeq500. HLA ligands were isolated from tumor tissue using immunoaffinity purification, UHPLC, and analyzed by tandem MS. Antibodies were measured in serum (NAb=27) utilizing the KREX™ CT262 protein array. Data analysis focused on 312 proteins (KREX™ CT262 panel + overexpressed self-proteins). Results 183 and 94 of HLA class I and II TAP were identified by comparative profiling with healthy tonsils. Genes from 26 TAP were overexpressed in tumors compared to healthy mucosa (LFC>1; FDR<0.05). Low concordance (r=0.25; p<0.0001) was found between upregulated mRNA and class I TAP. The specific mode of correlation of TAP was found to be dependent on clinical parameters. A lack of correlation was observed both between mRNA and class II TAP, as well as between class II tumor-unique TAP (TAP-U) presentation and antibody response (AR) levels. Discussion This study demonstrates that focusing exclusively on gene transcript levels fails to capture the full extent of TAP presentation in OPSCC. Furthermore, our findings reveal that although CTA are presented at relatively low levels, a few CTA TAP-U show potential as targets for immunotherapy.
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Affiliation(s)
- Tsima Abou Kors
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Matthias Meier
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Lena Mühlenbruch
- Department of Immunology, Institute for Cell Biology, Eberhard Karls University of Tübingen, Tübingen, Germany
- Department of Peptide-based Immunotherapy, Eberhard Karls University and University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen, Germany
| | - Annika C. Betzler
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Core Facility Immune Monitoring, Ulm University Medical Center, Ulm, Germany
| | - Franziska Oliveri
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Martin Bens
- Core Facility Next Generation Sequencing, Leibniz Institute on Aging - Fritz Lipmann Institute, Jena, Germany
| | - Jaya Thomas
- Cancer Sciences Unit, University of Southampton, Faculty of Medicine, Southampton, United Kingdom
| | - Johann M. Kraus
- Institute of Medical Systems Biology, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Johannes Doescher
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Department of Otolaryngology, Augsburg University Hospital, Augsburg, Germany
| | - Adrian von Witzleben
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Linda Hofmann
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Jasmin Ezic
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Diana Huber
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | | | | | - Jens Greve
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
| | - Patrick J. Schuler
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Cornelia Brunner
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Core Facility Immune Monitoring, Ulm University Medical Center, Ulm, Germany
| | - Jonathan M. Blackburn
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Thomas K. Hoffmann
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Christian Ottensmeier
- Institute of Systems, Molecular and Integrative Biology, Liverpool Head and Neck Center, University of Liverpool, Faculty of Medicine, Liverpool, United Kingdom
| | - Hans A. Kestler
- Institute of Medical Systems Biology, Faculty of Medicine, Ulm University, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
| | - Hans-Georg Rammensee
- Department of Immunology, Institute for Cell Biology, Eberhard Karls University of Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen, Germany
| | - Juliane S. Walz
- Department of Peptide-based Immunotherapy, Eberhard Karls University and University Hospital Tübingen, Tübingen, Germany
- Cluster of Excellence iFIT (EXC2180) “Image-Guided and Functionally Instructed Tumor Therapies”, University of Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, Tübingen, Germany
- Clinical Collaboration Unit Translational Immunology, Department of Internal Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Simon Laban
- Department of Otorhinolaryngology and Head and Neck Surgery, Ulm University Medical Center, Ulm, Germany
- Surgical Oncology Ulm, i2SOUL Consortium, Ulm, Germany
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15
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Boothe PF, Kumar VP, Kong Y, Wang K, Levinson H, Mu D, Brown ML. Radiation Induced Skin Fibrosis (RISF): Opportunity for Angiotensin II-Dependent Intervention. Int J Mol Sci 2024; 25:8261. [PMID: 39125831 PMCID: PMC11312688 DOI: 10.3390/ijms25158261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Medical procedures, such as radiation therapy, are a vital element in treating many cancers, significantly contributing to improved survival rates. However, a common long-term complication of such exposure is radiation-induced skin fibrosis (RISF), a complex condition that poses substantial physical and psychological challenges. Notably, about 50% of patients undergoing radiation therapy may achieve long-term remission, resulting in a significant number of survivors managing the aftereffects of their treatment. This article delves into the intricate relationship between RISF, reactive oxygen species (ROS), and angiotensin II (Ang II) signaling. It proposes the underlying mechanisms and examines potential treatments for mitigating skin fibrosis. The primary goal is to offer essential insights in order to better care for and improve the quality of life of cancer survivors who face the risk of developing RISF.
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Affiliation(s)
- Patricia F. Boothe
- Department of Internal Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA
| | - Vidya P. Kumar
- Armed Forces Radiobiology Research Institute, The Uniformed Services University of the Health Sciences, Bethesda, MD 20889, USA
| | - Yali Kong
- Department of Biomedical and Translational Sciences, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA; (Y.K.); (D.M.)
| | - Kan Wang
- Department of Biomedical and Translational Sciences, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA; (Y.K.); (D.M.)
| | - Howard Levinson
- The Center for Plastic Surgery at Sentara, 301 Riverview Ave. #400, Norfolk, VA 23510, USA;
| | - David Mu
- Department of Biomedical and Translational Sciences, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA; (Y.K.); (D.M.)
- Leroy T. Canoles Jr. Cancer Research Center, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA
| | - Milton L. Brown
- Department of Internal Medicine, Macon & Joan Brock Virginia Health Sciences at Old Dominion University, Norfolk, VA 23507, USA
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16
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Imahara Y, Ono T, Tanaka N, Chitose SI, Sato F, Tanoue S, Kurita T, Miyata Y, Muraki K, Ogo E, Hattori C, Abe T, Umeno H. Effectiveness and feasibility of selective intra-arterial low dose of cisplatin infusion and concomitant radiotherapy for patients with advanced laryngeal cancer with impaired renal function: A retrospective cohort study. Head Neck 2024. [PMID: 39041364 DOI: 10.1002/hed.27873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/01/2024] [Accepted: 06/10/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Chemoradiation therapy with high-dose cisplatin is the standard regimen against advanced squamous cell carcinoma of the larynx (SCC-L). However, patients with renal dysfunction are ineligible for this regimen. We investigated the effectiveness and feasibility of selective intra-arterial low-dose cisplatin infusion and radiotherapy (modified [m]-RADPLAT) for patients with impaired renal function. METHODS We retrospectively reviewed the data of 77 patients with SCC-L who received m-RADPLAT. RESULTS Fourteen and 63 patients had creatinine clearance (CrCl) values of 30 ≤ CrCl < 60 mL/min and ≥60 mL/min, respectively. The m-RADPLAT regimen led to no significant changes in serum creatinine or CrCl values post-treatment. The 5-year local control, overall survival, and laryngectomy-free survival rates of the CrCl < 60 and ≥60 groups were 90.0% and 90.5%, 100% and 81.8%, and 100% and 79.0%, respectively. Grade 3 or higher toxicity rates were not significantly different between the groups. CONCLUSIONS The m-RADPLAT regimen yielded favorable survival rates and clinical outcomes in patients with impaired renal function.
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Affiliation(s)
- Yuji Imahara
- Department of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Takeharu Ono
- Department of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Norimitsu Tanaka
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Shun-Ichi Chitose
- Department of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Fumihiko Sato
- Department of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Shuichi Tanoue
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Takashi Kurita
- Department of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Yusaku Miyata
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Koichiro Muraki
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Etsuyo Ogo
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Chikayuki Hattori
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Toshi Abe
- Department of Radiology, Kurume University School of Medicine, Kurume, Japan
| | - Hirohito Umeno
- Department of Otolaryngology - Head and Neck Surgery, Kurume University School of Medicine, Kurume, Japan
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17
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Rosenberg AJ, Agrawal N, Juloori A, Cursio J, Gooi Z, Blair E, Chin J, Ginat D, Pasternak-Wise O, Hasina R, Starus A, Jones FS, Izumchenko E, MacCracken E, Wolk R, Cipriani N, Lingen MW, Pearson AT, Seiwert TY, Haraf DJ, Vokes EE. Neoadjuvant Nivolumab Plus Chemotherapy Followed By Response-Adaptive Therapy for HPV+ Oropharyngeal Cancer: OPTIMA II Phase 2 Open-Label Nonrandomized Controlled Trial. JAMA Oncol 2024; 10:923-931. [PMID: 38842838 PMCID: PMC11157444 DOI: 10.1001/jamaoncol.2024.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/02/2024] [Indexed: 06/07/2024]
Abstract
Importance Immune checkpoint inhibitors improve survival in recurrent and/or metastatic head and neck cancer, yet their role in curative human papillomavirus-positive oropharyngeal cancer (HPV+ OPC) remains undefined. Neoadjuvant nivolumab and chemotherapy followed by response-adaptive treatment in HPV+ OPC may increase efficacy while reducing toxicity. Objective To determine the deep response rate and tolerability of the addition of neoadjuvant nivolumab to chemotherapy followed by response-adapted locoregional therapy (LRT) in patients with HPV+ OPC. Design, Setting, and Participants This phase 2 nonrandomized controlled trial conducted at a single academic center enrolled 77 patients with locoregionally advanced HPV+ OPC from 2017 to 2020. Data analyses were performed from February 10, 2021, to January 9, 2023. Interventions Addition of nivolumab to neoadjuvant nab-paclitaxel and carboplatin (studied in the first OPTIMA trial) followed by response-adapted LRT in patients with HPV+ OPC stages III to IV. Main Outcomes and Measures Primary outcome was deep response rate to neoadjuvant nivolumab plus chemotherapy, defined as the proportion of tumors with 50% or greater shrinkage per the Response Evaluation Criteria in Solid Tumors 1.1. Secondary outcomes were progression-free survival (PFS) and overall survival (OS). Swallowing function, quality of life, and tissue- and blood-based biomarkers, including programmed death-ligand 1 (PD-L1) expression and circulating tumor HPV-DNA (ctHPV-DNA), were also evaluated. Results The 73 eligible patients (median [range] age, 61 [37-82] years; 6 [8.2%] female; 67 [91.8%] male) started neoadjuvant nivolumab and chemotherapy. Deep responses were observed in 51 patients (70.8%; 95% CI, 0.59-0.81). Subsequent risk- and response-adaptive therapy was assigned as follows: group A, single-modality radiotherapy alone or transoral robotic surgery (28 patients); group B, intermediate-dose chemoradiotherapy of 45 to 50 Gray (34 patients); and group C, regular-dose chemoradiotherapy of 70 to 75 Gray (10 patients). Two-year PFS and OS were 90.0% (95% CI, 0.80-0.95) and 91.4% (95% CI, 0.82-0.96), respectively. By response-adapted group, 2-year PFS and OS for group A were 96.4% and 96.4%, and group B, 88.0% and 91.0%, respectively. Lower enteral feeding rates and changes in weight, as well as improved swallowing, were observed among patients who received response-adapted LRT. Pathologic complete response rate among patients who underwent transoral robotic surgery was 67.0%. PD-L1 expression was nonsignificantly higher for deeper responses and improved PFS, and ctHPV-DNA clearance was significantly associated with improved PFS. Conclusions and Relevance This phase 2 nonrandomized controlled trial found that neoadjuvant nivolumab and chemotherapy followed by response-adapted LRT is feasible and has favorable tolerability, excellent OS, and improved functional outcomes in HPV+ OPC, including among patients with high-risk disease. Moreover, addition of nivolumab may benefit high PD-L1 expressors, and sensitive dynamic biomarkers (eg, ctHPV-DNA) are useful for patient selection. Trial Registration ClinicalTrials.gov Identifier: NCT03107182.
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Affiliation(s)
- Ari J. Rosenberg
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Nishant Agrawal
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Aditya Juloori
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - John Cursio
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Zhen Gooi
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Elizabeth Blair
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Jeffrey Chin
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Daniel Ginat
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Olga Pasternak-Wise
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Rifat Hasina
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | | | | | - Evgeny Izumchenko
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Ellen MacCracken
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Rachelle Wolk
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Nicole Cipriani
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Mark W. Lingen
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Alexander T. Pearson
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Tanguy Y. Seiwert
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Daniel J. Haraf
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Everett E. Vokes
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
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Carsuzaa F, Chabrillac E, Marcy PY, Mehanna H, Thariat J. Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary. Strahlenther Onkol 2024; 200:553-567. [PMID: 38600366 DOI: 10.1007/s00066-024-02228-4] [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: 11/29/2023] [Accepted: 03/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with a focus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy. METHODS A narrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy. RESULTS Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying a specific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis. CONCLUSION Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.
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Affiliation(s)
- Florent Carsuzaa
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, Poitiers University Hospital, Poitiers, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Pierre Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Juliette Thariat
- Department of radiotherapy, Centre François Baclesse, Caen, France.
- Laboratoire de physique Corpusculaire, IN2P3/ENSICAEN/CNRS, UMR 6534, Normandie Université, Caen, France.
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19
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Pace GM, Morales-Olavarría C, Costantino A, Festa BM, Russo E, Iannella G, Carnevale C, Di Maio P, Sampieri C, Accorona R, De Virgilio A. Survival and complications after carotid resection for head and neck squamous cell carcinoma: A systematic review and pooled analysis. Head Neck 2024; 46:1777-1787. [PMID: 38469988 DOI: 10.1002/hed.27723] [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: 12/06/2023] [Revised: 01/28/2024] [Accepted: 02/24/2024] [Indexed: 03/13/2024] Open
Abstract
OBJECTIVE The aim of this study is to analyze oncologic outcomes and complications rate after common or internal carotid artery (CCA/ICA) resection for head and neck squamous cell carcinoma (HNSCC). METHODS This study was conducted in conformity with the PRISMA statement. A systematic review and pooled analysis was performed for overall survival (OS), disease specific survival (DSS) (primary outcomes), and perioperative death rate (secondary outcome). RESULTS A total of 276 patients (males: 76.7%, n = 191/249) with a median age of 59 years (n = 239/276; 95% CI 55.0-61.7) who underwent CCA/ICA resection for HNSCC were included. The median follow-up time was 11 months (n = 276). Estimated pooled OS rates (95% CI) at 1 and 2 years were 52.7% (46.9-59.2) and 29.8% (24.3-36.5), respectively. The median OS (95% CI) was 14 months (12-17). Estimated pooled DSS rates (95% CI) at 1 and 2 years were 58.6% (52.7-65.2) and 34.6% (28.5-41.9), respectively. The median DSS (95% CI) was 16 months (14-19). The perioperative death rate was 6.9% (n = 19/276). CONCLUSIONS CCA/ICA resection should be considered as a treatment option for accurately selected patients. Multicentric prospective studies are recommended to develop a predictive score guiding the decision-making process.
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Affiliation(s)
- Gian Marco Pace
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Andrea Costantino
- Department of Otolaryngology-Head and Neck Surgery, AdventHealth Orlando, Celebration, Florida, USA
| | - Bianca Maria Festa
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Russo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | - Pasquale Di Maio
- Unit of Otorhinolaryngology, Giuseppe Fornaroli Hospital, ASST Ovest Milanese, Milan, Italy
| | - Claudio Sampieri
- Department of Medical Science (DIMES), University of Genoa, Genoa, Italy
- Functional Unit of Head and Neck Tumors, Hospital Clínic, Barcelona, Spain
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Remo Accorona
- Unit of Otorhinolaryngology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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20
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Saturno M, Shaari AL, Yun J, Wein LE, Shaari D, Kappauf C, Laitman BM, Chai RL. Outcomes of Supracricoid Partial Laryngectomy Performed in the United States: A Systematic Review. Laryngoscope 2024; 134:3003-3011. [PMID: 38251796 DOI: 10.1002/lary.31273] [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: 07/24/2023] [Revised: 12/09/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE The primary objective of this study was to evaluate oncologic outcomes of all published cases of supracricoid partial laryngectomy (SCPL) performed in the United States. The secondary objective was to assess the functional outcomes associated with this procedure. REVIEW METHODS A systematic review of PubMed, SCOPUS, and Embase for all English-language studies pertaining to SCPL performed in the United States was conducted until August 2021. Primary outcomes included disease-specific survival (DSS), overall survival, and local recurrence rate. Secondary outcomes included larynx preservation rate, gastrostromy tube dependency, days to gastrostomy tube removal, decannulation rate, and days to decannulation. RESULTS A total of six studies were included in the analysis. A total of 113 patients (58.5%) underwent SCPL surgery as a primary treatment method whereas 80 patients (41.5%) underwent SCPL as salvage surgery. The 5-year DSS rates were 87.8% and 100% for primary and salvage procedures, respectively. Approximately 10.3% of patients undergoing a salvage SCPL procedure experienced a local recurrence whereas only 1.85% of primary SCPL procedures resulted in local recurrence. The rates of decannulation following primary and salvage SCPL were 92.7% and 88.1%, respectively. With regard to swallowing, primary and salvage SCPL procedures demonstrated comparably low postoperative gastrostomy tube dependency rates of 3.66% and 4.76%, respectively. CONCLUSIONS SCPL performed in the United States is an effective surgical technique that produces excellent outcomes in qualifying patients, thus validating its viability as an organ-preserving surgical alternative. Laryngoscope, 134:3003-3011, 2024.
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Affiliation(s)
- Michael Saturno
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Ariana L Shaari
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Jun Yun
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Lauren E Wein
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Diana Shaari
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
| | - Catharine Kappauf
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Benjamin M Laitman
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Raymond L Chai
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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21
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Rodrigo JP, López-Álvarez F, Medina JE, Silver CE, Robbins KT, Hamoir M, Mäkitie A, de Bree R, Takes RP, Golusinski P, Kowalski LP, Forastiere AA, Homma A, Hanna EY, Rinaldo A, Ferlito A. Treatment of the neck in residual/recurrent disease after chemoradiotherapy for advanced primary laryngeal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108389. [PMID: 38728962 DOI: 10.1016/j.ejso.2024.108389] [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: 11/26/2023] [Revised: 04/09/2024] [Accepted: 05/03/2024] [Indexed: 05/12/2024]
Abstract
Concomitant chemoradiotherapy (CRT) is extensively used as primary organ preservation treatment for selected advanced laryngeal squamous cell carcinomas (LSCC). The oncologic outcomes of such regimens are comparable to those of total laryngectomy followed by adjuvant radiotherapy. However, the management of loco-regional recurrences after CRT remains a challenge, with salvage total laryngectomy being the only curative option. Furthermore, the decision whether to perform an elective neck dissection (END) in patients with rN0 necks, and the extent of the neck dissection in patients with rN + necks is still, a matter of debate. For rN0 patients, meta-analyses have reported occult metastasis rates ranging from 0 to 31 %, but no survival advantage for END. In addition, meta-analyses also showed a higher incidence of complications in patients who received an END. Therefore, END is not routinely recommended in addition to salvage laryngectomy. Although some evidence suggests a potential role of END for supraglottic and locally advanced cases, the decision to perform END should weigh benefits against potential complications. In rN + patients, several studies suggested that selective neck dissection (SND) is oncologically safe for patients with specific conditions: when lymph node metastases are not fixed and are absent at level IV or V. Super-selective neck dissection (SSND) may be an option when nodes are confined to one level. In conclusion, current evidence suggests that in rN0 necks routine END is not necessary and that in rN + necks with limited nodal recurrences SND or a SSND could be sufficient.
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Affiliation(s)
- Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain.
| | - Fernando López-Álvarez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, CIBERONC, Oviedo, Spain
| | - Jesús E Medina
- Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Marc Hamoir
- Department of Otorhinolaryngology, Head and Neck Surgery, UC Louvain, St Luc University Hospital and King Albert II Cancer Institute, Institut de Recherche Experimentale, 1200, Brussels, Belgium
| | - Antti Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pawel Golusinski
- Department of Otolaryngology and Maxillofacial Surgery, University of Zielona Gora, Department of Maxillofacial Surgery Poznan University of Medical Sciences, Poznan, Poland
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School and Head and Neck Surgery and Otorhinolaryngology Department, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ehab Y Hanna
- Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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22
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Lim AM, McDowell L, Hurt C, Le Tourneau C, Homma A, Shenouda G, Thomson DJ, Moya-Plana A, Henson C, Szturz P, Day AT, Bates JE, Lazarakis S, Thariat J, Psyrri A, Mehanna H, Yom SS. Assessment of endpoint definitions in curative-intent trials for mucosal head and neck squamous cell carcinomas: Head and Neck Cancer International Group consensus recommendations. Lancet Oncol 2024; 25:e318-e330. [PMID: 38936390 DOI: 10.1016/s1470-2045(24)00067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 06/29/2024]
Abstract
Robust time-to-event endpoint definitions are crucial for the assessment of treatment effect and the clinical value of trial interventions. Here, the Head and Neck Cancer International Group investigated endpoint use in phase 3 trials and trials considered potentially practice-changing published between 2008 and 2021 in the curative-intent setting for patients with mucosal head and neck squamous cell carcinoma. Of the 92 trials reviewed, we show that all core components of endpoint reporting were heterogeneous, including definitions of common terms, such as overall survival and progression-free survival. Our report highlights the urgent need for harmonisation of fundamental components of clinical trial endpoints and the engagement of all stakeholders to ensure the transparent reporting of endpoint details.
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Affiliation(s)
- Annette M Lim
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.
| | - Lachlan McDowell
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Chris Hurt
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i) and INSERM U900 Research unit, Institut Curie, Paris, France; Paris-Saclay University, Paris, France
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine Hokkaido University, Sapporo, Hokkaido, Japan
| | - George Shenouda
- Division of Radiation Oncology, Department of Oncology, McGill University, McGill University Health Centre, Montreal, QC, Canada
| | - David J Thomson
- The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Antoine Moya-Plana
- Paris-Saclay University, Paris, France; Department of Head and Neck and Skull Base Surgery and INSERM U981 Research Unit, Gustave Roussy, Villejuif, France
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, OK, USA
| | - Petr Szturz
- Department of Oncology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Andrew T Day
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, TX, USA
| | - James E Bates
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Smaro Lazarakis
- Health Sciences Library, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, Caen, France; ARCHADE Research Community Caen, France; Laboratoire de Physique Corpusculaire, UMR 6534, Unicaen-Normandie Université, Caen, France
| | - Amanda Psyrri
- Department of Oncology, Attikon University Hospital, Chaidari, Athens, Greece
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Edgbaston, Birmingham, UK
| | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, CA, USA; Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA.
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Vashistha B, Negi P, Kingsley PA. The spectrum of late radiation sequelae in head and neck cancer. J Cancer Res Ther 2024; 20:1578-1583. [PMID: 39412922 DOI: 10.4103/jcrt.jcrt_1453_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/20/2024] [Indexed: 10/18/2024]
Abstract
INTRODUCTION Concurrent Chemoradiation is the standard of care in the treatment of unresectable locally advanced head and neck cancer. Some of the acute side effects seen after or alongside the head and neck radiotherapy include dermatitis, mucositis, xerostomia, dysphagia and swallowing dysfunction. Evolving data demonstrate that acute toxicities may persist long-term and develop into late effects. In addition, late effects may manifest months or years after completion of therapy, persisting for years or even lifelong, far longer than previously believed. When severe, late effects may profoundly affect function and quality of life. The present study was conducted to analyze the spectrum of late radiation toxicities in head and neck cancer patients treated with radical external beam radiation therapy and to determine its prevalence and severity. MATERIALS AND METHODS This prospective observational study was conducted in the Department of Radiotherapy, Christian Medical College and Hospital, Ludhiana. In all patients with a histopathological diagnosis of head and neck carcinoma who have received radical radiation therapy alone or definitive chemoradiation as part of cancer-directed therapy. RESULTS Salivary gland toxicity was the most common toxicity encountered in head and neck cancer survivors resulting in dysphagia followed by dental caries, subcutaneous late effects and dysphagia. As expected, the spectrum of side effects correlated with the primary site, stage of disease and ECOG performance status. CONCLUSION Technological advancement in radiation planning and equipment has resulted in a reduction in the most feared side effects of radiation which has led to improvement in the quality of life of the survivors. As no technology can entirely protect normal tissues from irradiation, utmost care should be taken to minimize the radiation dose received by normal tissues by following preventive and supportive measures.
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Affiliation(s)
- Bhanu Vashistha
- Department of Radiation Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Preety Negi
- Department of Radiation Oncology, Capitol Hospital, Jalandhar, Punjab, India
| | - Pamela A Kingsley
- Department of Radiation Oncology, Christian Medical College and Hospital, Ludhiana, Punjab, India
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Janopaul-Naylor J, Liu Y, Cao Y, Schlafstein AJ, Steuer C, Patel MR, Bates JE, McDonald MW, Stokes WA. Institution-level Patterns of Care for Early-stage Oropharynx Cancers in the United States. Am J Clin Oncol 2024:00000421-990000000-00202. [PMID: 38898571 DOI: 10.1097/coc.0000000000001125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVES The adoption of transoral robotic surgery and shifting epidemiology in oropharyngeal squamous cell cancer have stimulated debate over upfront and adjuvant treatment. Institutional variation in practice patterns can be obscured in patient-level analyses. We aimed to characterize institutional patterns of care as well as identify potential associations between patterns of care and survival. METHODS This was a retrospective cohort study of patients identified from 2004-2015 in the National Cancer Database. We analyzed 42,803 cases of oropharyngeal squamous cell cancer Stage cT1-2N0-2bM0 (AJCC 7th edition) treated with curative intent surgery and/or radiotherapy. We defined facility-4-year periods to account for changing institutional practice patterns. The 42,803 patients were treated within 2578 facility-4-year periods. We assessed institutional practice patterns, including the ratio of upfront surgery to definitive radiotherapy, case volumes, use of adjuvant therapies (radiotherapy or chemoradiotherapy), and margin positivity rates. Survival associations with institutional practice patterns were estimated with Cox regression. RESULTS The ratio of upfront surgery to definitive radiotherapy ranged from 80-to-1 to 1-to-23. The institution-level median rate of adjuvant radiotherapy was 69% (IQR 50%-100%), adjuvant chemoradiotherapy was 44% (IQR 0%-67%), and margin-positive resection was 33% (IQR 0%-50%). On patient-level MVA, worse overall survival was not significantly associated with institutional case volume, adjuvant radiotherapy, or adjuvant chemoradiotherapy utilization. CONCLUSIONS High rates of multimodal therapy and positive margins underscore the importance of multidisciplinary care and highlight variable patterns of care across institutions. Further work is warranted to explore indicators of high-quality care and to optimize adjuvant therapy in the HPV era.
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Affiliation(s)
- James Janopaul-Naylor
- Department of Radiation Oncology, Winship Cancer Institute at Emory University School of Medicine
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University
| | - Yichun Cao
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health at Emory University
| | - Ashley J Schlafstein
- Department of Radiation Oncology, Winship Cancer Institute at Emory University School of Medicine
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University School of Medicine
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, GA
| | - James E Bates
- Department of Radiation Oncology, Winship Cancer Institute at Emory University School of Medicine
| | - Mark W McDonald
- Department of Radiation Oncology, Winship Cancer Institute at Emory University School of Medicine
| | - William A Stokes
- Department of Radiation Oncology, Winship Cancer Institute at Emory University School of Medicine
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Li Y, Pan X, Luo W, Gamalla Y, Ma Z, Zhou P, Dai C, Han D. TMErisk score: A tumor microenvironment-based model for predicting prognosis and immunotherapy in patients with head and neck squamous cell carcinoma. Heliyon 2024; 10:e31877. [PMID: 38845978 PMCID: PMC11152963 DOI: 10.1016/j.heliyon.2024.e31877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/09/2024] Open
Abstract
Tumor microenvironment (TME) is closely associated with the progression and prognosis of head and neck squamous cell carcinoma (HNSCC). To investigate potential biomarkers for predicting therapeutic outcomes in HNSCC, we analyzed the immune and stromal status of HNSCC based on the genes associated with TME using the ESTIMATE algorithm. Immune and stromal genes were identified with differential gene expression and weighted gene co-expression network analysis (WGCNA). From these genes, 118 were initially selected through Cox univariate regression and then further input into least absolute shrinkage and selection operator (LASSO) regression analysis. As a result, 11 genes were screened out for the TME-related risk (TMErisk) score model which presented promising overall survival predictive potential. The TMErisk score was negatively associated with immune and stromal scores but positively associated with tumor purity. Individuals with high TMErisk scores exhibited decreased expression of most immune checkpoints and all human leukocyte antigen family genes, and reduced abundance of infiltrating immune cells. Divergent genes were mutated in HNSCC. In both high and low TMErisk score groups, the tumor protein P53 exhibited the highest mutation frequency. A higher TMErisk score was found to be associated with reduced overall survival probability and worse outcomes of immunotherapy. Therefore, the TMErisk score could serve as a valuable model for the outcome prediction of HNSCC in clinic.
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Affiliation(s)
- Yu Li
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- College of Health Science and Technology, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- Department of Otolaryngology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510000, China
- Department of the Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Xiaozhou Pan
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- College of Health Science and Technology, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Wenwei Luo
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guang-dong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510080, China
| | - Yaser Gamalla
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
- Department of Oncology, Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Alberta, T2N 4N1, Canada
| | - Zhan Ma
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- College of Health Science and Technology, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
| | - Pei Zhou
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
| | - Chunfu Dai
- Department of the Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, 200031, China
| | - Dingding Han
- Department of Clinical Laboratory, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- Institute of Pediatric Infection, Immunity, and Critical Care Medicine, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- College of Health Science and Technology, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200062, China
- Laboratory of Medical Systems Biology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, China
- Medical School, Guangxi University, Nanning, 530004, China
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Gamez ME, Blakaj DM, Bhateja P, Custer A, Klamer BG, Pan J, Gogineni E, Baliga S, Bonomi MR. Audiological Outcomes of Weekly vs. Triweekly Cisplatin in Head and Neck Cancer with Cochlear-Sparing Intensity-Modulated Radiation Therapy. Cancers (Basel) 2024; 16:2228. [PMID: 38927933 PMCID: PMC11201991 DOI: 10.3390/cancers16122228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/05/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
Cisplatin, one of the most ototoxic anti-neoplastic agents, causes permanent hearing loss in up to 90% of patients. We assessed ototoxicity rates and prospectively collected audiologic outcomes of patients receiving low-dose or high-dose cisplatin with concurrent cochlear-sparing intensity-modulated radiation therapy (IMRT). Patients with head and neck squamous cell carcinoma (HNSCC) receiving definitive or adjuvant cisplatin-based chemoradiotherapy (CRT) were analyzed. Cisplatin was administered either in low doses weekly (40 mg/m2) for up to seven doses or in high doses triweekly (100 mg/m2) for up to three doses. Cochlear-sparing IMRT was delivered in all cases. Audiologic data were prospectively collected before, during, and after treatment completion. The primary endpoint was a hearing change grade of ≥3 after CRT completion. Of the 96 HNSCC patients evaluated, 69 received weekly cisplatin and 58 received definitive CRT. Of patients receiving weekly cisplatin, 13% developed ≥G3 ototoxicity vs. 56% of patients who received triweekly cisplatin (p < 0.001). In multivariable modeling, the cisplatin dose schedule remained significant (OR: 8.4, 95%CI: 2.8-27.8, p < 0.001) for risk of severe irreversible ototoxicity. Triweekly cisplatin CRT significantly increased the ≥G3 severe irreversible ototoxicity risk compared to low-dose weekly cisplatin, irrespective of the cumulative cisplatin dose, even with the use of cochlear-sparing IMRT. No significant difference in oncologic outcomes was observed between the two schedules.
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Affiliation(s)
- Mauricio E. Gamez
- Department of Radiation Oncology, Mayo Clinic Rochester, Rochester, MN 55905, USA;
| | - Dukagjin M. Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (D.M.B.); (E.G.); (S.B.)
| | - Priyanka Bhateja
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Amy Custer
- Oncology Rehabilitation Team, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Brett G. Klamer
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (B.G.K.); (J.P.)
| | - Jeff Pan
- Center for Biostatistics, Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH 43210, USA; (B.G.K.); (J.P.)
| | - Emile Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (D.M.B.); (E.G.); (S.B.)
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (D.M.B.); (E.G.); (S.B.)
| | - Marcelo R. Bonomi
- Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
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Schoenberg P, Wulff-Burchfield E, Schlundt D, Bonnet K, Dietrich M, Murphy B. Qualitative Classification of Late Systemic Symptoms in Head and Neck Cancer Survivors. Cancers (Basel) 2024; 16:2106. [PMID: 38893225 PMCID: PMC11172150 DOI: 10.3390/cancers16112106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/19/2024] [Accepted: 05/25/2024] [Indexed: 06/21/2024] Open
Abstract
Improved rates of cancer control have increased the head and neck cancer survivor population. Cancer survivorship clinics are not widely available in the USA, and longitudinal supportive care for patients undergoing multimodal therapy has not advanced at a pace commensurate with improvements in cancer control. Consequently, a large head and neck cancer survivor population whose quality of life may be chronically and/or permanently diminished presently exists. This lack of awareness perpetuates under-recognition and under-investigation, leaving survivors' (mostly detrimental) experiences largely uncharted. We conducted a qualitative exploration of survivors' experiences, aiming to unpack the profound impact of late systemic symptoms on daily life, encompassing work, relationships, and self-identity in the head and neck cancer survivor community. The study included 15 remitted head and neck survivors, ≥12 months from their final treatment, who participated in semi-structured interviews conducted by a medical oncologist. Data analysis comprised qualitative thematic analysis, specifically inductive hierarchical linear modeling, enriched by a deductive approach of anecdotal clinical reporting. Results highlighted that 43.36% of all quotation material discussed in the interviews pertained to chronic emotion disturbance with significant implications for other domains of life. A central symptom cluster comprised impairments in mood/emotions, daily activity, and significant fatigue. Dysfunction in sleep, other medical conditions, and cognitive deficits comprised a secondary cluster. Physical dysfunctionality, encompassing pain, appetite, and eating, and alterations in experienced body temperature, constituted a tertiary cluster, and perhaps were surprisingly the least discussed symptom burden among head and neck cancer survivors. Symptoms causing heightened long-term survivor burden may be considered epiphenomenal to central physical dysfunctionality, albeit being presently the least represented in cancer survivor care programs. Moving forward, the development of targeted and multi-dimensional treatment programs that encompass physical, psychosocial, and spiritual domains are needed to increase clinical specificity and effective holistic long-term solutions that will foster a more compassionate and informed future of care for the cancer survivorship community.
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Affiliation(s)
- Poppy Schoenberg
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN 37203, USA
| | | | - David Schlundt
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA
| | - Kemberlee Bonnet
- Department of Psychology, Vanderbilt University, Nashville, TN 37212, USA
| | - Mary Dietrich
- Department of Biostatistics, School of Nursing, Vanderbilt University, Nashville, TN 37240, USA
| | - Barbara Murphy
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37203, USA
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Kornfeld B, Taha A, Kyang L, Sim HW, Dewhurst S, McCloy R, Chin V, Earls P, Parker A, Leavers B, Forstner D, Floros P, Crawford J, Gallagher R. Oncological outcomes post transoral robotic surgery (TORS) for HPV-associated oropharyngeal squamous cell carcinoma, a single-centre retrospective Australian study. J Robot Surg 2024; 18:226. [PMID: 38806847 PMCID: PMC11133022 DOI: 10.1007/s11701-024-01910-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/09/2024] [Indexed: 05/30/2024]
Abstract
We present a cohort review of TORS resection for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC) and its associated oncological outcomes spanning a 10-year period. A retrospective case series review was performed of patients undergoing primary surgical treatment for HPV-associated OPSCC through the St. Vincent's Head and Neck Cancer service from 2011 to 2022. The primary outcomes were to investigate complete resection of the primary tumour, rates of recurrence, and survival analysis. Secondary outcomes included complications, rates of adjuvant therapy, sites of recurrence and rates of percutaneous endoscopic gastrostomy (PEG). 184 patients underwent TORS-based therapy with neck dissection, and guideline-directed adjuvant therapy for HPV-associated OPSCC. Our median follow-up was 46 months. The positive margin rate on final histopathology analysis was 10.9%. Adjuvant therapy was indicated in 85 patients (46%). The local recurrence rate was 10.9% with the majority (80%) of patients recurring in the first 3 years since treatment. The disease-specific survival at 3 years was 98.6% and at 5 years was 94.4%. The 3-year and 5-year OS for the cohort was 96.7% and 92.5%, respectively. The presence of extranodal extension and positive margins were associated with increased risk of recurrence, whereas adjuvant therapy was found to be a protective factor for both overall recurrence and survival. Major complications occurred in 12 patients (6.5%), resulting in one death. This study has demonstrated that primary surgical therapy for HPV-associated OPSCC is a safe and effective treatment modality with low local recurrence and complication rates, and overall survival benefits.
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Affiliation(s)
- Belen Kornfeld
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia.
- Faculty of Medicine and Health, University of New South Wales, High St, Sydney, NSW, 2052, Australia.
- Department of Medicine, Notre Dame University, Sydney, NSW, 2010, Australia.
| | - Ahmed Taha
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Lee Kyang
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Hao-Wen Sim
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
- Faculty of Medicine and Health, University of New South Wales, High St, Sydney, NSW, 2052, Australia
- The Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Suzannah Dewhurst
- Faculty of Medicine and Health, University of New South Wales, High St, Sydney, NSW, 2052, Australia
| | - Rachael McCloy
- The Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Vanessa Chin
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
- The Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Peter Earls
- Department of Anatomical Pathology, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Andrew Parker
- Department of Anatomical Pathology, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Brett Leavers
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Dion Forstner
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, NSW, 2010, Australia
- GenesisCare, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Peter Floros
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Julia Crawford
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
| | - Richard Gallagher
- Department of Otolaryngology, Head and Neck Surgery, St. Vincent's Hospital, 390 Victoria St, Darlinghurst, NSW, 2010, Australia
- School of Medicine, Notre Dame University, 160 Oxford St, Darlinghurst, NSW, 2010, Australia
- The Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, NSW, 2010, Australia
- Department of Medical Oncology, The Kinghorn Cancer Centre, 370 Victoria St, Darlinghurst, NSW, 2010, Australia
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Rullan A, Marín-Jiménez JA, Lozano A, Bermejo O, Arribas L, Ruiz N, Linares I, Taberna M, Pérez X, Plana M, Oliva M, Mesía R. Study of late toxicity biomarkers of locally advanced head and neck cancer patients treated with radiotherapy plus cisplatin or cetuximab points to the relevance of skin macrophages (TOX-TTCC-2015-01). Clin Transl Oncol 2024:10.1007/s12094-024-03526-0. [PMID: 38782865 DOI: 10.1007/s12094-024-03526-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE Radiotherapy (RT) with concomitant cisplatin (CRT) or cetuximab (ERT) are accepted treatment options for locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). Long-term adverse events (AEs) have a vast impact on patients' quality of life. This study explored tissue biomarkers which could help predict late toxicity. METHODS/PATIENTS Single-institution prospective study including patients aged ≥ 18 with histologically confirmed newly diagnosed LA-SCCHN treated with RT and either concomitant cisplatin q3w or weekly cetuximab, according to institutional protocols. All patients underwent pre- and post-treatment skin biopsies of neck regions included in the clinical target volume. Angiogenesis, macrophages, and extracellular matrix (ECM) markers were evaluated by immunohistochemistry (IHC). RESULTS From April 15, 2016, to December 11, 2017; 31 patients were evaluated [CRT = 12 (38.7%) and ERT = 19 (61.3%)]. 27 patients (87%) had received induction chemotherapy. All patients finished RT as planned. IHC expression of vasculature (CD34) and collagen (Masson's Trichrome) did not differ significantly between and within CRT and ERT arms. Conversely, an increased CD68 and CD163 macrophage infiltration expression was observed after treatment, without significant impact of treatment modality. Patients with higher late toxicity showed lower expression of macrophage markers in pre-treatment samples compared with those with lower late toxicity, with statistically significant differences for CD68. CONCLUSIONS Angiogenesis and ECM biomarkers did not differ significantly between CRT and ERT. Macrophage markers increased after both treatments and deserve further investigation as predictors of late toxicity in LA-SCCHN patients. [Protocol code: TOX-TTCC-2015-01/Spanish registry of clinical studies (REec): 2015-003012-21/Date of registration: 27/01/2016].
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Affiliation(s)
- Antonio Rullan
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan A Marín-Jiménez
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alicia Lozano
- Department of Radiation Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Bermejo
- Departament of Plastic and Reconstructive Surgery, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lorena Arribas
- Clinical Nutrition Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Ruiz
- Department of Pathology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, Barcelona, Spain
| | - Isabel Linares
- Department of Radiation Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miren Taberna
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavi Pérez
- Clinical Investigation Unit (UIC), Catalan Institute of Oncology (ICO) L'Hospitalet, Barcelona, Spain
| | - María Plana
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marc Oliva
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ricard Mesía
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), B-ARGO Group, IGTP, Badalona, Barcelona, Spain.
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Cyberski TF, Singh A, Korzinkin M, Mishra V, Pun F, Shen L, Wing C, Cheng X, Baird B, Miao Y, Elkabets M, Kochanny S, Guo W, Dyer E, Pearson AT, Juloori A, Lingen M, Cole G, Zhavoronkov A, Agrawal N, Izumchenko E, Rosenberg AJ. Acquired resistance to immunotherapy and chemoradiation in MYC amplified head and neck cancer. NPJ Precis Oncol 2024; 8:114. [PMID: 38783041 PMCID: PMC11116544 DOI: 10.1038/s41698-024-00606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
The proto-oncogene MYC encodes a nuclear transcription factor that has an important role in a variety of cellular processes, such as cell cycle progression, proliferation, metabolism, adhesion, apoptosis, and therapeutic resistance. MYC amplification is consistently observed in aggressive forms of several solid malignancies and correlates with poor prognosis and distant metastases. While the tumorigenic effects of MYC in patients with head and neck squamous cell carcinoma (HNSCC) are well known, the molecular mechanisms by which the amplification of this gene may confer treatment resistance, especially to immune checkpoint inhibitors, remains under-investigated. Here we present a unique case of a patient with recurrent/metastatic (R/M) HNSCC who, despite initial response to nivolumab-based treatment, developed rapidly progressive metastatic disease after the acquisition of MYC amplification. We conducted comparative transcriptomic analysis of this patient's tumor at baseline and upon progression to interrogate potential molecular processes through which MYC may confer resistance to immunotherapy and/or chemoradiation and used TCGA-HNSC dataset and an institutional cohort to further explore clinicopathologic features and key molecular networks associated with MYC amplification in HNSCC. This study highlights MYC amplification as a potential mechanism of immune checkpoint inhibitor resistance and suggest its use as a predictive biomarker and potential therapeutic target in R/M HNSCC.
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Affiliation(s)
- Thomas F Cyberski
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Alka Singh
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | | | - Vasudha Mishra
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Frank Pun
- Insilico Medicine, Pak Shek Kok, Hong Kong
| | - Le Shen
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Claudia Wing
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Xiangying Cheng
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Brandon Baird
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Yuxuan Miao
- Ben May Department for Cancer Research, University of Chicago, Chicago, IL, USA
| | - Moshe Elkabets
- The Shraga Segal Department of Microbiology, Immunology, and Genetics, Ben-Gurion University, Beer Sheva, Israel
| | - Sara Kochanny
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Wenji Guo
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Emma Dyer
- Harvard T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Alexander T Pearson
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Aditya Juloori
- Department of Radiation Oncology, University of Chicago, Chicago, IL, USA
| | - Mark Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Grayson Cole
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | | | - Nishant Agrawal
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA.
| | - Ari J Rosenberg
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA.
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31
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Hu Q, Li F, Yang K. Systematic evaluation and meta-analysis of the prognosis of down-staging human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma using cetuximab combined with radiotherapy instead of cisplatin combined with radiotherapy. PeerJ 2024; 12:e17391. [PMID: 38784388 PMCID: PMC11114112 DOI: 10.7717/peerj.17391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To evaluate the efficacy and safety of cetuximab instead of cisplatin in combination with downstaging radiotherapy for papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC). Design Meta-analysis and systematic evaluation. Data sources The PubMed, Embase, Web of Science, and Cochrane library databases were searched up to June 8, 2023, as well as Clinicaltrials.gov Clinical Trials Registry, China Knowledge Network, Wanfang Data Knowledge Service Platform, and Wiprojournal.com. Eligibility criteria for selecting studies Randomized controlled trials reporting results of standard regimens of cetuximab + radiotherapy vs cisplatin + radiotherapy in treating HPV+ OPSCC were included. The primary outcomes of interest were overall survival (OS), progression-free survival (PFS), local regional failure rate (LRF), distant metastasis rate (DM), and adverse events (AE). Data extraction and synthesis Two reviewers independently extracted data and assessed the risk of bias of the included studies. The HR and its 95% CI were used as the effect analysis statistic for survival analysis, while the OR and its 95% CI were used as the effect analysis statistic for dichotomous variables. These statistics were extracted by the reviewers and aggregated using a fixed-effects model to synthesise the data. Results A total of 874 relevant papers were obtained from the initial search, and five papers that met the inclusion criteria were included; a total of 1,617 patients with HPV+ OPSCC were enrolled in these studies. Meta-analysis showed that OS and PFS were significantly shorter in the cetuximab + radiotherapy group of patients with HPV+ OPSCC compared with those in the conventional cisplatin + radiotherapy group (HR = 2.10, 95% CI [1.39-3.15], P = 0.0004; HR = 1.79, 95% CI [1.40-2.29], P < 0.0001); LRF and DM were significantly increased (HR = 2.22, 95% CI [1.58-3.11], P < 0.0001; HR = 1.66, 95% CI [1.07-2.58], P = 0.02), but there was no significant difference in overall grade 3 to 4, acute and late AE overall (OR = 0.86, 95% CI [0.65-1.13], P = 0.28). Conclusions Cisplatin + radiotherapy remains the standard treatment for HPV+ OPSCC. According to the 7th edition AJCC/UICC criteria, low-risk HPV+ OPSCC patients with a smoking history of ≤ 10 packs/year and non-pharyngeal tumors not involved in lymphatic metastasis had similar survival outcomes with cetuximab/cisplatin + radiotherapy. However, further clinical trials are necessary to determine whether cetuximab + radiotherapy can replace cisplatin + radiotherapy for degraded treatment in individuals who meet the aforementioned characteristics, particularly those with platinum drug allergies. Prospero registration number CRD42023445619.
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Affiliation(s)
- Qiong Hu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Yang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Salvestrini V, Caini S, Scricciolo M, Saerens M, Bollen H, Bonomo P, Caparrotti F, Lorini L, Oliva M, Urbanowicz-Nijaki M, Szturz P. Immunotherapy in elderly head and neck cancer patients: a systematic review and meta-analysis. Front Oncol 2024; 14:1395838. [PMID: 38800381 PMCID: PMC11127588 DOI: 10.3389/fonc.2024.1395838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Over the past years, there has been a growing interest in the role of immunotherapy in locally advanced (LA) and recurrent and metastatic head and neck squamous cell carcinoma (R/M HNSCC). High-quality data from prospective trials are lacking for the elderly subpopulation. This systematic review and meta-analysis aims to review the efficacy and safety of immunotherapy in older patients. Methods A systematic literature search was conducted. Randomized clinical trials providing outcome data on a subgroup of elderly (>65 years old) were available for meta-analysis. Primary outcomes of interest were OS and PFS for efficacy analysis. Results Seven studies were included in the systematic review and four in the efficacy analysis. The pooled analysis of OS and PFS showed a consistent benefit (HR 0.78 and 0.91, respectively). Conclusions Immunotherapy may be an effective and well-tolerated treatment option in the elderly population, but more prospective and randomized data are needed. Systematic Review Registration PROSPERO (CRD42022333891).
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Affiliation(s)
- Viola Salvestrini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research Prevention and Clinical Network, Florence, Italy
| | | | - Michael Saerens
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Heleen Bollen
- Department of Oncology, Laboratory of Experimental Radiotherapy, and Radiation Oncology, UZ Leuven, Leuven, Belgium
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Francesca Caparrotti
- Radiation Oncology Department, Clinique Générale Beaulieu - Swiss Medical Network, Geneva, Switzerland
| | - Luigi Lorini
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marc Oliva
- Department of Medical Oncology, Institut Català d’Oncologia (ICO) L´Hospitalet, Barcelona, Spain
- Department of Medical Oncology, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | | | - Petr Szturz
- Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Bitz HC, Sachpazidis I, Zou J, Schnell D, Baltas D, Grosu AL, Nicolay NH, Rühle A. The role of the soft palate dose regarding normal tissue toxicities in older adults with head and neck cancer undergoing definitive radiotherapy. Radiat Oncol 2024; 19:53. [PMID: 38689338 PMCID: PMC11061999 DOI: 10.1186/s13014-024-02426-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/29/2024] [Indexed: 05/02/2024] Open
Abstract
PURPOSE The number of older adults with head and neck squamous cell carcinoma (HNSCC) is continuously increasing. Older HNSCC patients may be more vulnerable to radiotherapy-related toxicities, so that extrapolation of available normal tissue complication probability (NTCP) models to this population may not be appropriate. Hence, we aimed to investigate the correlation between organ at risk (OAR) doses and chronic toxicities in older patients with HNSCC undergoing definitive radiotherapy. METHODS Patients treated with definitive radiotherapy, either alone or with concomitant systemic treatment, between 2009 and 2019 in a large tertiary cancer center were eligible for this analysis. OARs were contoured based on international consensus guidelines, and EQD2 doses using α/ß values of 3 Gy for late effects were calculated based on the radiation treatment plans. Treatment-related toxicities were graded according to Common Terminology Criteria for Adverse Events version 5.0. Logistic regression analyses were carried out, and NTCP models were developed and internally validated using the bootstrapping method. RESULTS A total of 180 patients with a median age of 73 years fulfilled the inclusion criteria and were analyzed. Seventy-three patients developed chronic moderate xerostomia (grade 2), 34 moderate dysgeusia (grade 2), and 59 moderate-to-severe (grade 2-3) dysphagia after definitive radiotherapy. The soft palate dose was significantly associated with all analyzed toxicities (xerostomia: OR = 1.028, dysgeusia: OR = 1.022, dysphagia: OR = 1.027) in the multivariable regression. The superior pharyngeal constrictor muscle was also significantly related to chronic dysphagia (OR = 1.030). Consecutively developed and internally validated NTCP models were predictive for the analyzed toxicities (optimism-corrected AUCs after bootstrapping: AUCxerostomia=0.64, AUCdysgeusia=0.60, AUCdysphagia=0.64). CONCLUSIONS Our data suggest that the dose to the soft palate is associated with chronic moderate xerostomia, moderate dysgeusia and moderate-to-severe dysphagia in older HNSCC patients undergoing definitive radiotherapy. If validated in external studies, efforts should be undertaken to reduce the soft palate dose in these patients.
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Affiliation(s)
- Helena C Bitz
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
| | - Ilias Sachpazidis
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jiadai Zou
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany
| | - Daniel Schnell
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Dimos Baltas
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Division of Medical Physics, Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany
| | - Alexander Rühle
- Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
- German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany.
- Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Leipzig, Germany.
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Thariat J, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, Merlotti A, Dejean C, Devauchelle B. Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy. Front Oncol 2024; 14:1379861. [PMID: 38665951 PMCID: PMC11043495 DOI: 10.3389/fonc.2024.1379861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Background Major advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy. Methods A systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT. Results Despite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap-tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications. Conclusion Flap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.
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Affiliation(s)
- Juliette Thariat
- Department of Radiotherapy, Centre François-Baclesse, Caen, France
- Corpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Caen, France
- Faculté de Médecine de Caen, Université de Normandie, Caen, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Orsay, France
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Deneuve
- Surgical Oncology Department, Centre Léon Bérard, UNICANCER, Lyon, France
- Inserm, U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon Bérard, Lyon, France
| | - Pierre-Yves Marcy
- Polyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Ollioules, France
| | - Anna Merlotti
- Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | | | - Bernard Devauchelle
- Departement of Maxillofacial Surgery, University Hospital of Amiens Picardy, Research Unit, UR7516 CHIMERE, University of Picardy Jules Verne, Institut Faire Faces, Amiens, France
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Pershad AR, Thakkar PG, Goodman JF, Joshi A, Steinberg SM, Allen CT, Floudas CS. Risk of recurrence after neoadjuvant chemotherapy and transoral robotic surgery in patients with oropharynx cancer that avoid adjuvant radiation. Cancer Med 2024; 13:e7146. [PMID: 38581118 PMCID: PMC10997843 DOI: 10.1002/cam4.7146] [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: 01/10/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND De-escalation strategies for newly-diagnosed p16-positive oropharyngeal squamous cell carcinoma (p16+ OPSCC), aim to reduce treatment-related morbidity without compromising disease control. One strategy is neoadjuvant cisplatin and docetaxel chemotherapy (NAC + S) before transoral robotic surgery, with pathology-based risk-adapted adjuvant treatment. METHODS We examined the recurrence-free survival (RFS) for patients who received NAC + S. RESULTS Comparing outcomes in 103 patients between 2008 and 2023, 92% avoided adjuvant treatment and showed significantly higher 2-year recurrence-free survival (RFS) compared to those with adjuvant treatment (95.9% vs. 43.8%, p = 0.0049) CONCLUSION: Our findings suggest that pathology-based risk-adapted omission of adjuvant treatment following NAC + S does not appear to elevate recurrence risk and that NAC may identify patients with favorable tumor biology, yielding a 2-year RFS probability exceeding 95% without adjuvant treatment. Further, the study identifies a patient subset experiencing disease recurrence despite triple modality therapy. Despite limitations, including a retrospective design and modest sample size, the data advocate for controlled NAC + S studies.
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Affiliation(s)
- Alisha R. Pershad
- Division of Otolaryngology‐Head and Neck SurgeryThe George Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Punam G. Thakkar
- Division of Otolaryngology‐Head and Neck SurgeryThe George Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Joseph F. Goodman
- Division of Otolaryngology‐Head and Neck SurgeryThe George Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Arjun Joshi
- Division of Otolaryngology‐Head and Neck SurgeryThe George Washington University School of Medicine & Health SciencesWashingtonDCUSA
| | - Seth M. Steinberg
- Astrix Technology, LLC, contractor to Biostatistics and Data Management Section, Office of the Clinical DirectorNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Clint T. Allen
- Surgical Oncology Program, Center for Cancer ResearchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Charalampos S. Floudas
- Center for Immuno‐Oncology, Center for Cancer ResearchNational Cancer Institute, National Institutes of HealthBethesdaMarylandUSA
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Bouassaly J, Karimi N, Kowalski LP, Sultanem K, Alaoui-Jamali M, Mlynarek A, Mascarella M, Hier M, Sadeghi N, da Silva SD. Rethinking treatment paradigms: Neoadjuvant therapy and de-escalation strategies in HPV-positive head and neck cancer. Crit Rev Oncol Hematol 2024; 196:104326. [PMID: 38479584 DOI: 10.1016/j.critrevonc.2024.104326] [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: 10/04/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024] Open
Abstract
Head and neck cancer (HNC) is the 6th most common cancer across the world, with a particular increase in HNC associated with human papilloma virus (HPV) among younger populations. Historically, the standard treatment for this disease consisted of combined surgery and radiotherapy or curative platinum-based concurrent chemoradiotherapy, with associated long term and late toxicities. However, HPV-positive HNC is recognized as a unique cancer subtype, typically with improved clinical outcomes. As such, treatment de-escalation strategies have been widely researched to mitigate the adverse effects associated with the current standard of care without compromising efficacy. These strategies include treatment de-escalation, such as novel surgical techniques, alternative radiation technologies, radiation dose and volume reduction, as well as neoadjuvant chemotherapies, immunotherapies, and combined therapies. Although these therapies show great promise, many of them are still under investigation due to hesitation surrounding their widespread implementation. The objective of this review is to summarize the most recent progress in de-escalation strategies and neoadjuvant therapies designed for HPV-positive HNC. While specific treatments may require additional research before being widely adopted, encouraging results from recent studies have highlighted the advantages of neoadjuvant chemotherapy and immunotherapy, as well as radiation and surgical de-escalation approaches in managing HPV-positive HNC.
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Affiliation(s)
- Jenna Bouassaly
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada
| | - Naser Karimi
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Luiz Paulo Kowalski
- AC Camargo Cancer Center, Faculty of Medicine - University of Sao Paulo, Sao Paulo, Brazil
| | - Khalil Sultanem
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Moulay Alaoui-Jamali
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada
| | - Alex Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Marco Mascarella
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Nader Sadeghi
- Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada
| | - Sabrina Daniela da Silva
- Division of Experimental Medicine, McGill University, Montreal QC H4A 3J1, Canada; Department of Otolaryngology Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal QC H3T 1E2, Canada; Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, Montreal QC H3T 1E2, Canada; AC Camargo Cancer Center, Faculty of Medicine - University of Sao Paulo, Sao Paulo, Brazil.
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Rühle A, Weymann M, Behrens M, Marschner S, Haderlein M, Fabian A, Senger C, Dickstein DR, Kraft J, von der Grün J, Chen E, Aquino-Michaels T, Domschikowski J, Bickel A, Altay-Langguth A, Kalinauskaite G, Lewitzki V, Bonomi M, Blakaj DM, Jhawar SR, Baliga S, Barve R, Ferentinos K, Zamboglou C, Schnellhardt S, Haehl E, Spohn SKB, Kuhnt T, Zöller D, Guckenberger M, Budach V, Belka C, Bakst R, Mayer A, Schmidberger H, Grosu AL, Balermpas P, Stromberger C, Nicolay NH. A Multicenter Evaluation of Different Chemotherapy Regimens in Older Adults With Head and Neck Squamous Cell Carcinoma Undergoing Definitive Chemoradiation. Int J Radiat Oncol Biol Phys 2024; 118:1282-1293. [PMID: 37914144 DOI: 10.1016/j.ijrobp.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/26/2023] [Accepted: 10/14/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE The number of older adults with head and neck squamous cell carcinoma (HNSCC) is increasing, and treatment of these patients is challenging. Although cisplatin-based chemotherapy concomitantly with radiation therapy is considered the standard regimen for patients with locoregionally advanced HNSCC, there is substantial real-world heterogeneity regarding concomitant chemotherapy in older patients with HNSCC. METHODS AND MATERIALS The SENIOR study is an international multicenter cohort study including older patients (≥65 years) with HNSCC treated with definitive radiation therapy at 13 academic centers in the United States and Europe. Patients with concomitant chemoradiation were analyzed regarding overall survival (OS) and progression-free survival (PFS) via Kaplan-Meier analyses. Fine-Gray competing risk regressions were performed regarding the incidence of locoregional failures and distant metastases. RESULTS Six hundred ninety-seven patients with a median age of 71 years were included in this analysis. Single-agent cisplatin was the most common chemotherapy regimen (n = 310; 44%), followed by cisplatin plus 5-fluorouracil (n = 137; 20%), carboplatin (n = 73; 10%), and mitomycin C plus 5-fluorouracil (n = 64; 9%). Carboplatin-based regimens were associated with diminished PFS (hazard ratio [HR], 1.39 [1.03-1.89]; P < .05) and a higher incidence of locoregional failures (subdistribution HR, 1.54 [1.00-2.38]; P = .05) compared with single-agent cisplatin, whereas OS (HR, 1.15 [0.80-1.65]; P = .46) was comparable. There were no oncological differences between single-agent and multiagent cisplatin regimens (all P > .05). The median cumulative dose of cisplatin was 180 mg/m2 (IQR, 120-200 mg/m2). Cumulative cisplatin doses ≥200 mg/m2 were associated with increased OS (HR, 0.71 [0.53-0.95]; P = .02), increased PFS (HR, 0.66 [0.51-0.87]; P = .003), and lower incidence of locoregional failures (subdistribution HR, 0.50 [0.31-0.80]; P = .004). Higher cumulative cisplatin doses remained an independent prognostic variable in the multivariate regression analysis for OS (HR, 0.996 [0.993-0.999]; P = .009). CONCLUSIONS Single-agent cisplatin can be considered in the standard chemotherapy regimen for older patients with HNSCC who can tolerate cisplatin. Cumulative cisplatin doses are prognostically relevant in older patients with HNSCC.
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Affiliation(s)
- Alexander Rühle
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Cancer Center Central Germany (CCCG), Partner Site Leipzig, Leipzig, Germany.
| | - Maria Weymann
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Max Behrens
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Sebastian Marschner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK) Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marlen Haderlein
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Carolin Senger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin; Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Berlin, Germany; German Cancer Consortium (DKTK) Partner Site Berlin, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, Heidelberg, Germany
| | - Daniel R Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johannes Kraft
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Jens von der Grün
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany; German Cancer Consortium (DKTK) Partner Site Frankfurt, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Eric Chen
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Todd Aquino-Michaels
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, Ohio
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Amanda Bickel
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Alev Altay-Langguth
- Department of Radiotherapy and Oncology, Goethe University Frankfurt, Frankfurt am Main, Germany; German Cancer Consortium (DKTK) Partner Site Frankfurt, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Goda Kalinauskaite
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin; Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Berlin, Germany; German Cancer Consortium (DKTK) Partner Site Berlin, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, Heidelberg, Germany
| | - Victor Lewitzki
- Department of Radiation Oncology, University Hospital Würzburg, Würzburg, Germany
| | - Marcelo Bonomi
- Department of Medical Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sachin R Jhawar
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sujith Baliga
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Rahul Barve
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus
| | - Constantinos Zamboglou
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus
| | - Sören Schnellhardt
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany; Department of Radiotherapy and Radiation Oncology, Saarland University Medical Center, Homburg, Germany
| | - Erik Haehl
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK) Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon K B Spohn
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas Kuhnt
- Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Cancer Center Central Germany (CCCG), Partner Site Leipzig, Leipzig, Germany
| | - Daniela Zöller
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Volker Budach
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin; Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Berlin, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK) Partner Site Munich, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Arnulf Mayer
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany; German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Heinz Schmidberger
- Department of Radiation Oncology and Radiation Therapy, University Medical Center Mainz, Mainz, Germany; German Cancer Consortium (DKTK) Partner Site Mainz, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carmen Stromberger
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin; Freie Universität Berlin, Humboldt-Universität zu Berlin; and Berlin Institute of Health, Berlin, Germany; German Cancer Consortium (DKTK) Partner Site Berlin, German Cancer Research Center (DKFZ), Neuenheimer Feld 280, Heidelberg, Germany
| | - Nils H Nicolay
- Department of Radiation Oncology, University of Freiburg - Medical Center, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany; Department of Radiation Oncology, University of Leipzig, Leipzig, Germany; Cancer Center Central Germany (CCCG), Partner Site Leipzig, Leipzig, Germany
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38
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Matos LL, Kowalski LP, Chaves ALF, de Oliveira TB, Marta GN, Curado MP, de Castro Junior G, Farias TP, Bardales GS, Cabrera MA, Capuzzo RDC, de Carvalho GB, Cernea CR, Dedivitis RA, Dias FL, Estefan AM, Falco AH, Ferraris GA, Gonzalez-Motta A, Gouveia AG, Jacinto AA, Kulcsar MAV, Leite AK, Lira RB, Mak MP, De Marchi P, de Mello ES, de Matos FCM, Montero PH, de Moraes ED, de Moraes FY, Morais DCR, Poenitz FM, Poitevin A, Riveros HO, Sanabria Á, Ticona-Castro M, Vartanian JG, Viani G, Vines EF, William Junior WN, Conway D, Virani S, Brennan P. Latin American Consensus on the Treatment of Head and Neck Cancer. JCO Glob Oncol 2024; 10:e2300343. [PMID: 38603656 DOI: 10.1200/go.23.00343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/19/2023] [Accepted: 02/07/2024] [Indexed: 04/13/2024] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is well known as a serious health problem worldwide, especially in low-income countries or those with limited resources, such as most countries in Latin America. International guidelines cannot always be applied to a population from a large region with specific conditions. This study established a Latin American guideline for care of patients with head and neck cancer and presented evidence of HNSCC management considering availability and oncologic benefit. A panel composed of 41 head and neck cancer experts systematically worked according to a modified Delphi process on (1) document compilation of evidence-based answers to different questions contextualized by resource availability and oncologic benefit regarding Latin America (region of limited resources and/or without access to all necessary health care system infrastructure), (2) revision of the answers and the classification of levels of evidence and degrees of recommendations of all recommendations, (3) validation of the consensus through two rounds of online surveys, and (4) manuscript composition. The consensus consists of 12 sections: Head and neck cancer staging, Histopathologic evaluation of head and neck cancer, Head and neck surgery-oral cavity, Clinical oncology-oral cavity, Head and neck surgery-oropharynx, Clinical oncology-oropharynx, Head and neck surgery-larynx, Head and neck surgery-larynx/hypopharynx, Clinical oncology-larynx/hypopharynx, Clinical oncology-recurrent and metastatic head and neck cancer, Head and neck surgery-reconstruction and rehabilitation, and Radiation therapy. The present consensus established 48 recommendations on HNSCC patient care considering the availability of resources and focusing on oncologic benefit. These recommendations could also be used to formulate strategies in other regions like Latin America countries.
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Affiliation(s)
- Leandro Luongo Matos
- Head and Neck Surgery, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
| | | | | | | | | | | | - Gilberto de Castro Junior
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | | | | | - Andrés Munyo Estefan
- Profesor Adjunto Catedra de Otorrinolaringologia del Hospital de Clínicas, Montevidéu, Uruguay
| | | | | | | | - Andre Guimarães Gouveia
- Juravinski Cancer Centre, Department of Oncology, Division of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | | | - Marco Aurelio Vamondes Kulcsar
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Ana Kober Leite
- Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Universidade de São Paulo (Icesp HCFMUSP), São Paulo, Brazil
| | - Renan Bezerra Lira
- AC Camargo Cancer Center and Hospital Albert Einstein, São Paulo, Brazil
| | - Milena Perez Mak
- 3Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | - Pablo H Montero
- Department of Surgical Oncology and Head and Neck Surgery, Division of Surgery, P. Universidad Católica de Chile, Santiago, Chile
| | | | | | | | | | | | | | - Álvaro Sanabria
- 4Department of Surgery, Universidad de Antioquia, Hospital Alma Mater, Medellin, Colombia
| | - Miguel Ticona-Castro
- 5ESMO Member, Peruvian Society of Medical Oncology (S.P.O.M.) Member, La Molina, Peru
| | - José Guilherme Vartanian
- 6Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Gustavo Viani
- 7Ribeirao Preto Medical School, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Eugenio F Vines
- Facultad de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | | | | | - Shama Virani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
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Blumenfeld P, Arbit E, Den R, Salhab A, Falick Michaeli T, Wygoda M, Hillman Y, Pfeffer RM, Fang M, Misrati Y, Weizman N, Feldman J, Popovtzer A. Real world clinical experience using daily intelligence-assisted online adaptive radiotherapy for head and neck cancer. Radiat Oncol 2024; 19:43. [PMID: 38555453 PMCID: PMC10981810 DOI: 10.1186/s13014-024-02436-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/25/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Philip Blumenfeld
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel.
| | - Eduard Arbit
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Robert Den
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Israel
| | - Ayman Salhab
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Tal Falick Michaeli
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Marc Wygoda
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Yair Hillman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Raphael M Pfeffer
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Marcel Fang
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Yael Misrati
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Noam Weizman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Jon Feldman
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Radiation Oncology, Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, POB 12272, 9112002, Jerusalem, Israel
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40
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Geiss C, Hoogland AI, Arredondo B, Rodriguez Y, Bryant C, Chung CH, Patel KB, Gonzalez BD, Jim HSL, Kirtane K, Oswald LB. Psychosocial consequences of head and neck cancer symptom burden after chemoradiation: a mixed-method study. Support Care Cancer 2024; 32:254. [PMID: 38538780 PMCID: PMC11062256 DOI: 10.1007/s00520-024-08424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/05/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE Patients with head and neck cancer (HNC) experience significant symptom burden from combination chemotherapy and radiation (chemoradiation) that affects acute and long-term health-related quality of life (HRQOL). However, psychosocial impacts of HNC symptom burden are not well understood. This study examined psychosocial consequences of treatment-related symptom burden from the perspectives of survivors of HNC and HNC healthcare providers. METHODS This was a cross-sectional, mixed-method study conducted at an NCI-designated comprehensive cancer center. Participants (N = 33) were survivors of HNC who completed a full course of chemoradiation (n = 20) and HNC healthcare providers (n = 13). Participants completed electronic surveys and semi-structured interviews. RESULTS Survivors were M = 61 years old (SD = 9) and predominantly male (75%), White (90%), non-Hispanic (100%), and diagnosed with oropharynx cancer (70%). Providers were mostly female (62%), White (46%) or Asian (31%), and non-Hispanic (85%) and included physicians, registered nurses, an advanced practice nurse practitioner, a registered dietician, and a speech-language pathologist. Three qualitative themes emerged: (1) shock, shame, and self-consciousness, (2) diminished relationship satisfaction, and (3) lack of confidence at work. A subset of survivors (20%) reported clinically low social wellbeing, and more than one-third of survivors (35%) reported clinically significant fatigue, depression, anxiety, and cognitive dysfunction. CONCLUSION Survivors of HNC and HNC providers described how treatment-related symptom burden impacts psychosocial identity processes related to body image, patient-caregiver relationships, and professional work. Results can inform the development of supportive interventions to assist survivors and caregivers with navigating the psychosocial challenges of HNC treatment and survivorship.
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Affiliation(s)
- Carley Geiss
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-AS PRISM, Tampa, FL, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Brandy Arredondo
- Participant Research, Interventions, and Measurement Core, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-AS PRISM, Tampa, FL, USA
| | - Yvelise Rodriguez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Crystal Bryant
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA
| | - Krupal B Patel
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA
| | - Kedar Kirtane
- Department of Head and Neck-Endocrine Oncology, Moffitt Cancer Center, 12902 USF Magnolia Drive, Tampa, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-EDU, Tampa, FL, 33612, USA.
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41
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Contrera KJ, Patel MR, Burtness B, Mehra R, Ferris RL. The role of surgery and deescalation for HPV-related oropharyngeal cancer. Cancer 2024. [PMID: 38497569 DOI: 10.1002/cncr.35287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Recently published and ongoing trials are helping to define the role of transoral robotic surgery for oropharyngeal cancer. Evidence to date supports the use of surgery as a valuable tool in the multidisciplinary deescalation of low-risk human papillomavirus-related oropharyngeal squamous cell carcinoma.
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Affiliation(s)
| | - Mihir R Patel
- Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Barbara Burtness
- Yale School of Medicine and Yale Cancer Center, New Haven, Connecticut, USA
| | - Ranee Mehra
- University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, Maryland, USA
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42
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Chen M, Wang K, Wang J. Vision Transformer-Based Multilabel Survival Prediction for Oropharynx Cancer After Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:1123-1134. [PMID: 37939732 PMCID: PMC11161220 DOI: 10.1016/j.ijrobp.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/06/2023] [Accepted: 10/15/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE A reliable and comprehensive cancer prognosis model for oropharyngeal cancer (OPC) could better assist in personalizing treatment. In this work, we developed a vision transformer-based (ViT-based) multilabel model with multimodal input to learn complementary information from available pretreatment data and predict multiple associated endpoints for radiation therapy for patients with OPC. METHODS AND MATERIALS A publicly available data set of 512 patients with OPC was used for both model training and evaluation. Planning computed tomography images, primary gross tumor volume masks, and 16 clinical variables representing patient demographics, diagnosis, and treatment were used as inputs. To extract deep image features with global attention, we used a ViT module. Clinical variables were concatenated with the learned image features and fed into fully connected layers to incorporate cross-modality features. To learn the mapping between the features and correlated survival outcomes, including overall survival, local failure-free survival, regional failure-free survival, and distant failure-free survival, we employed 4 multitask logistic regression layers. The proposed model was optimized by combining the multitask logistic regression negative-log likelihood losses of different prediction targets. RESULTS We employed the C-index and area under the curve metrics to assess the performance of our model for time-to-event prediction and time-specific binary prediction, respectively. Our proposed model outperformed corresponding single-modality and single-label models on all prediction labels, achieving C-indices of 0.773, 0.765, 0.776, and 0.773 for overall survival, local failure-free survival, regional failure-free survival, and distant failure-free survival, respectively. The area under the curve values ranged between 0.799 and 0.844 for different tasks at different time points. Using the medians of predicted risks as the thresholds to identify high-risk and low-risk patient groups, we performed the log-rank test, the results of which showed significantly larger separations in different event-free survivals. CONCLUSION We developed the first model capable of predicting multiple labels for OPC simultaneously. Our model demonstrated better prognostic ability for all the prediction targets compared with corresponding single-modality models and single-label models.
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Affiliation(s)
- Meixu Chen
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Kai Wang
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Jing Wang
- Medical Artificial Intelligence and Automation (MAIA) Lab, Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas.
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43
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Posner M, Roof SA. Endpoints in human papillomavirus-related oropharyngeal cancer trials. Lancet Oncol 2024; 25:270-272. [PMID: 38423041 DOI: 10.1016/s1470-2045(24)00065-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Marshall Posner
- Head and Neck Oncology Program, Tisch Cancer Institute, Division of Hematology/Oncology, Icahn School of Medicine at Mt Sinai, New York, NY 10029, USA.
| | - Scott A Roof
- Division of Head and Neck Oncology and Microvascular Surgery, Department of Otolaryngology, Head and Neck Surgery, Icahn School of Medicine at Mt Sinai, New York, NY 10029, USA
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44
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Becherini C, Salvestrini V, Desideri I, Vagnoni G, Bonaparte I, Bertini N, Mattioli C, Angelini L, Visani L, Scotti V, Livi L, Caini S, Bonomo P. Impact of fosaprepitant in the prevention of nausea and emesis in head and neck cancer patients undergoing cisplatin-based chemoradiation: a pilot prospective study and a review of literature. LA RADIOLOGIA MEDICA 2024; 129:457-466. [PMID: 38351333 PMCID: PMC10942929 DOI: 10.1007/s11547-024-01757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/03/2024] [Indexed: 03/16/2024]
Abstract
PURPOSE Cisplatin-based chemoradiotherapy (CRT) is standard treatment for head and neck squamous cell carcinoma (HNSCC). However, IMRT may increase chemotherapy-induced nausea and vomiting (CINV). The purpose of this study is to investigate the effect of fosaprepitant in preventing CINV. METHODS An infusion of 150 mg fosaprepitant was given through a 30 min. We assessed acute toxicity using CTCAE v.4 and the incidence of CINV using the FLIE questionnaire. The evaluation of CINV was done at the second and fifth weeks of CRT and 1 week after the end. The EORTC QLQ-HN 43 questionnaire was administered before treatment beginning (baseline), at second (T1) and fifth (T2) weeks. A dosimetric analysis was performed on dorsal nucleus of vagus (DVC) and area postrema (AP). RESULTS Between March and November 2020, 24 patients were enrolled. No correlation was found between nausea and DVC mean dose (p = 0.573), and AP mean dose (p = 0.869). Based on the FLIE questionnaire, patients reported a mean score of 30.5 for nausea and 30 for vomiting during week 2 and 29.8 for nausea and 29.2 for vomiting during week 5. After treatment ended, the mean scores were 27.4 for nausea and 27.7 for vomiting. All patients completed the EORTC QLQ-HN 43. Significantly higher scores at T2 assessment than baseline were observed. CONCLUSIONS The use of fosaprepitant in preventing CINV reduced incidence of moderate to severe nausea and vomiting. No correlation has been found between nausea and median dose to DVC and AP.
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Affiliation(s)
- Carlotta Becherini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Viola Salvestrini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Giulia Vagnoni
- Clinical Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Ilaria Bonaparte
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Niccolò Bertini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Chiara Mattioli
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lucia Angelini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Luca Visani
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Vieri Scotti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
| | - Saverio Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network (ISPRO), Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy
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Ebisumoto K, Sakai A, Iijima H, Goto F, Yamauchi M, Maki D, Teramura T, Wasano K, Okami K. Swallowing Function and Quality of Life in Patients Treated With Transoral Videolaryngoscopic Surgery for Pharyngolaryngeal Cancer. Cureus 2024; 16:e57143. [PMID: 38686230 PMCID: PMC11057633 DOI: 10.7759/cureus.57143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND It is controversial whether transoral resection for early pharyngolaryngeal cancer preserves swallowing function and quality of life. We investigated swallowing function and quality of life before and after transoral videolaryngoscopic surgery (TOVS). METHODS Seventy-three patients with pharyngolaryngeal cancer who underwent TOVS between July 2012 and July 2022 were enrolled in this prospective analysis. The Hyodo score and European Organization for Research and Treatment of Cancer Quality of Life Questionnaires were recorded preoperatively and at three, six, and 12 months postoperatively, in addition to the postoperative functional outcome swallowing scale (FOSS) at six months postoperatively. RESULTS Although most patients could consume food orally without restrictions with a preferable FOSS score, 23 patients showed impaired Hyodo scores. Age ≥65 years significantly predicted impaired swallowing. Sub-scores of the impaired patient group showed worsening for the glottal closure reflex when the endoscope touched the epiglottis or arytenoid, as well as a reduction in the extent of pharyngeal clearance following the ingestion of blue-dyed water. CONCLUSION After TOVS, swallowing function is generally well preserved. Elderly patients, especially those with laryngeal hypoesthesia and poor clearance, are at risk of swallowing dysfunction.
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Affiliation(s)
- Koji Ebisumoto
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Akihiro Sakai
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Hiroaki Iijima
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Fumiyuki Goto
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Mayu Yamauchi
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Daisuke Maki
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Takanobu Teramura
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Koichiro Wasano
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
| | - Kenji Okami
- Otolaryngology - Head and Neck Surgery, Tokai University, Isehara, JPN
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Raab G, Yu Y, Sherman E, Wong R, Mell LK, Lee NY, Zakeri K. Nomogram to predict risk of early mortality following definitive or adjuvant radiation and systemic therapy for head and neck cancer. Clin Transl Radiat Oncol 2024; 45:100725. [PMID: 38304239 PMCID: PMC10832379 DOI: 10.1016/j.ctro.2024.100725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose/Objectives We sought to create nomograms to predict individual risk of early mortality, which can identify patients who require interventions to prevent early death. Methods We included patients in the National Cancer Database with non-metastatic squamous cell carcinoma of the head and neck who received radiation and systemic therapy between 2004 and 2017 in the definitive or adjuvant setting. Early mortality was defined as any death less than 90 days after starting radiation. Multivariable logistic regression was used to assess the relationship between covariates and early mortality. Nomograms to predict the risk of early death were created for both the definitive and adjuvant settings. Results Among 84,563 patients in the definitive group and 18,514 patients in the adjuvant group, rates of early mortality were 3.5 % (95 % CI 3.4-3.7 %) and 2.2 %, (95 % CI 1.9-2.4 %), respectively. Patients above the age of 70 had an early mortality rate of 7.8 % (95 % CI 7.3-8.2 %) in the definitive group and 4.4 % (95 % CI 3.6-5.4 %) in the adjuvant group. In the multivariable analysis, age, comorbidity, T and N category, and tumor site were associated with early mortality in both cohorts (p < 0.05 for all). Nomograms including age, comorbidity, T and N category and tumor site performed better than age alone at predicting early mortality (AUC for definitive group: 0.70 vs 0.66; AUC for adjuvant group: 0.71 vs 0.61). Conclusion Nomograms including age, comorbidity, T and N category and tumor site were developed to predict the risk of early death following definitive or adjuvant chemoradiation.
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Affiliation(s)
- Gabriel Raab
- Weill Cornell Medical College, New York, NY, USA
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Loren K. Mell
- Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA, USA
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Cheng JT, Ramos Emos M, Leite V, Capozzi L, Woodrow LE, Gutierrez C, Ngo-Huang A, Krause KJ, Parke SC, Langelier DM. Rehabilitation Interventions in Head and Neck Cancer: A Scoping Review. Am J Phys Med Rehabil 2024; 103:S62-S71. [PMID: 38364033 DOI: 10.1097/phm.0000000000002384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
OBJECTIVE The aim of the study is to identify and appraise current evidence for rehabilitation interventions in head and neck cancer. DESIGN A previously published scoping review spanning 1990 through April 2017 was updated through January 11, 2023 and narrowed to include only interventional studies (Arch Phys Med Rehabil. 2019;100(12):2381-2388). Included studies had a majority head and neck cancer population and rehabilitation-specific interventions. Pairs of authors extracted data and evaluated study quality using the PEDro tool. Results were organized by intervention type. RESULTS Of 1338 unique citations, 83 studies with 87 citations met inclusion criteria. The median study sample size was 49 (range = 9-399). The most common interventions focused on swallow (16 studies), jaw (11), or both (6), followed by whole-body exercise (14) and voice (10). Most interventions took place in the outpatient setting (77) and were restorative in intent (65 articles). The overall study quality was fair (median PEDro score 5, range 0-8); none were of excellent quality (PEDro >9). CONCLUSIONS Most head and neck cancer rehabilitation interventions have focused on restorative swallow and jaw exercises and whole-body exercise to address dysphagia, trismus, and deconditioning. More high-quality evidence for head and neck cancer rehabilitation interventions that address a wider range of impairments and activity and social participation limitations during various cancer care phases is urgently needed to reduce head and neck cancer-associated morbidity.
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Affiliation(s)
- Jessica T Cheng
- From the Department of Supportive Care Medicine, City of Hope Orange County Lennar Foundation Cancer Center, California (JTC); Department of Orthopedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, New York (ME); Rehabilitation Department, Instituto do Cancer, Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil (VL); Faculty of Kinesiology, University of Calgary, Calgary, Canada (LC); Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, Calgary, Canada (LC); Department of Internal Medicine, Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Canada (LEW); Department of Physical Medicine and Rehabilitation, McGovern Medical School at UTHealth Houston, Houston, Texas (CG); Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas (AN-H); Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, Texas (KJK); Department of Physical Medicine and Rehabilitation, Mayo Clinic Arizona, Phoenix, Arizona (SCP); and Department of Medicine, Division of Physical Medicine and Rehabilitation, University Health Network and University of Toronto, Toronto, Canada (DML)
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Sannigrahi MK, Cao AC, Rajagopalan P, Sun L, Brody RM, Raghav L, Gimotty PA, Basu D. A novel pipeline for prioritizing cancer type-specific therapeutic vulnerabilities using DepMap identifies PAK2 as a target in head and neck squamous cell carcinomas. Mol Oncol 2024; 18:336-349. [PMID: 37997254 PMCID: PMC10850805 DOI: 10.1002/1878-0261.13558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 10/23/2023] [Accepted: 11/22/2023] [Indexed: 11/25/2023] Open
Abstract
There is limited guidance on exploiting the genome-wide loss-of-function CRISPR screens in cancer Dependency Map (DepMap) to identify new targets for individual cancer types. This study integrated multiple tools to filter these data in order to seek new therapeutic targets specific to head and neck squamous cell carcinoma (HNSCC). The resulting pipeline prioritized 143 targetable dependencies that represented both well-studied targets and emerging target classes like mitochondrial carriers and RNA-binding proteins. In total, 14 targets had clinical inhibitors used for other cancers or nonmalignant diseases that hold near-term potential to repurpose for HNSCC therapy. Comparing inhibitor response data that were publicly available for 13 prioritized targets between the cell lines with high vs. low dependency on each target uncovered novel therapeutic potential for the PAK2 serine/threonine kinase. PAK2 gene dependency was found to be associated with wild-type p53, low PAK2 mRNA, and diploid status of the 3q amplicon containing PAK2. These findings establish a generalizable pipeline to prioritize clinically relevant targets for individual cancer types using DepMap. Its application to HNSCC highlights novel relevance for PAK2 inhibition and identifies biomarkers of PAK2 inhibitor response.
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Affiliation(s)
- Malay K. Sannigrahi
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Austin C. Cao
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Pavithra Rajagopalan
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Lova Sun
- Department of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Robert M. Brody
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Lovely Raghav
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Phyllis A. Gimotty
- Department of Biostatistics, Epidemiology and InformaticsUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Devraj Basu
- Department of Otorhinolaryngology‐Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPAUSA
- Ellen and Ronald Caplan Cancer CenterThe Wistar InstitutePhiladelphiaPAUSA
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Tsuge H, Kawakita D, Taniyama Y, Oze I, Koyanagi YN, Hori M, Nakata K, Sugiyama H, Miyashiro I, Oki I, Nishino Y, Katanoda K, Ito Y, Shibata A, Matsuda T, Iwasaki S, Matsuo K, Ito H. Subsite-specific trends in mid- and long-term survival for head and neck cancer patients in Japan: A population-based study. Cancer Sci 2024; 115:623-634. [PMID: 37994633 PMCID: PMC10859624 DOI: 10.1111/cas.16028] [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: 07/02/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023] Open
Abstract
Advances in diagnostic techniques and treatment modalities have impacted head and neck cancer (HNC) prognosis, but their effects on subsite-specific prognosis remain unclear. This study aimed to assess subsite-specific trends in mid- and long-term survival for HNC patients diagnosed from 1993 to 2011 using data from population-based cancer registries in Japan. We estimated the net survival (NS) for HNC by subsite using data from 13 prefectural population-based cancer registries in Japan. Changes in survival over time were assessed by multivariate excess hazard model of mortality. In total, 68,312 HNC patients were included in this analysis. We observed an overall improvement in 5-year NS for HNC patients in Japan. However, survival varied among subsites of HNC, with some, such as naso-, oro- and hypopharyngeal cancers, showing significant improvement in both 5- and 10-year NS, whereas others such as laryngeal cancer showed only a slight improvement in 5-year NS and no significant change in 10-year NS after adjustment for age, sex and stage. In conclusion, the study provides insights into changing HNC survival by site at the population level in Japan. Although advances in diagnostic techniques and treatment modalities have improved survival, these improvements are not shared equally among subsites.
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Affiliation(s)
- Hiroshi Tsuge
- Division of Cancer Information and Control, Department of Preventive MedicineAichi Cancer Center Research InstituteNagoyaJapan
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Daisuke Kawakita
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Yukari Taniyama
- Division of Cancer Information and Control, Department of Preventive MedicineAichi Cancer Center Research InstituteNagoyaJapan
| | - Isao Oze
- Division of Cancer Epidemiology and Prevention, Department of Preventive MedicineAichi Cancer Center Research InstituteNagoyaJapan
| | - Yuriko N. Koyanagi
- Division of Cancer Epidemiology and Prevention, Department of Preventive MedicineAichi Cancer Center Research InstituteNagoyaJapan
| | - Megumi Hori
- School of NursingUniversity of ShizuokaShizuokaJapan
| | - Kayo Nakata
- Cancer Control CenterOsaka International Cancer InstituteOsakaJapan
| | - Hiromi Sugiyama
- Department of EpidemiologyRadiation Effects Research FoundationHiroshimaJapan
| | - Isao Miyashiro
- Cancer Control CenterOsaka International Cancer InstituteOsakaJapan
| | - Izumi Oki
- Department of Health Sciences, School of Health and Social ServicesSaitama Prefectural UniversitySaitamaJapan
| | - Yoshikazu Nishino
- Department of Epidemiology and Public HealthKanazawa Medical UniversityIshikawaJapan
| | - Kota Katanoda
- Division of Population Data ScienceNational Cancer Center Institute for Cancer ControlTokyoJapan
| | - Yuri Ito
- Department of Medical Statistics, Research & Development CenterOsaka Medical and Pharmaceutical UniversityOsakaJapan
| | - Akiko Shibata
- Department of Radiology, Division of Diagnostic RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Tomohiro Matsuda
- Division of International Collaborative ResearchCenter for Public Health Sciences, National Cancer CenterTokyoJapan
| | - Shinichi Iwasaki
- Department of Otorhinolaryngology, Head and Neck SurgeryNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Keitaro Matsuo
- Division of Cancer Epidemiology and Prevention, Department of Preventive MedicineAichi Cancer Center Research InstituteNagoyaJapan
- Department of Cancer EpidemiologyNagoya University Graduate School of MedicineNagoyaJapan
| | - Hidemi Ito
- Division of Cancer Information and Control, Department of Preventive MedicineAichi Cancer Center Research InstituteNagoyaJapan
- Division of Descriptive Cancer EpidemiologyNagoya University Graduate School of MedicineNagoyaJapan
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50
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Silver JA, Bouganim N, Richardson K, Henry M, Mascarella MA, Ramirez-GarciaLuna J, Golabi N, Mlynarek AM, Zeitouni A, Hier MP, Caglar D, Esfahani K, Sadeghi N. Quality of Life After Neoadjuvant Chemotherapy and Transoral Robotic Surgery for Oropharynx Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:65-74. [PMID: 38060238 PMCID: PMC10704343 DOI: 10.1001/jamaoto.2023.3781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/09/2023] [Indexed: 12/08/2023]
Abstract
Importance Efforts are underway to deintensified treatment protocols for patients with human papillomavirus virus-associated oropharyngeal squamous cell carcinoma (HPV-OPSCC) to achieve similar excellent oncologic outcomes while reducing treatment-related adverse effects. Transoral robotic surgery (TORS) as primary treatment often requires adjuvant therapy due to the high incidence of nodal metastasis. Treatment with neoadjuvant chemotherapy followed by TORS and neck dissection (NECTORS), reserving radiation therapy for salvage, yields excellent oncologic outcomes. Objective To assess patient-reported quality of life (QOL) and functional outcomes among patients with HPV-OPSCC who undergo NECTORS. Design, Settings, and Participants This was a multicenter prospective cohort study of patients with HPV-OPSCC treated with the NECTORS protocol in 2017 to 2022. Consecutive patients with stage III or IVa HPV-OPSCC treated with NECTORS in 2017 to 2022 who had completed the primary QOL questionnaire at baseline and at least once during the 24-month follow-up period were included. Ninety-four patients were eligible, and 67 were included in the analyses. Outcome Measures QOL questionnaires at baseline, and at month 1, 3, 6, 12, 18, and 24 posttreatment. Global score on the 30-item European Organization for Research and Treatment of Cancer Core quality of life questionnaire (EORTC QLQ-C30) was the primary outcome; the head and neck extension module (EORTC QLQ-HN35); the MD Anderson Dysphagia Inventory for dysphagia-related QOL; and the Decision Regret Scale were also used. Paired t tests assessed change between the baseline and 12- or 24-month patient-reported outcomes. Results Among the study population of 67 patients (median [range] age, 63 [58-67] years; 54 [80.6%] male) with HPV-OPSCC, the most frequent cancer subsites were palatine tonsil (41 [61%]) and base of tongue (26 [39%]); none required adjuvant RT. Global QOL at 24 months improved compared with baseline (mean difference, 9.49; 95% CI, 2.45 to 16.53). All EORTC QLQ-C30 functional scores returned to baseline or improved within 3 to 6 months posttreatment and remained stable at 24 months. EORTC QLQ-HN35 symptom scale scores improved or were stable at 24 months. The MD Anderson Dysphagia Inventory scores demonstrated no significant difference between baseline and month 12 for global scores (mean difference, 6.15; 95% CI, -4.18 to 16.49) and composite scores (mean difference, 2.73; 95% CI, -1.62 to 7.09). Median (range) score on the Decision Regret Scale was 5 of 100 (0-30), representing mild overall regret. Conclusion and Relevance The findings of this multicenter cohort study indicate that use of the NECTORS protocol is associated with excellent QOL outcomes. QOL measures returned to baseline levels or were better than baseline, which represents positive outcomes for patients with HPV-OPSCC who undergo this treatment regimen.
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Affiliation(s)
- Jennifer A. Silver
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nathaniel Bouganim
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Melissa Henry
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
- Lady Davis Research Institute, McGill University, Montreal, Quebec, Canada
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Marco A. Mascarella
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Nahid Golabi
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anthony Zeitouni
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael P. Hier
- Department of Otolaryngology−Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Derin Caglar
- Department of Pathology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Khashayar Esfahani
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nader Sadeghi
- Department of Otolaryngology−Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Oncology, McGill University Health Centre, Montreal, Quebec, Canada
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
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