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Tsai YT, Fang KH, Adarsh K. Current Concepts of Ablative Surgery in Oral Cavity Cancer. J Maxillofac Oral Surg 2024; 23:801-807. [PMID: 39118915 PMCID: PMC11303598 DOI: 10.1007/s12663-024-02188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 04/11/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Ablative surgery has evolved over the years with the attempt to extirpate the tumor in its entirety with the understanding of the molecular tumor biology, pattern of tumor invasion of the tumors, as well as availability of better instrumentations. Materials and Methods Subset-based evaluation and management of oral cancer. conclusion For oral cancer, surgery is still the primary therapeutic option. To establish surgical adequacy, a wide excision with sufficient margins in all three dimensions must be carried out.
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Affiliation(s)
- Yao-Te Tsai
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ku-Hao Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kudav Adarsh
- Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal, Manipal Academy of Higher Education, Manipal, 576104, India
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Tanaka R, Ueki Y, Ohshima S, Omata J, Yokoyama Y, Takahashi T, Shodo R, Yamazaki K, Ohtaki K, Togashi T, Horii A. Safety and efficacy of neoadjuvant chemotherapy with paclitaxel, carboplatin, and cetuximab for locally advanced head and neck squamous cell carcinoma. Int J Clin Oncol 2024; 29:1133-1141. [PMID: 38727853 DOI: 10.1007/s10147-024-02545-9] [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] [Accepted: 04/30/2024] [Indexed: 07/26/2024]
Abstract
BACKGROUND As a substantial waiting time is usually required for radical surgery, safe and effective preoperative neoadjuvant chemotherapy (NAC) is desired for the treatment of locally advanced head and neck squamous cell carcinoma (HNSCC). However, the significance of NAC in advanced HNSCC is still unclear. This study aimed to assess the safety and efficacy of NAC using the paclitaxel, carboplatin, and cetuximab (PCE) regimen. METHODS We retrospectively evaluated the background characteristics, incidence of adverse events, overall response rate (ORR), pathological response, recurrence-free survival (RFS), and overall survival (OS) in 26 patients. Patients receiving the PCE regimen were further divided into two groups based on the number of chemotherapy cycles (one cycle or more) and eligibility for cisplatin. Patients aged ≥ 75 years and those with an estimated glomerular filtration rate (eGFR) < 60 mL/min were classified as ineligible for cisplatin. RESULTS The median age was 70 (27-81) years. The median eGFR at treatment initiation was 63.2 (41.1-89.7) mL/min. Fourteen (53.8%) patients were ineligible for cisplatin. Grade 3 or higher neutropenia was observed in 11 of 25 (42.3%) patients. No delay in or withdrawal from surgery was observed. The ORR was 65.4%. The 2-year RFS and OS were 61.5% and 76.7%, respectively. No significant differences in safety and efficacy between the number of chemotherapy cycles and cisplatin eligibility were observed. CONCLUSION NAC using the PCE regimen for patients with locally advanced HNSCC, including cisplatin-ineligible patients, has acceptable toxicity and favorable efficacy.
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Affiliation(s)
- Ryoko Tanaka
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yushi Ueki
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan.
| | - Shusuke Ohshima
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Jo Omata
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Yusuke Yokoyama
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Takeshi Takahashi
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Ryusuke Shodo
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
| | - Keisuke Yamazaki
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Kohei Ohtaki
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Takafumi Togashi
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Arata Horii
- Department of Otolaryngology-Head and Neck Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757, Asahimachi-dori, Chuo-Ku, Niigata, 950-8510, Japan
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Gupta A, Popat SP, Dimri K, Punia RPS, Lehl GK, Singhal SK. Pre-surgical Tumor Marking by Tattooing in Patients Offered with Neoadjuvant Chemotherapy (Nact) for Advance Staged Oral Carcinomas. J Maxillofac Oral Surg 2024; 23:998-1000. [PMID: 39118924 PMCID: PMC11303348 DOI: 10.1007/s12663-024-02275-5] [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: 03/10/2024] [Accepted: 07/10/2024] [Indexed: 08/10/2024] Open
Abstract
We described a novel technique of marking the oral squamous cell carcinoma (OSCC) tumors before the pre-operative neoadjuvant chemotherapy (NACT). The pre-operative NACT may shrink the tumor, making it difficult for the oncosurgeon to identify the pre-NACT tumor area to be included in the surgical resection. Difficulty lies in exact topographic replication/documentation of examination findings on superficial or mucosal surface levels, primarily due to limited surface landmarks. This technique helps to identify the pre-NACT tumor margins during surgical resection and to achieve maximum oncological safety and refining surgical planning.
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Affiliation(s)
- Anand Gupta
- Oral Health Centre, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Shyam P. Popat
- Oral Health Centre, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Kislay Dimri
- Department of Radiation Oncology, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - R. P. S. Punia
- Department of Pathology, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Gurvanit Kaur Lehl
- Oral Health Centre, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Suurinder K. Singhal
- Department of ENT, Head & Neck Surgery, Government Medical College and Hospital, Sector 32, Chandigarh, India
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Barbosa-Martins J, Rolo A, Lima B, Pereira JC, Araújo C, Guimarães J, Dinis J, Vieira C. Efficacy and safety of induction chemotherapy in oral cavity cancer: An eight-year experience at a Portuguese reference center. TUMORI JOURNAL 2024:3008916241257099. [PMID: 38825833 DOI: 10.1177/03008916241257099] [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: 06/04/2024]
Abstract
BACKGROUND Induction chemotherapy has been described as an option in locally advanced oral cavity squamous cell carcinoma when the surgical morbidity is expected to be high. This work aimed to evaluate the outcome and safety of induction chemotherapy in this setting. METHODS We performed a retrospective and observational study including patients with oral cavity squamous cell carcinoma, treated with induction chemotherapy between January 2010 and December 2018. Outcomes included induction chemotherapy toxicity, treatment response, disease-free survival and overall survival. RESULTS A total of 108 oral cavity squamous cell carcinoma patients were included. Ninety-six (88.9%) had stage IV disease, while 12 (11.1%) had stage III. Eighty-four patients (80.8%) achieved at least a partial response to induction chemotherapy at clinical evaluation, and 75 (72.1%) at radiological evaluation. Seventy-eight patients have been proposed for subsequent definitive treatments, with no differences obtained in prognosis, when comparing surgical to non-surgical approaches. In patients treated with definitive treatments, improved five-year disease-free survival was obtained if at least a clinical (56.3%; p=0.001) or radiological (52.9%; p=0.001) partial response was achieved after induction chemotherapy. Similarly, superior five-year overall survival was verified for those achieving at least clinical (51.1%; p<0.0001) or radiological (52.6%; p=0.001) partial response. Also, accomplishing a pathologic complete response (n=22.6%) significantly improved disease-free survival (p=0.039) and overall survival (p=0.005). Grade 3 and 4 toxicities were observed in 52 patients (41.8%). CONCLUSION Responses to induction chemotherapy predicted prognosis in our population, however important toxicities were observed. Further studies are necessary to identify induction chemotherapy response predictors and subgroups who may benefit from this approach.
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Affiliation(s)
- João Barbosa-Martins
- Medical Oncology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Ana Rolo
- Medical Oncology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - Bárbara Lima
- Medical Oncology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal
| | - José Carlos Pereira
- Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Cláudia Araújo
- Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Jorge Guimarães
- Surgical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - José Dinis
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
| | - Cláudia Vieira
- Medical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil, Porto, Portugal
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Asarkar AA, Chang BA, de Bree R, Kowalski LP, Guntinas-Lichius O, Bradley PJ, de Graaf P, Strojan P, Rao KN, Mäkitie AA, López F, Rinaldo A, Palme C, Genden EM, Sanabria A, Rodrigo JP, Ferlito A. Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies. Adv Ther 2024; 41:2133-2150. [PMID: 38642199 DOI: 10.1007/s12325-024-02861-6] [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: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. METHODS A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. RESULTS Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. CONCLUSION The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.
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Affiliation(s)
- Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, Louisiana Health Sciences Center, Shreveport, LA, 71103, USA.
| | - Brent A Chang
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Patrick J Bradley
- Department of ORLHNS, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
| | - Pim de Graaf
- Amsterdam UMC Location Vrije Universiteit, Radiology and Nuclear Medicine, de Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, 1000, Ljubljana, Slovenia
| | - Karthik N Rao
- Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Center, Bangalore, India
| | - Antti A 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
| | - Fernando López
- ENT and Head and Neck Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Carsten Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY, 10029, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Universidad de Antioquia, Medellin, Colombia
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, 33011, Oviedo, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35030, Padua, Italy
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Chen Y, Zhong NN, Cao LM, Liu B, Bu LL. Surgical margins in head and neck squamous cell carcinoma: A narrative review. Int J Surg 2024; 110:3680-3700. [PMID: 38935830 PMCID: PMC11175762 DOI: 10.1097/js9.0000000000001306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 06/29/2024]
Abstract
Head and neck squamous cell carcinoma (HNSCC), a prevalent and frequently recurring malignancy, often necessitates surgical intervention. The surgical margin (SM) plays a pivotal role in determining the postoperative treatment strategy and prognostic evaluation of HNSCC. Nonetheless, the process of clinical appraisal and assessment of the SMs remains a complex and indeterminate endeavor, thereby leading to potential difficulties for surgeons in defining the extent of resection. In this regard, we undertake a comprehensive review of the suggested surgical distance in varying circumstances, diverse methods of margin evaluation, and the delicate balance that must be maintained between tissue resection and preservation in head and neck surgical procedures. This review is intended to provide surgeons with pragmatic guidance in selecting the most suitable resection techniques, and in improving patients' quality of life by achieving optimal functional and aesthetic restoration.
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Affiliation(s)
- Yang Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
- Department of Oral & Maxillofacial – Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
- Department of Oral & Maxillofacial – Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China
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A S, Mehta R, Nagarkar NM, Bodhey NK, Gupta RK, Satpute SS. Clinical, Radiological, and Pathological Correlation of Mandibular Invasion in Carcinoma Bucco-alveolar Complex. Indian J Surg Oncol 2024; 15:385-396. [PMID: 38741646 PMCID: PMC11088584 DOI: 10.1007/s13193-024-01903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/15/2024] [Indexed: 05/16/2024] Open
Abstract
A prospective cross-sectional study was conducted to correlate clinically, radiologically, and pathologically the mandibular invasion in carcinoma bucco-alveolar complex. All biopsy-proven oral cavity cancer cases (64 patients) were assessed clinically and radiologically for involvement of the mandible. Preoperative clinicoradiological findings were compared with postoperative histopathological findings. In our study, oral cancer was 4 times more prevalent in males as compared to females and clinical evaluation was found to be highly sensitive in predicting mandibular invasion. Orthopantomogram showed sensitivity of 66.6% and specificity of 100%. CT scan showed sensitivity of 100% and specificity of 46% whereas MRI showed sensitivity of 54.5% and a specificity of 96%. MRI correlates well with final histopathology in predicting size of tumor. Prevalence of bony invasion in carcinoma oral cavity was 18%. We noted an inverse relation with tumor differentiation and mandibular invasion, and none of the verrucous carcinoma lesions showed mandibular invasion. Association of clinical T and N staging with postoperative histopathology was found to be statistically significant. Despite recent advances in molecular biology, radiological techniques, and newer modalities like visual surgical planning, exact measurement of bone invasion is still challenging. At present, CT scan and MRI along with clinical evaluation are widely used to evaluate mandibular invasion in carcinoma oral cavity, and all these are complementary to each other. The recent progress in tissue engineering technologies and stem cell biology has significantly promoted the development of regenerative reconstruction of jawbone defects.
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Affiliation(s)
- Subinsha A
- Department of Otorhinolaryngology-Head and Neck Surgery, AIIMS, Raipur, Chhattisgarh India
| | - Rupa Mehta
- Department of Otorhinolaryngology-Head and Neck Surgery, AIIMS, Raipur, Chhattisgarh India
| | - Nitin M. Nagarkar
- Department of Otorhinolaryngology-Head and Neck Surgery, AIIMS, Raipur, Chhattisgarh India
| | | | - Rakesh Kumar Gupta
- Department of Pathology and Laboratory Medicine, AIIMS, Raipur, Chhattisgarh India
| | - Satish S. Satpute
- Department of Otorhinolaryngology-Head and Neck Surgery, AIIMS, Raipur, Chhattisgarh India
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Ram B, Verma S, Thakur S, Subash A, Rao VUS, Joy J. What's ahead for complete responders following NACT? Oral Oncol 2024; 152:106776. [PMID: 38554596 DOI: 10.1016/j.oraloncology.2024.106776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 03/24/2024] [Indexed: 04/01/2024]
Affiliation(s)
- Bhargav Ram
- Health Care Global Enterprises Ltd. Hospital Bengaluru, Karnataka, India.
| | - Shaurya Verma
- Health Care Global Enterprises Ltd. Hospital Bengaluru, Karnataka, India.
| | - Shalini Thakur
- Health Care Global Enterprises Ltd. Hospital Bengaluru, Karnataka, India.
| | - Anand Subash
- Health Care Global Enterprises Ltd. Hospital Bengaluru, Karnataka, India.
| | - Vishal U S Rao
- Health Care Global Enterprises Ltd. Hospital Bengaluru, Karnataka, India.
| | - Josephine Joy
- Health Care Global Enterprises Ltd. Hospital Bengaluru, Karnataka, India.
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Sexton GP, Hintze JM, Walsh P, Moriarty F, Lennon P, Fitzgerald CWR, O'Neill JP. Epidemiology and management of oral cavity squamous cell carcinoma in Ireland. Am J Otolaryngol 2024; 45:104235. [PMID: 38417262 DOI: 10.1016/j.amjoto.2024.104235] [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: 10/23/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION The epidemiology and management of oral cavity cancer have changed considerably in recent decades. This study examines epidemiological and management trends in oral cavity squamous cell carcinoma (OCSCC). METHODS A retrospective cohort study of data from the National Cancer Registry of Ireland between 1994 and 2014. RESULTS A total of 2725 patients were identified. The most common subsites were the tongue (34 %, n = 1025), lip (19 %, n = 575), floor of mouth (FOM) (18 %, n = 550), and retromolar trigone (RMT) (6 %, n = 189). The incidence of OCSCC remained largely unchanged (3.14 cases/100000/year) during the study period. 5-year disease-specific survival (DSS) was 58.6 % overall, varying between subsites (lip 85 %, RMT 62.9 %, tongue 54.7 %, and FOM 47.3 %). DSS improved over the study period (p = 0.03), in particular for tongue primaries (p = 0.007). Primary surgery significantly improved DSS versus radiotherapy (HR 0.28, p < 0.0001). Survival of T4 disease managed surgically was superior to that of T1 disease managed with radiotherapy. In node positive patients, chemotherapy improved overall survival (HR 0.8 p = 0.038) but not DSS (HR 0.87 p = 0.215). CONCLUSION Primary surgery remains the standard of care in the management of OCSCC. Prognosis has improved in line with an increase in the use of primary surgery in the same time frame, though the incidence remains unchanged.
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Affiliation(s)
- Gerard P Sexton
- Department of Otolaryngology-Head & Neck Surgery, Beaumont Hospital, Dublin 9, Ireland; Royal College of Surgeons in Ireland, Ireland.
| | - J M Hintze
- Department of Otolaryngology-Head & Neck Surgery, Beaumont Hospital, Dublin 9, Ireland
| | - Paul Walsh
- National Cancer Registry Ireland, Cork Airport Business Park, Ireland
| | - Frank Moriarty
- Royal College of Surgeons in Ireland, Ireland; School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Paul Lennon
- Department of Otolaryngology-Head & Neck Surgery, St James Hospital, Dublin 8, Ireland
| | - Conall W R Fitzgerald
- Department of Otolaryngology-Head & Neck Surgery, St James Hospital, Dublin 8, Ireland
| | - James Paul O'Neill
- Department of Otolaryngology-Head & Neck Surgery, Beaumont Hospital, Dublin 9, Ireland; Royal College of Surgeons in Ireland, Ireland
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10
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Noronha V, Patil V, Chaturvedi P, Mathrudev V, Menon N, Bhattacharjee A, Singh A, Peelay Z, Chakraborty S, Jadhav M, Alone M, Bhagyavant P, Kolkur M, Srinivas S, Das S, Roy S, Mandal T, Dsouza H, Saha S, Rai R, Srikanth A, Shah D, Khan A, Muthuluri H, Kumar A, Agarwal A, Rajpurohit A, Goli VB, Sekar A, Mantri A, Kanteti APK, Majumdar S, Khaddar S, Shenoy R, Elamarthi P, Rathnasamy N, Kashyap L, Abraham G, Booma N, Simha V, Chaukar D, Pai P, Nair S, Laskar S, Nawale K, Naidu P, Salian S, Shelar P, Raulo R, Dhumal SB, Prabhash K. Phase 3 RCT comparing docetaxel-platinum with docetaxel-platinum-5FU as neoadjuvant chemotherapy in borderline resectable oral cancer. Eur J Cancer 2024; 200:113560. [PMID: 38306841 DOI: 10.1016/j.ejca.2024.113560] [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: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/13/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) with TPF (docetaxel, cisplatin, and 5FU) is one of the treatment options in very locally advanced oral cancer with a survival advantage over PF (cisplatin and 5FU). TP (docetaxel and cisplatin) has shown promising results with a lower rate of adverse events but has never been compared to TPF. METHODS In this phase 3 randomized superiority study, adult patients with borderline resectable locally advanced oral cancers were randomized in a 1:1 fashion to either TP or TPF. After the administration of 2 cycles, patients were evaluated in a multidisciplinary clinic and further treatment was planned. The primary endpoint was overall survival (OS) and secondary endpoints were progression-free survival (PFS) and adverse events. RESULTS 495 patients were randomized in this study, 248 patients in TP arm and 247 in TPF arm. The 5-year OS was 18.5% (95% CI 13.8-23.7) and 23.9% (95% CI 18.1-30.1) in TP and TPF arms, respectively (Hazard ratio 0.778; 95% CI 0.637-0.952; P = 0.015). Following NACT, 43.8% were deemed resectable, but 34.5% underwent surgery. The 5-year OS was 50.7% (95% CI 41.5-59.1) and 5% (95%CI 2.9-8.1), respectively, in the surgically resected versus unresected cohort post NACT (P < 0.0001). Grade 3 or above adverse events were seen in 97 (39.1%) and 179 (72.5%) patients in the TP and TPF arms, respectively (P < 0.0001). CONCLUSION NACT with TPF has a survival benefit over TP in borderline resectable oral cancers, with an increase in toxicity which is manageable. Patients who undergo surgery achieve a relatively good, sustained survival.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Atanu Bhattacharjee
- Section of Biostatistics, Centre for Cancer Epidemiology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ajay Singh
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Monica Jadhav
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Mitali Alone
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Manali Kolkur
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sujay Srinivas
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sudeep Das
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Somnath Roy
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Tanmoy Mandal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Hollis Dsouza
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Saswata Saha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Rahul Rai
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anne Srikanth
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Darshit Shah
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Arif Khan
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Hemanth Muthuluri
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Amit Kumar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Amit Agarwal
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anu Rajpurohit
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vasu Babu Goli
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anbarasan Sekar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Anoop Mantri
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Swaratika Majumdar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Satvik Khaddar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ramnath Shenoy
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Prahlad Elamarthi
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Lakhan Kashyap
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - George Abraham
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Naveen Booma
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Vijay Simha
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Devendra Chaukar
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Prathamesh Pai
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sarbani Laskar
- Department of Radiation Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Priyanka Naidu
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Sushmita Salian
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Priyanka Shelar
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | - Ravinarayan Raulo
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India
| | | | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Centre, HBNI, Mumbai, India.
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11
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Yaniv D, Seiwert TY, Margalit DN, Williams MD, Barbon CEA, Largo RD, Smith JA, Gross ND. Neoadjuvant chemotherapy for advanced oral cavity cancer. CA Cancer J Clin 2024. [PMID: 38329372 DOI: 10.3322/caac.21829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/09/2024] Open
Affiliation(s)
- Dan Yaniv
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tanguy Y Seiwert
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Danielle N Margalit
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Carly E A Barbon
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rene D Largo
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Neil D Gross
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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12
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Foote RL, Harmsen WS, Amundson AC, Carr AB, Gamez ME, Garces YI, Lester SC, Ma DJ, McGee LA, Moore EJ, Neben Wittich MA, Patel SH, Routman DM, Rwigema JCM, Van Abel KM, Yin LX, Muller OM, Shiraishi S. Mean Oral Cavity Organ-at-Risk Dose Predicts Opioid Use and Hospitalization during Radiotherapy for Patients with Head and Neck Tumors. Cancers (Basel) 2024; 16:349. [PMID: 38254837 PMCID: PMC10814074 DOI: 10.3390/cancers16020349] [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: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Approximately 75% of all head and neck cancer patients are treated with radiotherapy (RT). RT to the oral cavity results in acute and late adverse events which can be severe and detrimental to a patient's quality of life and function. The purpose of this study was to explore associations between RT dose to a defined oral cavity organ-at-risk (OAR) avoidance structure, provider- and patient-reported outcomes (PROs), opioid use, and hospitalization. METHODS This was a retrospective analysis of prospectively obtained outcomes using multivariable modeling. The study included 196 patients treated with RT involving the oral cavity for a head and neck tumor. A defined oral cavity OAR avoidance structure was used in all patients for RT treatment planning. Validated PROs were collected prospectively. Opioid use and hospitalization were abstracted electronically from medical records. RESULTS Multivariable modeling revealed the mean dose to the oral cavity OAR was significantly associated with opioid use (p = 0.0082) and hospitalization (p = 0.0356) during and within 30 days of completing RT. CONCLUSIONS The findings of this study may be valuable in RT treatment planning for patients with tumors of the head and neck region to reduce the need for opioid use and hospitalization during treatment.
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Affiliation(s)
- Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - W. Scott Harmsen
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Adam C. Amundson
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Alan B. Carr
- Department of Dental Specialties, Division of Esthetic and Prosthetic Dentistry, Department of Advanced Prosthodontics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.B.C.); (O.M.M.)
| | - Mauricio E. Gamez
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Yolanda I. Garces
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Lisa A. McGee
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Michelle A. Neben Wittich
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - David M. Routman
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Jean-Claude M. Rwigema
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - Kathryn M. Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Linda X. Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Olivia M. Muller
- Department of Dental Specialties, Division of Esthetic and Prosthetic Dentistry, Department of Advanced Prosthodontics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.B.C.); (O.M.M.)
| | - Satomi Shiraishi
- Division of Medical Physics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
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13
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Ranganathan P, Dare A, Harrison EM, Kingham TP, Mutebi M, Parham G, Sullivan R, Pramesh CS. Inequities in global cancer surgery: Challenges and solutions. J Surg Oncol 2024; 129:150-158. [PMID: 38073139 PMCID: PMC11186466 DOI: 10.1002/jso.27551] [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: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023]
Abstract
The disparity in access to and quality of surgical cancer care between high and low resource settings impacts immediate and long-term oncological outcomes. With cancer incidence and mortality set to increase rapidly in the next few decades, we examine the factors leading to inequities in global cancer surgery, and look at potential solutions to overcome these challenges.
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Affiliation(s)
- Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Anna Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ewen M Harrison
- Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Groesbeck Parham
- Department of Obstetrics and Gynecology, Charles Drew University of Science and Medicine, Los Angeles, California, USA
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Zambia, Lusaka, Zambia
| | - Richard Sullivan
- School of Cancer Sciences, Centre for Cancer Society and Public Health, Institute of Cancer Policy, King’s College London, London, UK
| | - C. S. Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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14
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Kende P, Mathur Y, Varte V, Tayal S, Patyal N, Landge J. The efficacy of neoadjuvant chemotherapy as compared to upfront surgery for the management of oral squamous cell carcinoma: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2024; 53:1-10. [PMID: 37088590 DOI: 10.1016/j.ijom.2023.03.007] [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: 10/21/2021] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023]
Abstract
The efficacy of neoadjuvant chemotherapy in the field of head and neck oncology has always been debated. The aim of this study was to determine the efficacy of neoadjuvant chemotherapy followed by surgery in patients with oral squamous cell carcinoma (OSCC) by comparison to upfront surgery, in terms of overall survival, disease-free survival, response rates, positive surgical margins, loco-regional recurrence, distant metastasis, and toxicity. Prospective and retrospective studies were identified from a search of the PubMed, PubMed Central, and Cochrane Library databases (publication date between January 1, 1995 and January 1, 2022), as well as hand searches. Three randomized clinical trials and five retrospective studies reporting a total of 1373 patients were retrieved (493 treated with NACT, 880 treated with upfront surgery). All statistical analyses were done using RevMan 5.4. There was no statistically significant difference between the treatment groups for all outcomes (overall survival P = 0.41, disease-free survival P = 0.91, loco-regional recurrence P = 0.12, distant metastasis P = 0.23), except positive margins (P = 0.007); a reduced risk of positive margins was observed for neoadjuvant chemotherapy. The pooled proportion of patients with a complete pathological response (17%) was inadequate to obtain an improvement in survival. The lower margin positivity rate, leading to resectability with clear margins, may be a benefit of neoadjuvant chemotherapy in locally advanced OSCC; however, this treatment failed to provide a benefit in terms of survival and the response rate.
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Affiliation(s)
- P Kende
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, India.
| | - Y Mathur
- Department of Surgical Oncology, HCG Cancer Centre, Mumbai, India.
| | - V Varte
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, India.
| | - S Tayal
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, India.
| | - N Patyal
- SCB Government Dental College and Hospital, Cuttack, Odisha, India.
| | - J Landge
- Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Mumbai, India.
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15
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Xiang L, Rong JF, Xin-Chen, Li XY, Zheng Y, Ren PR, Lin S, Wen QL, He LJ, Zhang JW, Shang CL, Yang HR, Fan J, Pang HW, Zhang J, Tan BX, Zhang L, Du XB, Wen SM, Jiang L, Qin G, Wu JB. Reducing Target Volumes of Intensity Modulated Radiation Therapy After Induction Chemotherapy in Locoregionally Advanced Nasopharyngeal Carcinoma: Long-Term Results of a Prospective, Multicenter, Randomized Trial. Int J Radiat Oncol Biol Phys 2023; 117:914-924. [PMID: 37356553 DOI: 10.1016/j.ijrobp.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/28/2023] [Accepted: 06/11/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE The objective of this study was to estimate the long-term survival, late toxicity profile, and quality of life of patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated with combined induction chemotherapy (IC) and concurrent chemoradiotherapy from a clinical trial focused on reducing the target volume of intensity modulated radiation therapy (IMRT). METHODS AND MATERIALS This prospective, randomized clinical trial was conducted across 6 Chinese hospitals and included 212 patients with stage III-IVB NPC who were randomly allocated to a pre-IC or post-IC group. Eligible patients were treated with 2 cycles of IC + CCRT. All patients underwent radical IMRT. Gross tumor volumes of the nasopharynx were delineated according to pre-IC and post-IC tumor extent in the pre-IC and post-IC groups, respectively. RESULTS After a median follow-up of 98.4 months, 32 of 97 (32.9%) and 33 of 115 (28.7%) patients experienced treatment failure or died in the pre-IC and post-IC groups, respectively. None of the patients developed grade 4 late toxicity. Late radiation-induced toxicity predominantly manifested as grade 1 to 2 subcutaneous fibrosis, hearing loss, tinnitus, and xerostomia, whereas grade 3 late toxicity included xerostomia and hearing loss. The 5-year estimated overall, progression-free, locoregional recurrence-free, and distant metastasis-free survival rates in the pre-IC and post-IC groups were 78.2% versus 83.3%, 72.0% versus 78.1%, 90.2% versus 93.5%, and 78.1% versus 82.1%, respectively. The pre-IC group had a significantly higher incidence of xerostomia and hearing damage than the post-IC group. In terms of quality of life, compared with the pre-IC group, the post-IC group showed significant improvement in cognitive function (P = .045) and symptoms including dry mouth (P = .004), sticky saliva (P = .047), and feeling ill (P = .041). CONCLUSIONS After long-term follow-up, we confirmed that reducing the target volumes of IMRT after IC in locoregionally advanced NPC showed no inferiority in terms of the risk of locoregional relapse and potentially improved quality of life and alleviated late toxicity.
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Affiliation(s)
- Li Xiang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China
| | - Jin-Feng Rong
- Department of Oncology, Second People's Hospital of Yibin, Yibin, China
| | - Xin-Chen
- Department of Oncology, Second People's Hospital of Yibin, Yibin, China
| | - Xiao-Yue Li
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yun Zheng
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Pei-Rong Ren
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sheng Lin
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qing-Lian Wen
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Li-Jia He
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jian-Wen Zhang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chang-Ling Shang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hong-Ru Yang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Juan Fan
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao-Wen Pang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jing Zhang
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Bang-Xian Tan
- Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Ling Zhang
- Department of Oncology, People's Liberation Army the General Hospital of Western Theater Command, Chengdu, China
| | - Xiao-Bo Du
- Department of Oncology, Mianyang Central Hospital, Mianyang, China
| | - Shi-Min Wen
- Department of Oncology, Nanchong Central Hospital, Nanchong, China
| | - Liang Jiang
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Gang Qin
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jing-Bo Wu
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, China.
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16
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Wu WJ, Liu Q, An PG, Wang L, Zhang JY, Chen Y, Zhang T, Zhang J. Neoadjuvant tislelizumab combined with chemotherapy in locally advanced oral or oropharyngeal squamous cell carcinoma: a real-world retrospective study. Front Immunol 2023; 14:1282629. [PMID: 38035079 PMCID: PMC10685444 DOI: 10.3389/fimmu.2023.1282629] [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: 08/24/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives The treatment of locally advanced oral or oropharyngeal squamous cell carcinoma (LAOOPSCC) is surgery and radiotherapy or chemoradiotherapy but with unsatisfactory survival rate. Neoadjuvant programmed death-1 (PD-1) therapy are being used in several clinical trials. Therefore, in this retrospective study we aimed to determine the feasibility of neoadjuvant tislelizumab plus chemotherapy followed by surgery for LAOOPSCC. Materials and methods The clinical data of 33 patients with LAOOPSCC who received neoadjuvant PD-1 inhibitors and chemotherapy between April 2021 and October 2022 were retrospectively analyzed. Patients with stage III-IV LAOOPSCC received tislelizumab, albumin-bound paclitaxel, and cisplatin every 3 weeks (Q3W) for two cycles, followed by surgery and adjuvant radiotherapy or concurrent chemoradiotherapy. A median follow-up period was 20 months. Results The objective response rate (ORR) was 66.7%, with the major pathological response (MPR) rate at 54.5%, and the pathological complete response (pCR) rate was 33.3%. Sixteen patients underwent limited surgeries, and 15 patients were remitted from undergoing mandibulectomy and 9 patients were remitted from undergoing near total glossectomy or total glossectomy. A significant difference in the overall survival (OS) and disease-free survival (DFS) was observed in patients who achieved major pathological response (MPR) than who did not. The most common adverse events in neoadjuvant therapy were alopecia, decreased appetite or anorexia, leukopenia, and fatigue. Conclusion Neoadjuvant PD-1 inhibitors combined with chemotherapy are feasible and safe, with a high pathological response and possible organ preservation in oral or oropharyngeal squamous cell carcinoma. However, further studies with a larger cohort of patients and longer follow-up period is required to strengthen our findings and evaluate the survival benefits of the treatment.
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Affiliation(s)
- Wen-Jie Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qian Liu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Pu-Gen An
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Lin Wang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - Jian-Yun Zhang
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yan Chen
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Tong Zhang
- Departmet of Oncology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
- National Center of Stomatology & National Clinical Research Center for Oral Diseases, Beijing, China
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
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17
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Patel SA, Gibson MK, Deal A, Sheth S, Heiling H, Johnson SM, Douglas K, Flores M, Blumberg J, Lumley C, Yarbrough WG, Shen C, Chera BS, Bauman JR, Hackman T, Weiss J. A phase 2 study of neoadjuvant chemotherapy plus durvalumab in resectable locally advanced head and neck squamous cell carcinoma. Cancer 2023; 129:3381-3389. [PMID: 37395170 DOI: 10.1002/cncr.34930] [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: 01/19/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Patients with locally advanced head and neck squamous cell cancer (HNSCC) are treated with surgery followed by adjuvant (chemo) radiotherapy or definitive chemoradiation, but recurrence rates are high. Immune checkpoint blockade improves survival in patients with recurrent/metastatic HNSCC; however, the role of chemo-immunotherapy in the curative setting is not established. METHODS This phase 2, single-arm, multicenter study evaluated neoadjuvant chemo-immunotherapy with carboplatin, nab-paclitaxel, and durvalumab in patients with resectable locally advanced HNSCC. The primary end point was a hypothesized pathologic complete response rate of 50%. After chemo-immunotherapy and surgical resection, patients received study-defined, pathologic risk adapted adjuvant therapy consisting of either durvalumab alone (low risk), involved field radiation plus weekly cisplatin and durvalumab (intermediate risk), or standard chemoradiation plus durvalumab (high risk). RESULTS Between December 2017 and November 2021, 39 subjects were enrolled at three centers. Oral cavity was the most common primary site (69%). A total of 35 of 39 subjects underwent planned surgical resection; one subject had a delay in surgery due to treatment-related toxicity. The most common treatment-related adverse events were cytopenias, fatigue, and nausea. Post treatment imaging demonstrated an objective response rate of 57%. Pathologic complete response and major pathologic response were achieved in 29% and 49% of subjects who underwent planned surgery, respectively. The 1-year progression-free survival was 83.8% (95% confidence interval, 67.4%-92.4%). CONCLUSIONS Neoadjuvant carboplatin, nab-paclitaxel, and durvalumab before surgical resection of HNSCC were safe and feasible. Although the primary end point was not met, encouraging rates of pathologic complete response and clinical to pathologic downstaging were observed.
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Affiliation(s)
- Shetal A Patel
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael K Gibson
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center and the Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, USA
| | - Allison Deal
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Siddharth Sheth
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hillary Heiling
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steven M Johnson
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kathe Douglas
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Flores
- Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jeffrey Blumberg
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Catherine Lumley
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Wendell G Yarbrough
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Colette Shen
- Department of Radiation Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bhishamjit S Chera
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jessica R Bauman
- Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Trevor Hackman
- Department Otolaryngology-Head and Neck Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jared Weiss
- Division of Medical Oncology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Huang S, Xiong C, Tan K. Neoadjuvant PD-1/PD-L1 axis blockade for patients with head and neck squamous cell carcinoma. Am J Otolaryngol 2023; 44:103985. [PMID: 37442083 DOI: 10.1016/j.amjoto.2023.103985] [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: 04/25/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
Head and neck squamous cell carcinoma (HNSCC) is a common type of cancer, and approximately 64 % are in a locally advanced stage at diagnosis. Therefore, neoadjuvant therapy is of great importance. However, traditional neoadjuvant strategies for HNSCC have shown limited efficacy and high complications. And it is urgent to explore new neoadjuvant approaches. With the breakthrough progress of PD-1/PD-L1 axis blockade in recurrent/metastatic HNSCC, neoadjuvant PD-1/PD-L1 axis blockade is gradually showing positive prospects for HNSCC. This study found that the combination of PD-1/PD-L1 axis blockade and chemotherapy or radiotherapy are potential with the overall response rate (ORR) of 45.0 %-96.7 % and 47.6 %-56.7 %, the pathological complete response (pCR) of 16.7 %-42.3 % and 33.3 %-100.0 %, and the main pathological response (MPR) of 26.9 %-74.1 % and 60.0 %-100.0 %, respectively. But the combination of PD-1/PD-L1 axis blockade and CTLA-4 blockade is worth questioning. And we also found pCR and MPR can be early indicators for long-term prognosis and provide five directions for neoadjuvant PD-1/PD-L1 axis blockade in the future.
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Affiliation(s)
- Shuang Huang
- Department of Stomatology, The Affiliated Shapingba Hospital of Chongqing University, Chongqing, China.
| | - Chuang Xiong
- Department of Bone and Soft Tissue Oncology, Chongqing University Cancer Hospital, Chongqing, China
| | - Kui Tan
- Department of Stomatology, Chongqing University Jiangjin Hospital, Chongqing, China
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Worthington HV, Bulsara VM, Glenny AM, Clarkson JE, Conway DI, Macluskey M. Interventions for the treatment of oral cavity and oropharyngeal cancers: surgical treatment. Cochrane Database Syst Rev 2023; 8:CD006205. [PMID: 37650478 PMCID: PMC10476948 DOI: 10.1002/14651858.cd006205.pub5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Surgery is a common treatment option in oral cavity cancer (and less frequently in oropharyngeal cancer) to remove the primary tumour and sometimes neck lymph nodes. People with early-stage disease may undergo surgery alone or surgery plus radiotherapy, chemotherapy, immunotherapy/biotherapy, or a combination of these. Timing and extent of surgery varies. This is the third update of a review originally published in 2007. OBJECTIVES To evaluate the relative benefits and harms of different surgical treatment modalities for oral cavity and oropharyngeal cancers. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 9 February 2022. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared two or more surgical treatment modalities, or surgery versus other treatment modalities, for primary tumours of the oral cavity or oropharynx. DATA COLLECTION AND ANALYSIS Our primary outcomes were overall survival, disease-free survival, locoregional recurrence, and recurrence; and our secondary outcomes were adverse effects of treatment, quality of life, direct and indirect costs to patients and health services, and participant satisfaction. We used standard Cochrane methods. We reported survival data as hazard ratios (HRs). For overall survival, we reported the HR of mortality, and for disease-free survival, we reported the combined HR of new disease, progression, and mortality; therefore, HRs below 1 indicated improvement in these outcomes. We used GRADE to assess certainty of evidence for each outcome. MAIN RESULTS We identified four new trials, bringing the total number of included trials to 15 (2820 participants randomised, 2583 participants analysed). For objective outcomes, we assessed four trials at high risk of bias, three at low risk, and eight at unclear risk. The trials evaluated nine comparisons; none compared different surgical approaches for excision of the primary tumour. Five trials evaluated elective neck dissection (ND) versus therapeutic (delayed) ND in people with oral cavity cancer and clinically negative neck nodes. Elective ND compared with therapeutic ND probably improves overall survival (HR 0.64, 95% confidence interval (CI) 0.50 to 0.83; I2 = 0%; 4 trials, 883 participants; moderate certainty) and disease-free survival (HR 0.56, 95% CI 0.45 to 0.70; I2 = 12%; 5 trials, 954 participants; moderate certainty), and probably reduces locoregional recurrence (HR 0.58, 95% CI 0.43 to 0.78; I2 = 0%; 4 trials, 458 participants; moderate certainty) and recurrence (RR 0.58, 95% CI 0.48 to 0.70; I2 = 0%; 3 trials, 633 participants; moderate certainty). Elective ND is probably associated with more adverse events (risk ratio (RR) 1.31, 95% CI 1.11 to 1.54; I2 = 0%; 2 trials, 746 participants; moderate certainty). Two trials evaluated elective radical ND versus elective selective ND in people with oral cavity cancer, but we were unable to pool the data as the trials used different surgical procedures. Neither study found evidence of a difference in overall survival (pooled measure not estimable; very low certainty). We are unsure if there is a difference in effect on disease-free survival (HR 0.57, 95% CI 0.29 to 1.11; 1 trial, 104 participants; very low certainty) or recurrence (RR 1.21, 95% CI 0.63 to 2.33; 1 trial, 143 participants; very low certainty). There may be no difference between the interventions in terms of adverse events (1 trial, 148 participants; low certainty). Two trials evaluated superselective ND versus selective ND, but we were unable to use the data. One trial evaluated supraomohyoid ND versus modified radical ND in 332 participants. We were unable to use any of the primary outcome data. The evidence on adverse events was very uncertain, with more complications, pain, and poorer shoulder function in the modified radical ND group. One trial evaluated sentinel node biopsy versus elective ND in 279 participants. There may be little or no difference between the interventions in overall survival (HR 1.00, 95% CI 0.90 to 1.11; low certainty), disease-free survival (HR 0.98, 95% CI 0.90 to 1.07; low certainty), or locoregional recurrence (HR 1.04, 95% CI 0.91 to 1.19; low certainty). The trial provided no usable data for recurrence, and reported no adverse events (very low certainty). One trial evaluated positron emission tomography-computed tomography (PET-CT) following chemoradiotherapy (with ND only if no or incomplete response) versus planned ND (before or after chemoradiotherapy) in 564 participants. There is probably no difference between the interventions in overall survival (HR 0.92, 95% CI 0.65 to 1.31; moderate certainty) or locoregional recurrence (HR 1.00, 95% CI 0.94 to 1.06; moderate certainty). One trial evaluated surgery plus radiotherapy versus radiotherapy alone and provided very low-certainty evidence of better overall survival in the surgery plus radiotherapy group (HR 0.24, 95% CI 0.10 to 0.59; 35 participants). The data were unreliable because the trial stopped early and had multiple protocol violations. In terms of adverse events, subcutaneous fibrosis was more frequent in the surgery plus radiotherapy group, but there were no differences in other adverse events (very low certainty). One trial evaluated surgery versus radiotherapy alone for oropharyngeal cancer in 68 participants. There may be little or no difference between the interventions for overall survival (HR 0.83, 95% CI 0.09 to 7.46; low certainty) or disease-free survival (HR 1.07, 95% CI 0.27 to 4.22; low certainty). For adverse events, there were too many outcomes to draw reliable conclusions. One trial evaluated surgery plus adjuvant radiotherapy versus chemotherapy. We were unable to use the data for any of the outcomes reported (very low certainty). AUTHORS' CONCLUSIONS We found moderate-certainty evidence based on five trials that elective neck dissection of clinically negative neck nodes at the time of removal of the primary oral cavity tumour is superior to therapeutic neck dissection, with increased survival and disease-free survival, and reduced locoregional recurrence. There was moderate-certainty evidence from one trial of no difference between positron emission tomography (PET-CT) following chemoradiotherapy versus planned neck dissection in terms of overall survival or locoregional recurrence. The evidence for each of the other seven comparisons came from only one or two studies and was assessed as low or very low-certainty.
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Affiliation(s)
- Helen V Worthington
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Vishal M Bulsara
- School of Medicine, The University of Adelaide, Adelaide, Australia
- Oral and Maxillofacial Surgery, Central Adelaide Local Health Network, SA Health, Adelaide, Australia
| | - Anne-Marie Glenny
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Janet E Clarkson
- Cochrane Oral Health, Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - David I Conway
- Glasgow Dental School, University of Glasgow, Glasgow, UK
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Yokota T, Mukaigawa T, Yasunaga Y, Ogawa H, Onoe T, Yurikusa T, Yamashita A. Multidisciplinary tumor board for head and neck cancer from the perspective of medical oncologists-optimizing its effectiveness. Front Oncol 2023; 13:1257853. [PMID: 37711197 PMCID: PMC10498916 DOI: 10.3389/fonc.2023.1257853] [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: 07/13/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Head and neck cancer (HNC) treatment is becoming increasingly multidisciplinary, and patient characteristics vary. Therefore, a multidisciplinary tumor board (MTB) is essential in clinical practice. This review provides insights into the benefits and tips for improving head and neck MTB from the perspective of medical oncologists. The MTB is a platform to discuss the optimal application of the standard of care to each case, reach a consensus, and establish a recommendation to support patients' decision-making. A productive and educational MTB also provides an opportunity to share information on ongoing clinical trials with physicians. Case presentations should be systematic to discuss all new and challenging cases before, during, and after the treatment. Human resource development, particularly of head and neck medical oncologists, is crucial. The type of multidisciplinary network between medical staff and the extent of patient intervention differs among MTB teams. Subsequently, a virtual MTB can establish a medical network between institutions that will contribute to the equalization and centralization of head and neck oncologic care.
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Affiliation(s)
- Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Mukaigawa
- Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yoshichika Yasunaga
- Division of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Ogawa
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Tsuyoshi Onoe
- Division of Radiation Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Yurikusa
- Division of Dentistry and Oral Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Aiko Yamashita
- Division of Nutrition, Shizuoka Cancer Center, Shizuoka, Japan
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21
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Mohamad I, Glaun MDE, Prabhash K, Busheri A, Lai SY, Noronha V, Hosni A. Current Treatment Strategies and Risk Stratification for Oral Carcinoma. Am Soc Clin Oncol Educ Book 2023; 43:e389810. [PMID: 37200591 DOI: 10.1200/edbk_389810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Management of oral cavity squamous cell carcinoma (OSCC) involves a multidisciplinary team approach. Surgery is ideally the primary treatment option for nonmetastatic OSCC, and less invasive curative surgical approaches are preferred in early-stage disease to minimize surgical-related morbidity. For patients at high risk of recurrence, adjuvant treatment using radiation therapy or chemoradiation is often used. Systemic therapy may also be used in the neoadjuvant setting (for advanced-stage disease with the intent of mandibular preservation) or in the palliative setting (for nonsalvageable locoregional recurrence and/or distant metastases). Patient involvement in treatment decision is the key for patient-driven management, particularly in clinical situation with poor prognosis, for example, early postoperative recurrence before planned adjuvant therapy.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mica D E Glaun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ahmed Busheri
- Department of Radiation Oncology, Kuwait Cancer Control Center, Kuwait
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
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22
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Ju W, Zhang Y, Liu Y, Sun J, Li J, Dong M, Sun Q, Shi W, Zhao T, Zhou Z, Huang Y, Zhou X, Zhu D, Dou S, Zhang Z, He Y, Zhang C, Xia R, Zhu G, Zhong L. Can adjuvant radiotherapy be omitted for oral cavity cancer patients who received neoadjuvant therapy and surgery? A retrospective cohort study. Int J Surg 2023; 109:879-886. [PMID: 36999830 PMCID: PMC10389426 DOI: 10.1097/js9.0000000000000353] [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: 12/15/2022] [Accepted: 03/09/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Surgery and postoperative adjuvant therapy comprise the standard treatment for locally advanced resectable oral squamous cell carcinoma (LAROSCC), while preoperative neoadjuvant therapy is being explored without sufficient confirmation of improved survival. De-escalation regimens after neoadjuvant therapy, such as those omitting adjuvant radiotherapy, may provide comparable or better outcomes, suggesting rigorous assessment of adjuvant therapy outcomes is needed in LAROSCC patients. The authors thus performed this retrospective study in LAROSCC patients who received neoadjuvant therapy and surgery, to compare the outcomes for overall survival (OS) and locoregional recurrence-free survival (LRFS) between the adjuvant radiotherapy (radio) and nonradiotherapy (nonradio) cohorts. MATERIALS AND METHODS Patients diagnosed with LAROSCC who received neoadjuvant therapy and surgery were enrolled and divided into radio and nonradio cohorts to determine whether adjuvant radiotherapy could be omitted after neoadjuvant therapy and surgery. RESULTS From 2008 to 2021, 192 patients were enrolled. No significant differences were found in OS or LRFS between the radio and nonradio patient cohorts. The 10-year estimated OS rates were 58.9 versus 44.1% in radio versus nonradio cohorts, while 10-year estimated LRFS rates were 55.4 versus 48.2%, respectively. For clinical stage III patients, 10-year OS rates were 62.3 versus 62.6% (radio vs. nonradio), and estimated 10-year LRFS rates were 56.5 versus 60.7% (radio vs. nonradio). Multivariate Cox regression modeling of postoperative variables showed pathologic response of primary tumor and pathologic regional lymph nodes staging were associated with survival, while the adjuvant radiotherapy exposure was not included in the model due to nonsignificance. CONCLUSION These findings support further prospective evaluation of adjuvant radiotherapy omission, and suggest that de-escalation trials are warranted for LAROSCC surgery patients who received neoadjuvant therapy.
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Affiliation(s)
- Wutong Ju
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Yiyi Zhang
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Ying Liu
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | | | | | | | | | - Wentao Shi
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University
| | - Tongchao Zhao
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Zhihang Zhou
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Yingying Huang
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Xinyu Zhou
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Dongwang Zhu
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Shengjin Dou
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Zhiyuan Zhang
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Yue He
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Chenping Zhang
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | | | - Guopei Zhu
- Departments of Oral and Maxillofacial-Head and Neck Oncology
| | - Laiping Zhong
- Departments of Oral and Maxillofacial-Head and Neck Oncology
- National Center for Stomatology
- National Clinical Research Center for Oral Diseases
- Shanghai Key Laboratory of Stomatology
- Shanghai Research Institute of Stomatology, Shanghai, People’s Republic of China
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23
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Fu JY, Yue XH, Dong MJ, Li J, Zhang CP, Zhang ZY. Assessment of neoadjuvant chemotherapy with docetaxel, cisplatin, and fluorouracil in patients with oral cavity cancer. Cancer Med 2022; 12:2417-2426. [PMID: 35880556 PMCID: PMC9939210 DOI: 10.1002/cam4.5075] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chemotherapy with docetaxel, cisplatin, and fluorouracil (TPF) has been studied in patients with head and neck cancer. Its impact on patients with oral cavity cancer was not specified. METHODS We consecutively reviewed medical files of patients with untreated oral cavity cancer who received neoadjuvant TPF chemotherapy in our department from January 2017 to April 2020. Outcomes included the objective response to TPF chemotherapy, factors associated with the response, and progression and survival in different response groups. RESULTS A total of 167 patients were included, with half of stage IV disease. Complete or partial response was observed in 51 patients. A total of 91 patients had stable disease, and 25 patients had progressive disease. The response was not associated with age, sex, anatomic subsite, and the tumor's T stage. It was related with N stage (p < 0.001) and clinical stage (p = 0.004). Most patients with bulky nodes or nodes with obvious necrosis showed low response or even progressed after neoadjuvant TPF chemotherapy. The planned surgery was conducted in 159 patients. Disease relapse mostly occurred in 2 years after treatment. The 2-year overall survival and the progression-free survival were 89.0% and 85.2% for patients with complete or partial response, 62.4% and 55.6% for patients with stable disease, and 12.5% and 4.2% for patients with progressive disease, respectively. CONCLUSIONS The response of neoadjuvant TPF chemotherapy in patients with oral cavity cancer is related to disease stage, especially the nodal stage. Patients with complete or partial response developed less progression events and better survival.
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Affiliation(s)
- Jin Ye Fu
- Department of Oral & Maxillofacial – Head & Neck Oncology, Shanghai Ninth People's HospitalCollege of Stomatology, Shanghai Jiao Tong University School of MedicineShanghaiChina,National Clinical Research Center for Oral Diseases & National Center for StomatologyShanghaiChina,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of StomatologyShanghaiChina
| | - Xiu Hui Yue
- Department of RadiologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Min Jun Dong
- Department of RadiologyShanghai Ninth People's Hospital, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jiang Li
- National Clinical Research Center for Oral Diseases & National Center for StomatologyShanghaiChina,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of StomatologyShanghaiChina,Department of Oral PathologyShanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chen Ping Zhang
- Department of Oral & Maxillofacial – Head & Neck Oncology, Shanghai Ninth People's HospitalCollege of Stomatology, Shanghai Jiao Tong University School of MedicineShanghaiChina,National Clinical Research Center for Oral Diseases & National Center for StomatologyShanghaiChina,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of StomatologyShanghaiChina
| | - Zhi Yuan Zhang
- Department of Oral & Maxillofacial - Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases & National Center for Stomatology, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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24
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McDowell L, Chua MLK, Beadle BM, Ma DJ, Mierzwa M, Thomson DJ, Margalit DN. A Bit More Here and a Little Less There: The Trials (and Tribulations) of Adjuvant and Neoadjuvant Head and Neck Studies in 2021. Int J Radiat Oncol Biol Phys 2022; 113:243-251. [PMID: 35569469 DOI: 10.1016/j.ijrobp.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
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