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Rich BJ, Samuels SE, Azzam GA, Kubicek G, Freedman L. Oral Cavity Squamous Cell Carcinoma: Review of Pathology, Diagnosis, and Management. Crit Rev Oncog 2024; 29:5-24. [PMID: 38683151 DOI: 10.1615/critrevoncog.2023050055] [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: 05/01/2024]
Abstract
Squamous cell carcinoma of the oral cavity presents a significant global health burden, primarily due to risk factors such as tobacco smoking, smokeless tobacco use, heavy alcohol consumption, and betel quid chewing. Common clinical manifestations of oral cavity cancer include visible lesions and sores, often accompanied by pain in advanced stages. Diagnosis relies on a comprehensive assessment involving detailed history, physical examination, and biopsy. Ancillary imaging studies and functional evaluations aid in accurate staging and facilitate treatment planning. Prognostic information is obtained from histopathological factors, such as tumor grade, depth of invasion, lymphovascular invasion, and perineural invasion. Notably, lymph node metastasis, found in approximately half of the patients, carries significant prognostic implications. Effective management necessitates a multidisciplinary approach to optimize patient outcomes. Surgical resection is the backbone of treatment, aimed at complete tumor removal while preserving functional outcomes. Adjuvant therapies, including radiation and chemotherapy, are tailored according to pathological factors. Further work in risk stratification and treatment is necessary to optimize outcomes in squamous cell carcinoma of the oral cavity.
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Affiliation(s)
| | | | - Gregory A Azzam
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Gregory Kubicek
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
| | - Laura Freedman
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine
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Nangia S, Gaikwad U, Noufal MP, Sawant M, Wakde M, Mathew A, Chilukuri S, Sharma D, Jalali R. Proton therapy and oral mucositis in oral & oropharyngeal cancers: outcomes, dosimetric and NTCP benefit. Radiat Oncol 2023; 18:121. [PMID: 37468950 DOI: 10.1186/s13014-023-02317-1] [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: 09/01/2022] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION Radiation-induced oral mucositis (RIOM), is a common, debilitating, acute side effect of radiotherapy for oral cavity (OC) and oropharyngeal (OPx) cancers; technical innovations for reducing it are seldom discussed. Intensity-modulated-proton-therapy (IMPT) has been reported extensively for treating OPx cancers, and less frequently for OC cancers. We aim to quantify the reduction in the likelihood of RIOM in treating these 2 subsites with IMPT compared to Helical Tomotherapy. MATERIAL AND METHODS We report acute toxicities and early outcomes of 22 consecutive patients with OC and OPx cancers treated with IMPT, and compare the dosimetry and normal tissue complication probability (NTCP) of ≥ grade 3 mucositis for IMPT and HT. RESULTS Twenty two patients, 77% males, 41% elderly and 73% OC subsite, were reviewed. With comparable target coverage, IMPT significantly reduced the mean dose and D32, D39, D45, and D50, for both the oral mucosa (OM) and spared oral mucosa (sOM). With IMPT, there was a 7% absolute and 16.5% relative reduction in NTCP for grade 3 mucositis for OM, compared to HT. IMPT further reduced NTCP for sOM, and the benefit was maintained in OC, OPx subsites and elderly subgroup. Acute toxicities, grade III dermatitis and mucositis, were noted in 50% and 45.5% patients, respectively, while 22.7% patients had grade 3 dysphagia. Compared with published data, the hospital admission rate, median weight loss, feeding tube insertion, unplanned treatment gaps were lower with IMPT. At a median follow-up of 15 months, 81.8% were alive; 72.7%, alive without disease and 9%, alive with disease. CONCLUSION The dosimetric benefit of IMPT translates into NTCP reduction for grade 3 mucositis compared to Helical Tomotherapy for OPx and OC cancers and encourages the use of IMPT in their management.
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Affiliation(s)
- Sapna Nangia
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic Estate, Taramani, Chennai, Tamil Nadu, India.
| | - Utpal Gaikwad
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic Estate, Taramani, Chennai, Tamil Nadu, India
| | - M P Noufal
- Department of Medical Physics, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Mayur Sawant
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - Manoj Wakde
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic Estate, Taramani, Chennai, Tamil Nadu, India
| | - Ashwathy Mathew
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic Estate, Taramani, Chennai, Tamil Nadu, India
| | - Srinivas Chilukuri
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic Estate, Taramani, Chennai, Tamil Nadu, India
| | - Dayananda Sharma
- Department of Medical Physics, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic Estate, Taramani, Chennai, Tamil Nadu, India
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Mohamad I, Abu Hejleh T, Abdelqader S, Wahbeh L, Taqash A, Almousa A, Mayta E, Al-Ibraheem A, Abuhijla F, Abu-Hijlih R, Hussein T, Al-Gargaz W, Ghatasheh H, Hosni A. Re-Irradiation for Recurrent Head and Neck Cancer: Freedom from Cancer Recurrence Rate. J Clin Med 2023; 12:jcm12082979. [PMID: 37109315 PMCID: PMC10145776 DOI: 10.3390/jcm12082979] [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: 02/20/2023] [Revised: 04/04/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Salvage re-irradiation (rRT) for patients with locoregionally recurrent head and neck cancer (rHNC) remains challenging. A retrospective analysis was performed on 49 patients who received rRT between 2011 and 2018. The co-primary endpoint of the study was 2-year freedom from cancer recurrence rate (FCRR) and overall survival (OS), and secondary endpoints were 2-year disease-free survival (DFS), local failure (LF), regional failure (RF), distant metastases (DM), and RTOG grade 3 ≥ late toxicities. Adjuvant and definitive rRT were delivered to 22 and 27 patients, respectively. A total of 91% of patients were managed with conventional re-RT and 71% of patients received concurrent chemotherapy. The median follow-up after rRT was 30 months. The 2-year FCRR, OS, DFS, LF, RF, and DM were 64%, 51%, 28%, 32%, 9%, and 39% respectively. MVA showed that poor performance status (PS: 1-2 vs. 0) and age > 52 years were predictive of worse OS. In comparison, poor PS (1-2 vs. 0) and total dose of rRT < 60 Gy were predictive of worse DFS. Late RTOG toxicity of grade 3 ≥ was reported in nine (18.3%) patients. FCRR at 2 years after salvage rRT for rHNC was higher than other traditional endpoints and could be an important endpoint to be included in future rRT studies. rRT for rHNC at our cohort was relatively successful, with a manageable level of late severe toxicity. Replacing this approach in other developing countries is a viable option.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Taher Abu Hejleh
- Department of Medical Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Sania Abdelqader
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Lina Wahbeh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Ayat Taqash
- Department of Biostatistics, King Hussein Cancer Center, Amman 11942, Jordan
| | - Abdelatif Almousa
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Ebrahim Mayta
- Department of Surgical Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman 11942, Jordan
| | - Fawzi Abuhijla
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Ramiz Abu-Hijlih
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Tariq Hussein
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Wisam Al-Gargaz
- Department of Surgical Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Hamza Ghatasheh
- Department of Radiation Oncology, King Hussein Cancer Center, Amman 11942, Jordan
| | - Ali Hosni
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada
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Prognostic Impact of Sarcopenia's Occurrence during Radiotherapy in Oropharyngeal Cancer Patients. Cancers (Basel) 2023; 15:cancers15030723. [PMID: 36765681 PMCID: PMC9913355 DOI: 10.3390/cancers15030723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
The current study aims to profile sarcopenic condition (both at baseline and developed during treatment) in oropharyngeal carcinoma (OPC) patients treated with curative radiotherapy (RT) +/- chemotherapy and to evaluate its impact on oncological outcomes and toxicity. A total of 116 patients were included in this retrospective single-center study. Sarcopenia assessment at baseline and at 50 Gy re-evaluation CT was obtained from two different methodologies: (i) the L3-skeletal muscle index (SMI) derived from the contouring of the cross-sectional area (CSA) of the masticatory muscles (CSA-MM); and (ii) the paravertebral and sternocleidomastoid muscles at the level of the third cervical vertebra (CSA-C3). Based on L3-SMI from CSA-MM, developing sarcopenic condition during RT (on-RT sarcopenia) was associated with worse progression-free survival (PFS) (p = 0.03) on multivariable analysis and a trend of correlation with overall survival (OS) was also evident (p = 0.05). According to L3-SMI derived from CSA-C3, on-RT sarcopenia was associated with worse PFS (p = 0.0096) and OS (p = 0.013) on univariate analysis; these associations were not confirmed on multivariable analysis. A significant association was reported between becoming on-RT sarcopenia and low baseline haemoglobin (p = 0.03) and the activation of nutritional counselling (p = 0.02). No significant associations were found between sarcopenia and worse RT toxicity. Our data suggest that the implementation of prompt nutritional support to prevent the onset of sarcopenia during RT could improve oncological outcomes in OPC setting.
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Gaikwad U, Mookaiah M, Karthekeyan S, Wakde M, Noufal M, Chilukuri S, Sharma D, Jalali R, Nangia S. Standard Operating Procedure (SOP) for mould room practices and simulation of head neck cancer patients undergoing proton therapy. Tech Innov Patient Support Radiat Oncol 2022; 24:48-53. [PMID: 36217346 PMCID: PMC9547284 DOI: 10.1016/j.tipsro.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/27/2022] [Accepted: 09/14/2022] [Indexed: 12/01/2022] Open
Abstract
Critical role of immobilization and simulation in head neck cancer patients undergoing radiation therapy. Special requirements of proton HN immobilization and simulation. Details of immobilization materials/equipment used for HN immobilization. Detailed steps of all mould room procedures for HN proton patients.
Head Neck cancer patients treated with modern proton therapy need special attention during mould room procedures. In addition to usual mould room practices, patients undergoing Intensity Modulated Proton Therapy (IMPT) require attention to the special characteristics of protons viz., sensitivity to beam path and its alteration, sharp dose fall off and end of range. In this article, we discuss the Standard Operating Procedure (SOP) for HNC immobilization and simulation for IMPT, developed and practiced at our centre. The SOP details each step during the immobilization and simulation process, with nuances specific to IMPT.
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Affiliation(s)
- Utpal Gaikwad
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Minnal Mookaiah
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - S. Karthekeyan
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Manoj Wakde
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - M.P. Noufal
- Department of Medical Physics, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Srinivas Chilukuri
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Dayananda Sharma
- Department of Medical Physics, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Sapna Nangia
- Department of Radiation Oncology, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
- Corresponding author at: Radiation Oncology, Apollo Proton Cancer Centre, Dr. Vikram Sarabhai Instronic Estate, Taramani, Chennai, India.
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Abstract
ABSTRACT Head and neck squamous cell carcinomas are rising in incidence worldwide, and despite the advent of improved surgical and radiation techniques, a substantial proportion of patients have disease recurrence, where systemic therapies are the mainstay of management. Recent advances in systemic therapy include the development of epidermal growth factor receptor- and programmed death 1-targeting drugs, which have produced incremental improvements in disease outcomes. However, for most patients, responses to treatment remain elusive because of primary or acquired resistance. Novel drugs and rational drug combinations need to be tested based on biomarker identification and preclinical science that will ultimately advance outcomes for our patients. This review focuses on efforts untaken for epidermal growth factor receptor targeting in head and neck squamous cell carcinoma to date.
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Thariat J, Calugaru V, Aloi D, Maingon P, Grégoire V. Head and neck proton therapy in France: A missed opportunity or a challenge in front of us? Cancer Radiother 2021; 25:537-544. [PMID: 34272183 DOI: 10.1016/j.canrad.2021.06.018] [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: 06/10/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
Following major advances of the best of photon-techniques such as intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT) and, to arrive soon, magnetic resonance (MR)-linac radiotherapy, there are still substantial opportunities in the treatment of head and neck cancers to further reduce the toxicity burden. Proton therapy represents another attractive option in this high-quality and highly competitive precision radiotherapy landscape. Proton therapy holds promises to reduce toxicities and to escalate the dose in radioresistant cases or cases where dose distribution is not satisfactory with photons. However, the selection of patients for proton therapy needs to be done using evidence-based medicine to build arguments in favor of personalized precision radiation therapy. Referral to proton therapy versus IMRT or SBRT should be registered (ProtonShare® platform) and envisioned in a formalized clinical research perspective through randomized trials. The use of an enrichment process using a model-based approach should be done to only randomize patients doomed to benefit from proton. To tackle such great opportunities, the French proton therapy challenge is to collaborate at the national and international levels, and to demonstrate that the extra-costs of treatment are worth clinically and economically in the short, mid, and long-term. In parallel to the clinical developments, there are still preclinical issues to be tackled (e.g., proton FLASH, mini-beams, combination with immunotherapy), for which the French Radiotransnet network offers a unique platform. The current article provides a personal view of the challenges and opportunities with a focus on clinical research and randomized trial requirements as well as the needs for strong collaborations at the national and international levels for PT in squamous cell carcinomas of the head and neck to date.
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Affiliation(s)
- J Thariat
- Department of Radiation Oncology, Centre François-Baclesse, Caen, France; Laboratoire de physique Corpusculaire IN2P3/ENSICAEN/CNRS UMR 6534, Normandie Université, Caen, France; GORTEC - Intergroupe ORL, Tours, France.
| | - V Calugaru
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - D Aloi
- Department of Radiation Oncology, Centre Antoine-Lacassagne, Côte d'Azur University, Provence-Alpes-Côte d'Azur, Nice, France
| | - P Maingon
- Department of Oncology Radiotherapy, CLIP (2) Galilée, Institut Universitaire de Cancérologie (IUC), Sorbonne University, Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - V Grégoire
- Radiation Oncology Department, Centre Léon-Bérard, Lyon, France
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