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Jiménez-Labaig P, Rullan A, Hernando-Calvo A, Llop S, Bhide S, O'Leary B, Braña I, Harrington KJ. A systematic review of antibody-drug conjugates and bispecific antibodies in head and neck squamous cell carcinoma and nasopharyngeal carcinoma: Charting the course of future therapies. Cancer Treat Rev 2024; 128:102772. [PMID: 38820656 DOI: 10.1016/j.ctrv.2024.102772] [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: 04/19/2024] [Revised: 05/24/2024] [Accepted: 05/24/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION There is a need to improve the outcomes of patients with head and neck squamous cell carcinoma (HNSCC) and nasopharyngeal carcinoma (NPC), especially in recurrent unresectable and metastatic (R/M) setting. Antibody-drug conjugates (ADC) and bispecific antibodies (BsAb) may deliver promising results. METHODS We conducted a systematic literature review to identify ADC and BsAb clinical trials, involving patients with HNSCC and NPC, from database creation to December 2023. We reported trial characteristics, overall response rate (ORR), overall survival (OS), and grade ≥ 3 treatment-related adverse events (trAEs). RESULTS 23 trials (65 % phase I) were found, involving 540 R/M patients (355 [20trials] HNSCC and 185 [5trials] NPC). There were 13 ADC (n = 343) and 10 BsAb (n = 197) trials. 96 % patients were refractory to standard of care treatments. ORR ranged from 0 to 100 %, with the highest ORR for GEN1042 plus chemoimmunotherapy. ORRs for monotherapies were 47 % for ADC, and 0-37 % for BsAb. MRG003 reached in HNSCC 43 % and NPC 47 %. BL-B01D1 54 % in NPC. Longest median OS was seen with MRG003 and KN046. Grade ≥ 3 trAEs were 28-60 % in ADC trials, and 3-33 % BsAb. Grade ≥ 3 myelosuppressive trAEs were typically seen in 8 ADC trials, while 4 BsAb showed infusion-related reactions (IRR). Four treatment-related deaths were reported (1 pneumonitis), all ADC trials. CONCLUSION ADC and BsAb antibodies show promise in R/M HNSCC and NPC. Results are premature by small sample sizes and lack of control arm. ADC mainly caused myelosuppression and a pneumonitis case, and BsAb IRR. Further research is warranted in this setting.
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Affiliation(s)
- Pablo Jiménez-Labaig
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, Division of Radiotherapy and Imaging, London, United Kingdom
| | - Antonio Rullan
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, Division of Radiotherapy and Imaging, London, United Kingdom
| | - Alberto Hernando-Calvo
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Early Phase Clinical Trials Unit (UITM), Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Sandra Llop
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Shreerang Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, Division of Radiotherapy and Imaging, London, United Kingdom
| | - Ben O'Leary
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, Division of Radiotherapy and Imaging, London, United Kingdom
| | - Irene Braña
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Early Phase Clinical Trials Unit (UITM), Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain; Lung and Head & Neck Tumors Unit, Department of Medical Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Kevin J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, Division of Radiotherapy and Imaging, London, United Kingdom
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Jimenez-Labaig P, Aymerich C, Braña I, Rullan A, Cacicedo J, González-Torres MÁ, Harrington KJ, Catalan A. A comprehensive examination of mental health in patients with head and neck cancer: systematic review and meta-analysis. JNCI Cancer Spectr 2024; 8:pkae031. [PMID: 38702757 PMCID: PMC11149920 DOI: 10.1093/jncics/pkae031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/04/2024] [Accepted: 04/18/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Patients with head and neck cancer present particularly considerable levels of emotional distress. However, the actual rates of clinically relevant mental health symptoms and disorders among this population remain unknown. METHODS A Preferred Reporting Items for Systematic Review and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology-compliant systematic review and quantitative random-effects meta-analysis was performed to determine suicide incidence and the prevalence of depression, anxiety, distress, posttraumatic stress, and insomnia in this population. MEDLINE, Web of Science, Cochrane Central Register, KCI Korean Journal database, SciELO, Russian Science Citation Index, and Ovid-PsycINFO databases were searched from database inception to August 1, 2023 (PROSPERO: CRD42023441432). Subgroup analyses and meta-regressions were performed to investigate the effect of clinical, therapeutical, and methodological factors. RESULTS A total of 208 studies (n = 654 413; median age = 60.7 years; 25.5% women) were identified. Among the patients, 19.5% reported depressive symptoms (95% confidence interval [CI] = 17% to 21%), 17.8% anxiety symptoms (95% CI = 14% to 21%), 34.3% distress (95% CI = 29% to 39%), 17.7% posttraumatic symptoms (95% CI = 6% to 41%), and 43.8% insomnia symptoms (95% CI = 35% to 52%). Diagnostic criteria assessments revealed lower prevalence of disorders: 10.3% depression (95% CI = 7% to 13%), 5.6% anxiety (95% CI = 2% to 10%), 9.6% insomnia (95% CI = 1% to 40%), and 1% posttraumatic stress (95% CI = 0% to 84.5%). Suicide pooled incidence was 161.16 per 100 000 individuals per year (95% CI = 82 to 239). Meta-regressions found a statistically significant higher prevalence of anxiety in patients undergoing primary chemoradiation compared with surgery and increased distress in smokers and advanced tumor staging. European samples exhibited lower prevalence of distress. CONCLUSIONS Patients with head and neck cancer presented notable prevalence of mental health concerns in all domains. Suicide remains a highly relevant concern. The prevalence of criteria-meeting disorders is significantly lower than clinically relevant symptoms. Investigating the effectiveness of targeted assessments for disorders in highly symptomatic patients is essential.
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Affiliation(s)
- Pablo Jimenez-Labaig
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, National Institute of Health Research Biomedical Research Centre, London, UK
| | - Claudia Aymerich
- Psychiatry Department, Basurto University Hospital. Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Irene Braña
- Lung and Head & Neck Tumors Unit. Medical Oncology Department, Vall d‘Hebron University Hospital, Barcelona, Spain
- Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Antonio Rullan
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, National Institute of Health Research Biomedical Research Centre, London, UK
| | - Jon Cacicedo
- Radiotherapy Department, Cruces University Hospital, Barakaldo, Spain
- Biobizkaia Health Research Institute, OSI Ezkerraldea Enkarterri Cruces, Barakaldo, Spain
- Faculty of Medicine, University of the Basque Country, Leioa, Spain
| | - Miguel Ángel González-Torres
- Psychiatry Department, Basurto University Hospital. Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Kevin J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, National Institute of Health Research Biomedical Research Centre, London, UK
| | - Ana Catalan
- Psychiatry Department, Basurto University Hospital. Osakidetza, Basque Health Service, Bilbao, Spain
- Biobizkaia Health Research Institute, OSI Bilbao-Basurto, Bilbao, Spain
- Centro de Investigación en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Neuroscience Department, University of the Basque Country (UPV/EHU), Leioa, Spain
- Department of Psychiatry, University of Oxford, Oxford, UK
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van den Besselaar BN, Sewnaik A, Hoesseini A, Dorr MC, Baatenburg de Jong RJ, Offerman MPJ. Causes and Ways of Death in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2024; 150:303-310. [PMID: 38358760 PMCID: PMC10870226 DOI: 10.1001/jamaoto.2023.4694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/15/2023] [Indexed: 02/16/2024]
Abstract
Importance There is limited literature on the exact causes and ways of death in patients with head and neck cancer. To provide optimal care, especially in the palliative phase, more information on this is needed. Objective To provide insights into the causes and ways of death among patients with head and neck cancer. Design, Setting, and Participants This retrospective cohort study included a consecutive population of patients who received a diagnosis of primary squamous cell carcinoma of the head and neck between January 2006 and December 2013 who were treated in the Erasmus MC. Patient data were merged with nonpublic microdata from Statistics Netherlands. Follow-up time was specified as the date of diagnosis until death or December 3, 2019, whichever came first. The data were checked and reanalyzed in November 2023. Main outcomes and Measures Causes (eg, head and neck cancer, other cancer) and ways (eg, natural death, suicide) of death. Results A total of 1291 patients (59.2%; 342 women [26.5%]) died during follow-up (median [IQR] follow-up, 2.7 [1.2-5.6] years). The main cause of death was head and neck cancer (557 [43.1%]), followed by the competing cause of other cancers (344 [26.6%]). In total, 240 patients (18.6%) received palliative sedation and 70 patients (5.4%) euthanasia. Compared with patients with head and neck cancer as the underlying cause of death, lower odds ratios (ORs) were observed for receiving palliative sedation (OR, 0.32 vs 0.07; 95% CI, 0.22-0.46 vs 0.03-0.12) and euthanasia (OR, 0.22 vs 0.01; 95% CI, 0.11-0.41 vs 0-0.107) in patients with other causes of death. Patients with a middle and high income had higher ORs for receiving palliative sedation (OR, 1.46 vs 1.86; 95% CI, 1.05-2.04 vs 1.22-2.85) or euthanasia (OR, 2.25 vs 3.37; 95% CI, 1.18-4.3, 1.6-7.12) compared with low-income patients. Retired patients had lower ORs for receiving palliative sedation or euthanasia compared with employed patients (OR, 0.56 vs 0.44; 95% CI, 0.39-0.8 vs 0.24-0.82). Conclusion and Relevance The results of this cohort study suggest that more than half of the patients died of competing causes and palliative sedation and euthanasia were more common in patients with head and neck cancer as the underlying cause of death. Patients with a higher socioeconomic status had higher odds of receiving palliative sedation and euthanasia. These insights may support health care professionals in providing patient-centered care, especially for patients in the palliative phase.
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Affiliation(s)
- Boyd N. van den Besselaar
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Arta Hoesseini
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Maarten C. Dorr
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Robert. J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Marinella P. J. Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
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Guller M, Cooper DJ, Alkhatib H, Suru A, Blancaflor A, Maroun CA, Tham T, Allen H, Mazzara E, Thomas J, Amin N, Wu E, Eisele DW, Fakhry C, Pardoll D, Seiwert TY, Zhu G, Mandal R. Impact of comorbidities on outcomes in patients with advanced head and neck cancer undergoing immunotherapy. Head Neck 2023; 45:2789-2797. [PMID: 37682116 PMCID: PMC10634321 DOI: 10.1002/hed.27502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/31/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
OBJECTIVES To explore the impact of pre-existing comorbidities on immunotherapy response, overall and progression-free survival, and immune-related adverse events (irAEs) of patients with advanced head and neck cancer (HNC) treated with immunotherapy. PATIENTS AND METHODS Ninety-three patients treated with immunotherapy were identified and stratified into comorbidity absent or present (CCI < 1 and CCI ≥ 1, respectively) cohorts, and clinical outcomes were compared between these two groups. RESULTS Patients with no comorbidities had longer overall survival (aHR = 2.74, 95% CI [1.18, 6.40], p = 0.02) and progression-free survival (aHR = 2.07, 95% CI [1.03, 4.16], p = 0.04) and a higher tumor response rate (32% in CCI < 1 vs. 14% in CC ≥ 1, p = 0.05). Risk for irAEs was higher in the comorbidity absent group (p = 0.05). CONCLUSION Comorbidity should be considered as a significant prognostic factor in clinical decision-making for patients with advanced HNC undergoing immunotherapy.
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Affiliation(s)
- Meytal Guller
- Department of Otolaryngology—Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Bloomberg–Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Dylan J. Cooper
- Department of Otolaryngology—Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Hosam Alkhatib
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Aditya Suru
- Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Angelo Blancaflor
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Christopher A. Maroun
- Bloomberg–Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Tristan Tham
- Department of Otolaryngology—Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Hailey Allen
- Bloomberg–Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Eden Mazzara
- Department of Otolaryngology—Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Jerin Thomas
- Department of Otolaryngology—Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - Neha Amin
- Bloomberg–Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Evan Wu
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - David W. Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Drew Pardoll
- Bloomberg–Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Tanguy Y. Seiwert
- Bloomberg–Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD, USA
- Department of Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - Gangcai Zhu
- Bloomberg–Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Rajarsi Mandal
- Department of Otolaryngology—Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Bloomberg–Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MD, USA
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Denaro N, Succo G, Ostellino O, Airoldi M, Merlano MC, Badellino S, Solinas C, Garrone O, Iorio GC. The oligometastatic setting in HNSCC: A critical review by the Rete Oncologica Piemonte e Valle d'Aosta multidisciplinary team. Crit Rev Oncol Hematol 2023; 185:103968. [PMID: 36965646 DOI: 10.1016/j.critrevonc.2023.103968] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION The oligometastatic disease is a low burden metastatic disease that might still benefit from curable treatment. Squamous cell carcinoma of the head and neck (HNSCC) is a complex group of malignancies, with high rates of loco-regional recurrences. Distant metastases are less frequent, and a single or few deposits are often observed (oligometastatic disease). The optimal management of oligometastatic HNSCC remains to be defined. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of the available evidence on the management of oligometastatic HNSCC patients, with a focus on metastasis-directed therapy (MDT), particularly stereotactic ablative radiotherapy (SABR). CONCLUSIONS in line with literature data, the multidisciplinary evaluation emerged as the key element in the management of oligometastatic HNSCC patients.
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Affiliation(s)
- Nerina Denaro
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Giovanni Succo
- Oncology Department, Head & Neck Surgery, University of Turin, Turin, Italy
| | - Oliviero Ostellino
- Oncology Unit 2, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mario Airoldi
- Oncology Unit 2, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Carlo Merlano
- Scientific Direction, Candiolo Cancer Institute, FPO-IRCCS Candiolo, 10060 Torino, Italy
| | - Serena Badellino
- Department of Oncology, University of Torino, 10125 Torino, Italy
| | - Cinzia Solinas
- Oncology Department AOU Cagliari, Policlinico di Monserrato, Monserrato (CA) Italy
| | - Ornella Garrone
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
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Wang Y, Zhou B, Chen WL, Huang ZX, Chen R. Facial-submental island flap for reconstruction of hemitongue defects in young, middle-aged and elderly patients with early and middle stage oral tongue squamous cell carcinoma. Head Face Med 2022; 18:39. [PMID: 36471377 PMCID: PMC9720977 DOI: 10.1186/s13005-022-00343-0] [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: 08/08/2022] [Accepted: 10/03/2022] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND This study evaluated the outcomes of facial-submental artery island flap (FSAIF) for reconstruction of the hemitongue following cancer ablation in patients with early and middle-stage oral tongue squamous cell carcinoma (OTSCC). METHODS In total, 122 patients with early and middle-stage OTSCC were divided into young, middle-aged, and elderly groups. The Adult Comorbidity Evaluation-27 (ACE-27) index was used to determine the presence of comorbidities. The patients underwent surgical treatment with hemiglossectomy, neck dissection, and hemitongue reconstruction using FSAIF. In addition, stage I (n = 15) and II (n = 69) patients underwent ipsilateral selective neck dissection, whereas those with stage III (n = 38) underwent radical neck dissection. Six patients with T3N1 disease also underwent cobalt-60 adjuvant radiotherapy. RESULTS Young and elderly patients exhibited significant differences in comorbidities, as assessed by the ACE-27 (p < .05). The skin paddles in the young, middle-aged, and elderly patients were 3 × 9 to 4 × 12 cm, 3 × 11 to 4 × 12, and 3 × 10 to 5 × 13 cm in size, respectively. FSAIF failure occurred in four patients (success rate: 96.7%). No significant differences were observed in the skin paddle of the flap or rate of flap failure among the age groups (p > .05). Clavien-Dindo grades I, II, IIIa, IIIb, Iva, and IVb were assigned to 7.1, 36.1, 38.5, 9.8, 4.1, and 4.1% of the patients, respectively, with significant differences seen between the young and elderly patients (p < .05). In total, 52.5% of patients could eat normally, whereas 32.8% required a soft diet. Furthermore, 53.3 and 33.6% of patients achieved normal and intelligible speech, respectively. The aesthetic results were rated as excellent and good in 32.8 and 58.2% of patients, respectively. In total, 68.0% of the patients were alive and exhibited no evidence of disease, while 19.7% were alive with active disease. In addition, 12.3% of patients with stage III OTSCC died due to local recurrence or distant metastases. No differences in swallowing, speech, aesthetic, or survival outcomes were observed among the groups. CONCLUSIONS FSAIF is a simple, safe, and reliable method for reconstructing hemitongue defects following cancer ablation in young, middle-aged, and elderly patients with early and middle-stage OTSCC.
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Affiliation(s)
- Yan Wang
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
| | - Bin Zhou
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
| | - Wei-liang Chen
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
| | - Zi-xian Huang
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
| | - Rui Chen
- grid.412536.70000 0004 1791 7851Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan-jiang Road, Guangzhou, 510120 China
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A retrospective study on unresectable or inoperable head and neck cancers treated with stereotactic ablative brachytherapy. J Contemp Brachytherapy 2022; 14:519-526. [PMID: 36819475 PMCID: PMC9924145 DOI: 10.5114/jcb.2022.123971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/13/2022] [Indexed: 01/18/2023] Open
Abstract
Purpose The aim of the present study was to assess the clinical efficacy and safety of stereotactic ablative brachytherapy (SABT) for unresectable or inoperable head and neck cancers. Material and methods This study retrospectively assessed clinical data of 37 patients with unresectable or inoperable head and neck cancers treated with SABT from October 2016 to October 2021. Variables evaluated included local efficacy, local control rate (LCR), overall survival (OS) rate, and radiological adverse effects. Results The median follow-up was of 34 months (range, 5-59 months), and LCR at 6, 12, and 24 months was 89.2%, 78.2%, and 69.4%, respectively. The median survival time was 16 months [95% confidence interval (CI): 10.5-21.5 months], and the OS rate at 6, 12, and 24 months was 97.3%, 70.3%, and 34.5%, respectively. The results of univariate analysis revealed that the type of pathology and gross tumor volume (GTV) D90 were related to LCR (p < 0.05). However, the type of pathology, GTV D90, age, and implantation site were related to OS rate (p < 0.05). The results of multivariate analysis showed that the type of pathology and GTV D90 were substantially related to LCR and OS rate (p < 0.05). The evaluation of post-operative radiological adverse reactions revealed that seven cases (18.9%) developed grade 1-2 skin reactions, four cases (10.8%) developed grade 1-2 oral mucosal outcomes, and no cases developed grade 3 or higher adverse reactions. Post-operative seed dislocation occurred in three patients with tongue cancer. Conclusions SABT has produced good local control and mild adverse reactions in the treatment of unresectable or inoperable head and neck cancers. Additionally, it is safe, feasible, minimally invasive, and has fewer adverse effects than other treatment modalities.
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Zhang L, Xu Q, Liu H, Li B, Wang H, Liu C, Li J, Yang B, Qin L, Han Z, Feng Z. The application of salvage surgery improves the quality of life and overall survival of extensively recurrent head and neck cancer after multiple operation plus radiotherapy. Front Oncol 2022; 12:1017630. [PMID: 36387128 PMCID: PMC9664200 DOI: 10.3389/fonc.2022.1017630] [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: 08/12/2022] [Accepted: 10/18/2022] [Indexed: 08/29/2023] Open
Abstract
OBJECTIVES The prognosis, choice of reconstruction and the quality of life (QOL) after salvage surgery (SS) for extensively locoregional recurrent/metastatic head and neck cancer (R/M HNC) is an important issue, but there are few reports at present. MATERIALS AND METHODS We analyzed extensively locoregional R/M HNC patients from March 1, 2015, to December 31, 2021 who underwent SS with latissimus dorsi or pectoralis major musculocutaneous flaps. QOL were accessed using QLQ-H&N35 and UW-QOL questionnaire. Wilcoxon signed-rank test was used to compare difference between pre- and post-QOL and Kaplan-Meier curves were used in estimate overall survival (OS) and disease-free survival (DFS). The literature review summarized recent 10 years clinical trials of nonoperative treatment in R/M head and neck cancer. RESULTS 1362 patients were identified and 25 patients were analyzed after screened. Median age at surgery was 59 years (range 43-77), 15/25(60%) were male and 22/25(88%) chose latissimus dorsi flap. Better mean pain score after applying massive soft tissue flaps revealed relief of severe pain(p<0.001) which strongly associated with improvement of QOL. The improved mean overall QOL score after surgery revealed a better QOL(p<0.001). As of June 1, 2022, 11/25 (44%) of the patients were alive. The 1-year, 2-year OS after SS was 58.4% and 37.2%, while the 1-year, 2-year DFS was 26.2% and 20.9%. The median OS of our study was better than nonoperative treatment of 11 included clinical trials. CONCLUSIONS R/M HNC patients underwent SS can obtain survival benefit. The application of massive soft tissue flap in SS could significantly enhance the QOL for patients with extensively locoregional R/M HNC, especially by relieving severe pain.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Zhien Feng
- Department of Oral and Maxillofacial-Head and Neck Oncology, Beijing Stomatological Hospital, Capital Medical University, Beijing, China
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Marín-Jiménez JA, Oliva M, Peinado Martín P, Cabezas-Camarero S, Plana Serrahima M, Vázquez Masedo G, Lozano Borbalas A, Cabrera Martín MN, Esteve A, Iglesias Moreno MC, Vilajosana Altamis E, Arribas Hortigüela L, Taberna Sanz M, Pérez-Segura P, Mesía R. Paclitaxel Plus Cetuximab as Induction Chemotherapy for Patients With Locoregionally Advanced Head and Neck Squamous Cell Carcinoma Unfit for Cisplatin-Based Chemotherapy. Front Oncol 2022; 12:953020. [PMID: 35936723 PMCID: PMC9355730 DOI: 10.3389/fonc.2022.953020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Induction chemotherapy (ICT) followed by definitive treatment is an accepted non-surgical approach for locoregionally advanced head and neck squamous cell carcinoma (LA-HNSCC). However, ICT remains a challenge for cisplatin-unfit patients. We evaluated paclitaxel and cetuximab (P-C) as ICT in a cohort of LA-HNSCC patients unfit for cisplatin. Materials and Methods This is a retrospective analysis of patients with newly diagnosed LA-HNSCC considered unfit for cisplatin-based chemotherapy (age >70 and/or ECOG≥2 and/or comorbidities) treated with weekly P-C followed by definitive radiotherapy and cetuximab (RT-C) between 2010 and 2017. Toxicity and objective response rate (ORR) to ICT and RT-C were collected. Median overall survival (OS) and progression-free survival (PFS) were estimated using the Kaplan–Meier method. Cox regression analysis was performed to determine baseline predictors of OS and PFS. Results A total of 57 patients were included. Grade 3–4 toxicity rate to ICT was 54.4%, and there was a death deemed treatment-related (G5). P-C achieved an ORR of 66.7%, including 12.3% of complete responses (CR). After P-C, 45 patients (78.9%) continued with concomitant RT-C. Twenty-six patients (45.6%) achieved a CR after definitive treatment. With a median follow-up of 21.7 months (range 1.2–94.6), median OS and PFS were 22.9 months and 10.7 months, respectively. The estimated 2-year OS and PFS rates were 48.9% and 33.7%, respectively. Disease stage had a negative impact on OS (stage IVb vs. III–IVa: HR = 2.55 [1.08–6.04], p = 0.03), with a trend towards worse PFS (HR = 1.92 [0.91–4.05], p = 0.09). Primary tumor in the larynx was associated with improved PFS but not OS (HR = 0.45 [0.22–0.92], p = 0.03, and HR = 0.69 [0.32–1.54], p = 0.37, respectively). Conclusion P-C was a well-tolerated and active ICT regimen in this cohort of LA-HNSCC patients unfit for cisplatin-based chemotherapy. P-C might represent a valid ICT option for unfit patients and may aid patient selection for definitive treatment.
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Affiliation(s)
- Juan A. Marín-Jiménez
- Head and Neck Cancer Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO – L’Hospitalet de Llobregat), Barcelona, Spain
| | - Marc Oliva
- Head and Neck Cancer Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO – L’Hospitalet de Llobregat), Barcelona, Spain
- Oncobell Program - Bellvitge Biomedical Research Institute (Institut d'Investigació Biomèdica de Bellvitge), Barcelona, Spain
- *Correspondence: Marc Oliva, ; Ricard Mesía,
| | - Paloma Peinado Martín
- Head and Neck Cancer Unit, Department of Medical Oncology, Hospital Universitario Clínico San Carlos - Instituto de Investigación Sanitaria Hospital Clínica San Carlos, Madrid, Spain
| | - Santiago Cabezas-Camarero
- Head and Neck Cancer Unit, Department of Medical Oncology, Hospital Universitario Clínico San Carlos - Instituto de Investigación Sanitaria Hospital Clínica San Carlos, Madrid, Spain
| | - Maria Plana Serrahima
- Head and Neck Cancer Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO – L’Hospitalet de Llobregat), Barcelona, Spain
| | - Gonzalo Vázquez Masedo
- Department of Radiation Oncology, Hospital Universitario Clínico San Carlos - Instituto de Investigación Sanitaria Hospital Clínica San Carlos (IdISCC), Madrid, Spain
| | - Alicia Lozano Borbalas
- Department of Radiation Oncology, Catalan Institute of Oncology (ICO – L’Hospitalet de Llobregat), Barcelona, Spain
| | - María N. Cabrera Martín
- Department of Nuclear Medicine, Hospital Universitario Clínico San Carlos - IdISCC, Madrid, Spain
| | - Anna Esteve
- Department of Medical Oncology, Catalan Institute of Oncology (ICO-Badalona), B-ARGO group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain
- Oncology Data Analytics Program, Catalan Institute of Oncology (ICO – L’Hospitalet de Llobregat) - Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
| | - María C. Iglesias Moreno
- Otolaryngology - Head and Neck Surgery Department, Hospital Universitario Clínico San Carlos e- IdISCC, Madrid, Spain
| | - Esther Vilajosana Altamis
- Head and Neck Cancer Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO – L’Hospitalet de Llobregat), Barcelona, Spain
| | - Lorena Arribas Hortigüela
- Clinical Nutrition Unit, Catalan Institute of Oncology (ICO – L’Hospitalet de Llobregat), Barcelona, Spain
| | - Miren Taberna Sanz
- Head and Neck Cancer Unit, Department of Medical Oncology, Catalan Institute of Oncology (ICO – L’Hospitalet de Llobregat), Barcelona, Spain
- Oncobell Program - Bellvitge Biomedical Research Institute (Institut d'Investigació Biomèdica de Bellvitge), Barcelona, Spain
| | - Pedro Pérez-Segura
- Head and Neck Cancer Unit, Department of Medical Oncology, Hospital Universitario Clínico San Carlos - Instituto de Investigación Sanitaria Hospital Clínica San Carlos, Madrid, Spain
| | - Ricard Mesía
- Department of Medical Oncology, Catalan Institute of Oncology (ICO-Badalona), B-ARGO group, Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol (IGTP), Barcelona, Spain
- *Correspondence: Marc Oliva, ; Ricard Mesía,
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10
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Koskinen AI, Hemminki O, Försti A, Hemminki K. Incidence and survival in oral and pharyngeal cancers in Finland and Sweden through half century. BMC Cancer 2022; 22:227. [PMID: 35236321 PMCID: PMC8889707 DOI: 10.1186/s12885-022-09337-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Cancers of the oral cavity and pharynx encompass a heterogeneous group of cancers for which known risk factors include smoking, alcohol consumption and human papilloma virus (HPV) infection but their influence is site-specific with HPV mainly influencing oropharyngeal cancer. Their incidence and survival rates are not well known over extended periods of time. Patients/methods Data were obtained for Finnish (FI) and Swedish (SE) patients from the Nordcan database recently updated through 2019. Age-adjusted incidence trends (FI from 1953, SE from 1960) and relative survival rates for years 1970 through 2019 were calculated. Results We observed a prominent increase in oral and oropharyngeal cancers in FI and SE men and women but the trend for oral cancer was interrupted for SE men in 1985 and possibly also for FI and SE women in 2015. The trend changes in male and female oral cancer was confirmed in data for Denmark and Norway. Relative survival for these cancers has improved overall but they differed for one cluster of oral, oropharyngeal and nasopharyngeal cancers with 60–70% 5-year survival in the last period and hypopharyngeal cancer with 25% male survival. In all these cancers, survival for old patients was unfavorable. Discussion/conclusion We hypothesize that reduction in smoking prevalence helped to stop the increase in oral cancer especially in men. As the prevalence of smoking is decreasing, HPV is becoming a dominant risk factor, particularly for the increasing oropharyngeal cancer. Prevention needs to emphasize sexual hygiene and HPV vaccination. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09337-2.
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Affiliation(s)
- Anni I Koskinen
- Department of Otorhinolaryngology- Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, PO Box 263, 00029, Helsinki, Finland.
| | - Otto Hemminki
- Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Kari Hemminki
- Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, 30605, Pilsen, Czech Republic. .,Division of Cancer Epidemiology, German Cancer Research Centre (DKFZ), 69120, Heidelberg, Germany.
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