1
|
Wiriyakijja P, Niklander S, Santos-Silva AR, Shorrer MK, Simms ML, Villa A, Sankar V, Kerr AR, Riordain RN, Jensen SB, Delli K. World Workshop on Oral Medicine VIII: Development of a Core Outcome Set for Dry Mouth: A Systematic Review of Outcome Domains for Xerostomia. Oral Surg Oral Med Oral Pathol Oral Radiol 2023:S2212-4403(23)00068-8. [PMID: 37198047 DOI: 10.1016/j.oooo.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 01/25/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The purpose of this study was to identify all outcome domains used in clinical studies of xerostomia, that is, subjective sensation of dry mouth. This study is part of the extended project "World Workshop on Oral Medicine Outcomes Initiative for the Direction of Research" to develop a core outcome set for dry mouth. STUDY DESIGN A systematic review was performed on MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials databases. All clinical and observational studies that assessed xerostomia in human participants from 2001 to 2021 were included. Information on outcome domains was extracted and mapped to the Core Outcome Measures in Effectiveness Trials taxonomy. Corresponding outcome measures were summarized. RESULTS From a total of 34,922 records retrieved, 688 articles involving 122,151 persons with xerostomia were included. There were 16 unique outcome domains and 166 outcome measures extracted. None of these domains or measures were consistently used across all the studies. The severity of xerostomia and physical functioning were the 2 most frequently assessed domains. CONCLUSION There is considerable heterogeneity in outcome domains and measures reported in clinical studies of xerostomia. This highlights the need for harmonization of dry mouth assessment to enhance comparability across studies and facilitate the synthesis of robust evidence for managing patients with xerostomia.
Collapse
|
2
|
Suhag V, Sunita BS, Vats P, Chakravarty N, Pandya T, Lohia N. Tolerance of Chemoradiation in Advanced Head and Neck Cancers: Comparison Between Inpatients and Outpatients. Indian J Otolaryngol Head Neck Surg 2019; 71:192-198. [PMID: 31741959 DOI: 10.1007/s12070-017-1210-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 09/21/2017] [Indexed: 11/26/2022] Open
Abstract
Concurrent chemoradiation (CCRT) is the mainstay of treatment for majority of locally advanced head and neck carcinomas (LAHNC). Addition of chemotherapy to radiotherapy increases the probability of local control and improved disease-free survival but at the cost of acute and delayed toxicities. A retrospective observational study. To compare the tolerance of CCRT and its toxicity profile amongst two groups, first arm (Arm A) being outdoor patients and the second group (Arm B) was hospitalized patients of LAHNC in an oncology centre of a tertiary care hospital. A total of 100 patients were enrolled, 50 in each arm. Overall, the most common site was oropharynx, followed by larynx and hypopharynx. 38 patients in Arm A received full 6 cycles of weekly chemotherapy with Inj Cisplatin infusion. 39 of the hospitalized patients completed 6 cycles of weekly Cisplatin, 04 patients also received 3 weekly Cisplatin. Average duration of treatment was 49.18 days in arm A and 50.92 days in arm B. Incidence of Grade II onwards dysphagia was 48 and 45 (96 and 90%) in Arm A and Arm B respectively; Chi Square value-0.6 (Yate's corrected); P value-0.43. Grade III oral mucositis was seen in 14% patients in Arm A and 34% patients in Arm B. 3 patients (6%) in Arm A and 14 patients (28%) in Arm B has Grade II and III hematological toxicities and nephrological toxicities. Aspiration pneumonia was seen in 2 patients (4%) in Arm A and in 4 patients (8%) in Arm B, Chi Square value-0.2 (Yate's corrected) P value-0.67. The incidence of febrile neutropenia was 3 and 10 in Arms A and B (6 and 20%) respectively. The tolerance of CCRT in hospitalized patients is marginally better, with relatively few associated complications as compared to outdoor setting. Every institute should promulgate its own guidelines regarding hospitalization of such patients.
Collapse
Affiliation(s)
- Virender Suhag
- 1Department of Radiation Oncology, Army Hospital (R&R), Delhi Cantt, Delhi, 110010 India
| | - B S Sunita
- 2Department of Pathology, Army Hospital (R&R), Delhi Cantt, Delhi, 110010 India
| | - Pankaj Vats
- 1Department of Radiation Oncology, Army Hospital (R&R), Delhi Cantt, Delhi, 110010 India
| | - N Chakravarty
- 1Department of Radiation Oncology, Army Hospital (R&R), Delhi Cantt, Delhi, 110010 India
| | - Tejas Pandya
- 1Department of Radiation Oncology, Army Hospital (R&R), Delhi Cantt, Delhi, 110010 India
| | - Nishant Lohia
- 1Department of Radiation Oncology, Army Hospital (R&R), Delhi Cantt, Delhi, 110010 India
| |
Collapse
|
3
|
Hayashi Y, Minamiyama S, Ohya T, Iida M, Iwai T, Koizumi T, Oguri S, Hirota M, Kioi M, Hata M, Taguri M, Mitsudo K. Daily Cisplatin and Weekly Docetaxel versus Weekly Cisplatin Intra-Arterial Chemoradiotherapy for Late T2-3 Tongue Cancer: A Pilot and Feasibility Trial. MEDICINA (KAUNAS, LITHUANIA) 2018; 54:E52. [PMID: 30344283 PMCID: PMC6174343 DOI: 10.3390/medicina54040052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/10/2018] [Accepted: 07/24/2018] [Indexed: 12/17/2022]
Abstract
Background and objectives: The aim of present study was to compare the treatment results of daily cisplatin (CDDP), weekly docetaxel (DOC) intra-arterial infusion chemotherapy combined with radiotherapy (DIACRT) regimen and weekly CDDP intra-arterial infusion chemotherapy combined with radiotherapy (WIACRT) for patients with tongue cancer. Materials and Methods: Between January 2007 and December 2016, a total of 11 patients treated with WIACRT and 45 patients treated with DIACRT were enrolled in the present study. In the DIACRT group, 25 patients had late T2, and 20 patients had T3. A total of nine patients had late T2 and two had T3 in WIACRT (p = NS). In DIACRT, the treatment schedule consisted of intra-arterial chemotherapy (DOC, total 60 mg/m²; CDDP, total 150 mg/m²) and daily concurrent radiotherapy (RT) (total, 60 Gy). In WIACRT, the treatment schedule consisted of intra-arterial chemotherapy (CDDP, total 360 mg/m²) and daily concurrent RT (total, 60 Gy). Results: The median follow-up periods for DIACRT and WIACRT were 61 and 66 months, respectively. The five-year local control (LC) and overall survival (OS) rate were 94.5% and 89.6% for the DIACRT group, and 60.6% and 63.6% for the WIACRT group, respectively. The LC rate and OS of the DIACRT group were significantly higher than those of the WIACRT group. As regards toxicities, no treatment-related deaths were observed during the follow-up periods in both groups. Conclusions: DIACRT was found to be feasible and effective for patients with tongue cancer and could become a new treatment modality.
Collapse
Affiliation(s)
- Yuichiro Hayashi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Shuhei Minamiyama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Takashi Ohya
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masaki Iida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Toshiyuki Koizumi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Senri Oguri
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Makoto Hirota
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Mitomu Kioi
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masaharu Hata
- Department of Radiation Oncology, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Masataka Taguri
- Department of Biostatistics, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| |
Collapse
|
4
|
Carlsson L, Bratman SV, Siu LL, Spreafico A. The Cisplatin Total Dose and Concomitant Radiation in Locoregionally Advanced Head and Neck Cancer: Any Recent Evidence for Dose Efficacy? Curr Treat Options Oncol 2018; 18:39. [PMID: 28555374 DOI: 10.1007/s11864-017-0482-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OPINION STATEMENT Concurrent chemoradiotherapy (CRT) with high-dose (100 mg/m2), single-agent cisplatin is considered the standard of care for locoregionally advanced head and neck cancer (LAHNC). Poor compliance often due to significant treatment-related toxicities observed during CRT regimen has stimulated research efforts to examine for evidence of the optimal cumulative cisplatin dose and schedule. The findings from this systematic literature review demonstrate that there are insufficient prospective, randomized controlled data to determine the optimal total dose (and schedule) of cisplatin to administer concomitantly with radiotherapy in the treatment of LAHNC. Given the clinical challenges associated with administering concurrent CRT with single-agent high-dose cisplatin, as well as the long-term toxicities accompanying this treatment, an examination of the available literature for evidence of dose efficacy is of continued clinical interest. Moving forward, it is critical that researchers include complete descriptions of key disease and treatment variables (i.e. treatment compliance and HPV status) to inform and strengthen clinical decisions. The substantial heterogeneity of LAHNC has led to the focus of recent research efforts to risk-stratify using a combination of clinical and molecular markers (e.g. HPV status). Thus, the optimal total dose (and schedule) of cisplatin may need to be modified to reflect the specific characteristics of the individual patient subpopulations being treated. At present, CRT remains the standard of care for LAHNC, but this field is rapidly evolving. National and international clinical trials are ongoing to evaluate treatment de-intensification in favourable risk patient subsets and treatment intensification in poor-risk patient subsets, these will provide evidence-based guidance to individualize therapy with the ultimate goal of improving patient outcomes.
Collapse
Affiliation(s)
- Lindsay Carlsson
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lillian L Siu
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada
| | - Anna Spreafico
- Division of Medical Oncology and Hematology, Drug Development Program, Princess Margaret Cancer Centre, University Health Network, University of Toronto, 700 University Avenue, Toronto, ON, CA M5G 1Z5, Canada.
| |
Collapse
|
5
|
Barney CL, Walston S, Zamora P, Healy EH, Nolan N, Diavolitsis VM, Neki A, Rupert R, Savvides P, Agrawal A, Old M, Ozer E, Carrau R, Kang S, Rocco J, Teknos T, Grecula JC, Wobb J, Mitchell D, Blakaj D, Bhatt AD. Clinical outcomes and prognostic factors in cisplatin versus cetuximab chemoradiation for locally advanced p16 positive oropharyngeal carcinoma. Oral Oncol 2018; 79:9-14. [PMID: 29598954 DOI: 10.1016/j.oraloncology.2018.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/29/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Randomized trials evaluating cisplatin versus cetuximab chemoradiation (CRT) for p16+ oropharyngeal cancer (OPC) have yet to report preliminary data. Meanwhile, as a preemptive step toward morbidity reduction, the off-trial use of cetuximab in p16+ patients is increasing, even in those who could potentially tolerate cisplatin. The purpose of this study was to compare the efficacy of cisplatin versus cetuximab CRT in the treatment of p16+ OPC and to identify prognostic factors and predictors of tumor response. MATERIALS AND METHODS Cases of p16+ OPC treated with cisplatin or cetuximab CRT at our institution from 2010 to 2014 were identified. Recursive partitioning analysis (RPA) classification was used to determine low-risk (LR-RPA) and intermediate-risk (IR-RPA) groups. Log-rank/Kaplan-Meier and Cox Regression methods were used to compare groups. RESULTS We identified 205 patients who received cisplatin (n = 137) or cetuximab (n = 68) CRT in the definitive (n = 178) or postoperative (n = 27) setting. Median follow-up was 3 years. Cisplatin improved 3-year locoregional control (LRC) [92.7 vs 65.4%], distant metastasis-free survival (DMFS) [88.3 vs 71.2%], recurrence-free survival (RFS) [86.6 vs 50.6%], and overall survival (OS) [92.6 vs 72.2%] compared to cetuximab [all p < .001]. Concurrent cisplatin improved 3-year OS for LR-RPA (97.1 vs 80.3%, p < .001) and IR-RPA (97.1 vs 80.3%, p < .001) groupings. CONCLUSION When treating p16+ OPC with CRT, the threshold for substitution of cisplatin with cetuximab should be maintained appropriately high in order to prolong survival times and optimize locoregional and distant tumor control. When cetuximab is used in cisplatin-ineligible patients, altered fractionation RT should be considered in an effort to improve LRC.
Collapse
Affiliation(s)
- Christian L Barney
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Steve Walston
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Pedro Zamora
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Erin H Healy
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Nicole Nolan
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA
| | - Virginia M Diavolitsis
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA
| | - Anterpreet Neki
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Robert Rupert
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Panos Savvides
- The University of Arizona Cancer Center at Dignity Health St. Joseph's Hospital, 625 N 6th St, Phoenix, AZ 85004, USA
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Matthew Old
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Ricardo Carrau
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Stephen Kang
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - James Rocco
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Theodoros Teknos
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - John C Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Jessica Wobb
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Darrion Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Dukagjin Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| | - Aashish D Bhatt
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, 460 West 10th Avenue, Columbus, OH 43210, USA.
| |
Collapse
|