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Katano A, Minamitani M, Tongyu G, Ohira S, Yamashita H. Survival Following Palliative Radiotherapy for Head and Neck Squamous Cell Carcinoma: Examining Treatment Indications in Elderly Patients. CANCER DIAGNOSIS & PROGNOSIS 2024; 4:46-50. [PMID: 38173668 PMCID: PMC10758838 DOI: 10.21873/cdp.10284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
Background/Aim This study investigated the survival outcomes of patients with head and neck squamous cell carcinoma (HNSCC) undergoing palliative radiotherapy, particularly focusing on challenges and factors associated with older age, providing insights into appropriate palliative radiotherapy use in this demographic. Patients and Methods A retrospective study was conducted using electronic medical records of 73 patients with HNSCC who were deemed unsuitable for curative therapy. Palliative radiotherapy involved a uniform dose of 30 Gy in 10 fractions. Survival analysis was performed using Kaplan-Meier method, and multivariate analysis identified significant prognostic factors. Results The median overall survival was 7.5 months, with no significant difference between age groups. Karnofsky performance status (KPS) >70 correlated with favorable survival. Multivariate analysis confirmed KPS as an independent prognostic factor (hazard ratio=1.949, p=0.031). Conclusion The results of this study align with those of previous studies, emphasizing the importance of palliative radiotherapy for HNSCC treatment. Optimal dose fractionation regimens remain undetermined, and tailored approaches that consider factors, such as age and performance status are crucial. Individualized, comprehensive assessments and supportive care measures enhance patient well-being, reflecting palliative care principles.
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Affiliation(s)
- Atsuto Katano
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Masanari Minamitani
- Department of Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, Japan
| | - Gao Tongyu
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
| | - Shingo Ohira
- Department of Comprehensive Radiation Oncology, The University of Tokyo, Tokyo, Japan
| | - Hideomi Yamashita
- Department of Radiology, The University of Tokyo Hospital, Tokyo, Japan
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Viani GA, Gouveia AG, Matsuura FK, Neves LVF, Marta GN, Chua MLK, Moraes YF. Assessing the efficacy of palliative radiation treatment schemes for locally advanced squamous cell carcinoma of the head and neck: a meta-analysis. Rep Pract Oncol Radiother 2023; 28:137-146. [PMID: 37456700 PMCID: PMC10348333 DOI: 10.5603/rpor.a2023.0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/28/2023] [Indexed: 07/18/2023] Open
Abstract
Background The objective to assess the outcomes from different palliative radiotherapy (RT) schedules in incurable head and neck cancer (HNC), to evaluate if there is a relationship between RT dose, technique, and fractionation with tumor response in contrast to the occurrence of adverse effects. Materials and methods Eligible studies were identified on Medline, Embase, the Cochrane Library, and annual meetings proceedings through June 2020. Following PRISMA and MOOSE guidelines, a cumulative meta-analysis of studies for overall response rate (ORR), overall survival (OS), progression-free survival (PFS), pain/dysphagia relief, and toxicity was performed. A meta-regression analysis was done to assess if there is a connection between RT dose, schedule, and technique with ORR. Results Twenty-eight studies with 1,986 patients treated with palliative RT due to incurable HNC were included. The median OS was 6.5 months [95% confidence interval (CI): 5.6-7.4], and PFS was 3.6 months (95% CI: 2.7-4.3). The ORR, pain and dysphagia relief rates were 72% (95% CI: 0.6-0.8), 83% (95% CI: 52-100%), and 75% (95% CI: 52-100%), respectively. Conventional radiotherapy (2D-RT) or conformational radiotherapy (3D-RT) use were significantly associated with a higher acute toxicity rate (grade ≥ 3) than intensity-modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). On meta-regression analyses, the total biological effective doses (BED) of RT (p = 0.001), BED > 60 Gy10 (p = 0.001), short course (p = 0.01) and SBRT (p = 0.02) were associated with a superior ORR. Conclusions Palliative RT achieves tumor response and symptom relief in incurable HNC patients. Short course RT of BED > 60 Gy using IMRT could improve its therapeutic ratio. SBRT should be considered when available.
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Affiliation(s)
- Gustavo A Viani
- Department of Medical Imagings, Hematology And Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), São Paulo, Brazil
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Andre G Gouveia
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Radiation Oncology Department, Americas Centro de Oncologia Integrado, Rio de Janeiro, Brazil
| | - Fernando K Matsuura
- Department of Medical Imagings, Hematology And Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), São Paulo, Brazil
| | - Leonardo V F Neves
- Department of Medical Imagings, Hematology And Oncology, Ribeirão Preto Medical School, University of São Paulo (FMRP-USP), São Paulo, Brazil
| | - Gustavo N Marta
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Radiation Oncology Department, Hospital Sirio Libanês, São Paulo, Brazil
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Y Fabio Moraes
- Latin America Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Department of Oncology, Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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Brockwell M, Husain M, Verschraegen C, Wu R, Tinoco G. Case report: The power of immunotherapy in advanced cutaneous squamous cell carcinoma. Front Oncol 2023; 12:1081118. [PMID: 36686737 PMCID: PMC9846513 DOI: 10.3389/fonc.2022.1081118] [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: 10/26/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
We describe the case of a neglected cutaneous squamous cell carcinoma with extensive facial involvement. The patient is a male in his late 70s who presented to dermatology with a large destructive facial mass that had increased in size gradually over 3 years and then rapidly proliferated, consuming a large portion of his left maxillofacial region. While the immediate reaction was referral to hospice care, medical oncology recommended treatment with cemiplimab, an immune checkpoint inhibitor. Collaboration with multiple providers facilitated the delivery of a multidisciplinary approach utilizing immunotherapy with QUAD shot radiotherapy. The immunotherapy treatment resulted in a dramatic disease regression, but the large facial anatomical defect caused by the carcinoma remained. The patient is undergoing reconstructive surgeries. This case illustrates the potential for significant response with immune checkpoint inhibitors delivered in combination with cyclical hypofractionated radiation therapy for patients with cutaneous squamous cell carcinoma, even in very advanced disease.
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Affiliation(s)
| | - Marium Husain
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Claire Verschraegen
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Richard Wu
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States
| | - Gabriel Tinoco
- Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University, Columbus, OH, United States,*Correspondence: Gabriel Tinoco,
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Leming AB, Johnston AL, Krempl GA, Fowle EJ, Morton DJ, Henson CE. Pathologic complete response following low-dose radiation for advanced oral cavity cancer in a patient with human immunodeficiency virus. J Otolaryngol Head Neck Surg 2022; 51:37. [PMID: 36192808 PMCID: PMC9531370 DOI: 10.1186/s40463-022-00586-6] [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: 11/16/2021] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Advanced squamous cell carcinoma (SCCa) of the oral cavity is often not amenable to curative-intent therapy due to tumor location, tumor size, or comorbidities. CASE PRESENTATION A 51-year-old male patient with human immunodeficiency virus and on highly active antiretroviral therapy (HAART) presented with a cT4aN2c SCCa of the tongue. He received a preoperative single course of Quad-Shot radiation therapy to 14 Gy in 4 fractions followed by surgical resection. Patient had no residual carcinoma on surgical pathology and no evidence of disease on subsequent clinical and radiological exams. CONCLUSIONS To our knowledge, this is the first case of pathologic complete response for a patient on HAART following a single cycle of the Quad-Shot regimen for advanced oral cavity SCCa. Protease inhibitors in HAART can induce spontaneous tumor regression via inhibition of proteasome function and activation of apoptosis, and thus act as a cancer therapeutic.
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Affiliation(s)
- Amy B. Leming
- grid.266902.90000 0001 2179 3618College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA ,grid.267308.80000 0000 9206 2401Present Address: Department of Otorhinolaryngology – Head and Neck Surgery, The University of Texas Health Science Center at Houston, Houston, TX USA
| | - Andrea L. Johnston
- grid.266902.90000 0001 2179 3618Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 800 NE 10th Street, L100, Oklahoma City, OK 73104 USA
| | - Greg A. Krempl
- grid.266902.90000 0001 2179 3618Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA ,grid.266902.90000 0001 2179 3618Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Evan J. Fowle
- grid.266902.90000 0001 2179 3618Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Daniel J. Morton
- grid.266902.90000 0001 2179 3618Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA ,grid.266902.90000 0001 2179 3618Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
| | - Christina E. Henson
- grid.266902.90000 0001 2179 3618Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 800 NE 10th Street, L100, Oklahoma City, OK 73104 USA ,grid.266902.90000 0001 2179 3618Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK USA
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Fabian A, Domschikowski J, Letsch A, Schmalz C, Freitag-Wolf S, Dunst J, Krug D. Use and Reporting of Patient-Reported Outcomes in Trials of Palliative Radiotherapy: A Systematic Review. JAMA Netw Open 2022; 5:e2231930. [PMID: 36136335 PMCID: PMC9500555 DOI: 10.1001/jamanetworkopen.2022.31930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Approximately 50% of all patients with cancer have an indication for radiotherapy, and approximately 50% of radiotherapy is delivered with palliative intent, with the aim of alleviating symptoms. Symptoms are best assessed by patient-reported outcomes (PROs), yet their reliable interpretation requires adequate reporting in publications. OBJECTIVE To investigate the use and reporting of PROs in clinical trials of palliative radiotherapy. EVIDENCE REVIEW This preregistered systematic review searched PubMed/Medline, EMBASE, and the Cochrane Center Register of Controlled Trials for clinical trials of palliative radiotherapy published from 1990 to 2020. Key eligibility criteria were palliative setting, palliative radiotherapy as treatment modality, and clinical trial design (per National Institutes of Health definition). Two authors independently assessed eligibility. Trial characteristics were extracted and standard of PRO reporting was assessed in adherence to the Consolidated Standards of Reporting Trials (CONSORT) PRO extension. The association of the year of publication with the use of PROs was assessed by logistic regression. Factors associated with higher CONSORT-PRO adherence were analyzed by multiple regression. This study is reported following the PRISMA guidelines. FINDINGS Among 7377 records screened, 225 published clinical trials representing 24 281 patients were eligible. Of these, 45 trials (20%) used a PRO as a primary end point and 71 trials (31%) used a PRO as a secondary end point. The most prevalent PRO measures were the Numeric Rating Scale/Visual Analogue Scale (38 trials), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (32 trials), and trial-specific unvalidated measures (25 trials). A more recent year of publication was significantly associated with a higher chance of PROs as a secondary end point (odds ratio [OR], 1.04 [95% CI, 1.00-1.07]; P = .03) but not as primary end point. Adherence to CONSORT-PRO was poor or moderate for most items. Mean (SD) adherence to the extension adherence score was 46.2% (19.6%) for trials with PROs as primary end point and 31.8% (19.8%) for trials with PROs as a secondary end point. PROs as a primary end point (regression coefficient, 9.755 [95% CI, 2.270-17.240]; P = .01), brachytherapy as radiotherapy modality (regression coefficient, 16.795 [95% CI, 5.840-27.751]; P = .003), and larger sample size (regression coefficient, 0.028 [95% CI, 0.006-0.049]; P = .01) were significantly associated with better PRO reporting per extension adherence score. CONCLUSIONS AND RELEVANCE In this systematic review of palliative radiotherapy trials, the use and reporting of PROs had room for improvement for future trials, preferably with PROs as a primary end point.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Anne Letsch
- Department of Haematology and Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Claudia Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Juergen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
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Fabian A, Domschikowski J, Hoffmann M, Weiner O, Schmalz C, Dunst J, Krug D. Patient-Reported Outcomes Assessing the Impact of Palliative Radiotherapy on Quality of Life and Symptom Burden in Head and Neck Cancer Patients: A Systematic Review. Front Oncol 2021; 11:683042. [PMID: 34150646 PMCID: PMC8213366 DOI: 10.3389/fonc.2021.683042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/28/2021] [Indexed: 01/02/2023] Open
Abstract
Incurable head and neck cancer has a poor prognosis and impairs a patient's health-related quality of life. Palliative radiotherapy may improve or stabilize health-related quality of life and symptoms, best measured by patient-reported outcomes. There is no systematic analysis if palliative radiotherapy for head and neck cancer improves or stabilizes health-related quality of life or symptoms as validly measured by patient-reported outcomes. Therefore, the primary objective of this systematic review (PROSPERO-ID: CRD42020166434) was to assess the effect of palliative radiotherapy for head and neck cancer on patient-reported outcomes. The secondary objective was to assess the rate and quality of use of patient-reported outcomes in relevant studies claiming a "palliative effect" of radiotherapy. The databases MEDLINE/PubMed, EMBASE, Cochrane CENTRAL, "ClinicalTrials.gov" were searched. Concerning the primary objective, four studies were eligible to assess the effectiveness of palliative radiotherapy as measured by patient-reported outcomes. A narrative synthesis suggests a favorable impact of palliative radiotherapy on health-related quality of life and symptom burden. The risk of bias, however, is considerable and the overall quality of evidence low. Concerning the secondary objective, over 90% of studies claiming a "palliative effect" of palliative radiotherapy did either not use patient-reported outcomes or did so by limited quality. In conclusion, implementation of patient-reported outcomes in studies assessing palliative radiotherapy for head and neck cancer should be fostered. Palliative radiotherapy remains an option for head and neck cancer patients, although more studies focusing on patient-reported outcomes are needed. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier CRD42020166434.
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Affiliation(s)
- Alexander Fabian
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Justus Domschikowski
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Oliver Weiner
- University Library Kiel, Christian-Albrechts-University Kiel, Kiel, Germany
| | - Claudia Schmalz
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Jürgen Dunst
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
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