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He J, Luo G, Liu S, Chen L, Chen Z, Zhang B, Lin J, Qin W, Li H, Zhou H, Yu Y, Zhan D, Yang D, Luo H. Tislelizumab plus neoadjuvant chemotherapy and concurrent chemoradiotherapy versus neoadjuvant chemotherapy and concurrent chemoradiotherapy for locally advanced nasopharyngeal carcinoma: A retrospective study. Transl Oncol 2024; 48:102058. [PMID: 39079408 PMCID: PMC11339050 DOI: 10.1016/j.tranon.2024.102058] [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: 04/02/2024] [Revised: 05/30/2024] [Accepted: 07/05/2024] [Indexed: 08/25/2024] Open
Abstract
BACKGROUND The efficacy of immunotherapy plus neoadjuvant chemotherapy and concurrent chemoradiotherapy (CCRT) for locally advanced nasopharyngeal carcinoma (LA-NPC) has not been reported. This study retrospectively compared the efficacy of tislelizumab plus neoadjuvant chemotherapy and CCRT with neoadjuvant chemotherapy followed by CCRT. METHODS Ninety patients with stages III-IVa NPC were identified between January 2020 and March 2021 at the Affiliate Hospital of Guangdong Medical University. Forty-three patients in the observation group (OG) received tislelizumab plus nano albumin-paclitaxel and cisplatin (nab-TP) regimen, followed by CCRT, while forty-seven patients in the control group (CG) received nab-TP regimen followed by CCRT. RESULTS The complete response rate after neoadjuvant therapy was significantly higher in the OG compared to the CG (37.2% vs. 12.8 %). The objective response rates were 88.4 % in the OG and 70.2 % in the CG. The 3-year progression-free survival (PFS) rates for OG and CG patients were 93.0 % and 78.7 %, respectively (P = 0.04, HR = 0.31). The overall survival (OS) rates for the OG and the CG were 95.3 % and 87.2 %, respectively (P = 0.15, HR = 0.36). Locoregional relapse-free survival (LRFS) rates were 90.7 % for the OG and 72.3 % for the CG (P = 0.04, HR = 0.38), and distant metastasis-free survival (DMFS) rates were 95.3 % for the OG, and 80.9 % for the CG (P = 0.04, HR = 0.30). For PD-L1 high-expression and low-expression rates, the 3-year PFS rates were 89.2 % and 85.7 % (P = 0.77, HR = 1.21), and the OS rates were 90.2 % and 89.2 % (P = 0.65, HR = 1.36), respectively. CONCLUSION Tislelizumab combined with neoadjuvant chemotherapy and CCRT showed encouraging therapeutic effects and good tolerability in patients with LA-NPC compared to the standard treatment.
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Affiliation(s)
- Jiaqi He
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Guoqing Luo
- Otorhinolaryngology Department of Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, PR China
| | - Shen Liu
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Lingli Chen
- The First Clinical Medical College of Guangdong Medical University, Zhanjiang 524023, PR China
| | - Zihong Chen
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Bing Zhang
- Plastic Surgery Department of Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, PR China
| | - Jiong Lin
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Wenyi Qin
- Thyroid and Breast Surgery Department of Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, PR China
| | - Haiwen Li
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Haideng Zhou
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Ying Yu
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Dechao Zhan
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China
| | - Donghong Yang
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China.
| | - Haiqing Luo
- Specialty of Head and Neck Oncology of Affiliated Hospital Guangdong Medical University, Zhanjiang 524001, PR China.
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Dong S, Bei W, Lin L, Jiang Y, Lu N, Liu G, Xiang Y, Xia W. Short-term versus long-term metronomic adjuvant chemotherapy in locally advanced nasopharyngeal carcinoma: A propensity score-matched real-world study. Oral Oncol 2024; 156:106908. [PMID: 38936007 DOI: 10.1016/j.oraloncology.2024.106908] [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: 03/21/2024] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND This retrospective study aimed to determine the optimal metronomic chemotherapy duration (MTCD) as adjuvant therapy for patients with locally advanced nasopharyngeal carcinoma (LANPC). METHODS This study involved LANPC patients treated with metronomic chemotherapy (MTC) using a 5-FU prodrug (S1, capecitabine, or tegafur) from May 2013 to September 2020. The optimal MTCD threshold was established using X-tile Bioinformatics software. The overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional relapse-free survival (LRRFS) were compared between short-term and long-term groups using propensity score matching (PSM). RESULTS A total of 546 patients were analyzed. MTCD was an independent prognostic factor for OS, PFS, and DMFS (all P < 0.05). Patients were categorized into long-term (>3 months) and short-term (≤3 months) MTCD groups. After a median follow-up of 48 months, significant differences were observed in 4-year OS (97.0 % vs. 87.1 %; P < 0.01), PFS (84.6 % vs. 70.9 %; P < 0.01), DMFS (87.3 % vs. 78.8 %; P < 0.01), and LRRFS (95.3 % vs. 87.4 %; P < 0.01) between the long-term and short-term groups. In the PSM-matched cohort of 196 patients per group, the long-term group demonstrated superior 4-year OS and LRRFS (97.3 % vs. 87.1 %, P < 0.01; 95.2 % vs. 90.0 %, P < 0.05). No significant differences in acute toxicities were observed between the groups (P > 0.05). CONCLUSION Extended MTC with a 5-FU prodrug (>3 months) may benefit NPC patients. Further prospective studies are needed to validate these findings.
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Affiliation(s)
- Shuhui Dong
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou 510060, PR China.
| | - Weixin Bei
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou 510060, PR China.
| | - Lanfeng Lin
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine; Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou 510060, PR China.
| | - Yaofei Jiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou 510060, PR China.
| | - Nian Lu
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou 510060, PR China.
| | - Guoying Liu
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, 107 Yan Jiang Road, Guangzhou 510060, PR China.
| | - Yanqun Xiang
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou 510060, PR China.
| | - Weixiong Xia
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, 651 Dongfeng Road East, Guangzhou 510060, PR China.
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Li J, Liu Q, Qin H. Development and application of a serious adverse events risk model for concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma. Medicine (Baltimore) 2024; 103:e39377. [PMID: 39183401 DOI: 10.1097/md.0000000000039377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
The objective of this study was to construct a concise prediction model for serious adverse events (SAEs) in order to assess the likelihood of SAE occurrence among hospitalized patients undergoing concurrent chemoradiotherapy. An electronic database of a Cancer Centre was utilized to conduct a cross-sectional review survey. Our research involved the recruitment of 239 patients who were undergoing concurrent chemoradiotherapy in the Department of Nasopharynx and Radiotherapy. The clinical prediction rule was derived using logistic regression analysis, with SAE serving as the primary outcome. Internal verification was conducted. The occurrence rate of SAE in the derivation cohort was 59.4%. The ultimate model used had 3 variables, namely cystatin C, C-reactive protein, and serum amyloid A. The model exhibited an area under the curve of 0.626 (95% CI: 0.555-0.696; P < .001). The model accurately predicts the occurrence of SAE, and the variable data can be easily obtained, and the assessment technique is straightforward.
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Affiliation(s)
- Jiahui Li
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Qianwen Liu
- Department of Phase I Clinical Trials, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
| | - Huiying Qin
- Department of Nursing, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong Province, China
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Wenjie W, Rui L, Dongyong W, Lin C. Exploring the prognostic landscape of oral squamous cell carcinoma through mitochondrial damage-related genes. BMC Med Genomics 2024; 17:208. [PMID: 39134997 PMCID: PMC11321089 DOI: 10.1186/s12920-024-01985-6] [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: 03/08/2024] [Accepted: 08/06/2024] [Indexed: 08/15/2024] Open
Abstract
Oral squamous cell carcinoma (OSCC), the most prevalent form of oral cancer, poses significant challenges to the medical community due to its high recurrence rate and low survival rate. Mitochondrial Damage-Related Genes (MDGs) have been closely associated with the occurrence, metastasis, and progression of OSCC. Consequently, we constructed a prognostic model for OSCC based on MDGs and identified potential mitochondrial damage-related biomarkers. Gene expression profiles and relevant clinical information were obtained from The Cancer Genome Atlas (TCGA) database. Differential analysis was conducted to identify MDGs associated with OSCC. COX analysis was employed to screen seven prognosis-related MDGs and build a prognostic prediction model for OSCC. Cases were categorized into low-risk or high-risk groups based on the optimal risk score threshold. Kaplan-Meier (KM) analysis revealed significant survival differences (P < 0.05). Additionally, the area under the ROC curve (AUC) for patient survival at 1 year, 3 years, and 5 years were 0.687, 0.704, and 0.70, respectively, indicating a high long-term predictive accuracy of the prognostic model. To enhance predictive accuracy, age, gender, risk score, and TN staging were incorporated into a nomogram and verified using calibration curves. Risk scoring based on MDGs was identified as a potential independent prognostic biomarker. Furthermore, BID and SLC25A20 were identified as two potential independent mitochondrial damage-related prognostic biomarkers, offering new therapeutic targets for OSCC.
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Affiliation(s)
- Wen Wenjie
- Anhui Province Engineering Research Center for Dental Materials and Application, Wannan Medical College, Wuhu, 241002, China
- Oral Disease Research Center, School of Stomatology, Wannan Medical College, Wuhu, 241002, China
| | - Li Rui
- Anhui Province Engineering Research Center for Dental Materials and Application, Wannan Medical College, Wuhu, 241002, China
- Oral Disease Research Center, School of Stomatology, Wannan Medical College, Wuhu, 241002, China
| | - Wang Dongyong
- Anhui Province Engineering Research Center for Dental Materials and Application, Wannan Medical College, Wuhu, 241002, China
| | - Chai Lin
- Anhui Province Engineering Research Center for Dental Materials and Application, Wannan Medical College, Wuhu, 241002, China.
- Oral Disease Research Center, School of Stomatology, Wannan Medical College, Wuhu, 241002, China.
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Jin Q, Hua Y, Jin T, Wang L, Tao C, Huang S, Qin W, Chen X. Mecapegfilgrastim for the prophylaxis of chemotherapy-induced neutropenia in locally advanced nasopharyngeal carcinoma: A prospective phase II clinical study. Head Neck 2024. [PMID: 39129235 DOI: 10.1002/hed.27897] [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: 04/08/2024] [Revised: 06/24/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Induction chemotherapy of docetaxel plus cisplatin (TP) is myelosuppressive, leading to severe neutropenia and febrile neutropenia (FN). Herein, we aimed to investigate the efficacy and safety of mecapegfilgrastim in the prevention of neutropenia in patients with locally advanced nasopharyngeal carcinoma who received the TP regimen. METHODS A total of 30 treatment-naive patients with locally advanced nasopharyngeal carcinoma were included in this study. Mecapegfilgrastim 6 mg was injected 24-48 h after the completion of induction chemotherapy with the TP regimen. RESULTS The incidence of grade ≥3 neutropenia during the three induction chemotherapy cycles was 6.7% (95% CI, 0.8%-22.1%). In the first cycle of chemotherapy, the incidence of grade ≥3 neutropenia was 3.3% (95% CI, 0.1%-17.2%). No FN or antibiotic usage was reported. All 30 patients completed the induction chemotherapy cycles. CONCLUSION Mecapegfilgrastim effectively reduced the incidence of chemotherapy-induced neutropenia and FN in patients with locally advanced nasopharyngeal carcinoma.
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Affiliation(s)
- Qifeng Jin
- Department of Head and Neck Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Yonghong Hua
- Department of Head and Neck Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Ting Jin
- Department of Head and Neck Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Lei Wang
- Department of Head and Neck Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Changjuan Tao
- Department of Head and Neck Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Shuang Huang
- Department of Head and Neck Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Weifeng Qin
- Department of Head and Neck Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Xiaozhong Chen
- Department of Head and Neck Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, China
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Damazo BJ, Punjabi NA, Liu YF, Inman JC. Histopathologic predictors of recurrence and survival in early T stage oral tongue squamous cell carcinoma. FRONTIERS IN ORAL HEALTH 2024; 5:1426709. [PMID: 39165677 PMCID: PMC11333445 DOI: 10.3389/froh.2024.1426709] [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: 05/02/2024] [Accepted: 07/25/2024] [Indexed: 08/22/2024] Open
Abstract
Objectives Recurrence and survival in early T-stage oral tongue squamous cell carcinoma (OTSCC) may be impacted by histopathologic risk factors. This study aims to examine which of these factors predict long-term outcomes of T1 and T2 OTSCC. Methods A retrospective review of T1 and T2 OTSCC patients treated with surgery at a single tertiary care center was conducted. Multivariate regression and Kaplan-Meier survival plots were used to identify predictors of recurrence and compare disease-free survival respectively. Results 100 consecutive patients were studied. Of these, 51 were staged pT1, 49 pT2, 69 pN0, 10 pN1, and 21 pN2. Multivariate regression analysis revealed that >4 nodes was the strongest predictor of overall recurrence [odds ratio 1.68 (1.23-2.28), p = 0.001], while >4 nodes [odds ratio 1.14 (1.09-1.85), p = 0.008] and pT2 [odds ratio 1.15 (1.01-1.30), p = 0.033] were predictors of local recurrence (R2 = 0.112). Five-year disease-free survival was not significantly impacted by any risk factors except for the number of positive nodes-86% for ≤4 nodes vs. 20% for >4 nodes (p < 0.001)-and pathologic T-stage-90% for pT1 vs. 75% for pT2 (p = 0.035) regardless of adjuvant radiation and/or chemotherapy use. Conclusions Patients who underwent adjuvant radiation and/or chemotherapy had similar survival to those who did not despite having worse overall tumor prognostic factors. Adding adjuvant therapy may equalize some high-risk histopathologic factors. In the highest risk patients-specifically those with pathologic >4 nodes and pT2 staging-adjuvant therapy should be considered.
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Affiliation(s)
- Benjamin J. Damazo
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Nihal A. Punjabi
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
- Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Yuan F. Liu
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
| | - Jared C. Inman
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, CA, United States
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Harris CS, Groman A, Sigurdson SL, Magner WJ, Singh AK, Gupta V. Retrospective Cohort Study on the Impact of Travel Distance on Late-Stage Oral Cancer Treatment and Outcomes: An NCDB Analysis. Cancers (Basel) 2024; 16:2750. [PMID: 39123477 PMCID: PMC11311623 DOI: 10.3390/cancers16152750] [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: 04/29/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
The National Comprehensive Cancer Network guidelines provide evidence-based consensus for optimal individual site- and stage-specific treatments. This is a cohort study of 11,121 late-stage oral cancer patients in the National Cancer Database from 2010 to 2016. We hypothesized that patient travel distance may affect treatment choices and impact outcome. We split travel distance (miles) into quartiles (D1-4) and assessed treatment choices, type of facility, and survival outcome in relation to distance traveled. Univariate and multivariate analyses addressed contributions of specific variables. White patients were most likely to travel farthest (D4) for treatment compared to Black patients (D1). Urban area patients traveled shorter distances than those from rural areas. Greater travel distance was associated with patients undergoing surgical-based therapies and treatment at academic centers. Patients in D1 had the lowest median survival of all distance quartiles. Surgery-based multimodality treatment (surgery and radiation) had a median survival significantly greater than for non-surgical therapy. Several factors including travel distance and treatment facility were associated with survival outcomes for late-stage oral cavity cancers. Consideration of these factors may help improve the outcome for this patient population.
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Affiliation(s)
- Courtney S. Harris
- Roswell Park Summer Research Experience Program in Cancer Science, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
- College of Arts and Sciences, Cornell University, Ithaca, NY 14850, USA
- Weill Medical College, Cornell University, New York, NY 10065, USA
| | - Adrienne Groman
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - S. Lynn Sigurdson
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - William J. Magner
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - Anurag K. Singh
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
| | - Vishal Gupta
- Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA; (A.G.); (S.L.S.); (W.J.M.); (A.K.S.)
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Michelon I, Nachtigal GC, Dacoregio MI, Moraes ACBK, Moraes M, Piva LS, da Costa CT, Lund RG, Michelon D. Treatment options for cisplatin-ineligible patients with locally advanced head and neck squamous cell carcinoma: a systematic review. J Cancer Res Clin Oncol 2024; 150:379. [PMID: 39093329 PMCID: PMC11297068 DOI: 10.1007/s00432-024-05887-z] [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: 05/25/2024] [Accepted: 07/09/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE There is no agreed-upon standard option for patients with locally advanced head and neck squamous cell carcinoma (LA HNSCC) unfit for cisplatin-based regimens. Therefore, we performed a systematic review to explore alternative options for this population. METHODS We searched PubMed, Cochrane, and Embase databases for observational studies and clinical trials (CTs) assessing treatment options for LA HNSCC cisplatin-ineligible patients. This study was registered in PROSPERO under the number CRD42023483156. RESULTS This systematic review included 24 studies (18 observational studies and 6 CTs), comprising 4450 LA HNSCC cisplatin-ineligible patients. Most patients were treated with cetuximab-radiotherapy [RT] (50.3%), followed by carboplatin-RT (31.7%). In seven studies reporting median overall survival (OS) in patients treated with cetuximab-RT, it ranged from 12.8 to 46 months. The median OS was superior to 40 months in two studies assessing carboplatin-RT, and superior to 15 months in two studies assessing RT alone. For other regimens such as nimotuzumab-RT, docetaxel-RT, and carboplatin-RT plus paclitaxel the median OS was 21, 25.5, and 28 months, respectively. CONCLUSIONS Our systematic review supports the use of a variety of therapy combinations for LA HNSCC cisplatin-ineligible patients. We highlight the urgent need for clinical studies assessing treatment approaches in this population.
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Affiliation(s)
- Isabella Michelon
- Department of Medicine, Catholic University of Pelotas, Pelotas, Brazil
| | - Gilca Costa Nachtigal
- Department of Internal Medicine, Federal University of Pelotas Teaching Hospital (EBSERH), Pelotas, Brazil
| | | | - Ana Cristina Beitia Kraemer Moraes
- Department of Surgery, Faculty of Medicine, Catholic University of Pelotas, Pelotas, Brazil
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, 96015560, Brazil
| | - Mauricio Moraes
- Department of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Lívia Silva Piva
- Department of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | - Catiara Terra da Costa
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, 96015560, Brazil
| | - Rafael Guerra Lund
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, 96015560, Brazil
| | - Douver Michelon
- Graduate Program in Dentistry, School of Dentistry, Federal University of Pelotas, Pelotas, RS, 96015560, Brazil.
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Ishii R, Ohkoshi A, Katori Y. Treatment of elderly patients with head and neck cancer in an aging society: Focus on geriatric assessment and surgical treatment. Auris Nasus Larynx 2024; 51:647-658. [PMID: 38631257 DOI: 10.1016/j.anl.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
Previous studies of the treatment of elderly head and neck cancer (HNC) patients were very limited and sometimes controversial. Although conclusions differ across various reports, it is often concluded that advanced chronological age does not directly affect prognosis, but that comorbidities and declines in physical and cognitive functions promote the occurrence of adverse events, especially with surgical treatment. Geriatric assessment (GA) and its screening tools are keys to help us understand overall health status and problems, predict life expectancy and treatment tolerance, and to influence treatment choices and interventions to improve treatment compliance. In addition, personal beliefs and values play a large role in determining policies for HNC treatment for elderly patients, and a multidisciplinary approach is important to support this. In this review, past research on HNC in older adults is presented, and the current evidence is explained, focusing on the management of elderly HNC patients, with an emphasis on the existing reports on each treatment stage and modality, especially the surgical procedures.
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Affiliation(s)
- Ryo Ishii
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan.
| | - Akira Ohkoshi
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
| | - Yukio Katori
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Japan
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Yang D, Su L, Zhang L, Zhang Y, Li Y, Huang T, Huang X. Sarcopenia predicts postoperative complications in head and neck cancer: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2024; 281:3959-3975. [PMID: 38647686 DOI: 10.1007/s00405-024-08577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 02/19/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE We performed this systematic review and meta-analysis to explore the impact of preoperative sarcopenia on postoperative complication risks after head and neck cancer (HNC) surgery. METHODS We identified eligible studies by searching Ovid-MEDLINE, Ovid-Embase, EBM Reviews-Cochrane Central Register of Controlled Trials, Web of Science Core Collection, and Scopus. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. RESULTS Twenty-one studies with a total of 3480 patients met our inclusion criteria. The presence of sarcopenia significantly increased the incidence of overall postoperative complications (OR = 1.72, 95% CI 1.23, 2.41; P = 0.002; I2 = 59%). Subgroup analyses showed a higher risk of postoperative complications in the populations in which sarcopenia was diagnosed with low L3-skeletal muscle index (L3-SMI) or low cross-sectional area of the rectus femoris, but not in the group that sarcopenia was diagnosed with low C3-SMI. Preoperative sarcopenia also substantially increased the risk of severe postoperative complications (OR = 2.26), pharyngocutaneous fistulas (OR = 2.15), free flap-related complications (OR = 1.63), and surgical site infections (OR = 1.84). We also found a tendency toward a higher incidence of wound complications and 30-day mortality in patients with sarcopenia. CONCLUSION Preoperative sarcopenia is a negative prognostic indicator for postoperative complications in patients with HNC after surgery. To reduce the incidence of postoperative complications and improve poor prognosis, further attention needs to be paid to the evaluation and management of preoperative sarcopenia.
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Affiliation(s)
- Dan Yang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Lin Su
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Liying Zhang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Department of Biomedical Engineering, Sichuan University Library, Chengdu, 610041, Sichuan, China
| | - Yina Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Tingxuan Huang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiaoli Huang
- Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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11
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Zhou X, Zou C. Impact of various nutritional interventions on the physical and mental state of patients undergoing surgery for oral and maxillofacial tumor: guiding patients' informed choices. Support Care Cancer 2024; 32:559. [PMID: 39080071 DOI: 10.1007/s00520-024-08748-0] [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: 05/01/2024] [Accepted: 07/16/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE To compare the effects of oral nutritional supplements (ONS), parenteral nutrition (PN), and enteral nutrition (EN) on the recovery of patients who underwent oral and maxillofacial surgery. METHODS The shared decision-making process assigned 37, 56, and 35 patients to the ONS, PN, and EN groups, respectively. Details such as demographic data, duration of hospitalization, cost of nutritional therapy, nutritional assessments, patients' satisfaction, and compliance, Hamilton Anxiety Rating Scale (HAM-A) score, and relevant biochemical indices were systematically recorded and compared between the groups. RESULTS Patients with healthier biochemical indices and physical states at baseline, including a higher body mass index, preferred ONS. Patients using dentures and those with medical insurance often chose EN, while patients with recurrent disease preferred PN. Patients receiving EN had a similar duration of hospitalization to patients receiving ONS and also had the lowest nutritional costs. Patients receiving ONS had higher lymphocyte counts and levels of hemoglobin, albumin, and C-reactive protein. Patients in the PN group had elevated levels of serum potassium, chlorine, and sodium, while those receiving EN reported higher HAM-A scores, indicating greater anxiety than their counterparts. Predischarge surveys showed higher satisfaction and compliance in the PN and ONS groups than in the EN group. The PN group reported more adverse symptoms. At 7 days post-discharge, patients with EN reported a greater feeling of well-being. CONCLUSION ONS is the optimal choice for patients in good preoperative conditions, while PN is preferred during disease recurrence or when financially feasible. EN is suitable for patients using dentures or those with limited finances despite its potential psychological discomfort. Future studies with increased sample sizes and longer follow-up duration are necessary to corroborate our findings. The Trial Registration Number is ChiCTR2100049547. The date of registration is August 2, 2021.
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Affiliation(s)
- Xuan Zhou
- Institute of Sport, Exercise and Health, Tianjin University of Sport, No.16 Donghai Road, West Tuanbo New Town, Jinghai District, Tianjin, 300381, China.
| | - Chen Zou
- Department of Nutrition, Tianjin Stomatological Hospital, No. 75 Dagu Road, Heping District, Tianjin, 300041, China.
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12
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Zuo Z, Ma J, Yan M, Ge W, Yao T, Zhou L, Zeng Y, Liu Y. Machine learning-derived prognostic signature for progression-free survival in non-metastatic nasopharyngeal carcinoma. Head Neck 2024. [PMID: 39077955 DOI: 10.1002/hed.27895] [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: 03/11/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Early detection of high-risk nasopharyngeal carcinoma (NPC) recurrence is essential. We created a machine learning-derived prognostic signature (MLDPS) by combining three machine learning (ML) models to predict progression-free survival (PFS) in patients with non-metastatic NPC. METHODS A cohort of 653 patients with non-metastatic NPC was divided into a training (n = 457) and validation (n = 196) dataset (7:3 ratio). The study included clinicopathological characteristics, hematologic markers, and MRI findings in three machine learning models-random forest (RF), extreme gradient boosting (XGBoost), and least absolute shrinkage and selection operator (LASSO)-to predict progression-free survival (PFS). A Venn diagram identified the overlapping signatures from the three ML algorithms. Cox proportional hazard analysis determined the MLDPS for PFS. RESULTS The RF, XGBoost, and LASSO algorithms identified six consensus factors from the 33 signatures. Cox proportional hazards analysis showed that the MLDPS includes age, lymphocyte count, number of positive lymph nodes, and regional lymph node density. Additionally, MLDPS effectively stratified prognosis, with low-risk individuals showing better PFS than high-risk individuals (p < 0.001). CONCLUSION MLDPS, based on clinicopathological characteristics, hematologic markers, and MRI findings, is crucial for guiding clinical management and personalizing treatments for patients with non-metastatic NPC.
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Affiliation(s)
- Zhichao Zuo
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, China
| | - Jie Ma
- Department of Medical Imaging, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Mi Yan
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, China
| | - Wu Ge
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, China
| | - Ting Yao
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, China
| | - Lu Zhou
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, China
| | - Ying Zeng
- Department of Radiology, Xiangtan Central Hospital, Xiangtan, China
| | - Yang Liu
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, China
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13
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Jiang W, Chen L, Li R, Li J, Dou S, Ye L, He Y, Tian Z, Yao Y, Zhu G. Postoperative radiotherapy with docetaxel versus cisplatin for high-risk oral squamous cell carcinoma: a randomized phase II trial with exploratory analysis of ITGB1 as a potential predictive biomarker. BMC Med 2024; 22:314. [PMID: 39075531 PMCID: PMC11287860 DOI: 10.1186/s12916-024-03541-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) causes significant mortality and morbidity worldwide. Surgical resection with adjuvant radiotherapy remains the standard treatment for locally advanced resectable OSCC. Results from landmark trials have established postoperative concurrent cisplatin-radiotherapy (Cis-RT) as the standard treatment for OSCC patients with high-risk pathologic features. However, cisplatin-related toxicity limits usage in clinical practice. Given the need for effective but less toxic alternatives, we previously conducted a single-arm trial showing favorable safety profiles and promising efficacy of concurrent docetaxel-radiotherapy (Doc-RT). METHODS In this randomized phase 2 trial, we aimed to compare Doc-RT with the standard Cis-RT in postoperative OSCC patients. Eligible patients had AJCC stage III-IV resectable OSCC with high-risk pathologic features. Two hundred twenty-four patients were enrolled and randomly assigned to receive concurrent Doc-RT or Cis-RT. The primary endpoint was 2-year disease-free survival (DFS). Secondary endpoints included overall survival (OS), locoregional-free survival (LRFS), distant metastasis-free survival (DMFS), and adverse events (AEs). Integrin β1 (ITGB1) expression was analyzed as a biomarker for efficacy. RESULTS After a median 28.8-month follow-up, 2-year DFS rates were 63.7% for Doc-RT arm and 56.1% for Cis-RT arm (p = 0.55). Meanwhile, Doc-RT demonstrated comparable efficacy to Cis-RT in OS, LRFS, and DMFS. Doc-RT resulted in fewer grade 3 or 4 hematological AEs. Low ITGB1 was associated with improved Doc-RT efficacy versus Cis-RT. CONCLUSIONS This randomized trial directly compared Doc-RT with Cis-RT for high-risk postoperative OSCC patients, with comparable efficacy and less toxicity. ITGB1 merits further validation as a predictive biomarker to identify OSCC patients most likely to benefit from Doc-RT. Findings indicate docetaxel may be considered as a concurrent chemoradiation option in this setting. TRIAL REGISTRATION www. CLINICALTRIALS gov . NCT02923258 (date of registration: October 4, 2016).
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Affiliation(s)
- Wen Jiang
- Department of Oral and Maxillofacial-Head Neck Oncology, Division of Radiation Oncology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Lan Chen
- Department of Oral and Maxillofacial-Head Neck Oncology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Rongrong Li
- Department of Oral and Maxillofacial-Head Neck Oncology, Division of Radiation Oncology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jiang Li
- Department of Oral Pathology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shengjin Dou
- Department of Oral and Maxillofacial-Head Neck Oncology, Division of Radiation Oncology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Lulu Ye
- Department of Oral and Maxillofacial-Head Neck Oncology, Division of Radiation Oncology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yining He
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhen Tian
- Department of Oral Pathology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yanli Yao
- Department of Oral and Maxillofacial-Head Neck Oncology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China.
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Guopei Zhu
- Department of Oral and Maxillofacial-Head Neck Oncology, Division of Radiation Oncology, College of Stomatology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
- National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, China.
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China.
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14
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Noronha V, Patil V, Menon N, Singh A, Shah M, Shetake A, Peelay Z, Mathrudev V, Nawale K, Shah S, Prabhash K. Long-Term Update of a Phase 3 Randomized Study Comparing Once-a-Week Versus Once-Every-3-Weeks Cisplatin Along With Radiation in Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)03139-0. [PMID: 39074566 DOI: 10.1016/j.ijrobp.2024.07.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/08/2024] [Accepted: 07/13/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE In the weekly-3-weekly study, cisplatin at 100 mg/m2 once-every-3-weeks led to superior locoregional control compared with cisplatin 30 mg/m2 once-a-week in combination with radical radiation for locally advanced head and neck squamous cell carcinoma (LAHNSCC). We report the updated analysis of the study. METHODS AND MATERIALS In this phase 3 open-label noninferiority study conducted between 2013 and 2017, 300 patients with LAHNSCC were randomly assigned to receive cisplatin 100 mg/m2 once-in-every-weeks or cisplatin 30 mg/m2 once-a-week, concurrently with radiation. The primary endpoint was locoregional control. Secondary outcomes were overall survival, progression-free survival, and late adverse events. RESULTS The median follow-up was 6.91 years (95% CI, 6.12-7.36). The updated 2-year and 5-year locoregional control rates for the once-a-week cisplatin arm were 58.75% (95% CI, 51.08-67.58) and 48.09% (95% CI, 40.26-57.43), whereas for the once-every-3-weeks, cisplatin arm were 73.95% (95% CI, 66.93-81.70) and 56.76% (95% CI, 48.46-66.48), respectively, hazard ratio = 1.44 (95% CI, 1.03-2.03), P = .034. The 5-year overall survival was 43.60% (95% CI, 36.29-52.37) in the once-a-week cisplatin arm and 50.55% (95% CI, 43.06-59.35) in the once-every-3-weeks cisplatin arm; P = .19. There was no difference in any grade or grade ≥3 late adverse events between the 2 arms, except for hearing dysfunction, which was significantly more common in patients who received high-dose cisplatin. CONCLUSIONS Long-term follow-up confirms that cisplatin at 100 mg/m2 administered once-every-3-weeks concurrently with radical radiation for LAHNSCC leads to superior locoregional control compared with cisplatin 30 mg/m2 once-a-week and should remain one of the standard treatment options.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijay Patil
- Medical Oncology, P D Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ajaykumar Singh
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Minit Shah
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Ankush Shetake
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Zoya Peelay
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vijayalakshmi Mathrudev
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kavita Nawale
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Srushti Shah
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
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15
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Gandhi KA, Shirsat A, Hj SK, Chavan A, Dicholkar P, Shah S, Menon N, Noronha V, Joshi A, Prabhash K, Patil V, Gota V. Pharmacokinetics and clinical outcomes of low-dose nivolumab relative to conventional dose in patients with advanced cancer. Cancer Chemother Pharmacol 2024:10.1007/s00280-024-04697-x. [PMID: 39060628 DOI: 10.1007/s00280-024-04697-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
PURPOSE Nivolumab is approved at various doses, including 3 mg/kg, 240 mg and 480 mg flat doses at various dosing intervals. The concept of low-dose immunotherapy is gaining traction in recent years. However, there is a need to better understand the pharmacokinetics and clinical outcomes at lower doses. METHODS Patients were either administered 40 mg flat dose or 3 mg/kg Q2W/Q3W, depending on affordability as per prevailing hospital practice. All patients were hospitalized on day 1 and pharmacokinetic samples were collected at 0, 0.5, 1.0, 6.0, 24.0, 72.0 h and day 14 following administration of the first dose of nivolumab. Plasma nivolumab levels were measured by ELISA. Patients were followed up for response and toxicity. RESULTS Twenty five patients were included in the study. Fourteen received nivolumab at conventional dose (3 mg/kg), while 11 patients received low-dose (40 mg flat). The geometric means of dose normalized Cmax and AUC0-t were comparable between those who received conventional dose and low-dose of nivolumab (0.28 versus 0.23 µg/mL/mg and 0.0014 versus 0.0011 d/mL respectively). Nineteen patients were evaluable for response. ORR among patients who received conventional dose was 5/11 (45.5%) whereas it was 4/9 (44.4%) in the low-dose cohort. All 14 (100%) patients in conventional dosing group and 7/11 patients (63.64%) in low-dose group had treatment emergent adverse events. Grade ≥ 3 toxicities were observed in 4/14 patients in conventional dose group and none in low-dose group. CONCLUSION Low-dose nivolumab leads to lower exposure in patients as compared with conventional dose, but low-dose was better tolerated, while response rates were comparable to conventional dose.
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Affiliation(s)
- Khushboo A Gandhi
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC) Sector- 22, Kharghar, Navi Mumbai, 410210, India
| | - Aditi Shirsat
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC) Sector- 22, Kharghar, Navi Mumbai, 410210, India
| | - Sharat Kumar Hj
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC) Sector- 22, Kharghar, Navi Mumbai, 410210, India
| | - Ashish Chavan
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC) Sector- 22, Kharghar, Navi Mumbai, 410210, India
| | - Parnika Dicholkar
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC) Sector- 22, Kharghar, Navi Mumbai, 410210, India
| | - Saniya Shah
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC) Sector- 22, Kharghar, Navi Mumbai, 410210, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India
- Homi bhabha National Institute, Mumbai, 400094, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India
- Homi bhabha National Institute, Mumbai, 400094, India
| | - Amit Joshi
- Homi bhabha National Institute, Mumbai, 400094, India
- Department of Medical Oncology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC), Kharghar, Navi Mumbai, 410210, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India
- Homi bhabha National Institute, Mumbai, 400094, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, 400012, India
| | - Vikram Gota
- Department of Clinical Pharmacology, Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre (TMC) Sector- 22, Kharghar, Navi Mumbai, 410210, India.
- Homi bhabha National Institute, Mumbai, 400094, India.
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16
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Abdelazeem KN, Nguyen D, Corbo S, Darragh LB, Matsumoto MW, Court BV, Neupert B, Yu J, Olimpo NA, Osborne DG, Gadwa J, Ross RB, Nguyen A, Bhatia S, Kapoor M, Friedman RS, Jacobelli J, Saviola AJ, Knitz MW, Pasquale EB, Karam SD. Manipulating the EphB4-ephrinB2 axis to reduce metastasis in HNSCC. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.21.604518. [PMID: 39091728 PMCID: PMC11291065 DOI: 10.1101/2024.07.21.604518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The EphB4-ephrinB2 signaling axis has been heavily implicated in metastasis across numerous cancer types. Our emerging understanding of the dichotomous roles that EphB4 and ephrinB2 play in head and neck squamous cell carcinoma (HNSCC) poses a significant challenge to rational drug design. We find that EphB4 knockdown in cancer cells enhances metastasis in preclinical HNSCC models by augmenting immunosuppressive cells like T regulatory cells (Tregs) within the tumor microenvironment. EphB4 inhibition in cancer cells also amplifies their ability to metastasize through increased expression of genes associated with epithelial mesenchymal transition and hallmark pathways of metastasis. In contrast, vascular ephrinB2 knockout coupled with radiation therapy (RT) enhances anti-tumor immunity, reduces Treg accumulation into the tumor, and decreases metastasis. Notably, targeting the EphB4-ephrinB2 signaling axis with the engineered EphB4 ligands EFNB2-Fc-His and Fc-TNYL-RAW-GS reduces local tumor growth and distant metastasis in a preclinical model of HNSCC. Our data suggest that targeted inhibition of vascular ephrinB2 while avoiding inhibition of EphB4 in cancer cells could be a promising strategy to mitigate HNSCC metastasis.
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Affiliation(s)
- Khalid N.M. Abdelazeem
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Radiation Biology Research Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt
| | - Diemmy Nguyen
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Sophia Corbo
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Laurel B. Darragh
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mike W. Matsumoto
- Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Benjamin Van Court
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Brooke Neupert
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Justin Yu
- Department of Otolaryngology - Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicholas A. Olimpo
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Douglas Grant Osborne
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob Gadwa
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Richard B. Ross
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Alexander Nguyen
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Mohit Kapoor
- Krembil Research Institute, University Health Network, and University of Toronto, Toronto, Ontario, Canada
| | - Rachel S. Friedman
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Barbara Davis Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jordan Jacobelli
- Department of Immunology and Microbiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Barbara Davis Research Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Anthony J. Saviola
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Michael W. Knitz
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Elena B. Pasquale
- Cancer Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Sana D. Karam
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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17
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Zhu R, Wang P, Dai J, Cheng Y, Zhu H. Efficacy of chemoradiotherapy in elderly patients with stage IV inoperable head and neck cancer. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08805-8. [PMID: 39042169 DOI: 10.1007/s00405-024-08805-8] [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: 01/19/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024]
Abstract
OBJECTIVES This study aimed to compare the efficacy of chemoradiotherapy (CRT) with radiotherapy (RT) alone for elderly patients (≥ 65 years) with stage IV inoperable head and neck cancer (IV-HNC). METHODS Elderly patients diagnosed with inoperable IV-HNC from 2010 to 2015 were identified using the SEER database. Then, we performed a 1:1 propensity-score matched (PSM) analysis to reduce treatment selection bias, and the prognostic role of CRT was investigated using Kaplan-Meier analysis, log-rank test, and Cox proportional hazard models. The main outcome was overall survival (OS), and the secondary outcome was cancer-specific survival (CSS). RESULTS A total of 3318 patients were enrolled, of whom 601 received RT alone and 2717 received CRT. Through PSM, 526 patients were successfully matched, and balances between the two treatment groups were reached. In the matched dataset, multivariable Cox analysis revealed that CRT was associated with better OS (HR = 0.580, P < 0.001) and CSS (HR = 0.586, P < 0.001). Meanwhile, subgroups of patients with IV-HNC (younger age, male sex, being married, black race, grade I-II, oral cavity site, T3-T4 stage, N0-N1 stage, M1 stage) were inclined to benefit more from CRT treatment. Furthermore, the survival benefit of CRT was more pronounced in patients aged 65 to 80 years, but was absent in patients aged 80 years or older. CONCLUSIONS This study indicated that CRT resulted in better survival than RT alone in elderly patients with inoperable IV-HNC, especially for those subpopulations that benefit more from CRT treatment.
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Affiliation(s)
- Runqiu Zhu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Pan Wang
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jiahui Dai
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Yangxi Cheng
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Huiyong Zhu
- Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, 79# Qingchun Road, Hangzhou, Zhejiang Province, 310003, People's Republic of China.
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Kwiecien C, Workman AD, Wilensky J, Lerner DK, Rathi VK, Douglas JE, Kohanski MA, Kuan EC, Palmer JN, Adappa ND. Longer-term surveillance imaging and endoscopy critical for majority of patients in detection of sinonasal malignancy recurrence. Int Forum Allergy Rhinol 2024. [PMID: 39039645 DOI: 10.1002/alr.23412] [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: 03/29/2024] [Revised: 06/17/2024] [Accepted: 07/01/2024] [Indexed: 07/24/2024]
Abstract
BACKGROUND Sinonasal malignancy surveillance paradigms are often based on Head and Neck National Comprehensive Cancer Network guidelines, which do not recommend standard surveillance imaging beyond 6 months without concerning symptomatology or physical examination findings. METHODS This was a retrospective analysis of all patients who underwent resection of sinonasal malignancy at a tertiary care center over a 20-year period from 2000 to 2020, with an ensuing surveillance period demonstrating recurrence. RESULTS Fifty-two patients with sinonasal malignancy recurrence were included, with an average time to recurrence of 30.9 months and a follow-up period of over 60 months. Recurrence was diagnosed by routine imaging or endoscopy in asymptomatic patients in a majority (60%) of cases, while the remaining minority of diagnoses followed new symptomatology. Asymptomatic recurrence was associated with perineural spread of tumor at initial resection (p = 0.025), but not with age (p = 0.85) or stage at diagnosis (p = 0.68). Expectedly, positron emission tomography/computed tomography (CT) more often detected regional or distant recurrence, while structural imaging (CT/magnetic resonance imaging) demonstrated more frequent detection of recurrence in those with perineural spread of tumor (p = 0.01). CONCLUSIONS Our findings support high rates of asymptomatic recurrence in sinonasal malignancy, with the majority of recurrences diagnosed by routine endoscopy or imaging. Tailored and extended surveillance guidelines are necessary relative to those utilized for other head and neck mucosal cancers, and are especially appropriate when features such as perineural spread are present.
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Affiliation(s)
- Catherine Kwiecien
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan D Workman
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Jadyn Wilensky
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David K Lerner
- Department of Otolaryngology, University of Miami, Miami, Florida, USA
| | - Vinay K Rathi
- Department of Otolaryngology, Ohio State University, Columbus, Ohio, USA
| | - Jennifer E Douglas
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael A Kohanski
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology, University of California, Irvine, California, USA
| | - James N Palmer
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Dzienis M, Cundom J, Fuentes CS, Spreafico A, Nordlinger M, Pastor AV, Alesi E, Neki A, Fung AS, Figueiredo Lima IP, Oppelt P, da Cunha Junior GF, Burtness B, Franke FA, Tseng JE, Joshi A, McCarthy J, Swaby R, Sidi Y, Gumuscu B, Naicker N, de Castro G. Pembrolizumab Plus Carboplatin and Paclitaxel as First-Line Therapy for Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma (KEYNOTE-B10): A Single-Arm Phase IV Trial. J Clin Oncol 2024:JCO2302625. [PMID: 39038265 DOI: 10.1200/jco.23.02625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/29/2024] [Accepted: 04/23/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Standard-of-care first-line treatment for recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) is pembrolizumab plus platinum and fluorouracil (FU). However, FU is associated with potential challenges (continuous 4-day infusion, high administration costs, and cardiovascular and gastrointestinal toxicities), creating a clinical need for alternative chemotherapy combinations. We evaluated the efficacy and safety of first-line pembrolizumab plus carboplatin and paclitaxel for R/M HNSCC in the open-label, single-arm, phase IV KEYNOTE-B10 study (ClinicalTrials.gov identifier: NCT04489888). METHODS Eligible adults had previously untreated, histologically or cytologically confirmed R/M HNSCC regardless of PD-L1 status, measurable disease per RECIST v1.1 by blinded independent central review (BICR), and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients received pembrolizumab 200 mg intravenously once every 3 weeks for ≤35 cycles and carboplatin AUC 5 mg/mL/min intravenously once every 3 weeks for ≤6 cycles and investigator's choice of paclitaxel 100 mg/m2 on days 1 and 8 or 175 mg/m2 on day 1, intravenously once every 3 weeks. The primary end point was objective response rate per RECIST v1.1 by BICR. RESULTS Between October 27, 2020, and April 29, 2022, 149 patients were screened and 101 received treatment. As of February 20, 2023, the median follow-up was 18.9 months (range, 9.1-27.0). At this final analysis, 49 (49%) of 101 patients had an objective response (95% CI, 38.4 to 58.7), including seven patients (7%) with a confirmed complete response. Of the 101 treated patients, grade 3-5 and serious treatment-related adverse events occurred in 76 (75%) and 27 (27%), respectively. There were no new safety signals. CONCLUSION Pembrolizumab plus carboplatin and paclitaxel showed promising antitumor activity and a manageable safety profile in first-line R/M HNSCC, suggesting this combination may be an alternative option for this patient population.
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Affiliation(s)
- Marcin Dzienis
- Cancer Department, Gold Coast University Hospital, Southport, QLD, Australia
| | - Juan Cundom
- Department of Oncology, IDIM Instituto de Diagnóstico e Investigaciones Metabólicas, Buenos Aires, Argentina
| | | | - Anna Spreafico
- Division of Medical Oncology and Hematology, Princess Margaret Cancer Center, Toronto, ON, Canada
| | - Melanie Nordlinger
- Department of Medical Oncology, Sidney Kimmel Cancer Center at Jefferson-Abington Hospital, Philadelphia, PA
| | | | - Erin Alesi
- Department of Hematology/Oncology and Palliative Medicine, VCU Massey Cancer Center, Richmond, VA
| | - Anterpreet Neki
- Department of Hematology/Oncology, UC Davis Medical Center, Sacramento, CA
| | - Andrea S Fung
- Department of Oncology, Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, Canada
| | | | - Peter Oppelt
- Department of Oncology, Washington University School of Medicine, St Louis, MO
| | | | - Barbara Burtness
- Yale University School of Medicine and Yale Cancer Center, New Haven, CT
| | - Fabio Andre Franke
- Department of Oncology, Oncosite Centro de Pesquisa Clínica em Oncologia, Ijuí, Brazil
| | - Jennifer E Tseng
- Department of Hematology and Oncology, Orlando Health Cancer Institute, Orlando, FL
| | - Abhishek Joshi
- Department of Medical Oncology, The Townsville University Hospital, Douglas, QLD, Australia
| | - Joy McCarthy
- Dr. H. Bliss Murphy Cancer Centre, St John's, NL, Canada
| | | | | | | | - Niroshini Naicker
- Oncology European Clinical Development, MSD (UK) Limited, London, United Kingdom
| | - Gilberto de Castro
- Clinical Oncology, Instituto do Câncer do Estado de São Paulo-ICESP, São Paulo, Brazil
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Peterson DE, Stout NL, Shulman LN, Perkins J, LeMarier G, Nekhlyudov L. Gaps in Access to Medically Necessary Dental Care for Patients Living With and Beyond Cancer: We Must Do Better. J Clin Oncol 2024; 42:2495-2499. [PMID: 38630949 DOI: 10.1200/jco.24.00162] [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: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024] Open
Abstract
Delivery of high-quality, evidence-based oral care for those living with and beyond cancer needed!
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Affiliation(s)
- Douglas E Peterson
- Department of Oral & Maxillofacial Diagnostic Sciences, School of Dental Medicine, UConn Health, Farmington, CT
| | - Nicole L Stout
- School of Medicine, West Virginia University Cancer Institute, Morgantown, WV
- School of Public Health, West Virginia University, Morgantown, WV
| | - Lawrence N Shulman
- Center for Global Cancer Medicine, Innovation Faculty, Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jennifer Perkins
- Department of Oral and Maxillofacial Surgery, School of Dentistry, University of California San Francisco, San Francisco, CA
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Schmocker M, Engst R, Wirz M, Bana M. Factors influencing physical activity in individuals with head and neck cancer: a scoping review. BMJ Open 2024; 14:e083852. [PMID: 39019637 PMCID: PMC11331979 DOI: 10.1136/bmjopen-2023-083852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 06/07/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVES Higher physical activity (PA) levels are associated with better quality of life in people with head and neck cancer (HNC). Despite this positive association, most individuals with these cancer types have a sedentary or low-activity lifestyle. Limited knowledge exists regarding the factors that influence PA in this group. Therefore, we reviewed and mapped the available literature on factors that may influence PA in people with HNC. DESIGN We conducted a scoping review based on the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for scoping reviews. DATA SOURCES CINHAL, the Cochrane Library, EMBASE, PsycINFO, MEDLINE and Scopus were searched from inception to July 2023. ELIGIBILITY CRITERIA We included qualitative and quantitative studies that stated factors such as barriers, facilitators, beliefs, perceptions and views influencing PA in individuals with HNC. Furthermore, views and recommendations of healthcare professionals involved in the care of people affected by HNC and researchers in this domain were eligible for data extraction. DATA EXTRACTION AND SYNTHESIS Data were extracted and synthesised by one reviewer according to the predefined items including characteristics, barriers, facilitators, beliefs, perceptions and views of people being affected and views and recommendations of experts. Quantitative data were charted descriptively, and qualitative data were analysed and summarised using a basic content analysis approach. RESULTS Of the 1351 publications, we included 19 in our review. Publications mainly focused on barriers to PA, with some studies reporting facilitators and collecting data on patients' and healthcare professionals' views on PA. Most research teams made recommendations for promoting PA in people with HNC.Characteristics associated with activity levels included age, cancer type and stage, morbidity level and attitude towards being active. Prevalent barriers consisted of health-related factors, including fatigue, pain and nutritional issues, alongside personal and environmental impediments such as time constraints, lack of interest or motivation. Facilitating factors for PA included perceived or experienced mental and health-related benefits. Consensus among patients, healthcare professionals and researchers highlighted the necessity for enhanced information and education, emphasising individualised approaches to promote PA throughout the cancer continuum. CONCLUSIONS Numerous factors affect PA in individuals with HNC. Future research should concentrate on screening and addressing risk factors for sedentary behaviour and activity barriers and on optimal design and delivery of interventions to incorporate PA promotion into the care pathway.
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Affiliation(s)
- Martina Schmocker
- Institute for Therapies and Rehabilitation, Cantonal Hospital Winterthur, Winterthur, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Ramona Engst
- Institute of Nursing Sciences, Eastern Switzerland University of Applied Sciences, St. Gallen, Switzerland
| | - Markus Wirz
- Institute of Physiotherapy, School of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Marika Bana
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Fribourg, Switzerland
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22
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Dong Y, Gong K. Head and neck tumor segmentation from [ 18F]F-FDG PET/CT images based on 3D diffusion model. Phys Med Biol 2024; 69:10.1088/1361-6560/ad5ef2. [PMID: 38959909 PMCID: PMC11302413 DOI: 10.1088/1361-6560/ad5ef2] [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: 02/05/2024] [Accepted: 07/03/2024] [Indexed: 07/05/2024]
Abstract
Objective.Head and neck (H&N) cancers are among the most prevalent types of cancer worldwide, and [18F]F-FDG PET/CT is widely used for H&N cancer management. Recently, the diffusion model has demonstrated remarkable performance in various image-generation tasks. In this work, we proposed a 3D diffusion model to accurately perform H&N tumor segmentation from 3D PET and CT volumes.Approach.The 3D diffusion model was developed considering the 3D nature of PET and CT images acquired. During the reverse process, the model utilized a 3D UNet structure and took the concatenation of 3D PET, CT, and Gaussian noise volumes as the network input to generate the tumor mask. Experiments based on the HECKTOR challenge dataset were conducted to evaluate the effectiveness of the proposed diffusion model. Several state-of-the-art techniques based on U-Net and Transformer structures were adopted as the reference methods. Benefits of employing both PET and CT as the network input, as well as further extending the diffusion model from 2D to 3D, were investigated based on various quantitative metrics and qualitative results.Main results.Results showed that the proposed 3D diffusion model could generate more accurate segmentation results compared with other methods (mean Dice of 0.739 compared to less than 0.726 for other methods). Compared to the diffusion model in 2D form, the proposed 3D model yielded superior results (mean Dice of 0.739 compared to 0.669). Our experiments also highlighted the advantage of utilizing dual-modality PET and CT data over only single-modality data for H&N tumor segmentation (with mean Dice less than 0.570).Significance.This work demonstrated the effectiveness of the proposed 3D diffusion model in generating more accurate H&N tumor segmentation masks compared to the other reference methods.
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Affiliation(s)
- Yafei Dong
- Yale PET Center, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, United States of America
| | - Kuang Gong
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL 32611, United States of America
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, United States of America
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23
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Ledderose S, Ledderose C, Ledderose GJ. Expression of immune checkpoint molecules TIGIT and TIM-3 by tumor-infiltrating lymphocytes predicts poor outcome in sinonasal mucosal melanoma. Pathol Res Pract 2024; 260:155468. [PMID: 39018929 DOI: 10.1016/j.prp.2024.155468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 07/12/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Sinonasal mucosal melanoma (SNMM) is a rare but aggressive tumor with a poor prognosis. The co-inhibitory receptors T cell immunoglobulin and mucinodomain containing-3 (TIM-3), lymphocyte activation gene-3 (LAG-3) and T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain (TIGIT) are promising new targets in anti-cancer immunotherapy. The expression profiles of these immune checkpoint molecules (ICMs) and potential prognostic implications have not been characterized in SNMM yet. METHODS Immunohistochemical staining for TIGIT, LAG-3 and TIM-3 was performed on tumor tissue samples from 27 patients with primary SNMM. Associations between ICM expression and demographic parameters, AJCC tumor stage, overall survival, and recurrence-free survival were retrospectively analyzed. RESULTS SNMM patients with low numbers of TIGIT+ and TIM-3+ tumor infiltrating lymphocytes (TILs) in the primary tumor survived significantly longer than patients with a high degree of TIGIT+ and TIM-3+ TILs. High infiltration with TIM-3+ or TIGIT+ lymphocytes was associated with the higher T4 stage and decreased 5-year survival. CONCLUSION We identified high densities of TIM-3+ and TIGIT+ TILs as strong negative prognostic biomarkers in SNMM. This suggests that TIM-3 and TIGIT contribute to immunosuppression in SNMM and provides a rationale for novel treatment strategies based on this next generation of immune checkpoint inhibitors. Prospective studies with larger case numbers are warranted to confirm our findings and their implications for immunotherapy.
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Affiliation(s)
- Stephan Ledderose
- Institute of Pathology, Faculty of Medicine, LMU Munich, Munich, Germany.
| | - Carola Ledderose
- Department of Surgery, Division of Surgical Sciences, University of California San Diego, San Diego, CA, USA
| | - Georg J Ledderose
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of LMU Munich, Munich, Germany; ENT-Center Dr. Lübbers & Kollegen, Weilheim, Germany
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24
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Wang J, Fang Q, Zhang X, Dai L, Luo R. Role of elective neck dissection in cT2N0 maxillary sinus squamous cell carcinoma. Sci Rep 2024; 14:16230. [PMID: 39004629 PMCID: PMC11247074 DOI: 10.1038/s41598-024-66179-7] [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: 01/23/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Our objective was to examine the impact of elective neck dissection (END) on the prognosis of patients with cT2N0 maxillary sinus squamous cell carcinoma (MS-SCC) and to determine factors that predict the occurrence of occult metastasis in this patient population. A retrospective analysis was conducted using data from the SEER database. Patients with cT2N0 MS-SCC were included in the study and divided into two groups: those who received END and those who did not. The impact of END on disease-specific survival (DSS) and overall survival (OS) was assessed using propensity score matching. Multivariate logistic regression analysis was performed to determine predictors for occult metastasis. A total of 180 patients were included in the study, with 40 cases receiving END. Following propensity score matching, patients treated with END and those without showed similar DSS and OS rates. Occult metastasis was observed in 9 patients, corresponding to a rate of 22.5%. High-grade tumors were independently associated with a higher risk of occult metastasis compared to low-grade tumors (hazard ratio 1.52, 95% confidence interval 1.17-2.00). cT2 MS-SCC carries an occult metastasis rate of 22.5%, with histologic grade being the primary determinant of occult metastasis. END does not confer a significant survival benefit in this patient population.
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Affiliation(s)
- Jingjing Wang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Qigen Fang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
| | - Xu Zhang
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Liyuan Dai
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China
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25
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Du W, Jia M, Li J, Gao M, Zhang W, Yu Y, Wang H, Peng X. Prognostic prediction model for salivary gland carcinoma based on machine learning. Int J Oral Maxillofac Surg 2024:S0901-5027(24)00216-9. [PMID: 38981745 DOI: 10.1016/j.ijom.2024.07.006] [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: 08/23/2023] [Revised: 06/23/2024] [Accepted: 07/01/2024] [Indexed: 07/11/2024]
Abstract
Although rare overall, salivary gland carcinomas (SGCs) are among the most common oral and maxillofacial malignancies. The aim of this study was to develop a machine learning-based model to predict the survival of patients with SGC. Patients in whom SGC was confirmed by histological testing and who underwent primary extirpation at the authors' institution between 1963 and 2014 were identified. Demographic and clinicopathological data with complete follow-up information were collected for analysis. Feature selection methods were used to determine the correlation between prognosis-related factors and survival in the collected patient data. The collected clinicopathological data and multiple machine learning algorithms were used to develop a survival prediction model. Three machine learning algorithms were applied to construct the prediction models. The area under the receiver operating characteristic curve (AUC) and accuracy were used to measure model performance. The best classification performance was achieved with a LightGBM algorithm (AUC = 0.83, accuracy = 0.91). This model enabled prognostic prediction of patient survival. The model may be useful in developing personalized diagnostic and treatment strategies and formulating individualized follow-up plans, as well as assisting in the communication between doctors and patients, facilitating a better understanding of and compliance with treatment.
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Affiliation(s)
- W Du
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - M Jia
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China; Zhongguancun Hospital, Beijing, China
| | - J Li
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - M Gao
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - W Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - Y Yu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China
| | - H Wang
- School of Mathematical Sciences, Beihang University, Beijing, China
| | - X Peng
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China.
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26
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Krsek A, Baticic L, Sotosek V, Braut T. The Role of Biomarkers in HPV-Positive Head and Neck Squamous Cell Carcinoma: Towards Precision Medicine. Diagnostics (Basel) 2024; 14:1448. [PMID: 39001338 PMCID: PMC11241541 DOI: 10.3390/diagnostics14131448] [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: 06/10/2024] [Revised: 07/03/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024] Open
Abstract
Head and neck cancer (HNC) represents a significant global health challenge, with squamous cell carcinomas (SCCs) accounting for approximately 90% of all HNC cases. These malignancies, collectively referred to as head and neck squamous cell carcinoma (HNSCC), originate from the mucosal epithelium lining the larynx, pharynx, and oral cavity. The primary risk factors associated with HNSCC in economically disadvantaged nations have been chronic alcohol consumption and tobacco use. However, in more affluent countries, the landscape of HNSCC has shifted with the identification of human papillomavirus (HPV) infection, particularly HPV-16, as a major risk factor, especially among nonsmokers. Understanding the evolving risk factors and the distinct biological behaviors of HPV-positive and HPV-negative HNSCC is critical for developing targeted treatment strategies and improving patient outcomes in this complex and diverse group of cancers. Accurate diagnosis of HPV-positive HNSCC is essential for developing a comprehensive model that integrates the molecular characteristics, immune microenvironment, and clinical outcomes. The aim of this comprehensive review was to summarize the current knowledge and advances in the identification of DNA, RNA, and protein biomarkers in bodily fluids and tissues that have introduced new possibilities for minimally or non-invasive cancer diagnosis, monitoring, and assessment of therapeutic responses.
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Affiliation(s)
- Antea Krsek
- Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia;
| | - Lara Baticic
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Vlatka Sotosek
- Department of Clinical Medical Sciences I, Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia;
- Department of Anesthesiology, Reanimatology, Emergency and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Tamara Braut
- Department of Otorhinolaryngology and Head and Neck Surgery, Clinical Hospital Centre Rijeka, 51000 Rijeka, Croatia;
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27
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Aliotta E, Paudyal R, Diplas B, Han J, Hu YC, Hun Oh J, Hatzoglou V, Jensen N, Zhang P, Aristophanous M, Riaz N, Deasy JO, Lee NY, Shukla-Dave A. Multi-modality imaging parameters that predict rapid tumor regression in head and neck radiotherapy. Phys Imaging Radiat Oncol 2024; 31:100603. [PMID: 39040433 PMCID: PMC11261256 DOI: 10.1016/j.phro.2024.100603] [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: 03/13/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024] Open
Abstract
Background and purpose Volume regression during radiotherapy can indicate patient-specific treatment response. We aimed to identify pre-treatment multimodality imaging (MMI) metrics from positron emission tomography (PET), magnetic resonance imaging (MRI), and computed tomography (CT) that predict rapid tumor regression during radiotherapy in human papilloma virus (HPV) associated oropharyngeal carcinoma. Materials and methods Pre-treatment FDG PET-CT, diffusion-weighted MRI (DW-MRI), and intra-treatment (at 1, 2, and 3 weeks) MRI were acquired in 72 patients undergoing chemoradiation therapy for HPV+ oropharyngeal carcinoma. Nodal gross tumor volumes were delineated on longitudinal images to measure intra-treatment volume changes. Pre-treatment PET standardized uptake value (SUV), CT Hounsfield Unit (HU), and non-gaussian intravoxel incoherent motion DW-MRI metrics were computed and correlated with volume changes. Intercorrelations between MMI metrics were also assessed using network analysis. Validation was carried out on a separate cohort (N = 64) for FDG PET-CT. Results Significant correlations with volume loss were observed for baseline FDG SUVmean (Spearman ρ = 0.46, p < 0.001), CT HUmean (ρ = 0.38, p = 0.001), and DW-MRI diffusion coefficient, Dmean (ρ = -0.39, p < 0.001). Network analysis revealed 41 intercorrelations between MMI and volume loss metrics, but SUVmean remained a statistically significant predictor of volume loss in multivariate linear regression (p = 0.01). Significant correlations were also observed for SUVmean in the validation cohort in both primary (ρ = 0.30, p = 0.02) and nodal (ρ = 0.31, p = 0.02) tumors. Conclusions Multiple pre-treatment imaging metrics were correlated with rapid nodal gross tumor volume loss during radiotherapy. FDG-PET SUV in particular exhibited significant correlations with volume regression across the two cohorts and in multivariate analysis.
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Affiliation(s)
- Eric Aliotta
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ramesh Paudyal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bill Diplas
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Han
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yu-Chi Hu
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jung Hun Oh
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vaios Hatzoglou
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Naomi Jensen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Fitzgerald KT, Lyons C, England A, McEntee MF, Devine A, O'Donovan T, O'Sullivan E. Risk factors associated with the development of osteoradionecrosis (ORN) in Head and Neck cancer patients in Ireland: A 10-year retrospective review. Radiother Oncol 2024; 196:110286. [PMID: 38641259 DOI: 10.1016/j.radonc.2024.110286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/21/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND AND PURPOSES To assess osteoradionecrosis (ORN) incidence in a population of Irish Head and Neck cancer (HNC) patients, and assess precipitating factors that may contribute to ORN development to aid prevention. MATERIALS AND METHODS Review of 1050 HNC patients attending the Dental Oncology Clinic, CUDSH between 2010 and 2021 identified 47 cases of ORN. Medical, dental and radiotherapy records of these forty-seven patients were retrospectively reviewed. Patient-, tumour-, and treatment-related variables were investigated in association with osteoradionecrosis development. Analysis conducted using SPSS, Pearson's Chi-square test (p < 0.05), and ordinal regression model. RESULTS ORN incidence was 4.4 %. Median time from radiotherapy (RT) to ORN development was 9.5 months (range 1-98.5 months). ORN development within the mandibular surgical site was significant (p <.001), presenting at a higher Notani grade (p =.002), in mid-mandibular body region (p =.028), at radiation doses ≥ 60 Gy (p =.035), due to induced causes (p =.029), and without resolution (p =.019). CONCLUSION This is the first retrospective study of ORN in HNC patients in Ireland over 10-year period. ORN incidence was extremely low (4.4%). As patients reported high smoking/alcohol use and poor dental attendance pre-diagnosis, this suggests intensive dental intervention pre/post-diagnosis contributed to low ORN rates. Mandibular surgery pre-RT increased risk of developing ORN at the surgical site. Therefore, we recommend future treatment planning should contour the surgical site, designating it an organ at risk (OAR), assigning a dose constraint, where oncologically possible, with emphasis on reducing the hot-spot to this region; findings reinforce importance of life-long expert dental care to reduce ORN incidence.
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Affiliation(s)
| | - Ciara Lyons
- Radiation Therapy Dept., Glandore Centre, Cork University Hospital, Cork, Ireland
| | - Andrew England
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Mark F McEntee
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Annemarie Devine
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Theresa O'Donovan
- Medical Imaging & Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - Eleanor O'Sullivan
- Radiation Therapy Dept., Glandore Centre, Cork University Hospital, Cork, Ireland; ENTO Research Unit, Cork University Dental School & Hospital, Cork, Ireland.
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Chang YM, Lee CC. Incorporation of stromal tumor-infiltrating lymphocytes into an early death prediction model significantly improves net reclassification for outcome estimation in advanced buccal cancer. J Craniomaxillofac Surg 2024; 52:843-849. [PMID: 38729844 DOI: 10.1016/j.jcms.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
We explored the impact of stromal tumor-infiltrating lymphocytes (sTILs) on the prognostic value of an early death model for advanced buccal cancer. We assessed 121 patients with advanced buccal cancer who underwent primary tumor resection at a medical center. Predictors of early death and 5-year overall survival (OS) were analyzed using Cox regression models. Performance of models was evaluated with the Harrell C and Akaike information criterion. The net reclassification improvement of the early death model was also calculated relative to the 5-year OS model for one-year all-cause mortality. A total of 121 patients with advanced buccal cancer were recruited. Mean age was 56.1 ± 9.8 years; 117 (96.7%) patients were male. sTILs ≤30%, clinical nodal disease, pathological nodal disease, poor differentiation, lymphovascular invasion, perineural invasion, WPOI 5, and no adjuvant radiotherapy were risk factors for early death in univariate analysis. In multivariate analysis, clinical TNM, sTILs, clinical nodal disease, poor differentiation, lymphovascular invasion, and no adjuvant RT were independent factors for early death. sTILs, pathological nodal disease, poor differentiation, lymphovascular invasion, and no adjuvant RT were independent factors for early death in the multivariate model with pathological TNM. The discriminatory ability was better for early death model for 1-year all-cause mortality. Finally, incorporation of sTILs into the early death model increased net reclassification by 21% for the clinical TNM model and 28% for the pathological TNM model. Addition of sTILs improved the early death model, which may help physicians to identify high-risk patients for more intensive treatment and follow-up.
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Affiliation(s)
- Yi-Ming Chang
- Department of Pathology and Laboratory, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Pathology, Tri-Service General Hospital, Taipei, Taiwan.
| | - Ching-Chih Lee
- Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan; Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chao Tung University, Taipei, Taiwan; School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan.
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Khamdi S, Matangkasombut O, Lam-Ubol A. Non-pharmacologic interventions for management of radiation-induced dry mouth: A systematic review. Oral Dis 2024; 30:2876-2893. [PMID: 37946598 DOI: 10.1111/odi.14804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/01/2023] [Accepted: 10/12/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Radiation-induced dry mouth negatively impacts patients' oral health and quality of life. Currently, evidence-based recommendation for non-pharmacologic interventions is still lacking. This study aimed to systematically review clinical trials evaluating the efficacy of non-pharmacologic interventions in cancer patients with radiation-induced dry mouth. METHODS Randomized controlled trials from 2000 were searched from 4 databases, including MEDLINE, Cochrane, Embase via OVID, and SCOPUS, up to December 16th, 2022 (PROSPERO registration CRD42022378405). The risk of bias was assessed using the revised Cochrane risk of bias assessment tool. RESULTS Twenty-one studies were included: 11 on artificial saliva, 4 on electrical nerve stimulation (TENS), 2 on acupuncture, and one study each on low-level laser therapy, stem cells, chewing gum, and probiotics. Overall bias was low, medium, and high in 33%, 48%, and 19% of the studies, respectively. Certain artificial saliva products and TENS were shown to improve dry mouth symptoms and salivary flow rate (SFR). One study showed that stem cell transplantation significantly increased SFR. CONCLUSIONS The evidence suggested that certain artificial saliva products and TENS are promising management. However, the evidence was still limited due to heterogeneity of interventions and outcome measurements. Thus, future studies using standard measurements and long-term follow-up are warranted.
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Affiliation(s)
- Sukontha Khamdi
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
| | - Oranart Matangkasombut
- Department of Microbiology and Center of Excellence on Oral Microbiology and Immunology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
- Research Laboratory of Biotechnology, Chulabhorn Research Institute, Bangkok, Thailand
| | - Aroonwan Lam-Ubol
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
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Shi S, Li B, Zhou P, Chen L, Li H, Wang Y, Deng X, Dang Q, Wu J, Zha B, Li P, Zheng Y, Yang D. Analysis of the clinical efficacy and safety of anti-PD-1 immune checkpoint inhibitors in locally advanced nasopharyngeal cancer. Cancer Med 2024; 13:e7359. [PMID: 39032129 PMCID: PMC11260107 DOI: 10.1002/cam4.7359] [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: 09/23/2023] [Revised: 03/17/2024] [Accepted: 05/26/2024] [Indexed: 07/22/2024] Open
Abstract
OBJECTIVE To analyze the efficacy and adverse effects of anti-PD-1 immune checkpoint inhibitors aimed at nasopharyngeal carcinoma (NPC). METHODS During the first stage of the study, using 40 patients with stage III/IVa NPC treated with anti-PD-1 immune checkpoint inhibitors in combination with chemoradiotherapy as a first-line treatment (observation group) and 70 patients with NPC treated with chemoradiotherapy alone (control group). In the second stage of the study, 88 patients with NPC treated with immune checkpoint inhibitors were grouped according to the number of lines of immunotherapy, the number of times, and the types of application. RESULTS Observation of the short-term effects in the first stage indicated that the objective response rate (ORR) of the observation group and the control group against primary foci of NPC was 75.0% versus 40.0%; the mortality rate of the observation group was much lower than that of the control group. The overall first-line treatment evaluation of the observation vs. control groups were as follows: ORR (67.5% vs. 38.6%); median PFS (17.52 vs. 17.21 months); and median OS (18.68 vs. 18.14 months), respectively (p < 0.05). The second stage of the study had an ORR of 53.4%, and the efficacy of immunotherapy was related to staging, timing, and frequency. CONCLUSION Anti-PD-1 immune checkpoint inhibitors combined with chemoradiotherapy as the first-line treatment for nasopharyngeal carcinoma may improve patient outcomes significantly. Timing, frequency, and the type of immunotherapy exerted an effect on the efficacy of immunotherapy. Adverse effects that occurred during treatment were tolerable and controllable.
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Affiliation(s)
- Shuling Shi
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Bingyan Li
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Pengcheng Zhou
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Linhui Chen
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Huizhen Li
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Yingyi Wang
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Xiaoyu Deng
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | | | - Jingjing Wu
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Boya Zha
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Peihong Li
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
| | - Yingjuan Zheng
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
- Institute of Radiotherapy and Critical Care OncologyZhengzhou UniversityZhengzhouHenanChina
| | - Daoke Yang
- Department of Radiation OncologyThe First Affiliated Hospital of Zhengzhou UniversityZhengzhouHenanChina
- Institute of Radiotherapy and Critical Care OncologyZhengzhou UniversityZhengzhouHenanChina
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Lin H, Gao C, Heng Y, Zhu X, Wang T, Zhou L, Zhang M, Wu C, Tao L. Peripheral lymphocyte count as an indicator of radiotherapy effectiveness in hypopharyngeal squamous cell carcinoma. Clin Otolaryngol 2024; 49:436-444. [PMID: 38596906 DOI: 10.1111/coa.14160] [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: 12/12/2022] [Revised: 01/21/2024] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To explore the predictive significance of baseline absolute peripheral lymphocyte counts (ALC) in the effectiveness of radiation in hypopharyngeal squamous cell carcinoma (HPSCC) patients. DESIGN, SETTING, AND PARTICIPANTS A retrospective study of pathologically confirmed HPSCC patients who had definitive radiation between January 2020 and January 2022 at Fudan University Eye and ENT Hospital. The routine blood results of patients were obtained to determine if the baseline ALC was connected with the response to radiation. The receiver operator characteristic (ROC) curve and LASSO-based Cox regression were employed to assess the predictive value of ALC for the efficacy of radiotherapy (RT). MAIN OUTCOME MEASURES AND RESULTS RT induced a considerable drop in ALC and the level of ALC did not revert to the baseline values 1 year after radiation. The baseline level of ALC was higher in patients who met complete response after RT. The baseline ALC and monocyte counts demonstrated the predictive value of radiation effectiveness and ALC was an independent predictor. CONCLUSION In HPSCC, lymphocytes were sensitive to radiation and reduced significantly during RT. The baseline ALC might be regarded as a predictive indicator of the effectiveness of RT.
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Affiliation(s)
- Hanqing Lin
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
- Department of Otolaryngology, Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People's Republic of China
| | - Chunli Gao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yu Heng
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Xiaoke Zhu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Tian Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Liang Zhou
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ming Zhang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Chunping Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
| | - Lei Tao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, People's Republic of China
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Kirby RP, Kim S, Abdurrahman LM, Kietzman A, Doan J, Hernandez D. Distant Multilevel Spinal Metastasis Secondary to Hypopharyngeal Squamous Cell Carcinoma. Cureus 2024; 16:e64715. [PMID: 39156392 PMCID: PMC11328829 DOI: 10.7759/cureus.64715] [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] [Accepted: 07/16/2024] [Indexed: 08/20/2024] Open
Abstract
Head and neck squamous cell carcinomas account for most head and neck malignancies. While multi-modality treatment may be offered for locally advanced cancer, distant metastasis still occurs in a significant number of patients. This paper aims to present a rare case of a patient who developed bony metastases in the cervical spine from a primary hypopharyngeal malignancy status post-laryngopharyngectomy. We report a case of a male patient presenting with acute-on-chronic hypercapnic and hypoxic respiratory failure with two months of dysphagia and weight loss. On arrival, a barium swallow revealed mucosal irregularity of the upper thoracic esophagus as well as narrowing and stenosis. A direct laryngoscopy with biopsy revealed squamous cell carcinoma of the hypopharynx. CT neck and chest were obtained for staging. He underwent a total laryngopharyngectomy, bilateral neck dissections, and a free flap. His final staging was pT4aN2c cM0. Three months post-admission, during inpatient radiation therapy, the patient reported midline neck pain with focal bone tenderness, and an MRI was obtained of his cervical and thoracic spine with a report concerning spinal metastasis.A subsequent bone biopsy showed findings consistent with osseous metastasis from a primary hypopharyngeal squamous cell carcinoma. After multidisciplinary goals of care discussions, the patient ultimately decided to be discharged to inpatient hospice. This report highlights a rare case of hypopharyngeal carcinoma metastasis to the cervical spine. Despite its rarity and poor prognosis, such a metastasis should be considered in the differential diagnosis of patients with a history of hypopharyngeal squamous cell carcinoma and localizing symptoms.
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Affiliation(s)
- R Parker Kirby
- Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | - Sarah Kim
- Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | - Lama M Abdurrahman
- Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | - Alexander Kietzman
- Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | - James Doan
- Pathology, Baylor College of Medicine, Houston, USA
| | - David Hernandez
- Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
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Topkan E, Somay E, Selek U. In Regard to Xu et al. Int J Radiat Oncol Biol Phys 2024; 119:1025. [PMID: 38851259 DOI: 10.1016/j.ijrobp.2024.02.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/24/2024] [Indexed: 06/10/2024]
Affiliation(s)
- Erkan Topkan
- Department of Radiation Oncology, Faculty of Medicine, Baskent University, Adana, Turkey
| | - Efsun Somay
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Baskent University, Ankara, Turkey; Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Kyrenia University, Kyrenia, Cyprus
| | - Ugur Selek
- Department of Radiation Oncology, Faculty of Medicine, Koc University, Istanbul, Turkey
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Chen K, Lee Y, Kuriakose JP, Khan NS, Moreira A, Rajasekaran K. Appraisal of clinical practice guidelines for salivary gland cancer management utilizing AGREE II instrument. Am J Otolaryngol 2024; 45:104285. [PMID: 38657536 DOI: 10.1016/j.amjoto.2024.104285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE Salivary gland cancers (SGC) are rare neoplasms which comprise 1-5 % of all head and neck cancers. SGCs can be managed by resection, radiosurgery, chemotherapy, or a combination of these. Our team appraised the quality of clinical practice guidelines (CPGs) for SGC treatment and management using the Appraisal of Guidelines for Research and Evaluation (AGREE-II) instrument. DATA SOURCES PubMed, Scopus, & EMBASE were reviewed for CPGs regarding SGC management from database inception to January 1st, 2023. REVIEW METHODS The AGREE-II instrument was used by 4 reviewers to independently evaluate guidelines. Domain scores were generated with a satisfactory threshold being >60 % - a "high" quality CPG required >4 satisfactory domains. Intraclass correlation coefficients (ICCs) were used, via R 4.2.1., to determine inter-reviewer variability. RESULTS Literature review identified 645 articles, with six being included after applying inclusion and exclusion criteria. Of the six included articles, one CPG was "high" quality and 5 were "low" quality. The domains with the highest scores were "Editorial Independence" (72.57 ± 36.60) and "Clarity and Presentation" (63.19 ± 26.08), while the lowest were "Rigor of Development" (34.03 ± 30.63) and "Applicability" (30.21 ± 30.46). ICC scores for each domain ranged from 0.937 to 0.983, indicating a high level of inter-rater agreement. CONCLUSION This study found that most CPGs for the treatment and management of SGC were of "low" quality, with only one guideline being considered "high" quality based on the standard set by the AGREE-II instrument. These findings indicate that there is a high level of variability and little standardization when it comes to the quality of CPGs.
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Affiliation(s)
- Kaiwen Chen
- Department of Otolaryngology - Head and Neck Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America. https://twitter.com/KChenTweets
| | - Young Lee
- Central Michigan University College of Medicine, Mount Pleasant, MI, United States of America
| | - Jonathan P Kuriakose
- Department of Otolaryngology - Head and Neck Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America; Department of Otolaryngology - Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America. https://twitter.com/kuriousjon96
| | - Najm S Khan
- Department of Otolaryngology - Head and Neck Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America. https://twitter.com/Najm__Khan
| | - Alvaro Moreira
- Department of Pediatrics, University of Texas Health-San Antonio, San Antonio, TX, United States of America
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, United States of America; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America.
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Simopoulou F, Kyrgias G, Georgakopoulos I, Avgousti R, Armpilia C, Skarlos P, Softa V, Theodorou K, Kouloulias V, Zygogianni A. Does adaptive radiotherapy for head and neck cancer favorably impact dosimetric, clinical, and toxicity outcomes?: A review. Medicine (Baltimore) 2024; 103:e38529. [PMID: 38941415 DOI: 10.1097/md.0000000000038529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2024] Open
Abstract
PURPOSE The current review aims to summarize the international experience of the impact of adaptive radiotherapy on dosimetry and clinical and toxicity outcomes. Additionally, it might trigger Radiation Oncologists to use ART and evaluate whether ART improves target volume coverage and/or normal tissue sparing and, consequently, therapeutic results. MATERIALS AND METHODS We conducted an electronic literature search of PubMed/MEDLINE and ScienceDirect from January 2007 to January 2023. The search adhered to the PRISMA guidelines and employed keywords such as ART, HNC, parotid gland, and target volume. Furthermore, we examined the reference lists for studies pertinent to the present review. This study included both retrospective and prospective studies that were considered for inclusion. CONCLUSION ART replanning appears to be a sustainable strategy to minimize toxicity by improving normal tissue sparing. Furthermore, it can enhance target volume coverage by correctly determining the specific dose to be delivered to the tumor. In conclusion, this review confirmed that ART benefits dosimetric, clinical/therapeutic, and toxicity outcomes.
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Affiliation(s)
- Foteini Simopoulou
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - George Kyrgias
- Radiation Oncology Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioannis Georgakopoulos
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - Rafaela Avgousti
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - Christina Armpilia
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - Pantelis Skarlos
- Radiation Oncology Department, Metropolitan Hospital, Piraeus, Greece
| | - Vasiliki Softa
- Medical Physics Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Kiki Theodorou
- Medical Physics Department, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Vassilis Kouloulias
- Radiation Oncology Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens (NKUOA), Athens, Greece
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Zhang Z, Ren X, Wang Y, Liu P, Lin P, Jin S, Xu C. CTHRC1 is a prognostic biomarker correlated with immune infiltration in head and neck squamous cell carcinoma. BMC Oral Health 2024; 24:742. [PMID: 38937712 PMCID: PMC11209980 DOI: 10.1186/s12903-024-04525-x] [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: 03/06/2024] [Accepted: 06/23/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide, characterized by high morbidity, high mortality, and poor prognosis. Collagen triple helix repeat containing 1 (CTHRC1) has been shown to be highly expressed in various cancers. However, its biological functions, potential role as a biomarker, and its relationship with immune infiltrates in HNSCC remain unclear. Our principal objective was to analyze CTHRC1 expression, its prognostic implications, biological functions, and its effects on the immune system in HNSCC patients using bioinformatics analysis. METHODS The expression matrix was obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). CTHRC1 expression in HNSCC was analyzed between tumor and adjacent normal tissues, different stages were compared, and its impact on clinical prognosis was assessed using Kaplan-Meier analysis. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Variation Analysis (GSVA) were employed for enrichment analysis. The Search Tool for the Retrieval of Interacting Genes database (STRING) was used to analyze protein-protein interactions. Pearson correlation tests were used to investigate the association between CTHRC1 expression and immune checkpoints. The correlation between CTHRC1 and immune infiltration was investigated using CIBERSORT, TIMER, and ESTIMATE. RESULTS Compared to adjacent normal tissues, CTHRC1 was found to be highly overexpressed in tumors. Increased expression of CTHRC1 was more evident in the advanced stage of HNSCC and predicted a poor prognosis. Most genes related to CTHRC1 in HNSCC were enriched in physiological functions of Extracellular matrix(ECM) and tumor. Furthermore, several immune checkpoints, such as TNFSF4 and CD276 have been shown to be associated with CTHRC1 expression. Notably, the level of CTHRC1 expression correlated significantly with immune infiltration levels, particularly activated macrophages in HNSCC. CONCLUSIONS High expression of CTHRC1 predicts poor prognosis and is associated with immune infiltration in HNSCC, confirming its utility as a tumor marker for HNSCC. TRIAL REGISTRATION Not applicable. All data are from public databases and do not contain any clinical trials.
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Affiliation(s)
- Zhichao Zhang
- Department of Oral and Maxillofacial Surgery, The Second Hospital of Shandong University, 247 Beiyuan Street, Jinan, Shandong, China
| | - Xusheng Ren
- Department of Orthodontics, Jinan Stomatological Hospital, 101 Jingliu Road, Jinan, Shandong, China
| | - Yiling Wang
- Department of Orthodontics, Jinan Stomatological Hospital, 101 Jingliu Road, Jinan, Shandong, China
| | - Ping Liu
- Department of Orthodontics, Jinan Stomatological Hospital, 101 Jingliu Road, Jinan, Shandong, China
| | - Peng Lin
- Department of Orthodontics, Jinan Stomatological Hospital, 101 Jingliu Road, Jinan, Shandong, China
| | - Shumei Jin
- Department of Orthodontics, Jinan Stomatological Hospital, 101 Jingliu Road, Jinan, Shandong, China
| | - Chao Xu
- Department of Orthodontics, Jinan Stomatological Hospital, 101 Jingliu Road, Jinan, Shandong, China.
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Al Hasan MM, Ghazimoghadam S, Tunlayadechanont P, Mostafiz MT, Gupta M, Roy A, Peters K, Hochhegger B, Mancuso A, Asadizanjani N, Forghani R. Automated Segmentation of Lymph Nodes on Neck CT Scans Using Deep Learning. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01114-w. [PMID: 38937342 DOI: 10.1007/s10278-024-01114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 06/29/2024]
Abstract
Early and accurate detection of cervical lymph nodes is essential for the optimal management and staging of patients with head and neck malignancies. Pilot studies have demonstrated the potential for radiomic and artificial intelligence (AI) approaches in increasing diagnostic accuracy for the detection and classification of lymph nodes, but implementation of many of these approaches in real-world clinical settings would necessitate an automated lymph node segmentation pipeline as a first step. In this study, we aim to develop a non-invasive deep learning (DL) algorithm for detecting and automatically segmenting cervical lymph nodes in 25,119 CT slices from 221 normal neck contrast-enhanced CT scans from patients without head and neck cancer. We focused on the most challenging task of segmentation of small lymph nodes, evaluated multiple architectures, and employed U-Net and our adapted spatial context network to detect and segment small lymph nodes measuring 5-10 mm. The developed algorithm achieved a Dice score of 0.8084, indicating its effectiveness in detecting and segmenting cervical lymph nodes despite their small size. A segmentation framework successful in this task could represent an essential initial block for future algorithms aiming to evaluate small objects such as lymph nodes in different body parts, including small lymph nodes looking normal to the naked human eye but harboring early nodal metastases.
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Affiliation(s)
- Md Mahfuz Al Hasan
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Electrical and Computer Engineering, University of Florida College of Medicine, Gainesville, FL, USA
| | - Saba Ghazimoghadam
- Augmented Intelligence and Precision Health Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Padcha Tunlayadechanont
- Augmented Intelligence and Precision Health Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Diagnostic and Therapeutic Radiology and Research, Faculty of Medicine Ramathibodi Hospital, Ratchathewi, Bangkok, Thailand
| | - Mohammed Tahsin Mostafiz
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Electrical and Computer Engineering, University of Florida College of Medicine, Gainesville, FL, USA
| | - Manas Gupta
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
| | - Antika Roy
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Electrical and Computer Engineering, University of Florida College of Medicine, Gainesville, FL, USA
| | - Keith Peters
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bruno Hochhegger
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anthony Mancuso
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Navid Asadizanjani
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Electrical and Computer Engineering, University of Florida College of Medicine, Gainesville, FL, USA
| | - Reza Forghani
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA.
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA.
- Division of Medical Physics, University of Florida College of Medicine, Gainesville, FL, USA.
- Department of Neurology, Division of Movement Disorders, University of Florida College of Medicine, Gainesville, FL, USA.
- Augmented Intelligence and Precision Health Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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Zuo X, Chen Y, Zhu Y, Pan D, Rong X, Shen Q, Li H, Xu Y, Tang Y. Radiation-induced Chronic Pain Plagues Head and Neck Cancer Survivors: A Cross-sectional Analysis From the Cohort in Radiotherapy-related Nervous System Complications. THE JOURNAL OF PAIN 2024:104612. [PMID: 38908498 DOI: 10.1016/j.jpain.2024.104612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 05/03/2024] [Accepted: 06/14/2024] [Indexed: 06/24/2024]
Abstract
The epidemiology and prognosis of radiation-induced chronic pain, especially chronic neuropathic pain (CNP), are the understudied domain among head and neck cancer (HNC) survivors after radiotherapy (RT). This study aimed to estimate the prevalence of such chronic pain, and explore its correlations with mental health, sleep disorders, cognitive function, and quality of life (QOL) within these patients. This research encompassed HNC survivors post RT. The determination of radiation-induced chronic pain and CNP adhered to the guidelines outlined by the International Association for the Study of Pain. Multivariable regression analyses were employed to explore the relationship between pain and anxiety, depression, sleep disturbances, cognitive function, and QOL. A total of 1,071 HNC survivors post RT were included in this study. The prevalence of radiation-induced chronic pain was 67.1%, and the prevalence of RT-associated CNP was 38.3%. Compared with those reporting no pain, patients with radiation-induced chronic pain had a significantly increased risk of anxiety, depression, and sleep disorders (all P < .001). And there was a significantly negative association between chronic pain and QOL across physiological (P < .001), psychological (P < .001), social relationships (P = .001), and environmental (P = .009) domains. Compared with non-CNP, patients with RT-related CNP had a higher risk of anxiety (P = .027) and sleep disorders (P = .013). The significantly negative associations were found between CNP and the physiological (P = .001), psychological (P = .012), and social score (P = .035) in World Health Organisation Quality of Life Assessment-Bref. This study underscores the substantial prevalence of chronic pain, particularly CNP, and its potential impact on the mental health, sleep, and QOL among HNC survivors post RT. PERSPECTIVE: This study highlights the high prevalence of radiation-induced chronic pain and CNP, and their potential impacts on anxiety, depression, sleep, and QOL among the HNC survivors. Clinically, these findings have important implications for improving the care and outcomes of HNC survivors.
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Affiliation(s)
- Xuzheng Zuo
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanting Chen
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yingying Zhu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Division of Clinical Research Design, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dong Pan
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Xiaoming Rong
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qingyu Shen
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Honghong Li
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yongteng Xu
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yamei Tang
- Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Division of Clinical Research Design, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
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40
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Thabet W, Zitouni C, Chebil A, Masmoudi M, Hasnaoui M, Mighri K. Primary non-cutaneous melanomas of the head and neck: Case series and review of the literature. SAGE Open Med Case Rep 2024; 12:2050313X241262155. [PMID: 38911176 PMCID: PMC11191612 DOI: 10.1177/2050313x241262155] [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: 10/24/2023] [Accepted: 05/29/2024] [Indexed: 06/25/2024] Open
Abstract
Primary non-cutaneous melanoma is a rare type of melanoma that occurs mostly on mucosal surfaces. The head and neck region is the most common site for these melanomas. The following cases described herein include patients diagnosed with primary non-cutaneous melanomas. The locations included the parotid gland (one case), the submandibular gland (one case), and the nasal cavity and paranasal sinuses (three cases). Among these patients, one patient developed lymph node metastasis and one patient had distant metastasis. Treatment included endoscopic surgery (one case), endoscopic surgery with adjuvant radiotherapy (one case), open surgery (one case), and palliative chemotherapy (one case). One patient refused to receive treatment. After treatment, one patient had local recurrence. A local and distant recurrence was noted in one case. This report aims to describe clinical features, treatment options, and prognosis of primary non-cutaneous melanomas of the head and neck.
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Affiliation(s)
- Wadii Thabet
- Department of Otolaryngology—Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Chaima Zitouni
- Department of Otolaryngology—Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Azer Chebil
- Department of Otolaryngology—Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Mohamed Masmoudi
- Department of Otolaryngology—Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Mehdi Hasnaoui
- Department of Otolaryngology—Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
- University of Monastir, Monastir, Tunisia
| | - Khalifa Mighri
- Department of Otolaryngology—Head and Neck Surgery, Tahar Sfar Hospital, Mahdia, Tunisia
- University of Monastir, Monastir, Tunisia
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Liang H, Tan W, Wang J, Li M, Pang H, Wang X, Yang L, Jing X. Novel prediction model combining PET/CT metabolic parameters, inflammation markers, and TNM stage: prospects for personalizing prognosis in nasopharyngeal carcinoma. Ann Nucl Med 2024:10.1007/s12149-024-01949-x. [PMID: 38874876 DOI: 10.1007/s12149-024-01949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/30/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE This study aims to develop a novel prediction model and risk stratification system that could accurately predict progression-free survival (PFS) in patients with nasopharyngeal carcinoma (NPC). METHODS Herein, we included 106 individuals diagnosed with NPC, who underwent 18F-FDG PET/CT scanning before treatment. They were divided into training (n = 76) and validation (n = 30) sets. The prediction model was constructed based on multivariate Cox regression analysis results and its predictive performance was evaluated. Risk factor stratification was performed based on the nomogram scores of each case, and Kaplan-Meier curves were used to evaluate the model's discriminative ability for high- and low-risk groups. RESULTS Multivariate Cox regression analysis showed that N stage, M stage, SUVmax, MTV, HI, and SIRI were independent factors affecting the prognosis of patients with NPC. In the training set, the model considerably outperformed the TNM stage in predicting PFS (AUCs of 0.931 vs. 0.841, 0.892 vs. 0.785, and 0.892 vs. 0.804 at 1-3 years, respectively). The calibration plots showed good agreement between actual observations and model predictions. The DCA curves further justified the effectiveness of the model in clinical practice. Between high- and low-risk group, 3-year PFS rates were significantly different (high- vs. low-risk group: 62.8% vs. 9.8%, p < 0.001). Adjuvant chemotherapy was also effective for prolonging survival in high-risk patients (p = 0.009). CONCLUSION Herein, a novel prediction model was successfully developed and validated to improve the accuracy of prognostic prediction for patients with NPC, with the aim of facilitating personalized treatment.
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Affiliation(s)
- Huan Liang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, YuanjiagangChongqing, 400016, China
| | - Weilin Tan
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jie Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, YuanjiagangChongqing, 400016, China
| | - Mengdan Li
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, YuanjiagangChongqing, 400016, China
| | - Hua Pang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, YuanjiagangChongqing, 400016, China
| | - Xiaohui Wang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, YuanjiagangChongqing, 400016, China
| | - Lu Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, YuanjiagangChongqing, 400016, China
| | - Xingguo Jing
- Department of Nuclear Medicine, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, No. 1 Youyi Road, YuanjiagangChongqing, 400016, China.
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Lulić L, Šimić I, Božinović K, Pešut E, Manojlović L, Grce M, Dediol E, Sabol I, Tomaić V. Moderate SCRIB Expression Levels Correlate with Worse Prognosis in OPSCC Patients Regardless of HPV Status. Cells 2024; 13:1002. [PMID: 38920638 PMCID: PMC11201649 DOI: 10.3390/cells13121002] [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: 04/25/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
Head and neck cancers rank as the sixth most prevalent cancers globally. In addition to traditional risk factors such as smoking and alcohol use, human papillomavirus (HPV) infections are becoming a significant causative agent of head and neck cancers, particularly among Western populations. Although HPV offers a significant survival benefit, the search for better biomarkers is still ongoing. In the current study, our objective was to investigate whether the expression levels of three PDZ-domain-containing proteins (SCRIB, NHERF2, and DLG1), known HPV E6 cellular substrates, influence the survival of HNSCC patients treated by primary surgery (n = 48). Samples were derived from oropharyngeal and oral cancers, and HPV presence was confirmed by PCR and p16 staining. Clinical and follow-up information was obtained from the hospital database and the Croatian Cancer registry up to November 2023. Survival was evaluated using the Kaplan-Meier method and Cox proportional hazard regression. The results were corroborated through the reanalysis of a comparable subset of TCGA cancer patients (n = 391). In conclusion, of the three targets studied, only SCRIB levels were found to be an independent predictor of survival in the Cox regression analysis, along with tumor stage. Further studies in a more typical Western population setting are needed since smoking and alcohol consumption are still prominent in the Croatian population, while the strongest association between survival and SCRIB levels was seen in HPV-negative cases.
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Affiliation(s)
- Lucija Lulić
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia
- Division of Molecular Biology, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia
| | - Ivana Šimić
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia
| | - Ksenija Božinović
- Division of Molecular Biology, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia
| | - Ena Pešut
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia
| | - Luka Manojlović
- Department of Pathology and Cytology, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Magdalena Grce
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia
| | - Emil Dediol
- Department of Maxillofacial Surgery, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Ivan Sabol
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia
| | - Vjekoslav Tomaić
- Division of Molecular Medicine, Ruđer Bošković Institute, Bijenička Cesta 54, 10000 Zagreb, Croatia
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Liu X, Qu L, Xie Z, Zhao J, Shi Y, Song Z. Towards more precise automatic analysis: a systematic review of deep learning-based multi-organ segmentation. Biomed Eng Online 2024; 23:52. [PMID: 38851691 PMCID: PMC11162022 DOI: 10.1186/s12938-024-01238-8] [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: 12/08/2023] [Accepted: 04/11/2024] [Indexed: 06/10/2024] Open
Abstract
Accurate segmentation of multiple organs in the head, neck, chest, and abdomen from medical images is an essential step in computer-aided diagnosis, surgical navigation, and radiation therapy. In the past few years, with a data-driven feature extraction approach and end-to-end training, automatic deep learning-based multi-organ segmentation methods have far outperformed traditional methods and become a new research topic. This review systematically summarizes the latest research in this field. We searched Google Scholar for papers published from January 1, 2016 to December 31, 2023, using keywords "multi-organ segmentation" and "deep learning", resulting in 327 papers. We followed the PRISMA guidelines for paper selection, and 195 studies were deemed to be within the scope of this review. We summarized the two main aspects involved in multi-organ segmentation: datasets and methods. Regarding datasets, we provided an overview of existing public datasets and conducted an in-depth analysis. Concerning methods, we categorized existing approaches into three major classes: fully supervised, weakly supervised and semi-supervised, based on whether they require complete label information. We summarized the achievements of these methods in terms of segmentation accuracy. In the discussion and conclusion section, we outlined and summarized the current trends in multi-organ segmentation.
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Affiliation(s)
- Xiaoyu Liu
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, People's Republic of China
- Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, 200032, China
| | - Linhao Qu
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, People's Republic of China
- Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, 200032, China
| | - Ziyue Xie
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, People's Republic of China
- Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, 200032, China
| | - Jiayue Zhao
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, People's Republic of China
- Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, 200032, China
| | - Yonghong Shi
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, People's Republic of China.
- Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, 200032, China.
| | - Zhijian Song
- Digital Medical Research Center, School of Basic Medical Sciences, Fudan University, 138 Yixueyuan Road, Shanghai, 200032, People's Republic of China.
- Shanghai Key Laboratory of Medical Image Computing and Computer Assisted Intervention, Shanghai, 200032, China.
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Asarkar AA, Chang BA, de Bree R, Kowalski LP, Guntinas-Lichius O, Bradley PJ, de Graaf P, Strojan P, Rao KN, Mäkitie AA, López F, Rinaldo A, Palme C, Genden EM, Sanabria A, Rodrigo JP, Ferlito A. Primary Management of Operable Locally Advanced Oral Cavity Squamous Cell Carcinoma: Current Concepts and Strategies. Adv Ther 2024; 41:2133-2150. [PMID: 38642199 DOI: 10.1007/s12325-024-02861-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/25/2024] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Locally advanced oral cavity carcinoma (LAOCSCC) is primarily treated with surgery followed by radiotherapy with or without chemotherapy. METHODS A review of literature using PubMED was performed for studies reporting the management of LAOCSCC. Based on the reviewed literature and opinions of experts in the field, recommendations were made. RESULTS Studies have shown that outcomes following resection of T4a and infranotch (inferior to mandibular notch) T4b are comparable. We discuss the concept of compartmental resection of LAOCSCC and issues concerning the management of the neck. Further, patients who refuse or are unable to undergo surgery can be treated with chemoradiotherapy with uncertain outcomes. The role of neoadjuvant chemotherapy has shown promise for organ (mandibular) preservation in a select subset of patients. CONCLUSION The management strategy for LAOCSCC should be determined in a multidisciplinary setting with emphasis on tumor control, functional preservation, and quality of life of the patient.
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Affiliation(s)
- Ameya A Asarkar
- Department of Otolaryngology/Head and Neck Surgery, Louisiana Health Sciences Center, Shreveport, LA, 71103, USA.
| | - Brent A Chang
- Department of Otolaryngology/Head and Neck Surgery, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Luiz P Kowalski
- Head and Neck Surgery Department, University of Sao Paulo Medical School, Sao Paulo, Brazil
- Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, São Paulo, Brazil
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Institute of Phoniatry/Pedaudiology, Jena University Hospital, Jena, Germany
| | - Patrick J Bradley
- Department of ORLHNS, Queens Medical Centre Campus, Nottingham University Hospitals, Derby Road, Nottingham, NG7 2UH, UK
| | - Pim de Graaf
- Amsterdam UMC Location Vrije Universiteit, Radiology and Nuclear Medicine, de Boelelaan 1117, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, 1000, Ljubljana, Slovenia
| | - Karthik N Rao
- Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Center, Bangalore, India
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Fernando López
- ENT and Head and Neck Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Carsten Palme
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, NSW, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Medical Center, New York, NY, 10029, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Centro de Excelencia en Cirugia de Cabeza y Cuello-CEXCA, Universidad de Antioquia, Medellin, Colombia
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, IUOPA, University of Oviedo, CIBERONC, 33011, Oviedo, Spain
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35030, Padua, Italy
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Bisheshar SK, van der Kamp MF, de Vries J, Slagter-Menkema L, Schuuring EMD, Lunter GA, Halmos GB, van der Vegt B. Addition of tumor microenvironment immune cell composition to improve the performance of a predictive model for oral squamous cell carcinoma. Oral Oncol 2024; 153:106830. [PMID: 38718459 DOI: 10.1016/j.oraloncology.2024.106830] [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: 04/16/2024] [Accepted: 04/28/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Conventional clinicopathological characteristics insufficiently predict prognosis in oral squamous cell carcinoma (OSCC). We aimed to assess the added predictive value of tumor microenvironment immune cell composition (TMICC) in addition to conventional clinicopathological characteristics. METHODS Primary tumor samples of 290 OSCC patients were immunohistochemically stained for CD4, CD8, CD20, CD68, CD163, CD57, FoxP3 and Programmed cell Death Ligand 1. Additionally, clinicopathological characteristics were obtained from patients' medical files. Predictive models were trained and validated by conducting Least Absolute Shrinkage and Selection Operator (LASSO) regression analyses with cross-validation. To quantify the added predictive power of TMICC within models, receiver operating characteristic (ROC) analyses were used. RESULTS Recurrence occurred in 74 patients (25.5%). Conventional clinicopathological characteristics (tumor localization, pathological T-stage, pathological N-stage, extracapsular spread, resection margin, differentiation grade, perineural invasion, lymphovascular invasion) and treatment modality, were used to build a LASSO logistic regression-based predictive model. Addition of TMICC to the model resulted in a comparable AUC of respectively 0.79 (±0.01) and 0.76 (±0.1) in the training and test sets. The model indicated that high numbers of CD4+ T cells protected against recurrence. Lymph node metastasis, extracapsular spread, perineural invasion, positive surgical margins and reception of adjuvant treatment were associated with increased risk for recurrence. CONCLUSIONS The TMICC, specifically the number of CD4+ T cells, is an independent predictor , however, addition to conventional clinicopathological characteristics does not improve the performance of a predictive model for recurrence in OSCC.
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Affiliation(s)
- Sangeeta K Bisheshar
- University of Groningen, University Medical Center Groningen, Department of Pathology & Medical Biology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Martine F van der Kamp
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology and Head and Neck Surgery, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Julius de Vries
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology and Head and Neck Surgery, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Lorian Slagter-Menkema
- University of Groningen, University Medical Center Groningen, Department of Pathology & Medical Biology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology and Head and Neck Surgery, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Ed M D Schuuring
- University of Groningen, University Medical Center Groningen, Department of Pathology & Medical Biology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Gerton A Lunter
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Gyorgy B Halmos
- University of Groningen, University Medical Center Groningen, Department of Otorhinolaryngology and Head and Neck Surgery, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
| | - Bert van der Vegt
- University of Groningen, University Medical Center Groningen, Department of Pathology & Medical Biology, Hanzeplein 1, 9713 GZ Groningen, the Netherlands.
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Jamin C, Karam E, Marmouset F, Laure B, Moriniere S, Pare A. Tongue reconstruction after oncological resection: Analysis of the functional outcomes. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101707. [PMID: 38006946 DOI: 10.1016/j.jormas.2023.101707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 11/27/2023]
Abstract
The curative management of oral squamous cell carcinoma can be responsible for swallowing and/or speech impairments. In this study, we analyzed the functional outcomes in patients who underwent an oncological resection and a primary reconstruction of the tongue and/or of the floor of the mouth (TFM). We also investigated the predictive factors for poor functional outcomes. This retrospective study included operated patients from October 2013 to May 2021 at the TOURS University Hospital. We assessed the functional results two years after the completion of the cancer treatment with self-administered questionnaires quantifying swallowing and speech disorders. Thirty-three patients were included and reconstructed with antebrachial free flap (N = 16), local flap (N = 8) or Biodesign ® membrane (N = 9). A higher proportion of pT1 tumor was observed in patient who had a Biodesign-based reconstruction (p = 0.001). There was no significant difference between the groups in terms of postoperative complications or for the duration of enteral feeding. The 21 patients who had an adjuvant radiation therapy had no significant more altered functions. Functional scores were significantly higher in the free flap reconstruction group (DHI =24 and SHI=21) (p = 0.008). No predictive factors for poor outcomes were observed. The repair of TFM defects must be adapted to the resection size. The reconstruction techniques allow to get acceptable functional outcomes even for the greater tumors or in case of radiation therapy. Further research would be required to better identify the predictive factors for poor outcomes.
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Affiliation(s)
- Cerise Jamin
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France
| | - Elias Karam
- Department of Visceral Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Franck Marmouset
- Department of Otorhinolaryngology, Tours University Hospital, 2 bd Tonnellé, Tours 37000, France
| | - Boris Laure
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Sylvain Moriniere
- Department of Otorhinolaryngology, Tours University Hospital, 2 bd Tonnellé, Tours 37000, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France
| | - Arnaud Pare
- Department of Maxillofacial and Plastic Surgery, Tours University Hospital, Avenue de la République, Chambray les Tours 37100, France; School of Medicine, University of François Rabelais, 10 bd Tonnellé, Tours 37000, France.
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Chen Y, Zhong NN, Cao LM, Liu B, Bu LL. Surgical margins in head and neck squamous cell carcinoma: A narrative review. Int J Surg 2024; 110:3680-3700. [PMID: 38935830 PMCID: PMC11175762 DOI: 10.1097/js9.0000000000001306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/26/2024] [Indexed: 06/29/2024]
Abstract
Head and neck squamous cell carcinoma (HNSCC), a prevalent and frequently recurring malignancy, often necessitates surgical intervention. The surgical margin (SM) plays a pivotal role in determining the postoperative treatment strategy and prognostic evaluation of HNSCC. Nonetheless, the process of clinical appraisal and assessment of the SMs remains a complex and indeterminate endeavor, thereby leading to potential difficulties for surgeons in defining the extent of resection. In this regard, we undertake a comprehensive review of the suggested surgical distance in varying circumstances, diverse methods of margin evaluation, and the delicate balance that must be maintained between tissue resection and preservation in head and neck surgical procedures. This review is intended to provide surgeons with pragmatic guidance in selecting the most suitable resection techniques, and in improving patients' quality of life by achieving optimal functional and aesthetic restoration.
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Affiliation(s)
- Yang Chen
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
- Department of Oral & Maxillofacial – Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology
- Department of Oral & Maxillofacial – Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, People’s Republic of China
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Eweida A, Sandberg E, Ritthaler O, Fleckenstein J, Abo-Madyan Y, Giordano FA, Schulte M, Kneser U, Harhaus L. Hypoxia as a stimulus for tissue formation: The concept of organogenesis in microsurgically vascularized tissue engineering constructs. J Craniomaxillofac Surg 2024; 52:707-714. [PMID: 38582676 DOI: 10.1016/j.jcms.2024.03.020] [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: 01/12/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024] Open
Abstract
Axial vascularization of tissue constructs is essential to maintain an adequate blood supply for a stable regeneration of a clinically relevant tissue size. The versatility of the arterio-venous loop (AVL) has been previously shown in various small and large animal models as well as in clinical reports for bone regeneration. We have previously demonstrated the capability of the AVL to induce axial vascularization and to support the nourishment of tissue constructs in small animal models after applying high doses of ionizing radiation comparable to those applied for adjuvant radiotherapy after head and neck cancer. We hypothesize that this robust ability to induce regeneration after irradiation could be related to a state of hypoxia inside the constructs that triggers the HIF1 (hypoxia induced factor 1) - SDF1 (stromal derived factor 1) axis leading to chemotaxis of progenitor cells and induction of tissue regeneration and vascularization. We analyzed the expression of HIF1 and SDF1 via immunofluorescence in axially vascularized bone tissue engineering constructs in Lewis rats 2 and 5 weeks after local irradiation with 9Gy or 15Gy. We also analyzed the expression of various genes for osteogenic differentiation (collagen 1, RUNX, alkaline phosphatase and osteonectin) via real time PCR analysis. The expression of HIF1 and SDF1 was enhanced two weeks after irradiation with 15Gy in comparison to non-irradiated constructs. The expression of osteogenic markers was enhanced at the 5-weeks time point with significant results regarding collagen, alkaline phosphatase and osteonectin. These results indicate that the hypoxia within the AVL constructs together with an enhanced SDF1 expression probably play a role in promoting tissue differentiation. The process of tissue generation triggered by hypoxia in the vicinity of a definite vascular axis with enhanced tissue differentiation over time resembles hereby the well-known concept of organogenesis in fetal life.
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Affiliation(s)
- Ahmad Eweida
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany; Department of Head, Neck and Endocrine Surgery, Faculty of Medicine, University of Alexandria, Alkhartoum Square, 5372066, Alexandria, Egypt.
| | - Elli Sandberg
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Oliver Ritthaler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Yasser Abo-Madyan
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Anton Giordano
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Matthias Schulte
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
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Qu W, Qin Z, Cui L, Yuan S, Yao N, Ma J, Lu J, Wang J, Wang M, Yao Y. Diagnostic and prognostic nomograms for laryngeal carcinoma patients with lung metastasis: a SEER-based study. Eur Arch Otorhinolaryngol 2024; 281:3071-3082. [PMID: 38584217 DOI: 10.1007/s00405-024-08608-x] [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: 02/21/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE To establish two nomograms to quantify the risk of lung metastasis (LM) in laryngeal carcinoma (LC) and predict the overall survival of LC patients with LM. METHODS Totally 9515 LC patients diagnosed histologically from 2000 to 2019 were collected from the Surveillance, Epidemiology, and End Results database. The independent diagnostic factors for LM in LC patients and prognostic factors for LC patients with LM were identified by logistic and Cox regression analysis, respectively. Nomograms were established based on regression coefficients and evaluated by receiver operating characteristic curve, calibration curves, and decision curve analysis. RESULTS Patients with supraglottis, higher pathological grade, higher N stage, and distant metastasis (bone, brain, or liver) were more likely to have LM (P < 0.05). Chemotherapy, surgery and radiotherapy were independent factors of the overall survival of LC patients with LM (P < 0.05). The area under curve of diagnostic nomogram were 0.834 and 0.816 in the training and validation cohort respectively. For the prognostic nomogram, the area under curves of 1-, 2-, and 3-years were 0.735, 0.734, and 0.709 in the training cohort and 0.705, 0.803, and 0.809 in the validation cohort. The calibration curves and decision curve analysis indicated good performance of the nomograms. CONCLUSION Distant metastasis (bone, brain, or liver) and N stage should be considered for prediction of LM in LC patients. Chemotherapy is the most significant influencing prognostic factor improving the survival of LC patients with LM. Two nomograms may benefit for providing better precautionary measures and treatment decision.
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Affiliation(s)
- Wanxi Qu
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Zhaohui Qin
- Research Center for Medical and Health Emergency Rescue, Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Li Cui
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Shiwang Yuan
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Nan Yao
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Ji Ma
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Jiaying Lu
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Jiang Wang
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Minhan Wang
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Yuanhu Yao
- Graduate School of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China.
- Department of Radiation Oncology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, Jiangsu, China.
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50
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Su Z, Tang J, He Y, Zeng WH, Yu Q, Cao XL, Zou GR. Pan‑immune‑inflammation value as a novel prognostic biomarker in nasopharyngeal carcinoma. Oncol Lett 2024; 27:252. [PMID: 38646495 PMCID: PMC11027095 DOI: 10.3892/ol.2024.14385] [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: 09/18/2023] [Accepted: 02/06/2024] [Indexed: 04/23/2024] Open
Abstract
The pan-immune-inflammation-value (PIV) is a comprehensive biomarker that integrates different peripheral blood cell subsets. The present study aimed to evaluate the prognostic ability of PIV in patients with nasopharyngeal carcinoma (NPC) undergoing chemoradiotherapy. PIV was assessed using the following equation: (Neutrophil count × platelet count × monocyte count)/lymphocyte count. The Kaplan-Meier method and Cox hazards regression models were used for survival analyses. The optimal cut-off values for PIV and systemic immune-inflammation index (SII) were determined using receiver operating characteristic analysis to be 428.0 and 1032.7, respectively. A total of 319 patients were recruited. Patients with a low baseline PIV (≤428.0) accounted for 69.9% (n=223) and patients with a high baseline PIV (>428.0) accounted for 30.1% (n=96). Compared with patients with low PIV, patients with a high PIV had significantly worse 5-year progression-free survival [PFS; 66.8 vs. 77.1%; hazard ratio (HR), 1.97; 95% confidence interval (CI), 1.22-3.23); P=0.005] and 5-year overall survival (OS; 68.7 vs. 86.9%, HR, 2.71; 95% CI, 1.45-5.03; P=0.001). PIV was also a significant independent prognostic indicator for OS (HR, 2.19; 95% CI, 1.16-4.12; P=0.016) and PFS (HR, 1.86; 95% CI, 1.14-3.04; P=0.013) and outperformed the SII in multivariate analysis. In conclusion, the PIV was a powerful predictor of survival outcomes and outperformed the SII in patients with NPC treated with chemoradiotherapy. Prospective validation of the PIV should be performed to better stratify radical treatment of patients with NPC.
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Affiliation(s)
- Zhen Su
- Department of Oncology, Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Jie Tang
- Department of Oncology, Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, Guangdong 511400, P.R. China
- Department of Radiotherapy, Jinan University, Guangzhou, Guangdong 511400, P.R. China
| | - Yan He
- Department of Oncology, Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Wei Hua Zeng
- Department of Oncology, Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Qian Yu
- Department of Oncology, Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Xiao Long Cao
- Department of Oncology, Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, Guangdong 511400, P.R. China
| | - Guo Rong Zou
- Department of Oncology, Panyu Central Hospital, Cancer Institute of Panyu, Guangzhou, Guangdong 511400, P.R. China
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