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Kish JA, Zhang Q, Langer CJ, Nguyen-Tân PF, Rosenthal DI, Weber RS, List MA, Wong SJ, Garden AS, Hu K, Trotti AM, Bonner JA, Jones CU, Yom SS, Thorstad W, Schultz CJ, Ridge JA, Shenouda G, Harris J, Le QT. The impact of age on outcome in phase III NRG Oncology/RTOG trials of radiotherapy (XRT) +/- systemic therapy in locally advanced head and neck cancer. J Geriatr Oncol 2021; 12:937-944. [PMID: 33814339 PMCID: PMC8829803 DOI: 10.1016/j.jgo.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/08/2021] [Accepted: 03/17/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE To examine the role age plays in the treatment and prognosis of locally advanced head and neck cancer (LAHNC) treated definitively with radiation alone or combined modality therapy. METHODS A retrospective analysis was performed of three NRG/RTOG trials examining either radiation alone or combined radiation and systemic therapy for LAHNC. The effect of age (≥70 yrs.) on cause-specific survival (CSS), overall survival (OS), and toxicity was evaluated. RESULTS A total of 2688 patients were analyzed, of whom 309 patients (11.5%) were ≥ 70. For all studies combined, the hazard ratio (HR) for CSS for patients age ≥ 70 vs. those <70 was 1.33 (95%CI: 1.14-1.55, p < 0.001). For OS, the HR for patients age ≥ 70 vs. those <70 for all studies combined was 1.55 (95% CI 1.35-1.77, p < 0.001). After adjustment for all covariates, age ≥ 70 was associated with worse OS regardless of adjustment for smoking and p16 status. The survival difference was more pronounced in those receiving combined radiation and systemic therapy. Hematologic and renal toxicities were increased in combined modality trials in patients ≥70 years old. CONCLUSIONS Patients age ≥ 70 with LAHNC were underrepresented in these clinical trials. Their CSS and OS proved inferior to patients <70 years old.
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Affiliation(s)
- Julie A Kish
- H. Lee Moffitt Cancer Center & Research Institute, United States of America.
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center, United States of America
| | | | | | - David I Rosenthal
- University of Texas-MD Anderson Cancer Center, United States of America
| | - Randal S Weber
- University of Texas-MD Anderson Cancer Center, United States of America
| | - Marcy A List
- University of Chicago Comprehensive Cancer Center, United States of America
| | - Stuart J Wong
- Medical College of Wisconsin, United States of America
| | - Adam S Garden
- University of Texas-MD Anderson Cancer Center, United States of America
| | - Kenneth Hu
- New York University Langone, United States of America
| | - Andy M Trotti
- H. Lee Moffitt Cancer Center & Research Institute, United States of America
| | - James A Bonner
- University of Alabama at Birmingham, United States of America
| | | | - Sue S Yom
- University of California San Francisco, United States of America
| | | | | | - John A Ridge
- Fox Chase Cancer Center, United States of America
| | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, United States of America
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2
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Mell LK, Shen H, Nguyen-Tân PF, Rosenthal DI, Zakeri K, Vitzthum LK, Frank SJ, Schiff PB, Trotti AM, Bonner JA, Jones CU, Yom SS, Thorstad WL, Wong SJ, Shenouda G, Ridge JA, Zhang QE, Le QT. Nomogram to Predict the Benefit of Intensive Treatment for Locoregionally Advanced Head and Neck Cancer. Clin Cancer Res 2019; 25:7078-7088. [PMID: 31420360 DOI: 10.1158/1078-0432.ccr-19-1832] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/09/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Previous studies indicate that the benefit of therapy depends on patients' risk for cancer recurrence relative to noncancer mortality (ω ratio). We sought to test the hypothesis that patients with head and neck cancer (HNC) with a higher ω ratio selectively benefit from intensive therapy. EXPERIMENTAL DESIGN We analyzed 2,688 patients with stage III-IVB HNC undergoing primary radiotherapy (RT) with or without systemic therapy on three phase III trials (RTOG 9003, RTOG 0129, and RTOG 0522). We used generalized competing event regression to stratify patients according to ω ratio and compared the effectiveness of intensive therapy as a function of predicted ω ratio (i.e., ω score). Intensive therapy was defined as treatment on an experimental arm with altered fractionation and/or multiagent concurrent systemic therapy. A nomogram was developed to predict patients' ω score on the basis of tumor, demographic, and health factors. Analysis was by intention to treat. RESULTS Decreasing age, improved performance status, higher body mass index, node-positive status, P16-negative status, and oral cavity primary predicted a higher ω ratio. Patients with ω score ≥0.80 were more likely to benefit from intensive treatment [5-year overall survival (OS), 70.0% vs. 56.6%; HR of 0.73, 95% confidence interval (CI): 0.57-0.94; P = 0.016] than those with ω score <0.80 (5-year OS, 46.7% vs. 45.3%; HR of 1.02, 95% CI: 0.92-1.14; P = 0.69; P = 0.019 for interaction). In contrast, the effectiveness of intensive therapy did not depend on risk of progression. CONCLUSIONS Patients with HNC with a higher ω score selectively benefit from intensive treatment. A nomogram was developed to help select patients for intensive therapy.
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Affiliation(s)
- Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California.
| | - Hanjie Shen
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Phuc Felix Nguyen-Tân
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montreal, Montreal, Quebec, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kaveh Zakeri
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Lucas K Vitzthum
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, California
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter B Schiff
- Department of Radiation Oncology, New York University School of Medicine, New York, New York
| | - Andy M Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - James A Bonner
- Department of Radiation Oncology, Hazelrig-Salter Radiation Oncology Center, The University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Wade L Thorstad
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Stuart J Wong
- Division of Hematology Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - George Shenouda
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Qiang E Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
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3
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Fakhry C, Zhang Q, Gillison ML, Nguyen-Tân PF, Rosenthal DI, Weber RS, Lambert L, Trotti AM, Barrett WL, Thorstad WL, Yom SS, Wong SJ, Ridge JA, Rao SSD, Spencer S, Fortin A, Raben D, Harris J, Le QT. Validation of NRG oncology/RTOG-0129 risk groups for HPV-positive and HPV-negative oropharyngeal squamous cell cancer: Implications for risk-based therapeutic intensity trials. Cancer 2019; 125:2027-2038. [PMID: 30913305 PMCID: PMC6594017 DOI: 10.1002/cncr.32025] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radiation Therapy Oncology Group (RTOG)-0129 recursive partitioning analysis was the basis for risk-based therapeutic intensification trials for oropharyngeal cancer (OPC). To the authors' knowledge, the question of whether RTOG-0129 overall survival (OS) estimates for low-risk, intermediate-risk, and high-risk groups are similar in other data sets or applicable to progression-free survival (PFS) is unknown. Therefore, the authors evaluated whether survival differences between RTOG-0129 risk groups persist at 5 years, are reproducible in an independent clinical trial, and are applicable to PFS, and whether toxicities differ across risk groups. METHODS Prospective randomized clinical trials were analyzed retrospectively. RTOG-0129 evaluated standard versus accelerated fractionation radiotherapy concurrent with cisplatin. RTOG-0522 compared the combination of cisplatin and accelerated fractionation with or without cetuximab. Patients with OPC with available p16 status and tobacco history were eligible. RESULTS There was a total of 260 patients and 287 patients, respectively, from RTOG-0129 and RTOG-0522, with median follow-ups for surviving patients of 7.9 years (range, 1.7-9.9 years) and 4.7 years (range, 0.1-7.0 years), respectively. Previous OS differences in RTOG-0129 persisted at 5 years. In RTOG-0522, the 5-year OS rates for the low-risk, intermediate-risk, and high-risk groups were 88.1%, 69.9%, and 45.1%, respectively (P for trend, <.001). The 5-year PFS rates for the same 3 groups were 72.9%, 56.1%, and 42.2%, respectively. In RTOG-0522 among a subgroup of patients considered to be at very good risk (p16-positive disease, smoking history of ≤10 pack-years, and classified with T1-T2 disease with ipsilateral lymph nodes measuring ≤6 cm or T3 disease without contralateral or >6 cm lymph nodes), the 5-year OS and PFS rates were 93.8% and 82.2%, respectively. Overall rates of acute and late toxicities were similar by risk group. CONCLUSIONS RTOG-0129 risk groups persisted at 5 years and were reproducible in RTOG-0522. However, there was variability in the estimates. These data underscore the importance of long-term follow-up and appropriate patient selection in therapeutic deintensification trials.
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Affiliation(s)
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA
| | - Maura L Gillison
- University of Texas MD Anderson Cancer Center, Houston, TX Center
| | | | | | - Randal S Weber
- University of Texas MD Anderson Cancer Center, Houston, TX Center
| | - Louise Lambert
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Andy M Trotti
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL
| | - William L Barrett
- University of Cincinnati Cancer Institute, Cincinnati, OH (accruals under Thomas Jefferson University Hospital)
| | | | - Sue S Yom
- University of California San Francisco, San Francisco, CA
| | | | | | | | - Sharon Spencer
- University of Alabama at Birmingham Medical Center, Birmingham, AL
| | - Andre Fortin
- L’Hotel-Dieu de Quebec, Ville de Québec, QC, Canada
| | | | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA
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4
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Gillison ML, Trotti AM, Harris J, Eisbruch A, Harari PM, Adelstein DJ, Jordan RCK, Zhao W, Sturgis EM, Burtness B, Ridge JA, Ringash J, Galvin J, Yao M, Koyfman SA, Blakaj DM, Razaq MA, Colevas AD, Beitler JJ, Jones CU, Dunlap NE, Seaward SA, Spencer S, Galloway TJ, Phan J, Dignam JJ, Le QT. Radiotherapy plus cetuximab or cisplatin in human papillomavirus-positive oropharyngeal cancer (NRG Oncology RTOG 1016): a randomised, multicentre, non-inferiority trial. Lancet 2019; 393:40-50. [PMID: 30449625 PMCID: PMC6541928 DOI: 10.1016/s0140-6736(18)32779-x] [Citation(s) in RCA: 752] [Impact Index Per Article: 150.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 10/19/2018] [Accepted: 10/23/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma have high survival when treated with radiotherapy plus cisplatin. Whether replacement of cisplatin with cetuximab-an antibody against the epidermal growth factor receptor-can preserve high survival and reduce treatment toxicity is unknown. We investigated whether cetuximab would maintain a high proportion of patient survival and reduce acute and late toxicity. METHODS RTOG 1016 was a randomised, multicentre, non-inferiority trial at 182 health-care centres in the USA and Canada. Eligibility criteria included histologically confirmed HPV-positive oropharyngeal carcinoma; American Joint Committee on Cancer 7th edition clinical categories T1-T2, N2a-N3 M0 or T3-T4, N0-N3 M0; Zubrod performance status 0 or 1; age at least 18 years; and adequate bone marrow, hepatic, and renal function. We randomly assigned patients (1:1) to receive either radiotherapy plus cetuximab or radiotherapy plus cisplatin. Randomisation was balanced by using randomly permuted blocks, and patients were stratified by T category (T1-T2 vs T3-T4), N category (N0-N2a vs N2b-N3), Zubrod performance status (0 vs 1), and tobacco smoking history (≤10 pack-years vs >10 pack-years). Patients were assigned to receive either intravenous cetuximab at a loading dose of 400 mg/m2 5-7 days before radiotherapy initiation, followed by cetuximab 250 mg/m2 weekly for seven doses (total 2150 mg/m2), or cisplatin 100 mg/m2 on days 1 and 22 of radiotherapy (total 200 mg/m2). All patients received accelerated intensity-modulated radiotherapy delivered at 70 Gy in 35 fractions over 6 weeks at six fractions per week (with two fractions given on one day, at least 6 h apart). The primary endpoint was overall survival, defined as time from randomisation to death from any cause, with non-inferiority margin 1·45. Primary analysis was based on the modified intention-to-treat approach, whereby all patients meeting eligibility criteria are included. This study is registered with ClinicalTrials.gov, number NCT01302834. FINDINGS Between June 9, 2011, and July 31, 2014, 987 patients were enrolled, of whom 849 were randomly assigned to receive radiotherapy plus cetuximab (n=425) or radiotherapy plus cisplatin (n=424). 399 patients assigned to receive cetuximab and 406 patients assigned to receive cisplatin were subsequently eligible. After median follow-up duration of 4·5 years, radiotherapy plus cetuximab did not meet the non-inferiority criteria for overall survival (hazard ratio [HR] 1·45, one-sided 95% upper CI 1·94; p=0·5056 for non-inferiority; one-sided log-rank p=0·0163). Estimated 5-year overall survival was 77·9% (95% CI 73·4-82·5) in the cetuximab group versus 84·6% (80·6-88·6) in the cisplatin group. Progression-free survival was significantly lower in the cetuximab group compared with the cisplatin group (HR 1·72, 95% CI 1·29-2·29; p=0·0002; 5-year progression-free survival 67·3%, 95% CI 62·4-72·2 vs 78·4%, 73·8-83·0), and locoregional failure was significantly higher in the cetuximab group compared with the cisplatin group (HR 2·05, 95% CI 1·35-3·10; 5-year proportions 17·3%, 95% CI 13·7-21·4 vs 9·9%, 6·9-13·6). Proportions of acute moderate to severe toxicity (77·4%, 95% CI 73·0-81·5 vs 81·7%, 77·5-85·3; p=0·1586) and late moderate to severe toxicity (16·5%, 95% CI 12·9-20·7 vs 20·4%, 16·4-24·8; p=0·1904) were similar between the cetuximab and cisplatin groups. INTERPRETATION For patients with HPV-positive oropharyngeal carcinoma, radiotherapy plus cetuximab showed inferior overall survival and progression-free survival compared with radiotherapy plus cisplatin. Radiotherapy plus cisplatin is the standard of care for eligible patients with HPV-positive oropharyngeal carcinoma. FUNDING National Cancer Institute USA, Eli Lilly, and The Oral Cancer Foundation.
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Affiliation(s)
- Maura L Gillison
- Department of Thoracic Head and Neck Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA.
| | - Andy M Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - David J Adelstein
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Richard C K Jordan
- Department of Orofacial Sciences, University of California San Fransisco, San Francisco, CA, USA; Department of Pathology, University of California San Fransisco, San Francisco, CA, USA
| | - Weiqiang Zhao
- Division of Molecular Pathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Hematopathology, Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA; James Molecular Laboratory, Columbus, OH, USA
| | - Erich M Sturgis
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Barbara Burtness
- Department of Medicine, Yale School of Medicine and Yale Cancer Center, New Haven, CT, USA
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jolie Ringash
- Department of Radiation Oncology, Princess Margaret Cancer Centre and the University of Toronto, Toronto, ON, Canada
| | - James Galvin
- Imaging and Radiation Oncology Core Group, Philadelphia, PA, USA
| | - Min Yao
- Department of Radiation Oncology, Case Western Reserve/University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Dukagjin M Blakaj
- Department of Radiation Oncology, The Ohio State University, Columbus, OH, USA
| | - Mohammed A Razaq
- Department of Hematology/Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | | | - Christopher U Jones
- Department of Radiation Oncology, Sutter Cancer Research Consortium, Novato, CA, USA
| | - Neal E Dunlap
- Department of Radiation Oncology, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | | | - Sharon Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham Medical Center, Birmingham, AL, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Jack Phan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - James J Dignam
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA; NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, CA, USA
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5
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Fakhry C, Nguyen-Tân PF, Lambert L, Rosenthal DI, Weber RS, Gillison ML, Trotti AM, Barrett WL, Thorstad WL, Jones CU, Yom SS, Wong SJ, Ridge JA, Rao SSD, Bonner JA, Vigneault E, Raben D, Kudrimoti MR, Harris J, Le QT. In Regard to Bossi et al. Int J Radiat Oncol Biol Phys 2018; 102:669-670. [PMID: 30238902 DOI: 10.1016/j.ijrobp.2018.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 05/21/2018] [Accepted: 06/13/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Carole Fakhry
- Department of Otolaryngology Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | | | - Louise Lambert
- Centre Hospitalier de l'Université de Montréal, Montreal, Quebec City, Canada
| | | | | | | | - Andy M Trotti
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - William L Barrett
- University of Cincinnati Cancer Institute, Cincinnati, Ohio, (accruals under Thomas Jefferson University Hospital)
| | | | - Christopher U Jones
- Sutter General Hospital, Sacramento, California, (accruals under Radiologic Associates of Sacramento)
| | - Sue S Yom
- University of California San Francisco, San Francisco, California
| | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | - James A Bonner
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama
| | - Eric Vigneault
- L'Hotel-Dieu de Quebec, Ville de Québec, Quebec City, Canada
| | | | - Mahesh R Kudrimoti
- University of Kentucky, Lexington, Kentucky, (accrual under University of Maryland Medical Systems)
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania
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6
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Oliver DE, Sondak VK, Strom T, Zager JS, Naghavi AO, Sarnaik A, Messina JL, Caudell JJ, Trotti AM, Torres-Roca JF, Khushalani NI, Harrison LB. Interferon is associated with improved survival for node-positive cutaneous melanoma: a single-institution experience. Melanoma Manag 2018; 5:MMT02. [PMID: 30190928 PMCID: PMC6122528 DOI: 10.2217/mmt-2017-0025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 02/22/2017] [Indexed: 02/05/2023] Open
Abstract
Aim: We assessed the role of adjuvant interferon on relapse-free survival (RFS), distant metastasis-free survival (DMFS) and overall survival (OS) in node-positive melanoma patients. Methods: We retrospectively reviewed 385 node-positive patients without distant metastatic disease treated from 1998 to 2015. The surgery was therapeutic lymph node dissection (LND, n = 86) or sentinel lymph node biopsy ± completion LND (n = 270). 128 patients (33.2%) received adjuvant interferon. Results: After a median follow-up of 70 months, interferon was associated with improved RFS (hazard ratio [HR]: 0.55; p < 0.001), DMFS (HR: 0.59; p < 0.001) and OS (HR: 0.61; p = 0.003), controlling for tumor and nodal stage, node size, sex, primary site, adjuvant therapy and extracapsular extension. In an exploratory age-matched comparison of patients treated with (n = 67) and without (n = 233) adjuvant immunotherapy, interferon still showed improved RFS, DMFS and OS. Conclusion: Adjuvant interferon appears to improve OS among node-positive melanoma patients in a modern experience, providing context for comparison in the adjuvant therapy landscape.
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Affiliation(s)
- Daniel E Oliver
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Vernon K Sondak
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Tobin Strom
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75390, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Radiation Oncology, University of Texas Southwestern, Dallas, TX 75390, USA
| | - Jonathan S Zager
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Amod Sarnaik
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Jane L Messina
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Departments of Pathology & Cell Biology & Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Departments of Pathology & Cell Biology & Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Andy M Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Javier F Torres-Roca
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
| | - Nikhil I Khushalani
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Louis B Harrison
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA.,Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.,Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33612, USA
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7
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Vargo JA, Ward MC, Caudell JJ, Riaz N, Dunlap NE, Isrow D, Zakem SJ, Dault J, Awan MJ, Higgins KA, Hassanadeh C, Beitler JJ, Reddy CA, Marcrom S, Boggs DH, Bonner JA, Yao M, Machtay M, Siddiqui F, Trotti AM, Lee NY, Koyfman SA, Ferris RL, Heron DE. A Multi-institutional Comparison of SBRT and IMRT for Definitive Reirradiation of Recurrent or Second Primary Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2018; 100:595-605. [PMID: 28899556 PMCID: PMC7418052 DOI: 10.1016/j.ijrobp.2017.04.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/01/2017] [Accepted: 04/17/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE Two modern methods of reirradiation, intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), are established for patients with recurrent or second primary squamous cell carcinoma of the head and neck (rSCCHN). We performed a retrospective multi-institutional analysis to compare methods. METHODS AND MATERIALS Data from patients with unresectable rSCCHN previously irradiated to ≥40 Gy who underwent reirradiation with IMRT or SBRT were collected from 8 institutions. First, the prognostic value of our IMRT-based recursive partitioning analysis (RPA) separating those patients with unresectable tumors with an intertreatment interval >2 years or those with ≤2 years and without feeding tube or tracheostomy dependence (class II) from other patients with unresected tumors (class III) was investigated among SBRT patients. Overall survival (OS) and locoregional failure were then compared between IMRT and SBRT by use of 2 methods to control for baseline differences: Cox regression weighted by the inverse probability of treatment and subset analysis by RPA classification. RESULTS The study included 414 patients with unresectable rSCCHN: 217 with IMRT and 197 with SBRT. The unadjusted 2-year OS rate was 35.4% for IMRT and 16.3% for SBRT (P<.01). Among SBRT patients, RPA classification retained an independent association with OS. On Cox regression weighted by the inverse probability of treatment, no significant differences in OS or locoregional failure between IMRT and SBRT were demonstrated. Analysis by RPA class showed similar OS between IMRT and SBRT for class III patients. In all class II patients, IMRT was associated with improved OS (P<.001). Further subset analysis demonstrated comparable OS when ≥35 Gy was delivered with SBRT to small tumor volumes. Acute grade ≥4 toxicity was greater in the IMRT group than in the SBRT group (5.1% vs 0.5%, P<.01), with no significant difference in late toxicity. CONCLUSIONS Reirradiation both with SBRT and with IMRT appear relatively safe with favorable toxicity compared with historical studies. Outcomes vary by RPA class, which informs clinical trial design. Survival is poor in class III patients, and alternative strategies are needed.
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Affiliation(s)
- John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Matthew C Ward
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Derek Isrow
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Sara J Zakem
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Joshua Dault
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - Musaddiq J Awan
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Comron Hassanadeh
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia; Department of Otolaryngology Head and Neck Surgery, Emory University, Atlanta, Georgia
| | - Chandana A Reddy
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Samuel Marcrom
- Department of Radiation Oncology, University of Alabama, Birmingham, Birmingham, Alabama
| | - Drexell H Boggs
- Department of Radiation Oncology, University of Alabama, Birmingham, Birmingham, Alabama
| | - James A Bonner
- Department of Radiation Oncology, University of Alabama, Birmingham, Birmingham, Alabama
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Mitchell Machtay
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Robert L Ferris
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.
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8
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Ward MC, Riaz N, Caudell JJ, Dunlap NE, Isrow D, Zakem SJ, Dault J, Awan MJ, Vargo JA, Heron DE, Higgins KA, Beitler JJ, Marcrom S, Boggs DH, Hassanzadeh C, Reddy CA, Bonner JA, Yao M, Machtay M, Siddiqui F, Trotti AM, Lee NY, Koyfman SA. Refining Patient Selection for Reirradiation of Head and Neck Squamous Carcinoma in the IMRT Era: A Multi-institution Cohort Study by the MIRI Collaborative. Int J Radiat Oncol Biol Phys 2018; 100:586-594. [DOI: 10.1016/j.ijrobp.2017.06.012] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 04/04/2017] [Accepted: 06/12/2017] [Indexed: 12/19/2022]
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9
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Caudell JJ, Ward MC, Riaz N, Zakem SJ, Awan MJ, Dunlap NE, Isrow D, Hassanzadeh C, Vargo JA, Heron DE, Marcrom S, Boggs DH, Reddy CA, Dault J, Bonner JA, Higgins KA, Beitler JJ, Koyfman SA, Machtay M, Yao M, Trotti AM, Siddiqui F, Lee NY. Volume, Dose, and Fractionation Considerations for IMRT-based Reirradiation in Head and Neck Cancer: A Multi-institution Analysis. Int J Radiat Oncol Biol Phys 2018; 100:606-617. [PMID: 29413274 PMCID: PMC7269162 DOI: 10.1016/j.ijrobp.2017.11.036] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 11/12/2017] [Accepted: 11/24/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE Limited data exist to guide the treatment technique for reirradiation of recurrent or second primary squamous carcinoma of the head and neck. We performed a multi-institution retrospective cohort study to investigate the effect of the elective treatment volume, dose, and fractionation on outcomes and toxicity. METHODS AND MATERIALS Patients with recurrent or second primary squamous carcinoma originating in a previously irradiated field (≥40 Gy) who had undergone reirradiation with intensity modulated radiation therapy (IMRT); (≥40 Gy re-IMRT) were included. The effect of elective nodal treatment, dose, and fractionation on overall survival (OS), locoregional control, and acute and late toxicity were assessed. The Kaplan-Meier and Gray's competing risks methods were used for actuarial endpoints. RESULTS From 8 institutions, 505 patients were included in the present updated analysis. The elective neck was not treated in 56.4% of patients. The median dose of re-IMRT was 60 Gy (range 39.6-79.2). Hyperfractionation was used in 20.2%. Systemic therapy was integrated for 77.4% of patients. Elective nodal radiation therapy did not appear to decrease the risk of locoregional failure (LRF) or improve the OS rate. Doses of ≥66 Gy were associated with improvements in both LRF and OS in the definitive re-IMRT setting. However, dose did not obviously affect LRF or OS in the postoperative re-IMRT setting. Hyperfractionation was not associated with improved LRF or OS. The rate of acute grade ≥3 toxicity was 22.1% overall. On multivariable logistic regression, elective neck irradiation was associated with increased acute toxicity in the postoperative setting. The rate of overall late grade ≥3 toxicity was 16.7%, with patients treated postoperatively with hyperfractionation experiencing the highest rates. CONCLUSIONS Doses of ≥66 Gy might be associated with improved outcomes in high-performance patients undergoing definitive re-IMRT. Postoperatively, doses of 50 to 66 Gy appear adequate after removal of gross disease. Hyperfractionation and elective neck irradiation were not associated with an obvious benefit and might increase toxicity.
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MESH Headings
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/virology
- Dose Fractionation, Radiation
- Female
- Head and Neck Neoplasms/mortality
- Head and Neck Neoplasms/radiotherapy
- Head and Neck Neoplasms/virology
- Humans
- Kaplan-Meier Estimate
- Logistic Models
- Lymphatic Irradiation
- Male
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/virology
- Neoplasms, Second Primary/mortality
- Neoplasms, Second Primary/radiotherapy
- Neoplasms, Second Primary/virology
- Radiation Dose Hypofractionation
- Radiation Injuries/etiology
- Radiotherapy, Intensity-Modulated/adverse effects
- Radiotherapy, Intensity-Modulated/methods
- Re-Irradiation/adverse effects
- Re-Irradiation/methods
- Retrospective Studies
- Treatment Outcome
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Affiliation(s)
- Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
| | - Matthew C Ward
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sara J Zakem
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Musaddiq J Awan
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, Kentucky
| | - Derek Isrow
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | | | - John A Vargo
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania; Division of Head and Neck Surgery, Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Samuel Marcrom
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Drexell H Boggs
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joshua Dault
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia
| | - James A Bonner
- Department of Radiation Oncology, University of Alabama, Birmingham, Alabama
| | - Kristin A Higgins
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mitchell Machtay
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Lacas B, Bourhis J, Overgaard J, Zhang Q, Grégoire V, Nankivell M, Zackrisson B, Szutkowski Z, Suwiński R, Poulsen M, O'Sullivan B, Corvò R, Laskar SG, Fallai C, Yamazaki H, Dobrowsky W, Cho KH, Beadle B, Langendijk JA, Viegas CMP, Hay J, Lotayef M, Parmar MKB, Aupérin A, van Herpen C, Maingon P, Trotti AM, Grau C, Pignon JP, Blanchard P. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol 2017; 18:1221-1237. [PMID: 28757375 PMCID: PMC5737765 DOI: 10.1016/s1470-2045(17)30458-8] [Citation(s) in RCA: 173] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/29/2017] [Accepted: 05/31/2017] [Indexed: 01/30/2023]
Abstract
BACKGROUND The Meta-Analysis of Radiotherapy in squamous cell Carcinomas of Head and neck (MARCH) showed that altered fractionation radiotherapy is associated with improved overall and progression-free survival compared with conventional radiotherapy, with hyperfractionated radiotherapy showing the greatest benefit. This update aims to confirm and explain the superiority of hyperfractionated radiotherapy over other altered fractionation radiotherapy regimens and to assess the benefit of altered fractionation within the context of concomitant chemotherapy with the inclusion of new trials. METHODS For this updated meta-analysis, we searched bibliography databases, trials registries, and meeting proceedings for published or unpublished randomised trials done between Jan 1, 2009, and July 15, 2015, comparing primary or postoperative conventional fractionation radiotherapy versus altered fractionation radiotherapy (comparison 1) or conventional fractionation radiotherapy plus concomitant chemotherapy versus altered fractionation radiotherapy alone (comparison 2). Eligible trials had to start randomisation on or after Jan 1, 1970, and completed accrual before Dec 31, 2010; had to have been randomised in a way that precluded prior knowledge of treatment assignment; and had to include patients with non-metastatic squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx undergoing first-line curative treatment. Trials including a non-conventional radiotherapy control group, investigating hypofractionated radiotherapy, or including mostly nasopharyngeal carcinomas were excluded. Trials were grouped in three types of altered fractionation: hyperfractionated, moderately accelerated, and very accelerated. Individual patient data were collected and combined with a fixed-effects model based on the intention-to-treat principle. The primary endpoint was overall survival. FINDINGS Comparison 1 (conventional fractionation radiotherapy vs altered fractionation radiotherapy) included 33 trials and 11 423 patients. Altered fractionation radiotherapy was associated with a significant benefit on overall survival (hazard ratio [HR] 0·94, 95% CI 0·90-0·98; p=0·0033), with an absolute difference at 5 years of 3·1% (95% CI 1·3-4·9) and at 10 years of 1·2% (-0·8 to 3·2). We found a significant interaction (p=0·051) between type of fractionation and treatment effect, the overall survival benefit being restricted to the hyperfractionated group (HR 0·83, 0·74-0·92), with absolute differences at 5 years of 8·1% (3·4 to 12·8) and at 10 years of 3·9% (-0·6 to 8·4). Comparison 2 (conventional fractionation radiotherapy plus concomitant chemotherapy versus altered fractionation radiotherapy alone) included five trials and 986 patients. Overall survival was significantly worse with altered fractionation radiotherapy compared with concomitant chemoradiotherapy (HR 1·22, 1·05-1·42; p=0·0098), with absolute differences at 5 years of -5·8% (-11·9 to 0·3) and at 10 years of -5·1% (-13·0 to 2·8). INTERPRETATION This update confirms, with more patients and a longer follow-up than the first version of MARCH, that hyperfractionated radiotherapy is, along with concomitant chemoradiotherapy, a standard of care for the treatment of locally advanced head and neck squamous cell cancers. The comparison between hyperfractionated radiotherapy and concomitant chemoradiotherapy remains to be specifically tested. FUNDING Institut National du Cancer; and Ligue Nationale Contre le Cancer.
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Affiliation(s)
- Benjamin Lacas
- Ligue Nationale Contre le Cancer Meta-Analysis Platform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Jean Bourhis
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus, Denmark
| | - Qiang Zhang
- NRG Oncology Statistics and Data Management Center (formerly RTOG), Philadelphia, PA, USA
| | - Vincent Grégoire
- Radiation Oncology Department, UCL-Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Matthew Nankivell
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Björn Zackrisson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Zbigniew Szutkowski
- Department of Radiotherapy, Cancer Center, Marie Curie-Sklodowska Memorial Institute, Warsaw, Poland
| | - Rafał Suwiński
- Radiotherapy and Chemotherapy Clinic and Teaching Hospital, Marie Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland
| | - Michael Poulsen
- Radiation Oncology Services, Mater Centre, Brisbane, QLD, Australia
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Carlo Fallai
- Department of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Hideya Yamazaki
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, Osaka, Japan
| | - Werner Dobrowsky
- Department of Clinical Oncology, Freeman Hospital, Newcastle, UK
| | - Kwan Ho Cho
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Beth Beadle
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Celia Maria Pais Viegas
- Radiation Oncology Department, Instituto Nacional de Cancer, Brasil National Cancer Institute, Rio de Janeiro, Brazil
| | - John Hay
- Division of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada
| | - Mohamed Lotayef
- Radiation Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Anne Aupérin
- Ligue Nationale Contre le Cancer Meta-Analysis Platform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Carla van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Philippe Maingon
- European Organisation for Research and Treatment of Cancer, Radiation Oncology Group, Brussels, Belgium; Service d'Oncologie, Radiothérapie, Hôpitaux Universitaires Pitié Salpêtrière, Charles Foix, Paris, France
| | - Andy M Trotti
- Moffitt Cancer Center, Department of Radiation Oncology, Tampa, FL, USA
| | - Cai Grau
- Department of Experimental Clinical Oncology, Aarhus, Denmark
| | - Jean-Pierre Pignon
- Ligue Nationale Contre le Cancer Meta-Analysis Platform, Service de Biostatistique et d'Epidémiologie, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France.
| | - Pierre Blanchard
- Department of Radiation Therapy, Gustave Roussy Cancer Campus, INSERM U1018, CESP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
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11
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Fakhry C, Zhang Q, Nguyen-Tân PF, Rosenthal DI, Weber RS, Lambert L, Trotti AM, Barrett WL, Thorstad WL, Jones CU, Yom SS, Wong SJ, Ridge JA, Rao SSD, Bonner JA, Vigneault E, Raben D, Kudrimoti MR, Harris J, Le QT, Gillison ML. Development and Validation of Nomograms Predictive of Overall and Progression-Free Survival in Patients With Oropharyngeal Cancer. J Clin Oncol 2017; 35:4057-4065. [PMID: 28777690 DOI: 10.1200/jco.2016.72.0748] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Purpose Treatment of oropharyngeal squamous cell carcinoma (OPSCC) is evolving toward risk-based modification of therapeutic intensity, which requires patient-specific estimates of overall survival (OS) and progression-free survival (PFS). Methods To develop and validate nomograms for OS and PFS, we used a derivation cohort of 493 patients with OPSCC with known p16 tumor status (surrogate of human papillomavirus) and cigarette smoking history (pack-years) randomly assigned to clinical trials using platinum-based chemoradiotherapy (NRG Oncology Radiation Therapy Oncology Group [RTOG] 0129 and 0522). Nomograms were created from Cox models and internally validated by use of bootstrap and cross-validation. Model discrimination was measured by calibration plots and the concordance index. Nomograms were externally validated in a cohort of 153 patients with OPSCC randomly assigned to a third trial, NRG Oncology RTOG 9003. Results Both models included age, Zubrod performance status, pack-years, education, p16 status, and T and N stage; the OS model also included anemia and age × pack-years interaction; and the PFS model also included marital status, weight loss, and p16 × Zubrod interaction. Predictions correlated well with observed 2-year and 5-year outcomes. The uncorrected concordance index was 0.76 (95% CI, 0.72 to 0.80) for OS and 0.70 (95% CI, 0.66 to 0.74) for PFS, and bias-corrected indices were similar. In the validation set, OS and PFS models were well calibrated, and OS and PFS were significantly different across tertiles of nomogram scores (log-rank P = .003;< .001). Conclusion The validated nomograms provided useful prediction of OS and PFS for patients with OPSCC treated with primary radiation-based therapy.
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Affiliation(s)
- Carole Fakhry
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Qiang Zhang
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Phuc Felix Nguyen-Tân
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - David I Rosenthal
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Randal S Weber
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Louise Lambert
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Andy M Trotti
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - William L Barrett
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Wade L Thorstad
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Christopher U Jones
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Sue S Yom
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Stuart J Wong
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - John A Ridge
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Shyam S D Rao
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - James A Bonner
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Eric Vigneault
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - David Raben
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Mahesh R Kudrimoti
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Jonathan Harris
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Quynh-Thu Le
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
| | - Maura L Gillison
- Carole Fakhry, Johns Hopkins University, Baltimore, MD; Qiang Zhang and Jonathan Harris, NRG Oncology Statistics and Data Management Center, American College of Radiology; John A. Ridge, Fox Chase Cancer Center, Philadelphia, PA; Phuc Felix Nguyen-Tân and Louise Lambert, Centre Hospitalier de l'Université de Montréal, Montreal; Eric Vigneault, L'Hotel-Dieu de Quebec, Ville de Québec, Quebec, Canada; David I. Rosenthal, Randal S. Weber, and Maura L. Gillison, MD Anderson Cancer Center, Houston, TX; Andy M. Trotti III, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL; William L. Barrett, University of Cincinnati Cancer Institute, Cincinnati, OH; Wade L. Thorstad, Washington University, St Louis, MO; Christopher U. Jones, Sutter General Hospital, Sacramento; Sue S. Yom, University of California San Francisco, San Francisco; Shyam S.D. Rao, University of California Davis, Davis; Quynh-Thu Le, Stanford University, Stanford, CA; Stuart J. Wong, Medical College of Wisconsin, Milwaukee, WI; James A. Bonner, University of Alabama at Birmingham Medical Center, Birmingham, AL; David Raben, University of Colorado, Aurora, CO; and Mahesh R. Kudrimoti, University of Kentucky, Lexington, KY
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Strom T, Torres-Roca JF, Parekh A, Naghavi AO, Caudell JJ, Oliver DE, Messina JL, Khushalani NI, Zager JS, Sarnaik A, Mulé JJ, Trotti AM, Eschrich SA, Sondak VK, Harrison LB. Regional Radiation Therapy Impacts Outcome for Node-Positive Cutaneous Melanoma. J Natl Compr Canc Netw 2017; 15:473-482. [PMID: 28404758 PMCID: PMC7771284 DOI: 10.6004/jnccn.2017.0047] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/01/2016] [Indexed: 01/14/2023]
Abstract
Background: Regional radiation therapy (RT) has been shown to reduce the risk of regional recurrence with node-positive cutaneous melanoma. However, risk factors for regional recurrence, especially in the era of sentinel lymph node biopsy (SLNB), are less clear. Our goals were to identify risk factors associated with regional recurrence and to determine whether a radiosensitivity index (RSI) gene expression signature (GES) could identify patients who experience a survival benefit with regional RT. Methods: A single-institution, Institutional Review Board-approved study was performed including 410 patients treated with either SLNB with or without completion lymph node dissection (LND; n=270) or therapeutic LND (n=91). Postoperative regional RT was delivered to the involved nodal basin in 83 cases (20.2%), to a median dose of 54 Gy (range, 30-60 Gy) in 27 fractions (range, 5-30). Primary outcomes were regional control and overall survival by RSI GES status. Results: Median follow-up was 69 months (range, 13-180). Postoperative regional RT was associated with a reduced risk of regional recurrence among all patients on univariate (5-year estimate: 95.0% vs 83.3%; P=.036) and multivariate analysis (hazard ratio[HR], 0.15; 95% CI, 0.05-0.43; P<.001). Among higher-risk subgroups, regional RT was associated with a lower risk of regional recurrence among patients with clinically detected lymph nodes (n=175; 5-year regional control: 94.1% vs 69.5%; P=.003) and extracapsular extension (ECE) present (n=138; 5-year regional control: 96.7% vs 62.2%; P<.001). Among a subset of radiated patients with gene expression data available, a low RSI GES (radiosensitive) tumor status was associated with improved survival compared with a high RSI GES (5-year: 75% vs 0%; HR, 10.68; 95% CI, 1.24-92.14). Conclusions: Regional RT was associated with a reduced risk of regional recurrence among patients with ECE and clinically detected nodal disease. Gene expression data show promise for better predicting radiocurable patients in the future. In the era of increasingly effective systemic therapies, the value of improved regional control potentially takes on greater significance.
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Affiliation(s)
- Tobin Strom
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Javier F. Torres-Roca
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Akash Parekh
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Arash O. Naghavi
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jimmy J. Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Daniel E. Oliver
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jane L. Messina
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Pathology & Cell Biology and Dermatology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Nikhil I. Khushalani
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Jonathan S. Zager
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Amod Sarnaik
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
| | - James J. Mulé
- Center for Translational Research, Moffitt Cancer Center, Tampa, Florida
| | - Andy M. Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Steven A. Eschrich
- Department of Biomedical Informatics, Moffitt Cancer Center, Tampa, Florida
| | - Vernon K. Sondak
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Pathology & Cell Biology and Dermatology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Louis B. Harrison
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida
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Abstract
BACKGROUND Salivary carcinomas are a rare group of biologically diverse neoplasms affecting the head and neck. The wide array of different histological entities and clinical presentations has historically limited attempts to establish well-defined treatment algorithms. In general, low-risk lesions can be managed with a single treatment modality, whereas advanced lesions require a more complex, multidisciplinary approach. METHODS The relevant literature was reviewed, focusing on diagnostic and treatment algorithms for salivary malignancies. RESULTS Salivary carcinomas with high-risk features require an aggressive treatment approach with complete surgical resection, neck dissection to appropriate cervical lymph-node basins, and postoperative radiotherapy. CONCLUSIONS The heterogeneity of salivary neoplasms represents a unique clinical challenge. Despite the multidisciplinary management paradigm detailed in this review, outcomes for advanced disease are unsatisfactory. Future progress will likely require the addition of novel systemic therapeutic strategies.
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Affiliation(s)
- Matthew J Mifsud
- Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Hospital, Toronto, ON M5G1X5, Canada.
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14
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Strom TJ, Naghavi AO, Trotti AM, Russell J, Kish JA, McCaffrey J, Otto KJ, Harrison LB, Caudell JJ. Increased acute mortality with chemoradiotherapy for locally advanced head and neck cancer in patients ≥70years. J Geriatr Oncol 2016; 8:50-55. [PMID: 27720129 DOI: 10.1016/j.jgo.2016.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/22/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Concurrent chemoradiotherapy (CRT) is the standard of care for many sites of locally advanced head and neck squamous cell carcinomas (LAHNC). However, on meta-analysis, the addition of chemotherapy did not improve survival for patients >70years. We hypothesized that elderly patients treated with CRT would have increased toxicity without similar improvements in survival. METHODS A single-institution, IRB-approved retrospective study took place from 2005 to 2012 including 369 patients treated with CRT for LAHNC. Multivariate models for death at 3months and death over time were developed using logistic regression and Cox modeling, respectively. RESULTS Patients ≥70years were treated less often with concurrent cisplatin dosed every 3weeks (25.5% vs. 71.4%, respectively) and more often with weekly carboplatin (31.9% vs. 3.4%) than patients <70years (n=322; p<0.001). Patients ≥70years experienced increased toxicity during treatment with more frequently hospitalizations (36.2% vs. 21.1%; p=0.02) and a lower rate of PEG removal at last follow-up or death (77.1% vs. 92.9%; p=0.004). A higher proportion of patients ≥70years died within 3months (12.8% vs. 2.8%; p=0.001) following CRT. Patients ≥70 had an increased risk of death at 3months following CRT (odds ratio 5.19, 95% CI 1.64-16.41; p=0.005) and worse survival over time (hazard ratio 2.30, 95% CI 1.34-3.93; p=0.002). CONCLUSIONS Patients ≥70years were more often treated with less toxic chemotherapy, yet experienced higher rates of hospitalization during treatment and increased rates of acute mortality following CRT. The efficacy of chemoradiotherapy for elderly patients should be evaluated in a prospective setting.
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Affiliation(s)
- Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jeffery Russell
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Julie A Kish
- Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Judith McCaffrey
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kristen J Otto
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
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Naghavi AO, Echevarria MI, Grass GD, Strom TJ, Abuodeh YA, Ahmed KA, Kim Y, Trotti AM, Harrison LB, Yamoah K, Caudell JJ. Having Medicaid insurance negatively impacts outcomes in patients with head and neck malignancies. Cancer 2016; 122:3529-3537. [PMID: 27479362 DOI: 10.1002/cncr.30212] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients covered by Medicaid insurance appear to have poorer cancer outcomes. Herein, the authors sought to test whether Medicaid was associated with worse outcomes among patients with head and neck cancer (HNC). METHODS The records of 1698 patients with squamous cell HNC without distant metastatic disease were retrospectively reviewed from an institutional database between 1998 and 2011. At the time of diagnosis, insurance status was categorized as Medicaid, Medicare/other government insurance, or private insurance. Outcomes including locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan-Meier method and Cox regression multivariate analysis (MVA). RESULTS The median follow-up for all patients was 35 months. Medicaid patients comprised 11% of the population; the remaining patients were privately insured (56%) or had Medicare/government insurance (34%). On MVA, Medicaid patients were younger, were current smokers, had higher tumor T and N classifications, and experienced a longer time from diagnosis to treatment initiation (all P<.005). Medicaid insurance status was associated with a deficit of 13% in LRC (69% vs 82%) and 26% in OS (46% vs 72%) at 3 years (all with P<.001). A time from diagnosis to treatment initiation of >45 days was found to be associated with worse 3-year LRC (77% vs 83%; P = .009) and OS (68% vs 71%; P = .008). On MVA, Medicaid remained associated with a deficit in LRC (P = .002) and OS (P<.001). CONCLUSIONS Patients with Medicaid insurance more often present with locally advanced HNC and experience a higher rate of treatment delays compared with non-Medicaid patients. Medicaid insurance status appears to be independently associated with deficits in LRC and OS. Improvements in the health care system, such as expediting treatment initiation, may improve the outcomes of patients with HNC. Cancer 2016;122:3529-3537. © 2016 American Cancer Society.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michelle I Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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16
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Naghavi AO, Strom TJ, Ahmed KA, Echevarria MI, Abuodeh YA, Venkat PS, Frakes JM, Harrison LB, Trotti AM, Caudell JJ. Management of Oropharyngeal Cancer in the HPV Era. Cancer Control 2016; 23:197-207. [DOI: 10.1177/107327481602300302] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Historically, oropharyngeal cancer (OPC) has been attributed to risk factors such as smoking and alcohol use. The increased incidence of OPC has been driven by human papillomavirus (HPV) infection. Methods A search of the literature involving HPV infection and OPC was performed, along with a search of ongoing clinical trials regarding HPV-positive OPC. Results This review summarizes the differences in epidemiology and prognosis of HPV-positive OPC compared with non–HPV-related OPC. It will also discuss use of de-escalating treatment to minimize toxicity while maintaining excellent outcomes. Disease management is also addressed, including prevention and follow-up recommendations for this cohort of patients. Conclusions HPV-positive OPC is a distinct disease, and efforts should be made to personalize its management. Preventive measures and vaccinations, along with de-escalation of treatment, may help optimize outcomes in this population.
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Affiliation(s)
- Arash O. Naghavi
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Tobin J. Strom
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Kamran A. Ahmed
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Michelle I. Echevarria
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Yazan A. Abuodeh
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Puja S. Venkat
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Jessica M. Frakes
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Louis B. Harrison
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Andy M. Trotti
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
| | - Jimmy J. Caudell
- H. Lee Moffitt Cancer Center & Research Institute, Department of Radiation Oncology, Tampa, Florida
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17
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Strom T, Naghavi AO, Messina JL, Kim S, Torres-Roca JF, Russell J, Sondak VK, Padhya TA, Trotti AM, Caudell JJ, Harrison LB. Improved local and regional control with radiotherapy for Merkel cell carcinoma of the head and neck. Head Neck 2016; 39:48-55. [DOI: 10.1002/hed.24527] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Tobin Strom
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Arash O. Naghavi
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Jane L. Messina
- Department of Cutaneous Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
- Departments of Pathology & Cell Biology and Dermatology; University of South Florida Morsani College of Medicine; Tampa Florida
| | - Sungjune Kim
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Javier F. Torres-Roca
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Jeffery Russell
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Vernon K. Sondak
- Department of Cutaneous Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
- Departments of Oncologic Sciences and Surgery; University of South Florida Morsani College of Medicine; Tampa Florida
| | - Tapan A. Padhya
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Andy M. Trotti
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Jimmy J. Caudell
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Louis B. Harrison
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
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18
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Strom T, Carr M, Zager JS, Naghavi A, Smith FO, Cruse CW, Messina JL, Russell J, Rao NG, Fulp W, Kim S, Torres-Roca JF, Padhya TA, Sondak VK, Trotti AM, Harrison LB, Caudell JJ. Radiation Therapy is Associated with Improved Outcomes in Merkel Cell Carcinoma. Ann Surg Oncol 2016; 23:3572-3578. [PMID: 27251134 DOI: 10.1245/s10434-016-5293-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Following wide excision of Merkel cell carcinoma (MCC), postoperative radiation therapy (RT) is typically recommended. Controversy remains as to whether RT can be avoided in selected cases, such as those with negative margins. Additionally, there is evidence that RT can influence survival. METHODS We included 171 patients treated for non-metastatic MCC from 1994 through 2012 at a single institution. Patients without pathologic nodal evaluation (clinical N0 disease) were excluded to reflect modern treatment practice. The endpoints included local control (LC), locoregional control (LRC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS). RESULTS Median follow-up was 33 months. Treatment with RT was associated with improved 3-year LC (91.2 vs. 76.9 %, respectively; p = 0.01), LRC (79.5 vs. 59.1 %; p = 0.004), DFS (57.0 vs. 30.2 %; p < 0.001), and OS (73 vs. 66 %; p = 0.02), and was associated with improved 3-year DSS among node-positive patients (76.2 vs. 48.1 %; p = 0.035), but not node-negative patients (90.1 vs. 80.8 %; p = 0.79). On multivariate analysis, RT was associated with improved LC [hazard ratio (HR) 0.18, 95 % confidence interval (CI) 0.07-0.46; p < 0.001], LRC (HR 0.28, 95 % CI 0.14-0.56; p < 0.001), DFS (HR 0.42, 95 % CI 0.26-0.70; p = 0.001), OS (HR 0.53, 95 % CI 0.31-0.93; p = 0.03), and DSS (HR 0.42, 95 % CI 0.26-0.70; p = 0.001). Patients with negative margins had significant improvements in 3-year LC (90.1 vs. 75.4 %; p < 0.001) with RT. Deaths not attributable to MCC were relatively evenly distributed between the RT and no RT groups (28.5 and 29.3 % of patients, respectively). CONCLUSIONS RT for MCC was associated with improved LRC and survival. RT appeared to be beneficial regardless of margin status.
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Affiliation(s)
- Tobin Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Michael Carr
- School of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jonathan S Zager
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Arash Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Franz O Smith
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - C Wayne Cruse
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jane L Messina
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Departments of Pathology & Cell Biology and Dermatology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jeffery Russell
- Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Nikhil G Rao
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - William Fulp
- Department of Biostatistics, Moffitt Cancer Center, Tampa, FL, USA
| | - Sungjune Kim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | | | - Tapan A Padhya
- Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Vernon K Sondak
- Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL, USA.,Departments of Oncologic Sciences and Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center, Tampa, FL, USA.
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19
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Mifsud MJ, Tanvetyanon T, Mccaffrey JC, Otto KJ, Padhya TA, Kish J, Trotti AM, Harrison LB, Caudell JJ. Adjuvant radiotherapy versus concurrent chemoradiotherapy for the management of high-risk salivary gland carcinomas. Head Neck 2016; 38:1628-1633. [PMID: 27098984 DOI: 10.1002/hed.24484] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/31/2016] [Accepted: 03/16/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Given the aggressive behavior of advanced salivary malignancies, the purpose of the current study was to explore the utility of adjuvant chemoradiotherapy (CRT) in this population. METHODS A retrospective study of salivary carcinomas treated from 1998 to 2013 with postoperative CRT (37 patients) or radiotherapy (RT; 103 patients) was completed. RESULTS The decision to utilize adjuvant CRT versus RT was influenced by tumor grade and histology, cervical lymph node status, surgical margins, and perineural invasion. In both treatment cohorts, high locoregional control rates were obtained (79% for CRT vs 91% for RT; p = .031). Multivariate Cox regression analysis did not identify a difference in 3-year progression-free survival (PFS) with the use of CRT versus RT (hazard ratio [HR] = 0.783; 95% confidence interval [CI] = 0.396-1.549; p = .482). CONCLUSION Until prospective evidence is available, such as from Radiation Therapy Oncology Group 1008, the standard use of CRT for advanced salivary malignancies cannot be recommended. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
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Affiliation(s)
- Matthew J Mifsud
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Tawee Tanvetyanon
- Department of Thoracic Oncology and Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Judith C Mccaffrey
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kristen J Otto
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tapan A Padhya
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Julie Kish
- Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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20
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Robins HI, Zhang P, Gilbert MR, Chakravarti A, de Groot JF, Grimm SA, Wang F, Lieberman FS, Krauze A, Trotti AM, Mohile N, Kee AYJ, Colman H, Cavaliere R, Kesari S, Chmura SJ, Mehta M. A randomized phase I/II study of ABT-888 in combination with temozolomide in recurrent temozolomide resistant glioblastoma: an NRG oncology RTOG group study. J Neurooncol 2016; 126:309-16. [PMID: 26508094 PMCID: PMC4720526 DOI: 10.1007/s11060-015-1966-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/21/2015] [Indexed: 11/28/2022]
Abstract
This study tested the hypothesis that ABT-888 (velparib), a poly (ADP-ribose) polymerase (PARP) inhibitor, can modulate temozolomide (TMZ) resistance in recurrent TMZ refractory glioblastoma patients. The combination regimen (TMZ/ABT-888) was tested using two randomized schedules (5 vs. 21 days), with 6-month progression free survival (PFS6) as the primary endpoint. The maximum tolerated dose (MTD) for TMZ using the 21 day of 28 TMZ schedule, in concert with 40 mg BID ABT-888 was determined in a phase I portion of this study, and previously reported to be 75 mg/m(2) (arm1). The MTD for ABT-888 (40 mg BID) and the 5 of 28 day TMZ (150-200 mg/m(2)) schedule was known from prior trials (arm2). Two cohorts were studied: bevacizumab (BEV) naïve (n = 151), and BEV refractory (n = 74). Overall ten patients were ineligible. The incidence rate of grade 3/4 myelosuppression over all was 20.0 %. For the BEV refractory cohort, the PFS 6 was 4.4 %; for the BEV naïve cohort, PFS6 was 17 %. Overall survival was similar for both arms in both the BEV naïve [median survival time (MST) 10.3 M; 95 % CI 8.4-12] and BEV refractory cohort (MST 4.7 M; 95 %CI 3.5-5.6). The median PFS was essentially the same for both arms and both cohorts at ~2.0 M (95 % CI 1.9-2.1).
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Affiliation(s)
- H Ian Robins
- Paul Carbone Comprehensive Cancer Center, University of Wisconsin, 600 Highland Avenue, Madison, WI, 53792, USA.
| | - Peixin Zhang
- NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA
| | - Mark R Gilbert
- National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | | | - John F de Groot
- University of Texas-MD Anderson Cancer Center, Houston, TX, USA
| | | | - Fen Wang
- University of Kansas, Kansas City, KS, USA
| | | | - Andra Krauze
- National Cancer Institute Radiation Oncology Branch, Bethesda, MD, USA
| | - Andy M Trotti
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | | | | | - Howard Colman
- University of Utah Health Science Center, Salt Lake City, UT, USA
| | | | - Santosh Kesari
- Departments of Neurosciences and Radiation Medicine & Applied Sciences, UC San Diego Health Sciences, La Jolla, CA, USA
| | | | - Minesh Mehta
- University of Maryland Medical Systems, Baltimore, MD, USA
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21
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Frakes JM, Naghavi AO, Demetriou SK, Strom TJ, Russell JS, Kish JA, McCaffrey JC, Otto KJ, Padhya TA, Harrison LB, Trotti AM, Caudell JJ. Determining optimal follow-up in the management of human papillomavirus-positive oropharyngeal cancer. Cancer 2015; 122:634-41. [DOI: 10.1002/cncr.29782] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/10/2015] [Accepted: 10/14/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Jessica M. Frakes
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Arash O. Naghavi
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Stephanie K. Demetriou
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Tobin J. Strom
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Jeffery S. Russell
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Julie A. Kish
- Department of Senior Adult Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Judith C. McCaffrey
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Kristen J. Otto
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Tapan A. Padhya
- Department of Head and Neck and Endocrine Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Louis B. Harrison
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Andy M. Trotti
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
| | - Jimmy J. Caudell
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center and Research Institute; Tampa Florida
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22
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Strom TJ, Trotti AM, Kish J, Russell JS, Rao NG, McCaffrey J, Padhya TA, Otto KJ, Caudell JJ. Comparison of every 3 week cisplatin or weekly cetuximab with concurrent radiotherapy for locally advanced head and neck cancer. Oral Oncol 2015; 51:704-8. [DOI: 10.1016/j.oraloncology.2015.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
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23
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Schwartz DL, Harris J, Yao M, Rosenthal DI, Opanowski A, Levering A, Ang KK, Trotti AM, Garden AS, Jones CU, Harari P, Foote R, Holland J, Zhang Q, Le QT. Metabolic tumor volume as a prognostic imaging-based biomarker for head-and-neck cancer: pilot results from Radiation Therapy Oncology Group protocol 0522. Int J Radiat Oncol Biol Phys 2015; 91:721-9. [PMID: 25752384 DOI: 10.1016/j.ijrobp.2014.12.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 12/03/2014] [Accepted: 12/09/2014] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate candidate fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging biomarkers for head-and-neck chemoradiotherapy outcomes in the cooperative group trial setting. METHODS AND MATERIALS Radiation Therapy Oncology Group (RTOG) protocol 0522 patients consenting to a secondary FDG-PET/CT substudy were serially imaged at baseline and 8 weeks after radiation. Maximum standardized uptake value (SUVmax), SUV peak (mean SUV within a 1-cm sphere centered on SUVmax), and metabolic tumor volume (MTV) using 40% of SUVmax as threshold were obtained from primary tumor and involved nodes. RESULTS Of 940 patients entered onto RTOG 0522, 74 were analyzable for this substudy. Neither high baseline SUVmax nor SUVpeak from primary or nodal disease were associated with poor treatment outcomes. However, primary tumor MTV above the cohort median was associated with worse local-regional control (hazard ratio 4.01, 95% confidence interval 1.28-12.52, P=.02) and progression-free survival (hazard ratio 2.34, 95% confidence interval 1.02-5.37, P=.05). Although MTV and T stage seemed to correlate (mean MTV 6.4, 13.2, and 26.8 for T2, T3, and T4 tumors, respectively), MTV remained a strong independent prognostic factor for progression-free survival in bivariate analysis that included T stage. Primary MTV remained prognostic in p16-associated oropharyngeal cancer cases, although sample size was limited. CONCLUSION High baseline primary tumor MTV was associated with worse treatment outcomes in this limited patient subset of RTOG 0522. Additional confirmatory work will be required to validate primary tumor MTV as a prognostic imaging biomarker for patient stratification in future trials.
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Affiliation(s)
- David L Schwartz
- Department of Radiation Oncology, University of Texas Southwestern School of Medicine, Dallas, Texas.
| | - Jonathan Harris
- Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania
| | - Min Yao
- Department of Radiation Oncology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David I Rosenthal
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adam Opanowski
- American College of Radiology Imaging Network, Philadelphia, Pennsylvania
| | - Anthony Levering
- American College of Radiology Imaging Network, Philadelphia, Pennsylvania
| | - K Kian Ang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Andy M Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Adam S Garden
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Paul Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - John Holland
- Department of Radiation Medicine, Oregon Health & Science University, Portland, Oregon
| | - Qiang Zhang
- Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
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Abstract
Conventionally fractionated radiotherapy is delivered in 1.8- to 2.0-Gy fractions. With increases in understanding of radiation and tumor biology, various alterations of radiotherapy schedules have been tested in clinical trials and are now regarded by some as standard treatment options. Hyperfractionation is delivered through a greater number of smaller treatment doses. Accelerated fractionation decreases the amount of time over which radiotherapy is delivered typically by increasing the number of treatments per day. Hypofractionation decreases the number of fractions delivered by increasing daily treatment doses. Furthermore, many of these schedules have been tested with concurrent chemotherapy regimens. In this review, we summarize the major clinical studies that have been conducted on altered fractionation in various disease sites.
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Affiliation(s)
- Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Candace R Correa
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Thomas J Dilling
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Nikhil G Rao
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Ravi Shridhar
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Richard B Wilder
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.
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25
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Strom T, Trotti AM, Kish J, Rao NG, McCaffrey J, Padhya TA, Lin HY, Fulp W, Caudell JJ. Risk Factors for Percutaneous Endoscopic Gastrostomy Tube Placement During Chemoradiotherapy for Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2013; 139:1242-6. [DOI: 10.1001/jamaoto.2013.5193] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Tobin Strom
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Andy M. Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Julie Kish
- Department of Medical Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Nikhil G. Rao
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Judith McCaffrey
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, Florida
| | - Tapan A. Padhya
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, Florida
| | - Hui-Yi Lin
- Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida
| | - William Fulp
- Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida
| | - Jimmy J. Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
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Strom T, Caudell JJ, Han D, Zager JS, Yu D, Cruse CW, Marzban SS, Messina JL, Trotti AM, Sondak VK, Rao NG. Radiotherapy influences local control in patients with desmoplastic melanoma. Cancer 2013; 120:1369-78. [PMID: 24142775 DOI: 10.1002/cncr.28412] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 08/23/2013] [Accepted: 08/27/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Desmoplastic melanoma may have a high risk of local recurrence after wide excision. The authors hypothesized that adjuvant radiotherapy (RT) would improve local control in patients with desmoplastic melanoma, resulting in at least a 10% absolute decrease in local recurrence rate. METHODS A total of 277 patients from 1989 through 2010 who were treated for nonmetastatic desmoplastic melanoma by surgery with or without adjuvant RT were reviewed. Clinicopathologic and treatment variables were assessed with regard to their role in local control. RESULTS A total of 113 patients (40.8%) received adjuvant RT. After a median follow-up of 43.1 months, adjuvant RT was found to be independently associated with improved local control on multivariable analysis (hazards ratio, 0.15; 95% confidence interval, 0.06-0.39 [P<.001]). Among 35 patients with positive resection margins, 14% who received RT developed a local recurrence versus 54% who did not (P=.004). In patients with negative resection margins, there was a trend (P=.09) toward improved local control with RT. In patients with negative resection margins and traditionally high-risk features, including a head and neck tumor location, a Breslow depth >4 mm, or a Clark level V tumor, RT was found to significantly improve local control (P< .05). The data from the current study would suggest that patients who would be good candidates for omitting RT included those with negative resection margins, a Breslow depth ≤ 4 mm, and either no perineural invasion present or a non-head and neck tumor location. CONCLUSIONS RT for desmoplastic melanoma was independently associated with improved local control. Patients with positive resection margins or deeper tumors appeared to benefit the most from RT, whereas selected low-risk patients can safely omit RT.
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Affiliation(s)
- Tobin Strom
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
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27
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Bruner DW, Hanisch LJ, Reeve BB, Trotti AM, Schrag D, Sit L, Mendoza TR, Minasian L, O'Mara A, Denicoff AM, Rowland JH, Montello M, Geoghegan C, Abernethy AP, Clauser SB, Castro K, Mitchell SA, Burke L, Trentacosti AM, Basch EM. Stakeholder perspectives on implementing the National Cancer Institute's patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Transl Behav Med 2013; 1:110-22. [PMID: 24073038 DOI: 10.1007/s13142-011-0025-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The National Cancer Institute (NCI) is developing a patient-reported version of its Common Terminology Criteria for Adverse Events, called the "PRO-CTCAE." The PRO-CTCAE consists of a library of patient-reported items which can be administered in clinical trials to directly capture the patient experience of adverse events during cancer treatment, as well as a software platform for administering these items via computer or telephone. In order to better understand the impressions of stakeholders involved in cancer clinical research about the potential value of the PRO-CTCAE approach to capturing adverse event information in clinical research, as well as their perspectives about barriers and strategies for implementing the PRO-CTCAE in NCI-sponsored cancer trials, a survey was conducted. A survey including structured and open-ended questions was developed to elicit perceptions about the use of patient-reported outcomes (PROs) for adverse event reporting, and to explore logistical considerations for implementing the PRO-CTCAE in cancer trials. The survey was distributed electronically and by paper to a convenience sample of leadership and committee members in the NCI's cooperative group network, including principal investigators, clinical investigators, research nurses, data managers, patient advocates, and representatives of the NCI and Food and Drug Administration. Between October, 2008 through February, 2009, 727 surveys were collected. Most respondents (93%) agreed that patient reporting of adverse symptoms would be useful for improving understanding of the patient experience with treatment in cancer trials, and 88%, 80%, and 76%, respectively, endorsed that administration of PRO-CTCAE items in clinical trials would improve the completeness, accuracy, and efficiency of symptom data collection. More than three fourths believed that patient reports would be useful for informing treatment dose modifications and towards FDA regulatory evaluation of drugs. Eighty-eight percent felt that patients in clinical trials would be willing to self-report adverse symptoms at clinic visits via computer, and 68% felt patients would self-report weekly from home via the internet or an automated telephone system. Lack of computers and limited space and personnel were seen as potential barriers to in-clinic self-reporting, but these were judged to be surmountable with adequate funding. The PRO-CTCAE items and software are viewed by a majority of survey respondents as a means to improve adverse event data quality and comprehensiveness, enhance clinical decision-making, and foster patient-clinician communication. Research is ongoing to assess the measurement properties and feasibility of implementing this measure in cancer clinical trials.
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Affiliation(s)
- Deborah Watkins Bruner
- School of Nursing, Abramson Cancer Center, University of Pennsylvania, Claire M. Fagin Hall, Room 330, 418 Curie Boulevard, Philadelphia, PA 19104-4217 USA
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28
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Rao NG, Han G, Greene JN, Tanvetyanon T, Kish JA, De Conti RC, Chuong MD, Shridhar R, Biagioli MC, Caudell JJ, Trotti AM. Effect of prophylactic fluconazole on oral mucositis and candidiasis during radiation therapy for head-and-neck cancer. Pract Radiat Oncol 2012; 3:229-233. [PMID: 24674369 DOI: 10.1016/j.prro.2012.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 05/14/2012] [Accepted: 05/22/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Radiation therapy (RT) or chemoradiation therapy (CRT) for carcinoma of the head and neck can result in high rates of candidiasis and mucositis. Prophylactic fluconazole (FCZ) has been shown to reduce the incidence of candidiasis. We report our outcomes of patients with head-and-neck cancer undergoing CRT treated prophylactically with FCZ. METHODS AND MATERIALS An institutional review board-approved database of head-and-neck cancer patients treated with RT or CRT was reviewed to identify patients treated between 2004 and 2009 who received at least 50 Gy to approximately two-thirds of the oral cavity or oropharynx mucosa. Eligible patients were divided into 2 groups: the usual care group and the prophylaxis group. The primary endpoints were the incidence of mucositis and candidiasis. RESULTS A total of 181 patients were eligible for analysis: 72 patients in the prophylactic group and 109 patients in the usual care group. Patient characteristics and radiation dose were comparable between groups. RT alone was given in 28 patients (16%). Mucositis data were available in 161 (89%) patients. Grade 2 or higher mucositis was seen in 131 (81%) patients. Prophylactic FCZ had significantly decreased grade 2 or higher mucositis. In the usual care group and prophylaxis group patients, 83 of 93 patients (89.3%) and 48 of 68 patients (70.6%), respectively, developed grade 2 or higher mucositis (P = .003). CONCLUSIONS Prophylactic administration of FCZ twice weekly during CRT for head-and-neck cancer reduces incidence of mucositis and thrush.
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Affiliation(s)
- Nikhil G Rao
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida.
| | - Gang Han
- Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida
| | - John N Greene
- Department of Infectious Diseases, Moffitt Cancer Center, Tampa, Florida
| | - Tawee Tanvetyanon
- Department of Medical Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Julie A Kish
- Department of Medical Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ronald C De Conti
- Department of Medical Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Michael D Chuong
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Ravi Shridhar
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | - Jimmy J Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Andy M Trotti
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
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29
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Chung CH, Zhang Q, Hammond EM, Trotti AM, Wang H, Spencer S, Zhang HZ, Cooper J, Jordan R, Rotman MH, Ang KK. Integrating epidermal growth factor receptor assay with clinical parameters improves risk classification for relapse and survival in head-and-neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2010; 81:331-8. [PMID: 20732768 DOI: 10.1016/j.ijrobp.2010.05.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/15/2010] [Accepted: 05/19/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE Epidermal growth factor receptor (EGFR) overexpression has been consistently found to be an independent predictor of local-regional relapse (LRR) after radiotherapy. We assessed the extent by which it can refine risk classification for overall survival (OS) and LRR in patients with head-and-neck squamous cell carcinoma (HNSCC). METHODS AND MATERIALS EGFR expression in locally advanced HNSCC was measured by immunohistochemistry in a series of patients randomized to receive accelerated or conventional radiation regimens in a Phase III trial. Subsequently, data of the two series were pooled (N = 533) for conducting a recursive partitioning analysis that incorporated clinical parameters (e.g., performance status, primary site, T and N categories) and four molecular markers (EGFR, p53, Ki-67, and microvessel density). RESULTS This study confirmed that patients with higher than median levels of tumor EGFR expression had a lower OS (relative risk [RR]: 1.90, p = 0.0010) and a higher LRR (RR: 1.91, p = 0.0163). Of the four markers analyzed, only EGFR was found to contribute to refining classification of patients into three risk classes with distinct OS and LRR outcomes. The addition of EGFR to three clinical parameters could identify patients having up to a fivefold difference in the risk of LRR. CONCLUSIONS Adding pretreatment EGFR expression data to known robust clinical prognostic variables improved the estimation of the probability for OS and LRR after radiotherapy. Its use for stratifying or selecting patients with defined tumor feature and pattern of relapse for enrollment into clinical trials testing specific therapeutic strategy warrants further investigation.
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Affiliation(s)
- Christine H Chung
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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Murphy BA, Beaumont JL, Isitt J, Garden AS, Gwede CK, Trotti AM, Meredith RF, Epstein JB, Le QT, Brizel DM, Bellm LA, Wells N, Cella D. Mucositis-related morbidity and resource utilization in head and neck cancer patients receiving radiation therapy with or without chemotherapy. J Pain Symptom Manage 2009; 38:522-32. [PMID: 19608377 DOI: 10.1016/j.jpainsymman.2008.12.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 12/12/2008] [Accepted: 01/02/2009] [Indexed: 11/22/2022]
Abstract
The objective of this study was to estimate health care-resource utilization in head and neck cancer (HNC) patients. This was a prospective, longitudinal, multicenter, noninterventional study of mucositis in patients receiving radiation with or without chemotherapy for HNC. Mouth and throat soreness and functional impairment were measured using the Oral Mucositis Weekly Questionnaire-HNC. Resource utilization data were obtained from patient interviews and recorded from the patient's medical chart. Seventy-five patients were enrolled from six centers. Fifty (67%) patients received concurrent chemoradiation therapy; 34 (45%) received intensity-modulated radiation therapy. Over the course of treatment, 57 (76%) patients reported severe mouth and throat soreness. Pain and functional impairment because of mouth and throat soreness increased during the course of therapy despite the use of opioid analgesics in 64 (85%) of the patients. Complications of radiation therapy resulted in increased patient visits to physicians, nurses, and nutritionists. Thirty-eight (51%) patients had a feeding tube placed. Twenty-eight patients (37%) were hospitalized, five of whom were hospitalized twice; of the 33 admissions, 10 (30%) were designated as secondary to mucositis by their treating physician. Mean length of hospitalization was 4.9 days (range: 1-16). This study demonstrates that mucositis-related pain and functional impairment is associated with increased use of costly health resources. Effective treatments to reduce the pain and functional impairment of oral mucositis are needed in this patient population.
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Affiliation(s)
- Barbara A Murphy
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University, Nashville, Tennessee 37232-5536, USA.
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31
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Salama JK, Haddad RI, Kies MS, Busse PM, Dong L, Brizel DM, Eisbruch A, Tishler RB, Trotti AM, Garden AS. Clinical practice guidance for radiotherapy planning after induction chemotherapy in locoregionally advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys 2009; 75:725-33. [PMID: 19362781 DOI: 10.1016/j.ijrobp.2008.11.059] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 11/14/2008] [Accepted: 11/21/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE The use of induction chemotherapy (IC) for locoregionally advanced head-and-neck cancer is increasing. The response to IC often causes significant alterations in tumor volume and location and shifts in normal anatomy. Proper determination of the radiotherapy (RT) targets after IC becomes challenging, especially with the use of conformal and precision RT techniques. Therefore, a consensus conference was convened to discuss issues related to RT planning and coordination of care for patients receiving IC. METHODS AND MATERIALS Ten participants with special expertise in the various aspects of integration of IC and RT for the treatment of locoregionally advanced head-and-neck cancer, including radiation oncologists, medical oncologists, and a medical physicist, participated. The individual members were assigned topics for focused, didactic presentations. Discussion was encouraged after each presentation, and recommendations were formulated. RESULTS Recommendations and guidelines emerged that emphasize up-front evaluation by all members of the head-and-neck management team, high-quality baseline and postinduction planning scans with the patient in the treatment position, the use of preinduction target volumes, and the use of full-dose RT, even in the face of a complete response. CONCLUSION A multidisciplinary approach is strongly encouraged. Although these recommendations were provided primarily for patients treated with IC, many of these same principles apply to concurrent chemoradiotherapy without IC. A rapid response during RT is quite common, requiring the development of two or more plans in a sizeable fraction of patients, and suggesting the need for similar guidance in the rapidly evolving area of adaptive RT.
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Affiliation(s)
- Joseph K Salama
- Department of Radiationand Cellular Oncology, University of Chicago, 5758 S. Maryland Ave., Chicago, IL 60637, USA.
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Bensinger W, Schubert M, Ang KK, Brizel D, Brown E, Eilers JG, Elting L, Mittal BB, Schattner MA, Spielberger R, Treister NS, Trotti AM. NCCN Task Force Report: Prevention and Management of Mucositis in Cancer Care. J Natl Compr Canc Netw 2008. [DOI: 10.6004/jnccn.2008.2001] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Oral mucositis (OM) has emerged as a common cause of dose delays and interruptions of cancer therapies such as multicycle chemotherapy, myeloablative chemotherapy, and radiotherapy with or without concurrent chemotherapy of head and neck cancer. Research into both preventive and management strategies has lagged behind research into the common cancer treatment–related morbidities of nausea, vomiting, and cytopenias. This disparity is related to the complex risk assessment of multifactorial patient and treatment factors and different techniques of rating mucositis. In addition, relatively few clinical trials have focused on mucositis as a specific outcome. Currently, the only effective preventive strategies include the use of palifermin to prevent OM in the setting of hematopoietic stem cell transplantation and oral cryotherapy used in conjunction with bolus 5-FU, melphalan, or edatrexate. For the most part, managing OM relies on supportive care and symptom palliation. However, OM is a common problem associated with significant patient morbidity and increased resource use. The magnitude of the problem demands innovative approaches based on expert judgment as evidence accumulates to support specific recommendations. To improve this situation, the NCCN convened a multidisciplinary task force to address key issues. This report integrates expert judgment with a review of key literature on risk assessment, prevention, and treatment strategies, and provides recommendations for the overall management of OM. (JNCCN 2008;6[Suppl 1]:S1–S21)
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Bensinger W, Schubert M, Ang KK, Brizel D, Brown E, Eilers JG, Elting L, Mittal BB, Schattner MA, Spielberger R, Treister NS, Trotti AM. NCCN Task Force Report. prevention and management of mucositis in cancer care. J Natl Compr Canc Netw 2008; 6 Suppl 1:S1-S24. [PMID: 18289497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Oral mucositis (OM) has emerged as a common cause of dose delays and interruptions of cancer therapies such as multicycle chemotherapy, myeloablative chemotherapy, and radiotherapy with or without concurrent chemotherapy of head and neck cancer. Research into both preventive and management strategies has lagged behind research into the common cancer treatment-related morbidities of nausea, vomiting, and cytopenias. This disparity is related to the complex risk assessment of multifactorial patient and treatment factors and different techniques of rating mucositis. In addition, relatively few clinical trials have focused on mucositis as a specific outcome. Currently, the only effective preventive strategies include the use of palifermin to prevent OM in the setting of hematopoietic stem cell transplantation and oral cryotherapy used in conjunction with bolus 5-FU, melphalan, or edatrexate. For the most part, managing OM relies on supportive care and symptom palliation. However, OM is a common problem associated with significant patient morbidity and increased resource use. The magnitude of the problem demands innovative approaches based on expert judgment as evidence accumulates to support specific recommendations. To improve this situation, the NCCN convened a multidisciplinary task force to address key issues. This report integrates expert judgment with a review of key literature on risk assessment, prevention, and treatment strategies, and provides recommendations for the overall management of OM.
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Calvin DP, Hammond ME, Pajak TF, Trotti AM, Meredith RF, Rotman M, Jones CU, Byhardt RW, Demas WF, Ang KK, Fu KK. Microvessel density >or=60 does not predict for outcome after radiation treatment for locally advanced head and neck squamous cell carcinoma: results of a correlative study from the Radiation Therapy Oncology Group (RTOG) 90-03 Trial. Am J Clin Oncol 2007; 30:406-19. [PMID: 17762442 DOI: 10.1097/coc.0b013e3180342fd4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess whether microvessel density (MVD), an immunohistochemical marker for tumor vascularity, predicts for radiotherapy (RT) outcome in locally advanced HNSCC patients. METHODS A total of 459 patients, enrolled on the RTOG 90-03 trial, had biopsy specimens submitted, and a value for MVD determined, prior to definitive RT. 450 patients were analyzable for this study. Tumor microvessels were stained for factor VIII-related antigen using a standard immunoperoxidase method. The mean number of stained microvessel profiles, from three x200 fields containing the highest MVD (hot spot), was recorded as the MVD. A prospective value of >or=60 was chosen as the threshold for high MVD, tumor vascularity. RESULTS The median follow-up for the analyzable patients with MVD assessment was 22.0 months and 79.1 months for all living patients. There were no differences concerning the pretreatment characteristics between those RTOG 90-03 patients with a value for MVD and those without a value for MVD. Thus, the present study cohort possessed comparable characteristics with the entire RTOG 90-03 population. MVD values ranged from 5 to 80, with a median value of 30. Only 37 of 450 (8.2%) patients possessed an MVD >or=60. There were no outcome differences for patients with MVD <60 versus >or=60 on multivariate analysis for time to local-regional failure (P = 0.89), time to distant metastasis (P = 0.80), disease-free survival (P = 0.46), and overall survival (P = 0.39). CONCLUSIONS In this large, correlative study, a MVD >or=60, ie, high tumor vascularity, did not predict for outcome in locally advanced head and neck squamous cell carcinoma patients treated with radiotherapy.
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