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Zeng PYF, Prokopec SD, Lai SY, Pinto N, Chan-Seng-Yue MA, Clifton-Bligh R, Williams MD, Howlett CJ, Plantinga P, Cecchini MJ, Lam AK, Siddiqui I, Wang J, Sun RX, Watson JD, Korah R, Carling T, Agrawal N, Cipriani N, Ball D, Nelkin B, Rooper LM, Bishop JA, Garnis C, Berean K, Nicolson NG, Weinberger P, Henderson YC, Lalansingh CM, Tian M, Yamaguchi TN, Livingstone J, Salcedo A, Patel K, Vizeacoumar F, Datti A, Xi L, Nikiforov YE, Smallridge R, Copland JA, Marlow LA, Hyrcza MD, Delbridge L, Sidhu S, Sywak M, Robinson B, Fung K, Ghasemi F, Kwan K, MacNeil SD, Mendez A, Palma DA, Khan MI, Shaikh M, Ruicci KM, Wehrli B, Winquist E, Yoo J, Mymryk JS, Rocco JW, Wheeler D, Scherer S, Giordano TJ, Barrett JW, Faquin WC, Gill AJ, Clayman G, Boutros PC, Nichols AC. The genomic and evolutionary landscapes of anaplastic thyroid carcinoma. Cell Rep 2024; 43:113826. [PMID: 38412093 DOI: 10.1016/j.celrep.2024.113826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/11/2023] [Revised: 12/04/2023] [Accepted: 02/05/2024] [Indexed: 02/29/2024] Open
Abstract
Anaplastic thyroid carcinoma is arguably the most lethal human malignancy. It often co-occurs with differentiated thyroid cancers, yet the molecular origins of its aggressivity are unknown. We sequenced tumor DNA from 329 regions of thyroid cancer, including 213 from patients with primary anaplastic thyroid carcinomas. We also whole genome sequenced 9 patients using multi-region sequencing of both differentiated and anaplastic thyroid cancer components. Using these data, we demonstrate thatanaplastic thyroid carcinomas have a higher burden of mutations than other thyroid cancers, with distinct mutational signatures and molecular subtypes. Further, different cancer driver genes are mutated in anaplastic and differentiated thyroid carcinomas, even those arising in a single patient. Finally, we unambiguously demonstrate that anaplastic thyroid carcinomas share a genomic origin with co-occurring differentiated carcinomas and emerge from a common malignant field through acquisition of characteristic clonal driver mutations.
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Affiliation(s)
- Peter Y F Zeng
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada; London Regional Cancer Program, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada
| | - Stephenie D Prokopec
- Ontario Institute for Cancer Research, Toronto, ON, Canada; Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicole Pinto
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | | | - Roderick Clifton-Bligh
- Division of Endocrinology, Royal North Shore Hospital, and University of Sydney, Sydney, NSW, Australia
| | - Michelle D Williams
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Paul Plantinga
- Department of Pathology, Western University, London, ON, Canada
| | - Matthew J Cecchini
- Department of Pathology, School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Alfred K Lam
- Department of Pathology, School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Iram Siddiqui
- Department of Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Jianxin Wang
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Ren X Sun
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - John D Watson
- Ontario Institute for Cancer Research, Toronto, ON, Canada; Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Reju Korah
- Department of Surgery, Yale University, New Haven, CT, USA
| | - Tobias Carling
- Department of Surgery, Yale University, New Haven, CT, USA
| | - Nishant Agrawal
- Department of Otolaryngology - Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Nicole Cipriani
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Douglas Ball
- Division of Endocrinology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Barry Nelkin
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Lisa M Rooper
- Division of Pathology, Johns Hopkins University, Baltimore, MD, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern, Dallas, TX, USA
| | | | | | | | - Paul Weinberger
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA, USA; Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Ying C Henderson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Mao Tian
- Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Takafumi N Yamaguchi
- Ontario Institute for Cancer Research, Toronto, ON, Canada; Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Julie Livingstone
- Ontario Institute for Cancer Research, Toronto, ON, Canada; Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Adriana Salcedo
- Ontario Institute for Cancer Research, Toronto, ON, Canada; Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Krupal Patel
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada
| | | | - Alessandro Datti
- Network Biology Collaborative Centre, Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada; Department of Agricultural, Food, and Environmental Sciences, University of Perugia, Perugia, Italy
| | - Liu Xi
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Yuri E Nikiforov
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Robert Smallridge
- Division of Endocrinology, Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - John A Copland
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Laura A Marlow
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Martin D Hyrcza
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - Leigh Delbridge
- Department of Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NWS, Australia
| | - Stan Sidhu
- Department of Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NWS, Australia
| | - Mark Sywak
- Department of Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; University of Sydney, Sydney, NWS, Australia
| | - Bruce Robinson
- University of Sydney, Sydney, NWS, Australia; Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada
| | - Farhad Ghasemi
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada
| | - David A Palma
- London Regional Cancer Program, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada
| | - Mohammed I Khan
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Mushfiq Shaikh
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Kara M Ruicci
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, ON, Canada
| | - Eric Winquist
- London Regional Cancer Program, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada
| | - Joe S Mymryk
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada; London Regional Cancer Program, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada; Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - James W Rocco
- Department of Otolaryngology - Head and Neck Surgery, Ohio State University, Columbus, OH, USA
| | - David Wheeler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Steve Scherer
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony J Gill
- University of Sydney, Sydney, NWS, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medicine, Royal North Shore Hospital, Sydney, NSW, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Gary Clayman
- The Clayman Thyroid Surgery and Thyroid Cancer Center, The Thyroid Institute, Tampa General Hospital, Tampa, FL, USA
| | - Paul C Boutros
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Department of Human Genetics, University of California, Los Angeles, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, Los Angeles, CA, USA; Institute for Precision Health, University of California, Los Angeles, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada; London Regional Cancer Program, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Department of Oncology, Western University, London, ON, Canada.
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2
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Laxague F, Zeng PYF, Zabihi D, Fnais N, Alshahrani M, Fung K, MacNeil D, Mendez A, Yoo J, Mymryk JS, Barrett JW, Palma DA, Nichols AC. A comparison of timing and patterns of treatment failure, and survival outcomes after progression between HPV+ and HPV- patients undergoing chemoradiation for oropharyngeal squamous cell carcinomas. Head Neck 2024; 46:503-512. [PMID: 38100227 DOI: 10.1002/hed.27600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/16/2023] [Revised: 10/17/2023] [Accepted: 12/01/2023] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND We aimed to analyze and compare the timing and patterns of treatment failure, and survival after progression between HPV-positive (HPV+) and HPV-negative (HPV-) patients undergoing chemoradiation for oropharyngeal squamous cell carcinomas (OPSCC). METHODS A retrospective review was performed of all patients undergoing primary chemoradiation for OPSCC between 2008 and 2021. Demographic and clinical data were collected. Kaplan-Meier estimates for overall survival (OS), and time to recurrence/metastases (TTR) were compared using the log-rank test, with Cox regression used for multivariable modeling comparing HPV+ and HPV- patients. RESULTS HPV- patients developed recurrence or metastases at earlier time points than HPV+ patients (8.8 vs. 15.2 months, p < 0.05), due to earlier local/locoregional recurrence and distant metastases, but not isolated regional recurrences. HPV- distant metastases exclusively occurred in a single organ, most commonly the lungs or bone, while HPV+ metastases frequently had multi-organ involvement in a wide variety of locations (p < 0.05). Once progression (recurrence/metastases) was diagnosed, HPV+ patients experienced superior survival to HPV- patients on univariate and multivariate analysis, largely due to improved outcomes after treatment of local/locoregional recurrences (p < 0.05). There were no differences in survival after isolated regional recurrences or distant metastases. CONCLUSION HPV+ OPSCC patients relapse later compared to HPV- patients in local/locoregional and distant sites. HPV+ patients with local/locoregional recurrence experience superior survival after recurrence, which does not hold true for isolated regional recurrences or distant metastases. These data can be useful to inform prognosis and guide treatment decisions in patients with recurrent OPSCC.
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Affiliation(s)
- Francisco Laxague
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - Dorsa Zabihi
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - Naif Fnais
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
- Department of Otolaryngology - Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alshahrani
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - Joseph S Mymryk
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Center Children's Hospital, London, Ontario, Canada
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3
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Malik NH, Fu R, Hainc N, Noel CW, de Almeida JR, Hosni A, Huang SH, Yu E, Dzioba A, Leung A, Mangat A, MacNeil D, Nichols AC, Hiremath SB, Chakraborty S, Jooya A, Gaudet M, Johnson-Obaseki S, Whelan J, Forghani R, Hier MP, Morand G, Sultanem K, Dort J, Lysack J, Matthews W, Nakoneshny S, Gill G, Globerman A, Kerr P, Maralani P, Karam I, Eskander A. Tumor volumes in T3 supraglottic cancers treated with radiotherapy in the modern era: A study of the Canadian Head & Neck Collaborative Research Initiative. Head Neck 2024; 46:561-570. [PMID: 38116716 DOI: 10.1002/hed.27608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/02/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023] Open
Abstract
PURPOSE To evaluate the association of primary tumor volume (TV) with overall survival (OS) and disease-free survival (DFS) in T3 N0-3M0 supraglottic cancers treated with intensity-modulated radiotherapy (IMRT). METHODS This was a retrospective cohort study involving 239 patients diagnosed with T3 N0-3M0 supraglottic cancers between 2002 and 2018 from seven regional cancer centers in Canada. Clinical data were obtained from the patient records. Supraglottic TV was measured by neuroradiologists on diagnostic imaging. Kaplan-Meier method was used for survival probabilities, and a restricted cubic spline Cox proportional hazards regression analysis was used to analyze TV associations with OS and DFS. RESULTS Mean (SD) of participants was 65.2 (9.4) years; 176 (73.6%) participants were male. 90 (38%) were N0, and 151 (64%) received concurrent systemic therapy. Mean TV (SD) was 11.37 (12.11) cm3 . With mean follow up (SD) of 3.28 (2.60) years, 2-year OS was 72.7% (95% CI 66.9%-78.9%) and DFS was 53.6% (47.4%-60.6%). Increasing TV was associated (per cm3 increase) with worse OS (HR, 1.01, 95% CI 1.00-1.02, p < 0.01) and DFS (HR, 1.01, 95% CI 1.00-1.02, p = 0.02). CONCLUSIONS Increasing primary tumor volume is associated with worse OS and DFS in T3 supraglottic cancers treated with IMRT, with no clear threshold. The findings suggest that patients with larger tumors and poor baseline laryngeal function may benefit from upfront laryngectomy with adjuvant radiotherapy.
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Affiliation(s)
- Nauman H Malik
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rui Fu
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nicolin Hainc
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Andrew Leung
- Department of Radiology, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Arvindpaul Mangat
- Department of Radiology, Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Shivaprakash B Hiremath
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Santanu Chakraborty
- Department of Radiology, Division of Neuroradiology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alborz Jooya
- Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Whelan
- Department of Otolaryngology-Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Reza Forghani
- Department of Otolaryngology Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Québec, Canada
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Michael P Hier
- Department of Otolaryngology Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Québec, Canada
| | - Grégoire Morand
- Department of Otolaryngology Head and Neck Surgery, McGill University, Jewish General Hospital, Montreal, Québec, Canada
| | - Khalil Sultanem
- Department of Oncology, McGill University, Jewish General Hospital, Montréal, Québec, Canada
| | - Joseph Dort
- Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - John Lysack
- Section of Neuroradiology, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Wayne Matthews
- Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Steven Nakoneshny
- Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Gia Gill
- Department of Otolaryngology-Head & Neck Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam Globerman
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kerr
- Department of Otolaryngology-Head & Neck Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pejman Maralani
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Kim HAJ, Zeng PYF, Cecchini M, Shaikh MH, Laxague F, Deng X, Jarycki L, Ryan SEB, Dawson A, Liu MH, Palma DA, Patel K, Mundi N, Barrett JW, Mymryk JS, Boutros PC, Nichols AC. HPV-negative head and neck cancers with adverse pathological features carry specific molecular changes that are associated with survival. Head Neck 2024; 46:353-366. [PMID: 38059331 DOI: 10.1002/hed.27591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/19/2023] [Revised: 10/21/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Adverse pathological features following surgery in head and neck squamous cell carcinoma (HNSCC) are strongly associated with survival and guide adjuvant therapy. We investigated molecular changes associated with these features. METHODS We downloaded data from the Cancer Genome Atlas and Cancer Proteome Atlas HNSCC cohorts. We compared tumors positive versus negative for perineural invasion (PNI), lymphovascular invasion (LVI), extracapsular spread (ECS), and positive margins (PSM), with multivariable analysis. RESULTS All pathological features were associated with poor survival, as were the following molecular changes: low cyclin E1 (HR = 1.7) and high PKC-alpha (HR = 1.8) in tumors with PNI; six of 13 protein abundance changes with LVI; greater tumor hypoxia and high Raptor (HR = 2.0) and Rictor (HR = 1.6) with ECS; and low p38 (HR = 2.3), high fibronectin (HR = 1.6), low annexin A1 (HR = 3.1), and high caspase-9 (HR = 1.6) abundances with PSM. CONCLUSIONS Pathological features in HNSCC carry specific molecular changes that may explain their poor prognostic associations.
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Affiliation(s)
- Hugh Andrew Jinwook Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Matthew Cecchini
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Mushfiq Hassan Shaikh
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Francisco Laxague
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Xiaoxiao Deng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Laura Jarycki
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Sarah Elizabeth Belle Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Alice Dawson
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Mu Han Liu
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Krupal Patel
- Department of Otolaryngology-Head & Neck Surgery, Moffitt Cancer Center, Tampa, Florida, USA
| | - Neil Mundi
- Department of Otolaryngology-Head & Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - John W Barrett
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Joe S Mymryk
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, California, USA
- Department of Urology, University of California, Los Angeles, California, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, California, USA
- Institute for Precision Health, University of California, Los Angeles, California, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, California, USA
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
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5
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Black MD, Yoo J, Fung K, MacNeil D, Palma DA, Mymryk JS, Kuruvilla S, Barrett JW, Winquist E, Nichols AC. Personalized Treatment of Recurrent, Metastatic Head and Neck Cancer Guided by Patient-Derived Xenograft Models. Cureus 2024; 16:e53645. [PMID: 38449937 PMCID: PMC10917454 DOI: 10.7759/cureus.53645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Recurrent or metastatic head and neck squamous cell carcinoma (RMHNSCC) is associated with a poor prognosis and short survival duration. There is an urgent need to identify personalized predictors of drug response to guide the selection of the most effective therapy for each individual recurrence. We tested the feasibility of patient-derived xenografts (PDX) for guiding their RMHNSCC salvage treatment. Fresh tumor samples from eligible, consented patients were implanted into mice. Established tumors were expanded in mouse PDX cohorts to identify responses to candidate salvage drug treatments in parallel testing. Patients alive and suitable for chemotherapy were treated based on responses determined by PDX testing. Nine patient tumors were successfully engrafted in mice with an average time of 89.2±41.7 days. Four patients' PDX models underwent parallel drug testing. Two patients received PDX-guided therapy. In one of these patients, single agents of cetuximab and paclitaxel demonstrated the best responses in the PDX model, and this patient exhibited sequential partial responses to each drug, including a 17-month clinical response to cetuximab. The main limitation of PDX testing for RMHNSCC was the time delay in obtaining testing results. Despite this, parallel PDX testing may be feasible for a subset of patients and appears to correlate with clinical benefit.
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Affiliation(s)
- Morgan D Black
- Medical Oncology, London Health Sciences Centre, London, CAN
| | - John Yoo
- Otolaryngology - Head and Neck Surgery, Western University, London, CAN
| | - Kevin Fung
- Otolaryngology - Head and Neck Surgery, Western University, London, CAN
| | - Danielle MacNeil
- Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, London, CAN
| | - David A Palma
- Radiation Oncology, London Health Sciences Centre, London, CAN
| | | | - Sara Kuruvilla
- Medical Oncology, London Health Sciences Centre, London, CAN
| | - John W Barrett
- Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, London, CAN
| | - Eric Winquist
- Medical Oncology, London Health Sciences Centre, London, CAN
| | - Anthony C Nichols
- Otolaryngology - Head and Neck Surgery, Western University, London, CAN
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Chinnery TA, Lang P, Nichols AC, Mattonen SA. Predicting the need for a replan in oropharyngeal cancer: A radiomic, clinical, and dosimetric model. Med Phys 2023. [PMID: 38100260 DOI: 10.1002/mp.16893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/21/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Patients with oropharyngeal cancer (OPC) treated with chemoradiation can experience weight loss and tumor shrinkage, altering the prescribed treatment. Treatment replanning ensures patients do not receive excessive doses to normal tissue. However, it is a time- and resource-intensive process, as it takes 1 to 2 weeks to acquire a new treatment plan, and during this time, overtreatment of normal tissues could lead to increased toxicities. Currently, there are limited prognostic factors to determine which patients will require a replan. There remains an unmet need for predictive models to assist in identifying patients who could benefit from the knowledge of a replan prior to treatment. PURPOSE We aimed to develop and evaluate a CT-based radiomic model, integrating clinical and dosimetric information, to predict the need for a replan prior to treatment. METHODS A dataset of patients (n = 315) with OPC treated with chemoradiation was used for this study. The dataset was split into independent training (n = 220) and testing (n = 95) datasets. Tumor volumes and organs at risk (OARs) were contoured on planning CT images. PyRadiomics was used to compute radiomic image features (n = 1218) on the original and filtered images from each of the primary tumor, nodal volumes, and ipsilateral and contralateral parotid glands. Nine clinical features and nine dose features extracted from the OARs were collected and those significantly (p < 0.05) associated with the need for a replan in the training dataset were used in a baseline model. Random forest feature selection was applied to select the optimal radiomic features to predict replanning. Logistic regression, Naïve Bayes, support vector machine, and random forest classifiers were built using the non-correlated selected radiomic, clinical, and dose features on the training dataset and performance was assessed in the testing dataset. The area under the curve (AUC) was used to assess the prognostic value. RESULTS A total of 78 patients (25%) required a replan. Smoking status, nodal stage, base of tongue subsite, and larynx mean dose were found to be significantly associated with the need for a replan in the training dataset and incorporated into the baseline model, as well as into the combined models. Five predictive radiomic features were selected (one nodal volume, one primary tumor, two ipsilateral and one contralateral parotid gland). The baseline model comprised of clinical and dose features alone achieved an AUC of 0.66 [95% CI: 0.51-0.79] in the testing dataset. The random forest classifier was the top-performing radiomics model and achieved an AUC of 0.82 [0.75-0.89] in the training dataset and an AUC of 0.78 [0.68-0.87] in the testing dataset, which significantly outperformed the baseline model (p = 0.023, testing dataset). CONCLUSIONS This is the first study to use radiomics from the primary tumor, nodal volumes, and parotid glands for the prediction of replanning for patients with OPC. Radiomic features augmented clinical and dose features for predicting the need for a replan in our testing dataset. Once validated, this model has the potential to assist physicians in identifying patients that may benefit from a replan, allowing for better resource allocation and reduced toxicities.
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Affiliation(s)
- Tricia A Chinnery
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Baines Imaging Research Laboratory, London, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology, Western University, London, Ontario, Canada
| | - Sarah A Mattonen
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Baines Imaging Research Laboratory, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
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Gameiro SF, Salnikov MY, Zeng PYF, Barrett JW, Nichols AC, Mymryk JS. HPV16 Intratypic Variants in Head and Neck Cancers: A North American Perspective. Viruses 2023; 15:2411. [PMID: 38140652 PMCID: PMC10747106 DOI: 10.3390/v15122411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/01/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Human papillomavirus (HPV) is the major causative agent for cervical and many head and neck cancers (HNCs). HPVs randomly acquire single nucleotide polymorphisms (SNPs) that may become established via positive selection. Within an HPV type, viral isolates differing by <2% in the L1 region are termed "variants" and classified based on combinations of SNPs. Studies in cervical cancer demonstrate clear differences between HPV16 intratypic variants in terms of persistence of infection, tumor histology, cancer risk, and death. Much less is known about the frequency of HPV16 variants in HNC, and their effects on clinical outcomes. We combined HPV16 positive (HPV16+) HNC samples from a local Southwestern Ontario, Canada cohort with those from the Cancer Genome Atlas to create a larger North American cohort of 149 cases with clinical data and determined the distribution of intratypic variants and their impact on clinical outcomes. Most isolates were lineage A, sublineage A1, or A2, with roughly half exhibiting the T350G polymorphism in E6. Univariable analysis identified significant differences between 350T and 350G intratypic variants in clinical T, N, and O staging, as well as disease-free survival. Multivariable analysis failed to identify any clinical factor as a statistically significant covariate for disease-free survival differences between 350T and 350G. Significant differences in several measures of B-cell mediated immune response were also observed between 350T and 350G intratypic variants. We suggest that HPV genetic variation may be associated with HNC clinical characteristics and may have prognostic value.
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Affiliation(s)
- Steven F. Gameiro
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 3K7, Canada; (S.F.G.); (M.Y.S.)
| | - Mikhail Y. Salnikov
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 3K7, Canada; (S.F.G.); (M.Y.S.)
| | - Peter Y. F. Zeng
- Department of Pathology and Laboratory Medicine, The University of Western Ontario, London, ON N6A 5C1, Canada; (P.Y.F.Z.); (A.C.N.)
| | - John W. Barrett
- Department of Otolaryngology, The University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Anthony C. Nichols
- Department of Pathology and Laboratory Medicine, The University of Western Ontario, London, ON N6A 5C1, Canada; (P.Y.F.Z.); (A.C.N.)
- Department of Otolaryngology, The University of Western Ontario, London, ON N6A 5W9, Canada;
- Department of Oncology, The University of Western Ontario, London, ON N6A 5W9, Canada
| | - Joe S. Mymryk
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON N6A 3K7, Canada; (S.F.G.); (M.Y.S.)
- Department of Pathology and Laboratory Medicine, The University of Western Ontario, London, ON N6A 5C1, Canada; (P.Y.F.Z.); (A.C.N.)
- Department of Otolaryngology, The University of Western Ontario, London, ON N6A 5W9, Canada;
- Department of Oncology, The University of Western Ontario, London, ON N6A 5W9, Canada
- London Regional Cancer Program, Lawson Health Research Institute, London, ON N6A 5W9, Canada
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Laxague F, Gualtieri T, Brahm G, Yoo J, MacNeil SD, Fung K, Mendez A, Sahovaler A, Nichols AC. Ultrasound-guided wire localisation: a GPS for hidden head and neck tumours? A case series. Acta Otorhinolaryngol Ital 2023; 43:375-381. [PMID: 37519136 PMCID: PMC10773541 DOI: 10.14639/0392-100x-n2280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 04/11/2023] [Indexed: 08/01/2023]
Abstract
Objectives Ultrasound-guided wire (USGW) localisation for small non-palpable tumours before a revision head and neck surgery is an attractive pre-operative option to facilitate tumour identification and decrease potential complications. We describe five cases of pre-operative USGW localisation of non-palpable head and neck lesions to facilitate surgical localisation and resection. Methods All patients undergoing pre-operative USGW localisation for non-palpable tumours of the head and neck region at London Health and Sciences Center, London, Ontario, Canada, were included. All the USGW localisations were performed by the same interventional radiologist, and the surgeries were performed by fellowship trained head and neck surgeons. Results Five patients were included. All patients were undergoing revision surgery for recurrent or persistent disease. All successfully underwent a pre-operative USGW localisation of the non-palpable lesion before revision surgery. All lesions were localised intra-operatively with no peri-operative complications. Conclusions USGW localisation is a safe and effective pre-operative technique for the identification of small non-palpable head and neck tumours.
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Affiliation(s)
- Francisco Laxague
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Tommaso Gualtieri
- Department of Otorhinolaryngology - Head & Neck Surgery, “Nuovo Santo Stefano” Civil Hospital, Prato, PO, Italy
| | - Gary Brahm
- Department of Medical Imaging, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - S. Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Axel Sahovaler
- Department of Head & Neck Surgery, University College London Hospitals, London, United Kingdom
| | - Anthony C. Nichols
- Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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9
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Dayan GS, Bahig H, Johnson-Obaseki S, Eskander A, Hong X, Chandarana S, de Almeida JR, Nichols AC, Hier M, Belzile M, Gaudet M, Dort J, Matthews TW, Hart R, Goldstein DP, Yao CMKL, Hosni A, MacNeil D, Fowler J, Higgins K, Khalil C, Khoury M, Mlynarek AM, Morand G, Sultanem K, Maniakas A, Ayad T, Christopoulos A. Oncologic Significance of Therapeutic Delays in Patients With Oral Cavity Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:961-969. [PMID: 37422839 PMCID: PMC10331621 DOI: 10.1001/jamaoto.2023.1936] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Importance Oral cavity cancer often requires multidisciplinary management, subjecting patients to complex therapeutic trajectories. Prolonged treatment intervals in oral cavity cancer have been associated with poor oncological outcomes, but there has yet to be a study investigating treatment times in Canada. Objective To report treatment delays for patients with oral cavity cancer in Canada and evaluate the outcomes of treatment delays on overall survival. Design, Setting, and Participants This multicenter cohort study was performed at 8 Canadian academic centers from 2005 to 2019. Participants were patients with oral cavity cancer who underwent surgery and adjuvant radiation therapy. Analysis was performed in January 2023. Main Outcomes and Measures Treatment intervals evaluated were surgery to initiation of postoperative radiation therapy interval (S-PORT) and radiation therapy interval (RTI). The exposure variables were prolonged intervals, respectively defined as index S-PORT greater than 42 days and RTI greater than 46 days. Patient demographics, Charlson Comorbidity Index, smoking status, alcohol status, and cancer staging were also considered. Univariate (log rank and Kaplan-Meier) and multivariate (Cox regression) analyses were performed to determine associations with overall survival (OS). Results Overall, 1368 patients were included; median (IQR) age at diagnosis was 61 (54-70) years, and 896 (65%) were men. Median (IQR) S-PORT was 56 (46-68) days, with 1093 (80%) patients waiting greater than 42 days, and median (IQR) RTI was 43 (41-47) days, with 353 (26%) patients having treatment time interval greater than 46 days. There were variations in treatment time intervals between institutions for S-PORT (institution with longest vs shortest median S-PORT, 64 days vs 48 days; η2 = 0.023) and RTI (institution with longest vs shortest median RTI, 44 days vs 40 days; η2 = 0.022). Median follow-up was 34 months. The 3-year OS was 68%. In univariate analysis, patients with prolonged S-PORT had worse survival at 3 years (66% vs 77%; odds ratio 1.75; 95% CI, 1.27-2.42), whereas prolonged RTI (67% vs 69%; odds ratio 1.06; 95% CI, 0.81-1.38) was not associated with OS. Other factors associated with OS were age, Charlson Comorbidity Index, alcohol status, T category, N category, and institution. In the multivariate model, prolonged S-PORT remained independently associated with OS (hazard ratio, 1.39; 95% CI, 1.07-1.80). Conclusions and Relevance In this multicenter cohort study of patients with oral cavity cancer requiring multimodal therapy, initiation of radiation therapy within 42 days from surgery was associated with improved survival. However, in Canada, only a minority completed S-PORT within the recommended time, whereas most had an appropriate RTI. An interinstitution variation existed in terms of treatment time intervals. Institutions should aim to identify reasons for delays in their respective centers, and efforts and resources should be directed toward achieving timely completion of S-PORT.
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Affiliation(s)
- Gabriel S. Dayan
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | | | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Xinyuan Hong
- Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Shamir Chandarana
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - John R. de Almeida
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael Hier
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Mathieu Belzile
- Department of Otolaryngology–Head and Neck Surgery, Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Marc Gaudet
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada
| | - Joseph Dort
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - T. Wayne Matthews
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hart
- Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David P. Goldstein
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher M. K. L. Yao
- Department of Otolaryngology–Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - James Fowler
- Department of Otolaryngology–Head and Neck Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Carlos Khalil
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark Khoury
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alex M. Mlynarek
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Gregoire Morand
- Department of Otolaryngology–Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Anastasios Maniakas
- Department of Head and Neck Surgery, MD Anderson Cancer Center, University of Texas, Houston
| | - Tareck Ayad
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology–Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montéal, Montreal, Quebec, Canada
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Shaikh MH, Dawson A, Prokopec SD, Barrett JW, Y F Zeng P, Khan MI, Ryan SEB, Cecchini M, Palma DA, Mymryk JS, Boutros PC, Nichols AC. Loss of LRP1B expression drives acquired chemo and radio-resistance in HPV-positive head and neck cancer. Oral Oncol 2023; 146:106580. [PMID: 37778229 DOI: 10.1016/j.oraloncology.2023.106580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/01/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES Although human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) patients typically experience excellent survival, 15-20 % of patients recur after treatment with chemotherapy and radiation. Therefore, there is a need for biomarkers of treatment failure to guide treatment intensity. MATERIALS AND METHODS Whole genome sequencing was carried out on HPV+OPSCC patients who were primarily treated with concurrent chemotherapy (cisplatin) and radiation. We then explored whether the loss of LRP1Bwas sufficient to drive an aggressive phenotype, and promote a resistance to cisplatin and radiation therapy both in vitro using HPV+ cell lines (93VU147T, UMSCC47, UWO37 and UWO23) and in vivo. RESULTS Through integrative genomic analysis of three HPV+OPSCC tumour datasets, we identified that deletion of LRP1B was enriched in samples that recurred following chemo-radiation. Knockdown using siRNA in four HPV+ cell lines (UWO23, UWO37, UMSCC47 and 93VU147T) resulted in increased proliferation of all cases. CRISPR/Cas9 deletion of LRP1B in the same cell line panel demonstrated increased proliferation, clonogenic growth and migration, as well as resistance to both cisplatin and radiation in LRP1B deleted cells compared to their respective non-targeting control cells. Cell line derived xenograft studies indicated that the LRP1B knockout tumours were more resistant to cisplatin and radiation therapy compared to their controls invivo. CONCLUSION Taken together, our work implicates LRP1B deletion as a potential biomarker for identifying treatment resistant HPV+ OPSCC cases.
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Affiliation(s)
- Mushfiq H Shaikh
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Alice Dawson
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | | | - John W Barrett
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mohammed I Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Sarah E B Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Matthew Cecchini
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Joe S Mymryk
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA, USA; Institute for Precision Health, University of California, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA, USA
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada.
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11
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Gupta MK, Misariu AM, Saydy N, Nichols AC, Laxague F, Eskander A, Li H, Weisbrod N, Pasternak JD, Golbon B, Jin E, van Uum SHM, Brassard M, Lévesque F, Sadeghi N, Subramaniam T, Mlynarek AM, Morand GB, Fortier PH, Fradet L, Ghaznavi S, Chandarana SP, Prisman E, Ayad T, Christopoulos A, Davies JC, Rajaraman M, Corsten M, Rajaraman K, Maniakas A. A Multicentre Retrospective Study of Anaplastic Thyroid Cancer in the Era of Targeted Therapy in a Public Health Care System: Canada's Experience. Thyroid 2023; 33:1374-1377. [PMID: 37725592 DOI: 10.1089/thy.2023.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Affiliation(s)
- Michael K Gupta
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Canada
| | - Ana-Maria Misariu
- Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Canada
| | - Nadim Saydy
- Division of Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery and Western University, London, Canada
| | - Francisco Laxague
- Department of Head and Neck Surgery, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Huaqi Li
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Natalie Weisbrod
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jesse D Pasternak
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Bahar Golbon
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Elaine Jin
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Canada
| | | | - Maryse Brassard
- Division of Endocrinology, Department of Medicine, Université Laval, Quebec City, Canada
| | - Florence Lévesque
- Division of Endocrinology, Department of Medicine, Université Laval, Quebec City, Canada
| | - Nader Sadeghi
- Department of Otolaryngology, Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | - Thavakumar Subramaniam
- Department of Otolaryngology, Head and Neck Surgery, McGill University Health Centre, Montreal, Canada
| | - Aleksander M Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Canada
| | - Gregoire Bernard Morand
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Canada
- Department of Otolaryngology, University of Zurich, Zurich, Switzerland
| | - Pierre H Fortier
- Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Universite Sherbrooke, Sherbrooke, Canada
| | - Laurent Fradet
- Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Universite Sherbrooke, Sherbrooke, Canada
| | - Sana Ghaznavi
- Divisions of Endocrinology and University of Calgary, Calgary, Canada
| | | | - Eitan Prisman
- Division of Otolaryngology, University of British Columbia, Vancouver, Canada
| | - Tareck Ayad
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montreal, Canada
| | - Joel C Davies
- Department of Otolaryngology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Murali Rajaraman
- Department of Radiation Oncology and Dalhousie University, Halifax, Canada
| | - Martin Corsten
- Division of Otolaryngology, Dalhousie University, Halifax, Canada
| | - Kye Rajaraman
- Faculty of Medicine, Saint Mary's University, Halifax, Canada
| | - Anastasios Maniakas
- Division of Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, University of Montreal, Montreal, Canada
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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12
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Zhang K, Laxague F, MacMillan C, MacNeil SD, Fung K, Yoo J, Nichols AC, Mendez A. A sinonasal NUT midline carcinoma in an 84-year-old man undergoing radiation and proton therapy. Clin Case Rep 2023; 11:e7262. [PMID: 37397571 PMCID: PMC10307986 DOI: 10.1002/ccr3.7262] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 03/01/2023] [Accepted: 04/12/2023] [Indexed: 07/04/2023] Open
Abstract
NUT midline carcinomas are rare, aggressive, and poorly differentiated tumors that must be considered in the differential diagnosis of midline head and neck tumors. Despite the scarce data, proton therapy could be an option for some patients.
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Affiliation(s)
- Katherynn Zhang
- Schulich School of Medicine & DentistryWestern University, Lawson Health Research Institute, Western UniversityLondonOntarioCanada
| | - Francisco Laxague
- Schulich School of Medicine & DentistryWestern University, Lawson Health Research Institute, Western UniversityLondonOntarioCanada
- Department of Otolaryngology‐Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Christina MacMillan
- Department of Laboratory Medicine & Pathobiology‐Anatomic PathologyUniversity of TorontoTorontoOntarioCanada
- Mount Sinai HospitalSinai HealthTorontoOntarioCanada
| | - S. Danielle MacNeil
- Schulich School of Medicine & DentistryWestern University, Lawson Health Research Institute, Western UniversityLondonOntarioCanada
- Department of Otolaryngology‐Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Kevin Fung
- Schulich School of Medicine & DentistryWestern University, Lawson Health Research Institute, Western UniversityLondonOntarioCanada
- Department of Otolaryngology‐Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - John Yoo
- Schulich School of Medicine & DentistryWestern University, Lawson Health Research Institute, Western UniversityLondonOntarioCanada
- Department of Otolaryngology‐Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Anthony C. Nichols
- Schulich School of Medicine & DentistryWestern University, Lawson Health Research Institute, Western UniversityLondonOntarioCanada
- Department of Otolaryngology‐Head and Neck SurgeryWestern UniversityLondonOntarioCanada
| | - Adrian Mendez
- Schulich School of Medicine & DentistryWestern University, Lawson Health Research Institute, Western UniversityLondonOntarioCanada
- Department of Otolaryngology‐Head and Neck SurgeryWestern UniversityLondonOntarioCanada
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13
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Shin AE, Tesfagiorgis Y, Larsen F, Derouet M, Zeng PYF, Good HJ, Zhang L, Rubinstein MR, Han YW, Kerfoot SM, Nichols AC, Hayakawa Y, Howlett CJ, Wang TC, Asfaha S. F4/80 +Ly6C high Macrophages Lead to Cell Plasticity and Cancer Initiation in Colitis. Gastroenterology 2023; 164:593-609.e13. [PMID: 36634827 PMCID: PMC10038892 DOI: 10.1053/j.gastro.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
BACKGROUND & AIMS Colorectal cancer is a leading cause of cancer death, and a major risk factor is chronic inflammation. Despite the link between colitis and cancer, the mechanism by which inflammation leads to colorectal cancer is not well understood. METHODS To investigate whether different forms of inflammation pose the same risk of cancer, we compared several murine models of colitis (dextran sodium sulfate [DSS], 2,4,6-trinitrobenzene sulfonic acid, 4-ethoxylmethylene-2-phenyloxazol-5-one, Citrobacter rodentium, Fusobacterium nucleatum, and doxorubicin) with respect to their ability to lead to colonic tumorigenesis. We attempted to correlate the severity of colitis and inflammatory profile with the risk of tumorigenesis in both azoxymethane-dependent and Dclk1/APCfl/fl murine models of colitis-associated cancer. RESULTS DSS colitis reproducibly led to colonic tumors in both mouse models of colitis-associated cancer. In contrast, all other forms of colitis did not lead to cancer. When compared with the colitis not associated with tumorigenesis, DSS colitis was characterized by significantly increased CD11b+F4/80+Ly6Chigh macrophages and CD11b+Ly6G+ neutrophils. Interestingly, depletion of the CD11b+F4/80+Ly6Chigh macrophages inhibited tumorigenesis, whereas depletion of CD11b+Ly6G+ neutrophils had no effect on tumorigenesis. Furthermore, the macrophage-derived cytokines interleukin-1β, tumor necrosis factor-α, and interleukin-6 were significantly increased in DSS colitis and promoted stemness of Dclk1+ tuft cells that serve as the cellular origin of cancer. CONCLUSIONS We have identified CD11b+F4/80+Ly6Chigh macrophages as key mediators of cancer initiation in colitis-associated cancer. Development of new therapies that target these cells may provide an effective preventative strategy for colitis-associated cancer.
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Affiliation(s)
- Alice E Shin
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Yodit Tesfagiorgis
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Frederikke Larsen
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Mathieu Derouet
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Peter Y F Zeng
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Otolaryngology and Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Hayley J Good
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada
| | - Liyue Zhang
- Department of Medicine, Western University, London, Ontario, Canada
| | - Mara R Rubinstein
- Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University Irving Medical Center, New York, New York
| | - Yiping W Han
- Section of Oral, Diagnostic and Rehabilitation Sciences, College of Dental Medicine, Columbia University Irving Medical Center, New York, New York; Departments of Microbiology & Immunology and Medicine (Medical Sciences), Columbia University Irving Medical Center, New York, New York
| | - Steven M Kerfoot
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology and Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Yoku Hayakawa
- Department of Gastroenterology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Christopher J Howlett
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Timothy C Wang
- Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Samuel Asfaha
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Medicine, Western University, London, Ontario, Canada.
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14
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Malik NH, Fu R, Hainc N, Noel CW, de Almeida JR, Hosni A, Hui Huang S, Yu E, Dzioba A, Leung A, Mangat A, MacNeil D, Nichols AC, Hiremath SB, Chakraborty S, Jooya A, Gaudet M, Johnson-Obaseki S, Whelan J, Forghani R, Hier MP, Morand G, Sultanem K, Dort J, Lysack J, Matthews W, Nakoneshny S, Gill G, Globerman A, Kerr P, Maralani P, Karam I, Eskander A. Association of Primary Tumor Volume With Survival in Patients With T3 Glottic Cancer Treated With Radiotherapy: A Study of the Canadian Head & Neck Collaborative Research Initiative. JAMA Otolaryngol Head Neck Surg 2023; 149:103-109. [PMID: 36480193 PMCID: PMC9857688 DOI: 10.1001/jamaoto.2022.3996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/13/2022] [Indexed: 12/13/2022]
Abstract
Importance The association of primary tumor volume with outcomes in T3 glottic cancers treated with radiotherapy with concurrent chemotherapy remains unclear, with some evidence suggesting worse locoregional control in larger tumors. Objective To evaluate the association of primary tumor volume with oncologic outcomes in patients with T3 N0-N3 M0 glottic cancer treated with primary (chemo)radiotherapy in a large multi-institutional study. Design, Setting, and Participants This multi-institutional retrospective cohort study involved 7 Canadian cancer centers from 2002 to 2018. Tumor volume was measured by expert neuroradiologists on diagnostic imaging. Clinical and outcome data were extracted from electronic medical records. Overall survival (OS) and disease-free survival (DFS) outcomes were assessed with marginal Cox regression. Laryngectomy-free survival (LFS) was modeled as a secondary analysis. Patients diagnosed with cT3 N0-N3 M0 glottic cancers from 2002 to 2018 and treated with curative intent intensity-modulated radiotherapy (IMRT) with or without chemotherapy. Overall, 319 patients met study inclusion criteria. Exposures Tumor volume as measured on diagnostic imaging by expert neuroradiologists. Main Outcomes and Measures Primary outcomes were OS and DFS; LFS was assessed as a secondary analysis, and late toxic effects as an exploratory analysis determined before start of the study. Results The mean (SD) age of participants was 66 (12) years and 279 (88%) were men. Overall, 268 patients (84%) had N0 disease, and 150 (47%) received concurrent systemic therapy. The mean (SD) tumor volume was 4.04 (3.92) cm3. With a mean (SD) follow-up of 3.85 (3.04) years, there were 91 (29%) local, 35 (11%) regional, and 38 (12%) distant failures. Increasing tumor volume (per 1-cm3 increase) was associated with significantly worse adjusted OS (hazard ratio [HR], 1.07; 95% CI, 1.03-1.11) and DFS (HR, 1.04; 95% CI, 1.01-1.07). A total of 62 patients (19%) underwent laryngectomies with 54 (87%) of these within 800 days after treatment. Concurrent systemic therapy was associated with improved LFS (subdistribution HR, 0.63; 95% CI, 0.53-0.76). Conclusions and Relevance Increasing tumor volumes in cT3 glottic cancers was associated with worse OS and DFS, and systemic therapy was associated with improved LFS. In absence of randomized clinical trial evidence, patients with poor pretreatment laryngeal function or those ineligible for systemic therapy may be considered for primary surgical resection with postoperative radiotherapy.
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Affiliation(s)
- Nauman H. Malik
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Rui Fu
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nicolin Hainc
- Department of Neuroradiology, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Christopher W. Noel
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - John R. de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre–University Health Network, University of Toronto, Toronto, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yu
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Andrew Leung
- Department of Radiology, Western University, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Arvindpaul Mangat
- Department of Radiology, Western University, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Shivaprakash B. Hiremath
- Department of Radiology, Western University, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Santanu Chakraborty
- Department of Radiology, Western University, London, Ontario, Canada
- Department of Medical Imaging, Western University, London, Ontario, Canada
| | - Alboorz Jooya
- Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Marc Gaudet
- Division of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Jonathan Whelan
- Department of Otolaryngology-Head & Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Reza Forghani
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
- Department of Radiology, University of Florida College of Medicine, Gainesville
| | - Michael P. Hier
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Grégoire Morand
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Oncology, McGill University, Jewish General Hospital, Montréal, Québec, Canada
| | - Joseph Dort
- Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - John Lysack
- Section of Neuroradiology, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Wayne Matthews
- Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Steven Nakoneshny
- Division of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Gia Gill
- Department of Otolaryngology-Head & Neck Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam Globerman
- Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Paul Kerr
- Department of Otolaryngology-Head & Neck Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Pejman Maralani
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Antoine Eskander
- Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Patel KB, Turner K, Alishahi Tabriz A, Gonzalez BD, Oswald LB, Nguyen OT, Hong YR, Jim HSL, Nichols AC, Wang X, Robinson E, Naso C, Spiess PE. Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer. JAMA Netw Open 2023; 6:e2250211. [PMID: 36626174 PMCID: PMC9856804 DOI: 10.1001/jamanetworkopen.2022.50211] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
IMPORTANCE Patients with cancer typically have greater financial hardships and time costs than individuals without cancer. The COVID-19 pandemic has exacerbated this, while posing substantial challenges to delivering cancer care and resulting in important changes in care-delivery models, including the rapid adoption of telehealth. OBJECTIVE To estimate patient travel, time, and cost savings associated with telehealth for cancer care delivery. DESIGN, SETTING, AND PARTICIPANTS An economic evaluation of cost savings from completed telehealth visits from April 1, 2020, to June 30, 2021, in a single-institution National Cancer Institute-Designated Comprehensive Cancer Center. All patients aged 18 to 65 years who completed telehealth visits within the designated time frame and had a Florida mailing address documented in their electronic medical record were included in the study cohort. Data were analyzed from April 2020 to June 2021. MAIN OUTCOMES AND MEASURES The main outcome was estimated patient cost savings from telehealth, which included 2 components: costs of travel (defined as roundtrip distance saved from car travel) and potential loss of productivity due to the medical visit (defined as loss of income from roundtrip travel plus loss of income from in-person clinic visits). Two different models with a combination of 2 different mileage rates ($0.56 and $0.82 per mile) and census tract-level median hourly wages were used. RESULTS The study included 25 496 telehealth visits with 11 688 patients. There were 4525 (3795 patients) new or established visits and 20 971 (10 049 patients) follow-up visits. Median (IQR) age was 55.0 (46.0-61.0) years among the telehealth visits, with 15 663 visits (61.4%) by women and 18 360 visits (72.0%) by Hispanic non-White patients. According to cost models, the estimated mean (SD) total cost savings ranged from $147.4 ($120.1) at $0.56/mile to $186.1 ($156.9) at $0.82/mile. For new or established visits, the mean (SD) total cost savings per visit ranged from $176.6 ($136.3) at $0.56/mile to $222.8 ($177.4) at $0.82/mile, and for follow-up visits, the mean (SD) total cost savings per visit was $141.1 ($115.3) at $0.56/mile to $178.1 ($150.9) at $0.82/mile. CONCLUSIONS AND RELEVANCE In this economic evaluation, telehealth was associated with savings in patients time and travel costs, which may reduce the financial toxicity of cancer care. Expansion of telehealth oncology services may be an effective strategy to reduce the financial burden among patients with cancer.
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Affiliation(s)
- Krupal B. Patel
- Department of Head and Neck and Endocrine Oncology, Moffitt Cancer Center, Tampa, Florida
- Department of Otolaryngology, Head and Neck Surgery, University of South Florida, Tampa
| | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Amir Alishahi Tabriz
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Oliver T. Nguyen
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
| | - Heather S. L. Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Anthony C. Nichols
- Department of Otolaryngology, Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
| | - Edmondo Robinson
- Department of Internal and Hospital Medicine, Moffitt Cancer Center, Tampa, Florida
- Center for Digital Health, Moffitt Cancer Center, Tampa, Florida
| | - Cristina Naso
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
| | - Philippe E. Spiess
- Virtual Health Program, Moffitt Cancer Center, Tampa, Florida
- Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, Florida
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16
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Hathi K, Fowler J, Zahabi S, Dzioba A, Madou E, Gunz AC, Sowerby LJ, Nichols AC, Strychowsky JE. Attitudes and Perceptions of Canadian Otolaryngology‐Head and Neck Surgeons and Residents on Environmental Sustainability. OTO Open 2023; 7:e40. [PMID: 36998559 PMCID: PMC10046710 DOI: 10.1002/oto2.40] [Citation(s) in RCA: 1] [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] [Received: 01/09/2023] [Accepted: 01/21/2023] [Indexed: 02/25/2023] Open
Abstract
Objective Healthcare systems, specifically operating rooms, significantly contribute to greenhouse gas emissions. Addressing operating room environmental sustainability requires understanding current practices, opinions, and barriers. This is the first study assessing the attitudes and perceptions of otolaryngologists on environmental sustainability. Study Design Cross-sectional virtual survey. Setting Email survey to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery. Methods A 23-question survey was developed in REDCap. The questions focused on four themes: (1) demographics, (2) attitudes and beliefs, (3) institutional practices, and (4) education. A combination of multiple choice, Likert-scale, and open-ended questions were employed. Results Response rate was 11% (n = 80/699). Most respondents strongly believed in climate change (86%). Only 20% strongly agree that operating rooms contribute to the climate crisis. Most agree environmental sustainability is very important at home (62%) and in their community (64%), only 46% said it was very important in the operating room. Barriers to environmental sustainability were incentives (68%), hospital supports (60%), information/knowledge (59%), cost (58%), and time (50%). Of those involved in residency programs, 89% (n = 49/55) reported there was no education on environmental sustainability or they were unsure if there was. Conclusion Canadian otolaryngologists strongly believe in climate change, but there is more ambivalence regarding operating rooms as a significant contributor. There is a need for further education and a systemic reduction of barriers to facilitate eco-action in otolaryngology operating rooms.
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Affiliation(s)
- Kalpesh Hathi
- Faculty of Medicine Dalhousie Medicine New Brunswick Saint John New Brunswick Canada
| | - James Fowler
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Sarah Zahabi
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Edward Madou
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Anna C. Gunz
- Department of Paediatrics Western University Ontario London Canada
| | - Leigh J. Sowerby
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Anthony C. Nichols
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
| | - Julie E. Strychowsky
- Department of Otolaryngology–Head and Neck Surgery Western University Ontario London Canada
- Department of Paediatrics Western University Ontario London Canada
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17
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Zeng PYF, Cecchini MJ, Barrett JW, Shammas-Toma M, De Cecco L, Serafini MS, Cavalieri S, Licitra L, Hoebers F, Brakenhoff RH, Leemans CR, Scheckenbach K, Poli T, Wang X, Liu X, Laxague F, Prisman E, Poh C, Bose P, Dort JC, Shaikh MH, Ryan SEB, Dawson A, Khan MI, Howlett CJ, Stecho W, Plantinga P, Daniela da Silva S, Hier M, Khan H, MacNeil D, Mendez A, Yoo J, Fung K, Lang P, Winquist E, Palma DA, Ziai H, Amelio AL, Li SSC, Boutros PC, Mymryk JS, Nichols AC. Immune-based classification of HPV-associated oropharyngeal cancer with implications for biomarker-driven treatment de-intensification. EBioMedicine 2022; 86:104373. [PMID: 36442320 PMCID: PMC9706534 DOI: 10.1016/j.ebiom.2022.104373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is significant interest in treatment de-escalation for human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) patients given the generally favourable prognosis. However, 15-30% of patients recur after primary treatment, reflecting a need for improved risk-stratification tools. We sought to develop a molecular test to risk stratify HPV+ OPSCC patients. METHODS We created an immune score (UWO3) associated with survival outcomes in six independent cohorts comprising 906 patients, including blinded retrospective and prospective external validations. Two aggressive radiation de-escalation cohorts were used to assess the ability of UWO3 to identify patients who recur. Multivariate Cox models were used to assess the associations between the UWO3 immune class and outcomes. FINDINGS A three-gene immune score classified patients into three immune classes (immune rich, mixed, or immune desert) and was strongly associated with disease-free survival in six datasets, including large retrospective and prospective datasets. Pooled analysis demonstrated that the immune rich group had superior disease-free survival compared to the immune desert (HR = 9.0, 95% CI: 3.2-25.5, P = 3.6 × 10-5) and mixed (HR = 6.4, 95% CI: 2.2-18.7, P = 0.006) groups after adjusting for age, sex, smoking status, and AJCC8 clinical stage. Finally, UWO3 was able to identify patients from two small treatment de-escalation cohorts who remain disease-free after aggressive de-escalation to 30 Gy radiation. INTERPRETATION With additional prospective validation, the UWO3 score could enable biomarker-driven clinical decision-making for patients with HPV+ OPSCC based on robust outcome prediction across six independent cohorts. Prospective de-escalation and intensification clinical trials are currently being planned. FUNDING CIHR, European Union, and the NIH.
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Affiliation(s)
- Peter Y F Zeng
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Matthew Shammas-Toma
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Loris De Cecco
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy
| | - Mara S Serafini
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy
| | - Stefano Cavalieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, the Netherlands
| | - Ruud H Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, the Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, the Netherlands
| | - Kathrin Scheckenbach
- Department of Otolaryngology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tito Poli
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Parma-University Hospital of Parma, Parma, Italy
| | - Xiaowei Wang
- Department of Pharmacology and Regenerative Medicine, The University of Illinois at Chicago, Chicago, IL, USA
| | - Xinyi Liu
- Department of Pharmacology and Regenerative Medicine, The University of Illinois at Chicago, Chicago, IL, USA
| | - Francisco Laxague
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Eitan Prisman
- Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Catherine Poh
- Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pinaki Bose
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Joseph C Dort
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Mushfiq H Shaikh
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Sarah E B Ryan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Alice Dawson
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mohammed I Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Christopher J Howlett
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - William Stecho
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Paul Plantinga
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | | | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Halema Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Eric Winquist
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antonio L Amelio
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Cell Biology and Physiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shawn S-C Li
- Department of Biochemistry, University of Western Ontario, London, Ontario, Canada
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA, USA; Institute for Precision Health, University of California, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA, USA
| | - Joe S Mymryk
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada.
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18
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Chung EJ, Matic D, Fung K, MacNeil SD, Nichols AC, Kiwan R, Tay K, Yoo J. Bell's palsy misdiagnosis: characteristics of occult tumors causing facial paralysis. J Otolaryngol Head Neck Surg 2022; 51:39. [PMID: 36258246 PMCID: PMC9580210 DOI: 10.1186/s40463-022-00591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/30/2020] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study was to report the incidence and clinical course of a series of patients who were misdiagnosed with Bell’s palsy and were eventually proven to have occult neoplasms. Methods Two hundred forty patients with unilateral facial paralysis who were assessed at the facial nerve reanimation clinic, Victoria Hospital, London Health Science Centre, from 2008 through 2017 were reviewed. Persistent paralysis without recovery was the presenting complaint. Results Nine patients (3.8%) who were proven to have occult neoplasms initially presented with a diagnosis of Bell’s palsy. The mean diagnostic delay was 43.5 months. Four patients were proven to have skin cancers, 3 patients had parotid cancers, and 2 patients had facial nerve schwannomas as a final diagnosis. Initial magnetic resonance imaging (MRI) was performed in all 9 patients and 8 underwent a follow-up MRI. An occult tumor was identified upon review of the original MRI in one patient and at follow-up MRI in 8 patients. The mean time interval between the initial and follow-up imaging was 30.8 months. The disease status at most recent follow-up were no evidence of disease in 2 patients (22%) and alive with disease in 7 patients (78%). An irreversible, progressive pattern of facial paralysis combined with pain, multiple cranial neuropathies or history of skin cancer were predictable risk factors for occult tumors. Seven out of the 9 patients (77.8%) underwent at least one type of facial reanimation surgery, and the final subjective results by the surgeon were available for 5 patients. Three out of the 5 (60%) patients who were available for final subjective analysis were reported as Grade III according to the modified House-Brackmann scale. Conclusion Occult facial nerve neoplasm should be suspected in patients with progressive and irreversible facial paralysis but the diagnosis may only become evident with follow-up imaging. Facial reanimation surgery is a satisfactory option for these patients. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s40463-022-00591-9.
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Affiliation(s)
- Eun-Jae Chung
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, Room B3-433, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.,Department of Otorhinolaryngology - Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Damir Matic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, Room B3-433, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, Room B3-433, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, Room B3-433, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Ruba Kiwan
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - KengYeow Tay
- Department of Radiology, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, Schulich School of Medicine and Dentistry, Victoria Hospital, Western University, Room B3-433, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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19
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Murphy RM, Tasoulas J, Porrello A, Carper MB, Tsai YH, Coffey AR, Kumar S, Zeng PYF, Schrank TP, Midkiff BR, Cohen S, Salazar AH, Hayward MC, Hayes DN, Olshan A, Gupta GP, Nichols AC, Yarbrough WG, Pecot CV, Amelio AL. Tumor Cell Extrinsic Synaptogyrin 3 Expression as a Diagnostic and Prognostic Biomarker in Head and Neck Cancer. Cancer Res Commun 2022; 2:987-1004. [PMID: 36148399 PMCID: PMC9491693 DOI: 10.1158/2767-9764.crc-21-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/15/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022]
Abstract
Over 70% of oropharyngeal head and neck squamous cell carcinoma (HNSC) cases in the United States are positive for human papillomavirus (HPV) yet biomarkers for stratifying oropharyngeal head and neck squamous cell carcinoma (HNSC) patient risk are limited. We used immunogenomics to identify differentially expressed genes in immune cells of HPV(+) and HPV(-) squamous carcinomas. Candidate genes were tested in clinical specimens using both quantitative RT-PCR and IHC and validated by IHC using the Carolina Head and Neck Cancer Study (CHANCE) tissue microarray of HNSC cases. We performed multiplex immunofluorescent staining to confirm expression within the immune cells of HPV(+) tumors, receiver operating characteristic (ROC) curve analyses, and assessed survival outcomes. The neuronal gene Synaptogyrin-3 (SYNGR3) is robustly expressed in immune cells of HPV(+) squamous cancers. Multiplex immunostaining and single cell RNA-seq analyses confirmed SYNGR3 expression in T cells, but also unexpectedly in B cells of HPV(+) tumors. ROC curve analyses revealed that combining SYNGR3 and p16 provides more sensitivity and specificity for HPV detection compared to p16 IHC alone. SYNGR3-high HNSC patients have significantly better prognosis with five-year OS and DSS rates of 60% and 71%, respectively. Moreover, combining p16 localization and SYNGR3 expression can further risk stratify HPV(+) patients such that high cytoplasmic, low nuclear p16 do significantly worse (Hazard Ratio, 8.6; P = 0.032) compared to patients with high cytoplasmic, high nuclear p16. SYNGR3 expression in T and B cells is associated with HPV status and enhanced survival outcomes of HNSC patients.
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Affiliation(s)
- Ryan M. Murphy
- Graduate Curriculum in Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jason Tasoulas
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alessandro Porrello
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Miranda B. Carper
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yi-Hsuan Tsai
- Bioinformatics Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alisha R. Coffey
- Bioinformatics Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sunil Kumar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Technology Development, Naveris Inc., Natick, Massachusetts
| | - Peter YF. Zeng
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Travis P. Schrank
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Bentley R. Midkiff
- Pathology Services Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie Cohen
- Pathology Services Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ashley H. Salazar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michele C. Hayward
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - D. Neil Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Center for Cancer Research, University of Tennessee Health Sciences, Memphis, Tennessee
| | - Andrew Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gaorav P. Gupta
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Radiation Oncology, UNC School of Medicine, Chapel Hill, North Carolina
| | - Anthony C. Nichols
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Wendell G. Yarbrough
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Department of Pathology and Lab Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Chad V. Pecot
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Antonio L. Amelio
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Cancer Cell Biology Program, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Palma DA, Nichols AC. Caution Regarding Assessment of Toxic Effects and Survival in Treatment De-escalation With Radiotherapy vs Transoral Surgery for Human Papillomavirus-Associated Oropharyngeal Cancer-Reply. JAMA Oncol 2022; 8:1513-1514. [PMID: 35980611 DOI: 10.1001/jamaoncol.2022.3467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- David A Palma
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Wihlidal JGJ, Tay KY, MacNeil SD, Nichols AC, Fung K, Yoo JHJ, Mendez AI. Demographic and pathologic factor regression to a growth rate model of
p16
‐negative oral cavity squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2022; 7:1384-1390. [PMID: 36258883 PMCID: PMC9575115 DOI: 10.1002/lio2.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives The current study aims to quantify the growth rate of p16‐negative oral cavity squamous cell carcinoma, characterize causative relationships between demographic risk factors and tumor growth, and examine pathologic findings associated with the tumor growth rate at a tertiary care institution. It is hypothesized that causative relationships will be drawn between the individual sociodemographic and pathologic factors and oral cavity p16‐negative squamous cell carcinoma growth rate. Methods Prospectively recruited participants, receiving surgical intervention only, were followed from initial staging CT scan to surgical resection. Interval growth was calculated in cm3/week. Demographic information including age, sex, smoking history, alcohol consumption history, previous all‐type malignancy, previous chemotherapy treatment, previous head or neck radiation exposure, and time interval elapsed between diagnosis and surgery was collected from each participant, and regression analysis was applied to determine causality. Results Summary statistics revealed a mean growth rate for the study sample of 1.385cm3/week. Statistically significant regression correlations were detected between tumor growth and alcohol consumption, origination at the retromolar trigone, and clinical nodal stage. Conclusions Through a small prospective cohort sample, the current study suggests clinical associations between alcohol consumption, origination at the retromolar trigone, and clinical nodal stage with rate of tumor growth. Future work will validate these relationships in a larger patient cohort, and against stronger modeling techniques. Level of Evidence Prospective non‐random cohort design.
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Affiliation(s)
- Jacob G. J. Wihlidal
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - Keng Yeow Tay
- Department of Radiology, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - S. Danielle MacNeil
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - Anthony C. Nichols
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - Kevin Fung
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - John H. J. Yoo
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
| | - Adrian I. Mendez
- Department of Otolaryngology, Head and Neck Surgery, Schulich School of Medicine and Dentistry University of Western Ontario London Ontario Canada
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22
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Patel KB, Shabani S, Padhya T, Cao B, Wang X, Turner K, Nichols AC, Kang SY, Rocco JW, Old M. The Impact of the Affordable Care Act on Insurance Coverage and Stage Among Head and Neck Squamous Cell Carcinoma Patients. J Health Care Poor Underserved 2022; 33:1322-1336. [DOI: 10.1353/hpu.2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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23
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Laxague F, Dzioba A, Jasani D, Warner A, Palma DA, Lang P, Venkatesan V, Read N, Nichols AC, Fung K, Yoo J, Mendez A, MacNeil SD. Risk Factors for Poor Survival Outcomes in Parotid Metastatic Cutaneous Squamous Cell Carcinoma. Laryngoscope 2022; 133:1163-1168. [PMID: 35880608 DOI: 10.1002/lary.30289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/21/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We aimed to analyze risk factors associated with poor survival outcomes for metastatic cutaneous head-and-neck SCC to the parotid. METHODS All patients undergoing surgery for metastatic cutaneous SCC to the parotid with curative intent between 2011 and 2018, were reviewed. Demographic and clinical characteristics were evaluated. Histopathological data including tumor size and histology, tumor grade, TNM stage, resection margins, lymphovascular invasion, and perineural invasion, were analyzed. Overall survival (OS), disease-specific survival (DSS), and freedom from locoregional recurrence (LRR) were assessed. RESULTS Ninety patients were included (mean age, 77 years; 75 men [83.3%]). A total parotidectomy was performed in 48 patients (53.3%), and 42 (46.7%) underwent a superficial parotidectomy. Seventy patients (77.8%) underwent adjuvant RT. The median follow-up was 31 months (20-39 months). Tumor volume ≥ 50 cm3 and a shorter RT duration (<20 days) were associated with reduced OS (p = 0.002 and p = 0.01, p = 0.02 and p = 0.009, respectively), and DSS (p = 0.004 and p = 0.02, p = 0.04 and p = 0.02, respectively) on univariable and multivariable analysis, respectively. Only a shorter RT duration was associated with worse freedom from LRR on univariable and multivariable analysis, (p = 0.04 and p < 0.001, respectively). However, with death as a competing risk, a shorter duration of RT was not significantly associated with freedom from LRR. CONCLUSION A shorter duration of adjuvant RT, and excised tumor volume ≥50 cm3 were predictive factors of reduced OS and DSS, and a shorter duration of RT was also associated with reduced freedom from LRR in patients with metastatic SCC to the parotid gland. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2022.
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Affiliation(s)
- Francisco Laxague
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Dhruv Jasani
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Andrew Warner
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - David A Palma
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - Varagur Venkatesan
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - Nancy Read
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
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Eansor P, Norris ME, D'Souza LA, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, Warner A, Willmore KE, Campbell N, Palma DA. Can We Identify Predictors of Success in Contouring Education for Radiation Oncology Trainees? An Analysis of the Anatomy and Radiology Contouring Bootcamp: Predictors of Success in Contouring Education. Pract Radiat Oncol 2022; 12:e486-e492. [PMID: 35690353 DOI: 10.1016/j.prro.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Although several different contouring instructional programs are available to radiation oncologists and trainees, very little is known about which methods and resources benefit learners most, and whether some learners may need alternate forms of instruction. This study aimed to determine the factors that were predictors of learners' success in anatomy, radiology, and contouring education. METHODS Participants in the online and face-to-face (F2F) Anatomy and Radiology Contouring (ARC) Bootcamp completed pre- and post-intervention evaluations that assessed anatomy/radiology knowledge, contouring skills, self-confidence, and spatial ability. Baseline factors were assessed as predictors of outcomes across multiple educational domains. RESULTS One hundred and eighty (F2F: n=40; online: n=140) participants enrolled in the ARC Bootcamp and fifty-seven (F2F: n=30; online: n=27) participants completed both evaluations. Of the participants enrolled, 37% were female, and most were radiation oncology (RO) residents (62%). In the anatomy/radiology knowledge testing, all quartiles (based on baseline performance) improved numerically, however, the largest improvements occurred in learners with the lowest baseline scores (p<0.001). At the end of the Bootcamp, learners with lower-performing scores did not reach the level of learners with the highest baseline scores (Bonferroni-corrected p<0.001). Regarding the contouring assessment, improvements were only evident for the participants with lower-performing baseline scores (p<0.05). Spatial anatomy skills, as measured by the spatial anatomy task, was correlated to contouring ability. Overall, the greatest improvements were seen for learners in postgraduate year 1-3, those with no previous rotation experience in a given discipline, and those who attended from 'other' programs (i.e. medical physics residents and medical students). CONCLUSIONS The ARC Bootcamp improved all levels of performers' anatomy and radiology knowledge but only lower-performers' contouring ability. The course alone does not help lower-performing learners reach the abilities of higher-performers. The ARC Bootcamp tends to be most beneficial for participants with less RO experience. Curriculum modifications can be made to help support ARC Bootcamp participants with lower performing scores.
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Affiliation(s)
- Paige Eansor
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada.
| | - Madeleine E Norris
- Department of Anatomy, University of California San Francisco, San Francisco, California, United States
| | - Leah A D'Souza
- Department of Radiation Oncology, Rush University Medical Centre, Chicago, Illinois, United States
| | - Glenn S Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care, London, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Manas Sharma
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Keng Yeow Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Katherine E Willmore
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Nicole Campbell
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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Kuruvilla S, Meyers BM, Parker C, Nichols AC, Smoragiewicz M, Hotte SJ, Pond GR, Louie AV, Stewart P, Black M, Carreau C, Lee J, Read N, Sathya J, Lang P, Kevin F, Venkatesan V, Kim RB, Palma DA, Winquist E. The RADIO trial: Randomized assessment of cisplatin dosing interval for ototoxicity with curative concurrent chemo-radiation for locally advanced head and neck squamous cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps12144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS12144 Background: Patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) receive curative chemoradiation (CRT) with Cisplatin, as a standard of care. A meta-analysis of 52 randomized trials comparing Low Dose (LD) and High Dose (HD) schedules demonstrated differing toxicity profiles but hearing effects were not rigorously studied. Hearing loss associated with HD Cisplatin can result in survivorship challenges. A local study suggested a protective effect for LD Cisplatin in relation to ototoxicity and pharmacogenomic markers, MATE1 and COMT, to be associated with risk for ototoxicity. We hypothesize that LD cisplatin is associated with reduced frequency of hearing loss when compared to the standard HD cisplatin in LASCCHN patients on CRT and that differences in MATE1/COMT can predict for cisplatin-related ototoxicity and be identified prior to treatment. Our goal is to develop an innovative personalized treatment pathway incorporating predictive pharmacogenomics markers to improve the tolerability and survivorship outcomes of curative CRT for LASCCHN. Methods: This is a prospective, open-label, randomized clinical trial. Following informed consent, eligible LASCCHN patients planned for primary CRT will be stratified by tumor p16 status and then randomized in 1:1 fashion to either concurrent LD Cisplatin (40mg/m2 every week) or HD cisplatin (100mg/m2 every 3 weeks). The primary outcome is to measure the change in incidence of CTCAE grade ≥2 hearing loss and hearing-related quality of life (QOL) at 1 year. As part of secondary and exploratory outcomes, differences in survival, loco-regional control, global QOL and other toxicities (e.g. nephrotoxicity, neurotoxicity) will be assessed. The relationship between MATE1 and COMT, as predictors for cisplatin-related ototoxicity will be evaluated. Cost-effectiveness analyses comparing the two regimens will be assessed. Statistical plan: Based on rates of CTCAE grade ≥2 hearing loss in an earlier study (Winquist et al., 2016), assuming a conservative rate of hearing loss, amongst treated patients, of 60% with HD cisplatin and 30% with LD cisplatin, a total sample size of 92 patients would achieve > 80% statistical power, (two-sided, alpha = 0.05 test of two proportions) to detect these differences. 100 patients would be targeted to accrual for an assumed 5% noncompliance rate. For hearing related QOL, a two-sided, alpha = 0.05, two-sample t-test with 50 patients per group would achieve > 80% statistical power to detect an effect size of 0.60 and > 95% power to detect an effect size of 0.75. All analyses will be based primarily on the intent-to-treat population. An arms-length data and safety monitoring committee (DSMC) will review safety data bi-annually. Trial accrual status: 60 participants have been accrued. Clinical trial information: NCT03649048.
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Affiliation(s)
| | | | | | - Anthony C. Nichols
- Western University and London Health Sciences Centre, London, ON, Canada
| | | | | | | | - Alexander V. Louie
- Odette Cancer Center-Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Paul Stewart
- Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Morgan Black
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University and London Regional Cancer Program, London, ON, Canada
| | | | - Justin Lee
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Nancy Read
- London Health Sciences Centre, London, ON, Canada
| | - Jinka Sathya
- London Health Sciences Centre, London, ON, Canada
| | | | - Fung Kevin
- University of Western Ontario, London, ON, Canada
| | | | | | | | - Eric Winquist
- Department of Oncology, University of Western Ontario, London, ON, Canada
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D'Angelo K, Eansor P, D'Souza LA, Norris ME, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, O'Neil M, Mitchell S, Feuz C, Warner A, Willmore KE, Campbell N, Probst H, Palma DA. Implementation and Evaluation of an Online Anatomy, Radiology and Contouring Bootcamp for Radiation Therapists. J Med Imaging Radiat Sci 2022. [DOI: 10.1016/j.jmir.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Palma DA, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Eskander A, Higgins K, Karam I, Poon I, Husain Z, Enepekides D, Hier M, Sultanem K, Richardson K, Mlynarek A, Johnson-Obaseki S, Odell M, Bayley A, Dowthwaite S, Jackson JE, Dzienis M, O'Neil J, Chandarana S, Banerjee R, Hart R, Chung J, Tenenholtz T, Krishnan S, Le H, Yoo J, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Chen J, Parker C, Wehrli B, Kwan K, Theurer J, Sathya J, Hammond JA, Read N, Venkatesan V, MacNeil SD, Fung K, Nichols AC. Assessment of Toxic Effects and Survival in Treatment Deescalation With Radiotherapy vs Transoral Surgery for HPV-Associated Oropharyngeal Squamous Cell Carcinoma: The ORATOR2 Phase 2 Randomized Clinical Trial. JAMA Oncol 2022; 8:1-7. [PMID: 35482348 PMCID: PMC9052108 DOI: 10.1001/jamaoncol.2022.0615] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The optimal approach for treatment deescalation in human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCCs) is unknown. Objective To assess a primary radiotherapy (RT) approach vs a primary transoral surgical (TOS) approach in treatment deescalation for HPV-related OPSCC. Design, Setting, and Participants This international, multicenter, open-label parallel-group phase 2 randomized clinical trial was conducted at 9 tertiary academic cancer centers in Canada and Australia and enrolled patients with T1-T2N0-2 p16-positive OPSCC between February 13, 2018, and November 17, 2020. Patients had up to 3 years of follow-up. Interventions Primary RT (consisting of 60 Gy of RT with concurrent weekly cisplatin in node-positive patients) vs TOS and neck dissection (ND) (with adjuvant reduced-dose RT depending on pathologic findings). Main Outcomes and Measures The primary end point was overall survival (OS) compared with a historical control. Secondary end points included progression-free survival (PFS), quality of life, and toxic effects. Results Overall, 61 patients were randomized (30 [49.2%] in the RT arm and 31 [50.8%] in the TOS and ND arm; median [IQR] age, 61.9 [57.2-67.9] years; 8 women [13.6%] and 51 men [86.4%]; 31 [50.8%] never smoked). The trial began in February 2018, and accrual was halted in November 2020 because of excessive toxic effects in the TOS and ND arm. Median follow-up was 17 months (IQR, 15-20 months). For the OS end point, there were 3 death events, all in the TOS and ND arm, including the 2 treatment-related deaths (0.7 and 4.3 months after randomization, respectively) and 1 of myocardial infarction at 8.5 months. There were 4 events for the PFS end point, also all in the TOS and ND arm, which included the 3 mortality events and 1 local recurrence. Thus, the OS and PFS data remained immature. Grade 2 to 5 toxic effects occurred in 20 patients (67%) in the RT arm and 22 (71%) in the TOS and ND arm. Mean (SD) MD Anderson Dysphagia Inventory scores at 1 year were similar between arms (85.7 [15.6] and 84.7 [14.5], respectively). Conclusions and Relevance In this randomized clinical trial, TOS was associated with an unacceptable risk of grade 5 toxic effects, but patients in both trial arms achieved good swallowing outcomes at 1 year. Long-term follow-up is required to assess OS and PFS outcomes. Trial Registration Clinicaltrials.gov Identifier: NCT03210103.
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Affiliation(s)
- David A Palma
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Berthelet
- Division of Radiation Oncology, Department of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Tran
- Division of Radiation Oncology, Department of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Hamilton
- Division of Radiation Oncology, Department of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonn Wu
- Division of Radiation Oncology, Department of Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | | | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Samuel Dowthwaite
- Department of Otolaryngology-Head and Neck Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - James E Jackson
- Icon Cancer Centre, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Marcin Dzienis
- Department of Medical Oncology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - John O'Neil
- Icon Cancer Centre, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Shamir Chandarana
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Robyn Banerjee
- Division of Radiation Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hart
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Jeffson Chung
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown
| | - Todd Tenenholtz
- Department of Radiation Oncology, West Virginia University, Morgantown
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Eric Winquist
- Division of Medical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Sara Kuruvilla
- Division of Medical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Paul Stewart
- Division of Medical Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Andrew Warner
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Sylvia Mitchell
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Jeff Chen
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Christina Parker
- Department of Audiology, London Health Sciences Centre, London, Ontario, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, Ontario, Canada
| | - Julie Theurer
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Jinka Sathya
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - J Alex Hammond
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Nancy Read
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - Varagur Venkatesan
- Division of Radiation Oncology, Department of Oncology, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Nichols AC, Theurer J, Prisman E, Read N, Berthelet E, Tran E, Fung K, de Almeida JR, Bayley A, Goldstein DP, Hier M, Sultanem K, Richardson K, Mlynarek A, Krishnan S, Le H, Yoo J, MacNeil SD, Winquist E, Hammond JA, Venkatesan V, Kuruvilla S, Warner A, Mitchell S, Chen J, Corsten M, Johnson-Obaseki S, Odell M, Parker C, Wehrli B, Kwan K, Palma DA. Randomized Trial of Radiotherapy Versus Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma: Long-Term Results of the ORATOR Trial. J Clin Oncol 2022; 40:866-875. [PMID: 34995124 DOI: 10.1200/jco.21.01961] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The incidence of oropharyngeal squamous cell carcinoma (OPSCC) has risen rapidly, because of an epidemic of human papillomavirus infection. The optimal management of early-stage OPSCC with surgery or radiation continues to be a clinical controversy. Long-term randomized data comparing these paradigms are lacking. METHODS We randomly assigned patients with T1-T2, N0-2 (≤ 4 cm) OPSCC to radiotherapy (RT) (with chemotherapy if N1-2) versus transoral robotic surgery plus neck dissection (TORS + ND) (with or without adjuvant therapy). The primary end point was swallowing quality of life (QOL) at 1-year using the MD Anderson Dysphagia Inventory. Secondary end points included adverse events, other QOL outcomes, overall survival, and progression-free survival. All analyses were intention-to-treat. Herein, we present long-term outcomes from the trial. RESULTS Sixty-eight patients were randomly assigned (n = 34 per arm) between August 10, 2012, and June 9, 2017. Median follow-up was 45 months. Longitudinal MD Anderson Dysphagia Inventory analyses demonstrated statistical superiority of RT arm over time (P = .049), although the differences beyond 1 year were of smaller magnitude than at the 1-year timepoint (year 2: 86.0 ± 13.5 in the RT arm v 84.8 ± 12.5 in the TORS + ND arm, P = .74; year 3: 88.9 ± 11.3 v 83.3 ± 13.9, P = .12). These differences did not meet the threshold to qualify as a clinically meaningful change at any timepoint. Certain differences in QOL concerns including more pain and dental concerns in the TORS + ND arm seen at 1 year resolved at 2 and 3 years; however, TORS patients started to use more nutritional supplements at 3 years (P = .015). Dry mouth scores were higher in RT patients over time (P = .041). CONCLUSION On longitudinal analysis, the swallowing QOL difference between primary RT and TORS + ND approaches persists but decreases over time. Patients with OPSCC should be informed about the pros and cons of both treatment options (ClinicalTrials.gov identifier: NCT01590355).
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Affiliation(s)
- Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Julie Theurer
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - Eitan Prisman
- Department of Otolaryngology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Read
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Eric Berthelet
- Department of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric Tran
- Department of Radiation Oncology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael Hier
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Alex Mlynarek
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Suren Krishnan
- Department of Otolaryngology-Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Eric Winquist
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - J Alex Hammond
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Varagur Venkatesan
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Sara Kuruvilla
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Jeff Chen
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Martin Corsten
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michael Odell
- Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Christina Parker
- Department of Audiology, London Health Sciences Centre, London, Ontario, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, Ontario, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, Western University, London, Ontario, Canada
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Pinto N, Ruicci KM, Khan MI, Shaikh MH, Zeng YFP, Yoo J, Fung K, MacNeil SD, Mendez A, Mymryk JS, Barrett JW, Boutros PC, Nichols AC. Introduction and expression of PIK3CAE545K in a papillary thyroid cancer BRAFV600E cell line leads to a dedifferentiated aggressive phenotype. J of Otolaryngol - Head & Neck Surg 2022; 51:7. [PMID: 35193694 PMCID: PMC8862267 DOI: 10.1186/s40463-022-00558-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/02/2022] [Indexed: 01/03/2023]
Abstract
Anaplastic thyroid cancer (ATC) is a rare, aggressive form of undifferentiated thyroid cancer, which exhibits rapid progression and is almost universally fatal. At least a subset of ATC is thought to arise from pre-existing well-differentiated thyroid cancer, most frequently papillary thyroid cancer (PTC). While PIK3CA mutations are rare in PTC, they are common in ATC and tend to co-occur with BRAF mutations. This provided the rationale for our study to identify the potential role of PIK3CA mutations in the progression from well-differentiated to undifferentiated thyroid cancer. We introduced PIK3CAE545K into the LAM1 PTC cell line, which carries a BRAFV600E mutation. In culture, the engineered cell line (LAM1:PIK3CAE545K) proliferated faster and demonstrated increased clonogenic potential relative to the parental line carrying an empty vector (LAM1EV). Both the LAM1EV and LAM1:PIK3CAE545K edited lines were implanted into hind flanks of athymic nude mice for in vivo determination of disease progression. While tumour weights and volumes were not significantly higher in LAM1:PIK3CAE545K mice, there was a decrease in expression of thyroid differentiation markers TTF-1, thyroglobulin, PAX8 and B-catenin, suggesting that introduction of PIK3CAE545K led to dedifferentiation in vivo. Collectively, this study provides evidence of a role for PIK3CAE545K in driving disease progression from a well-differentiated to an undifferentiated thyroid cancer; however, over-expression was not a determinant of an accelerated growth phenotype in ATC.
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Kim HAJ, Zeng PYF, Sorgini A, Shaikh MH, Khan H, MacNeil D, Khan MI, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Patel KB, Boutros PC, Nichols AC. Tumor molecular differences associated with outcome disparities of Black patients with head and neck cancer. Head Neck 2022; 44:1124-1135. [PMID: 35187756 PMCID: PMC9047510 DOI: 10.1002/hed.27007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/17/2021] [Revised: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Numerous studies of head and neck squamous cell carcinoma (HNSCC) have demonstrated disparate outcomes by race and ethnicity. Beyond known associations with socioeconomic variables, whether these are also associated with differences in tumor molecular composition has thus far been poorly explored. METHODS We downloaded clinical and multiplatform molecular data from The Cancer Genome Atlas and other published studies. These were compared between non-Hispanic Black (n = 43) and White (n = 354) patients with non-HPV-related tumors, using multivariable models. Publicly available validation cohorts were used. RESULTS Black patients had poorer progression-free survival than White patients. Tumors of Black patients had greater copy number aberrations, and increased SFRP1 methylation and miRNA-mediated PRG4 silencing associated with poor survival. PI3K/AkT/mTOR pathway proteins were differentially expressed. CONCLUSIONS There are molecular differences between tumors of Black and White patients that may partially account for differences in survival. These may inform targeted treatment decisions to achieve equitable outcomes.
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Affiliation(s)
- Hugh A J Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Alana Sorgini
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mushfiq H Shaikh
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Halema Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Mohammed I Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Joe S Mymryk
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - John W Barrett
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Krupal B Patel
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, California, USA.,Department of Urology, University of California, Los Angeles, California, USA.,Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, California, USA.,Institute for Precision Health, University of California, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, California, USA
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada
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Mendez AI, Wihlidal JGJ, Eurich DT, Nichols AC, MacNeil SD, Seikaly HR. Validity of functional patient-reported outcomes in head and neck oncology: A systematic review. Oral Oncol 2022; 125:105701. [PMID: 35021152 DOI: 10.1016/j.oraloncology.2021.105701] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/12/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
Malignancy and treatment effects in head and neck oncology can be devastating to functional aspects of patient life such as swallowing, blinking, speech, salivation, and facial expression. Historically, the subjective nature of patient experience has resulted in difficulty with quantification and measurement of functional outcomes. Patient-Reported Outcomes (PROs) are questionnaires developed with patient input, forming the new gold standard for clinician assessment of subjective functional outcomes. The current review aims to identify and characterize the validation of PROs pertaining to four critical functional outcomes in head and neck oncology: swallowing, speech, dry mouth, and chewing. A literature search was conducted using MEDLINE, EMBASE, and the Cochrane databases for published, English language, peer-reviewed abstracts involving patients ≥ 18 years of age. Of 708 results, 705 were excluded at abstract or full text screening for not meeting inclusion criteria, exclusion of head and neck SCC patients in development, or absence of a functional domain measurement. The three reviewed studies-Xerostomia Questionnaire, Swallowing Outcomes After Laryngectomy, and Edmonton 33-exhibited strong reliability and construct and content validity, though two applied only to individual functional outcomes within specific patient populations receiving radiation or laryngectomy. While many PROs have been developed in head and neck oncology, very few properly employed extensive patient input in the development process. Further work must be committed to increasing head and neck cancer patient input in PRO development, particularly in the functional domains of speech and chewing.
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Affiliation(s)
- Adrian I Mendez
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440 112(th) Street Northwest, Edmonton, Alberta T6G 2R7, Canada; Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Jacob G J Wihlidal
- Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Dean T Eurich
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440 112(th) Street Northwest, Edmonton, Alberta T6G 2R7, Canada.
| | - Anthony C Nichols
- Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - S Danielle MacNeil
- Division of Head and Neck Oncology and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond Street, London, Ontario N6A 3K7, Canada.
| | - Hadi R Seikaly
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440 112(th) Street Northwest, Edmonton, Alberta T6G 2R7, Canada.
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Shabani S, Turner K, Reblin M, Nichols AC, Wang X, Patel KB. A Review of Health Care Disparities in Head and Neck Squamous Cell Carcinomas. J Health Care Poor Underserved 2022; 33:478-491. [PMID: 35153235 DOI: 10.1353/hpu.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Head and neck squamous cell carcinomas are aggressive cancers with significant morbidity and mortality that can be confounded by health care disparities, particularly race. This article is intended to educate and provide evidence on the status of health care disparities in head and neck squamous cell carcinomas. A review of the English-language literature was performed using Pubmed and MEDLINE. Results indicated that African American patients are diagnosed at a younger age, presented with higher tumor burden, are less likely to receive definitive cancer treatment, and have increased mortality compared with non-African American patients. Much of these differences are reversible and can be eliminated by education, instituting screening programs, and also extending health care coverage.
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Eansor P, Norris ME, D'Souza LA, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, Warner A, Willmore KE, Campbell N, Palma DA. Is Remote Learning as Effective as In-Person Learning for Contouring Education? A Prospective Comparison of Face-to-Face vs. Online Delivery of the Anatomy and Radiology Contouring Bootcamp. Int J Radiat Oncol Biol Phys 2021; 112:590-599. [PMID: 34710522 DOI: 10.1016/j.ijrobp.2021.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE The Anatomy and Radiology Contouring (ARC) Bootcamp was a face-to-face (F2F) intervention providing integrated education for radiation oncology (RO) residents and medical physicists. To increase access, we launched an online offering in 2019. We evaluated the impact of the online course on participants' knowledge acquisition, contouring skills, and self-confidence by comparing it to the F2F course. METHODS AND MATERIALS: Using modules, the online course offers similar content to the F2F comparator. Participants from the 2019 F2F and the 2019-2020 online course completed pre- and post-evaluations, assessing anatomy/radiology knowledge, contouring skills, self-confidence, and course satisfaction. RESULTS There were 180 (F2F: n=40; online: n=140) enrolled and 57 (F2F: n=30; online: n=27) participants completed both evaluations. The online course had a wider geographic participation (19 countries) than F2F (4 countries). F2F had primarily RO resident participation (80%), compared to online (41%). Both cohorts demonstrated similar improvements in self-confidence pertaining to their anatomy/radiology knowledge, contouring skills, and in interpreting radiology images (all p < 0.001). Both the online (mean ± SD improvement: 6.6 ± 6.7 on a 40-point scale; p < 0.001) and F2F (3.7 ± 5.7; p=0.002) groups showed anatomy/radiology knowledge improvement. Only the F2F group demonstrated improvement with the contouring assessment (F2F: 0.10 ± 0.17 on a 1-point Dice scale; p=0.004; online: 0.07 ± 0.16; p=0.076). Both cohorts perceived the course as a positive experience (F2F: 4.8 ± 0.4 on a 5-point scale; online: 4.5 ± 0.6), stated it would improve their professional practice (F2F: 4.6 ± 0.5; online: 4.2 ± 0.8), and said they would recommend it to others (F2F: 4.8 ± 0.4; online: 4.4 ± 0.6). CONCLUSIONS The online ARC Bootcamp demonstrated improved self-confidence, knowledge scores, and high satisfaction levels among participants. The offering had lower completion rates but was more accessible to geographic regions, provided a flexible learning experience, and allowed for ongoing education during the COVID-19 pandemic.
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Affiliation(s)
- Paige Eansor
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Madeleine E Norris
- Department of Anatomy, University of California San Francisco, San Francisco, California
| | - Leah A D'Souza
- Department of Radiation Oncology, Rush University Medical Centre, Chicago, Illinois
| | - Glenn S Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care, London, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Manas Sharma
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Keng Yeow Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Katherine E Willmore
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Nicole Campbell
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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Kim HAJ, Shaikh MH, Lee M, Zeng PYF, Sorgini A, Akintola T, Deng X, Jarycki L, Khan H, MacNeil D, Khan MI, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Patel K, Mymryk JS, Barrett JW, Boutros PC, Morris LGT, Nichols AC. 3p Arm Loss and Survival in Head and Neck Cancer: An Analysis of TCGA Dataset. Cancers (Basel) 2021; 13:5313. [PMID: 34771477 PMCID: PMC8582539 DOI: 10.3390/cancers13215313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Loss of the 3p chromosome arm has previously been reported to be a biomarker of poorer outcome in both human papillomavirus (HPV)-positive and HPV-negative head and neck cancer. However, the precise operational measurement of 3p arm loss is unclear and the mutational profile associated with the event has not been thoroughly characterized. We downloaded the clinical, single nucleotide variation (SNV), copy number aberration (CNA), RNA sequencing, and reverse phase protein assay (RPPA) data from The Cancer Genome Atlas (TCGA) and The Cancer Proteome Atlas HNSCC cohorts. Survival data and hypoxia scores were downloaded from published studies. In addition, we report the inclusion of an independent Memorial Sloan Kettering cohort. We assessed the frequency of loci deletions across the 3p arm separately in HPV-positive and -negative disease. We found that deletions on chromosome 3p were almost exclusively an all or none event in the HPV-negative cohort; patients either had <1% or >97% of the arm deleted. 3p arm loss, defined as >97% deletion in HPV-positive patients and >50% in HPV-negative patients, had no impact on survival (p > 0.05). However, HPV-negative tumors with 3p arm loss presented at a higher N-category and overall stage and developed more distant metastases (p < 0.05). They were enriched for SNVs in TP53, and depleted for point mutations in CASP8, HRAS, HLA-A, HUWE1, HLA-B, and COL22A1 (false discovery rate, FDR < 0.05). 3p arm loss was associated with CNAs across the whole genome (FDR < 0.1), and pathway analysis revealed low lymphoid-non-lymphoid cell interactions and cytokine signaling (FDR < 0.1). In the tumor microenvironment, 3p arm lost tumors had low immune cell infiltration (FDR < 0.1) and elevated hypoxia (FDR < 0.1). 3p arm lost tumors had lower abundance of proteins phospho-HER3 and ANXA1, and higher abundance of miRNAs hsa-miR-548k and hsa-miR-421, which were all associated with survival. There were no molecular differences by 3p arm status in HPV-positive patients, at least at our statistical power level. 3p arm loss is largely an all or none phenomenon in HPV-negative disease and does not predict poorer survival from the time of diagnosis in TCGA cohort. However, it produces tumors with distinct molecular characteristics and may represent a clinically useful biomarker to guide treatment decisions for HPV-negative patients.
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Affiliation(s)
- Hugh Andrew Jinwook Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Mushfiq Hassan Shaikh
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Mark Lee
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY 10065, USA; (M.L.); (L.G.T.M.)
| | - Peter Y. F. Zeng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Alana Sorgini
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Temitope Akintola
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Xiaoxiao Deng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Laura Jarycki
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Halema Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Mohammed Imran Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Pencilla Lang
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - David A. Palma
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Krupal Patel
- Moffitt Cancer Center, Department of Otolaryngology, Tampa, FL 33612, USA;
| | - Joe S. Mymryk
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
- Department of Microbiology & Immunology, University of Western Ontario, London, ON N6A3K7, Canada
| | - John W. Barrett
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Paul C. Boutros
- Department of Human Genetics, University of California, Los Angeles, CA 90095, USA;
- Department of Urology, University of California, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA 90095, USA
- Institute for Precision Health, University of California, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA 90095, USA
| | - Luc G. T. Morris
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY 10065, USA; (M.L.); (L.G.T.M.)
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
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D'Angelo K, Eansor P, D'Souza LA, Norris ME, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, O'Neil M, Mitchell S, Feuz C, Warner A, Willmore KE, Campbell N, Probst H, Palma DA. Implementation and evaluation of an online anatomy, radiology and contouring bootcamp for radiation therapists. J Med Imaging Radiat Sci 2021; 52:567-575. [PMID: 34635471 DOI: 10.1016/j.jmir.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/10/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND As new treatments and technologies have been introduced in radiation oncology, the clinical roles of radiation therapists (RTs) have expanded. However, there are few formal learning opportunities for RTs. An online, anatomy, radiology and contouring bootcamp (ARC Bootcamp) originally designed for medical residents was identified as a prospective educational tool for RTs. The purpose of this study was to evaluate an RT edition of the ARC Bootcamp on knowledge, contouring, and confidence, as well as to identify areas for future modification. METHODS Fifty licensed RTs were enrolled in an eight-week, multidisciplinary, online RT ARC Bootcamp. Contouring practice was available throughout the course using an online contouring platform. Outcomes were evaluated using a pre-course and post-course multiple-choice quiz (MCQ), contouring evaluation and qualitative self-efficacy and satisfaction survey. RESULTS Of the fifty enrolled RTs, 30 completed the course, and 26 completed at least one of the post-tests. Nineteen contouring dice similarity coefficient (DSC) scores were available for paired pre- and post-course analysis. RTs demonstrated a statistically significant increase in mean DSC scoring pooled across all contouring structures (mean ± SD improvement: 0.09 ± 0.18 on a scale from 0 to 1, p=0.020). For individual contouring structures, 3/15 reached significance in contouring improvement. MCQ scores were available for 26 participants and increased after RT ARC Bootcamp participation with a mean ± SD pre-test score of 18.6 ± 4.2 (46.5%); on a 40-point scale vs. post-test score of 24.5 ± 4.3 (61.4%) (p < 0.001). RT confidence in contouring, anatomy knowledge and radiographic identification improved after course completion (p < 0.001). Feedback from RTs recommended more contouring instruction, less in-depth anatomy review and more time to complete the course. CONCLUSIONS The RT ARC Bootcamp was an effective tool for improving anatomy and radiographic knowledge among RTs. The course demonstrated improvements in contouring and overall confidence. However, only approximately half of the enrolled RTs completed the course, limiting statistical power. Future modifications will aim to increase relevance to RTs and improve completion rates.
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Affiliation(s)
- Krista D'Angelo
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Paige Eansor
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Leah A D'Souza
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, United States
| | - Madeleine E Norris
- Department of Anatomy, University of California San Francisco, San Francisco, CA, United States
| | - Glenn S Bauman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Zahra Kassam
- Department of Medical Imaging, St. Joseph's Health Care, London, Ontario, Canada
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Manas Sharma
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Keng Yeow Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Vikram Velker
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Melissa O'Neil
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Carina Feuz
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Katherine E Willmore
- Department of Anatomy and Cell Biology, Western University, London, Ontario, Canada
| | - Nicole Campbell
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Heidi Probst
- Department of Radiotherapy and Oncology, Sheffield Hallam University, Sheffield, United Kingdom
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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Eansor P, D’Souza LA, Norris ME, Willmore KE, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, Bauman GS, Warner A, Campbell N, Palma DA. 12: Is Remote Learning as Effective as In-Person Learning for Contouring Education? a Comparison of Face-To-Face Versus Online Delivery of the Anatomy and Radiology Contouring Bootcamp. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sowerby LJ, Nichols AC, Gibson R, Sommer DD, Moore C, Fraser DD, Arts E. Assessing the Risk of SARS-CoV-2 Transmission via Surgical Electrocautery Plume. JAMA Surg 2021; 156:883-885. [PMID: 34019099 PMCID: PMC8140389 DOI: 10.1001/jamasurg.2021.2591] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Leigh J Sowerby
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Otolaryngology-Head and Neck Surgery, Western University, St Joseph's Hospital, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Richard Gibson
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
| | - Doron D Sommer
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Corey Moore
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Douglas D Fraser
- Department of Physiology and Pharmacology, Western University, London, Ontario, Canada
| | - Eric Arts
- Department of Microbiology and Immunology, Western University, London, Ontario, Canada
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Sawka AM, Ghai S, Tomlinson G, Baxter NN, Corsten M, Imran SA, Bissada E, Lebouef R, Audet N, Brassard M, Zhang H, Gupta M, Nichols AC, Morrison D, Johnson-Obeski S, Prisman E, Anderson D, Chandarana SP, Ghaznavi S, Jones J, Gafni A, Matelski JJ, Xu W, Goldstein DP. A Protocol for a Pan-Canadian Prospective Observational Study on Active Surveillance or Surgery for Very Low Risk Papillary Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:686996. [PMID: 34194396 PMCID: PMC8237853 DOI: 10.3389/fendo.2021.686996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/17/2021] [Indexed: 12/01/2022] Open
Abstract
Background The traditional management of papillary thyroid cancer (PTC) is thyroidectomy (total or partial removal of the thyroid). Active surveillance (AS) may be considered as an alternative option for small, low risk PTC. AS involves close follow-up (including regularly scheduled clinical and radiological assessments), with the intention of intervening with surgery for disease progression or patient preference. Methods This is a protocol for a prospective, observational, long-term follow-up multi-centre Canadian cohort study. Consenting eligible adults with small, low risk PTC (< 2cm in maximal diameter, confined to the thyroid, and not immediately adjacent to critical structures in the neck) are offered the choice of AS or surgery for management of PTC. Patient participants are free to choose either option (AS or surgery) and the disease management course is thus not assigned by the investigators. Surgery is provided as usual care by a surgeon in an institution of the patient's choice. Our primary objective is to determine the rate of 'failure' of disease management in respective AS and surgical arms as defined by: i) AS arm - surgery for progression of PTC, and ii) surgical arm - surgery or other treatment for disease persistence or progression after completing initial treatment. Secondary outcomes include long-term thyroid oncologic and treatment outcomes, as well as patient-reported outcomes. Discussion The results from this study will provide long-term clinical and patient reported outcome evidence regarding active surveillance or immediate surgery for management of small, low risk PTC. This will inform future clinical trials in disease management of small, low risk papillary thyroid cancer. Registration details This prospective observational cohort study is registered on clinicaltrials.gov (NCT04624477), but it should not be considered a clinical trial as there is no assigned intervention and patients are free to choose either AS or surgery.
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Affiliation(s)
- Anna M. Sawka
- Division of Endocrinology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Sangeet Ghai
- Joint Department of Medical Imaging, University Health Network-Mt Sinai Hospital-Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- Department of Medicine, University Health Network and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Nancy N. Baxter
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Martin Corsten
- Department of Otolaryngology-Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Syed Ali Imran
- Division of Endocrinology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Eric Bissada
- Department of Otolaryngology-Head and Neck Surgery, l’Université de Montréal, Montreal, QC, Canada
| | - Rebecca Lebouef
- Division of Endocrinology, Department of Medicine, l’Université de Montréal, Montreal, QC, Canada
| | - Nathalie Audet
- Department of Otolaryngology-Head and Neck Surgery, Université Laval, Quebec City, QC, Canada
| | - Maryse Brassard
- Division of Endocrinology, Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Han Zhang
- Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Gupta
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - Deric Morrison
- Division of Endocrinology, Department of Medicine, Western University, London, ON, Canada
| | | | - Eitan Prisman
- Department of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Don Anderson
- Department of Otolaryngology-Head & Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Shamir P. Chandarana
- Section of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Sana Ghaznavi
- Division of Endocrinology, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer Jones
- Department of Psychosocial Oncology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - John J. Matelski
- Mount Sinai Hospital, University of Toronto, Toronto, Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - Wei Xu
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David P. Goldstein
- Department of Otolaryngology and Head and Neck Surgery, University Health Network and University of Toronto, Toronto, ON, Canada
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Zayed S, Lin C, Boldt G, Lang P, Read N, Venkatesan V, Sathya J, Kevin F, MacNeil D, Mendez A, Yoo J, Warner A, Nichols AC, Palma DA. Survival outcomes in primary head and neck adult sarcoma: A systematic review and meta-analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6055 Background: Head and neck sarcomas (HNS) are rare entities and confer substantial morbidity and mortality. Yet, the optimal management of HNS remains unclear. This study aimed to describe the epidemiology of HNS and to identify the most favorable treatment approach. Methods: We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the PubMed (Medline), EMBASE, and Cochrane Library databases, queried from 1990 until present. Articles in the English language reporting on survival outcomes of adult primary HNS patients treated with curative-intent were included. All estimates were weighted based on sample size. Analysis of variance (ANOVA) and two-sample t-tests were used as appropriate. Meta-analyses were performed using random effects models. This study was registered with PROSPERO, CRD42021220970. Results: A total of 3652 articles were identified, with 42 articles reporting on 21228 patients, meeting inclusion criteria. Mean ± SD age was 56.7 ± 14.6 years with 14170 (67.0%) men and 6991 (33.0%) women. The most common locations included skin and soft tissues (n = 12749, 63.3%), bones of skull and face (n = 2256, 11.2%), and oral cavity (n = 1775, 8.8%). The most common histologies included undifferentiated pleomorphic sarcoma (n = 5065, 24.8%), osteosarcoma (n = 2578, 12.6%), Kaposi sarcoma (n = 2316, 11.3%), chondrosarcoma (n = 2141, 10.5%), and hemangiosarcoma (n = 2072, 10.1%). 5459 patients had early stage I-II disease (76.9%) whereas 1643 had late stage III-IV disease (23.1%). Most received surgery alone (n = 10968, 61.0%), 3917 (21.8%) received surgery and radiotherapy (RT), 2173 (12.1%) received definitive RT/chemoradiotherapy (CRT), 811 (4.5%) received surgery and CRT, and 98 (0.5%) received surgery and chemotherapy. Negative margins were achieved in 6081 (76.5%). Mean ± SD follow-up was 55.3 ± 42.8 months. Weighted mean, 2-, 5-, and 10-year overall survival (OS) were 78.5 months, 75.9%, 63.2%, and 54.9% respectively. There was no significant difference in mean OS (P = 0.674) or 5-year OS (P = 0.965) between patients who received surgery alone, multimodality treatment with surgery and RT/CRT, or definitive RT/CRT. Mean ± SD 5-year OS was significantly higher with negative margins (62.7 ± 20.8%) compared with positive margins (22.7 ± 19.1%; P = 0.001). Mean ± SD local recurrence rate (LRR) was 32.0 ± 13.0%. LRRs were 41.8% for definitive RT/CRT, 39.3% for surgery and CRT, 33.6% for surgery alone, 24.7% for surgery and chemotherapy, and 20.1% for surgery and RT (P = 0.126). Conclusions: In the largest HNS study to date, negative margins were associated with an improvement in OS. Multimodality treatment did not confer an OS benefit. Definitive RT/CRT may be associated with a higher LRR. Randomized trials are needed to establish the optimal treatment approach for HNS.
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Affiliation(s)
- Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Cindy Lin
- Western University, London, ON, Canada
| | - Gabriel Boldt
- Department of Oncology, London Regional Cancer Program, London, ON, Canada
| | | | - Nancy Read
- London Health Sciences Centre, London, ON, Canada
| | | | - Jinka Sathya
- London Health Sciences Centre, London, ON, Canada
| | - Fung Kevin
- University of Western Ontario, London, ON, Canada
| | - Danielle MacNeil
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Adrian Mendez
- London Health Sciences Centre, Western University, London, ON, Canada
| | - John Yoo
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Anthony C. Nichols
- Western University and London Health Sciences Centre, London, ON, Canada
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Zayed S, Lin C, Boldt G, Lang P, Read N, Venkatesan V, Sathya J, Kevin F, MacNeil D, Mendez A, Yoo J, Warner A, Nichols AC, Palma DA. Survival outcomes in primary angiosarcoma of the head and neck: A systematic review and meta-analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18039 Background: Angiosarcoma of the head and neck (ASHN) is a rare entity and confers substantial morbidity and mortality. Yet, the optimal management of ASHN remains unclear. This study aimed to describe the epidemiology of ASHN and to identify the most favorable treatment approach. Methods: We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the PubMed (Medline), EMBASE, and Cochrane Library databases, queried from 1990 until present. Articles in the English language reporting on survival outcomes of adult primary ASHN treated with curative-intent, were included. All estimates were weighted based on sample size. Analysis of variance (ANOVA) and two-sample t-tests were used as appropriate. This study was registered with PROSPERO, CRD42021220970. Results: A total of 3652 studies were identified, with 14 articles reporting on 2265 ASHN patients, meeting inclusion criteria. Mean ± SD age was 70.6 ± 7.7 years with 1621 (66.6%) men and 812 (33.4%) women. ASHN involved the scalp (n = 176, 57.9%) and the face (n = 128, 42.1%). 249 patients had early stage I-II disease (39.6%) whereas 379 had late stage III-IV disease (60.4%). Most (n = 529, 45.6%) received surgery and radiotherapy (RT), 305 (26.3%) received surgery alone, 210 (18.1%) received definitive RT/chemoradiotherapy (CRT), 75 (6.5%) received surgery and CRT, and 33 (2.8%) received surgery and chemotherapy. Negative margins were achieved in 471 (55.9%) whereas 371 (44.1%) had positive margins. Mean ± SD follow-up was 41.7 ± 15.4 months. Weighted mean, 1-, 5-, and 10-year overall survival (OS) were 26.9 months, 67.3%, 30.6%, and 20.8% respectively. Mean and 5-year disease-specific survival (DSS) were 72.9 months and 50.3% respectively. Mean ± SD local recurrence rate (LRR) was 32.1 ± 11.7%. Median RT dose delivered was 60 Gy (interquartile range: 60-70). Patients who received surgery had a significantly higher mean OS (34.9 vs. 18.7 months, P = 0.04) and 5-year OS (30.1 vs. 14.2%, P = 0.01) compared with those who did not receive surgery. There was no significant difference in mean OS for receiving adjuvant chemotherapy (P = 0.99) or RT (P = 0.51). Conclusions: In the largest ASHN study to date, definitive surgical resection was associated with an improvement in OS. Multimodality treatment did not confer an OS benefit. Randomized trials are needed to establish the optimal treatment approach for ASHN.
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Affiliation(s)
- Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Cindy Lin
- Western University, London, ON, Canada
| | - Gabriel Boldt
- Department of Oncology, London Regional Cancer Program, London, ON, Canada
| | | | - Nancy Read
- London Health Sciences Centre, London, ON, Canada
| | | | - Jinka Sathya
- London Health Sciences Centre, London, ON, Canada
| | - Fung Kevin
- University of Western Ontario, London, ON, Canada
| | - Danielle MacNeil
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Adrian Mendez
- London Health Sciences Centre, Western University, London, ON, Canada
| | - John Yoo
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Anthony C. Nichols
- Western University and London Health Sciences Centre, London, ON, Canada
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Bahig H, Rosenthal DI, Nguyen-Tan FP, Fuller DC, Yuan Y, Hutcheson KA, Christopoulos A, Nichols AC, Fung K, Ballivy O, Filion E, Ng SP, Lambert L, Dorth J, Hu KS, Palma D. Vocal-cord Only vs. Complete Laryngeal radiation (VOCAL): a randomized multicentric Bayesian phase II trial. BMC Cancer 2021; 21:446. [PMID: 33888069 PMCID: PMC8061218 DOI: 10.1186/s12885-021-08195-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/22/2020] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC. METHODS One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice. DISCUSSION This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.
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Affiliation(s)
- Houda Bahig
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David I. Rosenthal
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Félix-Phuc Nguyen-Tan
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David C. Fuller
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Ying Yuan
- grid.240145.60000 0001 2291 4776Biostatistics Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine A. Hutcheson
- grid.240145.60000 0001 2291 4776Head and Neck Surgery Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Apostolos Christopoulos
- grid.410559.c0000 0001 0743 2111Head and Neck Surgery Department, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Anthony C. Nichols
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Kevin Fung
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Olivier Ballivy
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Edith Filion
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Sweet Ping Ng
- grid.1055.10000000403978434Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Louise Lambert
- Radiation Oncology Department, Centre Intégré de Cancérologie de Laval, Laval, Canada
| | - Jennifer Dorth
- grid.67105.350000 0001 2164 3847Radiation Oncology Department, Case Western Reserve University, Cleveland, USA
| | - Kenneth S. Hu
- Radiation Oncology Department, NYU Langone Health, Newyork, USA
| | - David Palma
- grid.39381.300000 0004 1936 8884Radiation Oncology Department, Western University, London, Ontario Canada
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Sahovaler A, Ferrari M, Athayde J, Mendez A, Fung K, Yoo J, Nichols AC, MacNeil SD. Investigating the Sources of Heterogeneity in Systematic Review of Recurrence Rate after Hemithyroidectomy for Low-Risk Well-Differentiated Thyroid Cancer. Eur Thyroid J 2021; 10:179-182. [PMID: 33981623 PMCID: PMC8077353 DOI: 10.1159/000511870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
- *Axel Sahovaler, Department of Otolaryngology − Head and Neck Surgery, London Health Science Centre, Victoria Hospital, Room B3-432A, 437.217.3481, 800 Commissioners Rd. E, London ON N6A 5W9 (Canada),
| | - Marco Ferrari
- Guided Therapeutics (GTx) Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
- Unit of Otorhinolaryngology − Head and Neck Surgery, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
- Section of Otorhinolaryngology − Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Jonathan Athayde
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S. Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Kim HAJ, Zeng PYF, Shaikh MH, Mundi N, Ghasemi F, Di Gravio E, Khan H, MacNeil D, Khan MI, Patel K, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Boutros PC, Nichols AC. All HPV-negative head and neck cancers are not the same: Analysis of the TCGA dataset reveals that anatomical sites have distinct mutation, transcriptome, hypoxia, and tumor microenvironment profiles. Oral Oncol 2021; 116:105260. [PMID: 33725617 DOI: 10.1016/j.oraloncology.2021.105260] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) affects various anatomical sites, which often dictates whether the cancer is managed with primary surgery or radiation. This study aimed to assess differences in single nucleotide variation (SNV), copy number, mRNA abundance, methylation, and tumor microenvironment (TME) between HPV-negative oral cavity (OC), oropharyngeal (OPC), hypopharyngeal (HPC), and laryngeal (LC) cancers within The Cancer Genome Atlas (TCGA). METHODS We downloaded the clinical information and molecular data for the TCGA HNSCC cohort from the data portal and published literature. The TME was estimated using mRNA abundance data. We conducted our analyses within the Bioconductor statistical framework in the R environment. CNA and mRNA abundance results were correlated and grouped with SNV results for downstream pathway analysis. RESULTS LC had a higher mutational burden than OC and OPC (p <10-4). LC tumors were enriched in CSMD3, NSD1, DCHS2 and ANK2 SNVs, while OC tumors were enriched in CASP8 SNVs (FDR < 0.1). LCs were enriched for neuronal and glycosylation pathways, while OCs were enriched for extracellular matrix pathways. B cells and endothelial cells were more abundant in LC while monocytes were more abundant in OC (FDR < 0.1). OPC was the most hypoxic, followed by OC then LC (FDR < 0.05). OC had greater methylation of Hox genes than LC. Subsite analysis revealed that oral tongue cancers had fewer CASP8 and FBN2 mutations and higher dendritic cell abundance than other oral cavity cancers. CONCLUSIONS We identified significant genomic, transcriptional, and microenvironmental differences between HPV-negative HNSCC. Further study is warranted to determine if these findings portend differential response to specific treatment modalities.
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Affiliation(s)
- Hugh Andrew Jinwook Kim
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mushfiq Hassan Shaikh
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Neil Mundi
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Farhad Ghasemi
- Department of General Surgery, University of Western Ontario, London, Ontario, Canada
| | - Eric Di Gravio
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Halema Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Mohammed Imran Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Krupal Patel
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, FL, USA
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Joe S Mymryk
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA, USA; Institute for Precision Health, University of California, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA, USA
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada.
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Shi LL, McMullen C, Vorwald K, Nichols AC, MacNeil SD, Wadsworth JT, Chung CH, Wang X, Patel KB. Survival outcomes of patients with subglottic squamous cell carcinoma : a study of the National Cancer Database. Eur Arch Otorhinolaryngol 2021; 278:4923-4932. [PMID: 33646344 DOI: 10.1007/s00405-021-06712-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/30/2020] [Accepted: 02/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subglottic squamous cell carcinoma (SCC) represents less than 5% of all laryngeal cancers. Our objective was to better characterize survival using the National Cancer Database (NCDB) registry from 2004 to 2015. RESULTS 403 patients met inclusion criteria. 63.8% presented with advanced-stage disease. Treatment regimens were as follows: 15.9% underwent surgery alone, 16.9% underwent surgery followed by adjuvant therapy, and 67.2% underwent primary chemo/radiation (C/RT). Five-year overall survival (OS) was 58.6% for Stage I and II patients, 49.1% for Stage III, and 36.3% for stage IV. Adjusted OS for all-stage patients was worse with C/RT compared to upfront surgery (40.6% vs. 58.4%; HR 1.83 [95%CI 1.29-2.61] p < 0.001) and adjusted OS for stage 4 disease was significantly worse with C/RT compared to surgery (26.0% vs. 45.2%, HR 1.79 [95%CI 1.17-2.73] p = 0.007). CONCLUSION Majority of patients were treated with primary C/RT. Adjusted survival favors upfront surgery versus C/RT, especially in patients with Stage IV disease.
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Affiliation(s)
- Lucy L Shi
- Department of Otolaryngology-Head and Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Caitlin McMullen
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Kathryn Vorwald
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, ON, Canada
| | - J Trad Wadsworth
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Christine H Chung
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Xuefeng Wang
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Krupal B Patel
- Department of Head and Neck-Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
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Sahovaler A, Kim MH, Mendez A, Palma D, Fung K, Yoo J, Nichols AC, MacNeil SD. Survival Outcomes in Human Papillomavirus-Associated Nonoropharyngeal Squamous Cell Carcinomas: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg 2021; 146:1158-1166. [PMID: 33057610 DOI: 10.1001/jamaoto.2020.3382] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Although the survival impact of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma (OPSCC) is well known, there has been conflicting and scarce evidence on the role of HPV in non-OPSCC. Objective To undertake a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant systematic review and meta-analysis of all published studies on the association between HPV status and survival outcomes in patients with non-OPSCC, analyzing each site separately. Data Sources PubMed, CINAHL, and Embase were searched from 1946 to December 16, 2019, for English-language articles. Study Selection Analysis comprised randomized clinical trials or observational studies that each included at least 10 patients with non-OPSCC in which the presence of HPV was analyzed, survival outcomes were reported, and a clinical follow-up of 1 year or more was performed. Studies excluded were those in which data on OPSCC and non-OPSCC were not distinguished between both cohorts and studies on patients with distant metastatic tumors at diagnosis. Final analysis included outcomes that were analyzed in at least 3 studies. Data Extraction and Synthesis Two reviewers independently abstracted the data. Risk of bias was estimated with the Newcastle-Ottawa Scale. Meta-analysis was performed using the random-effects model. Main Outcomes and Measures The primary end point was overall survival (OS); secondary end points were disease-specific survival (DSS) and disease-free survival (DFS). Results Of the 3947 articles screened, a total of 22 observational and 2 randomized clinical trials were included in the analysis, representing 24 854 patients. In oral cavity locations, OS was not significantly associated with HPV positivity (hazard ratio [HR], 1.16; 95% CI, 0.83-1.61; I2 = 71%); however, HPV-positive tumors showed worse DFS (HR, 1.81; 95% CI, 1.12-2.91; I2 = 47%). Laryngeal and hypopharyngeal HPV-positive tumors were associated with improved OS (HR, 0.71; 95% CI, 0.54-0.92; I2 = 38% and HR, 0.60; 95% CI, 0.47-0.76; I2 = 0%), respectively, whereas, in nasopharyngeal locations HPV was not associated with OS (HR, 0.82; 95% CI, 0.49-1.38; I2 = 46%) or DSS (HR, 0.55; 95% CI, 0.22-1.42; I2 = 65%). Conclusions and Relevance In this meta-analysis of 24 studies, HPV was associated with improved OS in laryngeal and hypopharyngeal locations but not in the oral cavity and the nasopharynx. This information may be useful for future clinical studies of laryngeal and hypopharyngeal tumors and whether HPV status should be incorporated in prognostication of patients with these cancers.
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Affiliation(s)
- Axel Sahovaler
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.,Guided Therapeutics Program, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Min Hui Kim
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - David Palma
- Department of Radiation Oncology, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada
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Gameiro SF, Ghasemi F, Zeng PYF, Mundi N, Howlett CJ, Plantinga P, Barrett JW, Nichols AC, Mymryk JS. Low expression of NSD1, NSD2, and NSD3 define a subset of human papillomavirus-positive oral squamous carcinomas with unfavorable prognosis. Infect Agent Cancer 2021; 16:13. [PMID: 33588906 PMCID: PMC7885607 DOI: 10.1186/s13027-021-00347-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 11/05/2020] [Accepted: 01/19/2021] [Indexed: 12/20/2022] Open
Abstract
Background Frequent mutations in the nuclear receptor binding SET domain protein 1 (NSD1) gene have been observed in head and neck squamous cell carcinomas (HNSCC). NSD1 encodes a histone 3 lysine-36 methyltransferase. NSD1 mutations are correlated with improved clinical outcomes and increased sensitivity to platinum-based chemotherapy agents in human papillomavirus-negative (HPV-) tumors, despite weak T-cell infiltration. However, the role of NSD1 and related family members NSD2 and NSD3 in human papillomavirus-positive (HPV+) HNSCC is unclear. Methods Using data from over 500 HNSCC patients from The Cancer Genome Atlas (TCGA), we compared the relative level of mRNA expression of NSD1, NSD2, and NSD3 in HPV+ and HPV- HNSCC. Correlation analyses were performed between T-cell infiltration and the relative level of expression of NSD1, NSD2, and NSD3 mRNA in HPV+ and HPV- HNSCC. In addition, overall survival outcomes were compared for both the HPV+ and HPV- subsets of patients based on stratification by NSD1, NSD2, and NSD3 expression levels. Results Expression levels of NSD1, NSD2 or NSD3 were not correlated with altered lymphocyte infiltration in HPV+ HNSCC. More importantly, low expression of NSD1, NSD2, or NSD3 correlated with significantly reduced overall patient survival in HPV+, but not HPV- HNSCC. Conclusion These results starkly illustrate the contrast in molecular features between HPV+ and HPV- HNSCC tumors and suggest that NSD1, NSD2, and NSD3 expression levels should be further investigated as novel clinical metrics for improved prognostication and patient stratification in HPV+ HNSCC. Supplementary Information The online version contains supplementary material available at 10.1186/s13027-021-00347-6.
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Affiliation(s)
- Steven F Gameiro
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, N6A 3K7, Canada
| | - Farhad Ghasemi
- Department of Surgery, The University of Western Ontario, London, ON, N6A 3K7, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology, Head & Neck Surgery, The University of Western Ontario, London, ON, N6A 3K7, Canada
| | - Neil Mundi
- Department of Otolaryngology, Head & Neck Surgery, The University of Western Ontario, London, ON, N6A 3K7, Canada
| | - Christopher J Howlett
- Department of Pathology, The University of Western Ontario, London, ON, N6A 3K7, Canada
| | - Paul Plantinga
- Department of Pathology, The University of Western Ontario, London, ON, N6A 3K7, Canada
| | - John W Barrett
- Department of Otolaryngology, Head & Neck Surgery, The University of Western Ontario, London, ON, N6A 3K7, Canada
| | - Anthony C Nichols
- Department of Otolaryngology, Head & Neck Surgery, The University of Western Ontario, London, ON, N6A 3K7, Canada. .,Department of Pathology, The University of Western Ontario, London, ON, N6A 3K7, Canada. .,Department of Oncology, The University of Western Ontario, London, ON, N6A 3K7, Canada. .,London Regional Cancer Program, Lawson Health Research Institute, London, ON, N6C 2R5, Canada. .,Department of Otolaryngology - Head and Neck Surgery, Schulich School of Medicine & Dentistry, Western University, Room B3-431A, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
| | - Joe S Mymryk
- Department of Microbiology and Immunology, The University of Western Ontario, London, ON, N6A 3K7, Canada. .,Department of Otolaryngology, Head & Neck Surgery, The University of Western Ontario, London, ON, N6A 3K7, Canada. .,Department of Oncology, The University of Western Ontario, London, ON, N6A 3K7, Canada. .,London Regional Cancer Program, Lawson Health Research Institute, London, ON, N6C 2R5, Canada. .,London Regional Cancer Program, 790 Commissioners Rd. East, London, Ontario, N6A 4L6, Canada.
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Eansor P, Norris ME, D’Souza LA, Bauman GS, Kassam Z, Leung E, Nichols AC, Sharma M, Tay KY, Velker V, Warner A, Willmore KE, Palma DA, Campbell N. Development, Implementation, and Initial Participant Feedback of an Online Anatomy and Radiology Contouring Bootcamp in Radiation Oncology. J Med Educ Curric Dev 2021; 8:23821205211037756. [PMID: 34568575 PMCID: PMC8461572 DOI: 10.1177/23821205211037756] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/16/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The Anatomy and Radiology Contouring (ARC) Bootcamp was a face-to-face (F2F) course designed to ensure radiation oncology residents were equipped with the knowledge and skillset to use radiation therapy techniques properly. The ARC Bootcamp was proven to be a useful educational intervention for improving learners' knowledge of anatomy and radiology and contouring ability. An online version of the course was created to increase accessibility to the ARC Bootcamp and provide a flexible, self-paced learning environment. This study aimed to describe the instructional design model used to create the online offering and report participants' motivation to enroll in the course and the online ARC Bootcamp's strengths and improvement areas. METHODS The creation of the online course followed the analysis, design, development, implementation, and evaluation (ADDIE) framework. The course was structured in a linear progression of locked modules consisting of radiology and contouring lectures, anatomy labs, and integrated evaluations. RESULTS The online course launched on the platform Teachable in November 2019, and by January 2021, 140 participants had enrolled in the course, with 27 participants completing all course components. The course had broad geographic participation with learners from 19 different countries. Of the participants enrolled, 34% were female, and most were radiation oncology residents (56%), followed by other programs (24%), such as medical physics residents or medical students. The primary motivator for participants to enroll was to improve their subject knowledge/skill (44%). The most common strength identified by participants was the course's quality (41%), and the most common improvement area was to incorporate more course content (41%). CONCLUSIONS The creation of the online ARC Bootcamp using the ADDIE framework was feasible. The course is accessible to diverse geographic regions and programs and provides a flexible learning environment; however, the course completion rate was low. Participants' feedback regarding their experiences will inform future offerings of the online course.
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Affiliation(s)
| | | | | | | | | | - Eric Leung
- Odette Cancer Centre, Toronto, ON, Canada
| | | | - Manas Sharma
- London Health Sciences
Centre, London, ON, Canada
| | - Keng Y. Tay
- London Health Sciences
Centre, London, ON, Canada
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Sorgini A, Kim HAJ, Zeng PYF, Shaikh MH, Mundi N, Ghasemi F, Di Gravio E, Khan H, MacNeil D, Khan MI, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Patel KB, Boutros PC, Nichols AC. Analysis of the TCGA Dataset Reveals that Subsites of Laryngeal Squamous Cell Carcinoma are Molecularly Distinct. Cancers (Basel) 2020; 13:cancers13010105. [PMID: 33396315 PMCID: PMC7794818 DOI: 10.3390/cancers13010105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Squamous cell carcinomas from different parts of the larynx have distinct presentations and prognoses, but the molecular basis for this discrepancy has yet to be characterized. We aimed to determine whether different types of mutations at the DNA, mRNA, and protein levels exist to explain the differential prognoses observed. We found that cancers of the supraglottis had higher overall and smoking-associated genome mutations. Further, supraglottic cancers had a significantly poorer prognosis when other clinical variables and mutational status were controlled for. Different protein pathways were enriched in each subsite: muscle-related in the glottis and neural in the supraglottis. Specific cancer-related proteins were also differentially abundant between the supraglottis and glottis. Our findings may partially explain therapeutic response differences, but further study is required for validation. Abstract Laryngeal squamous cell carcinoma (LSCC) from different subsites have distinct presentations and prognosis. In this study, we carried out a multiomic comparison of LSCC subsites. The Cancer Genome Atlas (TCGA) LSCC cohort was analyzed in the R statistical environment for differences between supraglottic and glottic cancers in single nucleotide variations (SNVs), copy number alterations (CNAs), mRNA abundance, protein abundance, pathway overrepresentation, tumor microenvironment (TME), hypoxia status, and patient outcome. Supraglottic cancers had significantly higher overall and smoking-associated SNV mutational load. Pathway analysis revealed upregulation of muscle related pathways in glottic cancer and neural pathways in supraglottic cancer. Proteins involved in cancer relevant signaling pathways including PI3K/Akt/mTOR, the cell cycle, and PDL1 were differentially abundant between subsites. Glottic and supraglottic tumors have different molecular profiles, which may partially account for differences in presentation and response to therapy.
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Affiliation(s)
- Alana Sorgini
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Hugh Andrew Jinwook Kim
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Peter Y. F. Zeng
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Mushfiq Hassan Shaikh
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Neil Mundi
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Farhad Ghasemi
- Department of General Surgery, University of Western Ontario, London, ON N6A 5C5, Canada;
| | - Eric Di Gravio
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Halema Khan
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Danielle MacNeil
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Mohammed Imran Khan
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Adrian Mendez
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - John Yoo
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Kevin Fung
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Pencilla Lang
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - David A. Palma
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Joe S. Mymryk
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
- Department of Microbiology & Immunology, University of Western Ontario, London, ON N6A 5C1, Canada
| | - John W. Barrett
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Krupal B. Patel
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Paul C. Boutros
- Department of Human Genetics, University of California, Los Angeles, CA 90095, USA;
- Department of Urology, University of California, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA 90095, USA
- Institute for Precision Health, University of California, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA 90095, USA
| | - Anthony C. Nichols
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
- Correspondence: ; Tel.: +519-685-8804
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Kim HA, Zeng PY, Sorgini A, Shaikh MH, Mundi N, Khan H, MacNeil D, Khan MI, Patel K, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Boutros PC, Nichols AC. Abstract PR11: Multi-omic disparities in head and neck squamous cell carcinomas in patients of different racio-ethnic backgrounds. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-pr11] [Citation(s) in RCA: 0] [Impact Index Per Article: 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
Abstract
Background: Numerous studies have demonstrated poorer outcomes by race/ethnicity in head and neck squamous cell carcinoma (HNSCC). Although some studies have identified differences in socioeconomic status and access to care as important factors affecting outcomes, differences in the genomic and extracellular composition of tumors from patients of different races/ethnicities have yet to be explored. Methods: We downloaded the clinical information, single nucleotide variation (SNV), copy number aberration (CNA), mRNA sequencing, and reverse phase protein assay (RPPA) data from The Cancer Genome Atlas (TCGA) and The Cancer Proteome Altas HNSCC cohorts. Survival data and hypoxia scores were downloaded from published studies. We stratified the cohort into combined racio-ethnic groups (REG) as follows: White/Non-Hispanic (White), Hispanic/Latino (Hispanic), Black/African American (Black), Asian, American Indian/Non-Hispanic (Indigenous American). Cases positive for human papillomavirus (HPV) occurred almost exclusively among White patients (68/71) and thus they were excluded. Results: The HPV-negative cohort contained 354 White, 43 Black, 22 Hispanic and 11 Asian and 1 Indigenous American patient. Black patients had poorer overall and progression-free survival than White patients on univariate and multivariate analysis, respectively (p<0.05). There were no significant SNV differences between any REGs after false discovery rate (FDR) correction. However, there was a large number of CNAs with higher frequency in Black patients compared to White patients (2294 shallow deletions, 96 gains, FDR<0.1). In particular, loss of the 3p chromosome arm was markedly more frequent in tumors from Black patients (p<0.01), but was not associated with poorer prognosis. From the RPPA data we found 31 cancer-associated proteins and phosphoproteins differentially expressed between Black and White patients (FDR<0.1). These included proteins in the PI3K/Akt/mTOR pathway in White patients, and N-cadherin and Hsp70 in Black patients. Deconvolution of the mRNA sequencing counts revealed differences in lymphocyte infiltration of the tumor microenvironment between Black, Hispanic, and White patients (FDR<0.1). Black patients also had more hypoxic tumors than White patients (FDR<0.1). Conclusions: In summary, we have identified important biological differences between tumors of different REGs that may partially account for differences in survival and inform targeted treatment decisions towards equitable outcomes.
Citation Format: Hugh A.J. Kim, Peter Y.F. Zeng, Alana Sorgini, Mushfiq H. Shaikh, Neil Mundi, Halema Khan, Danielle MacNeil, Mohammed I. Khan, Krupal Patel, Adrian Mendez, John Yoo, Kevin Fung, Pencilla Lang, David A. Palma, Joe S. Mymryk, John W. Barrett, Paul C. Boutros, Anthony C. Nichols. Multi-omic disparities in head and neck squamous cell carcinomas in patients of different racio-ethnic backgrounds [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR11.
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Affiliation(s)
| | | | | | | | - Neil Mundi
- 1Western University, London, ON, Canada,
| | | | | | | | | | | | - John Yoo
- 1Western University, London, ON, Canada,
| | - Kevin Fung
- 1Western University, London, ON, Canada,
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Price KAR, Nichols AC, Shen CJ, Rammal A, Lang P, Palma DA, Rosenberg AJ, Chera BS, Agrawal N. Novel Strategies to Effectively De-escalate Curative-Intent Therapy for Patients With HPV-Associated Oropharyngeal Cancer: Current and Future Directions. Am Soc Clin Oncol Educ Book 2020; 40:1-13. [PMID: 32213088 DOI: 10.1200/edbk_280687] [Citation(s) in RCA: 11] [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] [Indexed: 12/12/2022]
Abstract
The treatment of patients with HPV-associated oropharyngeal cancer (HPV-OPC) is rapidly evolving and challenging the standard of care of definitive radiotherapy with concurrent cisplatin. There are numerous promising de-escalation strategies under investigation, including deintensified definitive chemoradiotherapy, transoral surgery followed by de-escalated adjuvant therapy, and induction chemotherapy followed by de-escalated locoregional therapy. Definitive radiotherapy alone or with cetuximab is not recommended for curative-intent treatment of patients with locally advanced HPV-OPC. The results of ongoing phase III studies are awaited to help answer key questions and address ongoing controversies to transform the treatment of patients with HPV-OPC. Strategies for de-escalation under investigation include the incorporation of immunotherapy and the use of novel biomarkers for patient selection for de-escalation.
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Affiliation(s)
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Almoaidbellah Rammal
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Division of Radiation Oncology, Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Ari J Rosenberg
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Bhisham S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Nishant Agrawal
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL
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