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Devault-Tousignant C, Harvie M, Bissada E, Christopoulos A, Tabet P, Guertin L, Bahig H, Ayad T. The use of artificial intelligence in reconstructive surgery for head and neck cancer: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08663-4. [PMID: 38662215 DOI: 10.1007/s00405-024-08663-4] [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: 02/25/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES The popularity of artificial intelligence (AI) in head and neck cancer (HNC) management is increasing, but postoperative complications remain prevalent and are the main factor that impact prognosis after surgery. Hence, recent studies aim to assess new AI models to evaluate their ability to predict free flap complications more effectively than traditional algorithms. This systematic review aims to summarize current evidence on the utilization of AI models to predict complications following reconstructive surgery for HNC. METHODS A combination of MeSH terms and keywords was used to cover the following three subjects: "HNC," "artificial intelligence," and "free flap or reconstructive surgery." The electronic literature search was performed in three relevant databases: Medline (Ovid), Embase (Ovid), and Cochrane. Quality appraisal of the included study was conducted using the TRIPOD Statement. RESULTS The review included a total of 5 manuscripts (n = 5) for a total of 7524 patients. Across studies, the highest area under the receiver operating characteristic (AUROC) value achieved was 0.824 by the Auto-WEKA model. However, only 20% of reported AUROCs exceeded 0.70. One study concluded that most AI models were comparable or inferior in performance to conventional logistic regression. The highest predictors of complications were flap type, smoking status, tumour location, and age. DISCUSSION Some models showed promising results. Predictors identified across studies were different than those found in existing literature, showing the added value of AI models. However, the algorithms showed inconsistent results, underlying the need for better-powered studies with larger databases before clinical implementation.
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Affiliation(s)
- Cyril Devault-Tousignant
- Faculty of Medicine, McGill University, 3605 de la Montagne Street, Montreal, QC, H3G 2M1, Canada.
| | - Myriam Harvie
- Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Eric Bissada
- Division of Otolaryngology Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulos
- Division of Otolaryngology Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Paul Tabet
- Division of Otolaryngology Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Louis Guertin
- Division of Otolaryngology Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Houda Bahig
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Tareck Ayad
- Division of Otolaryngology Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Meredith EG, Filion E, Faria S, Kundapur V, Thuc TVTT, Lok BH, Raman S, Bahig H, Laba JM, Lang P, Louie AV, Hope A, Rodrigues GB, Bezjak A, Campeau MP, Duclos M, Bratman S, Swaminath A, Salunkhe R, Warner A, Palma DA. Stereotactic Radiation for Ultra-Central Non-Small Cell Lung Cancer: A Safety and Efficacy Trial (SUNSET). Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00480-2. [PMID: 38614279 DOI: 10.1016/j.ijrobp.2024.03.050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION The use of stereotactic body radiotherapy (SBRT) for tumors in close proximity to the central mediastinal structures has been associated with a high risk of toxicity. This study (BLINDED FOR REVIEW) aimed to determine the maximally tolerated dose (MTD) of SBRT for ultra-central (UC) non-small cell lung carcinoma (NSCLC), using a time-to-event continual reassessment methodology (TITE-CRM). METHODS Patients with T1-3N0M0 (≤ 6 cm) NSCLC were eligible. The MTD was defined as the dose of radiotherapy associated with a ≤ 30% rate of grade (G) 3-5 pre-specified treatment-related toxicity occurring within 2 years of treatment. The starting dose level was 60 Gy in 8 daily fractions. The dose-maximum hotspot was limited to 120% and within the planning tumor volume (PTV); tumors with endobronchial invasion were excluded. This primary analysis occurred two years after completion of accrual. RESULTS Between March 2018 and April 2021, 30 patients were enrolled at 5 institutions. The median age was 73 years (range: 65-87) and 17 (57%) were female. PTV was abutting proximal bronchial tree in 19 (63%), esophagus 5 (17%), pulmonary vein 1 (3.3%) and pulmonary artery 14 (47%). All patients received 60 Gy in 8 fractions. The median follow-up was 37 months (range: 8.9-51). Two patients (6.7%) experienced G3-5 adverse events related to treatment: 1 patient with G3 dyspnea and 1 G5 pneumonia; the latter had CT findings consistent with a background of interstitial lung disease. Three-year overall survival was 72.5% (95% confidence interval [CI]: 52.3-85.3%), progression-free survival 66.1% (95% CI: 46.1-80.2%), local control 89.6% (95% CI: 71.2-96.5%), regional control 96.4% (95% CI: 77.2-99.5%) and distant control 85.9% (95% CI: 66.7-94.5%). Quality of life scores declined numerically over time, but the decreases were not clinically or statistically significant. CONCLUSIONS 60 Gy in 8 fractions, planned and delivered with only a moderate hotspot, has a favorable adverse event rate within the pre-specified acceptability criteria, and results in excellent control for UC tumors.
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Affiliation(s)
| | - Edith Filion
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Sergio Faria
- McGill University Health Centre, Montréal, Canada
| | | | | | | | | | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Joanna M Laba
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Pencilla Lang
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Alexander V Louie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Hope
- Princess Margaret Cancer Centre, Toronto, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | | | | | - Marie Duclos
- McGill University Health Centre, Montréal, Canada
| | | | | | | | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada.
| | - David A Palma
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
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Palma DA, Bahig H, Hope A, Harrow S, Debenham BJ, Louie AV, Vu TTT(T, Filion E, Bezjak A, Campeau MP, Duimering A, Giuliani ME, Laba JM, Lang P, Lok BH, Qu XM, Raman S, Rodrigues GB, Goodman CD, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson CJ. Stereotactic Radiation Therapy in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease: A Nonrandomized Clinical Trial. JAMA Oncol 2024:2815670. [PMID: 38451491 PMCID: PMC10921346 DOI: 10.1001/jamaoncol.2023.7269] [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: 08/16/2023] [Accepted: 09/25/2023] [Indexed: 03/08/2024]
Abstract
Importance Patients with interstitial lung disease (ILD) and early-stage non-small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options. Objective To prospectively assess the benefits and toxic effects of SABR in this patient population. Design, Setting, and Participants This prospective cohort study was conducted at 6 academic radiation oncology institutions, 5 in Canada and 1 in Scotland, with accrual between March 7, 2019, and January 12, 2022. Patients aged 18 years or older with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgical resection were enrolled. Intervention Patients were treated with SABR to a dose of 50 Gy in 5 fractions every other day. Main Outcomes and Measures The study prespecified that SABR would be considered worthwhile if median overall survival-the primary end point-was longer than 1 year, with a grade 3 to 4 risk of toxic effects less than 35% and a grade 5 risk of toxic effects less than 15%. Secondary end points included toxic effects, progression-free survival (PFS), local control (LC), quality-of-life outcomes, and changes in pulmonary function. Intention-to-treat analysis was conducted. Results Thirty-nine patients enrolled and received SABR. Median age was 78 (IQR, 67-83) years and 59% (n = 23) were male. At baseline, 70% (26 of 37) of patients reported dyspnea, median forced expiratory volume in first second of expiration was 80% (IQR, 66%-90%) predicted, median forced vital capacity was 84% (IQR, 69%-94%) predicted, and median diffusion capacity of the lung for carbon monoxide was 49% (IQR, 38%-61%) predicted. Median follow-up was 19 (IQR, 14-25) months. Overall survival at 1 year was 79% (95%, CI 62%-89%; P < .001 vs the unacceptable rate), and median overall survival was 25 months (95% CI, 14 months to not reached). Median PFS was 19 months (95% CI, 13-28 months), and 2-year LC was 92% (95% CI, 69%-98%). Adverse event rates (highest grade per patient) were grade 1 to 2: n = 12 (31%), grade 3: n = 4 (10%), grade 4: n = 0, and grade 5: n = 3 (7.7%, all due to respiratory deterioration). Conclusions and Relevance In this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Trial Registration ClinicalTrials.gov Identifier: NCT03485378.
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Affiliation(s)
- David A. Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Brock J. Debenham
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Thi Trinh Thuc (Toni) Vu
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marie-Pierre Campeau
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Adele Duimering
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Meredith E. Giuliani
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joanna M. Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin H. Lok
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - X. Melody Qu
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - George B. Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher D. Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Physics, Western University, London, Ontario, Canada
| | - Julie Morisset
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Inderdeep Dhaliwal
- Department of Respirology, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher J. Ryerson
- Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Olson R, Abraham H, Leclerc C, Benny A, Baker S, Matthews Q, Chng N, Bergman A, Mou B, Dunne EM, Schellenberg D, Jiang W, Chan E, Atrchian S, Lefresne S, Carolan H, Valev B, Tyldesley S, Bang A, Berrang T, Clark H, Hsu F, Louie AV, Warner A, Palma DA, Howell D, Barry A, Dawson L, Grendarova P, Walker D, Sinha R, Tsai J, Bahig H, Thibault I, Koul R, Senthi S, Phillips I, Grose D, Kelly P, Armstrong J, McDermott R, Johnstone C, Vasan S, Aherne N, Harrow S, Liu M. Single vs. multiple fraction non-inferiority trial of stereotactic ablative radiotherapy for the comprehensive treatment of oligo-metastases/progression: SIMPLIFY-SABR-COMET. BMC Cancer 2024; 24:171. [PMID: 38310262 PMCID: PMC10838428 DOI: 10.1186/s12885-024-11905-7] [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: 12/18/2023] [Accepted: 01/21/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Radiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a primary outcome while using SF and MF stereotactic ablative radiotherapy (SABR) as well as explore differences in patient-reported quality of life and experience. METHODS This study will randomize 598 patients in a 1:1 ratio between the standard arm (MF SABR) and the experimental arm (SF SABR). This trial is designed as two randomized controlled trials within one patient population for resource efficiency. The primary objective of the first randomization is to determine if SF SABR is non-inferior to MF SABR, with respect to healthcare provider (HCP)-reported grade 3-5 adverse events (AEs) that are related to SABR. Primary endpoint is toxicity while secondary endpoints include lesional control rate (LCR), and progression-free survival (PFS). The second randomization (BC Cancer sites only) will allocate participants to either complete quality of life (QoL) questionnaires only; or QoL questionnaires and a symptom-specific survey with symptom-guided HCP intervention. The primary objective of the second randomization is to determine if radiation-related symptom questionnaire-guided HCP intervention results in improved reported QoL as measured by the EuroQoL-5-dimensions-5levels (EQ-5D-5L) instrument. The primary endpoint is patient-reported QoL and secondary endpoints include: persistence/resolution of symptom reporting, QoL, intervention cost effectiveness, resource utilization, and overall survival. DISCUSSION This study will compare SF and MF SABR in the treatment of oligometastases and oligoprogression to determine if there is non-inferior toxicity for SF SABR in selected participants with 1-5 oligometastatic lesions. This study will also compare patient-reported QoL between participants who receive radiation-related symptom-guided HCP intervention and those who complete questionnaires alone. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT05784428. Date of Registration: 23 March 2023.
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Affiliation(s)
- Robert Olson
- University of British Columbia, Vancouver, Canada.
- University of Northern British Columbia, Prince George, Canada.
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada.
- Department of Radiation Oncology, BC Cancer - Centre for the North, 1215 Lethbridge Street, Prince George, British Columbia, V2M 7E9, Canada.
| | - Hadassah Abraham
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Curtis Leclerc
- University of British Columbia, Vancouver, Canada
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | | | - Sarah Baker
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Quinn Matthews
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Nick Chng
- BC Cancer - Prince George, 1215 Lethbridge Street, Prince George, BC, V2M7A9, Canada
| | - Alanah Bergman
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Benjamin Mou
- BC Cancer - Kelowna, Kelowna, British Columbia, Canada
| | - Emma M Dunne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Will Jiang
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Elisa Chan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | | | - Shilo Lefresne
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Hannah Carolan
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Boris Valev
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | | | - Andrew Bang
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
| | - Tanya Berrang
- BC Cancer- Victoria, Victoria, British Columbia, Canada
| | - Haley Clark
- BC Cancer - Surrey, Surrey, British Columbia, Canada
| | - Fred Hsu
- BC Cancer- Abbotsford, Abbotsford, British Columbia, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Andrew Warner
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Doris Howell
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Laura Dawson
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Debra Walker
- Patient partner, BC Cancer-Prince George, Prince George, BC, Canada
| | - Rishi Sinha
- Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Jillian Tsai
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | | | - Rashmi Koul
- Cancer Care Manitoba, Winnipeg, Manitoba, Canada
| | | | - Iain Phillips
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Derek Grose
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | - Paul Kelly
- Bon Secours Radiotherapy Cork (In Partnership with UPMC Hillman Cancer Centre), Cork, Ireland
| | | | | | - Candice Johnstone
- Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Srini Vasan
- Precision Cancer Center, Ashland, Kentucky, United States of America
| | - Noel Aherne
- Riverina Cancer Care Centre, Wagga Wagga, New South Wales, Australia
| | - Stephen Harrow
- Western General Hospital/Edinburgh Cancer Centre, Edinburgh, Scotland
| | - Mitchell Liu
- BC Cancer - Vancouver, Vancouver, British Columbia, Canada
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Hes C, Desilets A, Tonneau M, El Ouarzadi O, De Figueiredo Sousa M, Bahig H, Filion É, Nguyen-Tan PF, Christopoulos A, Benlaïfaoui M, Derosa L, Alves Costa Silva C, Ponce M, Malo J, Belkad W, Charpentier D, Aubin F, Hamilou Z, Jamal R, Messaoudene M, Soulières D, Routy B. Gut microbiome predicts gastrointestinal toxicity outcomes from chemoradiation therapy in patients with head and neck squamous cell carcinoma. Oral Oncol 2024; 148:106623. [PMID: 38006691 DOI: 10.1016/j.oraloncology.2023.106623] [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: 06/24/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVES Chemoradiation (CRT) in patients with locally advanced head and neck squamous cell cancer (HNSCC) is associated with significant toxicities, including mucositis. The gut microbiome represents an emerging hallmark of cancer and a potentially important biomarker for CRT-related adverse events. This prospective study investigated the association between the gut microbiome composition and CRT-related toxicities in patients with HNSCC, including mucositis. MATERIALS AND METHODS Stool samples from patients diagnosed with locally advanced HNSCC were prospectively collected prior to CRT initiation and analyzed using shotgun metagenomic sequencing to evaluate gut microbiome composition at baseline. Concurrently, clinicopathologic data, survival outcomes and the incidence and grading of CRT-emergent adverse events were documented in all patients. RESULTS A total of 52 patients were included, of whom 47 had baseline stool samples available for metagenomic analysis. Median age was 62, 83 % patients were men and 54 % had stage III-IV disease. All patients developed CRT-induced mucositis, including 42 % with severe events (i.e. CTCAE v5.0 grade ≥ 3) and 25 % who required enteral feeding. With a median follow-up of 26.5 months, patients with severe mucositis had shorter overall survival (HR = 3.3, 95 %CI 1.0-10.6; p = 0.02) and numerically shorter progression-free survival (HR = 2.8, 95 %CI, 0.8-9.6; p = 0.09). The gut microbiome beta-diversity of patients with severe mucositis differed from patients with grades 1-2 mucositis (p = 0.04), with enrichment in Mediterraneibacter (Ruminococcus gnavus) and Clostridiaceae family members, including Hungatella hathewayi. Grade 1-2 mucositis was associated with enrichment in Eubacterium rectale, Alistipes putredinis and Ruminococcaceae family members. Similar bacterial profiles were observed in patients who required enteral feeding. CONCLUSION Patients who developed severe mucositis had decreased survival and enrichment in specific bacteria associated with mucosal inflammation. Interestingly, these same bacteria have been linked to immune checkpoint inhibitor resistance.
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Affiliation(s)
- Cecilia Hes
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, 1001 Boulevard Decarie, Montreal, QC H4A 3J1, Canada
| | - Antoine Desilets
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada; Department of Medicine, Hematology-Oncology Division, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada
| | - Marion Tonneau
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada; Centre Oscar Lambert, Department of Radiotherapy, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Omar El Ouarzadi
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Marina De Figueiredo Sousa
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada
| | - Édith Filion
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada
| | - Apostolos Christopoulos
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Myriam Benlaïfaoui
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Lisa Derosa
- ClinicObiome, Institut Gustave Roussy Cancer Campus, 114 Rue Edouard-Vaillant, 94805 Villejuif Cedex, France
| | - Carolina Alves Costa Silva
- ClinicObiome, Institut Gustave Roussy Cancer Campus, 114 Rue Edouard-Vaillant, 94805 Villejuif Cedex, France
| | - Mayra Ponce
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Julie Malo
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Wiam Belkad
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Danielle Charpentier
- Department of Medicine, Hematology-Oncology Division, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada
| | - Francine Aubin
- Department of Medicine, Hematology-Oncology Division, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada
| | - Zineb Hamilou
- Department of Medicine, Hematology-Oncology Division, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada
| | - Rahima Jamal
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada; Department of Medicine, Hematology-Oncology Division, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada
| | - Meriem Messaoudene
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Denis Soulières
- Department of Medicine, Hematology-Oncology Division, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada.
| | - Bertrand Routy
- Centre hospitalier de l'Université de Montréal Research Center (CRCHUM), Pavillon R, 900 Rue Saint-Denis, Montreal, QC H2X 0A9, Canada; Department of Medicine, Hematology-Oncology Division, Centre hospitalier de l'Université de Montréal (CHUM), 1051 Rue Sanguinet, Montreal, QC H2X 0C1, Canada.
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Tankel J, Spicer J, Chu Q, Fiset PO, Kidane B, Leighl NB, Joubert P, Maziak D, Palma D, McGuire A, Melosky B, Snow S, Bahig H, Blais N. Canadian Consensus Recommendations for the Management of Operable Stage II/III Non-Small-Cell Lung Cancer: Results of a Modified Delphi Process. Curr Oncol 2023; 30:10363-10384. [PMID: 38132389 PMCID: PMC10742991 DOI: 10.3390/curroncol30120755] [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: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
The treatment paradigm for patients with stage II/III non-small-cell lung cancer (NSCLC) is rapidly evolving. We performed a modified Delphi process culminating at the Early-stage Lung cancer International eXpert Retreat (ELIXR23) meeting held in Montreal, Canada, in June 2023. Participants included medical and radiation oncologists, thoracic surgeons and pathologists from across Quebec. Statements relating to diagnosis and treatment paradigms in the preoperative, operative and postoperative time periods were generated and modified until all held a high level of consensus. These statements are aimed to help guide clinicians involved in the treatment of patients with stage II/III NSCLC.
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Affiliation(s)
- James Tankel
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Jonathan Spicer
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Quincy Chu
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
| | - Pierre Olivier Fiset
- Department of Pathology, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba & Cancer Care Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Natasha B. Leighl
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON M5G 2C4, Canada
| | - Philippe Joubert
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université, Laval, QC G1V 4G5, Canada
| | - Donna Maziak
- Department of Thoracic Surgery, Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - David Palma
- Department of Radiation Oncology, London Health Services Center, London, ON N6A 5A5, Canada
| | - Anna McGuire
- Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Barbara Melosky
- Department of Medical Oncology, BCCA, Vancouver, BC V5Z 4E6, Canada
| | - Stephanie Snow
- Department of Medical Oncology, Queen Elizabeth II Health Sciences Center, Halifax, NS B3H 3A7, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Normand Blais
- Department of Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
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7
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Dayan G, Bahig H, Fortin B, Filion É, Nguyen-Tan PF, O'Sullivan B, Charpentier D, Soulières D, Gologan O, Nelson K, Létourneau L, Schmittbuhl M, Ayad T, Bissada E, Guertin L, Tabet P, Christopoulos A. Predictors of prolonged treatment time intervals in oral cavity cancer. Oral Oncol 2023; 147:106622. [PMID: 37948896 DOI: 10.1016/j.oraloncology.2023.106622] [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: 08/11/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Delays in treatment time intervals have been associated with overall survival in oral cavity squamous cell carcinoma (OCSCC). The aim of this study was to identify bottlenecks leading to prolonged treatment intervals. MATERIAL AND METHODS A retrospective analysis was conducted using a cohort of OCSCC patients who underwent surgery and adjuvant radiation therapy. The endpoints of interest were prolonged treatment intervals. Multivariable logistic regression was used to adjust for patient and tumour characteristics. RESULTS Median diagnosis-to-treatment interval (DTI) and surgery to initiation of postoperative radiation therapy interval (S-PORT) were 39 days (IQR 30-54) and 64 days (IQR 54-66), respectively. Prolonged DTI was associated with older age, worse Charlson Comorbidity index scores and worse T stages. Patients with prolonged DTI had longer times to preoperative imaging reports (25 vs 9 days; P < 0.01). Time to preoperative pathology did not differ. Prolonged S-PORT was associated with longer times to pathology report (28 vs 18 days; P < 0.01), to maxillofacial consult (38 vs 15 days; P < 0.01) and to maxillofacial approval of radiation (50 vs 28 days; P < 0.01). In patients requiring medical oncology consults, those with prolonged S-PORT had longer waiting times until consultation (58 vs 38 days; P = 0.02). Multivariate analysis showed independent predictors of prolonged DTI: time to preoperative imaging; and prolonged S-PORT: time to pathology report, time to maxillofacial consult, and time to medical oncology consult. CONCLUSIONS Strategies targeting these organizational bottlenecks may be effective for shortening treatment time intervals, hence representing potential opportunities for improving oncological outcomes in OCSCC patients.
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Affiliation(s)
- Gabriel Dayan
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Fortin
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Hopital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Édith Filion
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Phuc-Felix Nguyen-Tan
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radio-Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Charpentier
- Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Denis Soulières
- Department of Medicine, Division of Hematology and Medical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Olga Gologan
- Department of Pathology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Kristoff Nelson
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Létourneau
- Department of Radiology, Radio-Oncology and Nuclear Medicine, Division of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Matthieu Schmittbuhl
- Department of Stomatology, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Tareck Ayad
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Eric Bissada
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Louis Guertin
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Paul Tabet
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Division of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montreal, Quebec, Canada.
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8
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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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9
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Morand GB, Eskander A, Fu R, de Almeida J, Goldstein D, Noroozi H, Hosni A, Seikaly H, Tabet P, Pyne JM, Matthews TW, Dort J, Nakoneshny S, Christopoulos A, Bahig H, Johnson-Obaseki S, Hua N, Gaudet M, Jooya A, Nichols A, Laxague F, Cecchini M, Du J, Shapiro J, Karam I, Dziegielewski PT, Hanubal K, Erovic B, Grasl S, Davies J, Monteiro E, Gete M, Witterick I, Sadeghi N, Richardson K, Shenouda G, Maniakas A, Landry V, Gupta M, Zhou K, Mlynarek AM, Pusztaszeri M, Sultanem K, Hier MP. The protective role of postoperative radiation therapy in low and intermediate grade major salivary gland malignancies: A study of the Canadian Head and Neck Collaborative Research Initiative. Cancer 2023; 129:3263-3274. [PMID: 37401841 DOI: 10.1002/cncr.34932] [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: 01/31/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The objective of this study was to examine the utility of postoperative radiation for low and intermediate grade cancers of the parotid and submandibular glands. METHODS The authors conducted a retrospective, Canadian-led, international, multi-institutional analysis of a patient cohort with low or intermediate grade salivary gland cancer of the parotid or submandibular gland who were treated from 2010 until 2020 with or without postoperative radiation therapy. A multivariable, marginal Cox proportional hazards regression analysis was performed to quantify the association between locoregional recurrence (LRR) and receipt of postoperative radiation therapy while accounting for patient-level factors and the clustering of patients by institution. RESULTS In total, 621 patients across 14 tertiary care centers were included in the study; of these, 309 patients (49.8%) received postoperative radiation therapy. Tumor histologies included 182 (29.3%) acinic cell carcinomas, 312 (50.2%) mucoepidermoid carcinomas, and 137 (20.5%) other low or intermediate grade primary salivary gland carcinomas. Kaplan-Meier LRR-free survival at 10 years was 89.0% (95% confidence interval [CI], 84.9%-93.3%). In multivariable Cox regression analysis, postoperative radiation therapy was independently associated with a lower hazard of LRR (adjusted hazard ratio, 0.53; 95% CI, 0.29-0.97). The multivariable model estimated that the marginal probability of LRR within 10 years was 15.4% without radiation and 8.8% with radiation. The number needed to treat was 16 patients (95% CI, 14-18 patients). Radiation therapy had no benefit in patients who had early stage, low-grade salivary gland cancer without evidence of nodal disease and negative margins. CONCLUSIONS Postoperative radiation therapy may reduce LLR in some low and intermediate grade salivary gland cancers with adverse features, but it had no benefit in patients who had early stage, low-grade salivary gland cancer with negative margins.
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Affiliation(s)
- Grégoire B Morand
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Rui Fu
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - John de Almeida
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Goldstein
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hesameddin Noroozi
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Center-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Center-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hadi Seikaly
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Paul Tabet
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Justin M Pyne
- Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - T Wayne Matthews
- Department Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Joseph Dort
- Department Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Steve Nakoneshny
- Department Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Apostolos Christopoulos
- Department of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montreal (CHUM), Université de Montreal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, CHUM, Université de Montreal, Montreal, Quebec, Canada
| | - Stephanie Johnson-Obaseki
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Nadia Hua
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Gaudet
- Department of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Alborz Jooya
- Department of Radiation Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Francisco Laxague
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Matthew Cecchini
- Department of Otolaryngology-Head and Neck Surgery and Oncology, London Health Sciences Center, London, Ontario, Canada
| | - Jenny Du
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Justin Shapiro
- Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Peter T Dziegielewski
- Department of Otolaryngology-Head and Neck Surgery, University of Florida Health Shands Hospital, University of Florida, Gainesville, Florida, USA
| | - Krishna Hanubal
- Department of Otolaryngology-Head and Neck Surgery, University of Florida Health Shands Hospital, University of Florida, Gainesville, Florida, USA
| | - Boban Erovic
- Institute of Head and Neck Diseases, Evangelical Hospital, Vienna, Austria
| | - Stefan Grasl
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Joel Davies
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Maru Gete
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ian Witterick
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nader Sadeghi
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Keith Richardson
- Department of Otolaryngology-Head and Neck Surgery, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - George Shenouda
- Department of Radiation Oncology, McGill University Heath Center, Montreal, Quebec, Canada
| | - Anastasios Maniakas
- Department Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Quebec, Canada
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Vivianne Landry
- Department Otolaryngology-Head and Neck Surgery, Hôpital Maisonneuve-Rosemont, Université de Montreal, Montreal, Quebec, Canada
| | - Michael Gupta
- Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Kelvin Zhou
- Department of Otolaryngology-Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Alex M Mlynarek
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Michael P Hier
- Department of Otolaryngology Head and Neck Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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10
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Tonneau M, Ng SP, Nguyen F, Filion E, Nelson K, Doucet R, Lahaie N, Bahig H. Agreement among Radiation Oncologists and Radiologist in Contouring GTV on Planning and Mid-Treatment MRI for Locally Advanced Oropharynx Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e727. [PMID: 37786115 DOI: 10.1016/j.ijrobp.2023.06.2242] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Over the 7-week radiotherapy course, patients with head and neck cancers undergo significant anatomical changes, including weight loss and tumor shrinkage (with complete response at mid-treatment in as high as 50% of patients). The current standard of care is to maintain the same plan for the entire treatment duration, unless major dosimetric deviations are suspected. The use of MRI for treatment adaptation has the advantage of increased soft tissue contrast and is being integrated into several clinical practices with the recent implementation of the MR-Linac technology. In this interim secondary analysis of a phase 2, randomized trial, we assessed inter-observer variability (IOV) in the delineation of GTV at planning and mid-treatment in locally advanced oropharynx cancer (OPC). MATERIALS/METHODS Three expert radiation oncologists (RO) and 1 expert radiologist, with a minimum of 5 years' experience in MRI contouring, blinded to each other's volumes, were provided with planning and mid-treatment MRI (T1 gadolinium, T2-weighted and DWI) of 9 patients with locally advanced OPC. Primary gross tumor volume (GTV) was independently contoured by all 3 ROs and the radiologist. Contouring agreement was analyzed using the dice similarity coefficient (DSC) index and the average Hausdorff distance. RESULTS Nine cases of locally advanced OPC were included. Fifty percent of the patients were stage 3 (AJCC 8th edition) and all were p16+ OPC. There was moderate IOV in the delineation of GTV on planning MRI as evidenced by mean DSC index and Hausdorff distance of 0.75 (range 0.53 - 0.87) and 0.30 cm (max 2.14 cm). At mid-treatment, the GTV IOV had a mean DSC index and Hausdorff distance of 0.30 (range 0.19 - 0.76) and 0.55 cm (max 2.83), respectively. The contours of the radiologist compared to RO shown a mean DSC index and Hausdorff distance on planning MRI 0.63 (range 0.53 - 0.69) and 0.41 cm (max 2.14 cm), and on mid-treatment MRI of 0.36 (range 0.19 - 0.59) and 0.68 cm (max 1.08 cm). CONCLUSION Although this study demonstrates the presence of moderate IOV between 3 experienced head and neck ROs and one radiologist in an academic institution for the delineation of GTV on planning MRI, we observed a higher IOV between the 4 experts on mid-treatment MRI. We also experienced a higher IOV between the radiologist and RO on planning and mid-treatment images. These results show high degree of GTV volume variability on mid-treatment MRI. Therefore, peer review of contours is important and guidelines for MR adaptive tumor delineation are needed.
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Affiliation(s)
- M Tonneau
- Centre Hospitalo-Universitaire de Montréal, Montréal, QC, Canada
| | - S P Ng
- Austin Health University Melbourne, Melbourne, Australia
| | - F Nguyen
- Centre Hospitalo-Universitaire de Montréal, Montreal, QC, Canada
| | - E Filion
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
| | - K Nelson
- Centre Hospitalo-Universitaire de Montréal, Montreal, QC, Canada
| | - R Doucet
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - N Lahaie
- Centre Hospitalo-Universitaire de Montréal, Montreal, QC, Canada
| | - H Bahig
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
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Bahig H, Nguyen-Tan PF, Yuan Y, Filion E, Ng SP, Soulières D, Christopoulos A, Fuller CD, Garden AS, Hutcheson KA, Lee A, Spiotto MT, Rosenthal DI, Phan J. Stereotactic Boost and Short-Course Radiotherapy for p16-Associated Oropharynx Cancer (SHORT-OPC): First Planned Interim Safety Analysis from a Randomized Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:e564-e565. [PMID: 37785728 DOI: 10.1016/j.ijrobp.2023.06.1888] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) There is a need for safe treatment de-intensification in p16+ oropharynx cancer (OPC). The standard of care (SOC) radiotherapy (RT) regimen is cumbersome and associated with high toxicity. Stereotactic radiotherapy (SBRT) and multimodality image guidance is an opportunity to precisely target the gross tumor while safely reducing elective irradiation dose. We aim to assess the safety and efficacy of a short course RT for p16+ OPC, consisting of an SBRT boost to the gross tumor volume (GTV) followed by de-escalated elective irradiation. MATERIALS/METHODS In this randomized phase II trial, patients with p16-positive, stage I-II OPSCC with primary tumor <30 cc (8th Ed AJCC) are planned with combined CT, MRI and FDG-PET, and randomized to 1) SBRT boost (14 Gy in 2 fractions) to the GTV followed with de-escalated RT (+/- Cisplatin) to a dose of 40 Gy in 20 fractions, or 2) SOC RT (+/- Cisplatin) to a dose of 70 Gy in 33 fractions to the GTV and 59.4-54Gy (or equivalent) to the intermediate-to-low dose elective region. Patients are stratified by stage (I vs. II) and use of chemotherapy. The primary endpoint of the trial is locoregional control at 2 years, powered for a sample size of 100 patients. A Bayesian adaptive design includes 2 planned safety interim analysis using grade ≥ 3 subacute toxicities >40% as a stopping criterion, and 1 planned futility analysis. Acute adverse events (AE) are defined as those occurring ≤ 60 days from RT, subacute AE between 60-180 days after RT, and late AE >180 days from RT. This is the first planned toxicity analysis. RESULTS Twenty-one patients were randomly assigned and eligible (11 in SOC and 10 in experimental arm). Median age was 69 years (range 49-84); 29% and 71% had stage T1 and T2, while 10%, 85% and 1 patient had N0, N1 and N2 disease, respectively. RT alone and chemoradiation was administered in 67% and 33% of patients, respectively. At a median follow-up of 11 months (range 1.7-17.6), there was 1 local recurrence at the primary tumor site in the SOC arm (at 10 month) and no recurrence in the experimental arm. All enrolled patients remain alive at the time of analysis. There was a 54.5% rate of grade 3 acute AE in the SOC arm and 30.0% rate of grade 3 acute AE in the experimental arm. More specifically, 1, 5 (45%), 2 (18%), and 2 (18%) versus 0, 1, 1 and 1 patient developed acute grade 3 dysphagia, mucositis, pain and dermatitis in the SOC and experimental arm, respectively. There was no acute grade 4 or 5 toxicity. There was no grade ≥ 3 subacute toxicity or late toxicity in both arms. CONCLUSION This primary safety analysis showed that SBRT boost followed by a short course of de-escalated elective irradiation in p16+ OPC has limited early toxicity and meets criteria for study continuation.
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Affiliation(s)
- H Bahig
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - P F Nguyen-Tan
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Y Yuan
- MD Anderson Cancer Center, Houston, TX
| | - E Filion
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - S P Ng
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Department of Radiation Oncology, Melbourne, VIC, Australia
| | - D Soulières
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - A Christopoulos
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - C D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - A S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - K A Hutcheson
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | - A Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - M T Spiotto
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - D I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - J Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Bang C, Le W, Nguyen-Tan PF, Filion E, Soulières D, O'Sullivan B, Christopoulos A, Bissada E, Ayad T, Guertin L, Lalonde A, Markel D, Kadoury S, Bahig H. Dynamic Prediction of Toxicities in Head and Neck Cancer Radiotherapy by 3D Convolutional Neural Network Using Daily Cone-Beam CTs. Int J Radiat Oncol Biol Phys 2023; 117:S55. [PMID: 37784524 DOI: 10.1016/j.ijrobp.2023.06.346] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Radiotherapy (RT) is essential in head and neck cancer (HNC) treatments, but often causes significant toxicity. Different machine learning models have shown promise in predicting RT-induced toxicity, but none have yet integrated the fluctuating anatomical changes. By integrating daily cone-beam CTs (CBCT) allowing sequential anatomical views, our aim is to build a dynamic predictive model for three major HNC RT toxicities: reactive feeding tube placement, hospitalization and radionecrosis (RN). MATERIALS/METHODS 292 HNC cases treated with curative RT between 2017 and 2019 at our institution were retrospectively analyzed for clinical and radiological data. VoxelMorph, a deep deformable registration model, integrated the daily anatomical deformations between each CBCT and the planning CT, then converted them to Jacobian determinant matrix (Jf). Resnet, a convolutional neural network with multiple layers was trained using a 5-fold cross validation to integrate both radiological and clinical data. Each toxicity was classified as a binary decision using the cross-entropy loss to account for a class imbalance. Its predictive performance was compared to the baseline model using only clinical data. RESULTS The cohort included 78% men and 22% women, with a median age of 63 years (range 35-84). Primary cancer sites were 46% oropharynx, 19% larynx, 14% oral cavity, 7.5% nasopharynx, 5% hypopharynx, 4% unknown primary and 5% others; and stage ranged between Tx-4b N0 and 3b M0 (AJCC 8th Ed). Induction chemotherapy, concurrent chemotherapy, and adjuvant RT was used in 9%, 57% and 20% of patients, respectively. The incidence of feeding tube, hospitalization and RN was 19.9%, 7.2%, and 3.8%, respectively. Integrating Jf from the 10th RT CBCT showed better accuracy for each toxicity prediction: feeding tube (69.1% > 57.2%), hospitalization (75.3% > 63.1%) and RN (85.8% > 75.7%). Integrating both the raw CBCT and Jf improved hospitalization prediction (79.0% > 73.6%). Substituting Jf for the raw CBCT improved the prediction for RN (79.7% > 74.7%) and hospitalization (73.6% > 64.4%). For feeding tube, predictive performance of the Jf model trained against deformations showed a positive correlation between its performance and the RT received (r2 > 0.9) with increasing RT fractions, with a maximum accuracy of 83.1% at the 25th fraction. No such correlation was found for RN or hospitalization prediction. CONCLUSION To our knowledge, this is the first study showing promising results to predict HNC RT toxicities using daily per-treatment CBCT. Next steps involve integrating both the radiomic and the dosimetric inputs to build a more powerful model. This could expand to predict therapeutic outcomes and, ultimately, could guide decisions in individualized RT.
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Affiliation(s)
- C Bang
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - W Le
- Polytechnique Montreal, Montreal, QC, Canada; CRCHUM (The University of Montreal Hospital Research Centre), Montreal, QC, Canada
| | - P F Nguyen-Tan
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - E Filion
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - D Soulières
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - B O'Sullivan
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - A Christopoulos
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - E Bissada
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - T Ayad
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - L Guertin
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - A Lalonde
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; University of Montreal, Montreal, QC, Canada
| | - D Markel
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada
| | - S Kadoury
- Polytechnique Montreal, Montreal, QC, Canada; CRCHUM (The University of Montreal Hospital Research Centre), Montreal, QC, Canada
| | - H Bahig
- CHUM (The University of Montreal Hospital Centre), Montreal, QC, Canada; CRCHUM (The University of Montreal Hospital Research Centre), Montreal, QC, Canada
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13
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Palma DA, Bahig H, Hope AJ, Harrow S, Debenham BJ, Louie A, Vu T, Filion EJ, Bezjak A, Campeau MP, Duimering A, Giuliani M, Laba JM, Lang P, Lok BH, Qu MX, Raman S, Rodrigues G, Goodman C, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson C. Assessment of Precision Irradiation in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease (ASPIRE-ILD): Primary Analysis of a Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:S28-S29. [PMID: 37784467 DOI: 10.1016/j.ijrobp.2023.06.289] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The use of stereotactic ablative radiotherapy (SABR) in patients with fibrotic interstitial lung disease (ILD) has been associated with an increased risk of toxicity, but patients with ILD and lung cancer may have no other options for curative-intent treatment. The goal of the ASPIRE-ILD trial was to assess the benefits and toxicities of SABR in patients with fibrotic ILD. MATERIALS/METHODS We enrolled patients with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgery. All patients were centrally reviewed prior to enrollment to confirm the presence and subtype of ILD. After stratification by the ILD-GAP score (a measure of ILD severity and prognosis), patients were treated with SABR to a dose of 50 Gy in 5 fractions EOD (BED = 100 Gy10), with a built-in de-escalation protocol in case of unacceptable toxicity. The primary endpoint was overall survival (OS), powered to distinguish 1-year OS >70% vs. an unacceptable rate of ≤50%. Secondary endpoints included toxicity (CTC-AE version 4.0), progression-free survival (PFS), local control (LC), patient-reported outcomes (FACT-L quality of life and cough severity), and changes in pulmonary function tests (PFTs). The study pre-specified that SABR would be considered worthwhile if median OS was >1 year, with a grade 3-4 toxicity risk <35% and a grade 5 toxicity risk <15%. Target accrual was 39 treated patients. RESULTS Thirty-nine patients were enrolled and treated with SABR between March 2019 and January 2022, all to a dose of 50 Gy in 5 fractions, at 5 institutions in Canada and 1 in Scotland. Median age was 78 years (interquartile range: 67-83), 59% were male, and 92% had a history of smoking (median 43 pack-years). At baseline, 70% reported dyspnea, median FEV1 was 80% predicted and median DLCO was 49% predicted. ILD-GAP scores were as follows: ≤2 (i.e., best ILD status): n = 14; 3-5: n = 23; ≥6 (i.e., worst ILD status): n = 2. Median follow-up was 19 months. OS at 1-year was 78.9% (p<0.001 by binomial test vs. the unacceptable rate). Median OS was 25 months, median PFS was 19 months, and 2-year LC was 92%. AE rates (possibly, probably or definitely related) were as follows (highest grade per patient): grade 1-2: n = 12 (31%); grade 3: n = 4 (10%); grade 4; n = 0; grade 5 n = 3 (7.7%, all due to respiratory deterioration). AE rates did not differ by ILD-GAP category or ILD subtype. FACT-L scores trended downward over time (p = 0.07), and cough severity scale scores worsened over time (p = 0.02). Comparing last-available PFTs with baseline, DLCO declined (median: -4%; p = 0.046), FVC trended downward (median: -2.5%; p = 0.11), and FEV1 remained stable (median change: 0%). CONCLUSION The use of SABR in patients with ILD met the pre-specified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Further studies exploring pharmacologic options to reduce toxicity may be beneficial in this population. ().
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Affiliation(s)
- D A Palma
- Department of Oncology, Western University, London, ON, Canada
| | - H Bahig
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - A J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Harrow
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | - A Louie
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - T Vu
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - E J Filion
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - A Bezjak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M P Campeau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J M Laba
- London Health Sciences Centre, London, ON, Canada
| | - P Lang
- Department of Oncology, Western University, London, ON, Canada
| | - B H Lok
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M X Qu
- London Regional Cancer Centre, London, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - G Rodrigues
- London Health Sciences Centre, London, ON, Canada
| | - C Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - S Gaede
- Department of Medical Physics, Western University, London, ON, Canada
| | - J Morisset
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - A Warner
- London Health Sciences Centre, London, ON, Canada
| | - I Dhaliwal
- London Health Sciences Centre, London, ON, Canada
| | - C Ryerson
- University of British Columbia, Vancouver, BC, Canada
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Tonneau M, Richard C, Routy B, Campeau MP, Vu T, Filion E, Roberge D, Mathieu D, Doucet R, Beliveau-Nadeau D, Bahig H. A competing risk analysis of the patterns and risk factors of recurrence in early-stage non-small cell lung cancer treated with stereotactic ablative radiotherapy. Radiother Oncol 2023; 185:109697. [PMID: 37169303 DOI: 10.1016/j.radonc.2023.109697] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION To assess patterns of recurrence after stereotactic ablative radiotherapy (SABR) in patient ineligible to surgery with early-stage non-small cell lung cancer (ES-NSCLC), report survival and treatment after first recurrence. METHODS We performed a retrospective analysis on 1068 patients with ES-NSCLC and 1143 lesions. Between group differences were estimated using competing risk analysis and cause-specific hazard ratios were calculated. Overall survival (OS) after first recurrence was calculated. RESULTS Median follow-up was 37.6 months. Univariate analysis demonstrated that ultra-central location was associated with higher risk of regional recurrence (RR) and distant metastasis (DM) (p = 0.004 and 0.01). Central lesions were associated with higher risk of local recurrence (LR) and RR (p < 0.001). Ultra-central lesions were associated with shorter OS (p = 0.002) compared to peripheral lesions. In multivariate analysis, central location was the only factor associated with increased LR and RR risks (p = 0.016 and 0.005). Median OS after first recurrence was 14.8 months. There was no difference in OS after first recurrence between ultra-central, central, and peripheral lesions (p = 0.83). Patients who received a second SABR course had an OS of 51.3 months, compared to 19.5 months with systemic therapy and 8.1 months with supportive care (p < 0.0001). DISCUSSION The main prognostic factor for LR and RR risks was central location. Ultra-central and central tumors might benefit from treatment intensification strategies such as dose escalation and/or addition of systemic therapy to improve radiotherapy outcomes. After a first recurrence post SABR, patients with contralateral lung recurrences and those who were eligible to receive a second course of SABR had improved OS.
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Affiliation(s)
- Marion Tonneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Université de Médecine Henri Warembourg, Lille, France
| | - Corentin Richard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Bertrand Routy
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada
| | - Marie-Pierre Campeau
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Toni Vu
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Edith Filion
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - David Roberge
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Dominique Mathieu
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Robert Doucet
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Dominic Beliveau-Nadeau
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Houda Bahig
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, QC, Canada; Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.
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Bahig H, Ehab HY, Garden AS, Ng SP, Frank SJ, Nguyen T, Gunn GB, Rosenthal DI, Fuller CD, Ferrarotto R, Bell D, Su S, Phan J. Long-term outcomes of modern multidisciplinary management of sinonasal cancers: The M. D. Anderson experience. Head Neck 2023. [PMID: 37165701 DOI: 10.1002/hed.27381] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/09/2023] [Accepted: 04/12/2023] [Indexed: 05/12/2023] Open
Abstract
PURPOSE To report long-term outcomes of modern radiotherapy for sinonasal cancers. METHODS AND MATERIALS A retrospective analysis of patients with sinonasal tumors treated with intensity-modulated radiotherapy or proton therapy. Multivariate analysis was used to determine predictive variables of progression free survival (PFS) and overall survival (OS). RESULTS Three hundred and eleven patients were included, with median follow-up of 75 months. The most common histologies were squamous cell (42%), adenoid cystic (15%), and sinonasal undifferentiated carcinoma (15%). Induction chemotherapy was administered to 47% of patients; 68% had adjuvant radiotherapy. Ten-year local control, regional control, distant metastasis free survival, PFS, and overall survival rates were 73%, 88%, 47%, 32%, and 51%, respectively. Age, non-nasal cavity tumor site, T3-4 stage, neck dissection, and radiation dose were predictive of PFS, while age, non-nasal cavity tumor site, T3-4 stage, positive margins, neck dissection, and use of neoadjuvant chemotherapy were predictive of OS. There was a 13% rate of late grade ≥3 toxicities. CONCLUSION This cohort of patients with sinonasal cancer treated with modern radiotherapy demonstrates favorable disease control rate and acceptable toxicity profile.
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Affiliation(s)
- Houda Bahig
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Hanna Y Ehab
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Victoria, Australia
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Theresa Nguyen
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Gary B Gunn
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Diana Bell
- Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Shirley Su
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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El-Habashy DM, Wahid KA, He R, McDonald B, Rigert J, Mulder SJ, Lim TY, Wang X, Yang J, Ding Y, Naser MA, Ng SP, Bahig H, Salzillo TC, Preston KE, Abobakr M, Shehata MA, Elkhouly EA, Alagizy HA, Hegazy AH, Mohammadseid M, Terhaard C, Philippens M, Rosenthal DI, Wang J, Lai SY, Dresner A, Christodouleas JC, Mohamed ASR, Fuller CD. Longitudinal diffusion and volumetric kinetics of head and neck cancer magnetic resonance on a 1.5T MR-Linear accelerator hybrid system: A prospective R-IDEAL Stage 2a imaging biomarker characterization/ pre-qualification study. medRxiv 2023:2023.05.04.23289527. [PMID: 37205359 PMCID: PMC10187456 DOI: 10.1101/2023.05.04.23289527] [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] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Objectives We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort. Methods Thirty patients with pathologically confirmed HNSCC who received curative-intent RT at the University of Texas MD Anderson Cancer Center, were included in this prospective study. Baseline and weekly Magnetic resonance imaging (MRI) (weeks 1-6) were obtained, and various ADC parameters (mean, 5 th , 10 th , 20 th , 30 th , 40 th , 50 th , 60 th , 70 th , 80 th , 90 th and 95 th percentile) were extracted from the target regions of interest (ROIs). Baseline and weekly ADC parameters were correlated with response during RT, loco-regional control, and the development of recurrence using the Mann-Whitney U test. The Wilcoxon signed-rank test was used to compare the weekly ADC versus baseline values. Weekly volumetric changes (Δvolume) for each ROI were correlated with ΔADC using Spearman's Rho test. Recursive partitioning analysis (RPA) was performed to identify the optimal ΔADC threshold associated with different oncologic outcomes. Results There was an overall significant rise in all ADC parameters during different time points of RT compared to baseline values for both gross primary disease volume (GTV-P) and gross nodal disease volumes (GTV-N). The increased ADC values for GTV-P were statistically significant only for primary tumors achieving complete remission (CR) during RT. RPA identified GTV-P ΔADC 5 th percentile >13% at the 3 rd week of RT as the most significant parameter associated with CR for primary tumor during RT (p <0.001). Baseline ADC parameters for GTV-P and GTV-N didn't significantly correlate with response to RT or other oncologic outcomes. There was a significant decrease in residual volume of both GTV-P & GTV-N throughout the course of RT. Additionally, a significant negative correlation between mean ΔADC and Δvolume for GTV-P at the 3 rd and 4 th week of RT was detected (r = -0.39, p = 0.044 & r = -0.45, p = 0.019, respectively). Conclusion Assessment of ADC kinetics at regular intervals throughout RT seems to be correlated with RT response. Further studies with larger cohorts and multi-institutional data are needed for validation of ΔADC as a model for prediction of response to RT.
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Affiliation(s)
- Dina M El-Habashy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jillian Rigert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Samuel J. Mulder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tze Yee Lim
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xin Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, Austin Health Melbourne, Australia
| | - Houda Bahig
- Department of radiology, radiation oncology and nuclear medicine, Université de Montréal, Canada
| | - Travis C Salzillo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathryn E Preston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- University of Houston College of Pharmacy, Houston, Texas, USA
| | - Moamen Abobakr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed A Shehata
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Enas A Elkhouly
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Hagar A Alagizy
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Amira H Hegazy
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Mustefa Mohammadseid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chris Terhaard
- Department of Radiation Therapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle Philippens
- Department of Radiation Therapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David I. Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, Division of Surgery,The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alex Dresner
- Philips Healthcare MR Oncology, Cleveland, Ohio, USA
| | | | | | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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17
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Lavigne D, De-Meric-de-Bellefon M, Nguyen-Tan FP, Landry D, Létourneau-Guillon L, Bélair M, O'Sullivan B, Filion E, Bahig H. Incidence and predictive factors of retropharyngeal lymph node metastases in patients with oropharyngeal cancer undergoing multimodality treatment planning imaging. Head Neck 2023; 45:1530-1538. [PMID: 37045788 DOI: 10.1002/hed.27368] [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: 10/08/2022] [Revised: 02/24/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND We investigated the incidence and predictive factors of retropharyngeal lymph node (RPLN) metastases in patients with oropharyngeal cancer (OPC) undergoing multimodality treatment planning imaging before radiotherapy. METHODS Consecutive patients with OPC treated with curative-intent radiotherapy from 2017 to 2019 were retrospectively analyzed. Treatment planning comprised contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and fluorodeoxyglucose-positron emission tomography (FDG-PET) unless contraindicated. RESULTS Of 300 patients, 66 (22%) had radiological evidence of RPLN involvement on planning images, compared to 17 (6%) on diagnostic CT alone. On multivariate analysis, RPLN involvement was statistically (p < 0.05) associated with tonsil, soft palate, and posterior pharyngeal wall primaries, and with disease extension to the soft palate or vallecula. CONCLUSIONS Multimodality treatment planning imaging reveals a high rate of RPLN metastases from OPC compared to diagnostic CT alone. Patients with tonsil, soft palate, or posterior pharyngeal wall primaries or disease extending to the soft palate or vallecula appear at higher risk.
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Affiliation(s)
- Danny Lavigne
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | | | - Felix-Phuc Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - David Landry
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Laurent Létourneau-Guillon
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Manon Bélair
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), University of Montreal, Montreal, Quebec, Canada
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18
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Bang C, Bernard G, Le WT, Lalonde A, Kadoury S, Bahig H. Artificial intelligence to predict outcomes of head and neck radiotherapy. Clin Transl Radiat Oncol 2023; 39:100590. [PMID: 36935854 PMCID: PMC10014342 DOI: 10.1016/j.ctro.2023.100590] [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: 01/13/2023] [Revised: 01/28/2023] [Accepted: 01/28/2023] [Indexed: 02/01/2023] Open
Abstract
Head and neck radiotherapy induces important toxicity, and its efficacy and tolerance vary widely across patients. Advancements in radiotherapy delivery techniques, along with the increased quality and frequency of image guidance, offer a unique opportunity to individualize radiotherapy based on imaging biomarkers, with the aim of improving radiation efficacy while reducing its toxicity. Various artificial intelligence models integrating clinical data and radiomics have shown encouraging results for toxicity and cancer control outcomes prediction in head and neck cancer radiotherapy. Clinical implementation of these models could lead to individualized risk-based therapeutic decision making, but the reliability of the current studies is limited. Understanding, validating and expanding these models to larger multi-institutional data sets and testing them in the context of clinical trials is needed to ensure safe clinical implementation. This review summarizes the current state of the art of machine learning models for prediction of head and neck cancer radiotherapy outcomes.
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Key Words
- ADASYN, adaptive synthetic sampling
- AI, artificial intelligence
- ANN, artificial neural network
- AUC, Area Under the ROC Curve
- Artificial intelligence
- BMI, body mass index
- C-Index, concordance index
- CART, Classification and Regression Tree
- CBCT, cone-beam computed tomography
- CIFE, conditional informax feature extraction
- CNN, convolutional neural network
- CRT, chemoradiation
- CT, computed tomography
- Cancer outcomes
- DL, deep learning
- DM, distant metastasis
- DSC, Dice Similarity Coefficient
- DSS, clinical decision support systems
- DT, Decision Tree
- DVH, Dose-volume histogram
- GANs, Generative Adversarial Networks
- GB, Gradient boosting
- GPU, graphical process units
- HNC, head and neck cancer
- HPV, human papillomavirus
- HR, hazard ratio
- Head and neck cancer
- IAMB, incremental association Markov blanket
- IBDM, image based data mining
- IBMs, image biomarkers
- IMRT, intensity-modulated RT
- KNN, k nearest neighbor
- LLR, Local linear forest
- LR, logistic regression
- LRR, loco-regional recurrence
- MIFS, mutual information based feature selection
- ML, machine learning
- MRI, Magnetic resonance imaging
- MRMR, Minimum redundancy feature selection
- Machine learning
- N-MLTR, Neural Multi-Task Logistic Regression
- NPC, nasopharynx
- NTCP, Normal Tissue Complication Probability
- OPC, oropharyngeal cancer
- ORN, osteoradionecrosis
- OS, overall survival
- PCA, Principal component analysis
- PET, Positron emission tomography
- PG, parotid glands
- PLR, Positive likelihood ratio
- PM, pharyngeal mucosa
- PTV, Planning target volumes
- PreSANet, deep preprocessor module and self-attention
- Predictive modeling
- QUANTEC, Quantitative Analyses of Normal Tissue Effects in the Clinic
- RF, random forest
- RFC, random forest classifier
- RFS, recurrence free survival
- RLR, Rigid logistic regression
- RRF, Regularized random forest
- RSF, random survival forest
- RT, radiotherapy
- RTLI, radiation-induced temporal lobe injury
- Radiomic
- SDM, shared decision making
- SMG, submandibular glands
- SMOTE, synthetic minority over-sampling technique
- STIC, sticky saliva
- SVC, support vector classifier
- SVM, support vector machine
- XGBoost, extreme gradient boosting
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Affiliation(s)
- Chulmin Bang
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Corresponding author at: Centre Hospitalier de l'Université de Montréal, 3840 Rue Saint-Urbain, Montréal, QC H2W 1T8, Canada.
| | - Galaad Bernard
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - William T. Le
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Polytechnique Montréal, Montreal, QC, Canada
| | - Arthur Lalonde
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Université de Montréal, Montreal, QC, Canada
| | - Samuel Kadoury
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Polytechnique Montréal, Montreal, QC, Canada
| | - Houda Bahig
- Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada
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19
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Mailhot-Larouche S, Chauvette V, Bergeron D, Larochelle C, Du Pont-Thibodeau G, Wang H, Cardinal H, Bourdeau I, Auger N, Bureau NBMMS, Prat A, Jutras-Aswad D, Madore F, Emeriaud G, Bahig H, Mayrand MH, Tadros R, Parent S, Richebe PRMP, Merhi Y, Nguyen D. University of Montreal's Clinician-Investigator Program: A 10-Year Descriptive Evaluation. Clin Invest Med 2022; 45:E1-10. [PMID: 36586100 DOI: 10.25011/cim.v45i4.39275] [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] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 01/01/2023]
Abstract
PURPOSE Clinician-investigators have an important role in the development and implantation of new therapies and treatment modalities; however, there have been several reports highlighting a pending shortage in the clinician-investigators' workforce. In Canada, the Royal College has promoted the development of clinician-investigators programs (CIP) to facilitate the training of these individuals. There is currently a paucity of data regarding the outcomes of such programs. This study aims to identify the strengths and areas of improvement of the Montreal University CIP. Methods: An internet-based 51-question survey was distributed to all the alumni from the University of Montreal CIP. Participation was voluntary and no incentives were provided. The response rate was 64%. Results: Among respondents, 50% (n=16) had completed their clinical residency and all CIP requirements. The majority of these individuals (63%) had become independent investigators and had secured provincial and national funding. Satisfaction of the respondents was high regarding the overall program (85%), the research skills developed during the CIP (84%) and the financial support obtained during the program (72%). The satisfaction rate regarding career planning was lower (63%). Conclusion: This survey demonstrates that, while indicators are favorable, some areas still require improvement. Several steps to improve the CIP have been identified; notably, the transition from the CIP to early independent career has been identified as critical in the development of clinician-investigators and steps have been taken to improve this progression.
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Affiliation(s)
| | - Vincent Chauvette
- Institut de Cardiologie de Montréal, Department of Cardiac Surgery, Montreal, QC, Canada.
| | | | - Catherine Larochelle
- Centre Hospitalier Universitaire de l'Université de Montréal, Department of Neurology, Montreal, QC, Canada.
| | | | - Han Wang
- Hôpital Maisonneuve-Rosemont, Department of Critical Care, Montreal, QC, Canada.
| | - Héloïse Cardinal
- Centre Hospitalier Universitaire de l'Université de Montréal, Department of Immunology, Montreal, QC, Canada.
| | - Isabelle Bourdeau
- Centre Hospitalier Universitaire de l'Université de Montréal, Department of Endocrinology, Montreal, QC, Canada.
| | - Nathalie Auger
- Institut National de Santé Publique du Québec, Department of Preventive Medicine, Montreal, QC, Canada.
| | | | - Alexandre Prat
- Centre Hospitalier Universitaire de l'Université de Montréal, Department of Neurology, Montreal, QC, Canada.
| | - Didier Jutras-Aswad
- Centre Hospitalier Universitaire de l'Université de Montréal, Department of Psychiatry, Montreal, QC, Canada.
| | - François Madore
- Hôpital du Sacré-Cœur de Montréal, Department of Nephrology, Montreal, QC, Canada.
| | - Guillaume Emeriaud
- Centre Hospitalier Universitaire Ste-Justine, Department of Critical Care, Montreal, QC, Canada.
| | - Houda Bahig
- Centre Hospitalier Universitaire de l'Université de Montréal, Department of Radiology, Montreal, QC, Canada.
| | | | - Rafik Tadros
- Institut de Cardiologie de Montréal, Department of Cardiology, Montreal, QC, Canada.
| | - Stefan Parent
- Centre Hospitalier Universitaire Ste-Justine, Department of Orthopedic Surgery, Montreal, QC, Canada.
| | | | - Yahye Merhi
- Institut de Cardiologie de Montréal, Department of Hematology, Montreal, QC, Canada.
| | - Dang Nguyen
- Centre Hospitalier Universitaire de l'Université de Montréal, Department of Neurology, Montreal, QC, Canada.
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20
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Mensour EA, Alam S, Mawani S, Bahig H, Lang P, Nichols A, Palma DA, Jasper K. What is the future of treatment de-escalation for HPV-positive oropharyngeal cancer? A review of ongoing clinical trials. Front Oncol 2022; 12:1067321. [PMID: 36620554 PMCID: PMC9816564 DOI: 10.3389/fonc.2022.1067321] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 10/11/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Background Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has increased in incidence in recent decades. With higher cure rates in younger populations, long-term survivors may live with acute- and long-term toxicity, leading to increased interest in de-escalation treatment strategies for HPV-related OPSCC. Herein, we have examined the current landscape of clinical trials in this context. Methods A review of active clinical trials related to de-escalation of HPV-associated OPSCC treatment was performed using the clinicaltrials.gov database from inception to January 2022. A search using the key words "oropharyngeal cancer" and "HPV" was completed. Three investigators independently reviewed each trial, with any discrepancies settled by a fourth. Data collected from each study included study phase, study design, primary, and secondary endpoints, and de-escalation treatment strategies. A final 24 articles were selected for full text review. Results Many trials (n=19, 79%) were non-randomized, and most studies employed a phase II design (n=14, 58%). Only 13% (n=3) were randomized trials, and 8% (n=2) included a phase III component. The most frequent primary endpoint was progression-free survival (PFS) (n=9, 37.5%). With regards to the identified de-escalation strategies, all the studies (n=24) had at least one component assessing changes in RT dose/fractionation and/or a reduction in RT volumes. A smaller percentage of trials assessed surgical interventions (n=9, 37.5%) and/or changes in systemic therapy (n=8, 33.3%). Conclusion A small number of randomized trials are underway, and a transition to more randomized phase III trials in the future will be important to change clinical practice.
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Affiliation(s)
- Emma A. Mensour
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Shintha Alam
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Seliya Mawani
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Houda Bahig
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON, Canada
| | - David A. Palma
- Department of Radiation Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada,*Correspondence: David A. Palma,
| | - Katie Jasper
- Department of Radiation Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
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21
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Abstract
The hypothesis that ablative therapies (such as surgery or radiation) can be used to cure patients with a limited number of metastases was influential in changing practice. Early assertions of efficacy were based on observational studies, often without control groups, showing better-than-expected outcomes. However, in the past decade, new evidence from randomized trials has emerged, which in some cases have affirmed old hypotheses, but in other cases have raised new questions. In this review, we discuss the challenges in defining oligometastatic disease, summarize the randomized evidence evaluating metastasis-directed therapy in patients with oligometastatic disease, provide context for the difficulty in generating randomized evidence, and examine ongoing phase III studies.
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Affiliation(s)
- Wei Liu
- Division of Radiation Oncology, BC Cancer Vancouver, Vancouver, BC, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - David A Palma
- Department of Oncology, Division of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
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22
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Chartrand G, Emiliani RD, Pawlowski SA, Markel DA, Bahig H, Cengarle-Samak A, Rajakesari S, Lavoie J, Ducharme S, Roberge D. Automated Detection of Brain Metastases on T1-Weighted MRI Using a Convolutional Neural Network: Impact of Volume Aware Loss and Sampling Strategy. J Magn Reson Imaging 2022; 56:1885-1898. [PMID: 35624544 DOI: 10.1002/jmri.28274] [Citation(s) in RCA: 2] [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: 02/10/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Detection of brain metastases (BM) and segmentation for treatment planning could be optimized with machine learning methods. Convolutional neural networks (CNNs) are promising, but their trade-offs between sensitivity and precision frequently lead to missing small lesions. HYPOTHESIS Combining volume aware (VA) loss function and sampling strategy could improve BM detection sensitivity. STUDY TYPE Retrospective. POPULATION A total of 530 radiation oncology patients (55% women) were split into a training/validation set (433 patients/1460 BM) and an independent test set (97 patients/296 BM). FIELD STRENGTH/SEQUENCE 1.5 T and 3 T, contrast-enhanced three-dimensional (3D) T1-weighted fast gradient echo sequences. ASSESSMENT Ground truth masks were based on radiotherapy treatment planning contours reviewed by experts. A U-Net inspired model was trained. Three loss functions (Dice, Dice + boundary, and VA) and two sampling methods (label and VA) were compared. Results were reported with Dice scores, volumetric error, lesion detection sensitivity, and precision. A detected voxel within the ground truth constituted a true positive. STATISTICAL TESTS McNemar's exact test to compare detected lesions between models. Pearson's correlation coefficient and Bland-Altman analysis to compare volume agreement between predicted and ground truth volumes. Statistical significance was set at P ≤ 0.05. RESULTS Combining VA loss and VA sampling performed best with an overall sensitivity of 91% and precision of 81%. For BM in the 2.5-6 mm estimated sphere diameter range, VA loss reduced false negatives by 58% and VA sampling reduced it further by 30%. In the same range, the boundary loss achieved the highest precision at 81%, but a low sensitivity (24%) and a 31% Dice loss. DATA CONCLUSION Considering BM size in the loss and sampling function of CNN may increase the detection sensitivity regarding small BM. Our pipeline relying on a single contrast-enhanced T1-weighted MRI sequence could reach a detection sensitivity of 91%, with an average of only 0.66 false positives per scan. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
| | | | | | - Daniel A Markel
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | - Selvan Rajakesari
- Department of Radiation Oncology, Hopital Charles Lemoyne, Greenfield Park, Québec, Canada
| | | | - Simon Ducharme
- AFX Medical Inc., Montréal, Canada.,Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montréal, Canada
| | - David Roberge
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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23
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Bang C, Chartrand G, Pawlowski S, Emiliani R, Markel D, Bahig H, Samak A, Rajakesari S, Lavoie J, Ducharme S, Roberge D. RADT-10. THE LOST METASTASES: DEEP LEARNING’S POTENTIAL IN RADIOSURGERY QUALITY ASSURANCE. Neuro Oncol 2022. [PMCID: PMC9660837 DOI: 10.1093/neuonc/noac209.200] [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
Introduction
Identifying, segmenting, measuring, and following multiple brain metastases treated with radiosurgery can be time consuming and error prone. Machine learning has shown promise for automated detection and segmentation. Recently, a U-Net inspired model combining volume aware loss functions and volume aware sampling methods was trained in an industrial-academic partnership. A total of 530 clinically annotated T1 gadolinium MRIs were used. Initial validation showed a high sensitivity (91%) with an average of 0.66 false positives per MRI. The goal of the present work was to characterize those “false positives” which may represent clinically undetected metastases.
METHODS
The images used for model development were clinically annotated for radiosurgery planning. Lesions had first been identified by a radiologist, second by clinicians during tumor board review, third by the treating radiation oncologist and the treating neurosurgeon (potentially after segmentation by a trainee) and finally by fellow radiation oncologists during quality assurance rounds. Despite these multiple checks, 10 patients (2%) had brain lesions considered potential clinical misses when all “false positives” were manually reviewed by a single investigator. Further detailed review including prior and subsequent imaging was used to arbitrate the nature of these lesions.
RESULTS
Among the 10 cases, four were confirmed as undetected metastases: two lesions required subsequent radiosurgery and 2 patients died prior to further imaging. The six other lesions were adjudicated as true “false positives” (typically vascular).
CONCLUSION
The multi-tier radiosurgery workflow at our institution left very few unidentified brain metastases (0.8%). Despite this low error rate, our AI algorithm still detected two lesions that required further treatment. Future investigations will focus on potential roles of AI in simplifying and accelerating our workflow. It also remains to be established if more undetected metastases would be seen in community settings where workflows include fewer sequential imaging reviews.
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Affiliation(s)
- Charmin Bang
- CHUM (Centre hospitalier de l'Université de Montréal), Montreal , Quebec , Canada
| | | | | | | | - Daniel Markel
- CHUM (Centre hospitalier de l'Université de Montréal), Montreal , Quebec , Canada
| | - Houda Bahig
- CHUM (Centre hospitalier de l'Université de Montréal), Montreal , Quebec , Canada
| | | | | | | | - Simon Ducharme
- Montreal Neurological Institute and Hospital, Montreal , Quebec , Canada
| | - David Roberge
- Centre hospitalier de l'Université de Montréal, Montreal , Quebec , Canada
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24
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Abana C, Garden A, Frankart A, Geier N, Bahig H, Gunn G, Mohamed A, Takiar V, Phan J. Two-Year Patient-Reported Outcomes after Ipsilateral IMRT for T1-2 N2b Squamous Cell Carcinoma of the Tonsils. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1375] [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: 10/31/2022]
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25
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Lavigne D, Ng SP, O’Sullivan B, Nguyen-Tan PF, Filion E, Létourneau-Guillon L, Fuller CD, Bahig H. Magnetic Resonance-Guided Radiation Therapy for Head and Neck Cancers. Curr Oncol 2022; 29:8302-8315. [PMID: 36354715 PMCID: PMC9689607 DOI: 10.3390/curroncol29110655] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Despite the significant evolution of radiation therapy (RT) techniques in recent years, many patients with head and neck cancer still experience significant toxicities during and after treatments. The increased soft tissue contrast and functional sequences of magnetic resonance imaging (MRI) are particularly attractive in head and neck cancer and have led to the increasing development of magnetic resonance-guided RT (MRgRT). This approach refers to the inclusion of the additional information acquired from a diagnostic or planning MRI in radiation treatment planning, and now extends to online high-quality daily imaging generated by the recently developed MR-Linac. MRgRT holds numerous potentials, including enhanced baseline and planning evaluations, anatomical and functional treatment adaptation, potential for hypofractionation, and multiparametric assessment of response. This article offers a structured review of the current literature on these established and upcoming roles of MRI for patients with head and neck cancer undergoing RT.
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Affiliation(s)
- Danny Lavigne
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, VI 3084, Australia
| | - Brian O’Sullivan
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Phuc Felix Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Laurent Létourneau-Guillon
- Department of Radiology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Clifton D. Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, University of Montreal, Montreal, QC H2X 3E4, Canada
- Correspondence:
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26
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Frankart AJ, Abana CO, Geier N, Bahig H, Manzar GS, Garden AS, Phan J, Takiar V. Long-term Locoregional Control With Unilateral Radiation for AJCC-7 T1-2N2b Tonsillar Cancer. Am J Clin Oncol 2022; 45:422-426. [PMID: 36083002 DOI: 10.1097/coc.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Unilateral radiation to cervical nodes has been used as a de-escalation strategy in well-lateralized tonsil cancers. The efficacy of this approach with multiple ipsilateral nodes is not established. The study hypothesis was that unilateral radiation for American Joint Committee on Cancer (AJCC)-7 T1-2N2b tonsillar cancer results in a low rate of contralateral nodal failure. MATERIALS AND METHODS This study was a retrospective chart review of patients with AJCC-7 T1-2N2b tonsillar cancer from 2 academic institutions who were treated with unilateral radiation. The primary endpoint was the contralateral nodal failure rate. Locoregional control, overall survival, and the need for gastrostomy tube placement were additional endpoints. RESULTS The study cohort included 66 patients treated between 2005 and 2016. The median follow-up time was 80.9 months; contralateral nodal failure occurred in 2/66 (3.0%) patients at 4.1 and 20.9 months, respectively. Both patients underwent salvage treatment with long-term subsequent survival. Overall locoregional control at both 2 and 5 years was 93.9% and the median duration of control was not reached. Overall survival at 5 years was 92.4%. CONCLUSIONS The use of unilateral radiation for AJCC-7 T1-2N2b tonsillar cancer resulted in low rates of contralateral nodal failure. This outcome demonstrates the safety of considering unilateral radiation treatment in patients with a relatively high ipsilateral nodal burden.
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Affiliation(s)
- Andrew J Frankart
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - Chike O Abana
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Natalie Geier
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | | | - Adam S Garden
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Jack Phan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH
- Cincinnati VA Medical Center, Cincinnati, OH
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Lavigne D, De-Meric-de-Bellefon M, Bahig H, Landry D, Belair M, Létourneau-Guillon L, Filion E, Nguyen-Tan FP. 180: Trimodality Imaging and Predictive Factors of Retropharyngeal Lymph Node Metastases in Oropharyngeal Cancers. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04460-7] [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: 10/14/2022]
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Tonneau M, Richard C, Routy B, Campeau MP, Vu T, Filion E, Roberge D, Mathieu D, Doucet R, Beliveau-Nadeau D, Bahig H. 42: A Competing Risk Analysis of Prognostic Factors for Local and Regional Recurrence and Survival Outcomes in Early-Stage Non-Small Cell Lung Cancer Treated with Stereotactic Ablative Radiation Therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04321-3] [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: 11/24/2022]
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Ng SP, Cardenas CE, Bahig H, Elgohari B, Wang J, Johnson JM, Moreno AC, Shah SJ, Garden AS, Phan J, Gunn GB, Frank SJ, Ding Y, Na L, Yuan Y, Urbauer D, Mohamed ASR, Rosenthal DI, Morrison WH, MacManus MP, Fuller CD. Changes in Apparent Diffusion Coefficient (ADC) in Serial Weekly MRI during Radiotherapy in Patients with Head and Neck Cancer: Results from the PREDICT-HN Study. Curr Oncol 2022; 29:6303-6313. [PMID: 36135064 PMCID: PMC9498049 DOI: 10.3390/curroncol29090495] [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: 07/23/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The PREDICT-HN study aimed to systematically assess the kinetics of imaging MR biomarkers during head and neck radiotherapy. Methods: Patients with intact squamous cell carcinoma of the head and neck were enrolled. Pre-, during, and post-treatment MRI were obtained. Serial GTV and ADC measurements were recorded. The correlation between each feature and the GTV was calculated using Spearman’s correlation coefficient. The linear mixed model was used to evaluate the change in GTV over time. Results: A total of 41 patients completed the study. The majority (76%) had oropharyngeal cancer. A total of 36 patients had intact primary tumours that can be assessed on MRI, and 31 patients had nodal disease with 46 nodes assessed. Median primary GTV (GTVp) size was 14.1cc. The rate of GTVp shrinkage was highest between pre-treatment and week 4. Patients with T3-T4 tumours had a 3.8-fold decrease in GTVp compared to T1-T2 tumours. The ADC values correlated with residual GTVp. The median nodal volume (GTVn) was 12.4cc. No clinical features were found to correlate with GTVn reduction. The overall change in ADC for GTVn from pre-treatment was significant for 35th−95th percentiles in weeks 1−4 (p < 0.001). Conclusion: A discrepancy in the trajectory of ADC between primary and nodal sites suggested that they exhibit different treatment responses and should be analysed separately in future studies.
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Affiliation(s)
- Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne, VIC 3071, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
- Correspondence:
| | - Carlos E. Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Baher Elgohari
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
- Department of Clinical Oncology and Nuclear Medicine, Mansoura University, Mansoura 35516, Egypt
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Jason M. Johnson
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Amy C. Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Shalin J. Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Adam S. Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - G. Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Lumine Na
- Department of Biostatistics, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Ying Yuan
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Diana Urbauer
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Abdallah S. R. Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - David I. Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - William H. Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
| | - Michael P. MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77098, USA
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Bahig H, Huang SH, O’Sullivan B. Oligometastatic Head and Neck Cancer: Challenges and Perspectives. Cancers (Basel) 2022; 14:cancers14163894. [PMID: 36010888 PMCID: PMC9405984 DOI: 10.3390/cancers14163894] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/25/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Oligometastasis represents a disease state and an opportunity for cure when metastases emerge. Emerging evidence supports that most head and neck cancer patients with oligometastatic disease are likely to benefit from curative intent local ablative therapy if appropriate selection criteria are applied. Biomarkers to predict development of oligometastasis, as well as to identify which patients could benefit from a radical intent approach, are under investigation. This review summarizes recent knowledge about the characteristics, investigational efforts, and evidence for local ablation regarding oligometastasis in head and neck cancer. We also describe the challenges and opportunities in patient selection and discuss the role of radiotherapy and immunotherapy combinations to enhance anti-tumor immunity. Abstract A minority of patients with metastatic head and neck squamous cell carcinoma (HNSCC) present with oligometastatic disease. Oligometastasis not only reflects a disease state, but might also present an opportunity for cure in the metastatic setting. Radical ablation of all oligometastatic sites may confer prolonged survival and possibly achieve cure in some patients. However, substantial debate remains about whether patients with oligometastatic disease could benefit from curative intent therapy or whether aggressive treatments expose some patients to futile toxicity. Optimal selection of patients, carefully balancing the currently known prognostic factors against the risks of toxicity is critical. Emerging evidence suggests that patients with a limited burden of disease, viral-related pharyngeal cancer, metachronous metastasis and lung-only metastasis may benefit most from this approach. Efforts are underway to identify biomarkers that can detect oligometastasis and better select patients who would derive the maximum benefit from an aggressive radical approach. The combination of radiotherapy and immunotherapy promises to enhance the anti-tumoral immune response and help overcome resistance. However, optimization of management algorithms, including patient selection, radiation dose and sequencing, will be critical in upcoming clinical trials. This review summarizes recent knowledge about the characteristics and investigational efforts regarding oligometastasis in HNSCC.
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Affiliation(s)
- Houda Bahig
- Department of Radiation Oncology, University of Montreal, Montreal, QC H2X 3E4, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2M9, Canada
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Brian O’Sullivan
- Department of Radiation Oncology, University of Montreal, Montreal, QC H2X 3E4, Canada
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2M9, Canada
- Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON M5G 2M9, Canada
- Correspondence:
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Ashram S, Bahig H, Barry A, Blanchette D, Celinksi A, Chung P, Darko J, Donath D, Doucet R, Erickson A, Giuliani M, Gopaul D, Hipwell S, Javor J, Kuk J, Lindsay P, Millman B, Oliver M, Pearce A, Russell C, Senthi S, Vu T, Warner A, Gaede S, Palma DA. Planning Trade-offs for Stereotactic Ablative Radiotherapy in Patients with 4-10 Metastases: A Sub-study of the SABR-COMET-10 randomized trial. Int J Radiat Oncol Biol Phys 2022; 114:1011-1015. [PMID: 35667527 DOI: 10.1016/j.ijrobp.2022.05.035] [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: 03/15/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of stereotactic ablative radiotherapy (SABR) for metastases often involves trade-offs, balancing adequate target coverage with the need to maintain a safe dose to organs at risk (OARs). Very few studies have evaluated this complexity in patients with >3 oligometastases. To explore these trade-offs, we analyzed planning outcomes from the first 60 patients enrolled on a randomized trial of SABR in patients with 4-10 metastases. METHODS Radiation plans for patients enrolled on the BLINDED-FOR-REVIEW randomized trial were analyzed. Data abstracted included target locations and sizes, dose prescriptions and target coverage, and OAR doses, and these parameters were evaluated based on target location to identify locations where compromise of planning constraints was required. RESULTS SABR was planned for 332 lesions in 296 separate PTVs. The median PTV size was 9.0 cc per lesion (interquartile range [IQR]: 5.3-24.3 cc) and 89.1 cc per patient (IQR: 37.0-177.0). The most common prescriptions were 30-35 Gy in 5 fractions (43% of lesions) and 20-24 Gy in 1 fraction (33% of lesions). The maximum dose within the PTV was a median of 124% of prescription (IQR: 117-130%). Only 3.3% of lesions had a dose to 95% of the PTV (D95) <95% of prescription; this was more common for spinal (25%) and lymph node (8.4%) targets (p<0.001), translating to median D95 values of 100.5% (IQR: 99.6%-101.5%) and 100.0% (IQR: 84.6%-100.5%), respectively. All OARs constraints were met in 95.2% of patients, with the only exceptions being lymph node targets (n=3). CONCLUSIONS SABR planning for patients with 4-10 metastases was achievable without dosimetric compromise in the large majority of patients. Nodal and spinal targets were most likely to lead to compromise of target coverage or OAR constraints. Further research is needed to determine how to best balance these trade-offs.
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Affiliation(s)
- Samaher Ashram
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Aisling Barry
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | | | - Anders Celinksi
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Johnson Darko
- Grand River Cancer Centre, Kitchener, Ontario, Canada
| | - David Donath
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Robert Doucet
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Abigail Erickson
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Darin Gopaul
- Grand River Cancer Centre, Kitchener, Ontario, Canada
| | - Scott Hipwell
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Joanna Javor
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Joda Kuk
- Grand River Cancer Centre, Kitchener, Ontario, Canada
| | - Patricia Lindsay
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, Toronto, Ontario, Canada
| | - Barbara Millman
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | | | - Toni Vu
- Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Warner
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stewart Gaede
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, London Health Sciences Centre, London, Ontario, Canada.
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Simard M, Lapointe A, Bahig H, Carrier J, Zhang S, Campeau M, Filion É, Roberge D, Bouchard H, Bedwani S. PO-1748 A DECT framework to measure the effect of radiation dose on lung function after radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03712-4] [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: 11/27/2022]
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Wise-Draper TM, Bahig H, Karivedu V, Burtness B. Current Therapy for Metastatic Head and Neck Cancer: Evidence, Opportunities, and Challenges. Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35486888 DOI: 10.1200/edbk_350442] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Management of metastatic head and neck squamous cell carcinoma is evolving as new systemic therapies have led to improvements in survival, and as advances in locoregional therapy and the increased numbers of patients with HPV-associated cancers who develop oligometastases raise the possibility of ablation of limited numbers of metastases. We review the data regarding first-line immunotherapy in PD-L1-expressing metastatic head and neck squamous cell carcinoma, the experience with aggressive local management of oligometastases, and promising novel immunotherapies, targeted therapies, and HPV-specific treatments. For patients with metastatic head and neck squamous cell carcinoma that is PD-L1 expressing, first-line systemic therapy is pembrolizumab or pembrolizumab with chemotherapy. Inclusion of chemotherapy is associated with higher objective response proportion in all biomarker subgroups and may have a greater impact on survival in HPV-associated cancers. For patients with oligometastatic disease, particularly when metastases are metachronous, current evidence supporting the role of local ablation is limited to a small number of retrospective studies. Based on retrospective data, patients with a smaller number of metastases, lung metastases, and/or virally associated head and neck squamous cell carcinoma are most likely to benefit from an aggressive ablative approach. Additionally, we review emerging evidence for targeted therapy in metastatic head and neck squamous cell carcinoma, including with agents that inhibit mutant HRAS or NOTCH1, or overexpressed EGFR. Studies of antiangiogenic agents in combination with immune checkpoint blockade, and combination immunotherapy, are also under study.
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Affiliation(s)
| | - Houda Bahig
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Vidhya Karivedu
- Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - Barbara Burtness
- Yale University School of Medicine and Yale Cancer Center, New Haven, CT
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Le WT, Vorontsov E, Romero FP, Seddik L, Elsharief MM, Nguyen-Tan PF, Roberge D, Bahig H, Kadoury S. Cross-institutional outcome prediction for head and neck cancer patients using self-attention neural networks. Sci Rep 2022; 12:3183. [PMID: 35210482 PMCID: PMC8873259 DOI: 10.1038/s41598-022-07034-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 07/07/2021] [Accepted: 02/10/2022] [Indexed: 12/13/2022] Open
Abstract
In radiation oncology, predicting patient risk stratification allows specialization of therapy intensification as well as selecting between systemic and regional treatments, all of which helps to improve patient outcome and quality of life. Deep learning offers an advantage over traditional radiomics for medical image processing by learning salient features from training data originating from multiple datasets. However, while their large capacity allows to combine high-level medical imaging data for outcome prediction, they lack generalization to be used across institutions. In this work, a pseudo-volumetric convolutional neural network with a deep preprocessor module and self-attention (PreSANet) is proposed for the prediction of distant metastasis, locoregional recurrence, and overall survival occurrence probabilities within the 10 year follow-up time frame for head and neck cancer patients with squamous cell carcinoma. The model is capable of processing multi-modal inputs of variable scan length, as well as integrating patient data in the prediction model. These proposed architectural features and additional modalities all serve to extract additional information from the available data when availability to additional samples is limited. This model was trained on the public Cancer Imaging Archive Head–Neck-PET–CT dataset consisting of 298 patients undergoing curative radio/chemo-radiotherapy and acquired from 4 different institutions. The model was further validated on an internal retrospective dataset with 371 patients acquired from one of the institutions in the training dataset. An extensive set of ablation experiments were performed to test the utility of the proposed model characteristics, achieving an AUROC of \documentclass[12pt]{minimal}
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\begin{document}$$82\%$$\end{document}82% for DM, LR and OS respectively on the public TCIA Head–Neck-PET–CT dataset. External validation was performed on a retrospective dataset with 371 patients, achieving \documentclass[12pt]{minimal}
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\begin{document}$$69\%$$\end{document}69% AUROC in all outcomes. To test for model generalization across sites, a validation scheme consisting of single site-holdout and cross-validation combining both datasets was used. The mean accuracy across 4 institutions obtained was \documentclass[12pt]{minimal}
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\begin{document}$$71\%$$\end{document}71% for DM, LR and OS respectively. The proposed model demonstrates an effective method for tumor outcome prediction for multi-site, multi-modal combining both volumetric data and structured patient clinical data.
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Affiliation(s)
- William Trung Le
- Polytechnique Montréal, 500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada.,Centre de recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Pavillon R, Montreal, QC, H2X 0A9, Canada
| | - Eugene Vorontsov
- Polytechnique Montréal, 500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada
| | | | - Lotfi Seddik
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
| | | | - Phuc Felix Nguyen-Tan
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
| | - David Roberge
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
| | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, QC, H2X 3E4, Canada
| | - Samuel Kadoury
- Polytechnique Montréal, 500 Chemin de Polytechnique, Montreal, QC, H3T 1J4, Canada. .,Centre de recherche du Centre Hospitalier de l'Université de Montréal, 900 Rue Saint-Denis, Pavillon R, Montreal, QC, H2X 0A9, Canada.
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Cardenas CE, Blinde SE, Mohamed ASR, Ng SP, Raaijmakers C, Philippens M, Kotte A, Al-Mamgani AA, Karam I, Thomson DJ, Robbins J, Newbold K, Fuller CD, Terhaard C, On Behalf Of The, Bahig H, Blanchard P, Dehnad H, Doornaert P, Elhalawani H, Frank SJ, Garden A, Gunn GB, Hamming-Vrieze O, Kamal M, Kasperts N, Lee LW, McDonald BA, McPartlin A, Meheissen MA, Morrison WH, Navran A, Nutting CM, Pameijer F, Phan J, Poon I, Rosenthal DI, Smid EJ, Sykes AJ. Comprehensive Quantitative Evaluation of Variability in MR-guided Delineation of Oropharyngeal Gross Tumor Volumes and High-risk Clinical Target Volumes: An R-IDEAL Stage 0 Prospective Study. Int J Radiat Oncol Biol Phys 2022; 113:426-436. [PMID: 35124134 DOI: 10.1016/j.ijrobp.2022.01.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Tumor and target volume manual delineation remains a challenging task in head-and-neck cancer radiotherapy. The purpose of this study was to conduct a multi-institutional evaluation of manual delineations of gross tumor volume (GTV), high-risk clinical target volume (CTV), parotids, and submandibular glands on treatment simulation MR scans of oropharyngeal cancer (OPC) patients. METHODS Pre-treatment T1-weighted (T1w), T1-weighted with gadolinium contrast (T1w+C) and T2-weighted (T2w) MRI scans were retrospectively collected for 4 OPC patients under an IRB-approved protocol. The scans were provided to twenty-six radiation oncologists from seven international cancer centers who participated in this delineation study. In addition, patients' clinical history and physical examination findings, along with a medical photographic image and radiological results, were provided. The contours were compared using overlap/distance metrics using both STAPLE and pair-wise comparisons. Lastly, participants completed a brief questionnaire to assess participants' experience and CTV delineation institutional practices. RESULTS Large variability was measured between observers' delineations for GTVs and CTVs. The mean Dice Similarity Coefficient values across all physicians' delineations for GTVp, GTVn, CTVp, and CTVn were 0.77, 0.67, 0.77, and 0.69, respectively, for STAPLE comparison and 0.67, 0.60, 0.67, and 0.58, respectively, for pair-wise analysis. Normal tissue contours were defined more consistently when considering overlap/distance metrics. The median radiation oncology clinical experience was 7 years. The median experience delineating on MRI was 3.5 years. The GTV-to-CTV margin used was 10 mm for six of seven participant institutions. One institution used 8 mm and three participants (from three different institutions) used a margin of 5 mm. CONCLUSION The data from this study suggests that appropriate guidelines, contouring quality assurance sessions, and training are still needed for the adoption of MR-based treatment planning for head-and-neck cancers. Such efforts should play a critical role in reducing delineation variation and ensure standardization of target design across clinical practices.
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Affiliation(s)
- Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Sanne E Blinde
- Department of Radiation Oncology, Klinikum Kassel, Kassel, Germany
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia
| | - Cornelis Raaijmakers
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle Philippens
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexis Kotte
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abrahim A Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jared Robbins
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
| | - Kate Newbold
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Chris Terhaard
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - On Behalf Of The
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Blanchard
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Homan Dehnad
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patricia Doornaert
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adam Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolien Kasperts
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lip Wai Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Brigid A McDonald
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mohamed Am Meheissen
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Frank Pameijer
- Department of Radiology, Division of Imaging & Oncology, University Medical Center, Utrecht, The Netherlands
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ernst J Smid
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew J Sykes
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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Desilets A, McCarvill W, Aubin F, Bahig H, Ballivy O, Charpentier D, Filion É, Jamal R, Lambert L, Nguyen-Tan PF, Vadnais C, Weng X, Soulières D. Upfront DPYD Genotyping and Toxicity Associated with Fluoropyrimidine-Based Concurrent Chemoradiotherapy for Oropharyngeal Carcinomas: A Work in Progress. Curr Oncol 2022; 29:497-509. [PMID: 35200545 PMCID: PMC8870563 DOI: 10.3390/curroncol29020045] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: 5-FU-based chemoradiotherapy (CRT) could be associated with severe treatment-related toxicities in patients harboring at-risk DPYD polymorphisms. Methods: The studied population included consecutive patients with locoregionally advanced oropharyngeal carcinoma treated with carboplatin and 5-FU-based CRT one year before and after the implementation of upfront DPYD*2A genotyping. We aimed to determine the effect of DPYD genotyping on grade ≥3 toxicities. Results: 181 patients were analyzed (87 patients before and 94 patients following DPYD*2A screening). Of the patients, 91% (n = 86) were prospectively genotyped for the DPYD*2A allele. Of those screened, 2% (n = 2/87) demonstrated a heterozygous DPYD*2A mutation. Extended genotyping of DPYD*2A-negative patients later allowed for the retrospective identification of six additional patients with alternative DPYD variants (two c.2846A>T and four c.1236G>A mutations). Grade ≥3 toxicities occurred in 71% of the patients before DPYD*2A screening versus 62% following upfront genotyping (p = 0.18). When retrospectively analyzing additional non-DPYD*2A variants, the relative risks for mucositis (RR 2.36 [1.39–2.13], p = 0.0063), dysphagia (RR 2.89 [1.20–5.11], p = 0.019), and aspiration pneumonia (RR 13 [2.42–61.5)], p = 0.00065) were all significantly increased. Conclusion: The DPYD*2A, c.2846A>T, and c.1236G>A polymorphisms are associated with an increased risk of grade ≥3 toxicity to 5-FU. Upfront DPYD genotyping can identify patients in whom 5-FU-related toxicity should be avoided.
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Cardin GB, Bernard M, Bourbonnais J, Bahig H, Nguyen-Tan PF, Filion E, Soulieres D, Gologan O, Ayad T, Guertin L, Bissada E, Rodier F, Christopoulos A. The rs6942067 genotype is associated with a worse overall survival in young or non-smoking HPV-negative patients with positive nodal status in head and neck squamous cell carcinoma. Oral Oncol 2022; 125:105696. [PMID: 35026667 DOI: 10.1016/j.oraloncology.2021.105696] [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] [Received: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Guillaume B Cardin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada
| | - Monique Bernard
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada
| | - Jessica Bourbonnais
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada
| | - Houda Bahig
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada; Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Phuc Félix Nguyen-Tan
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Denis Soulieres
- Department of Medicine, Service of Hemato-Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Olguta Gologan
- Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Tareck Ayad
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Department of Pathology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Eric Bissada
- Otolaryngology-Head and Neck Surgery Service, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Francis Rodier
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulos
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada; Institut du cancer de Montréal, Montreal, QC, Canada; Otolaryngology-Head and Neck Surgery Service, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada.
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Dal Fabbro C, Harris P, Dufresne E, Herrero Babiloni A, Mayer P, Bahig H, Filion E, Nguyen F, Ghannoum J, Schmittbuhl M, Lavigne G. Orofacial Pain and Snoring/Obstructive Sleep Apnea in Individuals with Head and Neck Cancer: A Critical Review. J Oral Facial Pain Headache 2022; 36:85-102. [PMID: 35943322 PMCID: PMC10586573 DOI: 10.11607/ofph.3176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/13/2022] [Indexed: 11/16/2023]
Abstract
AIMS (1) To summarize current knowledge on the prevalence, intensity, and descriptors of orofacial pain and snoring/obstructive sleep apnea (OSA) before and after head and neck cancer (HNC) treatment; and (2) to propose future directions for research. METHODS The median prevalence for each condition was estimated from the most recent systematic reviews (SRs) and updated with new findings retrieved from the PubMed, Web of Science, Embase, and Cochrane databases up to December 2021. RESULTS The prevalence of HNC pain seems relatively stable over time, with a median of 31% before treatment in three studies to a median of 39% at 1 month to 16 years after treatment in six studies. HNC pain intensity remains mild to moderate. There was a threefold increase in temporomandibular pain prevalence after surgery (median 7.25% before to 21.3% after). The data for snoring prevalence are unreliable. The OSA/HNC prevalence seems relatively stable over time, with a median of 72% before treatment in three studies to 77% after treatment in 14 studies. CONCLUSION With the exception of temporomandibular pain, the prevalence of HNC pain and OSA seems to be stable over time. Future studies should: (1) compare the trajectory of change over time according to each treatment; (2) compare individuals with HNC to healthy subjects; (3) use a standardized and comparable method of data collection; and (4) assess tolerance to oral or breathing devices, since HNC individuals may have mucosal sensitivity or pain.
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Bigelow EO, Harris J, Fakhry C, Gillison ML, Nguyen-Tân PF, Rosenthal DI, Frank SJ, Nair SG, Bahig H, Ridge JA, Caudell J, Donaldson C, Clifford BT, Shenouda G, Birrer MJ, Chen Y, Le QT. Risk stratification after recurrence of human papillomavirus (HPV)-related and non-HPV-related oropharyngeal cancer: A secondary analysis of NRG Oncology RTOG 0129 and 0522. Head Neck 2021; 44:158-167. [PMID: 34729846 DOI: 10.1002/hed.26915] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/12/2021] [Accepted: 10/15/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND No risk-stratification strategies exist for patients with recurrent oropharyngeal cancer (OPC). METHODS Retrospective analysis using data from prospective NRG Oncology clinical trials RTOG 0129 and 0522. Eligibility criteria included known p16 status and smoking history, and locoregional/distant recurrence. Overall survival (OS) was measured from date of recurrence. Recursive partitioning analysis was performed to produce mutually exclusive risk groups. RESULTS Hundred and fifty-four patients were included with median follow-up after recurrence of 3.9 years (range 0.04-9.0). The most important factors influencing survival were p16 status and type of recurrence, followed by surgical salvage and smoking history (≤20 vs. >20 pack-years). Three significantly different risk groups were identified. Patients in the low-, intermediate-, and high-risk groups had 2-year OS after recurrence of 81.1% (95%CI 68.5-93.7), 50.2% (95%CI 36.0-64.5), and 20.8% (95%CI 10.5-31.1), respectively. CONCLUSION Patient and tumor characteristics may be used to stratify patients into risk groups at the time of OPC recurrence.
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Affiliation(s)
- Elaine O Bigelow
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania, USA
| | - Carole Fakhry
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maura L Gillison
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Phuc Felix Nguyen-Tân
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - David I Rosenthal
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Steven J Frank
- The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Suresh G Nair
- Department of Hematology and Oncology, Lehigh Valley Hospital, Allentown, Pennsylvania, USA
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jimmy Caudell
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | | | - Bradley T Clifford
- Department of Oncology, Summa Health System - Akron Campus, Akron, Ohio, USA
| | - George Shenouda
- Department of Radiation Oncology, The Research Institute of the McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Michael J Birrer
- Department of Medical Oncology, University of Alabama at Birmingham Cancer Center, Birmingham, Alabama, USA
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester, Rochester, New York, USA
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Stanford, California, USA
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Ng S, Martin G, Guha-Thakurta N, Wang H, Pollard C, Bahig H, Meheissen M, Nguyen T, Mohamed A, Fuller C, Garden A, Frank S, Gunn G, Reddy J, Morrison W, Moreno A, Phan J. Patterns of Failure After IMRT and Proton Re-Irradiation for Patients With Recurrent Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1104] [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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Frankart A, Abana C, Geier N, Bahig H, Phan J, Takiar V. Long-Term Locoregional Control With Unilateral Radiation for AJCC-7 T1-2N2b Tonsillar Cancer. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1158] [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: 10/20/2022]
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Korte JC, Cardenas C, Hardcastle N, Kron T, Wang J, Bahig H, Elgohari B, Ger R, Court L, Fuller CD, Ng SP. Radiomics feature stability of open-source software evaluated on apparent diffusion coefficient maps in head and neck cancer. Sci Rep 2021; 11:17633. [PMID: 34480036 PMCID: PMC8417253 DOI: 10.1038/s41598-021-96600-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 03/22/2021] [Accepted: 08/10/2021] [Indexed: 02/07/2023] Open
Abstract
Radiomics is a promising technique for discovering image based biomarkers of therapy response in cancer. Reproducibility of radiomics features is a known issue that is addressed by the image biomarker standardisation initiative (IBSI), but it remains challenging to interpret previously published radiomics signatures. This study investigates the reproducibility of radiomics features calculated with two widely used radiomics software packages (IBEX, MaZda) in comparison to an IBSI compliant software package (PyRadiomics). Intensity histogram, shape and textural features were extracted from 334 diffusion weighted magnetic resonance images of 59 head and neck cancer (HNC) patients from the PREDICT-HN observational radiotherapy study. Based on name and linear correlation, PyRadiomics shares 83 features with IBEX and 49 features with MaZda, a sub-set of well correlated features are considered reproducible (IBEX: 15 features, MaZda: 18 features). We explore the impact of including non-reproducible radiomics features in a HNC radiotherapy response model. It is possible to classify equivalent patient groups using radiomic features from either software, but only when restricting the model to reliable features using a correlation threshold method. This is relevant for clinical biomarker validation trials as it provides a framework to assess the reproducibility of reported radiomic signatures from existing trials.
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Affiliation(s)
- James C. Korte
- grid.1055.10000000403978434Department of Physical Science, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Carlos Cardenas
- grid.240145.60000 0001 2291 4776Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Nicholas Hardcastle
- grid.1055.10000000403978434Department of Physical Science, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1007.60000 0004 0486 528XCentre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Tomas Kron
- grid.1055.10000000403978434Department of Physical Science, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Jihong Wang
- grid.240145.60000 0001 2291 4776Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Houda Bahig
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Baher Elgohari
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA ,grid.10251.370000000103426662Clinical Oncology & Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
| | - Rachel Ger
- grid.470142.40000 0004 0443 9766Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ USA
| | - Laurence Court
- grid.240145.60000 0001 2291 4776Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Clifton D. Fuller
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sweet Ping Ng
- grid.240145.60000 0001 2291 4776Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, USA ,grid.1055.10000000403978434Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia ,grid.482637.cDepartment of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Melbourne, Australia
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Bahig H, Gunn BG, Garden AS, Ye R, Hutcheson K, Rosenthal DI, Phan J, Fuller CD, Morrison WH, Reddy JP, Ng SP, Gross ND, Sturgis EM, Ferrarotto R, Gillison M, Frank SJ. Patient-Reported Outcomes after Intensity-Modulated Proton Therapy for Oropharynx Cancer. Int J Part Ther 2021; 8:213-222. [PMID: 34285948 PMCID: PMC8270092 DOI: 10.14338/ijpt-20-00081.1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/02/2021] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To report patient-reported outcomes (PROs) derived from the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN) tool, in patients with oropharynx cancer (OPC) treated with intensity-modulated proton therapy (IMPT) in the context of first-course irradiation. MATERIALS AND METHODS Patients with locally advanced OPC treated with radical IMPT between 2011 and 2018 were included in a prospective registry. FACT-HN scores were measured serially during and 24 months following IMPT. PRO changes in the FACT-HN scores over time were assessed with mixed-model analysis. RESULTS Fifty-seven patients met inclusion criteria. Median age was 60 years (range, 41-84), and 91% had human papillomavirus-associated disease. In total, 28% received induction chemotherapy and 68% had concurrent chemotherapy. Compliance to FACT-HN questionnaire completion was 59%, 48%, and 42% at 6, 12, and 24 months after treatment, respectively. The mean FACT-General (G), FACT-Total, and FACT-Trial Outcome Index (TOI) score changes were statistically and clinically significant relative to baseline from week 3 of treatment up to week 2 after treatment. Nadir was reached at week 6 of treatment for all scores, with maximum scores dropping by 15%, 20%, and 39% compared to baseline for FACT-G, FACT-Total, and FACT-TOI, respectively. Subdomain scores of physical well-being, functional well-being, and head and neck additional concerns decreased from baseline during treatment and returned to baseline at week 4 after treatment. CONCLUSIONS IMPT was associated with a favorable PRO trajectory, characterized by an acute decline followed by rapid recovery to baseline. This study establishes the expected acute, subacute, and chronic trajectory of PROs for patients undergoing IMPT for OPC.
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Affiliation(s)
- Houda Bahig
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
,Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Brandon G. Gunn
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rong Ye
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kate Hutcheson
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jack Phan
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Jay Paul Reddy
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sweet Ping Ng
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
,Peter MacCallum Cancer Center, Melbourne, Australia
| | - Neil D. Gross
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erich M. Sturgis
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Maura Gillison
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J. Frank
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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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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Bahig H, Fuller CD, Mitra A, Yoshida-Court K, Solley T, Ping Ng S, Abu-Gheida I, Elgohari B, Delgado A, Rosenthal DI, Garden AS, Frank SJ, Reddy JP, Colbert L, Klopp A. Longitudinal characterization of the tumoral microbiome during radiotherapy in HPV-associated oropharynx cancer. Clin Transl Radiat Oncol 2021; 26:98-103. [PMID: 33367119 PMCID: PMC7749292 DOI: 10.1016/j.ctro.2020.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/28/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To describe the baseline and serial tumor microbiome in HPV-associated oropharynx cancer (OPC) over the course of radiotherapy (RT). METHODS Patients with newly diagnosed HPV-associated OPC treated with definitive radiotherapy +/- concurrent chemotherapy were enrolled in this prospective study. Using 16S rRNA gene sequencing, dynamic changes in the tumor site microbiome during RT were investigated. Surface tumor samples were obtained before RT and at week 1, 3 and 5 of RT. Radiological primary tumor response at mid-treatment was categorized as complete (CR) or partial (PR). RESULTS Ten patients were enrolled, but 9 patients were included in the final analysis. Mean age was 62 years (range: 51-71). As per AJCC 8th Ed, 56%, 22% and 22% of patients had stage I, II and III, respectively. At 4-weeks, 6 patients had CR and 3 patients had PR; at follow-up imaging post treatment, all patients had CR. The baseline diversity of the tumoral versus buccal microbiome was not statistically different. For the entire cohort, alpha diversity was significantly decreased over the course of treatment (p = 0.04). There was a significant alteration in the bacterial community within the first week of radiation. Baseline tumor alpha diversity of patients with CR was significantly higher than those with PR (p = 0.03). While patients with CR had significant reduction in diversity over the course of radiation (p = 0.01), the diversity remained unchanged in patients with PR. Patients with history of smoking had significantly increased abundance of Kingella (0.05) and lower abundance of Stomatobaculum (p = 0.03) compared to never smokers. CONCLUSIONS The tumor microbiome of HPV-associated OPC exhibits reduced alpha diversity and altered taxa abundance over the course of radiotherapy. The baseline bacterial profiles of smokers vs. non-smokers were inherently different. Baseline tumor alpha diversity of patients with CR was higher than patients with PR, suggesting that the microbiome deserves further investigation as a biomarker of radiation response.
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Affiliation(s)
- Houda Bahig
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada
| | - Clifton D. Fuller
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Aparna Mitra
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kyoko Yoshida-Court
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Travis Solley
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sweet Ping Ng
- Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ibrahim Abu-Gheida
- Radiation Oncology Department, Burjeel Medical City, Abu-Dhabi, United Arab Emirates
| | - Baher Elgohari
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Clinical Oncology and Nuclear Medicine Department, Mansoura University, Mansoura, Egypt
| | - Andrea Delgado
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I. Rosenthal
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S. Garden
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J. Frank
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jay P. Reddy
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lauren Colbert
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ann Klopp
- Radiation Oncology Department, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Desilets A, Blanc-Durand F, Lau S, Hakozaki T, Kitadai R, Malo J, Belkaid W, Richard C, Messaoudene M, Cvetkovic L, Kazandjian S, Tehfe M, Florescu M, Jao K, Daaboul N, Owen S, Shieh B, Agulnik J, Cohen V, Charbonneau C, Marcoux N, Blais N, Leighl NB, Bradbury PA, Liu G, Shepherd FA, Bahig H, Routy B, Sacher A, Elkrief A. Durvalumab therapy following chemoradiation compared with a historical cohort treated with chemoradiation alone in patients with stage III non-small cell lung cancer: A real-world multicentre study. Eur J Cancer 2020; 142:83-91. [PMID: 33242835 DOI: 10.1016/j.ejca.2020.10.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [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: 05/28/2020] [Revised: 09/30/2020] [Accepted: 10/08/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The PACIFIC trial demonstrated that durvalumab therapy following chemoradiation (CRT) was associated with improved overall survival (OS) in patients with stage III non-small cell lung cancer (NSCLC). It is unclear whether the results obtained as part of randomised controlled trials are a reflection of real-world (RW) data. Several questions remain unanswered with regard to RW durvalumab use, such as optimal time to durvalumab initiation, incidence of pneumonitis and response in PD-L1 subgroups. METHODS In this multicentre retrospective analysis, 147 patients with stage III NSCLC treated with CRT followed by durvalumab were compared with a historical cohort of 121 patients treated with CRT alone. Survival curves were estimated using the Kaplan-Meier method and compared with the log-rank test in univariate analysis. Multivariate analysis was performed to evaluate the effect of standard prognostic factors for durvalumab use. RESULTS Median OS was not reached in the durvalumab group, compared with 26.9 months in the historical group (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.37-0.85, p = 0.001). In the durvalumab group, our data suggest improved 12-month OS in patients with PD-L1 expression ≥50% (100% vs 86%, HR: 0.25, 95% CI: 0.11-0.58, p = 0.007). There was no difference in OS between patients with a PD-L1 expression of 1-49% and patients with PD-L1 expression <1%. Delay in durvalumab initiation beyond 42 days did not impact OS. Incidence of pneumonitis was similar in the durvalumab and historical groups. In the durvalumab group, patients who experienced any-grade pneumonitis had a lower 12-month OS than patients without pneumonitis (85% vs 95%, respectively; HR: 3.3, 95% CI: 1.2-9.0, p = 0.006). CONCLUSIONS This multicentre analysis suggests that PD-L1 expression ≥50% was associated with favourable OS in patients with stage III NSCLC treated with durvalumab after CRT, whereas the presence of pneumonitis represented a negative prognostic factor.
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Affiliation(s)
- Antoine Desilets
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Félix Blanc-Durand
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Sally Lau
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Taiki Hakozaki
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, 113-8677, Bunkyo City, Tokyo, Japan.
| | - Rui Kitadai
- Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, 113-8677, Bunkyo City, Tokyo, Japan.
| | - Julie Malo
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada.
| | - Wiam Belkaid
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada.
| | - Corentin Richard
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada.
| | - Meriem Messaoudene
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada.
| | - Lena Cvetkovic
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Suzanne Kazandjian
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Mustapha Tehfe
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Marie Florescu
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Kevin Jao
- Department of Hematology and Oncology, Hôpital Du Sacré Coeur de Montréal, 5400, Boulevard Gouin Ouest, H4J 1C5, Montreal, Quebec, Canada.
| | - Nathalie Daaboul
- Integrated Cancer Center, Charles-Le-Moyne Hospital, 3120, Boulevard Taschereau, J4V 2H1, Greenfield Park, Quebec, Canada.
| | - Scott Owen
- Cedars Cancer Center, McGill University Healthcare Center (MUHC), 1001, Boulevard Décarie, H4A 3J1, Montreal, Quebec, Canada.
| | - Benjamin Shieh
- Cedars Cancer Center, McGill University Healthcare Center (MUHC), 1001, Boulevard Décarie, H4A 3J1, Montreal, Quebec, Canada.
| | - Jason Agulnik
- Segal Cancer Center, Jewish General Hospital, 3755, Chemin de La Côte-Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Victor Cohen
- Segal Cancer Center, Jewish General Hospital, 3755, Chemin de La Côte-Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
| | - Chloé Charbonneau
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Québec (CHUQ), 11, Côte Du Palais, G1R 2J6, Quebec City, Quebec, Canada.
| | - Nicolas Marcoux
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Québec (CHUQ), 11, Côte Du Palais, G1R 2J6, Quebec City, Quebec, Canada.
| | - Normand Blais
- Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Natasha B Leighl
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Penelope A Bradbury
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Frances A Shepherd
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Houda Bahig
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Bertrand Routy
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Department of Hematology and Oncology, Centre Hospitalier de L'Université de Montréal (CHUM), 1051, Rue Sanguinet, H2X 3E4, Montreal, Quebec, Canada.
| | - Adrian Sacher
- Princess Margaret Cancer Centre, University Health Network (UNH), 610 University Ave, M5G 2C1, Toronto, Ontario, Canada.
| | - Arielle Elkrief
- Centre de Recherche Du Centre Hospitalier de L'Université de Montréal (CRCHUM), 900, Rue Saint-Denis, Pavillon R, H2X 0A9, Montreal, Quebec, Canada; Cedars Cancer Center, McGill University Healthcare Center (MUHC), 1001, Boulevard Décarie, H4A 3J1, Montreal, Quebec, Canada; Segal Cancer Center, Jewish General Hospital, 3755, Chemin de La Côte-Sainte-Catherine, H3T 1E2, Montreal, Quebec, Canada.
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Taussky D, Soulières D, Bahig H, Delouya G. Systemic Inflammatory Markers Can Predictive Response in Radiation Therapy to the Prostate. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.547] [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: 10/23/2022]
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Korte J, Cardenas C, Kron T, Hardcastle N, Wang J, Bahig H, Elgohari B, Court L, Fuller C, Ng S. Reproducibility of Head and Neck MRI Radiomic Features Between Two Common Analysis Packages. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.220] [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: 11/25/2022]
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Zhang S, Lapointe A, Simard M, Filion E, Campeau M, Roberge D, Bouchard H, Carrier J, Blais D, Bedwani S, Bahig H. Evaluation of Radiation Dose Effect on Lung Function Using Iodine Maps Derived from Serial Dual-Energy Computed Tomograms. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2370] [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: 11/17/2022]
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Heng V, Diamant A, Chatterjee A, Faria S, Bahig H, Filion E, Doucet R, El Naqa I, Seuntjens J. PO-0995: Impact of the dose outside the PTV on distant recurrence in coplanar and non-coplanar lung SBRT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01012-4] [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: 10/22/2022]
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