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Cargill KR, Pifer P, Vargo JAA, Iheagwara UK, Kim S, Kubik MW, Sridharan S, Duvvuri U, Zandberg DP, Rahman Z, Seethala R, Zevallos JP, Ferris RL, Skinner HD. Outcomes of Patients with Oral Cavity Squamous Cell Carcinomas Treated with Adjuvant IMRT with Perineural Invasion. Int J Radiat Oncol Biol Phys 2023; 117:e569-e570. [PMID: 37785737 DOI: 10.1016/j.ijrobp.2023.06.1898] [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) Patients with advanced oral cavity squamous cell carcinoma (OCSCC) have high rates of recurrence and dismal outcomes. Treatment consists of definitive surgery followed by risk-adapted adjuvant radiation therapy based on pathologic review. Perineural invasion (PNI) is thought to be an intermediate risk factor, leading to clinical uncertainty as to adjuvant therapy in the setting of PNI. We performed a single institution retrospective review of patients with OCSCC treated with adjuvant radiation with or without PNI and examined relapse-free survival (RFS) and overall survival (OS). MATERIALS/METHODS We performed a single-institutional retrospective review of patients with OCSCC treated with adjuvant IMRT +/- chemotherapy after surgical resection from July 2002- August 2021 using our institution's Head and Neck SPORE database. Time to recurrence or death was calculated from end of RT. OCSCC within 5 years of RT was considered a recurrence, beyond this timeframe any OCSCC was considered a new primary. Univariate analysis of predictors for RFS and OS were performed using the Kaplan-Meier method with log-rank test. Factors significant on univariable analysis were entered into parsimonious cox multivariable analysis using forward selection methodology. A p-value <0.05 was considered significant in both analyses. RESULTS In total, 494 patients with OCSCC were identified that received surgery and adjuvant IMRT. In this cohort, 48.8% of patients had pT4 tumors, 62.2% of patients had nodal involvement, and 40.3% of patients had extranodal extension. PNI was present in 63.6% of patients (n = 314). With regards to tumor subsite, 40.9% originated from the oral tongue, 21.5% originated from the gums, 18% originated from the floor of mouth, and 19.6% from the other sites. Median age was 59 years, and median adjuvant RT dose was 63 Gy (Interquartile range [IQR]) 60-66 Gy). The majority of patient received platinum-based chemotherapy (51.8%), and 44.1% of patients did not receive adjuvant chemotherapy. The 3-year RFS and OS with a median follow-up of 32 months (IQR 12-69 months) is presented in Table 1. On univariable analysis for OS, T stage (p = 0.003), N stage (p<0.001), PNI (p = 0.005), extranodal extension (ENE) (p<0.001), margin status (p = 0.038), and chemotherapy (p<0.001) were significant. On multivariable analysis, T stage (p<0.001), N stage (p = 0.010), PNI (p = 0.017), and ENE (p = 0.007) remained significant. Similar results were seen in the RFS analysis. CONCLUSION In this large single institution study, PNI was a significant and independent negative predictive factor for RFS and OS in patients with OCSCC that had received definitive surgery followed by adjuvant IMRT. To our knowledge this is the largest study of its kind, and these findings can help guide clinical decision making for these patients.
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Affiliation(s)
- K R Cargill
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - P Pifer
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - J A A Vargo
- Department of Radiation Oncology, University of Pittsburgh, Pittsburgh, PA
| | - U K Iheagwara
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - S Kim
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - M W Kubik
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - S Sridharan
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - U Duvvuri
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - D P Zandberg
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Z Rahman
- Division of Hematology and Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R Seethala
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - J P Zevallos
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R L Ferris
- Department of Otolaryngology, Eye & Ear Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - H D Skinner
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA
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Hashim D, Sartori S, Brennan P, Curado MP, Wünsch-Filho V, Divaris K, Olshan AF, Zevallos JP, Winn DM, Franceschi S, Castellsagué X, Lissowska J, Rudnai P, Matsuo K, Morgenstern H, Chen C, Vaughan TL, Hofmann JN, D'Souza G, Haddad RI, Wu H, Lee YC, Hashibe M, Vecchia CL, Boffetta P. The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium. Ann Oncol 2016; 27:1619-25. [PMID: 27234641 PMCID: PMC4959929 DOI: 10.1093/annonc/mdw224] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 05/22/2016] [Accepted: 05/23/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Poor oral hygiene has been proposed to contribute to head and neck cancer (HNC) risk, although causality and independency of some indicators are uncertain. This study investigates the relationship of five oral hygiene indicators with incident HNCs. METHODS In a pooled analysis of 8925 HNC cases and 12 527 controls from 13 studies participating in the International Head and Neck Cancer Epidemiology Consortium, comparable data on good oral hygiene indicators were harmonized. These included: no denture wear, no gum disease (or bleeding), <5 missing teeth, tooth brushing at least daily, and visiting a dentist ≥once a year. Logistic regression was used to estimate the effects of each oral hygiene indicator and cumulative score on HNC risk, adjusting for tobacco smoking and alcohol consumption. RESULTS Inverse associations with any HNC, in the hypothesized direction, were observed for <5 missing teeth [odds ratio (OR) = 0.78; 95% confidence interval (CI) 0.74, 0.82], annual dentist visit (OR = 0.82; 95% CI 0.78, 0.87), daily tooth brushing (OR = 0.83, 95% CI 0.79, 0.88), and no gum disease (OR = 0.94; 95% CI 0.89, 0.99), and no association was observed for wearing dentures. These associations were relatively consistent across specific cancer sites, especially for tooth brushing and dentist visits. The population attributable fraction for ≤ 2 out of 5 good oral hygiene indicators was 8.9% (95% CI 3.3%, 14%) for oral cavity cancer. CONCLUSION Good oral hygiene, as characterized by few missing teeth, annual dentist visits, and daily tooth brushing, may modestly reduce the risk of HNC.
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Affiliation(s)
- D Hashim
- The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - S Sartori
- The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - P Brennan
- International Agency for Research on Cancer, Lyon, France
| | | | - V Wünsch-Filho
- School of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - A F Olshan
- Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill
| | - J P Zevallos
- Department of Otolaryntology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill
| | - D M Winn
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA
| | - S Franceschi
- International Agency for Research on Cancer, Lyon, France
| | - X Castellsagué
- Catalan Institute of Oncology (ICO)-IDIBELL, L'Hospitalet de Llobregat, Catalonia CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - J Lissowska
- Department of Cancer Epidemiology and Prevention, The M. Sklasodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - P Rudnai
- National Public Health Center, Budapest, Hungary
| | - K Matsuo
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - H Morgenstern
- Department of Epidemiology Department of Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor
| | - C Chen
- Fred Hutchinson Cancer Research Center, Seattle
| | - T L Vaughan
- Fred Hutchinson Cancer Research Center, Seattle
| | - J N Hofmann
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda
| | - G D'Souza
- Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - R I Haddad
- Dana Farber Cancer Institute, Harvard Medical School, Boston
| | - H Wu
- The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Y-C Lee
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA
| | - M Hashibe
- Division of Public Health, Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, USA
| | - C La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - P Boffetta
- The Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, USA The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
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Edefonti V, Hashibe M, Parpinel M, Ferraroni M, Turati F, Serraino D, Matsuo K, Olshan AF, Zevallos JP, Winn DM, Moysich K, Zhang ZF, Morgenstern H, Levi F, Kelsey K, McClean M, Bosetti C, Schantz S, Yu GP, Boffetta P, Chuang SC, A Lee YC, La Vecchia C, Decarli A. Vitamin E intake from natural sources and head and neck cancer risk: a pooled analysis in the International Head and Neck Cancer Epidemiology consortium. Br J Cancer 2015; 113:182-92. [PMID: 25989276 PMCID: PMC4647526 DOI: 10.1038/bjc.2015.149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 03/24/2015] [Accepted: 04/07/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Evidence for the possible effect of vitamin E on head and neck cancers (HNCs) is limited. METHODS We used individual-level pooled data from 10 case-control studies (5959 cases and 12 248 controls) participating in the International Head and Neck Cancer Epidemiology (INHANCE) consortium to assess the association between vitamin E intake from natural sources and cancer of the oral cavity/pharynx and larynx. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models applied to quintile categories of non-alcohol energy-adjusted vitamin E intake. RESULTS Intake of vitamin E was inversely related to oral/pharyngeal cancer (OR for the fifth vs the first quintile category=0.59, 95% CI: 0.49-0.71; P for trend <0.001) and to laryngeal cancer (OR=0.67, 95% CI: 0.54-0.83, P for trend <0.001). There was, however, appreciable heterogeneity of the estimated effect across studies for oral/pharyngeal cancer. Inverse associations were generally observed for the anatomical subsites of oral and pharyngeal cancer and within covariate strata for both sites. CONCLUSION Our findings suggest that greater vitamin E intake from foods may lower HNC risk, although we were not able to explain the heterogeneity observed across studies or rule out certain sources of bias.
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Affiliation(s)
- V Edefonti
- Laboratorio di Statistica Medica, Biometria ed Epidemiologia ‘G. A. Maccacaro', Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, via A. Vanzetti, 5, 20133 Milano, Italy
| | - M Hashibe
- Division of Public Health, Department of Family & Preventive Medicine and Huntsman Cancer Institute, University of Utah School of Medicine, 375 Chipeta Way, Salt Lake City, UT 84108, USA
| | - M Parpinel
- Department of Medical and Biological Sciences, University of Udine, Piazzale M. Kolbe, 4, 33100 Udine, Italy
| | - M Ferraroni
- Laboratorio di Statistica Medica, Biometria ed Epidemiologia ‘G. A. Maccacaro', Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, via A. Vanzetti, 5, 20133 Milano, Italy
| | - F Turati
- S. C. Statistica Medica, Biometria e Bioinformatica, Fondazione IRCSS Istituto Nazionale Tumori di Milano, via A. Vanzetti, 5, 20133, Milano, Italy
| | - D Serraino
- Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, IRCCS, via F. Gallini, 2, 33081 Aviano (PN), Italy
| | - K Matsuo
- Department of Preventive Medicine, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - A F Olshan
- University of North Carolina School of Public Health, Chapel Hill, NC, USA
| | - J P Zevallos
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus Box 7070, Chapel Hill, NC 27599-7070, USA
| | - D M Winn
- Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD 20892-9764, USA
| | - K Moysich
- Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Z-F Zhang
- Department of Epidemiology, UCLA School of Public Health, 71-225 CHS, Box 951772, Los Angeles, CA 90095-1772, USA
| | - H Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health and Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - F Levi
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - K Kelsey
- Department of Pathology and Laboratory Medicine, Brown University, 70 Ship Street, G-E5, Providence, RI 02912, USA
| | - M McClean
- Department of Environmental Health, Boston University School of Public Health, 715 Albany Street, Talbot 4W, Boston, MA 02118, USA
| | - C Bosetti
- Department of Epidemiology, IRCCS–Istituto di Ricerche Farmacologiche Mario Negri, via G. La Masa, 19, 20156 Milano, Italy
| | - S Schantz
- Department of Otolaryngology, New York Eye and Ear Infirmary, 310 E 14th Street, New York, NY 10003, USA
| | - G-P Yu
- Medical Informatics Center, Peking University, Peking, China
| | - P Boffetta
- The Tisch Cancer Institute and Institute of Translational Epidemiology, Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA
| | - S-C Chuang
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | - Y-C A Lee
- Division of Public Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Salt Lake City, UT 84108, USA
| | - C La Vecchia
- Laboratorio di Statistica Medica, Biometria ed Epidemiologia ‘G. A. Maccacaro', Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, via A. Vanzetti, 5, 20133 Milano, Italy
| | - A Decarli
- Laboratorio di Statistica Medica, Biometria ed Epidemiologia ‘G. A. Maccacaro', Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, via A. Vanzetti, 5, 20133 Milano, Italy
- S. C. Statistica Medica, Biometria e Bioinformatica, Fondazione IRCSS Istituto Nazionale Tumori di Milano, via A. Vanzetti, 5, 20133, Milano, Italy
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