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Harrington KJ, Cohen EEW, Soulières D, Dinis J, Licitra L, Ahn MJ, Soria A, Machiels JP, Mach N, Mehra R, Burtness B, Swaby RF, Lin J, Ge J, Lerman N, Tourneau CL. Pembrolizumab versus methotrexate, docetaxel, or cetuximab in recurrent or metastatic head and neck squamous cell carcinoma (KEYNOTE-040): Subgroup analysis by pattern of disease recurrence. Oral Oncol 2023; 147:106587. [PMID: 37925894 DOI: 10.1016/j.oraloncology.2023.106587] [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: 04/25/2023] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND In the phase 3 KEYNOTE-040 study, pembrolizumab prolonged OS versus chemotherapy in previously treated recurrent or metastatic (R/M) HNSCC. We present a post hoc subgroup analysis by disease recurrence pattern: recurrent-only, recurrent and metastatic (recurrent-metastatic), and metastatic-only HNSCC. MATERIALS AND METHODS Patients had HNSCC that progressed during or after platinum-containing treatment for R/M disease or had recurrence or progression within 3-6 months of previous platinum-containing definitive therapy for locally advanced disease. Patients were randomly assigned (1:1) to pembrolizumab 200 mg Q3W or investigator's choice of standards of care (SOC): methotrexate, docetaxel, or cetuximab. Outcomes included OS, PFS, ORR, and DOR. The data cutoff was May 15, 2017. RESULTS There were 125 patients (pembrolizumab, 53; SOC, 72) in the recurrent-only subgroup, 204 in the recurrent-metastatic subgroup (pembrolizumab, 108; SOC, 96), and 166 in the metastatic-only subgroup (pembrolizumab, 86; SOC, 80). The hazard ratio (95% CI) for death for pembrolizumab versus SOC was 0.83 (0.55-1.25) in the recurrent-only, 0.78 (0.58-1.06) in the recurrent-metastatic, and 0.74 (0.52-1.05) in the metastatic-only subgroups. PFS was similar between treatment arms in all subgroups. ORR was 22.6% for pembrolizumab versus 16.7% for SOC in the recurrent-only, 10.2% versus 6.3% in the recurrent-metastatic, and 15.1% versus 8.8% in the metastatic-only subgroups. DOR was numerically longer with pembrolizumab in all subgroups. CONCLUSION Pembrolizumab provided numerically longer OS and durable responses in all subgroups compared with SOC, suggesting that patients with previously treated R/M HNSCC benefit from pembrolizumab regardless of recurrence pattern.
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Affiliation(s)
- K J Harrington
- 105 Cotswold Road, Division of Radiotherapy and Imaging, The Institute of Cancer Research/The Royal Marsden NHS Foundation Trust National Institute of Health Research Biomedical Research Centre, London SM2 5NG, United Kingdom.
| | - E E W Cohen
- 3855 Health Sciences Dr, Department of Medical Oncology, Moores Cancer Center, UC San Diego Health, La Jolla, CA 92093, United States.
| | - D Soulières
- 1560, rue Sherbrooke estx, Department of Hematology and Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, QC H2L 4MN, Canada.
| | - J Dinis
- R Dr. Antonio Bernardino de Almeida Medicina Oncologica Unidade de Investigacao Clinica, Department of Medical Oncology, Instituto Português de Oncologia do Porto Francisco Gentil, 4200-072 Porto, Portugal.
| | - L Licitra
- Via Giacomo Venezian, 1, Department of Head and Neck Cancer, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, 20133 Milan, Italy
| | - M-J Ahn
- 81 Irwon-Ro Gangnam, Department of Hematology & Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - A Soria
- Ctra. de Colmenar Viejo km. 9,100, Department of Medical Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - J-P Machiels
- Avenue Hippocrate 10, Department of Medical Oncology, Institut Roi Albert II, Cliniques Universitaires Saint-Luc and Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), 1200 Brussels, Belgium
| | - N Mach
- Rue Gabrielle-Perret-Gentil 4, Clinical Research Unit, Department of Oncology, Hôpitaux Universitaires de Genève, 1205 Geneva, Switzerland
| | - R Mehra
- 22 South Greene Street, Department of Head and Neck Medical Oncology, Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, MD 21201, United States
| | - B Burtness
- 25 York Street PO Box 208028, Yale Cancer Center and Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | - R F Swaby
- 90 E Scott Ave, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - J Lin
- 90 E Scott Ave, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - J Ge
- 90 E Scott Ave, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - N Lerman
- 90 E Scott Ave, Merck & Co., Inc., Rahway, NJ 07065, United States
| | - C Le Tourneau
- 26 rue d'Ulm, Department of Drug Development and Innovation (D3i), Institut Curie, Paris-Saclay University, 75005 Paris, France
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Melake MJ, Smith HG, Mansfield D, Davies E, Dillon MT, Wilkins AC, Patin EC, Pedersen M, Buus R, Melcher AA, Thway K, Miah AB, Zaidi SH, Hayes AJ, Fenton TR, Harrington KJ, McLaughlin M. OX40 and 4-1BB delineate distinct immune profiles in sarcoma. Oncoimmunology 2022; 11:2066050. [PMID: 35558159 PMCID: PMC9090286 DOI: 10.1080/2162402x.2022.2066050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 03/30/2022] [Accepted: 03/31/2022] [Indexed: 01/08/2023] Open
Abstract
Systemic relapse after radiotherapy and surgery is the major cause of disease-related mortality in sarcoma patients. Combining radiotherapy and immunotherapy is under investigation as a means to improve response rates. However, the immune contexture of sarcoma is understudied. Here, we use a retrospective cohort of sarcoma patients, treated with neoadjuvant radiotherapy, and TCGA data. We explore therapeutic targets of relevance to sarcoma, using genomics and multispectral immunohistochemistry to provide insights into the tumor immune microenvironment across sarcoma subtypes. Differential gene expression between radioresponsive myxoid liposarcoma (MLPS) and more radioresistant undifferentiated pleomorphic sarcoma (UPS) indicated UPS contained higher transcript levels of a number of immunotherapy targets (CD73/NT5E, CD39/ENTPD1, CD25/IL2RA, and 4-1BB/TNFRSF9). We focused on 4-1BB/TNFRSF9 and other costimulatory molecules. In TCGA data, 4-1BB correlated to an inflamed and exhausted phenotype. OX40/TNFRSF4 and 4-1BB/TNFRSF9 were highly expressed in sarcoma subtypes versus other cancers. Despite OX40 and 4-1BB being described as Treg markers, we identified that they delineate distinct tumor immune profiles. This was true for sarcoma and other cancers. While only a limited number of samples could be analyzed, spatial analysis of OX40 expression identified two diverse phenotypes of OX40+ Tregs, one associated with and one independent of tertiary lymphoid structures (TLSs). Patient stratification is of intense interest for immunotherapies. We provide data supporting the viewpoint that a cohort of sarcoma patients, appropriately selected, are promising candidates for immunotherapies. Spatial profiling of OX40+ Tregs, in relation to TLSs, could be an additional metric to improve future patient stratification.
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Affiliation(s)
- MJ Melake
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
| | - HG Smith
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - D Mansfield
- Translational Immunotherapy Team, The Institute of Cancer Research, London, UK
| | - E Davies
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - MT Dillon
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | | | - EC Patin
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
| | - M Pedersen
- Translational Immunotherapy Team, The Institute of Cancer Research, London, UK
| | - R Buus
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - AA Melcher
- Translational Immunotherapy Team, The Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - K Thway
- The Royal Marsden Hospital, London, UK
| | - AB Miah
- The Royal Marsden Hospital, London, UK
| | - SH Zaidi
- The Royal Marsden Hospital, London, UK
| | - AJ Hayes
- The Royal Marsden Hospital, London, UK
| | - TR Fenton
- University of Southampton, Somers Cancer Research Building MP824, Southampton General Hospital, Southampton, UK
| | - KJ Harrington
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
- The Royal Marsden Hospital, London, UK
| | - M McLaughlin
- Targeted Therapy Team, The Institute of Cancer Research, London, UK
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3
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Henderson DR, Murray JR, Gulliford SL, Tree AC, Harrington KJ, Van As NJ. An Investigation of Dosimetric Correlates of Acute Toxicity in Prostate Stereotactic Body Radiotherapy: Dose to Urinary Trigone is Associated with Acute Urinary Toxicity. Clin Oncol (R Coll Radiol) 2018; 30:539-547. [PMID: 29807801 DOI: 10.1016/j.clon.2018.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/08/2018] [Revised: 04/06/2018] [Accepted: 04/13/2018] [Indexed: 12/25/2022]
Abstract
AIMS There are limited data on dosimetric correlates of toxicity in stereotactic body radiotherapy (SBRT) for prostate cancer. We aimed to identify potential relationships between dose and toxicity using conventional dose-volume histograms (DVHs) and dose-surface maps (DSMs). MATERIALS AND METHODS Urinary bladder trigone and rectum DSMs were produced for a single-institution service evaluation cohort of 50 patients receiving SBRT for localised prostate cancer, together with conventional DVHs for bladder and rectum. Patients had been prospectively recruited to this cohort and treated according to a pre-defined protocol to a dose of 36.25 Gy in five fractions. Radiation Therapy Oncology Group (RTOG) and International Prostate Symptom Score (IPSS) toxicity data were recorded prospectively. Logistic regression was used to identify dosimetric predictors of acute IPSS+10 (rise of 10 points or more above baseline) and grade 2+ RTOG toxicity. RESULTS On univariate analysis, trigone area receiving 40 Gy and trigone Dmax were associated with IPSS+10 (odds ratio 1.06 [1.02-1.11], P = 0.007 and odds ratio 1.54 [1.06-2.25], P = 0.024, respectively). These two variables were highly correlated. In a multivariate model, including all baseline variables, trigone Dmax remained associated with IPSS+10 (odds ratio 1.91 [1.13-3.22], P = 0.016). These findings were not significant with Holm-Bonferroni correction for multiple testing (corrected P value threshold 0.006). No associations were seen between rectal toxicity and DVH or DSM parameters. CONCLUSIONS Our study suggests a potential relationship between high doses to the urinary bladder trigone and patient-reported urinary toxicity in prostate SBRT, and is consistent with previous studies in conventionally fractionated radiotherapy, justifying further evaluation in larger cohorts.
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Affiliation(s)
- D R Henderson
- The Institute of Cancer Research, Sutton, UK; Chester Beatty Laboratories, London, UK; The Royal Marsden Hospital NHS Foundation Trust, Sutton, London, UK; The Cancer Centre, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK.
| | - J R Murray
- The Institute of Cancer Research, Sutton, UK; Chester Beatty Laboratories, London, UK; The Royal Marsden Hospital NHS Foundation Trust, Sutton, London, UK; The Cancer Centre, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - S L Gulliford
- The Institute of Cancer Research, Sutton, UK; Chester Beatty Laboratories, London, UK
| | - A C Tree
- The Royal Marsden Hospital NHS Foundation Trust, Sutton, London, UK
| | - K J Harrington
- The Institute of Cancer Research, Sutton, UK; Chester Beatty Laboratories, London, UK; The Royal Marsden Hospital NHS Foundation Trust, Sutton, London, UK
| | - N J Van As
- The Institute of Cancer Research, Sutton, UK; Chester Beatty Laboratories, London, UK; The Royal Marsden Hospital NHS Foundation Trust, Sutton, London, UK
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Richards TM, Hurley T, Grove L, Harrington KJ, Carpenter GH, Proctor GB, Nutting CM. The effect of parotid gland-sparing intensity-modulated radiotherapy on salivary composition, flow rate and xerostomia measures. Oral Dis 2017; 23:990-1000. [PMID: 28434191 DOI: 10.1111/odi.12686] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 05/19/2016] [Revised: 03/11/2017] [Accepted: 04/05/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe parotid gland (PG) saliva organic and inorganic composition and flow rate changes, after curative intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC), and analyse the relationship between PG saliva analytes and xerostomia measures. METHODS AND MATERIALS Twenty-six patients recruited to five prospective phase 2 or 3 trials which assessed toxicity and efficacy of IMRT by HNC subsite, provided longitudinal PG saliva. Salivary flow rate, and subjective and objective xerostomia measures were prospectively collected and saliva tested for inorganic and organic analytes. Statistical comparisons of longitudinal analyte changes and analysis for a relationship between dichotomized xerostomia score and saliva analytes were performed. RESULTS One hundred and forty-two PG saliva samples from 26 patients were analysed. At 3-6 months after IMRT, stimulated and unstimulated saliva showed significantly decreased flow rate, total protein (TP) secretion rate, phosphate concentration and increased lactoferrin (LF) concentration. Stimulated saliva alone had elevated LF secretion rate and beta-2-microglobulin (B2 M) concentration with decreased calcium (Ca2+ ) and magnesium (Mg2+ ) concentrations and Ca2+ secretion rate. At >12 months, under stimulated and unstimulated conditions, increased LF concentration and decreased Mg2+ and phosphate concentration persisted and, in stimulated saliva, there was decreased potassium (K+ ) and Mg2+ concentration. Unstimulated TP secretion rate was lower in the presence of high-grade xerostomia. Otherwise, no relationship between xerostomia grade and PG salivary flow rate, TP and Ca2+ secretion rate was found. CONCLUSION Fewer significant differences in PG saliva analytes >12 months after IMRT indicate good functional recovery. Residual xerostomia after IMRT will only be further reduced by addressing the sparing of subsites of the PG or other salivary gland tissues, in addition to the PG.
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Affiliation(s)
- T M Richards
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK
| | - T Hurley
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK
| | - L Grove
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK
| | - K J Harrington
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK.,The Institute of Cancer Research, London, UK
| | - G H Carpenter
- Mucosal & Salivary Biology Division, Dental Institute, Kings College London, London, UK
| | - G B Proctor
- Mucosal & Salivary Biology Division, Dental Institute, Kings College London, London, UK
| | - C M Nutting
- Head and Neck Unit, Royal Marsden Hospitals NHS Foundation Trust, London, Surrey, UK.,The Institute of Cancer Research, London, UK
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5
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Dean JA, Welsh LC, Wong KH, Aleksic A, Dunne E, Islam MR, Patel A, Patel P, Petkar I, Phillips I, Sham J, Schick U, Newbold KL, Bhide SA, Harrington KJ, Nutting CM, Gulliford SL. Normal Tissue Complication Probability (NTCP) Modelling of Severe Acute Mucositis using a Novel Oral Mucosal Surface Organ at Risk. Clin Oncol (R Coll Radiol) 2017; 29:263-273. [PMID: 28057404 PMCID: PMC6175048 DOI: 10.1016/j.clon.2016.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 07/12/2016] [Revised: 10/20/2016] [Accepted: 11/01/2016] [Indexed: 12/23/2022]
Abstract
AIMS A normal tissue complication probability (NTCP) model of severe acute mucositis would be highly useful to guide clinical decision making and inform radiotherapy planning. We aimed to improve upon our previous model by using a novel oral mucosal surface organ at risk (OAR) in place of an oral cavity OAR. MATERIALS AND METHODS Predictive models of severe acute mucositis were generated using radiotherapy dose to the oral cavity OAR or mucosal surface OAR and clinical data. Penalised logistic regression and random forest classification (RFC) models were generated for both OARs and compared. Internal validation was carried out with 100-iteration stratified shuffle split cross-validation, using multiple metrics to assess different aspects of model performance. Associations between treatment covariates and severe mucositis were explored using RFC feature importance. RESULTS Penalised logistic regression and RFC models using the oral cavity OAR performed at least as well as the models using mucosal surface OAR. Associations between dose metrics and severe mucositis were similar between the mucosal surface and oral cavity models. The volumes of oral cavity or mucosal surface receiving intermediate and high doses were most strongly associated with severe mucositis. CONCLUSIONS The simpler oral cavity OAR should be preferred over the mucosal surface OAR for NTCP modelling of severe mucositis. We recommend minimising the volume of mucosa receiving intermediate and high doses, where possible.
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Affiliation(s)
- J A Dean
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - L C Welsh
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - K H Wong
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Aleksic
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - E Dunne
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M R Islam
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Patel
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - P Patel
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - I Petkar
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - I Phillips
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Sham
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - U Schick
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - K L Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - S A Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - K J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - C M Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - S L Gulliford
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
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6
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Miah AB, Gulliford SL, Morden J, Newbold KL, Bhide SA, Zaidi SH, Hall E, Harrington KJ, Nutting CM. Recovery of Salivary Function: Contralateral Parotid-sparing Intensity-modulated Radiotherapy versus Bilateral Superficial Lobe Parotid-sparing Intensity-modulated Radiotherapy. Clin Oncol (R Coll Radiol) 2016; 28:e69-e76. [PMID: 26994893 PMCID: PMC4979532 DOI: 10.1016/j.clon.2016.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 03/19/2015] [Revised: 02/06/2016] [Accepted: 02/09/2016] [Indexed: 11/23/2022]
Abstract
AIMS To establish whether there is a difference in recovery of salivary function with bilateral superficial lobe parotid-sparing intensity-modulated radiotherapy (BSLPS-IMRT) versus contralateral parotid-sparing IMRT (CLPS-IMRT) in patients with locally advanced head and neck squamous cell cancers. MATERIALS AND METHODS A dosimetric analysis was carried out on data from two studies in which patients received BSLPS-IMRT (PARSPORT II) or CLPS-IMRT (PARSPORT). Acute (National Cancer Institute, Common Terminology Criteria for adverse events - NCI CTCAEv3.0) and late (Late Effects of Normal Tissue- subjective, objective, management analytical - LENTSOMA and Radiation Therapy Oncology Group) xerostomia scores were dichotomised: recovery (grade 0-1) versus no recovery (≥grade 2). Incidence of recovery of salivary function was compared between the two techniques and dose-response relationships were determined by fitting dose-response curves to the data using non-linear logistic regression analysis. RESULTS Seventy-one patients received BSLPS-IMRT and 35 received CLPS-IMRT. Patients received 65 Gy in 30 fractions to the primary site and involved nodal levels and 54 Gy in 30 fractions to elective nodal levels. There were significant differences in mean doses to contralateral parotid gland (29.4 Gy versus 24.9 Gy, P < 0.005) and superficial lobes (26.8 Gy versus 30.5 Gy, P = 0.02) for BSLPS and CLPS-IMRT, respectively. Lower risk of long-term ≥grade 2 subjective xerostomia (LENTSOMA) was reported with BSLPS-IMRT (odds ratio 0.50; 95% confidence interval 0.29-0.86; P = 0.012). The percentage of patients who reported recovery of parotid saliva flow at 1 year was higher with BSLPS-IMRT compared with CLPS-IMRT techniques (67.1% versus 52.8%), but the difference was not statistically significant (P = 0.12). For the whole parotid gland, the tolerance doses, D50, were 25.6 Gy (95% confidence interval 20.6-30.5), k = 2.7 (0.9-4.5) (CLPS-IMRT) and 28.9 Gy (26.1-31.9), k = 2.4 (1.4-3.4) (BSLPS-IMRT). For the superficial lobe, D50 were similar: BSLPS-IMRT 23.5 Gy (19.3-27.6), k = 1.9 (0.5-3.8); CLPS-IMRT 24.0 Gy (17.7-30.1), k = 2.1 (0.1-4.1). CONCLUSION BSLPS-IMRT reduces the risk of developing high-grade subjective xerostomia compared with CLPS-IMRT. The D50 of the superficial lobe may be a more reliable predictor of recovery of parotid function than the whole gland mean dose.
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Affiliation(s)
- A B Miah
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S L Gulliford
- Joint Department of Physics, The Institute of Cancer Research, Surrey, UK
| | - J Morden
- The Institute of Cancer Research, Clinical Trials and Statistic Unit, London, UK
| | - K L Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S A Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S H Zaidi
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - E Hall
- The Institute of Cancer Research, Clinical Trials and Statistic Unit, London, UK
| | - K J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C M Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK.
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7
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McQuaid D, Dunlop A, Nill S, Franzese C, Nutting CM, Harrington KJ, Newbold KL, Bhide SA. Evaluation of radiotherapy techniques for radical treatment of lateralised oropharyngeal cancers : Dosimetry and NTCP. Strahlenther Onkol 2016; 192:516-25. [PMID: 27295511 DOI: 10.1007/s00066-016-0980-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 09/25/2015] [Accepted: 04/12/2016] [Indexed: 12/22/2022]
Abstract
AIM The aim of this study was to investigate potential advantages and disadvantages of three-dimensional conformal radiotherapy (3DCRT), multiple fixed-field intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) in terms of dose to the planning target volume (PTV), organs at risk (OARs) and normal tissue complication probability (NTCP) for delivering ipsilateral radiotherapy. MATERIALS AND METHODS 3DCRT, IMRT and VMAT were compared in patients with well-lateralised primary tonsillar cancers who underwent primary radical ipsilateral radiotherapy. The following parameters were compared: conformity index (CI); homogeneity index (HI); dose-volume histograms (DVHs) of PTVs and OARs; NTCP, risk of radiation-induced cancer and dose accumulation during treatment. RESULTS IMRT and VMAT were superior to 3DCRT in terms of CI, HI and dose to the target volumes, as well as mandible and dose accumulation robustness. The techniques were equivalent in terms of dose and NTCP for the contralateral oral cavity, contralateral submandibular gland and mandible, when specific dose constraint objectives were used on the oral cavity volume. Although the volume of normal tissue exposed to low-dose radiation was significantly higher with IMRT and VMAT, the risk of radiation-induced secondary malignancy was dependant on the mathematical model used. CONCLUSION This study demonstrates the superiority of IMRT/VMAT techniques over 3DCRT in terms of dose homogeneity, conformity and consistent dose delivery to the PTV throughout the course of treatment in patients with lateralised oropharyngeal cancers. Dosimetry and NTCP calculations show that these techniques are equivalent to 3DCRT with regard to the risk of acute mucositis when specific dose constraint objectives were used on the contralateral oral cavity OAR.
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Affiliation(s)
- D McQuaid
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - A Dunlop
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - S Nill
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - C Franzese
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
| | - C M Nutting
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - K J Harrington
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - K L Newbold
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK
- The Institute of Cancer Research, SW3 6JB, London, UK
- The Institute of Cancer Research, SM2 5NG, Sutton, UK
| | - S A Bhide
- Head and Neck Unit, Royal Marsden Hospital, Downs road, SM2 5PT, Sutton, Surrey, UK.
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ, London, UK.
- The Institute of Cancer Research, SW3 6JB, London, UK.
- The Institute of Cancer Research, SM2 5NG, Sutton, UK.
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8
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Gujral DM, Shah BN, Chahal NS, Bhattacharyya S, Senior R, Harrington KJ, Nutting CM. Do traditional risk stratification models for cerebrovascular events apply in irradiated head and neck cancer patients? QJM 2016; 109:383-9. [PMID: 26109594 DOI: 10.1093/qjmed/hcv120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Primary radical radiotherapy (RT) for head and neck cancer (HNC) often results in significant radiation dose to the carotid arteries. AIM We assessed whether HNC patients are at increased risk of a cerebrovascular event primarily due to RT or other risk factors for atherosclerosis by (i) risk-stratifying patients according to validated QRISK-2 and QSTROKE scores and (ii) comparing the prevalence of carotid artery stenosis (CAS) in irradiated and unirradiated carotid arteries. DESIGN HNC patients treated with an RT dose >50 Gy to one side of the neck ≥2 years previously were included. METHODS QRISK-2 (2014) and Q-STROKE (2014) scores were calculated. We compared the prevalence of CAS in segments of the common carotid artery on the irradiated and unirradiated sides of the neck. RESULTS Fifty patients (median age of 58 years (interquartile range (IQR) 50-62)) were included. The median QRISK-2 score was 10% (IQR 4.4-15%) and the median QSTROKE score was 3.4% (IQR 1.4-5.3%). For both scores, no patient was classified as high risk. Thirty-eight patients (76%) had CAS in one or both arteries. There was a significant difference in the number of irradiated arteries with stenosis (N = 37) compared with unirradiated arteries (N = 16) (P < 0.0001). There were more plaques on the irradiated artery compared with the unirradiated side - 64/87 (73.6%) versus 23/87 (26.4%), respectively (P < 0.001). CONCLUSIONS Traditional vascular risk factors do not play a role in radiation-induced carotid atherosclerosis. Clinicians should be aware that traditional risk prediction models may under-estimate stroke risk in these patients.
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Affiliation(s)
- D M Gujral
- From the Head and Neck Unit, Department of Radiotherapy, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK and
| | - B N Shah
- Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - N S Chahal
- Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - S Bhattacharyya
- Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - R Senior
- Department of Echocardiography, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
| | - K J Harrington
- From the Head and Neck Unit, Department of Radiotherapy, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK and
| | - C M Nutting
- From the Head and Neck Unit, Department of Radiotherapy, The Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, UK and
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Mansfield DC, Kyula JN, Rosenfelder N, Chao-Chu J, Kramer-Marek G, Khan AA, Roulstone V, McLaughlin M, Melcher AA, Vile RG, Pandha HS, Khoo V, Harrington KJ. Oncolytic vaccinia virus as a vector for therapeutic sodium iodide symporter gene therapy in prostate cancer. Gene Ther 2016; 23:357-68. [PMID: 26814609 PMCID: PMC4827015 DOI: 10.1038/gt.2016.5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 12/07/2015] [Accepted: 01/13/2016] [Indexed: 12/16/2022]
Abstract
Oncolytic strains of vaccinia virus are currently in clinical development with clear evidence of safety and promising signs of efficacy. Addition of therapeutic genes to the viral genome may increase the therapeutic efficacy of vaccinia. We evaluated the therapeutic potential of vaccinia virus expressing the sodium iodide symporter (NIS) in prostate cancer models, combining oncolysis, external beam radiotherapy and NIS-mediated radioiodide therapy. The NIS-expressing vaccinia virus (VV-NIS), GLV-1h153, was tested in in vitro analyzes of viral cell killing, combination with radiotherapy, NIS expression, cellular radioiodide uptake and apoptotic cell death in PC3, DU145, LNCaP and WPMY-1 human prostate cell lines. In vivo experiments were carried out in PC3 xenografts in CD1 nude mice to assess NIS expression and tumor radioiodide uptake. In addition, the therapeutic benefit of radioiodide treatment in combination with viral oncolysis and external beam radiotherapy was measured. In vitro viral cell killing of prostate cancers was dose- and time-dependent and was through apoptotic mechanisms. Importantly, combined virus therapy and iodizing radiation did not adversely affect oncolysis. NIS gene expression in infected cells was functional and mediated uptake of radioiodide both in vitro and in vivo. Therapy experiments with both xenograft and immunocompetent Transgenic Adenocarcinoma of the Mouse Prostate (TRAMP) mouse models showed that the addition of radioiodide to VV-NIS-infected tumors was more effective than each single-agent therapy, restricting tumor growth and increasing survival. In conclusion, VV-NIS is effective in prostate cancer models. This treatment modality would be an attractive complement to existing clinical radiotherapy practice.
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Affiliation(s)
- D C Mansfield
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
| | - J N Kyula
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
| | - N Rosenfelder
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
| | - J Chao-Chu
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
| | - G Kramer-Marek
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
| | - A A Khan
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
| | - V Roulstone
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
| | - M McLaughlin
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
| | - A A Melcher
- Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - R G Vile
- Molecular Medicine Program, Mayo Clinic, Rochester, MN, USA
| | - H S Pandha
- Postgraduate Medical School, The University of Surrey, Guildford, UK
| | - V Khoo
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
- The Royal Marsden Hospital, London, UK
- University of Melbourne and Monash University, Victoria, Australia
| | - K J Harrington
- Divisions of Cancer Biology and Radiotherapy and Imaging, The Institute of Cancer Research, Chester Beatty Labs, London, UK
- The Royal Marsden Hospital, London, UK
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10
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Miah AB, Bhide SA, Del Rosario L, Matthews J, Nicol R, Tanay MA, Gupta S, Zaidi SH, Newbold KL, Harrington KJ, Nutting CM. Induction Chemotherapy Followed by Chemo-intensity-modulated Radiotherapy for Locally Advanced Nasopharyngeal Cancer. Clin Oncol (R Coll Radiol) 2016; 28:e61-7. [PMID: 26876458 DOI: 10.1016/j.clon.2016.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [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: 03/19/2015] [Revised: 12/01/2015] [Accepted: 12/30/2015] [Indexed: 11/16/2022]
Abstract
AIMS To determine the toxicity and tumour control rates after chemo-intensity-modulated radiotherapy (chemo-IMRT) for locally advanced nasopharyngeal cancers (LA-NPC). MATERIALS AND METHODS Patients with LA-NPC were enrolled in a trial to receive induction chemotherapy followed by parotid-sparing chemo-IMRT. The primary site and involved nodal levels received 65 Gy in 30 fractions and at risk nodal levels received 54 Gy in 30 fractions. Incidence of ≥grade 2 subjective xerostomia was the primary end point. Secondary end points included incidences of acute and late toxicities and survival outcomes. RESULTS Forty-two patients with American Joint Committee on Cancer stages II (12%), III (26%) and IV (62%) (World Health Organization subtype: I [5%]; II [40%]; III [55%]) completed treatment between January 2006 and April 2010 with a median follow-up of 32 months. Incidences of ≥grade 2 acute toxicities were: dysphagia 83%; xerostomia 76%; mucositis 97%; pain 76%; fatigue 99% and ototoxicity 12%. At 12 months, ≥grade 2 subjective xerostomia was observed in 31%, ototoxicitiy in 13% and dysphagia in 4%. Two year locoregional control was 86.2% (95% confidence interval: 70.0-94.0) with 2 year progression-free survival at 78.4% (61.4-88.6) and 2 year overall survival at 85.9% (69.3-93.9). CONCLUSIONS Chemo-IMRT for LA-NPC is feasible with good survival outcomes. At 1 year, 31% experience ≥grade 2 subjective xerostomia.
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Affiliation(s)
- A B Miah
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - S A Bhide
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - L Del Rosario
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - J Matthews
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - R Nicol
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M A Tanay
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S Gupta
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - S H Zaidi
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - K L Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - K J Harrington
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C M Nutting
- The Institute of Cancer Research, London, UK.
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11
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Dillon MT, Good JS, Harrington KJ. Selective targeting of the G2/M cell cycle checkpoint to improve the therapeutic index of radiotherapy. Clin Oncol (R Coll Radiol) 2014; 26:257-65. [PMID: 24581946 DOI: 10.1016/j.clon.2014.01.009] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/22/2014] [Accepted: 01/30/2014] [Indexed: 12/31/2022]
Abstract
Despite tremendous advances in radiotherapy techniques, allowing dose escalation to tumour tissues and sparing of organs at risk, cure rates from radiotherapy or chemoradiotherapy remain suboptimal for most cancers. In tandem with our growing understanding of tumour biology, we are beginning to appreciate that targeting the molecular response to radiation-induced DNA damage holds great promise for selective tumour radiosensitisation. In particular, approaches that inhibit cell cycle checkpoint controls offer a means of exploiting molecular differences between tumour and normal cells, thereby inducing so-called cancer-specific synthetic lethality. In this overview, we discuss cellular responses to radiation-induced damage and discuss the potential of using G2/M cell cycle checkpoint inhibitors as a means of enhancing tumour control rates.
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Affiliation(s)
- M T Dillon
- The Institute of Cancer Research, Targeted Therapy Team, Chester Beatty Laboratories, London, UK; The Royal Marsden Hospital, London, UK
| | - J S Good
- The Royal Marsden Hospital, London, UK
| | - K J Harrington
- The Institute of Cancer Research, Targeted Therapy Team, Chester Beatty Laboratories, London, UK; The Royal Marsden Hospital, London, UK.
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12
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Wilkins AC, Rosenfelder N, Schick U, Gupta S, Thway K, Nutting CM, Harrington KJ, Newbold K, Bhide SA. Equivalence of cisplatin and carboplatin-based chemoradiation for locally advanced squamous cell carcinoma of the head and neck: a matched-pair analysis. Oral Oncol 2013; 49:615-9. [PMID: 23485743 DOI: 10.1016/j.oraloncology.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carboplatin can be substituted for cisplatin in concomitant chemoradiation (CRT) for locally advanced squamous cell carcinoma of the head and neck (LASCCHN) when the latter is contraindicated. This matched-pair study aimed to compare the efficacy and acute toxicity of carboplatin and cisplatin. METHODS Patients treated with 2 cycles of concomitant carboplatin-based CRT were matched to patients treated with 2 cycles of cisplatin. Matching criteria included age, tumour site, stage, smoking status and use of induction chemotherapy. Radiation was delivered using conformal techniques. Data on weekly acute toxicity throughout CRT was compared using the chi-squared test for proportions. Kaplan Meier statistics described time to local relapse, distant relapse and overall survival, the log-rank test was used to compare 3-year survival outcomes. RESULTS Sixty-five patients who received carboplatin were matched to 65 who received cisplatin. Significant differences in toxicity included increased emesis with cisplatin and more anaemia and thrombocytopenia with carboplatin. There was no significant difference in 3-year locoregional control (87% vs. 79%, p=0.54), freedom from distant metastases (88% vs. 85%, p=0.79) and overall survival (59% vs. 68%, p=0.24) between the carboplatin and cisplatin cohorts, respectively. CONCLUSIONS When cisplatin is contraindicated, carboplatin-based CRT yields equivalent treatment outcomes in patients with LASCCHN.
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Affiliation(s)
- A C Wilkins
- Head and Neck Unit, Royal Marsden Hospital, London and Surrey, United Kingdom
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13
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Franzese C, Gujral DM, Good J, Thway K, Harrington KJ. Radical radiotherapy for radiation-induced malignancy in the context of Hereditary retinoblastoma. Clin Oncol (R Coll Radiol) 2013; 25:330-1. [PMID: 23357193 DOI: 10.1016/j.clon.2012.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 12/10/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022]
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14
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Touchefeu Y, Franken P, Harrington KJ. Radiovirotherapy: principles and prospects in oncology. Curr Pharm Des 2012; 18:3313-20. [PMID: 22397732 DOI: 10.2174/1381612811209023313] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 03/06/2012] [Indexed: 11/22/2022]
Abstract
Radiovirotherapy is defined as the use of viruses to deliver radioisotopic treatment into infected cells. Oncolytic viruses are able to selectively target and kill cancer cells. The combination of oncolytic viruses and radiation therapies can have synergistic antitumour properties. Viruses may act as radiosensitizers, and radiations can increase viral oncolytic properties. The combination of oncolytic viruses with a virally-directed radioisotope therapy is an innovative method to combine viruses and radiation therapy, selectively within the tumour cells. The sodium/iodide symporter (NIS) is the main transgene that has been studied for this approach. NIS can mediate the uptake of isotopes of iodine and technetium 99m for in vivo gene expression imaging and therapy. This review highlights the principles of radiovirotherapy, and its recent progress. Better understanding of the regulation of NIS opens up pathways by which to potentiate the functional expression of NIS. In terms of the therapeutic isotope, Iodine-131 has been most frequently studied but other isotopes (astatine- 211, rhenium-188) are of growing interest. Oncolytic viruses are able to infect selectively and replicate in cancer cells and promising early phase clinical trials have been recently published. Their development allows a better selectivity of viral infection and adds a virus-specific cytotoxicity to the therapeutic approach. Active research into strategies such as immunosuppressive treatment and cell-based carrier systems is seeking to circumvent the host antiviral immune response and, thus, increase the potential for systemic delivery. Finally, other anticancer therapies such as chemotherapy and external beam radiotherapy may have a synergistic effect with radiovirotherapy and such combinatorial approaches offering the prospect of accelerated translation into clinical studies.
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Affiliation(s)
- Y Touchefeu
- The Institute of Cancer Research, Targeted Therapy Laboratory, Division of Cancer Biology, London, United Kingdom.
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15
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Mansfield D, Pencavel T, Kyula JN, Zaidi S, Roulstone V, Thway K, Karapanagiotou L, Khan AA, McLaughlin M, Touchefeu Y, Seth R, Melcher AA, Vile RG, Pandha HS, Harrington KJ. Oncolytic Vaccinia virus and radiotherapy in head and neck cancer. Oral Oncol 2012; 49:108-18. [PMID: 22925693 DOI: 10.1016/j.oraloncology.2012.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/24/2012] [Accepted: 07/28/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Oncolytic forms of attenuated Vaccinia virus are now in clinical development, assessing the compatibility of this novel treatment with radiotherapy may reveal exploitable synergistic relationships. MATERIALS AND METHODS In vitro analyses of cell killing, cell cycle effects and caspase activation were carried out on HN3, HN5, CAL27, Detroit, SIHN5B, and PJ41 cells. In vivo studies of the virus and X-radiation were performed on H&N xenografts in CD1 nude mice. RESULTS Cell killing in vitro was demonstrated to be dose- and time-dependent. Infection causes an increase in S-phase and sub-G1 cells. A dose dependent increase in active caspase-3 indicated induction of apoptosis. Xenografts injected with Vaccinia stabilised and frequently completely regressed. Combination with radiation generated additional cell death, induction of caspase activity and in vivo further improved long term regression rates. CONCLUSIONS These data support continued exploration of this therapy combination and indicates potential for clinical trials in head and neck cancer.
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Affiliation(s)
- D Mansfield
- The Institute of Cancer Research, Divisions of Cancer Biology and Radiotherapy and Imaging, Targeted Therapy Team, London, UK.
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16
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Roulstone V, Twigger K, Zaidi S, Pencavel T, Kyula JN, White C, McLaughlin M, Seth R, Karapanagiotou EM, Mansfield D, Coffey M, Nuovo G, Vile RG, Pandha HS, Melcher AA, Harrington KJ. Synergistic cytotoxicity of oncolytic reovirus in combination with cisplatin-paclitaxel doublet chemotherapy. Gene Ther 2012; 20:521-8. [PMID: 22895509 DOI: 10.1038/gt.2012.68] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oncolytic reovirus is currently under active investigation in a range of tumour types. Early phase studies have shown that this agent has modest monotherapy efficacy and its future development is likely to focus on combination regimens with cytotoxic chemotherapy. Indeed, phase I/II clinical trials have confirmed that reovirus can be safely combined with cytotoxic drugs, including a platin-taxane doublet regimen, which is currently being tested in a phase III clinical trial in patients with relapsed/metastatic head and neck cancer. Therefore, we have tested this triple (reovirus, cisplatin, paclitaxel) combination therapy in a panel of four head and neck cancer cell lines. Using the combination index (CI) method, the triple therapy demonstrated synergistic cytotoxicity in vitro in both malignant and non-malignant cell lines. In head and neck cancer cell lines, this was associated with enhanced caspase 3 and 7 cleavage, but no increase in viral replication. In vitro analyses confirmed colocalisation of markers of reovirus infection and caspase 3. Triple therapy was significantly more effective than reovirus or cisplatin-paclitaxel in athymic nude mice. These data suggest that the combination of reovirus plus platin-taxane doublet chemotherapy has significant activity in head and neck cancer and underpin the current phase III study in this indication.
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Affiliation(s)
- V Roulstone
- Targeted Therapy Laboratory, Section of Cell and Molecular Biology, Chester Beatty Laboratories, The Institute of Cancer Research, Division of Cell Biology, London, UK
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17
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Bhide SA, Newbold KL, Harrington KJ, Nutting CM. Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers. Br J Radiol 2012; 85:487-94. [PMID: 22556403 DOI: 10.1259/bjr/85942136] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional two-dimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. Intensity-modulated radiotherapy (IMRT) can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This article reviews the current role of IMRT in head and neck cancer from the point of view of normal tissue sparing, and also reviews the current published literature by individual head and neck cancer subsites. In addition, we briefly discuss the role of image guidance in head and neck IMRT, and future directions in this area.
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, Royal Marsden Hospital, Sutton, Surrey, UK
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18
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Abstract
It is increasingly being recognized that oral cavity cancer incidences are rising globally. Furthermore, these tumors represent a high risk group of tumors comparative to other head and neck tumor sub-sites and have a high preponderance of occult nodal metastases. Surgery alone leads to excellent outcomes in early stage disease. Advanced tumors require adjuvant radiotherapy with or without concomitant chemotherapy. Irradiation using 3D conformal radiotherapy results in high incidence of late radiation side-effects. Xersostomia and mandibular osteoradionecrosis result in most significant effects on patients' quality of life. Intensity modulated radiotherapy (IMRT) is an advanced approach to 3-D treatment planning and conformal therapy (3D-CRT). It optimizes the delivery of irradiation to irregularly-shaped volumes and has the ability to produce concavities in radiation treatment volumes and hence enables sparing of normal tissue while delivering adequate doses to the tumor volumes. In this manuscript, we discuss the advantages of IMRT based on review of published peer reviewed literature.
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ London, United Kingdom.
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19
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Steven NM, Harrington KJ, Lee L, Jia H, Tanday MK, Roberts C, Edwards C, McGuigan L, Hartley AGJ, Viskaduraki M, Hui EP, Chan ATC, Rickinson AB, Taylor GS. A UK-based phase I trial of recombinant modified vaccinia ankara (MVA) vaccine encoding Epstein-Barr virus (EBV) antigens. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e13028] [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: 11/20/2022] Open
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20
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Pedersen JV, Karapanagiotou EM, Biondo A, Tunariu N, Puglisi M, Denholm KA, Sassi S, Mansfield D, Yap TA, De Bono JS, Harrington KJ. A phase I clinical trial of a genetically modified and imageable oncolytic vaccinia virus GL-ONC1 with clinical green fluorescent protein (GFP) imaging. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.2577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Bourke MG, Salwa S, Harrington KJ, Kucharczyk MJ, Forde PF, de Kruijf M, Soden D, Tangney M, Collins JK, O'Sullivan GC. The emerging role of viruses in the treatment of solid tumours. Cancer Treat Rev 2011; 37:618-32. [PMID: 21232872 DOI: 10.1016/j.ctrv.2010.12.003] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [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: 07/22/2010] [Revised: 12/04/2010] [Accepted: 12/07/2010] [Indexed: 12/13/2022]
Abstract
There is increasing optimism for the use of non-pathogenic viruses in the treatment of many cancers. Initial interest in oncolytic virotherapy was based on the observation of an occasional clinical resolution of a lymphoma after a systemic viral infection. In many cancers, by comparison with normal tissues, the competency of the cellular anti-viral mechanism is impaired, thus creating an exploitable difference between the tumour and normal cells, as an unimpeded viral proliferation in cancer cells is eventually cytocidal. In addition to their oncolytic capability, these particular viruses may be engineered to facilitate gene delivery to tumour cells to produce therapeutic effects such as cytokine secretion and anti -tumour immune responses prior to the eventual cytolysis. There is now promising clinical experience with these viral strategies, particularly as part of multimodal studies, and already several clinical trials are in progress. The limitations of standard cancer chemotherapies, including their lack of specificity with consequent collateral toxicity and the development of cross-resistance, do not appear to apply to viral-based therapies. Furthermore, virotherapy frequently restores chemoradiosensitivity to resistant tumours and has also demonstrated efficacy against cancers that historically have a dismal prognosis. While there is cause for optimism, through continued improvements in the efficiency and safety of systemic delivery, through the emergence of alternative viral agents and through favourable clinical experiences, clinical trials as part of multimodal protocols will be necessary to define clinical utility. Significant progress has been made and this is now a major research area with an increasing annual bibliography.
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Affiliation(s)
- M G Bourke
- Cork Cancer Research Centre, Leslie C. Quick Jnr. Laboratory, Biosciences Institute, University College Cork, Ireland.
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Abstract
Intensity-modulated radiotherapy (IMRT) has been a significant technological advance in the field of radiotherapy in recent years. IMRT allows sparing of normal tissue while delivering radical radiation doses to the target volumes. The role of IMRT for parotid salivary gland sparing in head and neck cancer is well established. The utility of IMRT for pharyngeal constrictor muscle and cochlear sparing requires investigation in clinical trials. The current evidence supporting the use of IMRT in various head and neck subsites has been summarized. Sparing of organs at risk allows for dose-escalation to the target volumes, taking advantage of the steep dose-response relationship for squamous cell carcinomas to improve treatment outcomes in advanced head and neck cancers. However, dose-escalation could result in increased radiation toxicity (acute and late), which has to be studied in detail. The future of IMRT in head and neck cancers lies in exploring the use of biological imaging for dose-escalation using targeted dose painting.
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, The Institute of Cancer Research and The Royal Marsden Hospital, London and Surrey, United Kingdom
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23
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Touchefeu Y, Harrington KJ, Galmiche JP, Vassaux G. Review article: gene therapy, recent developments and future prospects in gastrointestinal oncology. Aliment Pharmacol Ther 2010; 32:953-68. [PMID: 20937041 DOI: 10.1111/j.1365-2036.2010.04424.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gene therapy consists of the introduction of genetic material into cells for a therapeutic purpose. A wide range of gene therapy vectors have been developed and used for applications in gastrointestinal oncology. AIM To review recent developments and published clinical trials concerning the application of gene therapy in the treatment of liver, colon and pancreatic cancers. METHODS Search of the literature published in English using the PubMed database. RESULTS A large variety of therapeutic genes are under investigation, such as tumour suppressor, suicide, antiangiogenesis, inflammatory cytokine and micro-RNA genes. Recent progress concerns new vectors, such as oncolytic viruses, and the synergy between viral gene therapy, chemotherapy and radiation therapy. As evidence of these basic developments, recently published phase I and II clinical trials, using both single agents and combination strategies, in adjuvant or advanced disease settings, have shown encouraging results and good safety records. CONCLUSIONS Cancer gene therapy is not yet indicated in clinical practice. However, basic and clinical advances have been reported and gene therapy is a promising, new therapeutic approach for the treatment of gastrointestinal tumours.
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Affiliation(s)
- Y Touchefeu
- Institut des Maladies de l'Appareil Digestif, INSERM U, University Hospital, Nantes, France.
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Karapanagiotou EM, Chester JD, Pandha HS, Gill GM, Coffey MC, Mettinger K, Harrington KJ. A phase I/II study of oncolytic reovirus plus carboplatin/paclitaxel in patients with advanced solid cancers with emphasis on squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.3080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Harrington KJ, Berrier A, Robinson M, Remenar E, Housset M, Hurtado de Mendoza F, Compton N, Lau M, Legenne P, Kumar R. Phase II study of oral lapatinib, a dual-tyrosine kinase inhibitor, combined with chemoradiotherapy (CRT) in patients (pts) with locally advanced, unresected squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5505] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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26
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Kazi R, Dwivedi RC, St. Rose S, Roe JW, Nutting C, Rhys-Evans PH, Harrington KJ. Validation of first speech-specific questionnaire for English-speaking head and neck cancer (HNC) patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9081] [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: 11/20/2022] Open
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27
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Dwivedi RC, Rose SS, Nutting C, Rhys-Evans PH, Harrington KJ, Kazi R. A report on the development and validation of first-ever perceptual speech evaluation tool for head and neck cancer (HNC) patients. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9116] [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: 11/20/2022] Open
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28
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Pencavel T, Seth R, Hayes A, Melcher A, Pandha H, Vile R, Harrington KJ. Locoregional intravascular viral therapy of cancer: precision guidance for Paris's arrow? Gene Ther 2010; 17:949-60. [PMID: 20445580 DOI: 10.1038/gt.2010.48] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Viral therapy of cancer includes strategies such as viral transduction of tumour cells with 'suicide genes', using viral infection to trigger immune-mediated tumour cell death and using oncolytic viruses for their direct anti-tumour action. However, problems still remain in terms of adequate viral delivery to tumours. A role is also emerging for single-organ isolation and perfusion. Having begun with the advent of isolated limb perfusion for extremity malignancy, experimental systems have been developed for the perfusion of other organs, particularly the liver, kidneys and lungs. These are beginning to be adopted into clinical treatment pathways. The combination of these two modalities is potentially significant. Locoregional perfusion increases the exposure of tumour cells to viral agents. In addition, the avoidance of systemic elimination through the immune and reticulo-endothelial systems should provide a mechanism for increased transduction/infection of target cells. The translation of laboratory research to clinical practice would occur within the context of perfusion programmes, which are already established in the clinic. Many of these programmes include the use of vasoactive cytokines such as tumour necrosis factor-alpha, which may have an effect on viral uptake. Evidence of activation of specific anti-tumour immunological responses by intratumoural and other existing methods of viral administration raises the intriguing possibility of a locoregional therapy, with the ability to affect distant sites of disease. In this review, we examined the state of the literature in this area and summarized current findings before indicating likely areas of continuing interest.
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Affiliation(s)
- T Pencavel
- Targeted Therapy Team, The Institute of Cancer Research, and Sarcoma/Melanoma Unit, Royal Marsden Hospital, London, UK
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Harrington KJ, Vile RG, Melcher A, Chester J, Pandha HS. Clinical trials with oncolytic reovirus: moving beyond phase I into combinations with standard therapeutics. Cytokine Growth Factor Rev 2010; 21:91-8. [PMID: 20223697 PMCID: PMC3915505 DOI: 10.1016/j.cytogfr.2010.02.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [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] [Indexed: 02/07/2023]
Abstract
It is time for those working on oncolytic viruses to take stock of the status of the field. We now have at our disposal an array of potential therapeutic agents, and are beginning to conduct early-phase clinical trials in patients with relapsed/metastatic cancers. By drawing on lessons learned during the development of other biological therapies, such as monoclonal antibodies and targeted small molecule inhibitors, we are now in a position to chart the course of the next wave of trials that will go beyond the phase I studies of safety and feasibility. In this article we review our approach to the development of oncolytic viruses as cancer therapeutics. In doing so, we emphasise the fact that this process is modular and involves multiple iterative steps between the laboratory and the clinic. Ultimately, at least in the medium term, the future of oncolytic virotherapy lies in combination regimens with standard anti-cancer agents such as radiation and chemotherapy.
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Affiliation(s)
- K J Harrington
- The Institute of Cancer Research, Chester Beatty Laboratories, Targeted Therapy Laboratory, 237 Fulham Road, London SW3 6JB, UK.
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Harrington KJ, Kazi R, Bhide SA, Newbold K, Nutting CM. Novel therapeutic approaches to squamous cell carcinoma of the head and neck using biologically targeted agents. Indian J Cancer 2010; 47:248-59. [DOI: 10.4103/0019-509x.64711] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Ismail M, Bokaee S, Morgan R, Davies J, Harrington KJ, Pandha H. Erratum: Inhibition of the aquaporin 3 water channel increases the sensitivity of prostate cancer cells to cryotherapy. Br J Cancer 2009. [PMCID: PMC2720227 DOI: 10.1038/sj.bjc.6605233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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32
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Ismail M, Bokaee S, Morgan R, Davies J, Harrington KJ, Pandha H. Inhibition of the aquaporin 3 water channel increases the sensitivity of prostate cancer cells to cryotherapy. Br J Cancer 2009; 100:1889-95. [PMID: 19513079 PMCID: PMC2714232 DOI: 10.1038/sj.bjc.6605093] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [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] [Indexed: 11/30/2022] Open
Abstract
Aquaporins (AQPs) are intrinsic membrane proteins that facilitate selective water and small solute movement across the plasma membrane. In this study, we investigate the role of inhibiting AQPs in sensitising prostate cancer cells to cryotherapy. PC-3 and DU145 prostate cancer cells were cooled to 0, −5 and −10°C. The expression of AQP3 in response to freezing was determined using real-time quantitative polymerase chain reaction (RT–qPCR) and western blot analysis. Aquaporins were inhibited using mercuric chloride (HgCl2) and small interfering RNA (siRNA) duplex, and cell survival was assessed using a colorimetric assay. There was a significant increase in AQP3 expression in response to freezing. Cells treated with AQP3 siRNA were more sensitive to cryoinjury compared with control cells (P<0.001). Inhibition of the AQPs by HgCl2 also increased the sensitivity of both cell lines to cryoinjury and there was a complete loss of cell viability at −10°C (P<0.01). In conclusion, we have shown that AQP3 is involved directly in cryoinjury. Inhibition of AQP3 increases the sensitivity of prostate cancer cells to freezing. This strategy may be exploited in the clinic to improve the efficacy of prostate cryotherapy.
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Affiliation(s)
- M Ismail
- Department of Oncology, Postgraduate Medical School, University of Surrey, Guildford GU2 7WG, UK.
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Dwivedi RC, Nutting CM, Rhys-Evans P, Harrington KJ, Kazi R. Future perspectives for health related quality of life (HRQOL) studies in head and neck cancer. G Ital Med Lav Ergon 2009; 31:B17-B20. [PMID: 20518223] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The impact of a head and neck cancer (HNC) diagnosis on a person and the consequences of its treatment across multiple functional domains can profoundly alter quality of life (QOL). By pursuing patient-centered management and considering the entire gamut of physical, psychological and social problems, QOL studies contribute more than just routine mortality and morbidity data. Assessments can now be made using a variety of both specific and generic measures to optimise patient care and to aid the development of informed rehabilitation services. Unfortunately, there exists no 'gold-standard' questionnaire in the literature and the choice is largely based on clinician preference, research objectives and psychometric properties. Future efforts must be made to effectively use modern technological and computational advances to set up item banks and newer theoretical models. Longitudinal studies with pre-determined priori should be encouraged as should the utilisation of minimalist approaches and incisive item response theory. Most importantly, in order to link research to clinical practice, health related QOL (HRQOL) studies should be devised and utilised in a way as to provide clinically meaningful data to the treating physician useful for patient' care.
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Affiliation(s)
- R C Dwivedi
- Head & Neck Unit, Royal Marsden NHS, Fulham Road, London SW3 6JJ, UK
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Kazi R, Rhys-Evans P, Nutting CM, Harrington KJ. The great debate: stroboscopy vs high- speed imaging for assessment of alaryngeal phonation. J Cancer Res Ther 2009; 5:121-3. [PMID: 19542669 DOI: 10.4103/0973-1482.52796] [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: 11/04/2022]
Abstract
Assessment of total laryngectomy patients has always been problematic and controversial. This is particularly so when one wants to assess and characterize the mucosal wave using the existing modalities of assessment. Videostroboscopy is generally regarded as an easily available and clinically relevant technique for adequately assessing this important parameter. However, it has its limitations, especially in laryngectomies. Recently, high-speed imaging has been recommended as the ideal tool for studying the physiology and mucosal parameters in this set of patients. In this brief article we examine this debate on the 'best' modality for assessment of the total laryngectomy patient.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, United Kingdom.
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35
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Karapanagiotou E, Pandha HS, Hall G, Chester J, Melcher A, Coffey M, de Bono J, Gore ME, Nutting CM, Harrington KJ. Phase I/II trial of oncolytic reovirus (Reolysin) in combination with carboplatin/paclitaxel in patients (pts) with advanced solid cancers. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e14519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14519 Background: Reolysin, a wild type reovirus (Dearing strain), replicates preferentially in Ras-activated cancer cells. Preclinical data have demonstrated synergistic tumor kill when reolysin is combined with standard chemotherapies including platinum agents and taxanes, justifying the clinical evaluation of this drug combination. Methods: Pts were initially treated in an open-label, dose-escalating, phase I trial and received iv reolysin, d1–5, iv carboplatin (AUC5), d1, and paclitaxel (175mg/m2), d1, qw3. Reolysin was administered at a starting dose of 3x109 TCID50 and then increased to 1x1010 and 3x1010 TCID50 in cohorts of 3 pts. Primary endpoints for the dose escalation trial were to determine the maximum tolerated dose, dose limiting toxicity (DLT) and to recommend a dose for phase II studies. Secondary endpoints were to evaluate pharmacokinetics, immune response and anti-tumour activity. The primary endpoint for the phase II expansion cohort in head and neck (H&N) pts is to characterize response rate. Results: 17 heavily pre-treated pts (11 M, median age 55 yrs) with advanced cancer: H&N (10), melanoma (4), peritoneal/endometrial cancer (2), and sarcoma (1) have received 82 cycles of treatment to date; 4 pts are still on study. There were no DLTs in the dose escalation. Toxicities were mainly grade 1 and 2 and included: nausea, fatigue, vomiting, myalgia, fever, neutropenia, lymphopenia, thrombocytopenia and hypotension. This combination resulted in a blunting of antiviral immune response as compared to monotherapy virus. Response rates in 15 evaluable patients were partial response (PR) (4 pts), stable disease (SD) (6 pts) and progressive disease (5 pts). Of note, all PRs and 4/5 SDs were in H&N disease. Conclusions: The combination of reolysin and carboplatin/paclitaxel was well tolerated and resulted in disease control in the majority of pts. Significant responses in refractory H&N pts recommended this combination for phase II evaluation. Enrollment is ongoing and randomized studies are planned. [Table: see text]
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Affiliation(s)
- E. Karapanagiotou
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - H. S. Pandha
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - G. Hall
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - J. Chester
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - A. Melcher
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - M. Coffey
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - J. de Bono
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - M. E. Gore
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - C. M. Nutting
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
| | - K. J. Harrington
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Leeds Institute of Molecular Medicine, Leeds, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada
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Rudman SM, Comins C, Mukherji D, Coffey M, Mettinger K, Protheroe A, Harrington KJ, Pandha H, Spicer JF. Results of a phase I study to evaluate the feasibility, safety, and biological effects of intravenous administration of wild-type reovirus with docetaxel to patients with advanced malignancies. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e13524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13524 Background: Reovirus has minimal pathogenicity in humans but selectively replicates in cells with activated Ras. Wild- type reovirus serotype 3 Dearing strain (Reolysin) has selective antitumor activity in vitro, in murine models, and after systemic delivery in humans in phase 1 trials. Synergistic tumour kill has been observed combining reovirus with taxanes in a range of cancer cell lines and in vivo. Methods: Patients were treated in an open-label, dose-escalating, phase I trial and received 3- weekly 75mg/m2 docetaxel i.v. and reovirus i.v. (day 1–5 of first week inclusive). Reovirus was administered at a starting dose of 3x109 tissue culture infectious dose (TCID50) and then increased to 1 x 1010 and 3 x 1010 TCID50. Primary endpoints were to determine the maximum tolerated dose (MTD), dose limiting toxicity (DLT) and to recommend a dose and schedule for future investigation. Secondary endpoints were to evaluate pharmacokinetics, neutralizing antibody development, cell- mediated immune response and anti-tumour activity. Results: 17 patients were treated (15 males, median age 60 years). No MTD has been reached. DLT's observed were G4 neutropenia (and a recurrent perianal abcess) and G3 rise in AST. Other toxicities observed were fatigue, hypotension and neutropenic sepsis. At present, 5 patients remain on treatment. We have observed 2 partial responses (breast and gastric carcinoma) and 10 patients had stable disease as best response. Conclusions: Reovirus is well tolerated when administered in combination with intravenous docetaxel, with predictable toxicity observed. The recommended dose has been defined at 3x1010 TCID50 and phase II studies are planned. Objective radiological evidence of anticancer activity for this combination has been observed. [Table: see text]
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Affiliation(s)
- S. M. Rudman
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - C. Comins
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - D. Mukherji
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - M. Coffey
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - K. Mettinger
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A. Protheroe
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - K. J. Harrington
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - H. Pandha
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - J. F. Spicer
- Guy's Hospital, London, United Kingdom; University of Surrey, Guildford, United Kingdom; Oncolytics Biotech Inc., Calgary, AB, Canada; Churchill Hospital, Oxford, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Clark CH, Miles EA, Urbano MTG, Bhide SA, Bidmead AM, Harrington KJ, Nutting CM. Pre-trial quality assurance processes for an intensity-modulated radiation therapy (IMRT) trial: PARSPORT, a UK multicentre Phase III trial comparing conventional radiotherapy and parotid-sparing IMRT for locally advanced head and neck cancer. Br J Radiol 2009; 82:585-94. [PMID: 19332518 DOI: 10.1259/bjr/31966505] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to compare conventional radiotherapy with parotid gland-sparing intensity-modulated radiation therapy (IMRT) using the PARSPORT trial. The validity of such a trial depends on the radiotherapy planning and delivery meeting a defined standard across all centres. At the outset, many of the centres had little or no experience of delivering IMRT; therefore, quality assurance processes were devised to ensure consistency and standardisation of all processes for comparison within the trial. The pre-trial quality assurance (QA) programme and results are described. Each centre undertook exercises in target volume definition and treatment planning, completed a resource questionnaire and produced a process document. Additionally, the QA team visited each participating centre. Each exercise had to be accepted before patients could be recruited into the trial. 10 centres successfully completed the quality assurance exercises. A range of treatment planning systems, linear accelerators and delivery methods were used for the planning exercises, and all the plans created reached the standard required for participation in this multicentre trial. All 10 participating centres achieved implementation of a comprehensive and robust IMRT programme for treatment of head and neck cancer.
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Affiliation(s)
- C H Clark
- Department of Physics, Royal Marsden NHS Foundation Trust, London and Sutton, Surrey, UK.
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Nutting CM, van Herpen CML, Miah AB, Bhide SA, Machiels JP, Buter J, Kelly C, de Raucourt D, Harrington KJ. Phase II study of 3-AP Triapine in patients with recurrent or metastatic head and neck squamous cell carcinoma. Ann Oncol 2009; 20:1275-9. [PMID: 19246715 DOI: 10.1093/annonc/mdn775] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment options for recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) are limited with response rates to cytotoxic chemotherapy of approximately 30% and median survival of 6 months. PATIENTS AND METHODS In a multicentre phase II study, 32 patients with recurrent or metastatic HNSCC received 3-AP Triapine (3-aminopyridine-2-carboxaldehyde thiosemicarbazone), an inhibitor of ribonucleotide reductase, 96 mg/m2, daily for 4 days every 14 days (one cycle). Eligibility criteria required Eastern Cooperative Oncology Group performance status (ECOG PS) of zero to two with a life expectancy of >3 months; one prior chemotherapy regimen was allowed. RESULTS Thirty patients were assessable for response and toxicity. Median age was 57 years (range 36-79) and median ECOG PS was one (range 0-2). Thirteen patients had previously been treated with chemotherapy. A total of 130 cycles were administered with a median number of cycles of 3.5 (range 1-8). Mild anaemia (40%), nausea (22%) and fatigue (22%) were commonly reported with G3 and G4 neutropenia documented in 22% and 22%, respectively. Overall response rate was 5.9% (95% confidence interval 0.2% to 28.7%). One patient achieved a partial response, eight had stable disease and 21 progressive disease. Median time to disease progression was 3.9 months. CONCLUSIONS 3-AP Triapine as a single agent, at this dose and schedule, is well tolerated but has only minor activity in the treatment of advanced HNSCC.
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Affiliation(s)
- C M Nutting
- Head and Neck Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK.
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Plowright L, Harrington KJ, Pandha HS, Morgan R. HOX transcription factors are potential therapeutic targets in non-small-cell lung cancer (targeting HOX genes in lung cancer). Br J Cancer 2009; 100:470-5. [PMID: 19156136 PMCID: PMC2658540 DOI: 10.1038/sj.bjc.6604857] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [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] [Revised: 11/13/2008] [Accepted: 12/05/2008] [Indexed: 01/28/2023] Open
Abstract
The HOX genes are a family of homeodomain-containing transcription factors that determine the identity of cells and tissues during embryonic development. They are also known to behave as oncogenes in some haematological malignancies. In this study, we show that the expression of many of the HOX genes is highly elevated in primary non-small-cell lung cancers (NSCLCs) and in the derived cell lines A549 and H23. Furthermore, blocking the activity of HOX proteins by interfering with their binding to the PBX co-factor causes these cells to undergo apoptosis in vitro and reduces the growth of A549 tumours in vivo. These findings suggest that the interaction between HOX and PBX proteins is a potential therapeutic target in NSCLC.
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Affiliation(s)
- L Plowright
- Postgraduate Medical School, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - K J Harrington
- Targeted Therapy Team, Chester Beatty Laboratories, The Institute of Cancer Research, London, UK
| | - H S Pandha
- Postgraduate Medical School, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
| | - R Morgan
- Postgraduate Medical School, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
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Ross PJ, Teoh EM, A'hern RP, Rhys-Evans PH, Harrington KJ, Nutting CM, Gore ME. Epirubicin, cisplatin and protracted venous infusion 5-Fluorouracil chemotherapy for advanced salivary adenoid cystic carcinoma. Clin Oncol (R Coll Radiol) 2009; 21:311-4. [PMID: 19201585 DOI: 10.1016/j.clon.2008.12.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 12/15/2008] [Accepted: 12/18/2008] [Indexed: 11/30/2022]
Abstract
AIMS Adenoid cystic carcinoma (ACC) is a rare tumour that usually arises in the salivary glands. Initial management is surgery often combined with adjuvant radiotherapy. Chemotherapy is reserved for treatment of symptomatic recurrence. We evaluated the combination of epirubicin, cisplatin and protracted venous infusion 5-fluorouracil (ECF) in the management of ACC. MATERIALS AND METHODS Patients referred for treatment of advanced, symptomatic ACC were considered. The drugs given were epirubicin 50 mg/m(2) 3-weekly, cisplatin 60 mg/m(2) 3-weekly and protracted venous infusion 5-fluorouracil 200 mg/m(2)/day. RESULTS Eight patients (median age 46 years) received a median of five cycles of chemotherapy. All patients had had previous surgery, seven had had previous radiotherapy and one had had previous chemotherapy. One patient showed a partial response (duration 34 months) and five showed stable disease (median duration 13.6 months [6.8-15.9+ months]). Median survival was 27 months (3.5-62.3 months). CONCLUSIONS The activity of ECF in ACC of the head and neck seems to be similar to the combination of cisplatin and 5-fluorouracil and single-agent epirubicin.
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Affiliation(s)
- P J Ross
- The Head and Neck Unit, Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ, UK
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Kazi R, Johnson C, Prasad V, De Cordova J, Venkitaraman R, Nutting CM, Clarke P, Evans PR, Harrington KJ. Quality of life outcome measures following partial glossectomy: assessment using the UW-QOL scale. J Cancer Res Ther 2008; 4:116-20. [PMID: 18923203 DOI: 10.4103/0973-1482.42641] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The consequences of a diagnosis of head and neck cancer and the impact of treatment have a clear and direct influence on well-being and associated quality of life (QOL) in these patients. AIMS To determine the QOL in head and neck cancer patients following a partial glossectomy operation. DESIGN AND SETTING Cross-sectional cohort study; Head and Neck Oncology Unit, tertiary referral center. MATERIALS AND METHODS 38 patients with partial glossectomy were assessed with the University of Washington head and neck quality of life (UW-QOL) scale, version 4. STATISTICAL ANALYSIS Statistical analysis was performed using the Statistical Package for Social Sciences 10.0 (SPSS Inc, Chicago version III). Information from the scale was correlated using the Mann Whitney test. A P value less than/equal to 0.05 was considered as significant. RESULTS The mean (sd) composite score of the QOL in our series was 73.6 (16.1). The majority (71.8%) quoted their QOL as good or very good. Swallowing (n = 16, 47.1%), speech (n = 15, 44.1%) and saliva (n = 15, 44.1%) were most commonly cited issues over the last 7 days. On the other hand, the groups with reconstruction, neck dissection, complications and radiotherapy demonstrated a significant reduction of quality of life scores (Mann Whitney test, P < 0.005). CONCLUSION The composite score and overall QOL as assessed using the UW-QOL scale (version 4) were modestly high in our series of partial glossectomy patients. Swallowing, speech, and saliva are regarded as the most important issues. Stage of the disease, neck dissection, reconstruction, complications, radiotherapy and time since operation were seen to significantly affect domain scores.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, 203 Fulham Road, London SW3 6JJ, United Kingdom.
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Bhide SA, Ahmed M, Barbachano Y, Newbold K, Harrington KJ, Nutting CM. Sequential induction chemotherapy followed by radical chemo-radiation in the treatment of locoregionally advanced head-and-neck cancer. Br J Cancer 2008; 99:57-62. [PMID: 18560402 PMCID: PMC2453042 DOI: 10.1038/sj.bjc.6604444] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [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] [Indexed: 12/21/2022] Open
Abstract
We describe a retrospective series of patients with advanced head-and-neck cancer who were treated with induction chemotherapy followed by radical chemo-radiation. Patients treated with two cycles of induction chemotherapy followed by definitive chemo-radiation for squamous cell carcinoma of the head-and-neck region, from 2001 – 2006 at the Royal Marsden Hospital, formed the basis of this study. Cisplatin (75 mg m−2) on day 1 and 5-FU (1000 mg m−2) day 1 – 4 was the standard regimen used for induction treatment. Cisplatin (100 mg m−2) on day 1 and day 29 was used for concomitant treatment. The radiation was delivered using conformal technique. Tissues containing macroscopic and microscopic disease were treated to doses of 65 Gray (Gy) in 30 fractions and 50 Gy in 25 fractions, respectively. Data on patterns of relapse and acute toxicity (NCICTCv.3.0) were collected. A total of 129 patients were included, median age was 58 (range: 27 – 78). The site of tumour was: oropharynx 70 (54%), larynx 30 (23%), hypopharynx 24 (19%) and other 5 (4%). The median follow-up was 19 months (range: 4 – 58). Local control, disease-specific survival and overall survival at 2 years were 71%, 68% and 63%, respectively. The distant recurrence rate at 2 years was 9%. Ten patients required dose reduction during induction chemotherapy due to toxicity. The dose of 5-FU was reduced in six patients and that of cisplatin in four patients. The incidence of grade 3/4 toxicity was: neutropenia 5%, thrombocytopenia 1%, nausea and vomiting 3%. One cycle of concurrent cisplatin was omitted in 23 patients due to toxicity. Full-dose radiotherapy was administered to 98% of patients. The incidence of grade 3/4 toxicity was: skin 20%, dysphagia 65%, mucositis 60%, neutropenia 3%, anaemia 1%, nausea and vomiting 4%, nephrotoxicity 1%. Induction chemotherapy followed by radical chemo-radiation is a safe and tolerable regimen in the treatment of advanced head-and-neck cancer. Distant recurrence rates are lower with equivalent local control and survival compared to chemo-radiation alone (historical controls).
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, Royal Marsden Hospital, London SW3 6JJ, UK
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White CL, Menghistu T, Twigger KR, Searle PF, Bhide SA, Vile RG, Melcher AA, Pandha HS, Harrington KJ. Escherichia coli nitroreductase plus CB1954 enhances the effect of radiotherapy in vitro and in vivo. Gene Ther 2007; 15:424-33. [PMID: 18079753 DOI: 10.1038/sj.gt.3303081] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Escherichia coli nitroreductase (NTR) converts the prodrug CB1954 (5-(aziridin-1-yl)-2,4-dinitrobenzamide) into a bifunctional alkylating agent that causes DNA crosslinks. In this study, the ability of NTR to enhance the combined effects of CB1954 and radiation has been tested in vitro and in vivo. Stably transduced ovarian cancer cells (SKOV3-NTR) that are sensitive to CB1954 (IC(50)=0.35 muM) demonstrated enhanced cytotoxicity when treated with CB1954 and single-fraction irradiation. The NTR-CB1954 system mediated a bystander effect in combination with radiation on transfer of conditioned medium from SKOV3-NTR, but not SKOV3, cells to SW480 target cells. The ability of CB1954 to enhance radiation-induced cytotoxicity in SKOV3-NTR (but not SKOV3) cells was also demonstrated by fluorescence-activated cell sorting (FACS) with dual staining for propidium iodide/fluorescein diacetate, 4',6-diamidino-2-phenylindole dichloride staining of apoptotic cells and measurement of double-stranded DNA breaks by FACS and confocal microscopy for gammaH2AX foci. Adenoviral delivery of NTR, under constitutive cytomegalovirus or tissue-specific CTP1 promoters, increased the in vitro cytotoxicity of CB1954 plus radiation in MTT and clonogenic assays. Finally, adenoviral delivery of NTR plus CB1954 enhanced the effect of fractionated radiotherapy (12 Gy in four fractions) in SW480 xenograft tumours in nude mice.
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Affiliation(s)
- C L White
- Targeted Therapy Laboratory, Cancer Research UK Centre for Cell and Molecular Biology, Chester Beatty Laboratories, The Institute of Cancer Research, London, UK
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Kazi R, De Cordova J, Singh A, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Voice-related Quality of Life in Laryngectomees: Assessment Using the VHI and V-RQOL Symptom Scales. J Voice 2007; 21:728-34. [PMID: 16815670 DOI: 10.1016/j.jvoice.2006.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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: 02/04/2006] [Accepted: 05/22/2006] [Indexed: 11/23/2022]
Abstract
The primary purpose of this study was to investigate the effect of the voice impairment across the physical, emotional, and functional domains in patients using valved speech following total laryngectomy with the help of two symptom specific scales. The study design used was a cross-sectional cohort. The setting was the Head and Neck Oncology Unit of a tertiary referral centre. Subjects were 54 patients who had undergone total laryngectomy. Two voice-specific questionnaires, the Voice-Related Quality of Life (V-RQOL-short form) Measure, and the Voice Handicap Index (VHI-long form) were used. The main outcome measure was patient perception of the voice following total laryngectomy in response to specific questions correlated with sociodemographic/treatment factors. Responses were received from 40 males and 14 females (response rate of 85.7%) with a median age of 63.4 years (range: 37-84). The V-RQOL overall analysis showed that 3 patients (5.6%) scored "excellent," 29 patients (53.7%) "fair to good," 14 patients (25.9%) "poor to fair," and 8 patients (14.8%) "poor." Analysis of the VHI revealed that 20 patients (37.0%) had a minimal handicap, 20 patients (37.0%) a moderate handicap, and 14 patients (25.9%) had a serious voice handicap. The individual domain or subscale scores for the VHI revealed a mean (SD) functional score of 15.8 (7.7), a physical score of 13.6 (7.2), and finally an emotional score of 11.6 (8.9). Functional aspects of the voice were significantly affected by age, radiotherapy, and chemotherapy (Spearman rho, P=0.01; Mann-Whitney, P=0.04 and P=0.01). The physical aspects of the voice were significantly affected by age and chemotherapy (Spearman rho, P=0.004; Mann-Whitney, P=0.04). Only age significantly affected the emotional aspects of the voice (Spearman rho, P=0.002). We found a strong correlation (Spearman rho, P<0.001) between the V-RQOL and VHI questionnaires. Our study revealed that the V-RQOL and VHI scores in our series of patients following voice restoration in laryngectomees were consistent with that reported in the literature. Only age, radiation, and chemotherapy were seen to influence the voice handicap scores. In addition, both symptom scales had good correlation between them and either one could be used with reliability in laryngectomees with a few modifications.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, London, UK.
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Guerrero Urbano MT, Clark CH, Kong C, Miles E, Dearnaley DP, Harrington KJ, Nutting CM. Target volume definition for head and neck intensity modulated radiotherapy: pre-clinical evaluation of PARSPORT trial guidelines. Clin Oncol (R Coll Radiol) 2007; 19:604-13. [PMID: 17706404 DOI: 10.1016/j.clon.2007.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [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: 11/09/2006] [Revised: 06/09/2007] [Accepted: 07/05/2007] [Indexed: 10/23/2022]
Abstract
AIMS There is considerable controversy surrounding target volume definition for parotid-sparing intensity modulated radiotherapy (IMRT) for head and neck cancer. The aim of this study was to evaluate the dosimetric and radiobiological predictors of outcome anticipated by application of the detailed target volume definition guidelines agreed for the UK multicentre randomised controlled trial of parotid-sparing IMRT (PARSPORT). MATERIALS AND METHODS Five patients eligible for the study were delineated using the trial guidelines. Following the protocol, plans were produced to treat these volumes with three-dimensional radiotherapy (control arm) and IMRT aimed to spare dose to the contralateral parotid gland (experimental arm). Dosimetric comparisons were made between plans, and normal tissue complication probability (NTCP) modelling for salivary glands was carried out. RESULTS Doses delivered to the planning target volumes (PTV) were similar with each technique, although IMRT produced more homogeneous irradiation of the PTV. Mean doses to the contralateral parotid gland were 22.4+/-1.7 Gy with the IMRT plans vs 60.0+/-7.2 Gy with three-dimensional radiotherapy, P=0.0003. Calculated contralateral parotid gland NTCP values for grade 2 xerostomia were 20-22% for IMRT and 98-100% for three-dimensional radiotherapy (P<0.0001). CONCLUSION Pre-clinical evaluation of the PARSPORT trial target volume definition guidelines provides theoretical support for a significant reduction in xerostomia rates. These data await confirmation from the clinical trial results.
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Pitkin L, Luangdilok S, Corbishley C, Wilson POG, Dalton P, Bray D, Mady S, Williamson P, Odutoye T, Rhys Evans P, Syrigos KN, Nutting CM, Barbachano Y, Eccles S, Harrington KJ. Expression of CC chemokine receptor 7 in tonsillar cancer predicts cervical nodal metastasis, systemic relapse and survival. Br J Cancer 2007; 97:670-7. [PMID: 17687340 PMCID: PMC2360373 DOI: 10.1038/sj.bjc.6603907] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [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] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the expression of CC chemokine receptor 7 (CCR7) in squamous cell cancer of the tonsil with respect to patterns of spread, relapse-free, overall and disease-specific survival. Eighty-four patients with squamous cell cancer of the tonsil were identified. There was a male predominance of 3 : 1 and the median age at diagnosis was 53 (range 35–86) years. The median duration of follow-up was 33 (range 2–124) months. There was a significant association between CCR7 immunopositivity and synchronous cervical nodal metastasis in patients with tonsillar cancer (Spearman's correlation coefficient 0.564; P<0.001). Relapse-free (P=0.0175), overall (P=0.0136) and disease-specific (P=0.0062) survival rates were significantly lower in patients whose tumours expressed high levels of CCR7. On multivariate analysis, high-level CCR7 staining predicted relapse-free (hazard ratio 3.0, 95% confidence intervals 1.1–8.0, P=0.026) and disease-specific (hazard ratio 10.2, 95% confidence intervals 2.1–48.6, P=0.004) survival. Fifteen percent of patients with the highest level of tumour CCR7 immunopositivity relapsed with systemic metastases. These data demonstrated that CCR7 expression was associated with cervical nodal and systemic metastases from tonsillar cancers. High levels of CCR7 expression predicted a poor prognosis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Blotting, Western
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Cell Line, Tumor
- Female
- Gene Expression Regulation, Neoplastic
- Humans
- Immunohistochemistry
- Kaplan-Meier Estimate
- Lymphatic Metastasis
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Recurrence, Local
- Predictive Value of Tests
- Prognosis
- Receptors, CCR7
- Receptors, Chemokine/genetics
- Receptors, Chemokine/metabolism
- Reverse Transcriptase Polymerase Chain Reaction
- Tonsillar Neoplasms/genetics
- Tonsillar Neoplasms/metabolism
- Tonsillar Neoplasms/pathology
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Affiliation(s)
- L Pitkin
- Thomas Tatum Head and Neck Unit, St George's Hospital, London, UK
| | - S Luangdilok
- The Institute of Cancer Research, McElwain Laboratories, Sutton, UK
| | - C Corbishley
- Department of Cellular Pathology, St George's Hospital, London, UK
| | - P O G Wilson
- Department of Cellular Pathology, St George's Hospital, London, UK
| | - P Dalton
- Department of Cellular Pathology, St George's Hospital, London, UK
| | - D Bray
- Thomas Tatum Head and Neck Unit, St George's Hospital, London, UK
| | - S Mady
- Thomas Tatum Head and Neck Unit, St George's Hospital, London, UK
| | - P Williamson
- Thomas Tatum Head and Neck Unit, St George's Hospital, London, UK
| | - T Odutoye
- Thomas Tatum Head and Neck Unit, St George's Hospital, London, UK
| | - P Rhys Evans
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - K N Syrigos
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - C M Nutting
- Thomas Tatum Head and Neck Unit, St George's Hospital, London, UK
- Head and Neck Unit, Royal Marsden Hospital, London, UK
| | - Y Barbachano
- Statistics Unit, Royal Marsden Hospital, London, UK
| | - S Eccles
- The Institute of Cancer Research, McElwain Laboratories, Sutton, UK
| | - K J Harrington
- Thomas Tatum Head and Neck Unit, St George's Hospital, London, UK
- Head and Neck Unit, Royal Marsden Hospital, London, UK
- The Institute of Cancer Research, Chester Beatty Laboratories, London, UK
- Targeted Therapy Laboratory, The Institute of Cancer Research, Cancer Research UK Centre for Cell and Molecular Biology, Chester Beatty Laboratories, 237 Fulham Road, London SW3 6JB, UK. E-mail:
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Kazi R, Singh A, De Cordova J, Al-Mutairy A, O'Leary L, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Postlaryngectomy vocal rehabilitation: assessment using a validated questionnaire in 51 patients. ORL J Otorhinolaryngol Relat Spec 2007; 69:289-94. [PMID: 17565232 DOI: 10.1159/000103873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [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: 07/06/2006] [Accepted: 11/20/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to assess valved speech and related issues in total laryngectomy patients with the help of the validated Voice Prosthesis Questionnaire (VPQ). PATIENTS AND METHODS We identified 61 patients who had undergone a surgical voice restoration with a valve following total laryngectomy and who were sent the VPQ by mail. RESULTS Fifty-one patients (37 males) completed the questionnaire giving a response rate of 83.6%. Fifty-three percent of the patients (n = 27) were fully aware of the dimensions of their valve including the length and diameter, whilst 25% (n = 13) were aware of only one of the two. There was a strong correlation between the patient's perception of tone and their gender with the tone scores significantly lower in women as compared to men (Mann-Whitney test, p = 0.04). Ten patients (19.6%) had had leakage-related issues during the previous 7 days. CONCLUSIONS This questionnaire provided a significant amount of valuable data. Based on our experience, we recommend the VPQ for prospective use in the serial monitoring and audit of total laryngectomy patients.
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Affiliation(s)
- R Kazi
- Royal Marsden Hospital and Institute of Cancer Research, London, UK.
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Abstract
Radiotherapy is commonly used in the management of malignant parotid gland tumours that have adverse pathological risk factors after surgery. Radiation to the parotid bed is associated with predictable complications. In particular, the close proximity of the auditory apparatus, which receives a significant radiation dose, results in significant toxicity in a proportion of patients. Here we review auditory toxicity after radiation to the parotid bed.
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, Institute of Cancer Research and Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK.
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49
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Kazi R, Singh A, Mullan GPJ, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Can objective parameters derived from videofluoroscopic assessment of post-laryngectomy valved speech replace current subjective measures? An e-tool-based analysis. Clin Otolaryngol 2006; 31:518-24. [PMID: 17184458 DOI: 10.1111/j.1365-2273.2006.01320.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The primary purpose of this study was to assess the pharyngoesophageal segment in total laryngectomy patients using a videofluoroscopy e-tool. STUDY DESIGN Cross-sectional study. SETTING Head and Neck Oncology Unit, Tertiary Referral Centre. PATIENTS Forty-two patients following total laryngectomy. INTERVENTION Videofluoroscopy using an e-tool (JRuler). MAIN OUTCOME MEASURES Subjective and objective videofluoroscopy parameters correlated with the GRBAS scale and treatment variables. RESULTS Of 32 men and 10 women, mean age 63.5 years (10.8) the majority (64.3%) had a reasonable voice (good = 11 and poor = 4 patients). Comparing subjective and objective parameters, significant correlations were only seen with a smaller minimal neoglottic distance at phonation with no regurgitation of barium at phonation (P = 0.05) and a type 1 shape of neoglottis at phonation (P = 0.02). There were also significant correlations between smaller maximum sub-neoglottic distance at phonation and type 1 shape of neoglottis (P = 0.02), smaller maximum sub-neoglottic distance at rest and absence of stasis of barium at phonation (P = 0.05) and the length of neoglottis at phonation and type 1 shape of neoglottis (P = 0.01). For perceptual evaluation, significant correlation was seen only between G1 voice and a smaller minimal neoglottic distance at phonation (P = 0.03) amongst the subjective and objective parameters. There were no correlations between visual parameters and the clinical parameters. CONCLUSIONS Our observations suggest that this interesting concept has limitations. While objective and quantifiable data can be obtained using videofluoroscopy in laryngectomees, only a few correlate with each other and with voice quality.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, The Institute of Cancer Research, London, UK.
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50
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Kazi R, De Cordova J, Kanagalingam J, Venkitaraman R, Nutting CM, Clarke P, Rhys-Evans P, Harrington KJ. Quality of Life following Total Laryngectomy: Assessment Using the UW-QOL Scale. ORL J Otorhinolaryngol Relat Spec 2006; 69:100-6. [PMID: 17148941 DOI: 10.1159/000097792] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [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: 05/05/2006] [Accepted: 06/30/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the quality of life (QOL) in patients using valved speech following total laryngectomy with a validated patient self-report scale. STUDY DESIGN Cross-sectional cohort study. PATIENTS 63 patients following total laryngectomy using valved speech. INTERVENTION University of Washington Quality of Life (UW-QOL) questionnaire. MAIN OUTCOME MEASURES Patient perception of the QOL over the last 7 days following total laryngectomy in response to specific questions and correlated with sociodemographic and treatment factors. RESULTS Responses were received from 44 males and 11 females (response rate: 87.3%) with a median age of 66 years (range: 40-84). The mean (SD) composite score of the QOL in our series of patients with total laryngectomy was 81.3 (10.9). As regards the overall QOL, 80% of our patients cited it as very good (45.5%) to good (34.5%). Patients identified speech, appearance, and activity as the most important issues following total laryngectomy. Only age and pharyngo-oesophageal segment closure were significant predictors of QOL scores (Student t test, p < 0.05) and not other demographic and treatment variables. CONCLUSIONS The composite score and overall QOL were high in our series of total laryngectomy patients and this possibly reflects adequate multidisciplinary management. We strongly urge the use of prospective longitudinal studies that will adequately identify any QOL changes over time. Although the UW-QOL questionnaire is a simple and brief scale, it has limitations that can curtail its effective use in laryngectomy patients and we advise supplementing it with the use of domain-specific questionnaires.
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Affiliation(s)
- R Kazi
- Head and Neck Unit, Royal Marsden Hospital, London, UK.
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