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Saunders D, Koyfman SA, Ismaila N, Futran ND, Mowery YM, Watson E, Yang DH, Peterson DE. Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline Clinical Insights. JCO Oncol Pract 2024:OP2400182. [PMID: 38691818 DOI: 10.1200/op.24.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 05/03/2024] Open
Affiliation(s)
- Deborah Saunders
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Health Sciences North, Sudbury, Ontario, Canada
| | | | | | - Neal D Futran
- University of Washington School of Medicine, Seattle, WA
| | - Yvonne M Mowery
- UPMC Hillman Cancer Center, Pittsburgh, PA
- University of Pittsburgh, Pittsburgh, PA
| | - Erin Watson
- Department of Dental Oncology, Princess Margaret Cancer Center/Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - David H Yang
- BC Cancer/University of British Columbia, Vancouver, Canada
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Peterson DE, Koyfman SA, Yarom N, Lynggaard CD, Ismaila N, Forner LE, Fuller CD, Mowery YM, Murphy BA, Watson E, Yang DH, Alajbeg I, Bossi P, Fritz M, Futran ND, Gelblum DY, King E, Ruggiero S, Smith DK, Villa A, Wu JS, Saunders D. Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline. J Clin Oncol 2024:JCO2302750. [PMID: 38691821 DOI: 10.1200/jco.23.02750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer. METHODS The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008. RESULTS A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation. RECOMMENDATIONS Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | - Noam Yarom
- Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Charlotte Duch Lynggaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lone E Forner
- Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Yvonne M Mowery
- UPMC Hillman Cancer Center, Pittsburgh, PA
- University of Pittsburgh, Pittsburgh, PA
| | | | - Erin Watson
- Department of Dental Oncology, Princess Margaret Cancer Center/Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - David H Yang
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Ivan Alajbeg
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Neal D Futran
- University of Washington School of Medicine, Seattle, WA
| | | | - Edward King
- Northern Colorado Head and Neck Cancer Support Group, Windsor, CO
| | - Salvatore Ruggiero
- New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | | | - Jonn S Wu
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Deborah Saunders
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Health Sciences North, Sudbury, Ontario, Canada
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Yalamanchali A, Griffith C, Reddy CA, Koyfman SA, Woody NM, Campbell SR, Silver N, Scharpf J, Lorenz RR, Prendes B, Ku JA, Lamarre E, Geiger JL. Evaluating the impact of the degree of extranodal extension on outcomes in locally advanced oral cavity cancer. Head Neck 2024. [PMID: 38660928 DOI: 10.1002/hed.27782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Evaluate whether extranodal extension (ENE) extent impacts outcomes in patients with oral cavity squamous cell carcinoma (OCSCC). METHODS From an institutional database, patients with OCSCC and pathologic ENE who received adjuvant treatment were included. Surgical slides were reviewed to confirm ENE extent. Multivariable Cox regression was used to relate patient/treatment characteristics with disease-free survival (DFS) and overall survival (OS). ENE was analyzed as both a dichotomous and continuous variable. RESULTS A total of 113 patients were identified. Between major (>2 mm) versus minor ENE (≤2 mm), there was no significant difference in DFS (HR 1.18, 95%CI 0.72-1.92, p = 0.51) or OS (HR 1.17, 95%CI 0.70-1.96, p = 0.55). There was no significant association between ENE as a continuous variable and DFS (HR 0.97 per mm, 95%CI 0.87-1.4, p = 0.96) or OS (HR 0.96 per mm, 95%CI 0.83-1.11, p = 0.58). CONCLUSION No significant relationship was seen between ENE extent and DFS or OS in individuals with OCSCC.
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Affiliation(s)
- Anirudh Yalamanchali
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher Griffith
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Natalie Silver
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brandon Prendes
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie A Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Zhang ES, Hair BB, Lamarre ED, Koyfman SA, Burkey BB. Occult Nodal Metastases in Individuals with Clinically Node-Negative Salivary Gland Malignancies. Laryngoscope 2024; 134:1705-1715. [PMID: 37847121 DOI: 10.1002/lary.31119] [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: 03/06/2023] [Revised: 09/03/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES Salivary gland malignancies comprise a heterogeneous group of pathologies, for which treatment of the clinically negative neck may vary depending on numerous factors. Herein we present data on occult nodal metastases (ONM) as well as survival and recurrence from a large series of cN0 salivary gland malignancies. METHODS Retrospective chart review was conducted on 532 patients, with 389 patients with major salivary gland cancers and 143 patients with minor salivary gland cancers. Demographic and treatment data were included and rates of ONM, overall survival, local recurrence, regional recurrence, and distant recurrence were analyzed. RESULTS We found that the overall rate of ONM for parotid was 27% (63/235), for submandibular/sublingual was 35% (18/52), and for minor was 15% (4/26). Analysis of ONM rate at each nodal level was also performed, finding higher rates of level IV and V ONM than prior studies. Submandibular/sublingual and minor salivary gland malignancies showed a predominance of ONMs at levels I-III. Our survival and recurrence rates were similar to those found in previous studies. CONCLUSION Our data also demonstrate a predominance of ONM in levels I-III for submandibular/sublingual and minor salivary gland cancers, suggesting elective dissection in these levels. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1705-1715, 2024.
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Affiliation(s)
- Emily S Zhang
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Bryan B Hair
- Department of Otolaryngology - Head and Neck Surgery, University Hospitals, Cleveland, Ohio, U.S.A
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Brian B Burkey
- Department of Otolaryngology, Cleveland Clinic Florida, Vero Beach, Florida, U.S.A
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Koyfman SA, Geiger JL. Checkpoint Inhibition for Kidney Transplant Recipients With Advanced Cutaneous Carcinomas: An Emerging Standard for Select Patients. J Clin Oncol 2024; 42:981-983. [PMID: 38330257 DOI: 10.1200/jco.23.02570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/07/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024] Open
Affiliation(s)
- Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH
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Wysong A, Somani AK, Ibrahim SF, Cañueto J, Fitzgerald AL, Siegel JJ, Prasai A, Goldberg MS, Farberg AS, Regula C, Bar A, Kasprzak J, Brodland DG, Koyfman SA, Arron ST. Integrating the 40-Gene Expression Profile (40-GEP) Test Improves Metastatic Risk-Stratification Within Clinically Relevant Subgroups of High-Risk Cutaneous Squamous Cell Carcinoma (cSCC) Patients. Dermatol Ther (Heidelb) 2024; 14:593-612. [PMID: 38424384 DOI: 10.1007/s13555-024-01111-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The validated 40-gene expression profile (40-GEP) test independently stratifies risk of regional or distant metastasis for cutaneous squamous cell carcinoma (cSCC) tumors with high-risk clinicopathologic features. This study evaluated the stratification of risk by the 40-GEP test in a large cohort of tumors with one or more high-risk factors and in clinically relevant subgroups, including tumors within National Comprehensive Cancer Network (NCCN) high- and very-high-risk groups, lower-stage BWH T1 and T2a tumors, and patients > 65 years old. METHODS This multicenter (n = 58) performance study of the 40-GEP included 897 patients. Kaplan-Meier analyses were performed to assess risk stratification profiles for 40-GEP Class 1 (low), Class 2A (higher) and Class 2B (highest) risk groups, while nested Cox regression models were used to compare risk prediction of clinicopathologic risk classification systems versus risk classification systems in combination with 40-GEP. RESULTS Patients classified as 40-GEP Class 1, Class 2A, or Class 2B had significantly different metastatic risk profiles (p < 0.0001). Integrating 40-GEP results into models with individual clinicopathologic risk factors or risk classification systems (Brigham and Women's Hospital, American Joint Committee on Cancer Staging Manual, 8th Edition) and NCCN demonstrated significant improvement in accuracy for prediction of metastatic events (ANOVA for model deviance, p < 0.0001 for all models). CONCLUSION The 40-GEP test demonstrates accurate, independent, clinically actionable stratification of metastatic risk and improves predictive accuracy when integrated into risk classification systems. The improved accuracy of risk assessment when including tumor biology via the 40-GEP test ensures more risk-aligned, personalized patient management decisions.
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Affiliation(s)
- Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ally-Khan Somani
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
- SkinMD, L.L.C., Orland Park, IL, USA
| | | | - Javier Cañueto
- Department of Dermatology Complejo, Asistencial Universitario de Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
- Instituto de Biología Celular y Molecular de Cáncer (CIC-IBMCC)-CSIC/USAL, Salamanca, Spain
| | | | - Jennifer J Siegel
- Research and Development, Castle Biosciences, Inc., Friendswood, TX, USA
| | - Anesh Prasai
- Research and Development, Castle Biosciences, Inc., Friendswood, TX, USA
| | - Matthew S Goldberg
- Research and Development, Castle Biosciences, Inc., Friendswood, TX, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Anna Bar
- Department of Dermatology, Oregon Health & Science University, Portland, OR, USA
| | - Julia Kasprzak
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
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Groover M, Gupta N, Granger E, Forrester VJ, Anstadt EJ, Su W, Heusinkveld L, Chen A, Lukens JN, Silk AW, Vidimos AT, Schoenfeld JD, Koyfman SA, Ruiz ES. A multicenter real-world analysis of risk factors, therapeutics, and outcomes of patients with metastatic basal cell carcinoma. J Am Acad Dermatol 2024; 90:545-551. [PMID: 37949119 DOI: 10.1016/j.jaad.2023.10.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Metastatic basal cell carcinoma (mBCC) is rare and there are limited data regarding patient and tumor risk factors, optimal treatments, and disease prognosis. OBJECTIVE To assess patient and tumor characteristics, therapeutics, and outcomes of mBCC stratified by location of metastasis. METHODS Retrospective cohort study of 53 patients with mBCC treated at 4 large academic centers in Boston, Massachusetts; Philadelphia, Pennsylvania; and Cleveland, Ohio between January 1, 2005 and December 31, 2021. RESULTS A total of 53 patients with mBCC were identified across 4 centers, 22 (42%) of whom had mBCC with spread limited to lymph nodes and 31 (58%) patients with distant organ spread (with or without lymph node involvement). Overall, half (n = 11) of patients with nodal metastasis achieved complete remission of disease, compared with just 1 (3%) patient with distant metastasis. The 5-year survival for nodal and distant metastatic patients was 89.3% and 61.0%, respectively. LIMITATIONS Small sample size due to disease rarity. CONCLUSIONS AND RELEVANCE Patients with nodal disease are more likely to have disease remission whereas patients with distant metastasis are more likely to have persistent disease and die from their disease. However, 5-year survival rates exceed 50%, even for stage IV disease.
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Affiliation(s)
- Morgan Groover
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neha Gupta
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Granger
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vernon J Forrester
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily J Anstadt
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Su
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren Heusinkveld
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Anna Chen
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann W Silk
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Allison T Vidimos
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Groover M, Gupta N, Granger E, Forrester VJ, Anstadt EJ, Su W, Heusinkveld L, Lukens JN, Silk AW, Schoenfeld JD, Koyfman SA, Vidimos AT, Ruiz ES. Patterns of metastasis from a multicenter cohort of metastatic basal cell carcinoma. J Am Acad Dermatol 2024:S0190-9622(24)00244-5. [PMID: 38331097 DOI: 10.1016/j.jaad.2024.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/29/2023] [Accepted: 01/05/2024] [Indexed: 02/10/2024]
Affiliation(s)
- Morgan Groover
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neha Gupta
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Granger
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vernon J Forrester
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily J Anstadt
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Su
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren Heusinkveld
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann W Silk
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Allison T Vidimos
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Groover M, Gupta N, Granger E, Murad F, Forrester VJ, Anstadt EJ, Su W, Heusinkveld L, Lukens JN, Silk AW, Schoenfeld JD, Koyfman SA, Ruiz ES, Vidimos AT. A multicenter retrospective cohort analysis of advanced basal cell carcinoma outcomes by sex. J Am Acad Dermatol 2024; 90:137-139. [PMID: 37604231 DOI: 10.1016/j.jaad.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/06/2023] [Accepted: 08/10/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Morgan Groover
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neha Gupta
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Granger
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vernon J Forrester
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily J Anstadt
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Su
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren Heusinkveld
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - John N Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann W Silk
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Allison T Vidimos
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
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Buchberger DS, Cook SK, Koyfman SA. Progressive Cranial Neuropathy. JAMA Neurol 2023; 80:1375-1376. [PMID: 37870852 DOI: 10.1001/jamaneurol.2023.3706] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
A 68-year-old man had right facial weakness with a droop, slurred speech, and eyelid ptosis that progressed over 5 years from right temple numbness and did not respond to gabapentin or steroids. What is your diagnosis?
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Affiliation(s)
- David S Buchberger
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samantha K Cook
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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Groover MK, Gupta N, Granger E, Murad F, Forrester VJ, Anstadt EJ, Su W, Heusinkveld L, Lukens JN, Silk AW, Vidimos AT, Schoenfeld JD, Koyfman SA, Ruiz ES. A multicenter real-world analysis of first-line systemic monotherapy for locally advanced basal cell carcinoma. JAAD Case Rep 2023; 42:69-71. [PMID: 38156099 PMCID: PMC10753044 DOI: 10.1016/j.jdcr.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
- Morgan K. Groover
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neha Gupta
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily Granger
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vernon J. Forrester
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily J. Anstadt
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Su
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren Heusinkveld
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - John N. Lukens
- Department of Radiation Oncology, Perelman Center for Advanced Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann W. Silk
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Allison T. Vidimos
- Department of Dermatology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Emily S. Ruiz
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Wu SS, Lamarre ED, Scharpf J, Prendes B, Ku JA, Silver N, Burkey B, Woody N, Campbell SR, Yilmaz E, Koyfman SA, Geiger J. Survival Outcomes of Advanced Thyroid Cancer Enriched in Brain Metastases Following Treatment With Small Molecule Inhibitors. Endocr Pract 2023; 29:881-889. [PMID: 37597577 DOI: 10.1016/j.eprac.2023.08.003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/19/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Small molecule inhibitors (SMIs) are targeted therapies increasingly used in advanced thyroid carcinomas. This study aimed to evaluate the survival outcomes of thyroid cancer on SMI treatment, including in patients with brain metastases. METHODS This retrospective study included patients with thyroid carcinomas who received at least one SMI between 2008 and 2022 at a tertiary level, academic institution. SMI included lenvatinib, sorafenib, dabrafenib-trametinib, selpercatinib, and cabozantinib. Patients were grouped by the presence of brain metastasis. Kaplan-Meier and log-rank tests modeled the overall survival (OS), defined from detection of first metastasis. RESULTS In total, 116 patients (49.1% female, median age 61.1 years [IQR, 51.1-71.0]) were included. Thyroid cancer subtypes were: 57 (49.6%) papillary, 23 (19.8%) anaplastic, 23 (19.8%) medullary, and 13 (11.2%) follicular. There were 18 (15.5%) patients with brain metastases, and 98 (84.5%) with visceral metastases. Age, sex, thyroid subtype, SMI, and time to recurrence were not different between cohorts. OS was shorter in the brain metastasis cohort (31.7 vs 42.2 months, P =.44) and was not different after excluding anaplastic thyroid cancer (29.1 vs 62.3 months, P =.21). In the case of papillary thyroid cancer, patients with brain metastases trended toward worse OS (22.0 vs 59.9 months, P =.13). Nonanaplastic histology, total thyroidectomy (OR, 40.0; P <.001), number of unique therapies (OR, 10.9; P =.047), and mutation-directed therapy (OR, 24.7; P =.003) were associated with improved OS. CONCLUSION This single-institutional analysis reports survival outcomes of 116 patients with advanced thyroid cancer on targeted therapies, including 18 patients with brain metastases. Mutation-directed therapy for BRAFV600E mutations, RET mutations, RET fusions, and NTRK fusions had superior survival.
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Affiliation(s)
- Shannon S Wu
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Eric D Lamarre
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Scharpf
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brandon Prendes
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamie A Ku
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Natalie Silver
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Burkey
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Vero Beach, Florida
| | - Neil Woody
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Emrullah Yilmaz
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Jessica Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio.
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Wu SS, Woody N, Hesse J, Cook S, Cracolici V, Ku JA, Prendes B, Silver N, Scharpf J, Brauer PR, Reddy CA, Campbell SR, Koyfman SA, Burkey B, Lamarre ED. Margin Assessment Methods in Oral Cavity Squamous Cell Carcinoma and Recurrence: Tumor Bed vs Resection Specimen Sampling. JAMA Otolaryngol Head Neck Surg 2023; 149:1011-1020. [PMID: 37768650 PMCID: PMC10540056 DOI: 10.1001/jamaoto.2023.2982] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/05/2023] [Indexed: 09/29/2023]
Abstract
Importance Positive margins and margin clearance are risk factors for recurrence in oral cavity squamous cell carcinoma (OCSCC), and these features are used to guide decisions regarding adjuvant radiation treatment. However, the prognostic value of intraoperative tumor bed vs resection specimen sampling is not well defined. Objective To determine the prognostic implications of intraoperative margin assessment methods (tumor bed vs resection specimen sampling) with recurrence among patients who undergo surgical resection for OCSCC. Design, Setting, and Participants This was a retrospective study of patients who had undergone surgical resection of OCSCC between January 1, 2000, and December 31, 2021, at a tertiary-level academic institution. Patients were grouped by margin assessment method (tumor bed [defect] or resection specimen sampling). Of 223 patients with OCSCC, 109 patients had localized tumors (pT1-T2, cN0), 154 had advanced tumors, and 40 were included in both cohorts. Disease recurrence after surgery was estimated by the cumulative incidence method and compared between cohorts using hazard ratios (HRs). Data analyses were performed from January 5, 2023, to April 30, 2023. Main Outcome and Measures Recurrence-free survival (RFS). Results The study population comprised 223 patients (mean [SD] age, 62.7 [12.0] years; 88 (39.5%) female and 200 [90.0%] White individuals) of whom 158 (70.9%) had defect-driven and 65 (29.1%) had specimen-driven margin sampling. Among the 109 patients with localized cancer, intraoperative positive margins were found in 5 of 67 (7.5%) vs 8 of 42 (19.0%) for defect- vs specimen-driven sampling, respectively. Final positive margins were 3.0% for defect- (2 of 67) and 2.4% for specimen-driven (1 of 42) margin assessment. Among the 154 patients with advanced cancer, intraoperative positive margins were found in 29 of 114 (25.4%) vs 13 of 40 (32.5%) for defect- and specimen-driven margins, respectively. Final positive margins were higher in the defect-driven group (9 of 114 [7.9%] vs 1 of 40 [2.5%]). When stratified by margin assessment method, the 3-year rates of local recurrence (9.7% vs 5.1%; HR, 1.37; 95% CI, 0.51-3.66), regional recurrence (11.0% vs 10.4%; HR, 0.85; 95% CI, 0.37-1.94), and distant recurrence (6.4% vs 5.0%; HR, 1.10; 95% CI, 0.36-3.35) were not different for defect- vs specimen-driven sampling cohorts, respectively. The 3-year rate of any recurrence was 18.9% in the defect- and 15.2% in the specimen-driven cohort (HR, 0.93; 95% CI, 0.48-1.81). There were no differences in cumulative incidence of disease recurrence when comparing defect- vs specimen-driven cases. Conclusions and Relevance The findings of this retrospective cohort study indicate that margin assessment methods using either defect- or specimen-driven sampling did not demonstrate a clear association with the risk of recurrence after OCSCC resection. Specimen-driven sampling may be associated with reduced surgical margin positivity rates, which often necessitate concurrent chemotherapy with adjuvant radiation therapy.
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Affiliation(s)
- Shannon S. Wu
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Neil Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Hesse
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Samantha Cook
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Jamie A. Ku
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brandon Prendes
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Natalie Silver
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Scharpf
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Philip R. Brauer
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Chandana A. Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shauna R. Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Burkey
- Department of Otolaryngology, Head and Neck Institute, Head and Neck Institute, Cleveland Clinic, Vero Beach, Florida
| | - Eric D. Lamarre
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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14
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Cook SK, Parker SM, Woody NM, Vos DJ, Campbell SR, Lamarre E, Scharpf J, Geiger JL, Yilmaz E, Miller JA, Silver N, Ku J, Koyfman SA, Prendes B. Oral Cavity Squamous Cell Carcinomas in Patients with a History of Oral Lichen Planus: Frequency and Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:e573. [PMID: 37785747 DOI: 10.1016/j.ijrobp.2023.06.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Oral lichen planus (OLP) is an inflammatory condition which affects the mucous membranes of the oral cavity. While previous studies have described the association between OLP and development of oral cavity cancer, there is currently a paucity of literature examining the impact of this disease on treatment response and prognosis. As such, we present a retrospective cohort study of Oral cavity squamous cell carcinoma (OCSCC) patients with a history of OLP to explore the course of their disease. MATERIALS/METHODS Using an IRB approved tertiary care registry of head and neck cancer patients, we identified patients with OCSCC who had a prior diagnosis of OLP. The number of new primary tumors, rates of local (LF), regional (RF) and distant failure (DF), as well as overall survival (OS) were assessed using Cox proportional hazards and Kaplan Meier analysis for actuarial survival estimates. RESULTS Fifty-four patients with OCSCC and OLP were identified with 109 individual OCSCC diagnoses. Patients had a median age of 67 years, were predominantly female (n = 42, 77.8%) and never smokers (n = 29, 53.7%) with a median follow up after diagnosis of OCSCC of 46.5 months. Nine patients (16.7%) had a history of immunosuppression of whom 6 (11.1%) had chronic steroid use for treatment of OLP. Within the cohort, 33 (61.1%) of OLP patients had a single OCSCC, 11 (20.4%) had 2, and 10 (18.5%) had >3 separate tumors develop. The most common oral cavity subsites were oral tongue (n = 42, 38.5%), followed by alveolar ridge (n = 14, 12.8%) and gingiva (n = 13, 11.9%). Papillary SCC subtype was identified in 10.1%. 92.7% of tumors (n = 101) were treated with primary surgery, with 23 (21.1%) receiving adjuvant RT and 10 of those patients receiving concurrent chemotherapy. Among resected patients, pathologic stages were predominantly T1-2 (84.1%) and N0 (50% vs N1 15.6% and N2a-3 34.4%). The mean RT dose was 62 Gy in 32 fractions. Locoregional failure occurred in 24.8% of cancers (n = 27), with local and regional failure occurring in 13.8% (n = 15) and 11% (n = 12) of lesions, respectively. Recurrence free survival at 3 and 5 years was 75% and 70.3%, respectively, with overall survival at 3 and 5 years of 71.1% and 67%, respectively. CONCLUSION Patients with OCSCC and a history of OLP are predominantly female and never smokers. The tumors that develop in such patients are often early stage but a proportion of patients appear to be at higher risk of developing multiple malignancies and surveillance of this patient population to identify new tumors is crucial.
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Affiliation(s)
- S K Cook
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - S M Parker
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH
| | - N M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - D J Vos
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - S R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - E Lamarre
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J Scharpf
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J L Geiger
- Cleveland Clinic Foundation, Cleveland, OH
| | - E Yilmaz
- University of New Mexico Comprehensive Cancer Center, Albuquerque, NM
| | - J A Miller
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - N Silver
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J Ku
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - S A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - B Prendes
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
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15
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Kocsis J, Billena C, Woody NM, Miller JA, Joshi NP, Koyfman SA, Campbell SR. Stereotactic Body Radiation Therapy (SBRT) for Head and Neck Cancer Re-Irradiation: Should >180˚ Carotid Encasement or Dermal Involvement Remain an Exclusion Criteria? Int J Radiat Oncol Biol Phys 2023; 117:e593-e594. [PMID: 37785793 DOI: 10.1016/j.ijrobp.2023.06.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Patients with recurrent head and neck cancer (HNC) who present with carotid encasement (CE) >180˚ and skin involvement/abutment (SI/A) are often not considered for SBRT re-irradiation and are excluded from RTOG 3507. We reviewed our institutional experience of SBRT re-irradiation in such cases. MATERIALS/METHODS From an IRB approved registry, we identified previously irradiated HNC patients treated by SBRT with CE >180˚, SI/A, or use of bolus from 2013-2022. Toxicity as per CTCAEv4.0 and recurrence patterns were analyzed. The cumulative incidence of local progression was estimated with death as a competing risk. Survival analysis was performed with the Kaplan-Meier method. RESULTS Thirty-five patients were treated with SBRT to 37 sites with median follow up of 5.7 months (mo) (IQR 2.7-10.6). A total of 20 cases exhibited CE >180˚, 20 cases had SI/A, and 3 cases had both. The median time from prior radiation was 12.7 mo (range 1.9-144.1). Histology was squamous cell carcinoma in 89%. The site of SBRT was most commonly the neck (65%), 24% mucosa, 8% skull base, and 3% scalp. SBRT was delivered in 5 fractions every other day (62%) or 2 fractions per week (38%). 78% (N = 29) received ≥40 Gy while 22% (N = 8) received a lower dose. The cumulative incidence of local failure at 3 and 6 mo was 12.4% (95% CI 0.8-24.0) and 31.3% (95% CI 14.9-47.8), respectively. The median time of local and regional recurrence free survival was 7.0 and 4.9 mo. Median OS was 8.3 mo. Of the 20 cases with true SI, 40% (N = 8) completely resolved, 35% (N = 7) improved or had residual ulceration attributed to disease, and 25% (N = 5) had ulceration related to toxicity. There were no carotid bleeding events (CBE) related to SBRT, however 10% (N = 2) experienced fatal CBE related to progressive disease at 2.3 mo and 6.7 mo from SBRT. The rate of grade ≥2 treatment related skin toxicity was 19% (N = 7) and only occurred in those with pre-SBRT SI/A. These included a grade 2 neck wound and tracheostomy infection, a grade 3 infection, and two grade 3 soft tissue necrosis. One patient had cellulitis/meningitis related to scalp radiation, and one had an untreated SBRT wound as they transitioned to hospice. Dysphagia requiring PEG occurred in 5% (N = 2), one of which was related to CNX palsy. Six patients (17%) had post-SBRT nerve impairment including one each of grade 2 facial nerve paralysis, grade 2 brachial plexopathy, grade 3 CNVIII dysfunction, grade 3 CNX impairment, and two patients with grade 2 CNXII impairment. CONCLUSION SBRT for locally recurrent previously radiated HNC can provide effective local control in a patient population at high risk of morbidity and mortality from local disease progression. In patients who have >180˚ CE or SI/A, we observed non-trivial toxicity, but disease progression may have been more morbid. For appropriately counseled patients with limited treatment options, CE or SI/A may not be an absolute contraindication to SBRT re-irradiation.
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Affiliation(s)
- J Kocsis
- Cleveland Clinic, Cleveland, OH, United States
| | - C Billena
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - N M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - J A Miller
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - N P Joshi
- Rush University Medical Center, Chicago, IL
| | - S A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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16
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Buchberger DS, Dennert K, Campbell SR, Scharpf J, Siperstein A, Heiden K, Lamarre E, Prendes B, Geiger JL, Yilmaz E, Davis RW, Silver N, Ku J, Miller JA, Koyfman SA, Woody NM. Definitive Radiotherapy for the Treatment of Gross Disease in Unresected Differentiated Thyroid Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e568-e569. [PMID: 37785736 DOI: 10.1016/j.ijrobp.2023.06.1895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) While surgery (with or without radioactive iodine (RAI)) is the mainstay of locoregional control in differentiated thyroid cancer (DTC), patients with unresectable disease present a clinical challenge. Uncontrolled disease in the neck can lead to substantial morbidity and mortality in DTC and obtaining locoregional control is vital to preserving quality of life and longevity. High dose definitive radiotherapy (RT) for gross disease in DTC is understudied. This study examines the efficacy of definitive RT in this setting. MATERIALS/METHODS From an IRB-approved registry of head and neck cancer cases treated at a tertiary care center over a period of 8 years (2014-2022), patients with incompletely resected or unresectable DTC including papillary, follicular, mixed, medullary, and poorly differentiated types were identified. All patients were treated to the neck and/or thyroid regions with visible gross disease to a definitive dose of radiation. The primary endpoint was local control within the radiated portal with a secondary endpoint of locoregional control within the neck. RESULTS A total of 31 patients were identified, of whom 74.2% were Caucasian. Fourteen were female (45.2%), and 17 (54.8%) were male. The median age was 68 years (range 26-90) and the median follow-up was 31 months. Histologically, 19 (61.3%) cases were papillary, 4 (12.9%) were follicular, 2 (6.5%) were mixed, 3 (9.7%) were medullary, and 3 (9.7%) were poorly differentiated. Among patients with non-medullary DTC 18 (69.2%) received prior RAI. Twelve patients were treated with radiation at initial diagnosis, while 19 patients were treated at the time of recurrence; two patients received concurrent chemotherapy. Twenty-eight patients (90.3%) were treated with IMRT and 3 (9.7%) were treated with SBRT. The median dose to the gross disease was 66 Gy (range 30-70.4) in 32 fractions (range 5-35). Overall, 5 patients (16.1%) experienced a locoregional failure after RT and all experienced failure in the RT portal. The actuarial infield control/locoregional control of radiation therapy at 3 and 5 years was 84.8% and 74.2%, respectively. Overall survival at 3 and 5 years was 68.5% and 47.4%, respectively. Among patients who had a locoregional failure after RT, 2 patients were salvaged with systemic therapy, 2 patients with surgery, and 1 patient with SBRT re-irradiation (40 Gy/5 fractions). The patient salvaged with SBRT remains without disease 8 months post-RT. CONCLUSION Definitive radiotherapy is a highly effective strategy to obtain durable control of unresected DTC. It should be standard for unresected disease and considered as a viable alternative for patients with borderline resectable disease for whom resection would be highly morbid.
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Affiliation(s)
- D S Buchberger
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - K Dennert
- Cleveland Clinic Foundation, Cleveland, OH
| | - S R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - J Scharpf
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | | | - K Heiden
- Cleveland Clinic Foundation, Cleveland, OH
| | - E Lamarre
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - B Prendes
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J L Geiger
- Cleveland Clinic Foundation, Cleveland, OH
| | - E Yilmaz
- Department of Hematology Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - R W Davis
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - N Silver
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J Ku
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, OH
| | - J A Miller
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - S A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - N M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Newman JG, Ibrahim S, Ruiz ES, Prasai A, Siegel J, Fitzgerald A, Goldberg M, Koyfman SA. Risk-Stratification using the 40-Gene Expression Profile (40-GEP) Test Identifies Patients with Node Negative Cutaneous Squamous Cell Carcinoma (cSCC) at Higher Risk of Metastasis Who May Benefit from Adjuvant Radiation Therapy (ART). Int J Radiat Oncol Biol Phys 2023; 117:S153. [PMID: 37784387 DOI: 10.1016/j.ijrobp.2023.06.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) ART is a standard treatment used to reduce the risk of metastasis and recurrence in moderate‒to‒high-risk cSCC patients. Indications for ART have been largely based on pathologic risk factors and informed by staging systems, and while radiation oncologists generally designate a >10% risk threshold for usage of ART, there is no consensus on which groups of tumors may benefit from ART. The 40-GEP test has been independently validated to predict a cSCC patient's risk for regional/distant metastasis in patients with one or more high-risk clinicopathologic factors and reports three biologic risk groups: Class 1 (low, ∼7%), Class 2A (moderate, 20-25%), and Class 2B (high risk, >50%) for metastasis. This study aims to evaluate whether a biomarker informed risk stratification approach using a 40-GEP result could refine the ability to select patients with node negative cSCC at higher risk of metastasis who are most likely to benefit from ART. MATERIALS/METHODS In this retrospective study, all patients had primary cSCC tissue with verified clinicopathologic information of tumors with one or more high-risk factors, met clinical testing criteria, were comprehensively staged, and had outcomes data (n = 954). Patients with node positive disease, or those with nodal failure within 3 months of diagnosis were excluded (n = 19). From the n = 935, an intermediate risk population wherein ART is often considered was defined as Brigham and Women's Hospital (BWH) ≥T2a (n = 489). Kaplan-Meier survival analysis and log-rank test were used to assess metastasis free survival (MFS). Univariate Cox regression compared metastasis rates between 40-GEP results. RESULTS The 3-year MFS rate for this eligible for ART cohort was 82.4% The 40-GEP demonstrated statistically significant risk stratification with MFS rates of 92.4%, 76.1% and 59.4% for Class 1, Class 2A and Class 2B, respectively (p<0.0001). Cox regression was significant for Class 2A and 2B compared to Class 1, with a 3.2-fold and 6.4-fold increase in metastasis, respectively (p<0.0001). 64% (59/92) of all metastases received a Class 2A result, and 44% (14/32) of Class 2B patients metastasized. 46% (223/489) of the cohort received a Class 1 result. Of patients staged BWH T1 (n = 446), those with a Class 2A and 2B had an 88.7% and 66.7% MFS rate, respectively. CONCLUSION Within this eligible for ART population, patients with Class 2A or 2B 40-GEP results have inferior rates of MFS, while Class 1 patients have <10% risk of metastasis. Nearly half of this population received a 40-GEP Class 1 result and could be considered for treatment de-intensification trials. Conversely, patients with low-risk BWH T1 stage, who are traditionally not considered for ART, that received a Class 2A or 2B (>10% risk of metastasis) could be considered for adjuvant therapy.
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Affiliation(s)
- J G Newman
- Department of Otorhinolaryngology: Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
| | - S Ibrahim
- Rochester Dermatologic Surgery, Victor, NY
| | - E S Ruiz
- Department of Dermatology, Dana-Farber/Brigham & Women's Cancer Center, Boston, MA
| | - A Prasai
- Castle Biosciences Inc., Friendswood, TX
| | - J Siegel
- Castle Biosciences Inc., Friendswood, TX
| | | | - M Goldberg
- Castle Biosciences Inc., Friendswood, TX
| | - S A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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18
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Buchberger DS, Cook SK, Anderson PM, Shepard DR, Ku JA, Fritz MA, Sindwani R, Recinos P, Murphy ES, Koyfman SA. Salvage stereotactic body radiation therapy re-irradiation for unresectable locally recurrent nasopharyngeal rhabdomyosarcoma in a young adult: A case report. Pediatr Blood Cancer 2023; 70:e30548. [PMID: 37461101 DOI: 10.1002/pbc.30548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 08/24/2023]
Affiliation(s)
- David S Buchberger
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samantha K Cook
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter M Anderson
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dale R Shepard
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie A Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael A Fritz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pablo Recinos
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erin S Murphy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Campbell SR, Fan CA, Dennert K, Cook SK, Xia P, Miller JA, Greskovich JF, Dorfmeyer A, Hymes C, Dylong M, Zickefoose LM, Murray EJ, Koyfman SA, Woody NM. Partial Tongue Sparing without Marginal Failures: The Dosimetric Advantages for Oral Tongue Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2023; 117:e569. [PMID: 37785738 DOI: 10.1016/j.ijrobp.2023.06.1897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Due to a lack of internal barriers, many radiation oncologists believe whole tongue (WT) irradiation is warranted in the adjuvant setting for oral tongue cancer. Our institutional practice is to include the resection bed and flap with a 5-10 mm margin, attempting to spare unaffected oral tongue. We hypothesize that partial tongue (PT) irradiation, when feasible, results in decreased dose to surrounding normal structures without an increased risk of local recurrence (LR). MATERIALS/METHODS Patients with a new diagnosis of squamous cell carcinoma of the oral tongue treated with adjuvant IMRT between 2010 and 2021 were collected from an IRB approved database. PT was defined as <80% of residual tongue in the clinical target volume (CTV). Recurrence was deemed local if in the tongue or floor of mouth, and in field if within the CTV or marginal if outside of CTV. Mean dose to mandible, pharyngeal constrictors, and oral cavity were evaluated. Comparisons between groups were made using parametric one-way ANOVA. Multivariable linear regression was used to predict mean radiation dose. Local control and overall survival were estimated using Kaplan-Meier. RESULTS A total of 130 patients are included with median follow up 34.1 months (IQR 13.5-64.6). Radiation dose was 48-72 Gy in 24-36 fractions, most commonly 60-66 Gy in 30-33 fractions (84.6%). All were treated to oral cavity, and neck irradiation included bilateral 96 (72%), unilateral 31 (24%), and none 3 (4%). PT sparing was feasible in 91 (70%) and 39 (30%) required WT. Primary tumor stage in PT included 20 pT1, 50 pT2, 17 pT3, and 4 pT4, and WT included 3 pT1, 8 pT2, 15 pT3, and 13 pT4. 3-year local control for PT and WT was 96% and 87%, respectively. LR occurred in 14 patients overall (10.8%), 6.6% (6) of patients treated with PT and 20.5% (8) treated with WT (p = 0.072). Of the LR for PT, stage was 2 pT1, 3 pT2, and 1 pT3, and all occurred within the radiation field. Of the LR for WT, stage was 1 each of pT1 and pT2, 2 pT3, and 4 pT4. Overall survival was 57%, regional and distant recurrence was each 17.7%. Dosimetric analysis for PT vs WT is described in Table 1, demonstrating lower mean dose when the primary tumor CTV is limited to PT. Unilateral neck irradiation also resulted in a lower mandible [-8.5 Gy (-11.2 - -5.8)], pharyngeal constrictor [-14.3 Gy (-18.1 - -10.5)], and oral cavity [-9.0 Gy (-13.0 - -5.0)] dose (all p<0.001). CONCLUSION Limiting the primary tumor CTV to PT for adjuvant radiotherapy resulted in significant sparing of the mandible and pharyngeal constrictors, and a routinely lower oral cavity mean dose of ≥3.5 Gy. There was a low risk of LR when implementing PT, and all LR occurred in field. Given the increased sparing of normal structures, and low risk of LR outside of PT radiation field, sparing a portion of unaffected oral tongue should be considered.
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Affiliation(s)
- S R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - C A Fan
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH
| | - K Dennert
- Cleveland Clinic Foundation, Cleveland, OH
| | - S K Cook
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH
| | - P Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - J A Miller
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - J F Greskovich
- Department of Radiation Oncology, Cleveland Clinic Florida, Weston, FL
| | | | - C Hymes
- Cleveland Clinic Foundation, Cleveland, OH
| | - M Dylong
- Cleveland Clinic Foundation, Cleveland, OH
| | - L M Zickefoose
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | | | - S A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - N M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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McAfee JL, Hoda RS, Hoyle C, McCoy L, Sprague C, Reddy CA, Koyfman SA, Geiger JL, Komforti MK, Griffith CC. ERBB2 Amplification and HER2 Expression in Salivary Duct Carcinoma: Evaluation of Scoring Guidelines and Potential for Expanded Anti-HER2 Therapy. Mod Pathol 2023; 36:100273. [PMID: 37423585 DOI: 10.1016/j.modpat.2023.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/09/2023] [Accepted: 06/30/2023] [Indexed: 07/11/2023]
Abstract
Salivary duct carcinoma (SDC) is aggressive with limited therapeutic options. A subset of SDC display human epidermal growth factor receptor 2 (HER2) protein overexpression by immunohistochemistry, and some show ERBB2 gene amplification. Guidelines for HER2 scoring are not firmly established. Recent advances in breast carcinoma have established a role for anti-HER2 therapies in lesions with low HER2 expression lacking ERBB2 amplification. Delineating HER2 staining patterns in SDC is critical for evaluating anti-HER2 treatments. In total, 53 cases of SDC resected at our institution between 2004 and 2020 were identified. Androgen receptor (AR) and HER2 immunohistochemistry and ERBB2 fluorescence in situ hybridization were performed in all cases. AR expression was scored for percentage positive cells and categorized as positive (>10% of cells), low positive (1%-10%), or negative (<1%). HER2 staining levels and patterns were recorded, scored using 2018 ASCO/CAP guidelines, and categorized into HER2-positive (3+ or 2+ with ERBB2 amplification), HER2-low (1+ or 2+ without ERBB2 amplification), HER2-very low (faint staining in <10% of cells), or HER2-absent types. Clinical parameters and vital status were recorded. Median age was 70 years, with a male predominance. ERBB2-amplified tumors (11/53; 20.8%) presented at lower pT stages (pTis/pT1/pT2; P = .005, Fisher exact test) and more frequently had perineural invasion (P = .007, Fisher exact test) compared with ERBB2 nonamplified tumors; no other pathologic features differed significantly by gene amplification status. In addition, 2+ HER2 staining by 2018 ASCO/CAP criteria was most common (26/53; 49%); only 4 cases (8%) were HER2-absent status; 3+ HER2 staining was found in 9 tumors, and all were ERBB2 amplified. Six patients with HER2-expressing tumors received trastuzumab therapy, including 2 with ERBB2-amplified tumors. Overall survival and recurrence-free survival did not differ significantly based on ERBB2 status. This work suggests that 2018 ASCO/CAP guidelines for HER2 evaluation in breast carcinoma could be applied to SDC. Our findings also show broad overexpression of HER2 in SDC raising the possibility that more patients may benefit from anti-HER2-directed therapies.
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Affiliation(s)
- John L McAfee
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Raza S Hoda
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Carrie Hoyle
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lauren McCoy
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Cathy Sprague
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | - Miglena K Komforti
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida
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21
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Koyfman SA. 2B Or Not 2B? Int J Radiat Oncol Biol Phys 2023; 117:8-9. [PMID: 37574247 DOI: 10.1016/j.ijrobp.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
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22
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Koyuncu CF, Frederick MJ, Thompson LDR, Corredor G, Khalighi S, Zhang Z, Song B, Lu C, Nag R, Sankar Viswanathan V, Gilkey M, Yang K, Koyfman SA, Chute DJ, Castro P, Lewis JS, Madabhushi A, Sandulache VC. Machine learning driven index of tumor multinucleation correlates with survival and suppressed anti-tumor immunity in head and neck squamous cell carcinoma patients. Oral Oncol 2023; 143:106459. [PMID: 37307602 DOI: 10.1016/j.oraloncology.2023.106459] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Matching treatment intensity to tumor biology is critical to precision oncology for head and neck squamous cell carcinoma (HNSCC) patients. We sought to identify biological features of tumor cell multinucleation, previously shown by us to correlate with survival in oropharyngeal (OP) SCC using a machine learning approach. MATERIALS AND METHODS Hematoxylin and eosin images from an institutional OPSCC cohort formed the training set (DTr). TCGA HNSCC patients (oral cavity, oropharynx and larynx/hypopharynx) formed the validation set (DV). Deep learning models were trained in DTr to calculate a multinucleation index (MuNI) score. Gene set enrichment analysis (GSEA) was then used to explore correlations between MuNI and tumor biology. RESULTS MuNI correlated with overall survival. A multivariable nomogram that included MuNI, age, race, sex, T/N stage, and smoking status yielded a C-index of 0.65, and MuNI was prognostic of overall survival (2.25, 1.07-4.71, 0.03), independent of the other variables. High MuNI scores correlated with depletion of effector immunocyte subsets across all HNSCC sites independent of HPV and TP53 mutational status although the correlations were strongest in wild-type TP53 tumors potentially due to aberrant mitotic events and activation of DNA-repair mechanisms. CONCLUSION MuNI is associated with survival in HNSCC across subsites. This may be driven by an association between high levels of multinucleation and a suppressive (potentially exhausted) tumor immune microenvironment. Mechanistic studies examining the link between multinucleation and tumor immunity will be required to characterize biological drivers of multinucleation and their impact on treatment response and outcomes.
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Affiliation(s)
- Can F Koyuncu
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Mitchell J Frederick
- Bobby R. Alford Department of Otolaryngology- Head and Neck Surgery, Baylor College of Medicine, Houston, TX, United States
| | | | - Germán Corredor
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Sirvan Khalighi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Zelin Zhang
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Bolin Song
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Cheng Lu
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Reetoja Nag
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Vidya Sankar Viswanathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Michael Gilkey
- Atlanta Veterans Administration Medical Center, Atlanta, GA, United States
| | - Kailin Yang
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland OH, United States
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic Foundation, Cleveland OH, United States
| | - Deborah J Chute
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Patricia Castro
- Department of Pathology, Baylor College of Medicine, Houston, TX, United States
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States; Department of Otolaryngology - Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anant Madabhushi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; Atlanta Veterans Administration Medical Center, Atlanta, GA, United States.
| | - Vlad C Sandulache
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States; ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States; Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States.
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23
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Lopetegui-Lia N, Dima D, Buchberger DS, Yalamanchali A, Osantowski B, Ondeck M, Lorenz RR, Prendes B, Ku J, Lamarre E, Scharpf J, Silver NL, Schwartzman L, Geiger JL, Woody NM, Campbell SR, Koyfman SA, Yilmaz E. Immunotherapy response in patients with cutaneous squamous cell carcinoma of head and neck with cranial nerve involvement. Head Neck 2023. [PMID: 37272705 DOI: 10.1002/hed.27419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/07/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Metastatic or locally advanced cutaneous squamous cell carcinoma (cSCC) can be treated with immunotherapy (IO). Cranial nerve involvement (CNI) is uncommon in cSCC and is a poor prognostic factor. Our aim is to describe how patients with CNI respond to IO monotherapy and/or as an adjunct to RT. METHODS Under an IRB approved protocol, patients with histologically proven cSCC of the head and neck with CNI treated with IO were retrospectively reviewed. RESULTS Twelve patients were included and received cemiplimab or pembrolizumab. Eight patients had CNI at diagnosis, and 4 at time of recurrence after non-IO therapy. Best responses were complete response (1), partial response (7), stable disease (1), progressive disease (2), and pending response (1). Nine patients are alive, 6 of which remain on IO. CONCLUSIONS In this cohort, IO showed clinical response in 83% of patients, indicating IO can be an effective monotherapy, reserving RT for instances of local failure after IO.
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Affiliation(s)
- Nerea Lopetegui-Lia
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Danai Dima
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - David Scott Buchberger
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | | | - Mariah Ondeck
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert Roman Lorenz
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Brandon Prendes
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie Ku
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric Lamarre
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph Scharpf
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Natalie Lea Silver
- Department of Otolaryngology, Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Larisa Schwartzman
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica Lyn Geiger
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil McIver Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shauna Rosalie Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emrullah Yilmaz
- Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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24
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Wu SS, Hong H, Fritz M, Ku J, Prendes B, Silver N, Genther DJ, Ciolek P, Byrne P, Brauer P, Reddy CA, Woody N, Campbell S, Koyfman SA, Lamarre ED. Rates of osteoradionecrosis in resected oral cavity cancer reconstructed with free tissue transfer in the intensity-modulated radiotherapy era. Head Neck 2023; 45:890-899. [PMID: 36808674 DOI: 10.1002/hed.27310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 01/24/2023] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Resected oral cavity carcinoma defects are often reconstructed with osteocutaneous or soft-tissue free flaps, but risk of osteoradionecrosis (ORN) is unknown. METHODS This retrospective study included oral cavity carcinoma treated with free-tissue reconstruction and postoperative IMRT between 2000 and 2019. Risk-regression assessed risk factors for grade ≥2 ORN. RESULTS One hundred fifty-five patients (51% male, 28% current smokers, mean age 62 ± 11 years) were included. Median follow-up was 32.6 months (range, 1.0-190.6). Thirty-eight (25%) patients had fibular free flap for mandibular reconstruction, whereas 117 (76%) had soft-tissue reconstruction. Grade ≥2 ORN occurred in 14 (9.0%) patients, at a median 9.8 months (range, 2.4-61.5) after IMRT. Post-radiation teeth extraction was significantly associated with ORN. One-year and 10-year ORN rates were 5.2% and 10%, respectively. CONCLUSIONS ORN risk was comparable between osteocutaneous and soft-tissue reconstruction for resected oral cavity carcinoma. Osteocutaneous flaps can be safely performed with no excess concern for mandibular ORN.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner, College of Medicine, Cleveland, Ohio, USA
| | - Hanna Hong
- Cleveland Clinic Lerner, College of Medicine, Cleveland, Ohio, USA
| | - Michael Fritz
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Jamie Ku
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Brandon Prendes
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Natalie Silver
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Dane J Genther
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Peter Ciolek
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Patrick Byrne
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
| | - Philip Brauer
- Case Western Reserve, University School of Medicine, Cleveland, Ohio, USA
| | - Chandana A Reddy
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Neil Woody
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Shauna Campbell
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Shlomo A Koyfman
- Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Eric D Lamarre
- Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA
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25
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Wu SS, Lamarre ED, Yalamanchali A, Brauer PR, Hong H, Reddy CA, Yilmaz E, Woody N, Ku JA, Prendes B, Burkey B, Nasr C, Skugor M, Heiden K, Chute DJ, Knauf JA, Campbell SR, Koyfman SA, Geiger JL, Scharpf J. Association of Treatment Strategies and Tumor Characteristics With Overall Survival Among Patients With Anaplastic Thyroid Cancer: A Single-Institution 21-Year Experience. JAMA Otolaryngol Head Neck Surg 2023; 149:300-309. [PMID: 36757708 PMCID: PMC9912167 DOI: 10.1001/jamaoto.2022.5045] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/15/2022] [Indexed: 02/10/2023]
Abstract
Importance Survival outcomes for anaplastic thyroid cancer (ATC), the most aggressive subtype of thyroid cancers, have remained poor. However, targeted therapies and immunotherapies present new opportunities for treatment of this disease. Evaluations of survival outcomes over time with new multimodal therapies are needed for optimizing treatment plans. Objective To evaluate the association of treatment strategies and tumor characteristics with overall survival (OS) among patients with ATC. Design, Setting, and Participants This retrospective case series study evaluated the survival outcomes stratified by treatment strategies and tumor characteristics among patients with ATC treated at a tertiary level academic institution from January 1, 2000, to December 31, 2021. Demographic, tumor, treatment, and outcome characteristics were analyzed. Kaplan-Meier method and log rank test modeled OS by treatment type and tumor characteristics. Data were analyzed in May 2022. Main Outcomes and Measures Overall survival (OS). Results The study cohort comprised 97 patients with biopsy-proven ATC (median [range] age at diagnosis, 70 [38-93] years; 60 (62%) female and 85 [88%] White individuals; 59 [61%] never smokers). At ATC diagnosis, 18 (19%) patients had stage IVA, 19 (20%) had stage IVB, and 53 (55%) had stage IVC disease. BRAF status was assessed in 38 patients; 18 (47%) had BRAF-V600E variations and 20 (53%), BRAF wild type. Treatment during clinical course included surgery for 44 (45%) patients; chemotherapy, 41 (43%); definitive or adjuvant radiation therapy, 34 (RT; 35%); and targeted therapy, 28 (29%). Median OS for the total cohort was 6.5 (95% CI, 4.3-10.0) months. Inferior OS was found in patients who did not receive surgery (hazard ratio [HR], 2.12; 95% CI, 1.35-3.34; reference, received surgery), chemotherapy (HR, 3.28; 95% CI, 1.99-5.39; reference, received chemotherapy), and definitive or adjuvant RT (HR, 2.47; 95% CI, 1.52-4.02; reference, received definitive/adjuvant RT). On multivariable analysis, age at diagnosis (HR, 1.03; 95% CI, 1.01-1.06), tumor stage IVC (HR, 2.65; 95% CI, 1.35-5.18), and absence of definitive or adjuvant RT (HR, 1.90; 95% CI, 1.01-3.59) were associated with worse OS. Conclusions and Relevance This retrospective single-institution study found that lower tumor stage, younger age, and the ability to receive definitive or adjuvant RT were associated with improved OS in patients with ATC.
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Affiliation(s)
- Shannon S. Wu
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | | | | | - Philip R. Brauer
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Hanna Hong
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Chandana A. Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Emrullah Yilmaz
- Department of Hematology & Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Neil Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jamie A. Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Brian Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christian Nasr
- Department of Internal Medicine, Division of Endocrinology, University of Arizona, Phoenix
| | - Mario Skugor
- Department of Endocrinology, Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Katherine Heiden
- Department of Endocrinology, Endocrinology & Metabolism Institute, Cleveland Clinic, Cleveland, Ohio
| | - Deborah J. Chute
- Department of Pathology, Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeffrey A. Knauf
- Center for Immunotherapy and Precision Immuno-Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Shauna R. Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jessica L. Geiger
- Department of Hematology & Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
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26
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Ruiz ES, Koyfman SA, Schmults CD. Reply to "Rational radiotherapy: The role in node-negative squamous cell carcinoma". J Am Acad Dermatol 2023; 88:e143. [PMID: 31589949 DOI: 10.1016/j.jaad.2019.09.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Emily Stamell Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Sherman EJ, Harris J, Bible KC, Xia P, Ghossein RA, Chung CH, Riaz N, Gunn GB, Foote RL, Yom SS, Wong SJ, Koyfman SA, Dzeda MF, Clump DA, Khan SA, Shah MH, Redmond K, Torres-Saavedra PA, Le QT, Lee NY. Radiotherapy and paclitaxel plus pazopanib or placebo in anaplastic thyroid cancer (NRG/RTOG 0912): a randomised, double-blind, placebo-controlled, multicentre, phase 2 trial. Lancet Oncol 2023; 24:175-186. [PMID: 36681089 PMCID: PMC9969528 DOI: 10.1016/s1470-2045(22)00763-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND Anaplastic thyroid cancer is a rare and aggressive cancer with no standard radiotherapy-based local treatment. Based on data suggesting synergy between pazopanib and paclitaxel in anaplastic thyroid cancer, NRG Oncology did a double-blind, placebo-controlled, randomised phase 2 clinical trial comparing concurrent paclitaxel and intensity-modulated radiotherapy (IMRT) with the addition of pazopanib or placebo with the aim of improving overall survival in this patient population. METHODS Eligible patients were aged 18 years or older with a pathological diagnosis of anaplastic thyroid cancer, any TNM stage, Zubrod performance status of 0-2, no recent haemoptysis or bleeding, and no brain metastases. Patients were enrolled from 34 centres in the USA. Initially, a run-in was done to establish safety. In the randomised phase 2 trial, patients in the experimental group (pazopanib) received 2-3 weeks of weekly paclitaxel (80 mg/m2) intravenously and daily pazopanib suspension 400 mg orally followed by concurrent weekly paclitaxel (50 mg/m2), daily pazopanib (300 mg), and IMRT 66 Gy given in 33 daily fractions (2 Gy fractions). In the control group (placebo), pazopanib was replaced by matching placebo. Patients were randomly assigned (1:1) to the two treatment groups by permuted block randomisation by NRG Oncology with stratification by metastatic disease. All investigators, patients, and funders of the study were masked to group allocation. The primary endpoint was overall survival in the intention-to-treat population. Safety was assessed in all patients who received at least one dose of study treatment. This trial is registered with Clinicaltrials.gov, NCT01236547, and is complete. FINDINGS The safety run-showed the final dosing regimen to be safe based on two out of nine participants having adverse events of predefined concern. Between June 23, 2014, and Dec 30, 2016, 89 patients were enrolled to the phase 2 trial, of whom 71 were eligible (36 in the pazopanib group and 35 in the placebo group; 34 [48%] males and 37 [52%] females). At the final analysis (data cutoff March 9, 2020), with a median follow-up of 2·9 years (IQR 0·002-4·0), 61 patients had died. Overall survival was not significantly improved with pazopanib versus placebo, with a median overall survival of 5·7 months (95% CI 4·0-12·8) in the pazopanib group versus 7·3 months (4·3-10·6) in the placebo group (hazard ratio 0·86, 95% CI 0·52-1·43; one-sided log-rank p=0·28). 1-year overall survival was 37·1% (95% CI 21·1-53·2) in the pazopanib group and 29·0% (13·2-44·8) in the placebo group. The incidence of grade 3-5 adverse events did not differ significantly between the treatment groups (pazopanib 88·9% [32 of 36 patients] and placebo 85·3% [29 of 34 patients]; p=0·73). The most common clinically significant grade 3-4 adverse events in the 70 eligible treated patients (36 in the pazopanib group and 34 in the placebo group) were dysphagia (13 [36%] vs 10 [29%]), radiation dermatitis (8 [22%] vs 13 [38%]), increased alanine aminotransferase (12 [33%] vs none), increased aspartate aminotransferase (eight [22%] vs none), and oral mucositis (five [14%] vs eight [24%]). Treatment-related serious adverse events were reported for 16 (44%) patients on pazopanib and 12 (35%) patients on placebo. The most common serious adverse events were dehydration and thromboembolic event (three [8%] each) in patients on pazopanib and oral mucositis (three [8%]) in those on placebo. There was one treatment-related death in each group (sepsis in the pazopanib group and pneumonitis in the placebo group). INTERPRETATION To our knowledge, this study is the largest randomised anaplastic thyroid cancer study that has completed accrual showing feasibility in a multicenter NCI National Clinical Trials Network setting. Although no significant improvement in overall survival was recorded in the pazopanib group, the treatment combination was shown to be feasible and safe, and hypothesis-generating data that might warrant further investigation were generated. FUNDING National Cancer Institute and Novartis.
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Affiliation(s)
- Eric J Sherman
- Department of Medicine, Division of Head and Neck Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Weill Cornell Medicine and New York Presbyterian Hospital, New York, NY, USA.
| | - Jonathan Harris
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | | | - Ping Xia
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Ronald A Ghossein
- Department of Medicine, Division of Head and Neck Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Nadeem Riaz
- Department of Medicine, Division of Head and Neck Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - G Brandon Gunn
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Sue S Yom
- Radiation Oncology, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Michael F Dzeda
- Christiana Care Health System-Helen F Graham Cancer Center & Research Institute, Newark, DE, USA
| | | | - Saad A Khan
- UT Southwestern Harold C Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Manisha H Shah
- Ohio State University Comprehensive Cancer Center, OSU Wexner Medical Center, Columbus, OH, USA
| | - Kevin Redmond
- Radiation Oncology, University of Cincinnati-Barrett Cancer Center, Cincinnati, OH, USA
| | - Pedro A Torres-Saavedra
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Quynh-Thu Le
- Stanford Cancer Institute Palo Alto, Stanford, CA, USA
| | - Nancy Y Lee
- Department of Medicine, Division of Head and Neck Oncology, Solid Tumor Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Wu SS, Joshi N, Sharrett J, Rao S, Shah A, Scharpf J, Burkey B, Lamarre ED, Prendes B, Siperstein A, Shin J, Berber E, Jin J, Krishnamurthi V, Nasr C, Hong L, Buchberger DS, Woody N, Koyfman SA, Geiger JL. Risk Factors Associated With Recurrence and Death in Patients With Tall Cell Papillary Thyroid Cancer: A Single-Institution Cohort Study With Predictive Nomogram. JAMA Otolaryngol Head Neck Surg 2023; 149:79-86. [PMID: 36454559 PMCID: PMC9716436 DOI: 10.1001/jamaoto.2022.3781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
Importance Tall cell morphology (TCM) is a rare and aggressive variant of papillary thyroid carcinoma (PTC) that has been associated with poor outcomes; however, the risk factors for worse survival are not well characterized. Objective To identify prognostic factors associated with cancer recurrence and death in patients with PTC-TCM. Design, Setting, and Participants All patients treated for PTC-TCM at a single tertiary-level academic health care institution from January 1, 1997, through July 31, 2018, were included. Tall cell variant (TCV) was defined as PTC with TCM of 30% or more; and tall cell features (TCF) was defined as PTC with TCM of less than 30%. Patients with other coexisting histologic findings and/or nonsurgical management were excluded. Clinicopathologic features associated with worse outcomes were identified using Kaplan-Meier and Cox proportional-hazards model. Data were analyzed from March 1, 2018, to August 15, 2018. Main Outcomes and Measures Locoregional recurrence-free survival (LRRFS), distant recurrence-free survival (DRFS), and overall survival (OS) after surgery. Results A total of 365 patients (median [range] age, 51.8 [15.9-91.6] years; 242 [66.3%] female) with PTC-TCM (TCV, 32%; TCF, 68%) were evaluable. Total thyroidectomy was performed in 336 (92%) patients; 19 (5.2%) received radiotherapy; and 15 (4.1%) received radioactive iodine. Clinical features were pT3 or T4, 65%; node-positive, 53%; and positive surgical margins, 24%. LRRFS at 1-, 3-, 5-, and 10-year was 95%, 87%, 82%, and 73%, respectively. On multivariable analysis, male sex and age were not independent predictors of inferior 5-year LRRFS, whereas positive surgical margins (HR, 3.5; 95% CI, 2.0-6.3), positive lymph nodes (HR, 2.8; 95% CI, 1.4-5.8), and primary tumor size of 3 cm or more (HR, 3.3; 95% CI, 1.4-7.8) were strongly associated with worse LRRFS. Age 55 years or older (HR, 3.2; 95% CI, 1.5-7.0), male sex (HR 4.5; 95% CI, 2.1-10.0), positive surgical margins (HR, 2.7; 95% CI, 1.2-6.0), nodal positivity (HR, 3.1; 95% CI, 1.3-7.7), tumor diameter of 1.5 cm or more (HR, 20.6; 95% CI, 2.8-152.1), and TCV vs TCF (HR, 3.1; 95% CI, 1.5-6.7) were associated with worse DRFS. Male sex (HR, 3.1; 95% 1.4-6.8) and tumor diameter of 1.5 cm or more (HR, 2.8; 95% CI, 1.0-7.4) were associated with worse OS. A findings-based nomogram was constructed to predict 10-year LRRFS (C index, 0.8). Conclusions and Relevance This retrospective cohort study found that in patients with PTC-TCM, positive surgical margins, node positive disease, and tumor size of 3 cm or more were risk factors for worse LRRFS. Intensified locoregional therapy, including adjuvant radiation, may be considered for treating these patients.
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Affiliation(s)
- Shannon S. Wu
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio
| | - Nikhil Joshi
- Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois
| | - Jonathan Sharrett
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Sanjay Rao
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Akeesha Shah
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio
| | - Joseph Scharpf
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio
| | - Brian Burkey
- Department of Otolaryngology, Cleveland Clinic, Vero Beach, Florida
| | - Eric D. Lamarre
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio
| | - Brandon Prendes
- Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio
| | - Allan Siperstein
- Department of Endocrine Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Joyce Shin
- Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio
| | - Eren Berber
- Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio
| | - Judy Jin
- Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio
| | | | - Christian Nasr
- Department of Endocrinology, Cleveland Clinic, Cleveland, Ohio
| | - Li Hong
- Department of Statistics, Cleveland Clinic, Cleveland, Ohio
| | - David S. Buchberger
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Neil Woody
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio
| | - Jessica L. Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio
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Koyuncu CF, Nag R, Lu C, Corredor G, Viswanathan VS, Sandulache VC, Fu P, Yang K, Pan Q, Zhang Z, Xu J, Chute DJ, Thorstad WL, Faraji F, Bishop JA, Mehrad M, Castro PD, Sikora AG, Thompson LD, Chernock RD, Lang Kuhs KA, Wasman JK, Luo JR, Adelstein DJ, Koyfman SA, Lewis Jr JS, Madabhushi A. Image analysis reveals differences in tumor multinucleations in Black and White patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma. Cancer 2022; 128:3831-3842. [PMID: 36066461 PMCID: PMC9782693 DOI: 10.1002/cncr.34446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/17/2022] [Accepted: 06/28/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Understanding biological differences between different racial groups of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) patients, who have differences in terms of incidence, survival, and tumor morphology, can facilitate accurate prognostic biomarkers, which can help develop personalized treatment strategies. METHODS This study evaluated whether there were morphologic differences between HPV-associated tumors from Black and White patients in terms of multinucleation index (MuNI), an image analysis-derived metric that measures density of multinucleated tumor cells within epithelial regions on hematoxylin-eosin images and previously has been prognostic in HPV-associated OPSCC patients. In this study, the authors specifically evaluated whether the same MuNI cutoff that was prognostic of overall survival (OS) and disease-free survival in their previous study, TTR , is valid for Black and White patients, separately. We also evaluated population-specific cutoffs, TB for Blacks and TW for Whites, for risk stratification. RESULTS MuNI was statistically significantly different between Black (mean, 3.88e-4; median, 3.67e-04) and White patients (mean, 3.36e-04; median, 2.99e-04), with p = .0078. Using TTR , MuNI was prognostic of OS in the entire population with hazard ratio (HR) of 1.71 (p = .002; 95% confidence interval [CI], 1.21-2.43) and in White patients with HR of 1.72 (p = .005; 95% CI, 1.18-2.51). Population-specific cutoff, TW , yielded improved HR of 1.77 (p = .003; 95% CI, 1.21-2.58) for White patients, whereas TB did not improve risk-stratification in Black patients with HR of 0.6 (p = .3; HR, 0.6; 95% CI, 0.2-1.80). CONCLUSIONS Histological difference between White and Black patient tumors in terms of multinucleated tumor cells suggests the need for considering population-specific prognostic biomarkers for personalized risk stratification strategies for HPV-associated OPSCC patients.
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Affiliation(s)
- Can F. Koyuncu
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA,Louis Stokes Cleveland Veterans Affairs Medical CenterClevelandOhioUSA
| | - Reetoja Nag
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Cheng Lu
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Germán Corredor
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA,Louis Stokes Cleveland Veterans Affairs Medical CenterClevelandOhioUSA
| | - Vidya S. Viswanathan
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Vlad C. Sandulache
- Baylor College of MedicineHoustonTexasUSA,Otolaryngology‐Head and Neck SurgeryOperative Care Line, Michael E. DeBakey Veterans Affairs Medical CenterHoustonTexasUSA
| | - Pingfu Fu
- Department of Population and Quantitative Health SciencesCase Western Reserve UniversityClevelandOhioUSA
| | | | - Quintin Pan
- Case Comprehensive Cancer CenterCase Western Reserve UniversityClevelandOhioUSA
| | - Zelin Zhang
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA
| | - Jun Xu
- Nanjing University of Information Science and TechnologyNanjingChina
| | | | | | - Farhoud Faraji
- University of California San DiegoSan DiegoCaliforniaUSA
| | | | - Mitra Mehrad
- Vanderbilt University Medical CenterNashvilleTennesseeUSA
| | | | | | | | | | | | - Jay K. Wasman
- School of MedicineCase Western Reserve UniversityClevelandOhioUSA
| | | | | | | | | | - Anant Madabhushi
- Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology and Emory UniversityAtlantaGeorgiaUSA,Atlanta Veterans Administration Medical CenterAtlantaGeorgiaUSA,Louis Stokes Cleveland Veterans Affairs Medical CenterClevelandOhioUSA
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30
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Smile TD, Reddy CA, Matia B, Fleming CW, Domb C, Geiger JL, Joshi NP, Woody NM, Chute DJ, Griffith CC, Adelstein DJ, Koyfman SA. A Reappraisal of Definitive Chemoradiotherapy for Older Adults With Advanced Head and Neck Cancer. Anticancer Res 2022; 42:3845-3852. [PMID: 35896238 DOI: 10.21873/anticanres.15875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Definitive treatment for locally advanced head and neck squamous cell carcinoma (LAHNSCC) is often compromised in older adults due to concerns about potential treatment toxicity intolerance. We reviewed our institutional experience with definitive management of older adults with LAHNSCC. PATIENTS AND METHODS From our Institutional Review Board-approved registry, we identified patients aged >60 years with stage III-IV, M0 LAHNSCC (seventh/earlier editions of the American Joint Committee on Cancer classification) treated with definitive radiotherapy from 1993-2019. Indications for concurrent chemotherapy included T3-4 or N2-3 disease. Multivariable analysis using Fine and Gray regression was performed to identify risk factors associated with recurrence. The cumulative incidence method was used to calculate recurrence rates. RESULTS Overall, 350 patients were identified: 223 aged 60-69, 82 aged 70-74, and 45 aged ≥75 years. Median follow-up was 36.3 months. Two-year recurrence rates were 13.7%, 20.2% and 34.8%, respectively; human papillomavirus-positive disease was present in 190 (85%), 44 (54%), and 25 (56%), respectively; and systemic therapy was given to 194 (87%), 64 (88%), and 23 (56%) patients, respectively. Factors significantly associated with increased risk of recurrence included age ≥75 years, Karnofsky performance status 70-80, clinical N2c-N3, and Charlson score 2-3. CONCLUSION Patients aged ≥75 years received less aggressive therapy and experienced increased recurrence compared to younger patients. Outcomes for those aged 70-74 years were similar to younger patients treated with aggressive therapy, despite their inferior performance status/comorbidity, and such patients should not routinely be excluded from standard-of-care therapy. Further study is needed to optimize therapy for a redefined older adult (age ≥75 years) population.
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Affiliation(s)
- Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.;
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Brian Matia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Christopher W Fleming
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Chaim Domb
- Case Western Reserve University College of Medicine, Cleveland, OH, U.S.A
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Nikhil P Joshi
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, U.S.A
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Deborah J Chute
- Department of Pathology, Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Christopher C Griffith
- Department of Pathology, Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - David J Adelstein
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
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Yalamanchali A, Griffith C, Reddy CA, Koyfman SA, Woody NM, Campbell S, Silver NL, Scharpf J, Lorenz RR, Prendes B, Ku J, Lamarre E, Geiger JL. Evaluating the impact of the degree of extranodal extension on outcomes in locally advanced oral cavity cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18058 Background: The presence of extranodal extension (ENE) in oral cavity cancer is associated with a higher risk of distant metastasis and worse overall survival (OS). Trials show that patients with locally advanced head and neck cancer and ENE benefit from concurrent chemoradiation over radiation therapy alone.We explored whether degree of ENE impacts survival outcomes in individuals with oral cavity cancer. Methods: From an IRB-approved database of 303 pts with locally advanced oral cavity cancer treated with surgical resection between 2001-2020, patients with pathologic ENE who received adjuvant treatment were included. Patient demographics, tumor staging, treatment information, disease recurrence, and survival were collected. Surgical slides were reviewed to confirm the extent of ENE. All staging was updated to AJCC 8th edition. Cox proportional hazards regression was used to relate patient, tumor, or treatment characteristics with either disease-free survival (DFS, composite of disease recurrence and death) or OS, from the time of radiation therapy completion. ENE was analyzed as both a dichotomous variable (major if > 2 mm, minor if ≤2 mm) and as a continuous variable in the subset of patients for whom exact ENE extent could be confirmed. Results: A total of 113 patients were identified who underwent surgery and adjuvant therapy for advanced oral cavity cancer with ENE, with 35 having major ENE and 78 having minor ENE. Forty-one patients had T1-T2 disease while 72 had T3-T4 disease. Additionally, 24 had N2a disease and 89 had N3b disease. Of these, 78 received concurrent chemoradiation while 35 received radiation therapy alone. Ninety-nine patients had pathologic slides available for review to determine exact ENE extent. Median ENE distance was 1 mm (IQR 1-2, range 0.1-10). With a median follow up time of 22.3 months, there were 48 recurrences and 67 deaths. Median DFS was 21.3 months (95%CI 11.1-33.2) and median OS was 29.9 months (95%CI 20.6-66.6). Between major vs minor ENE, there was no statistically significant difference in DFS (HR 1.18, 95%CI 0.72-1.92, p = 0.51) or OS (HR 1.17, 95%CI 0.70-1.96, p = 0.55). Furthermore, there was no statistically significant association between ENE as a continuous variable and DFS (HR 0.97 per mm, 95%CI 0.87-1.4, p = 0.96) or OS (HR 0.96 per mm, 95%CI 0.83-1.11, p = 0.58). The benefit of concurrent chemotherapy on OS was not seen (HR 0.74, 95%CI 0.44-1.22, p = 0.24), though those patients on average had more advanced nodal disease (85% N3b vs 66%). Conclusions: No significant relationship was seen between extent of ENE and DFS or OS in individuals with locally advanced oral cavity cancer. This analysis was limited by the small number of patients, that most patients had ≤2 mm of ENE, and the presence of confounding risk factors such as nodal stage and receipt of chemotherapy. Overall, the effect of the degree of ENE on outcomes in advanced oral cavity cancer remains unclear.
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Affiliation(s)
| | - Christopher Griffith
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, OH
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Ilori EO, Campbell SR, Smile TD, Keller L, Joshi NP, Woody NM, Koyfman SA. Adjuvant Intensity-Modulated Radiotherapy Improves Outcomes for Resected Complex Keloids. JAAD Case Rep 2022; 25:47-52. [PMID: 35755175 PMCID: PMC9213232 DOI: 10.1016/j.jdcr.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Allen-Proctor MK, Rahman M, Reddy CA, Koyfman SA, Chute DJ, Griffith CC. Variability in Depth of Invasion Measurements in Carcinomas of the Oral Cavity and the Effect on Pathologic Tumor Staging. Head Neck Pathol 2022; 16:963-968. [PMID: 35499641 PMCID: PMC9729630 DOI: 10.1007/s12105-022-01439-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 12/16/2022]
Abstract
Depth of invasion (DOI) was added to the staging criteria for carcinoma of the lip and oral cavity in the 8th edition of the American Joint Committee on Cancer Staging Manual (AJCC8). However, there are multiple practical challenges to obtaining an accurate DOI measurement with limited data regarding interobserver variability in DOI measurement. The aim of this study was to investigate interobserver variability in DOI measurement and its effect on tumor stage. We performed an electronic medical record search for excisions of squamous cell carcinoma of the oral cavity between January 1, 2010 and December 25, 2017. All slides containing significant tumor were selected for independent blinded DOI measurement by four head and neck pathologists per AJCC8 guidelines. Pathologic stage was assigned in conjunction with reported tumor greatest dimension. Observers recorded the slide used for measurement and potential issues limiting assessment of DOI. Results were compared for reproducibility in DOI and tumor stage using intraclass correlation coefficient (ICC) analysis. A total of 167 cases of oral squamous cell carcinoma with available slides were included. The ICC score for DOI between observers was 0.91339 (> 0.9 considered excellent). Only 7.2% of cases had uniform DOI amongst observers. Increasing overall tumor size and average DOI correlated with increasing range in DOI amongst observers. Differences in DOI resulted in differences in pathologic tumor staging (pT) for 15% of tumors. Use of different slides for DOI measurements was significantly associated with different pT staging. In contrast, ulceration and exophytic growth did not correlate with higher DOI or pT variability. Despite the excellent ICC score, differences in DOI measurement resulted in variable pT staging for a considerable number of cases. We therefore recommend consensus for DOI in at least some cases in which potential differences in DOI could alter pT stage assignment.
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Affiliation(s)
- Mary K. Allen-Proctor
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, L2, 44195 Cleveland, Ohio USA
| | - Mobeen Rahman
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, L2, 44195 Cleveland, Ohio USA
| | - Chandana A. Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio USA
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio USA
| | - Deborah J. Chute
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, L2, 44195 Cleveland, Ohio USA
| | - Christopher C. Griffith
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, L2, 44195 Cleveland, Ohio USA
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Ward MC, Koyfman SA, Bakst RL, Margalit DN, Beadle BM, Beitler JJ, Chang SSW, Cooper JS, Galloway TJ, Ridge JA, Robbins JR, Sacco AG, Tsai CJ, Yom SS, Siddiqui F. Retreatment of Recurrent or Second Primary Head and Neck Cancer After Prior Radiation: Executive Summary of the American Radium Society® (ARS) Appropriate Use Criteria (AUC): Expert Panel on Radiation Oncology - Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2022; 113:759-786. [PMID: 35398456 DOI: 10.1016/j.ijrobp.2022.03.034] [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: 10/27/2021] [Revised: 02/16/2022] [Accepted: 03/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Re-treatment of recurrent or second primary head and neck cancers occurring in a previously irradiated field is complex. Few guidelines exist to support practice. METHODS We performed an updated literature search of peer-reviewed journals in a systematic fashion. Search terms, key questions, and associated clinical case variants were formed by panel consensus. The literature search informed the committee during a blinded vote on the appropriateness of treatment options via the modified Delphi method. RESULTS The final number of citations retained for review was 274. These informed five key questions, which focused on patient selection, adjuvant re-irradiation, definitive re-irradiation, stereotactic body radiation (SBRT), and re-irradiation to treat non-squamous cancer. Results of the consensus voting are presented along with discussion of the most current evidence. CONCLUSIONS This provides updated evidence-based recommendations and guidelines for the re-treatment of recurrent or second primary cancer of the head and neck.
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Affiliation(s)
- Matthew C Ward
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina; Southeast Radiation Oncology Group, Charlotte, North Carolina.
| | | | | | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Beth M Beadle
- Stanford University School of Medicine, Palo Alto, California
| | | | | | | | | | - John A Ridge
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jared R Robbins
- University of Arizona College of Medicine Tucson, Tucson, Arizona
| | - Assuntina G Sacco
- University of California San Diego Moores Cancer Center, La Jolla, California
| | - C Jillian Tsai
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sue S Yom
- University of California, San Francisco, California
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Smile TD, Ruiz ES, Kus KJB, Murad F, Wei W, Xiong DD, Vidimos AT, Schmults CD, Koyfman SA. Implications of Satellitosis or In-transit Metastasis in Cutaneous Squamous Cell Carcinoma: A Prognostic Omission in Cancer Staging Systems. JAMA Dermatol 2022; 158:390-394. [PMID: 35195668 PMCID: PMC8867391 DOI: 10.1001/jamadermatol.2022.0001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Unlike Merkel cell carcinoma and melanoma, satellitosis or in-transit metastasis (S-ITM) is not incorporated into the current cutaneous squamous cell carcinoma (CSCC) staging systems. It is important to determine if the clinical outcomes of S-ITM are relevant to prognosis for patients with CSCC. OBJECTIVES To evaluate the association of S-ITM with clinical outcomes in patients with CSCC and to determine its prognostic implications. DESIGN, SETTINGS, AND PARTICIPANTS A dual-institution (Cleveland Clinic and Brigham and Women's Hospital) database was queried for patients who were treated for CSCC in 2010 to 2020. Patients who were node-negative and had S-ITM-the presence of dermal lesions between the primary tumor and first-echelon lymphatic nodal basins at any point in the disease course-were identified. Subcohorts of patients with T3N0 tumors, T4N0 tumors (bone invasive), N1 to 3, and M1 disease were identified for comparison. The American Joint Committee on Cancer staging system was used to define cancer stages. Data were analyzed from January 15 to March 31, 2021. MAIN OUTCOMES AND MEASURES Pairwise comparison of CSCC recurrence and disease-specific survival in patients with and without S-ITM was performed using Cox proportional hazard modeling. Kaplan-Meier and Fine-Gray competing risk methods were used to estimate disease-specific survival and CSCC recurrence, respectively. RESULTS In a total of 518 patients with CSCC, S-ITM was present in 72 (13.9 %) patients (median age [range], 73.9 [31.6-95.8] years; 59 [82%] men; 69 [96%] White non-Hispanic individuals; 25 [35%] patients with immunosuppression) who were node-negative. The subcohorts were composed of 341 patients with T3N0 cancer, 36 with T4N0, 70 with N1 to 3, and 19 with M1 disease. Pairwise comparisons between disease levels using Cox proportional hazard model demonstrated lower cumulative incidence of CSCC recurrence rates in the T3N0 (HR, 0.21; 95% CI, 0.14-0.30; P < .001) and T4N0 (HR, 0.36; 95% CI, 0.19-0.68; P = .001) cohorts compared with the S-ITM cohort. No significant difference was observed between patients who were node-positive and those with S-ITM (HR, 0.74; 95% CI, 0.48-1.14; P = .16). The 5-year disease-specific survival rates were 76% for T3N0, 64% for T4N0, 41% for S-ITM, and 39% for N1 to 3. Compared with the S-ITM cohort, DSS was significantly higher in the T3N0 (HR, 0.23; 95% CI, 0.15-0.35; P < .0001) and T4N0 (HR, 0.37; 95% CI, 0.19-0.76; P = .01) cohorts, and not significantly different in the node-positive (HR, 0.77; 95% CI, 0.84-3.93; P = .30) and metastatic cohorts (HR, 1.81; 95% CI, 0.84-3.93; P = .13). CONCLUSIONS AND RELEVANCE This multi-institutional cohort study found that patients with CSCC and S-ITM appear to have clinical outcomes comparable to those of patients who are node-positive, and an increased risk of recurrence and worse survival compared with patients who have T3 and T4 disease. These outcomes are similar to those observed for Merkel cell carcinoma and melanoma. Given that S-ITM may be a powerful prognostic factor, it should be incorporated into clinical staging systems.
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Affiliation(s)
- Timothy D. Smile
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Emily S. Ruiz
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kylee J. B. Kus
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts,Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Fadi Murad
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Wei Wei
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - David D. Xiong
- Case Western Reserve University School of Medicine, Cleveland, Ohio,Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Allison T. Vidimos
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - Chrysalyne D. Schmults
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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Koyfman SA. Your First Shot Is Your Best Shot. Int J Radiat Oncol Biol Phys 2022; 112:852. [DOI: 10.1016/j.ijrobp.2020.10.016] [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: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 10/19/2022]
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Sharma BK, Contrera KJ, Jia X, Fleming C, Lorenz RR, Koyfman SA, Mahomva C, Arianpour K, Burkey BB, Fritz M, Ku JA, Lamarre ED, Scharpf J, Prendes BL. Outcomes After Oral Cavity and Oropharyngeal Salvage Surgery. Laryngoscope 2022; 132:1984-1992. [PMID: 35191537 DOI: 10.1002/lary.30070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/06/2021] [Accepted: 02/02/2022] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Investigate outcomes following oral cavity and oropharyngeal salvage surgery. METHODS Adult patients who underwent salvage surgery for recurrent squamous cell carcinoma of the oral cavity and oropharynx from 1996 to 2018 were analyzed using multivariable Cox proportional hazards regression. Disease-free survival (DFS), overall survival (OS), associated factors, and basic quality measures were analyzed. RESULTS One hundred and eight patients (72% oral cavity, 28% oropharynx) were followed for a median of 17.9 months. Median DFS and OS were 9.9 and 21 months, respectively. Surgery with adjuvant chemoradiotherapy compared to surgery alone (hazard ratio [HR] = 0.15, 95% confidence interval [CI]: 0.03-0.78) and negative margins (HR = 0.36, 95% CI: 0.14-0.90) were associated with better DFS, while lymphovascular space invasion (LVSI) (HR = 2.66, 95% CI: 1.14-6.19) and higher stage (III vs. I-II, HR = 3.94, 95% CI: 1.22-12.71) were associated with worse DFS. Higher stage was associated with worse OS (HR = 3.79, 95% CI: 1.09-13.19). Patients were hospitalized for a median of 8 days with 24% readmitted within 30 days. A total of 72% and 38% of patients, respectively, underwent placement of a feeding tube or tracheostomy. CONCLUSIONS After oral cavity and oropharyngeal salvage surgery, adjuvant chemoradiotherapy, negative margins, negative LVSI, and lower stage were associated with a lower risk of recurrence. Only lower-stage disease was associated with improved survival. The majority of patients had feeding tubes, half underwent free tissue transfer, a third required tracheostomy, and a quarter was readmitted. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Bhavya K Sharma
- College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio, U.S.A
| | - Kevin J Contrera
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Xuefei Jia
- Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Christopher Fleming
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Robert R Lorenz
- Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | | | | | - Brian B Burkey
- Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Michael Fritz
- Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Jamie A Ku
- Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Eric D Lamarre
- Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
| | - Joseph Scharpf
- Head & Neck Institute, Cleveland Clinic, Cleveland, Ohio, U.S.A
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Arron ST, Wysong A, Hall MA, Bailey CN, Covington KR, Kurley SJ, Goldberg MS, Kasprzak JM, Somani A, Ibrahim SF, Brodland DG, Cleaver NJ, Maher IA, Xia Y, Koyfman SA, Newman JG. Gene expression profiling for metastatic risk in head and neck cutaneous squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2022; 7:135-144. [PMID: 35155791 PMCID: PMC8823155 DOI: 10.1002/lio2.724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/19/2021] [Accepted: 12/21/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Over 50% of newly diagnosed cutaneous squamous cell carcinoma (cSCC) lesions occur in the head and neck (cSCC-HN), and metastasis to nodal basins in this region further complicates surgical and adjuvant treatment. The current study addressed whether the 40-gene expression profile (40-GEP) test can predict metastatic risk in cSCC-HN with improved accuracy and provide independent prognostic value to complement current risk assessment methods. STUDY DESIGN Multicenter, retrospective cohort study. METHODS Formalin-fixed paraffin-embedded primary tumor tissue and associated clinical data from patients with cSCC-HN (n = 278) were collected from 33 independent centers. Samples were analyzed via the 40-GEP test. Cases were staged per American Joint Committee on Cancer, Eighth Edition (AJCC8) and Brigham and Women's Hospital (BWH) criteria after comprehensive medical record and pathology report review. Metastasis-free survival (MFS) rates were determined, and risk factors were analyzed via Cox regression. RESULTS The 40-GEP test classified the cohort into low (Class 1, n = 126; 45.3%), moderate (Class 2A, n = 134; 48.2%), and high (Class 2B, n = 18; 6.5%) metastatic risk at 3 years postdiagnosis. Regional/distant metastasis occurred in 54 patients (19.4%). MFS rates were 92.1% (Class 1), 76.1% (Class 2A), and 44.4% (Class 2B; p < .0001). Multivariate analysis of 40-GEP results with AJCC8 or BWH tumor stage, or clinicopathologic risk factors, demonstrated independent prognostic value of the 40-GEP test (p < .03). Accuracy of predicting metastatic risk was also improved using 40-GEP classification (p < .02). CONCLUSIONS Improved metastatic risk stratification through the 40-GEP test could complement cSCC-HN risk assessment for better-informed decision-making for treatment and surveillance and ultimately improve patient outcomes. LEVEL OF EVIDENCE 3.
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Affiliation(s)
| | - Ashley Wysong
- Department of DermatologyUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Mary A. Hall
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | | | - Kyle R. Covington
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | - Sarah J. Kurley
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | - Matthew S. Goldberg
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
- Department of DermatologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Julia M. Kasprzak
- Department of DermatologyMedical College of WisconsinMilwaukeeWisconsinUSA
| | - Ally‐Khan Somani
- Department of DermatologyIndiana University School of MedicineIndianapolisIndianaUSA
| | - Sherrif F. Ibrahim
- Department of DermatologyUniversity of Rochester Medical CenterRochesterNew YorkUSA
- Rochester Dermatologic SurgeryVictorNew YorkUSA
| | - David G. Brodland
- Zitelli and Brodland, P.C., Z&B Skin Cancer CenterPittsburghPennsylvaniaUSA
| | | | | | - Yang Xia
- Brooke Army Medical CenterSan AntonioTexasUSA
| | | | - Jason G. Newman
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Wu SS, Chen B, Fleming CW, Shah AA, Griffith CC, Domb C, Reddy CA, Campbell SR, Woody NM, Lamarre ED, Lorenz RR, Prendes BL, Scharpf J, Schwartzman L, Geiger JL, Koyfman SA, Ku JA. Nasopharyngeal cancer: Incidence and prognosis of human papillomavirus and Epstein-Barr virus association at a single North American institution. Head Neck 2022; 44:851-861. [PMID: 35040516 DOI: 10.1002/hed.26976] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/21/2021] [Accepted: 01/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The prognostication of Epstein-Barr virus (EBV) and human papillomavirus (HPV) status in nasopharyngeal cancer (NPC) is unclear. METHODS This retrospective study analyzed NPC from 2000 to 2019. RESULTS Seventy-eight patients were included: 43 EBV+ , 12 HPV+ , 23 EBV- /HPV- , and 0 EBV+ /HPV+ . All p16+ tumors were also positive for HPV-CISH. Baseline characteristics were not different between groups except age, N-classification, and Karnofsky Performance Scale (KPS) (p < 0.05). For EBV+ , HPV+ , and EBV- /HPV- respectively, 3-year overall survival (OS) was 89.9%, 69.8%, and 52.5% (p = 0.006). EBV- /HPV- status was significantly associated with worse OS but not freedom from progression (FFP) on univariate analysis, and did not remain a significant predictor of OS after adjusting for KPS, age, and group stage. CONCLUSIONS EBV+ NPC tumors were seen in younger, healthier patients than HPV+ and EBV- tumors, and there were no cases of coinfection. The association of viral status with OS was insignificant after adjusting for KPS and age.
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Affiliation(s)
- Shannon S Wu
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Bonnie Chen
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher W Fleming
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Akeesha A Shah
- Department of Pathology, Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher C Griffith
- Department of Pathology, Pathology & Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chaim Domb
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Chandana A Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Eric D Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Robert R Lorenz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Larissa Schwartzman
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jessica L Geiger
- Department of Hematology & Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie A Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Gupta N, Weitzman RE, Murad F, Koyfman SA, Smile TD, Chang MS, Maher JM, Schmults CD, Vidimos AT, Ruiz ES. Identifying Brigham and Women's Hospital stage T2a cutaneous squamous cell carcinomas at risk of poor outcomes. J Am Acad Dermatol 2021; 86:1301-1308. [PMID: 34864111 DOI: 10.1016/j.jaad.2021.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/29/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although most of the poor outcomes with cutaneous squamous cell carcinoma (CSCC) occur in high-stage tumors, 26% of nodal metastases and 8% of disease-specific deaths develop in Brigham and Women's Hospital (BWH) T2a tumors. OBJECTIVE To determine risk factors associated with poor outcomes (nodal metastasis, distant metastases, and disease-specific deaths) in BWH T2a CSCC. METHODS A 17-year retrospective multi-institutional cohort study of primary CSCC BWH T2a tumors. A predictive model based on tumor characteristics was developed to identify those at higher risk of poor outcomes. RESULTS Presence of 1 major criterion (primary tumor diameter ≥40 mm, invasion depth beyond subcutaneous fat, poor differentiation, or large-caliber perineural invasion) and ≥ 1 minor criterion (invasion depth in subcutaneous fat, moderate differentiation, small-caliber perineural invasion, or lymphovascular invasion) was most predictive of developing poor outcomes (area under the curve, 0.53; C-statistic, 0.60). This model has a sensitivity of 7.7%, specificity of 97.4%, and a positive and negative predictive value of 33.3% and 86.1%, respectively. The 5-year cumulative incidence of poor outcomes in these tumors is 8.0% (95% CI, 5.1-13.7) compared to 2.8% (95% CI, 1.9-4.1) in other T2a tumors (sub-hazard ratio, 3.0; 95% CI, 1.5-5.8). LIMITATIONS Multi-institutional cohort study was not externally validated. CONCLUSIONS BWH T2a-high CSCCs have an 8% chance of developing poor outcomes.
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Affiliation(s)
- Neha Gupta
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rachel E Weitzman
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael S Chang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jacqueline M Maher
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; New York Medical College, Valhalla, New York
| | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Corredor G, Toro P, Koyuncu C, Lu C, Buzzy C, Bera K, Fu P, Mehrad M, Ely KA, Mokhtari M, Yang K, Chute D, Adelstein DJ, Thompson LDR, Bishop JA, Faraji F, Thorstad W, Castro P, Sandulache V, Koyfman SA, Lewis JS, Madabhushi A. An Imaging Biomarker of Tumor-Infiltrating Lymphocytes to Risk-Stratify Patients With HPV-Associated Oropharyngeal Cancer. J Natl Cancer Inst 2021; 114:609-617. [PMID: 34850048 PMCID: PMC9002277 DOI: 10.1093/jnci/djab215] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/03/2021] [Accepted: 11/19/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has excellent control rates compared to nonvirally associated OPSCC. Multiple trials are actively testing whether de-escalation of treatment intensity for these patients can maintain oncologic equipoise while reducing treatment-related toxicity. We have developed OP-TIL, a biomarker that characterizes the spatial interplay between tumor-infiltrating lymphocytes (TILs) and surrounding cells in histology images. Herein, we sought to test whether OP-TIL can segregate stage I HPV-associated OPSCC patients into low-risk and high-risk groups and aid in patient selection for de-escalation clinical trials. METHODS Association between OP-TIL and patient outcome was explored on whole slide hematoxylin and eosin images from 439 stage I HPV-associated OPSCC patients across 6 institutional cohorts. One institutional cohort (n = 94) was used to identify the most prognostic features and train a Cox regression model to predict risk of recurrence and death. Survival analysis was used to validate the algorithm as a biomarker of recurrence or death in the remaining 5 cohorts (n = 345). All statistical tests were 2-sided. RESULTS OP-TIL separated stage I HPV-associated OPSCC patients with 30 or less pack-year smoking history into low-risk (2-year disease-free survival [DFS] = 94.2%; 5-year DFS = 88.4%) and high-risk (2-year DFS = 82.5%; 5-year DFS = 74.2%) groups (hazard ratio = 2.56, 95% confidence interval = 1.52 to 4.32; P < .001), even after adjusting for age, smoking status, T and N classification, and treatment modality on multivariate analysis for DFS (hazard ratio = 2.27, 95% confidence interval = 1.32 to 3.94; P = .003). CONCLUSIONS OP-TIL can identify stage I HPV-associated OPSCC patients likely to be poor candidates for treatment de-escalation. Following validation on previously completed multi-institutional clinical trials, OP-TIL has the potential to be a biomarker, beyond clinical stage and HPV status, that can be used clinically to optimize patient selection for de-escalation.
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Affiliation(s)
- Germán Corredor
- Department of Biomedical Engineering, Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, USA,Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Paula Toro
- Department of Biomedical Engineering, Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, USA
| | - Can Koyuncu
- Department of Biomedical Engineering, Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, USA
| | - Cheng Lu
- Department of Biomedical Engineering, Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, USA
| | - Christina Buzzy
- Department of Biomedical Engineering, Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, USA
| | - Kaustav Bera
- Department of Biomedical Engineering, Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, USA
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Mitra Mehrad
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kim A Ely
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mojgan Mokhtari
- Department of Biomedical Engineering, Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, USA
| | - Kailin Yang
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Deborah Chute
- Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - David J Adelstein
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Lester D R Thompson
- Department of Pathology, Southern California Permanente Medical Group, Woodland Hills, CA, USA
| | - Justin A Bishop
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Farhoud Faraji
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, UC San Diego Health, La Jolla, CA, USA
| | - Wade Thorstad
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MS, USA
| | - Patricia Castro
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Vlad Sandulache
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA,ENT Section, Operative Care Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA,Center for Translational Research on Inflammatory Disease (CTRID), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - James S Lewis
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anant Madabhushi
- Correspondence to: Anant Madabhushi, PhD, Center of Computational Imaging and Personalized Diagnostics, Case Western Reserve University, 2071 Martin Luther King Drive, Cleveland, OH 44106-7207, USA (e-mail: )
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Ibrahim SF, Kasprzak JM, Hall MA, Fitzgerald AL, Siegel JJ, Kurley SJ, Covington KR, Goldberg MS, Farberg AS, Trotter SC, Reed K, Brodland DG, Koyfman SA, Somani AK, Arron ST, Wysong A. Enhanced metastatic risk assessment in cutaneous squamous cell carcinoma with the 40-gene expression profile test. Future Oncol 2021; 18:833-847. [PMID: 34821148 DOI: 10.2217/fon-2021-1277] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim: To clinically validate the 40-gene expression profile (40-GEP) test for cutaneous squamous cell carcinoma patients and evaluate coupling the test with individual clinicopathologic risk factor-based assessment methods. Patients & methods: In a 33-site study, primary tumors with known patient outcomes were assessed under clinical testing conditions (n = 420). The 40-GEP results were integrated with clinicopathologic risk factors. Kaplan-Meier and Cox regression analyses were performed for metastasis. Results: The 40-GEP test demonstrated significant prognostic value. Risk classification was improved via integration of 40-GEP results with clinicopathologic risk factor-based assessment, with metastasis rates near the general cutaneous squamous cell carcinoma population for Class 1 and ≥50% for Class 2B. Conclusion: Combining molecular profiling with clinicopathologic risk factor assessment enhances stratification of cutaneous squamous cell carcinoma patients and may inform decision-making for risk-appropriate management strategies.
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Affiliation(s)
- Sherrif F Ibrahim
- Rochester Dermatologic Surgery, Victor, NY 14564, USA.,Department of Dermatology, University of Rochester Medical Center, Rochester, NY 14620, USA
| | - Julia M Kasprzak
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Mary A Hall
- Castle Biosciences, Inc., Friendswood, TX 77546, USA
| | | | | | | | | | - Matthew S Goldberg
- Castle Biosciences, Inc., Friendswood, TX 77546, USA.,Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY 10025, USA
| | - Aaron S Farberg
- Department of Dermatology, Baylor University Medical Center, Dallas, TX 75246, USA
| | | | | | | | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Ally-Khan Somani
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | | | - Ashley Wysong
- Department of Dermatology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Kus KJB, Murad F, Smile TD, Chang M, Ashrafzadeh S, Zhou G, Ilori EO, Koyfman SA, Vidimos AT, Schmults CD, Ruiz ES. Higher metastasis and death rates in cutaneous squamous cell carcinomas with lymphovascular invasion. J Am Acad Dermatol 2021; 86:766-773. [PMID: 34774657 DOI: 10.1016/j.jaad.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lymphovascular invasion (LVI) is an aggressive histologic finding but is excluded from current staging systems due to its lack of demonstrated independent prognostic significance. OBJECTIVE To evaluate the impact of LVI on cutaneous squamous cell carcinoma tumor outcomes. METHODS In total, 10,707 cutaneous squamous cell carcinoma tumors from a 20-year, retrospective, multicenter cohort were stratified by the presence (LVI+) or absence (LVI-) of LVI. Outcomes (local recurrence, in-transit metastasis, nodal metastasis, disease-specific death) were compared based on low (Brigham and Women's Hospital [BWH] stage T1/T2a) and high (BWH T2b/T3) tumor stages. RESULTS Of the 10,707 tumors, 78 had LVI. The analysis of low-stage BWH tumors showed the LVI+ group had a significantly higher 5-year cumulative incidence of local recurrence (LVI+: 12.3%; LVI-: 1.1%; P < .01), metastasis (LVI+: 4.2%; LVI-: 0.4%; P < .01), and disease-specific death (LVI+: 16.2%; LVI-: 0.4%; P < .01). The analysis of BWH high-stage tumors showed the LVI+ group maintained a higher 5-year cumulative incidence of metastasis (LVI+: 28.5%; LVI-: 16.8%; P = .06) and disease-specific death (LVI+: 25.3%; LVI-: 13.9%; P = .03), however, there was no difference in local recurrence (LVI+: 16.3%; LVI-: 15.8%; P = .11). LIMITATIONS Retrospective study design. CONCLUSION LVI+ cutaneous squamous cell carcinomas have higher rates of metastasis and death at 5 years. Future staging systems should consider incorporating LVI.
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Affiliation(s)
- Kylee J B Kus
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Michael Chang
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sepideh Ashrafzadeh
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Guohai Zhou
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
| | - Evelyn O Ilori
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio; Department of Pathology, University of Texas Southwestern, Dallas, Texas
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Chrysalyne D Schmults
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Emily S Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Cui T, Ward MC, Kittel JA, Joshi N, Koyfman SA, Xia P. Dosimetric Benefits of Omitting Primary Tumor Beds in Postoperative Radiotherapy After Transoral Robotic Surgery Using the Auto-Planning Technique. Cureus 2021; 13:e18065. [PMID: 34671536 PMCID: PMC8520787 DOI: 10.7759/cureus.18065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction: It has been suggested that post-transoral robotic surgery (post-TORS) radiotherapy (RT) might reduce the dose to organs at risk (OARs) adjacent to the primary tumor bed; however, the evidence supporting this has yet to be sufficient. This study examined the radiation dose reduction to OARs by omitting the primary tumor bed through the use of an Auto-Planning (AP)-based workflow. Methods: Twelve patients were identified who underwent post-TORS RT to the primary tumor bed and the unilateral/bilateral neck lymph nodes. In each patient, two treatment plans were designed: a Comprehensive (Comp)-plan treating the original planning target volume (PTV) including both the primary tumor bed and the lymph nodes, and a Neck-plan treating only the lymph nodes and omitting the primary tumor bed. Both plans were optimized using AP to ensure plan quality consistency. We compared the doses received by 95% of the primary tumor beds and lymph nodes (D95%) and our institutional dose constraints for the OARs between the Comp- and Neck-plans. Statistical analysis was performed using R Statistical Software (R Foundation for Statistical Computing, Vienna, Austria) with a two-tailed paired Wilcoxon signed-rank test. Results: All plans met target dose coverage requirements with at least 95% of the PTVs covered with the corresponding prescription doses. The primary tumor bed in the Neck-plans was spared with a significantly lower mean D95% (25.9 Gy vs. 60.0 Gy; p < 0.01; Wilcoxon test). The mean dose to the oral cavity (20.9 Gy vs. 28.1 Gy; p < 0.01) and the supraglottis (36.9 Gy vs. 28.2 Gy; p < 0.01) was significantly lower in the Neck-plans. Conclusion: This study suggests that sparing the primary tumor bed during post-TORS RT offers dosimetric benefits to nearby OARs with significant dose reductions to the oral cavity and supraglottis. Further study of the clinical risks and benefits afforded by this strategy is needed.
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Affiliation(s)
- Taoran Cui
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, USA
| | - Matthew C Ward
- Department of Radiation Oncology, Atrium Health, Charlotte, USA
| | | | - Nikhil Joshi
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, USA
| | - Ping Xia
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, USA
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45
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Domb C, Smile TD, Reddy C, Woody NM, Campbell SR, Canavan JF, Joshi NP, Greskovich JF, Chute DJ, Burkey BB, Ku LA, Lamarre E, Lorenz RR, Prendes B, Scharpf J, Schwartzman L, Geiger JL, Koyfman SA, Fleming CW. Updated Outcomes of Split Course Radiotherapy in Elderly or Infirm Patients With Advanced Cancers of the Head and Neck. Anticancer Res 2021; 41:4995-5000. [PMID: 34593447 DOI: 10.21873/anticanres.15313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Head and neck cancers are often treated with extended courses of radiotherapy (RT), which may prove excessively toxic for frail patients. Split course RT (SCRT) delivers two courses of RT separated by 4-6 weeks, personalizing treatment intensity based on response. In this study, we present our updated experience using this technique. PATIENTS AND METHODS From a single institution database, we identified patients considered for SCRT. For patients undergoing a second course of RT, cumulative incidence of locoregional recurrence (LRR) and overall survival (OS) are reported. RESULTS A total of 98 patients were included, of whom seventy-five percent underwent a second course of RT. The most common fractionation was 30 Gy in 10 fractions for each course, with a median cumulative dose of 60 Gy. In those undergoing a second course of RT, median OS was 9.7 months and cumulative incidence of LRR at 6, 12, and 24 months was 17.0%, 23.1%, and 29.4%, respectively. CONCLUSION SCRT offers an attractive treatment paradigm to personalize radiation intensity based on patient tolerance, while maintaining reasonable safety and efficacy in those unfit for standard full course RT.
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Affiliation(s)
- Chaim Domb
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Chandana Reddy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Shauna R Campbell
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Joycelin F Canavan
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Nikhil P Joshi
- Department of Radiation Oncology, Rush University Cancer Center, Chicago, IL, U.S.A
| | - John F Greskovich
- Department of Radiation Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, U.S.A
| | - Deborah J Chute
- Department of Pathology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Brian B Burkey
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Lamie A Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Eric Lamarre
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Robert R Lorenz
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Brandon Prendes
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Larisa Schwartzman
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Christopher W Fleming
- Department of Radiation Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, FL, U.S.A.;
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46
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Song B, Yang K, Garneau J, Lu C, Li L, Lee J, Stock S, Braman NM, Koyuncu CF, Toro P, Fu P, Koyfman SA, Lewis JS, Madabhushi A. Radiomic Features Associated With HPV Status on Pretreatment Computed Tomography in Oropharyngeal Squamous Cell Carcinoma Inform Clinical Prognosis. Front Oncol 2021; 11:744250. [PMID: 34557418 PMCID: PMC8454409 DOI: 10.3389/fonc.2021.744250] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/16/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose There is a lack of biomarkers for accurately prognosticating outcome in both human papillomavirus-related (HPV+) and tobacco- and alcohol-related (HPV-) oropharyngeal squamous cell carcinoma (OPSCC). The aims of this study were to i) develop and evaluate radiomic features within (intratumoral) and around tumor (peritumoral) on CT scans to predict HPV status; ii) investigate the prognostic value of the radiomic features for both HPV- and HPV+ patients, including within individual AJCC eighth edition-defined stage groups; and iii) develop and evaluate a clinicopathologic imaging nomogram involving radiomic, clinical, and pathologic factors for disease-free survival (DFS) prediction for HPV+ patients. Experimental Design This retrospective study included 582 OPSCC patients, of which 462 were obtained from The Cancer Imaging Archive (TCIA) with available tumor segmentation and 120 were from Cleveland Clinic Foundation (CCF, denoted as SCCF) with HPV+ OPSCC. We subdivided the TCIA cohort into training (ST, 180 patients) and validation (SV, 282 patients) based on an approximately 3:5 ratio for HPV status prediction. The top 15 radiomic features that were associated with HPV status were selected by the minimum redundancy-maximum relevance (MRMR) using ST and evaluated on SV. Using 3 of these 15 top HPV status-associated features, we created radiomic risk scores for both HPV+ (RRSHPV+) and HPV- patients (RRSHPV-) through a Cox regression model to predict DFS. RRSHPV+ was further externally validated on SCCF. Nomograms for the HPV+ population (Mp+RRS) were constructed. Both RRSHPV+ and Mp+RRS were used to prognosticate DFS for the AJCC eighth edition-defined stage I, stage II, and stage III patients separately. Results RRSHPV+ was prognostic for DFS for i) the whole HPV+ population [hazard ratio (HR) = 1.97, 95% confidence interval (CI): 1.35-2.88, p < 0.001], ii) the AJCC eighth stage I population (HR = 1.99, 95% CI: 1.04-3.83, p = 0.039), and iii) the AJCC eighth stage II population (HR = 3.61, 95% CI: 1.71-7.62, p < 0.001). HPV+ nomogram Mp+RRS (C-index, 0.59; 95% CI: 0.54-0.65) was also prognostic of DFS (HR = 1.86, 95% CI: 1.27-2.71, p = 0.001). Conclusion CT-based radiomic signatures are associated with both HPV status and DFS in OPSCC patients. With additional validation, the radiomic signature and its corresponding nomogram could potentially be used for identifying HPV+ OPSCC patients who might be candidates for therapy deintensification.
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Affiliation(s)
- Bolin Song
- Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States
| | - Kailin Yang
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, United States
| | - Jonathan Garneau
- Department of Otolaryngology and Head and Neck Surgery, University of Virginia, Charlottesville, VA, United States
| | - Cheng Lu
- Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States
| | - Lin Li
- Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States
| | - Jonathan Lee
- Imaging Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Sarah Stock
- Imaging Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Nathaniel M Braman
- Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States
| | - Can Fahrettin Koyuncu
- Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States
| | - Paula Toro
- Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, United States
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Anant Madabhushi
- Center for Computational Imaging and Personalized Diagnostics, Case Western Reserve University, Cleveland, OH, United States.,Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, United States
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47
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Newman JG, Hall MA, Kurley SJ, Cook RW, Farberg AS, Geiger JL, Koyfman SA. Adjuvant therapy for high-risk cutaneous squamous cell carcinoma: 10-year review. Head Neck 2021; 43:2822-2843. [PMID: 34096664 PMCID: PMC8453797 DOI: 10.1002/hed.26767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Standard of care for high-risk cutaneous squamous cell carcinoma (cSCC) is surgical excision of the primary lesion with clear margins when possible, and additional resection of positive margins when feasible. Even with negative margins, certain high-risk factors warrant consideration of adjuvant therapy. However, which patients might benefit from adjuvant therapy is unclear, and supporting evidence is conflicting and limited to mostly small retrospective cohorts. Here, we review literature from the last decade regarding adjuvant radiation therapy and systemic therapy in high-risk cSCC, including recent and current trials and the role of immune checkpoint inhibitors. We demonstrate evidence gaps in adjuvant therapy for high-risk cSCC and the need for prognostic tools, such as gene expression profiling, to guide patient selection. More large-cohort clinical studies are needed for collecting high-quality, evidence-based data for determining which patients with high-risk cSCC may benefit from adjuvant therapy and which therapy is most appropriate for patient management.
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Affiliation(s)
- Jason G. Newman
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Mary A. Hall
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | - Sarah J. Kurley
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | - Robert W. Cook
- Research and Development, Castle Biosciences, Inc.FriendswoodTexasUSA
| | - Aaron S. Farberg
- Section of DermatologyBaylor University Medical CenterDallasTexasUSA
| | - Jessica L. Geiger
- Department of Hematology and Medical OncologyCleveland ClinicClevelandOhioUSA
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48
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Babar A, Woody NM, Ghanem AI, Tsai J, Dunlap NE, Schymick M, Liu HY, Burkey BB, Lamarre ED, Ku JA, Scharpf J, Prendes BL, Joshi NP, Caudell JJ, Siddiqui F, Porceddu SV, Lee N, Schwartzman L, Koyfman SA, Adelstein DJ, Geiger JL. Outcomes of Post-Operative Treatment with Concurrent Chemoradiotherapy (CRT) in High-Risk Resected Oral Cavity Squamous Cell Carcinoma (OCSCC): A Multi-Institutional Collaboration. ACTA ACUST UNITED AC 2021; 28:2409-2419. [PMID: 34209302 PMCID: PMC8293216 DOI: 10.3390/curroncol28040221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/13/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
Adjuvant chemoradiation (CRT), with high-dose cisplatin remains standard treatment for oral cavity squamous cell carcinoma (OCSCC) with high-risk pathologic features. We evaluated outcomes associated with different cisplatin dosing and schedules, concurrent with radiation (RT), and the effect of cumulative dosing of cisplatin. An IRB-approved collaborative database of patients (pts) with primary OCSCC (Stage I–IVB AJCC 7th edition) treated with primary surgical resection between January 2005 and January 2015, with or without adjuvant therapy, was established from six academic institutions. Patients were categorized by cisplatin dose and schedule, and resultant groups compared for demographic data, pathologic features, and outcomes by statistical analysis to determine disease free survival (DFS) and freedom from metastatic disease (DM). From a total sample size of 1282 pts, 196 pts were identified with high-risk features who were treated with adjuvant CRT. Administration schedule of cisplatin was not significantly associated with DFS. On multivariate (MVA), DFS was significantly better in patients without perineural invasion (PNI) and in those receiving ≥200 mg/m2 cisplatin dose (p < 0.001 and 0.007). Median DFS, by cisplatin dose, was 10.5 (<200 mg/m2) vs. 20.8 months (≥200 mg/m2). Our analysis demonstrated cumulative cisplatin dose ≥200 mg/m2 was associated with improved DFS in high-risk resected OCSCC pts.
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Affiliation(s)
- Arslan Babar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA;
| | - Neil M. Woody
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (N.M.W.); (N.P.J.); (S.A.K.)
| | - Ahmed I. Ghanem
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI 48202, USA; (A.I.G.); (M.S.); (F.S.)
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria 00203, Egypt
| | - Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.T.); (N.L.)
| | - Neal E. Dunlap
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY 40202, USA; (N.E.D.); (S.V.P.)
| | - Matthew Schymick
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI 48202, USA; (A.I.G.); (M.S.); (F.S.)
| | - Howard Y. Liu
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia;
| | - Brian B. Burkey
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Eric D. Lamarre
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Jamie A. Ku
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Joseph Scharpf
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Brandon L. Prendes
- Head and Neck Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (B.B.B.); (E.D.L.); (J.A.K.); (J.S.); (B.L.P.)
| | - Nikhil P. Joshi
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (N.M.W.); (N.P.J.); (S.A.K.)
| | - Jimmy J. Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA;
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI 48202, USA; (A.I.G.); (M.S.); (F.S.)
| | - Sandro V. Porceddu
- Department of Radiation Oncology, University of Louisville Hospital, Louisville, KY 40202, USA; (N.E.D.); (S.V.P.)
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.T.); (N.L.)
| | - Larisa Schwartzman
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (L.S.); (D.J.A.)
| | - Shlomo A. Koyfman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (N.M.W.); (N.P.J.); (S.A.K.)
| | - David J. Adelstein
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (L.S.); (D.J.A.)
| | - Jessica L. Geiger
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH 44195, USA; (L.S.); (D.J.A.)
- Correspondence:
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49
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Koyfman SA, Wysong A, Arron S, Somani AKB, Siegel J, Fitzgerald A, Kurley SJ, Goldberg MS, Schmults C, Newman J. Improved risk stratification in an adjuvant radiation therapy (ART) eligible cutaneous squamous cell carcinoma (cSCC) patient population by integration of the 40-gene expression profile prognostic test (40-GEP). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e21589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21589 Background: Although cure rates are high for cSCC, an estimated 2-6% of cSCC patients will develop regional/distant metastasis and due to high incidence, mortality levels are similar to melanoma. ART is used for high-risk cSCC (HRcSCC) patients to reduce the risk of recurrence and/or metastasis, but guidelines are confounding and lack clarity regarding which patients may benefit from ART. The 40-GEP test has been validated to predict a patient’s risk for regional/distant metastasis: Class 1-low; Class 2A-moderate; and Class 2B-high risk for metastasis. We hypothesize that a 40-GEP Class result could help further stratify patient risk within an ART-eligible population. Methods: Using criteria within NCCN guidelines and other high-risk features to determine ART-eligibility, 86 cases of the 420 HRcSCC patients having known outcomes from the 40-GEP multicenter validation cohort were identified. Criteria included patients presenting with two or more risk factors: tumor diameter ≥2 cm, poor differentiation, perineural invasion ≥0.1 mm, invasion beyond subcutaneous fat, and immunosuppression. Kaplan-Meier survival analysis and log rank test were used to assess metastasis free survival (MFS). Univariate Cox regression compared metastasis rates between 40-GEP Class results. Results: The 3-year MFS rate for the overall ART-eligible cohort was 65% (n = 86, 32 events, 95% CI: 56 – 76%). The 40-GEP demonstrated statistically significant stratification of risk with MFS rates of 79%, 63% and 33% for Class 1, Class 2A and Class 2B, respectively (p = 0.005). Cox regression was significant between Class 1 and Class 2B 40-GEP results (p = 0.002), with Class 2B having a 4.59-fold increase in metastases. 40% (34/86) of the cohort received a Class 1 result, highlighting HRcSCC patients who may be considered for reduction or avoidance of ART. In 14% (12/86) of cases with a Class 2B result, 2 of 3 patients went on to have metastasis and thus may be appropriate for more aggressive intervention in the setting of a clinical trial. Those cases meeting eligibility for 40-GEP testing but not ART-criteria (n = 334) and with a Class 2B result (n = 11) had a 64% MFS rate, similar to the ART-eligible population. Conclusions: The 40-GEP test stratifies a patient’s risk of regional and/or distant metastasis in patients for whom ART is typically considered. Incorporation of 40-GEP testing may help guide patient management decisions in HRcSCC by potentially decreasing over-treatment of patients with HRcSCC and identifying patients with otherwise lower risk disease who may benefit from ART and/or other adjunctive therapies.
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Affiliation(s)
| | | | - Sarah Arron
- University of California, San Francisco, San Francisco, CA
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Smile TD, Xiong DX, Varra V, Winter IW, Beal BT, Gastman BR, Geiger JL, Adelstein DJ, Bergfeld WF, Piliang MP, Billings SD, Ko JS, Knackstedt TJ, Lucas JL, Poblete-Lopez CM, Meine JG, Vij A, Vidimos AT, Koyfman SA. Disease Progression in Cutaneous Squamous Cell Carcinoma Patients With Satellitosis and In-transit Metastasis. Anticancer Res 2021; 41:289-295. [PMID: 33419823 DOI: 10.21873/anticanres.14775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Satellitosis/in-transit metastasis (S-ITM) has prognostic value in melanoma and Merkel cell carcinoma, but is not incorporated into cutaneous squamous cell carcinoma (cSCC) staging. PATIENTS AND METHODS From our IRB-approved registry, patients with high-risk cSCC, including patients with S-ITM, were identified. Univariate (UVA) and multivariate (MVA) analyses were performed to compare disease progression (DP) and overall survival (OS). Cumulative incidence of DP and OS analyses were performed using Fine-Gray and Kaplan-Meier methods, respectively. RESULTS A total of 18 S-ITM subjects were compared to 247 high risk subjects including T3N0 (n=143), N1-N3 without extranodal extension (ENE) (n=56), N1-N3 with ENE (n=26) and M1 disease (n=22). Median follow up was 16.5 months. Three-year rates of DP were 22% for T3N0, 42% for S-ITM, 48% for T4 bone invasion, 50% for N1-N3 without extranodal extension (ENE), 53% for N1-N3 with ENE, and 66% for M1. Patients with S-ITM did not experience significantly worse DP compared to those with T3N0 (HR=1.96, 95%CI=0.8-4.9; p=0.14). CONCLUSION Cutaneous SCC patients with S-ITM experienced outcomes similar to locally advanced non-metastatic cSCC patients. Larger studies are needed to guide incorporation into staging systems.
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Affiliation(s)
- Timothy D Smile
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A.;
| | - David X Xiong
- College of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A.,Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - Vamsi Varra
- College of Medicine, Case Western Reserve University, Cleveland, OH, U.S.A.,Department of Internal Medicine, University Hospitals Medical Center, Cleveland, OH, U.S.A
| | - Ian W Winter
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Brandon T Beal
- Jacksonville Skin Cancer Specialists, Jacksonville, FL, U.S.A
| | - Brian R Gastman
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Jessica L Geiger
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - David J Adelstein
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | | | | | | | - Jennifer S Ko
- Institute of Pathology, Cleveland Clinic, Cleveland, OH, U.S.A
| | | | - Jennifer L Lucas
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | | | - Jon G Meine
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Alok Vij
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Allison T Vidimos
- Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, U.S.A
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A
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