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Chen CY, Huang BS, Hong JH, Chang JTC, Chen MC, Tang WR, Shun SC, Chen ML. Persistent Fatigue in Patients With Hepatocellular Carcinoma Receiving Radiotherapy. J Nurs Res 2024; 32:e319. [PMID: 38506576 DOI: 10.1097/jnr.0000000000000606] [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: 03/21/2024] Open
Abstract
BACKGROUND Radiation therapy has attracted much attention in the treatment of patients with hepatocellular carcinoma (HCC). However, the association between radiotherapy-related fatigue and HCC has been examined in only a few studies. PURPOSE This study was designed to explore the change over time in fatigue in patients with HCC treated with radiotherapy and related factors. METHODS One hundred patients were enrolled in this prospective longitudinal study using convenience sampling at a medical center in northern Taiwan. The Functional Assessment of Chronic Illness Therapy-Fatigue scale, the Brief Pain Inventory-Short Form, and the psychological subscale of Memorial Symptom Assessment Scale-Short Form were used to assess the symptoms at five time points: before radiotherapy (T0), during treatment (T1), and at 1 month (T2), 3 months (T3), and 6 months (T4) after radiotherapy. The generalized estimating equations method was used to determine the changes in fatigue and the influencing factors. RESULTS Fatigue levels at T1, T2, T3, and T4 were significantly higher than that at T0. Higher fatigue was significantly associated with lower income and poorer functional status. Having worse pain levels and psychological symptoms were both associated with higher fatigue. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The results indicate fatigue does not recover to the baseline (pretherapy) level by 6 months after radiotherapy. Thus, fatigue in patients with HCC receiving radiotherapy should be regularly and effectively assessed, and patients experiencing pain and psychological symptoms should be given greater attention from clinicians.
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Affiliation(s)
- Chiao-Yi Chen
- MS, RN, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Bing-Shen Huang
- MD, Associate Professor, Department of Radiation Oncology, Chang Gung Memorial Hospital; and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ji-Hong Hong
- MD, PhD, Professor, Department of Radiation Oncology, Chang Gung Memorial Hospital; and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- MD, MHA, Professor, Department of Radiation Oncology, Chang Gung Memorial Hospital; and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Min-Chi Chen
- PhD, Professor, Department of Public Health and Biostatistics Consulting Center, College of Medicine, Chang Gung University, Taoyuan; and Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Woung-Ru Tang
- PhD, RN, Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shiow-Ching Shun
- PhD, RN, Professor, School of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mei-Ling Chen
- PhD, RN, Professor, School of Nursing, College of Medicine, Chang Gung University, Taoyuan; Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan; and Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
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Hung CY, Hsu MH, Lee SH, Hsueh SW, Lu CH, Yeh KY, Wang HM, Chang JTC, Hung YS, Chou WC. Impact of pretreatment quality of life on tolerance and survival outcome in head and neck cancer patients undergoing definitive CCRT. J Formos Med Assoc 2024:S0929-6646(24)00055-X. [PMID: 38331637 DOI: 10.1016/j.jfma.2024.01.022] [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: 08/08/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is a predictor of treatment outcomes in cancer patients. This study aimed to evaluate the effect of pretreatment HRQoL on treatment tolerance and survival outcomes in patients with HNC planned for concurrent chemoradiotherapy (CCRT) in Taiwan. METHODS This study included 461 patients with HNC planned for definitive CCRT at three medical centers in Taiwan between August 2017 and December 2018. HRQoL was assessed using the QLQ-HN35 one week before the initiation of CCRT. Patients were grouped based on the sum scores of QLQ-HN35 ( RESULTS The median QLQ-HN35 sum score among 461 patients was 39 (range, 30 to 96), varying with tumor site: 34 for nasopharynx, 44 for oropharynx, 45 for oral cavity, and 38 for hypopharynx. Patients with sum scores ≥ median were associated with higher risk for incomplete CCRT (13.4 % vs 6.5 %, odds ratio [OR] = 2.22, 95 % confidence interval [CI] = 1.17-4.24, p = 0.015), emergency room visits (36.4 % vs 27.0 %, OR = 1.55, 95 % CI = 1.04-2.30, p = 0.030), unexpected hospitalization (33.8 % vs 19.6 %, OR = 2.10, 95 % CI = 1.37-3.21, p = 0.001), ≥ grade 3 hematological toxicities (34.2 % vs 21.3 %, OR = 1.92, 95 % CI = 1.27-2.91, p = 0.002), ≥ grade 3 non-hematological toxicities (78.8 % vs 68.7 %, OR = 1.69, 95 % CI = 1.11-2.58, p = 0.014), and low survival outcomes (hazard radio = 2.76, 95 % CI = 1.67-4.54, p < 0.001). Patients with lower sum scores in nasopharyngeal/oropharyngeal tumors exhibited better OS than those with higher scores, while no significant difference in OS based on HRQoL was observed in oral cavity/hypopharyngeal cancer patients. Higher sum scores remained a negative indicator even after adjusting for other confounding factors. CONCLUSION In patients with HNC planned for definitive CCRT, pre-treatment HRQoL was significantly associated with treatment-related complications, tolerance, and survival outcomes. Furthermore, our results validated the clinical value of QLQ-HN35 as an indicator for predicting treatment tolerance and outcomes.
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Affiliation(s)
- Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung University, Taoyuan, Taiwan; Division of Hema-oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Mei-Hui Hsu
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hui Lee
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Wen Hsueh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Chang-Hsien Lu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Kun-Yun Yeh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Hung-Ming Wang
- Department of Hematology and Oncology, Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung University, Taoyuan, Taiwan.
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Chang YC, Wu YY, Tsan DL, Yap WK, Fan KH, Chang JTC, Shen EYL. Dose-Escalated Radiation Therapy as Primary Treatment for Residual Bladder Cancer After Transurethral Resection. Adv Radiat Oncol 2024; 9:101302. [PMID: 38260237 PMCID: PMC10801638 DOI: 10.1016/j.adro.2023.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/26/2023] [Indexed: 01/24/2024] Open
Abstract
Purpose The aim of this study was to determine whether escalating the local radiation dose can improve the outcome of residual bladder cancer after transurethral resection of bladder tumor without increasing treatment-related toxicity. Methods and Materials The treatment plans and medical records of patients with bladder cancer treated with curative-intent radiation therapy between 2008 and 2020 were reviewed. Those who had residual tumors in the computed tomography simulation images were included. A cumulative radiation dose higher than 6600 cGy was defined as dose escalation. The effect of dose escalation on 3-year locoregional control, progression-free survival, and overall survival was evaluated. Results A total of 149 patients with residual tumors were identified. The median follow-up period was 27.5 months. Among them, 51 patients received an escalated radiation dose, and 98 received a standard dose in the residual tumor area. Patients in the dose-escalation group had higher 3-year locoregional control (65.6% vs 27.8%; P < .001) and progression-free survival (42.6% vs 18.2%; P < .001) than the standard-dose group. Overall survival also showed a trend favoring the dose-escalation group (54.9% vs 36.2%; P = .059). In the multivariate analyses, the differences between the dose-escalation and standard-dose groups were significant in terms of locoregional control (hazard ratio, 0.32; CI, 0.18-0.59; P = <.001) and progression-free survival (hazard ratio, 0.51; CI, 0.32-0.82; P = .005). There was no statistical difference in acute and chronic treatment-related toxicities between the 2 groups. Conclusions The outcome of residual bladder cancer after transurethral resection of bladder tumor could be improved by dose-escalated radiation therapy.
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Affiliation(s)
- Yu-Chen Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Yao-Yu Wu
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Din-Li Tsan
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wing-Keen Yap
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Kan-Hsin Fan
- Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Eric Yi-Liang Shen
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
- Clinical Metabolomics Core Lab, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan
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Lin CH, Yan JL, Yap WK, Kang CJ, Chang YC, Tsai TY, Chang KP, Liao CT, Hsu CL, Chou WC, Wang HM, Huang PW, Fan KH, Huang BS, Tung-Chieh Chang J, Tu SJ, Lin CY. Prognostic value of interim CT-based peritumoral and intratumoral radiomics in laryngeal and hypopharyngeal cancer patients undergoing definitive radiotherapy. Radiother Oncol 2023; 189:109938. [PMID: 37806562 DOI: 10.1016/j.radonc.2023.109938] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/20/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND PURPOSE We aimed to investigate the prognostic value of peritumoral and intratumoral computed tomography (CT)-based radiomics during the course of radiotherapy (RT) in patients with laryngeal and hypopharyngeal cancer (LHC). MATERIALS AND METHODS A total of 92 eligible patients were 1:1 randomly assigned into training and validation cohorts. Pre-RT and mid-RT radiomic features were extracted from pre-treatment and interim CT. LASSO-Cox regression was used for feature selection and model construction. Time-dependent area under the receiver operating curve (AUC) analysis was applied to evaluate the models' prognostic performances. Risk stratification ability on overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method and Cox regression. The associations between radiomics and clinical parameters as well as circulating lymphocyte counts were also evaluated. RESULTS The mid-RT peritumoral (AUC: 0.77) and intratumoral (AUC: 0.79) radiomic models yielded better performance for predicting OS than the pre-RT intratumoral model (AUC: 0.62) in validation cohort. This was confirmed by Kaplan-Meier analysis, in which risk stratification depended on the mid-RT peritumoral (p = 0.009) and intratumoral (p = 0.003) radiomics could be improved for OS, in comparison to the pre-RT intratumoral radiomics (p = 0.199). Multivariate analysis identified mid-RT peritumoral and intratumoral radiomic models as independent prognostic factors for both OS and PFS. Mid-RT peritumoral and intratumoral radiomics were correlated with treatment-related lymphopenia. CONCLUSION Mid-RT peritumoral and intratumoral radiomic models are promising image biomarkers that could have clinical utility for predicting OS and PFS in patients with LHC treated with RT.
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Affiliation(s)
- Chia-Hsin Lin
- Proton and Radiation Therapy Center, Chang Gung Memorial Hospital-Linkou Medical Center, Department of Radiation Oncology, Chang Gung University, Taoyuan, Taiwan.
| | - Jiun-Lin Yan
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wing-Keen Yap
- Proton and Radiation Therapy Center, Chang Gung Memorial Hospital-Linkou Medical Center, Department of Radiation Oncology, Chang Gung University, Taoyuan, Taiwan.
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Yun-Chen Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Tsung-You Tsai
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Cheng-Lung Hsu
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Hung-Ming Wang
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Pei-Wei Huang
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Medical College of Chang Gung University, Taoyuan, Taiwan.
| | - Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.
| | - Bing-Shen Huang
- Proton and Radiation Therapy Center, Chang Gung Memorial Hospital-Linkou Medical Center, Department of Radiation Oncology, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan.
| | - Joseph Tung-Chieh Chang
- Proton and Radiation Therapy Center, Chang Gung Memorial Hospital-Linkou Medical Center, Department of Radiation Oncology, Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China.
| | - Shu-Ju Tu
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Chien-Yu Lin
- Proton and Radiation Therapy Center, Chang Gung Memorial Hospital-Linkou Medical Center, Department of Radiation Oncology, Chang Gung University, Taoyuan, Taiwan.
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Liu CH, Lin CY, Huang BS, Wei YC, Chang TY, Yeh CH, Sung PS, Jiang JL, Lin LY, Chang JTC, Fan KH. Risk of temporal lobe necrosis between proton beam and volumetric modulated arc therapies in patients with different head and neck cancers. Radiat Oncol 2023; 18:155. [PMID: 37735389 PMCID: PMC10512503 DOI: 10.1186/s13014-023-02344-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND To investigate the frequency of temporal lobe necrosis (TLN) soon after radiotherapy (RT) and identify differences among patients with various types of head and neck cancer (HNC) and between different RT methods. METHODS We retrospectively reviewed 483 patients with HNC who had completed RT in our hospital after January, 2015. These patients were followed-up at the radio-oncology department and received contrast-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) to identify metastases or recurrence of cancer at regular intervals. Meanwhile, the occurrence of TLN, graded according to the Common Terminology Criteria for Adverse Events V5.0, was recorded. We categorized the patients into nasopharyngeal carcinoma (NPC) and non-NPC groups and compared the cumulative occurrence of TLN between the groups using Kaplan-Meier and Cox regression analyses. We further compared the cumulative occurrence of TLN between proton beam therapy (PBT) and volumetric modulated arc therapy (VMAT) in patients with any HNC, NPC, and non-NPC HNC. RESULTS Compared with the non-NPC group, the NPC group had a higher frequency of TLN (5.6% vs. 0.4%, p < 0.01) and were more commonly associated with TLN in the Kaplan-Meier analysis (p < 0.01) and the Cox regression model after covariates were adjusted for (adjusted hazard ratio: 13.35, 95% confidence interval: 1.37-130.61) during the follow-up period. Furthermore, the frequency of TLN was similar between patients receiving PBT and those receiving VMAT (PBT vs. VMAT: 4.7% vs. 6.3%, p = 0.76). Kaplan-Meier analysis revealed that the accumulated risks of TLN were similar between PBT and VMAT in patients with any HNC (p = 0.44), NPC (p = 0.84), and non-NPC HNC (p = 0.70). CONCLUSION Our study demonstrated that patients with NPC are susceptible to TLN during the early period after RT. In addition, PBT may be associated with an equivalent risk of TLN when compared with VMAT in patients with NPC or other HNCs.
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Affiliation(s)
- Chi-Hung Liu
- Stroke Center, Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyüan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyüan, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chien-Yu Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyüan, Taiwan
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyüan, Taiwan
- Particle Physics and Beam Delivery Core Laboratory of Institute for Radiological Research, Linkou Medical Center, Chang Gung University/Chang Gung Memorial Hospital, Taoyüan, Taiwan
| | - Bing-Shen Huang
- School of Medicine, College of Medicine, Chang Gung University, Taoyüan, Taiwan
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan
| | - Yi-Chia Wei
- Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ting-Yu Chang
- Stroke Center, Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyüan, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyüan, Taiwan
| | - Chih-Hua Yeh
- School of Medicine, College of Medicine, Chang Gung University, Taoyüan, Taiwan
- Department of Neuroradiology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyüan, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Jian-Lin Jiang
- Stroke Center, Department of Neurology, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyüan, Taiwan
| | - Li-Ying Lin
- School of Medicine, College of Medicine, Chang Gung University, Taoyüan, Taiwan
| | - Joseph Tung-Chieh Chang
- School of Medicine, College of Medicine, Chang Gung University, Taoyüan, Taiwan.
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyüan, Taiwan.
| | - Kang-Hsing Fan
- School of Medicine, College of Medicine, Chang Gung University, Taoyüan, Taiwan.
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyüan, Taiwan.
- Taipei Chang Gung Head and Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyüan, Taiwan.
- Department of Radiation Oncology, New Taipei Municipal Tu-Cheng Hospital, New Taipei City, Taiwan.
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Li CL, Chen PY, Yang TY, Chang JTC, Tang WR, Chen ML. Changes in fatigue among cancer patients before, during, and after radiation therapy: A meta-analysis. Worldviews Evid Based Nurs 2023. [PMID: 37574783 DOI: 10.1111/wvn.12672] [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: 12/05/2022] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Fatigue is a common symptom in cancer patients receiving radiotherapy. However, previous studies report inconsistent patterns of fatigue change. AIM The aim of this study was to estimate changes in fatigue among patients with cancer before, during, and after radiotherapy. METHODS Five databases (PubMed, SDOL, CINAHL Plus with Full Text, Medline [ProQuest], and ProQuest Dissertations) were searched for studies published from January 2006 to May 2021. Three effect sizes of fatigue change (immediate, short-term, and long-term) were calculated for each primary study using standardized mean difference. A random-effect model was used to combine effect sizes across studies. Subgroup analyses and meta-regression were performed to identify potential categorical and continuous moderators, respectively. RESULTS Sixty-five studies were included in this meta-analysis. The weighted mean effect size for immediate, short-term, and long-term effects was 0.409 (p < .001; 95% CI [0.280, 0.537]), 0.303 (p < .001; 95% CI [0.189, 0.417]), and 0.201 (p = .05; 95% CI [-0.001, 0.404]), respectively. Studies with prostate cancer patients had a significantly higher short-term (0.588) and long-term weight mean effect size (0.531) than studies with breast (0.128, -0.072) or other cancers (0.287, 0.215). Higher radiotherapy dosage was significantly associated with a higher effect size for both immediate (β = .0002, p < .05) and short-term (β = .0002, p < .05) effect. LINKING EVIDENCE TO ACTION Findings from this meta-analysis indicated that radiotherapy-induced fatigue (RIF) exist for more than 3 months after the completion of treatment. Assessment of radiation-induced fatigue in cancer patients should extend long after treatment completion, especially for patients with prostate cancer and patients receiving a higher radiation dose. Interventions to reduce fatigue tailored for different treatment phases may be developed.
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Affiliation(s)
- Chia-Ling Li
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Pei-Ying Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsin-Chu, Taiwan
| | - Tsui-Yun Yang
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Linkou, Taiwan
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Mei-Ling Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial, Tao-Yuan, Taiwan
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Lu CH, Hsu CC, Su PH, Lin SY, Yeh KY, Hsueh SW, Chang JTC, Wang HM, Hung YS, Chou WC. Effect of prophylactic tube feeding in head and neck cancer patients with high Mallampati score undergoing definitive concurrent chemoradiotherapy. Support Care Cancer 2023; 31:384. [PMID: 37289404 DOI: 10.1007/s00520-023-07859-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE There is no consensus on the selection of appropriate prophylactic tube feeding in patients with head and neck squamous cell carcinoma (HNSCC) undergoing concurrent chemoradiotherapy (CCRT). This study aimed to evaluate the effect of prophylactic tube feeding in patients with HNSCC who presented with a high Mallampati score and underwent CCRT. METHODS We prospectively enrolled 185 consecutive patients with stage II to IVa HNSCC and a pre-treatment Mallampati score of 3 or 4 who received CCRT between August 2017 and December 2018 with follow-up data collected retrospectively. Patients were divided to either with or without prophylactic tube feeding group for comparison of treatment tolerance, toxicities, and quality of life(QOL). Propensity score matching (PSM) was used to achieve balanced covariates across the two groups. RESULTS Of the cohort, 52 (28.1%) and 133 (71.9%) patients were allocated to the prophylactic and non-prophylactic tube feeding groups, respectively. Before and after PSM, patients in the tube feeding group had a significantly lower incidence of incomplete radiotherapy, incompletion of chemotherapy, emergency room visits, and grade 3 or higher infection, and improved symptoms of quality of life after CCRT than those in the non-tube feeding group. CONCLUSION Prophylactic tube feeding was associated with better treatment tolerance, safety profiles, and quality of life in patients with HNSCC and high Mallampati scores who underwent CCRT. Therefore, Mallampati score might serve as a clinical tool for proactive selection of patients receiving prophylactic tube feeding in HNSCC patients upon receiving CCRT.
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Affiliation(s)
- Chang-Hsien Lu
- Department of Hematology-Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
| | - Chih-Chung Hsu
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Po-Hsu Su
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shinn-Yn Lin
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kun-Yun Yeh
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Shun-Wen Hsueh
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Joseph Tung-Chieh Chang
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Ming Wang
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yu-Shin Hung
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wen-Chi Chou
- College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan.
- Departments of Hematology-Oncology, and Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Tang SJ, Fan KH, You GR, Huang SF, Kang CJ, Huang YF, Huang YC, Chang JTC, Cheng AJ. Tumor Suppressor miRNA-503 Inhibits Cell Invasion in Head and Neck Cancer through the Wnt Signaling Pathway via the WNT3A/MMP Molecular Axis. Int J Mol Sci 2022; 23:ijms232415900. [PMID: 36555553 PMCID: PMC9786678 DOI: 10.3390/ijms232415900] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Head and neck cancer (HNC) is the fifth most common cancer worldwide, and its incidence and death rates have been consistently high throughout the past decades. MicroRNAs (miRNAs) have recently gained significant attention because of their role in the regulation of a variety of biological processes via post-transcriptional silencing mechanisms. Previously, we determined a specific profile of miRNAs associated with HNC using a miRNA microarray analysis. Of the 23 miRNAs with highly altered expression in HNC cells, miR-503 was the most significantly downregulated miRNA. In this study, we confirmed that miR-503 acts as a tumor suppressor, as our results showed decreased levels of miR-503 in cancer cells and patients with HNC. We further characterized the role of miR-503 in the malignant functions of HNC. Although there was a minimal effect on cell growth, miR-503 was found to inhibit cellular invasion significantly. Algorithm-based studies identified multiple potential target genes and pathways associated with oncogenic mechanisms. The candidate target gene, WNT3A, was confirmed to be downregulated by miR-503 at both the mRNA and protein levels and validated by a reporter assay. Furthermore, miR-503 modulated multiple invasion-associated genes, including matrix metalloproteinases (MMPs), through the Wnt downstream signaling pathway. Overall, this study demonstrates that miR-503 suppresses HNC malignancy by inhibiting cell invasion through the Wnt signaling pathway via the WNT3A/MMP molecular axis. The modulation of miR-503 may be a novel therapeutic approach to intervene in cancer invasion.
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Affiliation(s)
- Shang-Ju Tang
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal TuCheng Hospital, New Taipei City 236017, Taiwan
| | - Guo-Rung You
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology—Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - Yi-Fang Huang
- Department of General Dentistry, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yu-Chen Huang
- Department of General Dentistry, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: (J.T.-C.C.); (A.-J.C.)
| | - Ann-Joy Cheng
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
- Correspondence: (J.T.-C.C.); (A.-J.C.)
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9
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Shen EYL, Hung TM, Tsan DL, Cheng NM, Kang CJ, Huang SF, Hsu CL, Lin CY, Wang HM, Hsieh JCH, Cheng AJ, Fan KH, Chang JTC. Utilization of the lymph node-to-primary tumor ratio of PET standardized uptake value and circulating Epstein-Barr virus DNA to predict distant metastasis in nasopharyngeal carcinoma. Radiother Oncol 2022; 177:1-8. [PMID: 35568282 DOI: 10.1016/j.radonc.2022.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/25/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE To determine the clinical impact of integrating Epstein-Barr virus (EBV) DNA and lymph node-to-primary tumor ratio (NTR) of positron emission tomography (PET) standardized uptake value (SUV) in predicting distant metastasis, such as distant metastasis-free survival (DMFS), in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS We retrospectively reviewed patients diagnosed with non-disseminated NPC between 2010 and 2017. The optimal cut-off values of EBV DNA and SUV NTR were determined using receiver operating characteristic analysis. The prognostic values of SUV NTR and EBV DNA on DMFS and overall survival were evaluated using the Kaplan-Meier method. Univariate and multivariable analyses were performed using the Wald Chi-squared test and Cox proportional hazards regression, respectively. RESULTS A total of 488 patients were included in the analysis. The median follow-up period was 61.6 months. The optimal cut-off values of EBV DNA and SUV NTR were 3377.5 copies per mL and 0.64, respectively. The five-year DMFS for patients with high vs low EBV DNA and SUV NTR levels were 64.9% vs 86.6% (p < 0.001) and 78.7% vs 87.4% (p = 0.021), respectively. In subgroup analysis, the high-risk group with high levels of pretreatment EBV DNA and SUV NTR had worse DMFS in either American Joint Committee on Cancer (AJCC) stage I-III or IVA-B (p = 0.001 and <0.001, respectively). Univariate and multivariable analyses showed the statistical significance of EBV DNA, SUV NTR, and their composite in DMFS (p < 0.001 for EBV DNA; p = 0.022 for SUV NTR; p < 0.001 for their composite). CONCLUSION This study showed that EBV DNA and SUV NTR have independent and additive values as prognosticators for distant metastasis in patients with NPC, suggesting that these two individual factors, except the AJCC staging system, should be included in future studies.
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Affiliation(s)
- Eric Yi-Liang Shen
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, United Kingdom
| | - Tsung-Min Hung
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Din-Li Tsan
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Department of Radiation Oncology and Proton Therapy Center, Keelung Chang Gung Memorial Hospital and Chang Gung University, Keelung City, Taiwan
| | - Nai-Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Lung Hsu
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Jason Chia-Hsun Hsieh
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Ann-Joy Cheng
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
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10
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Chen YC, Fan KH, Lin CY, Kang CJ, Huang SF, Wang HM, Cheng AJ, Chang JTC. Outcomes of re-irradiation for oral cavity squamous cell carcinoma. Biomed J 2022; 45:940-947. [PMID: 34968771 PMCID: PMC9795343 DOI: 10.1016/j.bj.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To predict the outcome of reirradiation (re-RT) for oral cavity squamous cell carcinoma (OSCC). METHODS Eighty-three patients met the criterion of having previously irradiated OSCC treated via curative intent re-RT for recurrent or new primary OSCC. The exclusion criteria were a suboptimal dose (<45 Gy) for the first RT and palliative intent for the second irradiation. Re-RT was defined as at least 75% volume at second RT after receiving at least 45 Gy at the first RT. RESULTS The 2-year locoregional progression-free survival (LRPFS) and overall survival (OS) rates were 20% and 28%. For LRPFS, four predictors were noted through univariate analyses: performance status (PS) (p = 0.001), a dose of at least 60 Gy (p = 0.001), stage IVB (p = 0.020), and surgery before re-RT (p = 0.041). In multivariate analyses, only PS (p = 0.005) and a dose of at least 60 Gy (p = 0.001) remained significant. For OS, PS (p = 0.001) and a dose of at least 60 Gy (p = 0.042) were still independently associated predictors, but surgery before re-RT became marginally beneficial (p = 0.053). For patients with a poor PS (ECOG = 2-3), the 2-year OS was only 4.5%. Twenty-nine percent of the patients experienced severe late complications (≥Grade 3), and 18% had new episodes of osteoradionecrosis during their follow-up. CONCLUSION We identified PS and a re-RT dose ≥60 Gy as predictors for LRPFS and OS. Surgery before re-RT might improve OS. However, the treatment results of re-RT for OSCC were suboptimal. Prospective trials using modern RT techniques, in combination with new therapeutic drugs or radioenhancers, are warranted for improving these dismal outcomes.
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Affiliation(s)
- Yen-Chao Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan,Department of Radiation Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ann-Joy Cheng
- Department of Radiation Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan,Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan,Corresponding author. Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, 5, Fusing St., Gueishan, Taoyuan 333, Taiwan.
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11
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Liu CH, Huang BS, Lin CY, Yeh CH, Lee TH, Wu HC, Chang CH, Chang TY, Huang KL, Jiang JL, Chang JTC, Chang YJ. Head and Neck Cancer Types and Risks of Cervical-Cranial Vascular Complications within 5 Years after Radiation Therapy. J Pers Med 2022; 12:jpm12071060. [PMID: 35887557 PMCID: PMC9317699 DOI: 10.3390/jpm12071060] [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: 05/19/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose: to investigate the frequency of cervical−cranial vascular complications soon after radiation therapy (RT) and identify differences among patients with various types of head and neck cancer (HNC). Methods: We enrolled 496 patients with HNC who had received their final RT dose in our hospital. These patients underwent carotid duplex ultrasound (CDU) for monitoring significant carotid artery stenosis (CAS). Brain imaging were reviewed to detect vertebral, intracranial artery stenosis, or preexisted CAS before RT. Primary outcome was significant CAS at the internal or common carotid artery within first 5 years after RT. We categorized the patients into nasopharyngeal carcinoma (NPC) and non-NPC groups and compared the cumulative occurrence of significant CAS between the groups using Kaplan−Meier and Cox-regression analyses. Results: Compared to the NPC group, the non-NPC group had a higher frequency of significant CAS (12.7% vs. 2.0%) and were more commonly associated with significant CAS after adjusting the covariates (Adjusted hazard ratio: 0.17, 95% confident interval: 0.05−0.57) during the follow-up period. All the non-NPC subtypes (oral cancer/oropharyngeal, hypopharyngeal, and laryngeal cancers) were associated with higher risks of significant CAS than the NPC group (p < 0.001 respectively). Conclusion: Significant CAS was more frequently noted within 5 years of RT among the patients with non-NPC HNC than among the patients with NPC. Scheduled carotid artery surveillance and vascular risk monitoring should be commenced earlier for patients with non-NPC HNC. By contrast, vascular surveillance could be deferred to 5 years after RT completion in NPC patients.
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Affiliation(s)
- Chi-Hung Liu
- Stroke Center, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan; (C.-H.L.); (T.-H.L.); (H.-C.W.); (C.-H.C.); (T.-Y.C.); (K.-L.H.); (J.-L.J.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
| | - Bing-Shen Huang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan
| | - Chien-Yu Lin
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan
- Taipei Chang Gung Head & Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan 33333, Taiwan
- Particle Physics and Beam Delivery Core Laboratory of Institute for Radiological Research, Chang Gung Memorial Hospital, Chang Gung University, Linkou Medical Center, Taoyuan 33333, Taiwan
| | - Chih-Hua Yeh
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
- Department of Neuroradiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan
| | - Tsong-Hai Lee
- Stroke Center, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan; (C.-H.L.); (T.-H.L.); (H.-C.W.); (C.-H.C.); (T.-Y.C.); (K.-L.H.); (J.-L.J.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
| | - Hsiu-Chuan Wu
- Stroke Center, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan; (C.-H.L.); (T.-H.L.); (H.-C.W.); (C.-H.C.); (T.-Y.C.); (K.-L.H.); (J.-L.J.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
| | - Chien-Hung Chang
- Stroke Center, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan; (C.-H.L.); (T.-H.L.); (H.-C.W.); (C.-H.C.); (T.-Y.C.); (K.-L.H.); (J.-L.J.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
| | - Ting-Yu Chang
- Stroke Center, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan; (C.-H.L.); (T.-H.L.); (H.-C.W.); (C.-H.C.); (T.-Y.C.); (K.-L.H.); (J.-L.J.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
| | - Kuo-Lun Huang
- Stroke Center, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan; (C.-H.L.); (T.-H.L.); (H.-C.W.); (C.-H.C.); (T.-Y.C.); (K.-L.H.); (J.-L.J.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
| | - Jian-Lin Jiang
- Stroke Center, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan; (C.-H.L.); (T.-H.L.); (H.-C.W.); (C.-H.C.); (T.-Y.C.); (K.-L.H.); (J.-L.J.)
| | - Joseph Tung-Chieh Chang
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan 33333, Taiwan
- Taipei Chang Gung Head & Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan 33333, Taiwan
- Correspondence: (J.T.-C.C.); (Y.-J.C.)
| | - Yeu-Jhy Chang
- Stroke Center, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 33333, Taiwan; (C.-H.L.); (T.-H.L.); (H.-C.W.); (C.-H.C.); (T.-Y.C.); (K.-L.H.); (J.-L.J.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan 33333, Taiwan; (B.-S.H.); (C.-Y.L.); (C.-H.Y.)
- Chang Gung Medical Education Research Centre, Taoyuan 33333, Taiwan
- Correspondence: (J.T.-C.C.); (Y.-J.C.)
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12
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Lu LS, Wu YW, Chang JTC, Chang WT, Chao TH, Chen HHW, Chen YJ, Cheng KH, Hsu WL, Hung CL, Kuo SH, Liang JA, Lin HJ, Liu PY, Liu WS, Liu YW, Shueng PW, Wang CY, Hou CJY, Chiou JF. Risk Management for Radiation-Induced Cardiovascular Disease (RICVD): The 2022 Consensus Statement of the Taiwan Society for Therapeutic Radiology and Oncology (TASTRO) and Taiwan Society of Cardiology (TSOC). Acta Cardiol Sin 2022; 38:1-12. [PMID: 35068877 PMCID: PMC8743478 DOI: 10.6515/acs.202201_38(1).20211122a] [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] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/22/2021] [Indexed: 01/24/2023]
Abstract
Advances in cancer management have significantly improved survival in patients with cancers. Cardiovascular complications of cancer treatment are becoming significant competing causes of death in these patients. Radiotherapy is an indispensable component of cancer treatment, and irradiation of the heart and vasculature during cancer radiotherapy is now recognized as a new risk factor for cardiovascular diseases. It is important to involve multidisciplinary expertise and provide practical recommendations to promote awareness, recognize risks, and provide adequate interventions without jeopardizing cancer control. In this consensus paper, experts from the Taiwan Society for Therapeutic Radiology and Oncology and Taiwan Society of Cardiology provide a focused update on the clinical practice for risk stratification and management of radiation-induced cardiovascular disease (RICVD). We believe that implementing RICVD care under a collaborative cardio-oncology program will significantly improve cancer treatment outcomes and will facilitate high quality clinical investigations.
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Affiliation(s)
- Long-Sheng Lu
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei
| | - Yen-Wen Wu
- Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan
| | - Wei-Ting Chang
- Division of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center
| | - Ting-Hsing Chao
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University College of Medicine and Hospital
| | - Helen Hai-Wen Chen
- Department of Radiation Oncology, National Cheng Kung University Hospital, Tainan
| | - Yu-Jen Chen
- Department of Radiation Oncology, MacKay Memorial Hospital, Taipei
| | - Kai-Hung Cheng
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung
| | - Wen-Lin Hsu
- Department of Radiation Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien
| | - Chung-Lieh Hung
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital
| | - Sung-Hsin Kuo
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
| | - Ji-An Liang
- Department of Radiation Oncology, China Medical University Hospital, Taichung
| | - Hung-Ju Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Ping-Yen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Wen-Shan Liu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Yen-Wen Liu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City
| | - Chao-Yung Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan
| | | | - Jeng-Fong Chiou
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei
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13
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Lin CH, Lin CY, Fan KH, Hung SP, Chou YC, Liu CJ, Chou WC, Chen YC, Huang SF, Kang CJ, Chang KP, Wang HM, Cheng AJ, Chang JTC. Efficacy of Postoperative Unilateral Neck Irradiation in Patients with Buccal Mucosa Squamous Carcinoma with Extranodal Extension: A Propensity Score Analysis. Cancers (Basel) 2021; 13:cancers13235997. [PMID: 34885107 PMCID: PMC8656711 DOI: 10.3390/cancers13235997] [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: 09/02/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Unilateral radiotherapy (RT) as a postoperative treatment for multiple ipsilateral lymph node (LN) metastases remains controversial. We investigated the efficacy of postoperative unilateral RT for buccal mucosa squamous cell carcinoma (BMSCC) with extranodal extensions (ENEs). We retrospectively reviewed the clinical records of 186 patients with ENE+ BMSCC who received postoperative RT during 1997-2016. Propensity score matching was used to establish comparable cohorts. The endpoints were contralateral nodal control (CLNC), overall survival (OS), disease-free survival (DFS), distant metastasis-free survival (DMFS), local control (LC), and regional control (RC). After matching, 123 patients were selected for analysis; 45 (36.6%) and 78 (63.4%) patients underwent unilateral and bilateral RT, respectively. The median follow-up was 36.27 months. The survival outcomes in the unilateral and bilateral RT groups were similar: 3-year CLNC (85.6% vs. 89.1%, p = 0.748), OS (53.2% vs. 57.4%, p = 0.229), DFS (46.5% vs. 48.6%, p = 0.515), DMFS (70.7% vs. 72.0%, p = 0.499), LC (78.0% vs. 75.6%, p = 0.692), and RC (79.9% vs. 76.2%, p = 0.465). On multivariable Cox regression analysis, unilateral and bilateral RT showed comparable outcomes; the number of ENEs ≥ 4 was the only significant prognostic factor for all clinical outcomes. Using decision tree analysis, we classified our patients to have a low, intermediate, or high risk of contralateral failure based on three factors: number of ENEs, margin status, and tumor stage. In conclusion, postoperative unilateral RT did not worsen outcomes in patients with ENE+ BMSCC in this cohort. The decision tree model may assist physicians in optimizing and tailoring radiation fields.
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Affiliation(s)
- Chia-Hsin Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-Y.L.); (K.-H.F.); (S.-P.H.); (Y.-C.C.); (A.-J.C.)
| | - Chien-Yu Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-Y.L.); (K.-H.F.); (S.-P.H.); (Y.-C.C.); (A.-J.C.)
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-Y.L.); (K.-H.F.); (S.-P.H.); (Y.-C.C.); (A.-J.C.)
| | - Sheng-Ping Hung
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-Y.L.); (K.-H.F.); (S.-P.H.); (Y.-C.C.); (A.-J.C.)
| | - Yung-Chih Chou
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-Y.L.); (K.-H.F.); (S.-P.H.); (Y.-C.C.); (A.-J.C.)
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- Institute of Public Health, National Yang-Ming University, Taipei 112, Taiwan
| | - Wen-Chi Chou
- Department of Medical Oncology, Chang Gung Memorial Hospital at LinKou, Chang Gung University, Taoyuan 333, Taiwan; (W.-C.C.); (H.-M.W.)
| | - Yen-Chao Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Keelung, Keelung 204, Taiwan;
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (S.-F.H.); (C.-J.K.); (K.-P.C.)
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (S.-F.H.); (C.-J.K.); (K.-P.C.)
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (S.-F.H.); (C.-J.K.); (K.-P.C.)
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital at LinKou, Chang Gung University, Taoyuan 333, Taiwan; (W.-C.C.); (H.-M.W.)
| | - Ann-Joy Cheng
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-Y.L.); (K.-H.F.); (S.-P.H.); (Y.-C.C.); (A.-J.C.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-H.L.); (C.-Y.L.); (K.-H.F.); (S.-P.H.); (Y.-C.C.); (A.-J.C.)
- Correspondence: or ; Tel.: +88-6332812007000
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Cheng AJ, You GR, Lee CJ, Lu YC, Tang SJ, Huang YF, Huang YC, Lee LY, Fan KH, Chen YC, Huang SF, Chang JTC. Systemic Investigation Identifying Salivary miR-196b as a Promising Biomarker for Early Detection of Head-Neck Cancer and Oral Precancer Lesions. Diagnostics (Basel) 2021; 11:diagnostics11081411. [PMID: 34441345 PMCID: PMC8392418 DOI: 10.3390/diagnostics11081411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Liquid biopsy is a rapidly growing field, for it may provide a minimally invasive way to acquire pathological data for personalized medicine. This study developed a systemic strategy to discover an effective salivary biomarker for early detection of patients with head-neck squamous carcinoma (HNSC) and oral precancer lesion (OPC). Methods: A total of 10 miRNAs were examined in parallel with multiple independent cohorts. These included a training set of salivary samples from HNSC patients, the TCGA-HNSC and GSE31277 cohorts to differentiate miRNAs between tumor and normal tissues, and groups of salivary samples from healthy individuals, patients with HNSC and OPC. Results: The combined results from the salivary training set and the TCGA-HNSC cohort showed that four miRNAs (miR-148b, miR-155, miR-196b, and miR-31) consistently increased in HNSC patients. Further integration with the GSE31277 cohort, two miRNAs (miR-31 and miR-196b) maintained at high significances. Further assessment showed that salivary miR-196b was a prominent diagnostic biomarker, as it remarkably discriminated between healthy individuals and patients with HNSC (p < 0.0001, AUC = 0.767, OR = 5.64) or OPC (p < 0.0001, AUC = 0.979, OR = 459). Conclusion: Salivary miR-196b could be an excellent biomarker for diagnosing OPC and early detection of HNSC. This molecule may be used for early screening high-risk groups of HNSC.
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Affiliation(s)
- Ann-Joy Cheng
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33302, Taiwan; (A.-J.C.); (K.-H.F.); (S.-F.H.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (G.-R.Y.); (C.-J.L.); (Y.-C.L.); (S.-J.T.)
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Guo-Rung You
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (G.-R.Y.); (C.-J.L.); (Y.-C.L.); (S.-J.T.)
| | - Che-Jui Lee
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (G.-R.Y.); (C.-J.L.); (Y.-C.L.); (S.-J.T.)
| | - Ya-Ching Lu
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (G.-R.Y.); (C.-J.L.); (Y.-C.L.); (S.-J.T.)
| | - Shang-Ju Tang
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (G.-R.Y.); (C.-J.L.); (Y.-C.L.); (S.-J.T.)
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Fang Huang
- Department of General Dentistry, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Dental and Craniofacial Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yu-Chen Huang
- Department of Oral and Maxillofacial Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Li-Yu Lee
- Department of Pathology, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
| | - Kang-Hsing Fan
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33302, Taiwan; (A.-J.C.); (K.-H.F.); (S.-F.H.)
- Department of Radiation Oncology, New Taipei Municipal TuCheng Hospital, New Taipei City 236017, Taiwan
- Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yen-Chao Chen
- Department of Radiation Oncology, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Shiang-Fu Huang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33302, Taiwan; (A.-J.C.); (K.-H.F.); (S.-F.H.)
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 33302, Taiwan; (A.-J.C.); (K.-H.F.); (S.-F.H.)
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200
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Chou YC, Fan KH, Lin CY, Hung TM, Huang BS, Chang KP, Kang CJ, Huang SF, Chang PH, Hsu CL, Wang HM, Hsieh JCH, Cheng AJ, Chang JTC. Intensity Modulated Proton Beam Therapy versus Volumetric Modulated Arc Therapy for Patients with Nasopharyngeal Cancer: A Propensity Score-Matched Study. Cancers (Basel) 2021; 13:cancers13143555. [PMID: 34298769 PMCID: PMC8307135 DOI: 10.3390/cancers13143555] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: We compared the outcomes of patients with nasopharyngeal carcinoma treated with IMPT and VMAT. (2) Methods: We performed a retrospective propensity score matching analysis (1:1) of patients treated with IMPT (years: 2016-2018) and VMAT (2014-2018). Survival was estimated using the Kaplan-Meier method. Multivariate Cox proportional hazards regression analysis was used to identify the independent predictors of survival. Binary toxicity endpoint analyses were performed using a Cox model and logistic regression. (3) Results: Eighty patients who received IMPT and VMAT were included. The median follow-up time was 24.1 months in the IMPT group. Progression-free survival (PFS) and overall survival (OS) were not statistically different between the two groups but potentially better in IMPT group. In multivariate analysis, advanced N-stage and body weight loss (BWL; >7%) during radiotherapy were associated with decreased PFS. The IMPT group had significantly less requirement for nasogastric (NG) tube placement and BWL during treatment. The mean oral cavity dose was the only predictive factor in stepwise regression analysis, and IMPT required a significantly lower mean dose. However, IMPT increased the grade 3 radiation dermatitis. (4) Conclusions: IMPT is associated with reduced rates of NG tube insertion and BWL through reducing oral mean dose, potentially producing better oncologic outcomes.
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Affiliation(s)
- Yung-Chih Chou
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (K.-H.F.); (C.-Y.L.); (T.-M.H.); (B.-S.H.); (A.-J.C.)
- Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Kang-Hsing Fan
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (K.-H.F.); (C.-Y.L.); (T.-M.H.); (B.-S.H.); (A.-J.C.)
- Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Chien-Yu Lin
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (K.-H.F.); (C.-Y.L.); (T.-M.H.); (B.-S.H.); (A.-J.C.)
| | - Tsung-Min Hung
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (K.-H.F.); (C.-Y.L.); (T.-M.H.); (B.-S.H.); (A.-J.C.)
| | - Bing-Shen Huang
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (K.-H.F.); (C.-Y.L.); (T.-M.H.); (B.-S.H.); (A.-J.C.)
| | - Kai-Ping Chang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (K.-P.C.); (C.-J.K.); (S.-F.H.); (P.-H.C.)
| | - Chung-Jan Kang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (K.-P.C.); (C.-J.K.); (S.-F.H.); (P.-H.C.)
| | - Shiang-Fu Huang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (K.-P.C.); (C.-J.K.); (S.-F.H.); (P.-H.C.)
| | - Po-Hung Chang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (K.-P.C.); (C.-J.K.); (S.-F.H.); (P.-H.C.)
| | - Cheng-Lung Hsu
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-L.H.); (H.-M.W.); (J.C.-H.H.)
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-L.H.); (H.-M.W.); (J.C.-H.H.)
| | - Jason Chia-Hsun Hsieh
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (C.-L.H.); (H.-M.W.); (J.C.-H.H.)
| | - Ann-Joy Cheng
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (K.-H.F.); (C.-Y.L.); (T.-M.H.); (B.-S.H.); (A.-J.C.)
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Joseph Tung-Chieh Chang
- Proton and Radiation Therapy Center, Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333, Taiwan; (Y.-C.C.); (K.-H.F.); (C.-Y.L.); (T.-M.H.); (B.-S.H.); (A.-J.C.)
- Department of Radiation Oncology, Xiamen Chang Gung Memorial Hospital, Xiamen 361000, China
- Correspondence: ; Tel.: +886-3-3281200 (ext. 7000); Fax: +886-3-3280797
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Chan SC, Yeh CH, Chang JTC, Chang KP, Wang JH, Ng SH. Combing MRI Perfusion and 18F-FDG PET/CT Metabolic Biomarkers Helps Predict Survival in Advanced Nasopharyngeal Carcinoma: A Prospective Multimodal Imaging Study. Cancers (Basel) 2021; 13:cancers13071550. [PMID: 33800542 PMCID: PMC8036946 DOI: 10.3390/cancers13071550] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 02/06/2023] Open
Abstract
We prospectively investigated the prognostic value of imaging parameters for nasopharyngeal carcinoma (NPC) using dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted imaging (DWI), and 2-deoxy-2-[fluorine-18]fluoro-D-glucose positron emission tomography (18F-FDG PET)/computed tomography (CT). Patients with stage III-IVb NPC underwent F-FDG PET/CT, DCE-MRI, and DWI before treatment. Kaplan-Meier and Cox-regression analyses were used to assess associations of PET and MRI imaging biomarkers with overall survival (OS) and recurrence-free survival (RFS). We used independent prognosticators to establish prognostic models; model performance was examined using Harrell's concordance index (c-index). Sixty-one patients were available for analysis, as 13 patients died and 20 experienced recurrence. Total lesion glycolysis (TLG) (p = 0.002) from PET/CT and the initial area under the curve (iAUC) (p = 0.036) from DCE-MRI were identified as independent prognosticators of OS; Epstein-Barr virus (EBV) DNA (p = 0.027), the extracellular volume fraction (Ve) (p = 0.027) from DCE-MRI, and TLG/iAUC (p = 0.025) were significant predictors of RFS. The c-indices of the prognostic models incorporating TLG + iAUC in predicting OS and incorporating EBV DNA + Ve + TLG/iAUC in predicting RFS were 0.79 and 0.76, respectively. These were significantly higher than the corresponding c-indices of the TNM staging system (p = 0.047 and 0.025, respectively); they were also higher than those of models with only MRI or PET biomarkers. In conclusion, the combination of pretreatment DCE-MRI and 18F-FDG PET/CT imaging biomarkers helps survival prediction in advanced NPC. Integrating MRI perfusion with PET metabolism and plasma EBV information may aid clinicians in planning the optimal personalized management strategy.
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Affiliation(s)
- Sheng-Chieh Chan
- Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
- Department of Medicine, School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan;
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan;
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan;
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970473, Taiwan;
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan 333423, Taiwan;
- Correspondence: ; Tel.: +886-3-3281200; Fax: +886-3-3281200-2620
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Liu CH, Chang JTC, Lee TH, Chang PY, Chang CH, Wu HC, Chang TY, Huang KL, Lin CY, Fan KH, Chu CL, Chang YJ. Total plaque score helps to determine follow-up strategy for carotid artery stenosis progression in head and neck cancer patients after radiation therapy. PLoS One 2021; 16:e0246684. [PMID: 33577590 PMCID: PMC7880459 DOI: 10.1371/journal.pone.0246684] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/22/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To identify predictors of carotid artery stenosis (CAS) progression in head and neck cancer (HNC) patients after radiation therapy (RT). METHODS We included 217 stroke-naïve HNC patients with mild carotid artery stenosis after RT in our hospital. These patients underwent annual carotid duplex ultrasound (CDU) studies to monitor CAS progression. CAS progression was defined as the presence of ≥50% stenosis of the internal/common carotid artery on follow-up CDU. We recorded total plaque score (TPS) and determined the cut-off TPS to predict CAS progression. We categorized patients into high (HP) and low plaque (LP) score groups based on their TPS at enrolment. We analyzed the cumulative events of CAS progression in the two groups. RESULTS The TPS of the CDU study at enrolment was a significant predictor for CAS progression (adjusted odds ratio [aOR] = 1.69, p = 0.002). The cut-off TPS was 7 (area under the curve: 0.800), and a TPS ≥ 7 strongly predicted upcoming CAS progression (aOR = 41.106, p = 0.002). The HP group had a higher risk of CAS progression during follow-up (adjusted hazard ratio = 6.15; 95% confident interval: 2.29-16.53) in multivariable Cox analysis, and also a higher trend of upcoming ischemic stroke (HP vs. LP: 8.3% vs. 2.2%, p = 0.09). CONCLUSIONS HNC patients with a TPS ≥ 7 in any CDU study after RT are susceptible to CAS progression and should receive close monitoring within the following 2 years.
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Affiliation(s)
- Chi-Hung Liu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Taipei Chang Gung Head & Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pi-Yueh Chang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Chang
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Chuan Wu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ting-Yu Chang
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Lun Huang
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Taipei Chang Gung Head & Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Particle Physics and Beam Delivery Core Laboratory of Institute for Radiological Research, Chang Gung University/Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Medical Foundation, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Taipei Chang Gung Head & Neck Oncology Group, Chang Gung Memorial Hospital Linkou Medical Center, Taoyuan, Taiwan.,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chan-Lin Chu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yeu-Jhy Chang
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Chang Gung Medical Education Research Centre, Taoyuan, Taiwan
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Fan KH, Yeh CH, Hung SP, Kang CJ, Huang SF, Chang KP, Wang HM, Chia-Hsun Hsieh J, Lin CY, Cheng AJ, Ng SH, Tung-Chieh Chang J. Prognostic value of radiologic extranodal extension in patients with hypopharyngeal cancer treated with primary chemoradiation. Radiother Oncol 2020; 156:217-222. [PMID: 33385465 DOI: 10.1016/j.radonc.2020.12.028] [Citation(s) in RCA: 2] [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: 05/20/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the prognostic value of radiologic extranodal extension (rENE) in patients with hypopharyngeal cancer (HPC) treated with primary chemoradiation. MATERIALS AND METHODS Cancer registry data were reviewed from 2005 to 2014. Inclusion criteria included HPC, clinical N1-3 disease (AJCC staging system, 7th edition), and receiving radiotherapy. Patients with M1 diseaseor with synchronous/metachronous cancer were excluded. Staging images were reviewed by two radiologists. rENE was defined as infiltration of adjacent fat/muscles, irregular nodal surface, or irregular capsular enhancement. Clinical stage, rENE status, and clinical outcome were analyzed. RESULTS Overall, 355 patients were included. Patients with rENE had lower 3-year overall survival (OS) and recurrence-free survival (RFS) rates. Univariate analysis showed that clinical T4 or N3 stage, overall stage IV, and rENE correlated with OS and RFS. In multivariate analysis, clinical T4 or N3 stage correlated with poor OS, while clinical T4 or N3 stage and rENE were independent predictors of poor RFS. N1/2 without rENE was designated as Group 1, N1/2 with rENE as Group 2, and N3 with/without rENE as Group 3. The 3-year RFS rates in Groups 1, 2, and 3 were 55.8%, 41.0%, and 29.3%, respectively. The 3-year RFS rate in Group 1 was significantly higher than that in the other two groups. CONCLUSIONS rENE is an adverse prognostic factor for survival in patients with HPC treated with primary chemoradiation. It correlated with inferior RFS regardless of N stage. rENE may be used as a criterion for clinical ENE in future staging systems.
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Affiliation(s)
- Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal Tucheng Hospital, Taiwan; Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Ping Hung
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal Tucheng Hospital, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ann-Joy Cheng
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital at Xiamen, China.
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Hung SP, Chen PR, Ho TY, Chang KP, Chou WC, Lee CH, Wu YY, Chen PJ, Lin CH, Chou YC, Fan KH, Lin CY, Huang BS, Tung-Chieh Chang J, Wang CC, Tsang NM. Prognostic significance of the preoperative systemic immune-inflammation index in patients with oral cavity squamous cell carcinoma treated with curative surgery and adjuvant therapy. Cancer Med 2020; 10:649-658. [PMID: 33325655 PMCID: PMC7877364 DOI: 10.1002/cam4.3650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/18/2020] [Revised: 11/21/2020] [Accepted: 11/21/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To investigate the prognostic value of the preoperative systemic immune-inflammation index (SII) in patients with oral cavity squamous cell carcinoma (OC-SCC) treated with curative surgery followed by adjuvant radiotherapy (RT) or chemoradiotherapy (CCRT). MATERIALS AND METHODS We retrospectively reviewed the clinical records of patients with OC-SCC who received surgery and postoperative adjuvant RT/CCRT between January 2005 and December 2012. Blood samples were drawn in the 2 weeks preceding surgery. SII was calculated by multiplying the absolute neutrophil and platelet counts, and then, divided by the absolute lymphocyte count, and its optimal cutoff value was identified using the Youden's index. The study endpoints included overall survival (OS), local control (LC), regional control (RC), and distant control (DC). RESULTS The study sample consisted of 993 patients (58.8% of them treated with CCRT). The optimal cutoff value for SII was 810.6. A total of 347 (34.9%) study participants had high preoperative SII values. After allowance for potential confounders in multivariable analysis, high SII values were independently associated with less favorable DC (adjusted hazard ratio [HR] = 1.683, p = 0.001) and OS (adjusted HR = 1.466, p < 0.001). No independent association between SII and LC/RC was observed. CONCLUSION Increased SII values predict poor DC and OS in patients with OC-SCC treated with curative resection and adjuvant RT/CCRT. Owing to the higher risk of systemic failure in this patient group, a thorough follow-up surveillance schedule may be advisable pending independent confirmation of our data.
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Affiliation(s)
- Sheng-Ping Hung
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Rung Chen
- Department of Anesthesiology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tsung-Ying Ho
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital, Chang Gung University at Lin-Kou, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yao-Yu Wu
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Jui Chen
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chia-Hsin Lin
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Chih Chou
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Radiation Oncology, Proton and Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Chou WC, Chang PH, Chen PT, Wang HM, Yeh KY, Lu CH, Hung YS, Tung-Chieh Chang J, Tsang NM, Ho YW, Chen SY, Lee SH, Hung CY, Wang LJ, Liao KC, Lin CH, Tang WR, Lin YC. Clinical Significance of Vulnerability Assessment in Patients with Primary Head and Neck Cancer Undergoing Definitive Concurrent Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 2020; 108:602-611. [DOI: 10.1016/j.ijrobp.2020.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 12/05/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022]
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21
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Lin CH, Chou WC, Wu YY, Lin CY, Chang KP, Liao CT, Ho TY, Yeh CM, Liu CJ, Hung SP, Lee CH, Chen PJ, Chou YC, Fan KH, Huang BS, Tung-Chieh Chang J, Wang CC, Tsang NM. Prognostic significance of dynamic changes in lymphocyte-to-monocyte ratio in patients with head and neck cancer treated with radiotherapy: results from a large cohort study. Radiother Oncol 2020; 154:76-86. [PMID: 32941957 DOI: 10.1016/j.radonc.2020.09.012] [Citation(s) in RCA: 2] [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: 04/29/2020] [Revised: 08/23/2020] [Accepted: 09/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE We sought to investigate whether dynamic changes in lymphocyte-to-monocyte ratio (LMR) occurring during the course of radiotherapy (RT) may have prognostic value in patients with head and neck cancer (HNC). MATERIALS AND METHODS We retrospectively reviewed the clinical records of patients with HNC who underwent RT at our center between 2005 and 2013. Generalized estimating equations were used to longitudinally assess changes in LMR through the course of RT. Delta-LMR was calculated as the difference between LMR measured during treatment and baseline LMR values. Freedom from metastasis (FFM) and overall survival (OS) served as the main outcome measures. RESULTS A total of 1431 patients with HNC were enrolled. After a median follow-up of 9 years, 636 (44.4%) patients died and 240 (16.8%) had distant metastases. Compared with patients with low delta-LMR at two weeks, those with high delta-LMR experienced less favorable outcomes (five-year OS: 73% versus 59%, respectively, p < 0.001; five-year FFM: 87% versus 80%, respectively, p = 0.015). Similar findings were observed for delta-LMR measured at four weeks (five-year OS: 72% versus 60%, p < 0.001; five-year FFM: 86% versus 79%, respectively, p = 0.002) and six weeks (five-year OS: 72% versus 57%, p < 0.001; five-year FFM: 87% versus 79%, respectively, p = 0.002). Multivariate analysis identified delta-LMR as an independent prognostic factor for both FFM and OS. CONCLUSION Delta-LMR is a simple and inexpensive biomarker that may be clinically useful for predicting FFM and OS in patients with HNC treated with RT.
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Affiliation(s)
- Chia-Hsin Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Wen-Chi Chou
- Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, College of Medicine, Taoyaun, Taiwan.
| | - Yao-Yu Wu
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Chien-Yu Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Kai-Ping Chang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University at Lin-Kou, Taoyuan, Taiwan.
| | - Chun-Ta Liao
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University at Lin-Kou, Taoyuan, Taiwan.
| | - Tsung-Ying Ho
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Chiu-Mei Yeh
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
| | - Sheng-Ping Hung
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Po-Jui Chen
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Yung-Chih Chou
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Bing-Shen Huang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; Department of Radiation Oncology, Xiamen Chang Gung Memorial Hospital, Fujian, China.
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan; School of Traditional Chinese Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Radiation Oncology, Fangliao General Hospital, PingTung Hsien, Taiwan.
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22
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Lin CR, Fan KH, Lin CY, Hung TM, Huang BS, Chen EYC, Kang CJ, Huang SF, Chang JTC, Chang CH. Development and evaluation of a computerized clinical outcome assessment tool for head and neck cancer patients. Medicine (Baltimore) 2020; 99:e20304. [PMID: 32846748 PMCID: PMC7447395 DOI: 10.1097/md.0000000000020304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Paper-based clinical outcome data collection methods have practical limitations when used in clinical settings, as the data are often not summarized in time to facilitate patient-physician communications and therefore cannot be used in clinical decision making. This study aimed to develop a computerized clinical outcome assessment tool (COAT) and evaluate its acceptability, feasibility, and potential clinical applications during clinical encounters for patients with head and neck cancer (HNC).The traditional Chinese (TChi) character version of the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) questionnaire was first transcribed and implemented into a touch-screen computerized administration and reporting system (COAT-HNC for short). Each HNC patient was invited to complete the COAT-HNC during their scheduled clinic visits as part of their clinical care. Upon completion, a structured summary report was generated, and subsequently used for treatment evaluation and planning.A cohort of 385 HNC patients were enrolled. Each scale of the computerized TChi FACT-H&N questionnaire demonstrated acceptable internal consistency, with Cronbach coefficient alpha ranging from 0.74 to 0.90. The touch-screen-based and audio-capable COAT-HNC was reported to be easy to use. Patients and physicians were able to utilize the summary report during their clinical encounters to discuss treatment progress and to plan care.It is practically feasible to design, develop, and implement the COAT-HNC system in routine HNC care. The COAT-HNC has the potential to become a valuable tool for data collection and management of clinical outcomes, and appears useful for HNC patients. However, larger studies to demonstrate its clinical usefulness are still needed.
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Affiliation(s)
- Ching-Rong Lin
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
- Chang Gung University, Tao-Yuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
- Chang Gung University, Tao-Yuan, Taiwan
| | - Tsung-Min Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Eric Yen-Chao Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chung-Jan Kang
- Department of E.N.T., Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Shiang-Fu Huang
- Department of E.N.T., Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, Tao-Yuan, Taiwan
- Chang Gung University, Tao-Yuan, Taiwan
- Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China
| | - Chih-Hung Chang
- Washington University School of Medicine, St. Louis, MO, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- China Medical University, Taichung, Taiwan
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23
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Chiang YY, Chou YC, Chang KP, Liao CT, Wu YY, Yap WK, Pai PC, Chang JTC, Lin CY, Fan KH, Huang BS, Hung TM, Tsang NM. Missed radiation therapy sessions in first three weeks predict distant metastasis and less favorable outcomes in surgically treated patients with oral cavity squamous cell carcinoma. Radiat Oncol 2020; 15:194. [PMID: 32795324 PMCID: PMC7427928 DOI: 10.1186/s13014-020-01632-1] [Citation(s) in RCA: 2] [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: 04/20/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
Background We sought to investigate the prognostic impact of missed RT sessions in patients who had undergone surgery for oral cavity squamous cell carcinoma (OCSCC). Methods The study sample consisted of 905 patients with surgically treated OCSCC who fulfilled criteria of RT course ≤8 weeks. The study participants were divided into three groups based on the characteristics of missed RT, as follows: 1) early missed RT, 2) late missed RT, and 3) RT as scheduled. Results The 5-year overall survival (OS) rates in the early missed RT, late missed RT, and RT as scheduled groups were 53.0, 58.1, and 64.5%, respectively (p = 0.046). In multivariate analysis, early missed RT was independently associated with both OS (hazard ratio (HR) = 1.486; 95% confidence interval (CI): 1.122–1.966; p = 0.006) and the occurrence of distant metastasis (HR = 1.644; 95% CI: 1.047–2.583; p = 0.031). Conclusion Early missed RT was independently associated with a higher occurrence of distant metastasis and less favorable OS in patients who had undergone surgery for OCSCC.
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Affiliation(s)
- Yin-Yin Chiang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Yung-Chih Chou
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.,College of Medicine Chang Gung University, Taoyuan, Taiwan.,Department of Head and Neck Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology-Head Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan.,College of Medicine Chang Gung University, Taoyuan, Taiwan.,Department of Head and Neck Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Yao-Yu Wu
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Wing-Keen Yap
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Ping-Ching Pai
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Tsung-Min Hung
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, Taiwan. .,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Radiation Oncology, Fangliao General Hospital, No. 139, Zhongshan Rd., Fangliao Township, Pingtung County, 940, Taiwan. .,Department of Radiation Oncology, Chang Gung Memorial Hospital at Lin-Kou, School of Traditional Chinese Medicine, Chang Gung University, No. 5 Fu-Hsing Street, Kwei-Shan, Taoyuan, 333, Taiwan.
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Hung TM, Fan KH, Kang CJ, Huang SF, Lin CY, Ho ATY, Wang HM, Hsieh JCH, Cheng AJ, Ng SH, Chang JTC. Lymph node-to-primary tumor standardized uptake value ratio on PET predicts distant metastasis in nasopharyngeal carcinoma. Oral Oncol 2020; 110:104756. [PMID: 32652479 DOI: 10.1016/j.oraloncology.2020.104756] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 12/08/2022]
Abstract
OBJECTIVES To investigate the prognostic value of the relative maximum standardized uptake value (SUV) ratio between neck lymph node and primary tumor (NTR) measured by pretreatment 18F-FDG PET in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS We retrospectively reviewed patients with non-disseminated NPC who underwent PET scans before radical intensity-modulated radiotherapy (IMRT). Receiver operating characteristic analysis was performed to identify the optimal cut-off value for NTR. The prognostic value of NTR for distant metastasis-free survival (DMFS) was evaluated using Kaplan-Meier method for survival analyses and Cox regression for multivariable analysis. RESULTS Among the 437 eligible patients, the median follow-up time was 62.9 (range, 2.1-113.0) months. Patients with high NTR (NTR > 0.9181) experienced significantly worse DMFS (5-year 80.5% vs. 91.6%, P < 0.001). In the subgroup analysis, we found that patients with high NTR had significantly lower DMFS in T1-2 category (5-year 86.1% vs. 98.1%, P = 0.002), T3-4 category (5-year 71.5% vs. 86.2%, P = 0.010), N2-3 category (5-year 75.3% vs. 86.2%, P = 0.048), and stage IVA-B (5-year 69.8% vs. 85.4%, P = 0.012). Multivariable analysis showed that NTR was an independent prognostic factor for DMFS (HR 2.20, 95% CI 1.20-4.03, P = 0.011). CONCLUSION Pretreatment NTR is an easily accessible but potential prognosticator for DMFS in NPC patients treated by IMRT, which may help in providing more personalized treatment or designing future clinical trials.
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Affiliation(s)
- Tsung-Min Hung
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Albert Tsung-Ying Ho
- Department of Nuclear Medicine and Molecular Imaging Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Jason Chia-Hsun Hsieh
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ann-Joy Cheng
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology and Proton Therapy Center, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital at Xiamen, Xiamen, China.
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25
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Lin YH, Huang SM, Yap WK, Yang JW, Yeung L, Tsan DL, Chang JTC, Chen LC. Outcomes in patients with lacrimal gland carcinoma treated with definitive radiotherapy or eye-sparing surgery followed by adjuvant radiotherapy. Radiat Oncol 2020; 15:156. [PMID: 32571366 PMCID: PMC7310012 DOI: 10.1186/s13014-020-01601-8] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background The optimal treatment for lacrimal gland cancer remains unclear. Eye-preserving surgery, as opposed to exenteration, followed by adjuvant radiotherapy (RT), has recently been reported to deliver satisfactory outcomes, but evidence is sparse. The aim of the present study was to evaluate outcomes in patients with lacrimal gland cancer treated at two tertiary medical centers. Methods We retrospectively examined data from patients with lacrimal gland cancer who had received eye-preserving surgical treatment followed by adjuvant RT with or without chemotherapy, or (if the tumor was inoperable) needle biopsy with definitive RT with or without chemotherapy. Baseline clinical and pathological characteristics were considered. Outcomes of interest included post-treatment complications, overall survival (OS), locoregional progression-free survival (LPFS), and distant metastasis-free survival (DMFS). Results Eighteen patients were included. Two-year OS, LPFS, and DMFS rates were 69.0, 76.7, and 71.4%, respectively. Patients with early-stage (T1–T2) lacrimal gland cancer had significantly better outcomes than those with advanced-stage disease (T3–T4). Two-year OS, LPFS, and DMFS rates were each 100% in patients with disease stages T1–T2, and 37.5, 50, and 37.5%, respectively, in those with disease stages T3–T4 (P < 0.05). Orbital complications were well tolerated. Conclusions Eye-sparing surgery with adjuvant RT can achieve satisfactory results in patients with T1–T2 lacrimal gland carcinoma. Disease stage T3 and above was associated with poor outcomes even with post-operative RT, likely due to distant metastasis. Adding neoadjuvant chemotherapy or adjuvant chemotherapy to current treatment strategies might be a suitable choice for this group of patients.
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Affiliation(s)
- Yun-Hsuan Lin
- Department of Electro-Optical Engineering, National Taipei University of Technology, 1, Sec. 3, Chung-Hsiao E. Rd, Taipei, 10608, Taiwan, ROC.,Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wing-Keen Yap
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ju-Wen Yang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ling Yeung
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Din-Li Tsan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | | | - Lung-Chien Chen
- Department of Electro-Optical Engineering, National Taipei University of Technology, 1, Sec. 3, Chung-Hsiao E. Rd, Taipei, 10608, Taiwan, ROC.
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Lin HC, Chan SC, Cheng NM, Liao CT, Hsu CL, Wang HM, Lin CY, Chang JTC, Ng SH, Yang LY, Yen TC. Pretreatment 18F-FDG PET/CT texture parameters provide complementary information to Epstein-Barr virus DNA titers in patients with metastatic nasopharyngeal carcinoma. Oral Oncol 2020; 104:104628. [DOI: 10.1016/j.oraloncology.2020.104628] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 01/07/2023]
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27
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Lee CH, Chen PJ, Lai HY, Lee CY, Fan KH, Tsang NM, Chang JTC. A scoping review of medical education research for residents in radiation oncology. BMC Med Educ 2020; 20:13. [PMID: 31931783 PMCID: PMC6958614 DOI: 10.1186/s12909-020-1927-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 01/06/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Both medical education and radiation oncology have progressed significantly in the past decade, but a generalized overview of educational research for radiation oncology residents has not been produced. This study examines recent research trends in medical education for residents in radiation oncology through a scoping review. METHODS We conducted a scoping review of medical education research for residents in radiation oncology to survey the research trends. We used publications available on MEDLINE, PubMed, and Scopus to conduct this scoping review. RESULTS We screened 221 full-text articles, 146 of which met our inclusion criteria. These publications showed increased activity in medical education research for residents, most involving affiliations in the United States. We identified persistent interest in training-, contouring-, and technology-related issues. An increase in research related to career, treatment quality, and multidisciplinary training was also observed. However, no research about teacher training was identified. CONCLUSIONS This scoping review presents the trends in study interests among stakeholders of medical education research in radiation oncology. With an investigation of existing studies, this research identifies areas of high priority and a lack of studies about teacher training. This study provides potential future directions for medical education research for residents in radiation oncology.
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Affiliation(s)
- Ching-Hsin Lee
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Po-Jui Chen
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Hung-Yi Lai
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Ching-Yi Lee
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist, Taoyuan City, 333 Taiwan
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Lin H, Zhou J, Wu Q, Hung TM, Chen W, Yu Y, Chang JTC, Pan J, Qiu S, Chen R. Human blood test based on surface-enhanced Raman spectroscopy technology using different excitation light for nasopharyngeal cancer detection. IET Nanobiotechnol 2019; 13:942-945. [PMID: 31811763 DOI: 10.1049/iet-nbt.2019.0221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC), a kind of squamous cell carcinoma, occurs in the top and the side wall of nasopharyngeal, which harms human health and life. In this study, a novel blood test (SERS) was carried out for 30 NPC patients and 30 normal ones. Using multi-variate statistical analysis for spectral data, the diagnostic sensitivities of 89.3% (50/56) and 85.7% (48/56) can be achieved for 633 and 785 nm exciting wavelength, respectively. Also corresponding specificities are 71.4% (41/56) and 78.6% (44/56), respectively. These results demonstrated that the two kinds of excitation wavelength all have the feasibility of obtaining high-quality SERS spectra to differentiate cancer from normal samples. Furthermore, the performance of the SERS test with 785 nm wavelength excitation is nearly equal to the SERS experimental effect under 633 nm wavelength excitation for NPC detection.
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Affiliation(s)
- Huijing Lin
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou, Fujian, People's Republic of China
| | - Jiahui Zhou
- College of Integrated Traditional Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People's Republic of China
| | - Qiong Wu
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou, Fujian, People's Republic of China
| | - Tsung-Min Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Weiwei Chen
- College of Integrated Traditional Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People's Republic of China
| | - Yun Yu
- College of Integrated Traditional Chinese and Western Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian, People's Republic of China
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jianji Pan
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China
| | - Sufang Qiu
- Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, People's Republic of China.
| | - Rong Chen
- Key Laboratory of OptoElectronic Science and Technology for Medicine, Ministry of Education, Fujian Provincial Key Laboratory for Photonics Technology, Fujian Normal University, Fuzhou, Fujian, People's Republic of China
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Hsieh CH, Lin CY, Hsu CL, Fan KH, Huang SF, Liao CT, Lee LY, Ng SK, Yen TC, Chang JTC, Lin JR, Wang HM. Incorporation of Astragalus polysaccharides injection during concurrent chemoradiotherapy in advanced pharyngeal or laryngeal squamous cell carcinoma: preliminary experience of a phase II double-blind, randomized trial. J Cancer Res Clin Oncol 2019; 146:33-41. [PMID: 31728618 DOI: 10.1007/s00432-019-03033-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/18/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Concurrent chemoradiotherapy (CCRT) is one of the standard treatments for patients with advanced head and neck squamous cell carcinoma (HNSCC). However, CCRT may lead to decreased quality of life (QoL) and treatment compliance. This study aimed to determine the effects of PG2 (Astragalus polysaccharides) injection on CCRT-associated adverse events (AEs) and patients' compliance with the CCRT course. METHODS In this phase II double-blind randomized placebo-controlled trial, PG2 injection (sterile powder form) or placebo was administrated three times per week in parallel with CCRT to patients with HNSCC. The chemotherapy regimen included 50 mg/m2 cisplatin every 2 weeks with daily tegafur-uracil (300 mg/m2) and leucovorin (60 mg/day). RESULTS The study was terminated prematurely due to the successful launch of a newly formulated PG2 injection (lyophilized form). A total of 17 patients were enrolled. The baseline demographics and therapeutic compliance were comparable between the CCRT/PG2 and CCRT/placebo groups. During CCRT, severe treatment-associated AEs were less frequent in the CCRT/PG2 group than in the CCRT/placebo group. Furthermore, less QoL fluctuations from the baseline during CCRT were noted in the CCRT/PG2 group than in the CCRT/placebo group, with a significant difference in the pain, appetite loss, and social eating behavior. The tumor response, disease-specific survival and overall survival did not differ between the two groups. CONCLUSION This preliminary study demonstrated PG2 injection exhibited an excellent safety profile, and has potential in ameliorating the deterioration in QoL and the AEs associated with active anticancer treatment among patients with advanced pharyngeal or laryngeal HNSCC under CCRT. Further research in patients with other cancer types or treatment modalities may widen PG2's application in clinical settings.
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Affiliation(s)
- Chia-Hsun Hsieh
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University, No. 5, Fushin St., Gueishan District, Taoyuan, 333, Taiwan, ROC
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Cheng-Lung Hsu
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University, No. 5, Fushin St., Gueishan District, Taoyuan, 333, Taiwan, ROC
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University at Linkou, Taoyuan, Taiwan, ROC
| | - Shu-Kung Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University at Linkou, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou; College of Medicine, Chang Gung University, No. 5, Fushin St., Gueishan District, Taoyuan, 333, Taiwan, ROC.
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Fan KH, Chao YK, Chang JTC, Tsang NM, Liao CT, Chang KP, Lin CY, Wang HM, Hsu CL, Huang SF. A retrospective analysis of the treatment results for advanced synchronous head and neck and esophageal cancer. BJR Open 2019; 1:20190015. [PMID: 33178944 PMCID: PMC7592436 DOI: 10.1259/bjro.20190015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/16/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: The treatments for synchronous head and neck cancer (HNC) and esophageal cancer (ESC) are toxic and difficult to employ. The aim of this study was to identify the feasibility of a protracted, less toxic treatment course and prognostic factor of synchronous HNC and ESC. Methods: Cancer registry data from 2004 to 2012 were reviewed. The inclusion criteria were two cancer diagnoses within 30 days, and Stage III/IV HNC or Stage II–IV ESC that chemoradiation therapy was indicated. Evident metastasis, Eastern Cooperative Oncology Group performance score >2, a history of prior cancer, or palliative treatment were excluded. Survival rates and patient and treatment characteristics were analyzed. Results: There were 51 eligible cases. The 2 year overall survival rate was 25.1%. Univariate analysis found that anemia, larynx/hypopharynx HNC, and no esophagectomy correlated with poor overall survival. Multivariate analysis demonstrated that anemia and no esophagectomy were independent poor prognostic factors. The 2 year progression-free survival rate was 14.8%. Univariate analysis found only no esophagectomy correlated with poor progression-free survival. Conclusion: The outcomes are poor for patients with advanced synchronous HNC and ESC. Radiotherapy with a split or protracted course does not result in inferior treatment result and can be considered when the aim is to avoid adverse events. Esophagectomy correlated with good prognosis and should be performed for patients if possible. Advances in knowledge: The treatment results of synchronous HNC and ESC is poor. A protracted chemoradiation course for synchronous HNC and ESC did not result in inferior survival and should be applied to patients with a poor prognosis. Esophagectomy correlates with good outcomes and should be encouraged if the patient has a good prognosis.
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Affiliation(s)
- Kang-Hsing Fan
- Department of Radiation Oncology, Chang-Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine
| | - Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | - Ng-Ming Tsang
- Department of Radiation Oncology, Chang-Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang-Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang-Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang-Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine
| | - Hong-Ming Wang
- Department of Medical Oncology, Chang-Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine
| | - Cheng-Lung Hsu
- Department of Medical Oncology, Chang-Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang-Gung Memorial Hospital at Linkou; Chang Gung University College of Medicine
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Li YC, Cheng AJ, Lee LY, Huang YC, Chang JTC. Multifaceted Mechanisms of Areca Nuts in Oral Carcinogenesis: the Molecular Pathology from Precancerous Condition to Malignant Transformation. J Cancer 2019; 10:4054-4062. [PMID: 31417650 PMCID: PMC6692602 DOI: 10.7150/jca.29765] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 09/06/2018] [Accepted: 03/29/2019] [Indexed: 02/06/2023] Open
Abstract
Oral cancer is one of the most frequent malignant diseases worldwide, and areca nut is a primary carcinogen causing this cancer in Southeast Asia. It has been widely reported that areca nut induced several cytotoxic effects in oral cells, including ROS generation, inflammation, tissue hypoxia, DNA damage, and cell invasion. Recently, through chronic exposure model, more extensive pathological effects due to areca nut have been found. These include the induction of autophagy, promotion of epithelial- mesenchymal transition, and facilitation of cancer stemness conversion. Clinical findings support these adverse effects. Oral submucosal fibrosis, a premalignant condition, is prevalent in the area with habitual chewing of areca nuts. Consistently, oral cancer patients with habitual chewing areca nut exhibit more aggressive phenotypes, including resistance to chemo-radiotherapy. In this review, we comprehensively discuss and concisely summarize the up-to-date molecular and cellular mechanisms by which areca nuts contribute to malignant transformation. This review may provide critical information regarding clinical applications in risk assessment, disease prevention, diagnosis, and personalized therapeutics for areca nut-induced oral malignancy.
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Affiliation(s)
- Yi-Chen Li
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Ann-Joy Cheng
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou, Taoyuan 333, Taiwan
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital-Linkou, Taoyuan 333, Taiwan
| | - Yu-Chen Huang
- Department of Oral Maxillofacial Surgery, Chang Gung Memorial Hospital-Linkou, Taoyuan 333, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou, Taoyuan 333, Taiwan.,Department of Radiation Oncology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China
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DE Paz D, Young CK, Chien HT, Tsao CK, Fok CC, Fan KH, Liao CT, Wang HM, Kang CJ, Chang JTC, Huang SF. Prognostic Roles of SCC Antigen, CRP and CYFRA 21-1 in Oral Cavity Squamous Cell Carcinoma. Anticancer Res 2019; 39:2025-2033. [PMID: 30952746 DOI: 10.21873/anticanres.13313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 03/03/2019] [Revised: 03/20/2019] [Accepted: 03/20/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Tumor-related and inflammation-related markers were reported to be prognostic in cancer patients. In this study, we evaluated squamous cell carcinoma antigen (SCC-Ag), cytokeratin 19 fragment (CYFRA 21-1) and C-reactive protein (CRP) simultaneously in oral cavity squamous cell carcinoma (OSCC) patients. PATIENTS AND METHODS Two hundred and forty-six newly diagnosed OSCC patients were retrospectively recruited between December 2010 and December 2016. RESULTS The elevation of CRP levels (≥5.0 mg/l) and SCC-Ag levels (≥2.0 ng/ml) were significantly related with tumor invasion parameters and metastatic factors. In contrast, the elevation of CYFRA 21-1 levels (≥3.3 ng/ml) was related with extranodal extension alone. For patients with all three markers being elevated before surgery, their overall survival and disease-free survival were significantly worse than others. CONCLUSION Concurrent elevation of preoperative SCC-Ag, CYFRA 21-1 and CRP serum levels can be correlated with worse survival rates in OSCC.
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Affiliation(s)
- Dante DE Paz
- Department of Otolaryngology - Head & Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.,Department of Head and Neck Surgery, San Pedro University, San Pedro, Peru
| | - Chi-Kuang Young
- Department of Otolaryngology, Chang Gung Memorial Hospital, Keelung, Taiwan, R.O.C
| | - Huei-Tzu Chien
- Department of Public Health, Chang Gung University, Taoyuan, Taiwan, R.O.C.,Department of Nutrition and Health Sciences, Chang Gung University of Science and Technology, Taoyuan, Taiwan, R.O.C
| | - Chung-Kang Tsao
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, R.O.C.,Medical College, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Cheong Chon Fok
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, R.O.C.,Medical College, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Kang-Hsing Fan
- Medical College, Chang Gung University, Taoyuan, Taiwan, R.O.C.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Chun-Ta Liao
- Department of Otolaryngology - Head & Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.,Medical College, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Hung-Ming Wang
- Medical College, Chang Gung University, Taoyuan, Taiwan, R.O.C.,Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Chung-Jan Kang
- Department of Otolaryngology - Head & Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C.,Medical College, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Joseph Tung-Chieh Chang
- Medical College, Chang Gung University, Taoyuan, Taiwan, R.O.C.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, R.O.C
| | - Shiang-Fu Huang
- Department of Otolaryngology - Head & Neck Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C. .,Department of Public Health, Chang Gung University, Taoyuan, Taiwan, R.O.C
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Hsieh CE, Venkatesulu BP, Lee CH, Hung SP, Wong PF, Aithala SP, Kim BK, Rao A, Tung-Chieh Chang J, Tsang NM, Wang CC, Lee CC, Lin CC, Tseng JH, Chou WC, Wang YC, Krishnan S, Hong JH. Predictors of Radiation-Induced Liver Disease in Eastern and Western Patients With Hepatocellular Carcinoma Undergoing Proton Beam Therapy. Int J Radiat Oncol Biol Phys 2019; 105:73-86. [PMID: 30797890 DOI: 10.1016/j.ijrobp.2019.02.032] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/03/2019] [Accepted: 02/11/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify predictors of radiation-induced liver disease (RILD) in patients with hepatocellular carcinoma (HCC) treated with proton beam therapy (PBT). METHODS This multicenter study included 136 patients with HCC (eastern, n = 102; western, n = 34) without evidence of intrahepatic tumor progression after PBT. The RILD was defined as ascites with alkaline-phosphatase abnormality, grade ≥3 hepatic toxicity, or Child-Pugh score worsening by ≥2 within 4 months after PBT completion. The proton doses were converted to equivalent doses in 2-GyE fractions. The unirradiated liver volume (ULV) was defined as the absolute liver volume (LV) receiving <1 GyE; the standard liver volume (SLV) was calculated using body surface area. Possible correlations of clinicodosimetric parameters with RILD were examined. RESULTS The mean pretreatment LV was 85% of SLV, and patients with a history of hepatectomy (P < .001) or hepatitis B virus infection (P = .035) had significantly smaller LV/SLV. Nineteen (14%) patients developed RILD. Multivariate logistic regression analysis identified ULV/SLV (P = .001), gross tumor volume (P = .001), and Child-Pugh classification (P = .002) as independent RILD predictors, and mean liver dose and target-delivered dose were not associated with RILD occurrence. A "volume-response" relationship between ULV/SLV and RILD was consistently observed in both eastern and western cohorts. In Child-Pugh class-A patients whose ULV/SLV were ≥50%, 49.9%-40%, 39.9%-30% and <30%, the RILD incidences were 0%, 6%, 16%, and 39% (P < .001), respectively. For the Child-Pugh class-B group, the RILD incidences in patients with ≥60%, 59.9%-40%, and <40% of ULV/SLV were 0%, 14%, and 83% (P = .006), respectively. CONCLUSIONS The ULV/SLV, not mean liver dose, independently predicts RILD in patients with HCC undergoing PBT. The relative and absolute contraindications for Child-Pugh class-A patient's ULV/SLV are <50% and <30%, and <60% and <40% for Child-Pugh class-B patients, respectively. Our results indicate that the likelihood of hepatic complications for PBT is dictated by similar metrics as that for surgery.
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Affiliation(s)
- Cheng-En Hsieh
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China; Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center-UT Health Graduate School of Biomedical Sciences, Houston, Texas
| | - Bhanu Prasad Venkatesulu
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ching-Hsin Lee
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Sheng-Ping Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Pei-Fong Wong
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sathvik Panambur Aithala
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Byung Kyu Kim
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center-UT Health Graduate School of Biomedical Sciences, Houston, Texas
| | - Arvind Rao
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, Michigan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China; School of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China; Department of Medical Imaging and Radiological Science, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Chung-Chi Lee
- Department of Medical Imaging and Radiological Science, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Chen-Chun Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Jeng-Hwei Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Wen-Chi Chou
- Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Yu-Chao Wang
- Department of Surgery, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China
| | - Sunil Krishnan
- Department of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center-UT Health Graduate School of Biomedical Sciences, Houston, Texas; Department of Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ji-Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China; Department of Institute for Radiological Research, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan City, Taiwan, China.
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Huang SM, Chen YC, Chen WY, Yang LY, Tsan DL, Tsang NM, Yap WK, Tsai CS, Leung WM, Hong JH, Chang JTC, Yeh TS, Wu TH, Chen YC, Lin YH, Huang BS. Optimal Timing for Postsurgical Adjuvant Therapy in Patients with Gastric Cancer: A Propensity Score Matching Study. J Cancer 2019; 10:332-340. [PMID: 30719127 PMCID: PMC6360315 DOI: 10.7150/jca.27753] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022] Open
Abstract
Background:In clinical trials, adjuvant therapy (AT) has been shown to improve the prognosis in patients with gastric adenocarcinoma who undergo curative gastrectomy and adequate lymph node dissection. However, the optimal timing for initiating AT is still unclear. Method:We collected data from 538 patients with stage II-III gastric cancer who underwent curative gastrectomy and AT in two tertiary hospitals from 2006 to 2013. Patients were divided into the early group (≤8 weeks, n=393) and the late group (>8 weeks, n=145), based on the interval between gastrectomy and initiation of AT. Propensity score matching was applied according to baseline characteristics. Results:After 1:1 propensity score matching, an even distribution of characteristics in both groups (143:143) was achieved. The 5-year overall survival (OS) rates were 56.6% and 40.2% in the matched early and late groups, respectively (p=0.062), while the corresponding 5-year recurrence-free survival (RFS) rates were 57.6% and 46.4%, respectively (p=0.028). The time to AT initiation was correlated with RFS and had a positive association with OS. The 5-year distant metastasis-free survival was also significantly better (HR 0.682, 95% CI 0.472-0.985, p=0.040), suggesting an early AT results in a better outcome in patients. Conclusion:We observed that initiation of AT within 8 weeks of curative gastrectomy produces better disease control and may contribute to better overall survival.
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Affiliation(s)
- Shih-Ming Huang
- Department of Radiation Oncology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yen-Chao Chen
- Department of Radiation Oncology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wan-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lan-Yan Yang
- Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Din-Li Tsan
- Department of Radiation Oncology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wing-Keen Yap
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Sheng Tsai
- Department of Radiation Oncology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wai-Man Leung
- Department of Radiation Oncology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Han Wu
- Division of Hematology and Oncology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Food Science, National Taiwan Ocean University, Keelung, Taiwan
| | - Yi-Chan Chen
- Division of general surgery, Department of surgery, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yun-Hsuan Lin
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
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Hsieh CE, Lee LY, Chou YC, Fan KH, Tsang NM, Chang JTC, Wang HM, Ng SH, Liao CT, Yen TC, Fang KH, Lin CY. Nodal failure patterns and utility of elective nodal irradiation in submandibular gland carcinoma treated with postoperative radiotherapy - a multicenter experience. Radiat Oncol 2018; 13:184. [PMID: 30241545 PMCID: PMC6151022 DOI: 10.1186/s13014-018-1130-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The patterns of nodal relapse in submandibular gland carcinoma (SMGC) patients treated with postoperative radiotherapy (PORT) remain unclear. This study aims to investigate the nodal failure patterns and the utility of elective nodal irradiation (ENI) in SMGC patients undergoing PORT. METHODS We retrospectively enrolled 65 SMGC patients who underwent PORT between 2000 and 2014. The nodal failure sites in relation to irradiation fields and pathological parameters were analyzed. ENI regions were categorized into three bilateral echelons (first, levels I-II; second, level III; and third, levels IV-V). Extended ENI was defined as coverage of at least the immediately adjacent uninvolved echelons bilaterally; otherwise, limited ENI was administered. RESULTS Thirty patients (46%) were stage III-IV, and 18 (28%) were pN+. Neck irradiation included limited (72%) and extended ENI (28%). With a median follow-up of 79 months, 11 patients (17%) developed nodal failures (ipsilateral, N = 6; contralateral, N = 7), 7 (64%) of whom relapsed in the adjacent uninvolved echelons. We identified pN+ (P = 0.030), extranodal extension (ENE, P = 0.002), pT3-4 (P = 0.021), and lymphovascular invasion (LVI, P = 0.004) as significant predictors of contralateral neck recurrence. Extended ENI significantly improved regional control (RC) in patients with pN+ (P = 0.003), ENE (P = 0.022), pT3-4 (P = 0.044), and LVI (P = 0.014), and improved disease-free survival (DFS) in patients with pN+ (P = 0.034). For patients with ≥2 coincident adverse factors, extended ENI significantly increased RC (P < 0.001), distant metastasis-free survival (P = 0.019), and DFS (P = 0.007); conversely, no nodal recurrence was observed in patients without these adverse factors, even when only the involved echelon was irradiated. CONCLUSIONS Nodal failure is not uncommon in SMGC patients treated with PORT if pN+, ENE, pT3-4, and LVI are present. Extended ENI should be considered, particularly in patients with multiple pathological adverse factors.
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Affiliation(s)
- Cheng-En Hsieh
- Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Departments of Experimental Radiation Oncology, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,The University of Texas MD Anderson Cancer Center-UT Health Graduate School of Biomedical Sciences, Houston, Texas, USA
| | - Li-Yu Lee
- Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Yung-Chih Chou
- Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China
| | - Kang-Hsing Fan
- Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Ngan-Ming Tsang
- Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Joseph Tung-Chieh Chang
- Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Radiation Oncology, Xiamen Chang Gung Hospital, Xiamen City, Fujian Province, China
| | - Hung-Ming Wang
- Medical Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Shu-Hang Ng
- Diagnostic Radiology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Chun-Ta Liao
- Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Tzu-Chen Yen
- Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Ku-Hao Fang
- Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.,Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan City, Taiwan, Republic of China
| | - Chien-Yu Lin
- Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, No. 5, Fuxing St., Guishan Dist, Taoyuan City, 33305, Taiwan, Republic of China. .,Head and Neck Oncology Group, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China. .,Particle Physics and Beam Delivery Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan City, Taiwan, Republic of China.
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Lee CH, Hung SP, Hong JH, Chang JTC, Tsang NM, Chan KM, Tseng JH, Huang SC, Lin SM, Lien JM, Liu NJ, Lin CC, Chen WT, Chen WY, Chen PJ, Huang BS. How small is TOO small? New liver constraint is needed- Proton therapy of hepatocellular carcinoma patients with small normal liver. PLoS One 2018; 13:e0203854. [PMID: 30204800 PMCID: PMC6133378 DOI: 10.1371/journal.pone.0203854] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study evaluated the outcomes of hepatocellular carcinoma (HCC) patients with small normal liver volume (NLV) treated with proton beam therapy (PBT) and introduced estimated standard liver volume (eSLV) as a new constraint. MATERIALS AND METHODS HCC patients with NLV < 800 cm3 and no distant metastasis who received treatment in our proton center were included. The doses of PBT were mainly 72.6 Gray equivalents (GyE) in 22 fractions and 66 GyE in 10 fractions according to tumor locations. The Urata equation was used to calculate eSLV. RESULTS Twenty-two patients were treated between November 2015 and December 2016. The 1-year progression-free and overall survival rates were 40.4% and 81.8%, respectively. The 1-year in-field failure-free rate was 95.5%. NLV ranged from 483.9 to 795.8 cm3 (median = 673.8 cm3), eSLV ranged from 889.3 to 1290.0 cm3 (median = 1104.5 cm3), and the resulting NLV/eSLV ratio ranged from 44.3 to 81.2% (median = 57.7%). Non-irradiated liver volume (NILV) ranged from 232.9 to 531.6 cm3 (median = 391.2 cm3). The NILV/eSLV ratio ranged from 21.2 to 48.0% (median = 33.3%). NLV in the patients who received <30 GyE (rV30) ranged from 319.1 to 633.3 cm3 (median = 488.2 cm3), and their rV30/eSLV ratio ranged from 30.7 to 58.0%. None of our patients developed liver failure. One patient with initial abnormal liver enzyme levels developed non-classic radiation-induced liver disease (RILD). CONCLUSION From the viewpoint of minimal liver toxicity occurring in our patients with NLV < 800 cm3, conventional liver constraints involving the use of absolute volume could not accurately predict the risk of RILD. It is reasonable to start using individualized constraints with eSLV for HCC patients undergoing PBT. According to the study results, an NILV/eSLV ratio of >20% and an rV30/eSLV ratio of >30% are acceptable.
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Affiliation(s)
- Ching-Hsin Lee
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Sheng-Ping Hung
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Department of General Surgery, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Jeng-Hwei Tseng
- Department of Radiology, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Shih-Chiang Huang
- Department of Anatomic Pathology, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Shi-Ming Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Jau-Min Lien
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Nai-Jen Liu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Chen-Chun Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Wei-Ting Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Wan-Yu Chen
- Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
- Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Jui Chen
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Proton and radiation therapy center, Linkou Chang Gung Memorial Hospital and University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
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Cheng YJ, Tsai MH, Chiang CJ, Tsai ST, Liu TW, Lou PJ, Liao CT, Lin JC, Chang JTC, Tsai MH, Chu PY, Leu YS, Tsai KY, Terng SD, Chien CY, Yang MH, Hao SP, Wang CC, Tsai MH, Chen HHW, Kuo C, Wu YH. Adjuvant radiotherapy after curative surgery for oral cavity squamous cell carcinoma and treatment effect of timing and duration on outcome-A Taiwan Cancer Registry national database analysis. Cancer Med 2018; 7:3073-3083. [PMID: 29905028 PMCID: PMC6051157 DOI: 10.1002/cam4.1611] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 03/16/2018] [Revised: 05/16/2018] [Accepted: 05/21/2018] [Indexed: 11/05/2022] Open
Abstract
Conduct an accurate risk assessment of resected oral cavity squamous cell carcinoma (OSCC) patients by accessing a nationwide systemic investigation is pivotal to improve treatment outcomes. In this article, we tried to determine the impact of different prognostic factors for OSCC patients who received adjuvant radiotherapy (RT) after curative surgery, using Taiwan's national cancer registry database (TCR). A nationwide, large population‐based study was conducted using TCR with patients identified from 2007 to 2015. The study variables included age, gender, cancer subsites, stage, histology grade, margin and extra‐nodal extension (ENE) status, treatment type, surgery to RT interval (ORI), total RT treatment time (RTT), and RT dose. Univariate and multivariate analysis were performed to identify predictors of the variables associated with overall survival (OS), cause‐specific survival (CSS), local‐regional relapse‐free survival (LRFS), and distant metastasis‐free survival (DMFS). 8986 OSCC patients treated with surgery and adjuvant RT were analyzed. In multivariate analysis, worse outcomes were associated with males, older age, subsite in the oral tongue, advanced stage, higher histologic grade, involved margin, and positive ENE. ORI only showed an adverse trend in LRFS, when exceeding 7 weeks (P = .06). RTT >8 weeks was a significant poor predictor in OS, CSS and LRFS (P < .001). Extreme RT dose (>70 Gy or ≤50 Gy) also demonstrated an adverse impact on the outcomes. Prolonged RT treatment time and extreme RT doses were identified as significantly poor prognostic predictors in OSCC patients who received adjuvant RT after curative surgery.
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Affiliation(s)
- Yung-Jen Cheng
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Mu-Hung Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Sen-Tien Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Otolaryngology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tsang-Wu Liu
- National Institute of Cancer Research, National Health Research Institutes, Taipei, Taiwan
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Jin-Ching Lin
- Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Head and Neck Oncology Group, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Hsui Tsai
- Department of Otorhinolaryngology, Head and Neck Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Pen-Yuan Chu
- Department of Otolaryngology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Shing Leu
- Department of Otolaryngology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuo-Yang Tsai
- Department of Oral and Maxillofacial Surgery, Head and Neck Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Shyuang-Der Terng
- Department of Head and Neck Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Chih-Yen Chien
- Department of Otolaryngology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University, College of Medicine, Kaohsiung, Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Po Hao
- Department of Otolaryngology Head and Neck Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chuan-Cheng Wang
- Division of Medical Oncology in the Hematology-Oncology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ming-Hsun Tsai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Taiwan Cancer Registry, Taipei, Taiwan
| | - Helen H W Chen
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chin Kuo
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Hua Wu
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Huang PW, Lin CY, Hsieh CH, Hsu CL, Fan KH, Huang SF, Liao CT, Ng SK, Yen TC, Chang JTC, Wang HM. A phase II randomized trial comparing neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in advanced squamous cell carcinoma of the pharynx or larynx. Biomed J 2018; 41:129-136. [PMID: 29866601 PMCID: PMC6138767 DOI: 10.1016/j.bj.2018.04.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 08/14/2017] [Revised: 11/20/2017] [Accepted: 04/12/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To clarify the effect of induction chemotherapy (ICT) in patients with advanced pharyngeal and laryngeal squamous cell carcinoma (PLSCC) treated with concurrent chemoradiotherapy (CCRT). METHODS Patients with treatment-naïve nonmetastatic advanced PLSCC were stratified according to disease stage (III or IV) and resectability before being randomized to either a ICT/CCRT or CCRT arm. A cisplatin/tegafur-uracil/leucovorin regimen was administered during ICT and CCRT. The primary end point was overall survival (OS). RESULTS We enrolled 151 patients during December 2006 to February 2011. The median follow-up of surviving patients was 54.5 months. The ICT/CCRT arm included more patients with hypopharynx cancer (57.1% vs 40.5%, p = 0.09) and N2 or N3 diseases (85.7% vs 74.4%, p = 0.02). In the ICT/CCRT and CCRT arms, the 5-year OS was 48.1% and 53.2% (p = 0.45); progression-free survival (PFS) was 31.8% and 55.6% (p = 0.015); and locoregional control (LRC) was 37.7% and 56.2% (p = 0.026), respectively. The adverse events and compliance to radiotherapy were similar. However, the proportion of patients receiving a total dose of cisplatin during CCRT <150 mg/m2 was higher in the ICT/CCRT arm (46.8% vs 16.2%; p = 0.000) and independently predicted poorer PFS and LRC in multivariate analysis. CONCLUSION OS did not vary between the ICT/CCRT and CCRT arms. However, poorer compliance to CCRT and inferior LRC and PFS were observed in the ICT/CCRT arm. Optimizing the therapeutic ratio in both ICT and CCRT settings are necessary for developing a sequential strategy for patients with advanced-stage PLSCC.
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Affiliation(s)
- Pei-Wei Huang
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsun Hsieh
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Lung Hsu
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Section of Head and Neck Surgery, Department of Otorhinolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Section of Head and Neck Surgery, Department of Otorhinolaryngology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Kung Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chan SC, Yeh CH, Yen TC, Ng SH, Chang JTC, Lin CY, Yen-Ming T, Fan KH, Huang BS, Hsu CL, Chang KP, Wang HM, Liao CT. Clinical utility of simultaneous whole-body 18F-FDG PET/MRI as a single-step imaging modality in the staging of primary nasopharyngeal carcinoma. Eur J Nucl Med Mol Imaging 2018; 45:1297-1308. [PMID: 29502310 DOI: 10.1007/s00259-018-3986-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 10/11/2017] [Accepted: 02/19/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Both head and neck magnetic resonance imaging (MRI) and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) play a crucial role in the staging of primary nasopharyngeal carcinoma (NPC). In this study, we sought to prospectively investigate the clinical utility of simultaneous whole-body 18F-FDG PET/MRI for primary staging of NPC patients. METHODS We examined 113 patients with histologically confirmed NPC who underwent pretreatment, simultaneous whole-body PET/MRI and PET/CT for primary tumor staging. The images obtained with the different imaging modalities were interpreted independently and compared with each other. RESULTS PET/MRI increased the accuracy of head and neck MRI for assessment of primary tumor extent in four patients via addition of FDG uptake information to increase the conspicuity of morphologically subtle lesions. PET/MR images were more discernible than PET/CT images for mapping tumor extension, especially intracranial invasion. Regarding the N staging assessment, the sensitivity of PET/MRI (99.5%) was higher than that of head and neck MRI (94.2%) and PET/CT (90.9%). PET/MRI was particularly useful for distinguishing retropharyngeal nodal metastasis from adjacent nasopharyngeal tumors. For distant metastasis evaluation, PET/MRI exhibited a similar sensitivity (90% vs. 86.7% vs. 83.3%), but higher positive predictive value (93.1% vs. 78.8% vs. 83.3%) than whole-body MRI and PET/CT, respectively. CONCLUSIONS For tumor staging of NPC, simultaneous whole-body PET/MRI was more accurate than head and neck MRI and PET/CT, and may serve as a single-step staging modality.
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Affiliation(s)
- Sheng-Chieh Chan
- Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Linkou Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tsang Yen-Ming
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Bing-Shen Huang
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Lung Hsu
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Division of Medical Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Linkou Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Cheng NM, Fang YHD, Tsan DL, Lee LY, Chang JTC, Wang HM, Ng SH, Liao CT, Yang LY, Yen TC. Heterogeneity and irregularity of pretreatment 18F-fluorodeoxyglucose positron emission tomography improved prognostic stratification of p16-negative high-risk squamous cell carcinoma of the oropharynx. Oral Oncol 2018; 78:156-162. [PMID: 29496044 DOI: 10.1016/j.oraloncology.2018.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 09/11/2017] [Revised: 12/27/2017] [Accepted: 01/30/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Human papillomavirus-negative oropharyngeal squamous cell carcinoma (OPSCC) has unfavorable survival outcomes. Two outcomes have been identified based on smoking history and tumor stage. We investigate the prognostic role of pre-treatment positron emission tomography (PET) in high-risk OPSCC. MATERIALS AND METHODS We enrolled 147 M0 OPSCC patients with p16-negative staining and a history of heavy smoking (>10 pack-years) or T4 disease. All patients completed primary chemoradiotherapy, and 42% maximum standard uptake values (SUVmax) were used as the threshold for primary tumor. Patients were classified into training and validation cohorts with a ratio of 1:1.5 according to the PET date. Heterogeneity and irregularity indices were obtained. PET parameters with significant impact on progression-free survival (PFS) in receiver operating characteristic curves and univariate Cox models were identified and included in recursive partitioning analysis (RPA) for constructing a prognostic model. The RPA-based prognostic model was further tested in the validation cohort using multivariate Cox models. RESULTS Fifty-eight and 89 patients were in the training and validation groups, respectively. Heterogeneity parameter, SUV-entropy (derived from histogram analysis), and irregularity index, and asphericity were significantly associated with PFS. The RPA model revealed that patients with both high SUV-entropy and high asphericity experienced the worst PFS. Results were confirmed in the validation group. The overall concordance index for PFS of the model was 0.75, which was higher than the clinical stages, performance status, SUVmax, and metabolic tumor volume of PET. CONCLUSIONS PET prognostic model provided useful prediction of PFS for patients with high-risk OPSCC.
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Affiliation(s)
- Nai-Ming Cheng
- Nuclear Medicine and Molecular Imaging Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan; Nuclear Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Hua Dean Fang
- Biomedical Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Din-Li Tsan
- Radiation Oncology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Li-Yu Lee
- Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Joseph Tung-Chieh Chang
- Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Hung-Ming Wang
- Hematology/Oncology, Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Shu-Hang Ng
- Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chun-Ta Liao
- Otolaryngology, Head & Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit, Clinical Trial Centre, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Tzu-Chen Yen
- Nuclear Medicine and Molecular Imaging Centre, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan.
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Chen HY, Chang JTC, Chien KY, Lee YS, You GR, Cheng AJ. The Endogenous GRP78 Interactome in Human Head and Neck Cancers: A Deterministic Role of Cell Surface GRP78 in Cancer Stemness. Sci Rep 2018; 8:536. [PMID: 29323121 PMCID: PMC5765009 DOI: 10.1038/s41598-017-14604-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 10/09/2017] [Indexed: 12/04/2022] Open
Abstract
Cell surface glucose regulated protein 78 (GRP78), an endoplasmic reticulum (ER) chaperone, was suggested to be a cancer stem cell marker, but the influence of this molecule on cancer stemness is poorly characterized. In this study, we developed a mass spectrometry platform to detect the endogenous interactome of GRP78 and investigated its role in cancer stemness. The interactome results showed that cell surface GRP78 associates with multiple molecules. The influence of cell population heterogeneity of head and neck cancer cell lines (OECM1, FaDu, and BM2) according to the cell surface expression levels of GRP78 and the GRP78 interactome protein, Progranulin, was investigated. The four sorted cell groups exhibited distinct cell cycle distributions, asymmetric/symmetric cell divisions, and different relative expression levels of stemness markers. Our results demonstrate that cell surface GRP78 promotes cancer stemness, whereas drives cells toward a non-stemlike phenotype when it chaperones Progranulin. We conclude that cell surface GRP78 is a chaperone exerting a deterministic influence on cancer stemness.
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Affiliation(s)
- Hsin-Ying Chen
- Graduate Institute of Biomedical Sciences, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | | | - Kun-Yi Chien
- Graduate Institute of Biomedical Sciences, Chang Gung University College of Medicine, Tao-Yuan, Taiwan.,Proteomics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Tao-Yuan, Taiwan
| | - Yun-Shien Lee
- Genomic Medicine Research Core Laboratory, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan.,Department of Biotechnology, Ming Chuan University, Tao-Yuan, Taiwan
| | - Guo-Rung You
- Graduate Institute of Biomedical Sciences, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Ann-Joy Cheng
- Graduate Institute of Biomedical Sciences, Chang Gung University College of Medicine, Tao-Yuan, Taiwan. .,Department of Radiation Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan. .,Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Fan KH, Chen YC, Lin CY, Kang CJ, Lee LY, Huang SF, Liao CT, Ng SH, Wang HM, Chang JTC. Postoperative radiotherapy with or without concurrent chemotherapy for oral squamous cell carcinoma in patients with three or more minor risk factors: a propensity score matching analysis. Radiat Oncol 2017; 12:184. [PMID: 29166942 PMCID: PMC5700467 DOI: 10.1186/s13014-017-0910-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/11/2017] [Accepted: 10/30/2017] [Indexed: 01/16/2023] Open
Abstract
Background To investigate the advantage of concurrent chemotherapy with postoperative radiotherapy (RT) of oral squamous cell carcinoma (OSCC) in patients with three or more minor risk factors. Methods Minor risk factors included pT4 disease, pN1 disease, margin ≤ 4 mm, poor differentiation, perineural invasion, vessel or lymphatic invasion, and tumor invasion depth ≥ 11 mm. Surgery was the primary treatment, followed by RT or concurrent chemoradiation (CCRT). After propensity score matching, 34 patients in each treatment group were selected for comparison. Results The median follow-up for living patients was 86.4 months (range: 47–189 months). The 5-year overall survival of the RT and CCRT groups was 35.3% and 67.2% (p = 0.018), respectively. The 5-year recurrence-free survival of the RT group and CCRT group was 42.6% and 75.4% (p < 0.01). Conclusion Postoperative CCRT for patients with three or more minor risk factors increased recurrence-free and overall survival.
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Affiliation(s)
- Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Science, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen-Chao Chen
- Departments of Radiation Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.,Departments of Diagnostic Radiology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Departments of Otolaryncology-Head and Neck Surgery, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan
| | - Li-Yu Lee
- Departments of Pathology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Departments of Otolaryncology-Head and Neck Surgery, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.,Departments of Diagnostic Radiology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Departments of Otolaryncology-Head and Neck Surgery, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Departments of Diagnostic Radiology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan
| | - Hung-Ming Wang
- Department of Internal Medicine, Division of Hematology/Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan.,Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at LinKou, Taoyuan, Taiwan. .,Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Radiation Oncology, Xiamen Chang Gung Memorial Hospital, Xiamen, Fujian, China.
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Hung TM, Lin CR, Chi YC, Lin CY, Chen EYC, Kang CJ, Huang SF, Juang YY, Huang CY, Chang JTC. Body image in head and neck cancer patients treated with radiotherapy: the impact of surgical procedures. Health Qual Life Outcomes 2017; 15:165. [PMID: 28830456 PMCID: PMC5568269 DOI: 10.1186/s12955-017-0740-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 04/11/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022] Open
Abstract
Background In this study, we aimed to investigate the impact of surgical procedures on the body image of head and neck cancer patients treated with radiotherapy and with or without radical surgery. Methods A cross-sectional survey of 150 patients with head and neck cancer was conducted. Sixty patients had nasopharyngeal cancer treated with definitive radiotherapy without surgery, and 90 patients had oral cavity cancer treated with radical surgery plus adjuvant radiotherapy. All participants completed a 10-item Body Image Scale (BIS) questionnaire to assess body image dissatisfaction. Among all patients, the socio-demographic and clinical variables were age, gender, partnership, education, employment, and radical surgery. In surgically-treated patients, the clinical variables were facial skin sacrificed, mouth angle sacrificed, glossectomy, maxillectomy, and mandibulectomy. ANOVAs, t-tests, and multiple regressions were used to evaluate the relationships between these variables and BIS results. Results In all patients, radical surgery was the strongest independent predictor of BIS scores. Surgically-treated patients had significantly worse BIS scores than the patients without surgery. In surgically-treated patients, facial skin sacrificed, mouth angle sacrificed, maxillectomy, and mandibulectomy were significantly associated with body image. According to multivariable analyses, inferior maxillectomy and segmental mandibulectomy were independent prognosticators of a poor BIS score in surgically-treated patients. Conclusion Radical surgery for head and neck cancer patients has a significant impact on their body image, especially for those undergoing facial bone destructive surgery.
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Affiliation(s)
- Tsung-Min Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, No.5 Fu-Shin Street, Kwei-Shan, Taoyuan, Taiwan.,Department of Radiation Oncology, Xiamen Chang Gung Hospital, Xiamen City, Fujian Province, China
| | - Ching-Rong Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, No.5 Fu-Shin Street, Kwei-Shan, Taoyuan, Taiwan.,School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chun Chi
- Department of Psychology, Chung Yuan Christian University, 200 Chung Pei Road, Chung Li District, Taoyuan City, 32023, Taiwan, Republic of China
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, No.5 Fu-Shin Street, Kwei-Shan, Taoyuan, Taiwan
| | - Eric Yen-Chao Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yeong-Yuh Juang
- Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Chun-Yu Huang
- Department of Psychology, Chung Yuan Christian University, 200 Chung Pei Road, Chung Li District, Taoyuan City, 32023, Taiwan, Republic of China.
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou, No.5 Fu-Shin Street, Kwei-Shan, Taoyuan, Taiwan. .,Department of Radiation Oncology, Xiamen Chang Gung Hospital, Xiamen City, Fujian Province, China.
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Chou YC, Lin CY, Pai PC, Tseng CK, Hsieh CE, Chang KP, Hsu CL, Liao CT, Wang CC, Chin SC, Yen TC, Ho TY, Hong JH, Lei KF, Chang JTC, Tsang NM. Dose-escalated radiation therapy is associated with better overall survival in patients with bone metastases from solid tumors: a propensity score-matched study. Cancer Med 2017; 6:2087-2097. [PMID: 28809463 PMCID: PMC5603838 DOI: 10.1002/cam4.1150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/14/2017] [Revised: 06/29/2017] [Accepted: 07/01/2017] [Indexed: 11/17/2022] Open
Abstract
We aimed to compare the overall survival (OS) of patients with bone metastases (BM) from solid tumors after standard‐dose radiotherapy ([RT]; 30 Gy administered in 10 fractions; EQD2Gy = 32.5 Gy) and dose‐escalated RT (EQD2Gy > 32.5 Gy). We retrospectively reviewed the clinical charts of 1795 patients (median age, 62.3 years; age range, 18–96 years) with BM from solid tumors who were referred for RT to our institute between 2000 and 2013. These patients were assigned to the standard‐dose (n = 1125; 63%) and dose‐escalated (n = 670; 37%) RT groups. OS, estimated as the duration between the first RT session and death, served as the main outcome measure. The dose‐escalated RT group had a significantly better OS than the standard‐dose RT group (P = 0.000). After allowing potential confounders in multivariate analysis, the RT dose retained its independent association with OS (hazard ratio [HR], 0.837; 95% confidence interval [CI], 0.753–0.929, P = 0.001). After propensity score matching of the baseline characteristics of both groups, RT dose retained its independent association with OS (HR, 0.887; 95% CI, 0.737–0.951; P = 0.011) on multivariate analysis. Dose‐escalated RT exerted more favorable effects on OS in patients with non‐lung cancer, those without multiple metastases, those without symptoms, and those with favorable prognosis. Dose‐escalated RT was significantly associated with better OS in patients with BM from solid malignancies, particularly among those with non‐lung cancer, those without multiple metastases, those without symptoms, and those with favorable prognosis.
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Affiliation(s)
- Yung-Chih Chou
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan
| | - Ping-Ching Pai
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan
| | - Chen-Kan Tseng
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan
| | - Cheng-En Hsieh
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University at Lin-Kou, Taoyuan, Taiwan
| | - Cheng-Lung Hsu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan
| | - Shy-Chyi Chin
- Department of Medical Imaging and Intervention, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tsung-Ying Ho
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ji-Hong Hong
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan
| | - Kin-Fong Lei
- Graduate Institute of Medical Mechatronics, Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and University at Lin-Kou, Taoyuan, Taiwan.,School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
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Hsin LJ, Lin WN, Fang TJ, Lee LA, Kang CJ, Huang BS, Lin CY, Fan KH, Tsang NM, Hsu CL, Chang JTC, Liao CT, Yen TC, Chang KP, Chuang HF, Li HY. Life quality improvement in hoarse patients with early glottic cancer after transoral laser microsurgery. Head Neck 2017; 39:2070-2078. [PMID: 28695624 DOI: 10.1002/hed.24873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/11/2017] [Accepted: 05/29/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the recovery kinetics of voice and quality of life (QOL) over time in patients with early glottic cancer who underwent transoral laser microsurgery (TLM). METHODS A prospective cohort study was conducted in which acoustic and aerodynamic voice assessments and QOL analyses were done using health-related questionnaires (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions [EORTC-QLQ-C30] and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35-questions [EORTC-QLQ-H&N35]) were administered at designated times. RESULTS Most voice laboratory parameters worsened during the first month, then recovered to baseline after 6 months. The QLQ-H&N35 speech subscale was significantly improved. Among the voice laboratory parameters, pretreatment harmonics-to-noise ratio was an independent predictor (P = .041) for improvement on the speech subscale at the endpoint. CONCLUSION Despite an initial deterioration of voice and QOL in the first month, patients who underwent TLM recovered to a plateau since the sixth month and then to better than preoperative status afterward. A greater improvement in QOL was seen in patients with poorer baseline voice quality.
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Affiliation(s)
- Li-Jen Hsin
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wan-Ni Lin
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Ang Lee
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Jan Kang
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Bing-Shan Huang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Yu Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kang-Hsing Fan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ngan-Ming Tsang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Lung Hsu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Medical Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Departmen of Radiation Oncology, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Chen Yen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Nuclear Medicine and Molecular Imaging, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsiu-Feng Chuang
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- Department of Otolaryngology, Head and Neck Surgery, Linkou-Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Fang TJ, Lee LA, Huang BS, Lin CY, Hsu CL, Chang JTC, Yen TC, Liao CT, Chiang HC. What should we expect from robotic surgery for second primary oropharyngeal cancer? Eur Arch Otorhinolaryngol 2017; 274:3161-3168. [PMID: 28484837 DOI: 10.1007/s00405-017-4594-8] [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: 03/28/2017] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
The outcomes of second primary oropharyngeal cancer (SPOPC) may not be determined by oropharyngeal cancer but from the other index cancer as well. The management of (SPOPC) remains inconclusive and limited. Transoral robotic surgery (TORS) to maximize the functional outcomes without reducing oncologic effect is suggested as the primary treatment for selected oropharyngeal cancer. This study aimed to evaluate the feasibility and outcomes of TORS for the management of SPOPC. Patients who underwent TORS from January 2011 to June 2015 at a tertian referral center in Taiwan were recruited. Loco-regional status, overall survival (OS), disease-specific survival (DSS), and postoperative functional status were evaluated. Fifteen patients received TORS for SPOPC with curative intent, including eleven with tongue-base carcinomas, and four with tonsil carcinomas. One case was terminated because of inadequate exposure and the other 14 cases were completed with negative pathologic margins. Two-year OS and DSS were 53 and 77%, respectively. Patients with SPOPC occurring within 6 months had poorer outcomes (p = 0.044). The median time to feeding-tube removal was 5 days, and one patient had long-term gastric-tube dependence. Patients of age <65 years with synchronous SPOPC and esophageal cancer as the other index cancer were significant worse in oncologic outcomes. We concluded that TORS is a feasible alternative treatment in selected patients with SPOPC. Patients with metachronous T1-2 SPOPC without an esophageal primary can achieve excellent survival after TORS, while TORS can maximize functional preservation with limited destruction in patients with low life expectancy.
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Affiliation(s)
- Tuan-Jen Fang
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Head and Neck Oncologic Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan. .,, 5 Fu-Shin Street, Kweishan 333, Taoyuan, Taiwan.
| | - Li-Ang Lee
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Head and Neck Oncologic Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Bing-Shan Huang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Head and Neck Oncologic Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chien-Yu Lin
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Head and Neck Oncologic Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Cheng-Lung Hsu
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Head and Neck Oncologic Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Medical Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Joseph Tung-Chieh Chang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Head and Neck Oncologic Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Radiation Oncology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Tzu-Chen Yen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Head and Neck Oncologic Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Head and Neck Oncologic Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Hui-Chen Chiang
- Graduate School of Management, Ming Chung University, Taipei, Taiwan
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Wang HM, Lin CY, Hsieh CH, Hsu CL, Fan KH, Chang JTC, Huang SF, Kang CJ, Liao CT, Ng SH, Yen TC. Induction chemotherapy with dose-modified docetaxel, cisplatin, and 5-fluorouracil in Asian patients with borderline resectable or unresectable head and neck cancer. J Formos Med Assoc 2017; 116:185-192. [DOI: 10.1016/j.jfma.2016.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 03/10/2016] [Accepted: 03/14/2016] [Indexed: 10/21/2022] Open
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Tai SF, Chien HT, Young CK, Tsao CK, de Pablo A, Fan KH, Liao CT, Wang HM, Kang CJ, Chang JTC, Huang SF. Roles of preoperative C-reactive protein are more relevant in buccal cancer than other subsites. World J Surg Oncol 2017; 15:47. [PMID: 28209200 PMCID: PMC5314474 DOI: 10.1186/s12957-017-1116-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/01/2017] [Indexed: 02/06/2023] Open
Abstract
Background C-reactive protein (CRP) is an early marker for inflammation, and a relationship between serum CRP levels and survival in oral cancer has been demonstrated previously. In this study, we investigated the roles of CRP in different oral cancer subsites. Methods Three hundred and forty-three oral squamous cell carcinoma patients between June 1999 and March 2015 were retrospectively reviewed. Serum CRP levels were measured preoperatively. Results The elevation of CRP levels (≥5.0 mg/L) was significantly correlated with pathologic tumor status, pathologic nodal status, nodal extracapsular spread, tumor stage, skin invasion, tumor depth (≥10 mm), and bone invasion. The correlation between elevation of CRP and clinicopathologic factors was more evident in the buccal cancer compared to other tumor subsites. The disease-free survival and overall survival correlation was significant in buccal cancer (p = 0.003 and p < 0.001) but not in tongue cancer (p = 0.119 and p = 0.341) or other oral cancer subsites (p = 0.246 and p = 0.696). Conclusions Preoperative serum CRP level was a prognosticator in oral squamous cell carcinoma, and its effect was more prominent in buccal cancer that occurs more frequently in areca-quid (AQ) endemic regions. Electronic supplementary material The online version of this article (doi:10.1186/s12957-017-1116-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shiao Fwu Tai
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Huei-Tzu Chien
- Department of Public Health, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chi-Kuang Young
- Department of Otolaryngology, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Chung-Kang Tsao
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Alba de Pablo
- Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan, Republic of China
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chun-Ta Liao
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Chung-Jan Kang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan.,Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Shiang-Fu Huang
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan. .,Department of Public Health, Chang Gung University, Taoyuan, Taiwan, Republic of China.
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Hung TM, Fan KH, Chen EYC, Lin CY, Kang CJ, Huang SF, Liao CT, Ng SH, Wang HM, Chang JTC. An elective radiation dose of 46 Gy is feasible in nasopharyngeal carcinoma treated by intensity-modulated radiotherapy: A long-term follow-up result. Medicine (Baltimore) 2017; 96:e6036. [PMID: 28178144 PMCID: PMC5313001 DOI: 10.1097/md.0000000000006036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The purpose of this study is to compare the treatment outcome of different radiation doses of elective neck irradiation (ENI) in nasopharyngeal carcinoma (NPC) patients treated with intensity-modulated radiotherapy (IMRT).In total, 504 patients with nondisseminated NPC who underwent magnetic resonance imaging before radical IMRT between 2000 and 2008 were retrospectively reviewed. The patients were classified into 2 groups based on the ENI dose: low ENI when the ENI dose was 46 Gy (n = 446) and high ENI when the ENI doses were 50 to 60 Gy (n = 58). All the patients in both the groups received a median dose of 72 Gy to the gross tumor and involved nodes. The fraction size was 2 Gy per fraction. Matching was performed between low ENI and high ENI in a 2:1 ratio, and the matching criteria were N-stage, T-stage, treatment modality, pathology classification, sex, and age.The median follow-up for all patients was 63.5 months. In all patients, the 5-year progression-free survival (PFS), local control (LC), regional control (RC), distant metastasis-free survival (DMFS), overall survival (OS), and cancer-specific survival (CSS) for low ENI and high ENI patients were 69.0% and 63.2% (P = 0.331), 89.0% and 83.9% (P = 0.235), 90.1% and 85.2% (P = 0.246), 86.8% and 76.6% (P = 0.056), 77.5% and 80.8% (P = 0.926), and 84.4% and 82.5% (P = 0.237), respectively. In the matched-pair analysis, the 5-year PFS, LC, RC, DMFS, OS, and CSS for matched low ENI and high ENI patients were 74.1% and 63.2% (P = 0.134), 92.0% and 83.9% (P = 0.152), 90.1% and 85.2% (P = 0.356), 86.2% and 76.6% (P = 0.125), 87.0% and 80.8% (P = 0.102), and 88.6% and 82.5% (P = 0.080), respectively. In the multivariable analysis for all patients, the ENI group was not a significant factor for PFS, LC, RC, DMFS, OS, and CSS.A low ENI dose of 46 Gy in 23 fractions is feasible in NPC patients treated with IMRT, and this concept should be validated in the prospective studies.
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Affiliation(s)
- Tsung-Min Hung
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan
| | | | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery,
| | | | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery,
| | | | - Hung-Ming Wang
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan
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Abstract
This study is a retrospective analysis of 134 patients treated with radiotherapy at our hospital. The sample included 88 stage T1 and 46 stage T2 patients. Sixty-two patients had anterior commissure involvement, 37 patients had impaired vocal cord mobility, and 24 patients had supraglottic or subglottic extension. Irradiation was given, with the dose ranging from 60 to 72 Gy. Laryngectomy was the main salvage treatment for local recurrence. The 5-year initial and final local control rates were 71% and 83%, and the 10-year initial and final local control rates were 69% and 80%, comparable to the results of other series. The 5-year rate of overall survival with final larynx preservation was 77%. Multivariate analysis revealed that anterior commissure involvement is prognostic of a poor outcome in patients with T1 glottic cancer. Further subgroup analysis revealed that a fraction size of >200 cGy could overcome the negative impact of anterior commissure involvement and significantly improve the 5-year local control rate in T1 patients (100% at >200 cGy versus 45% at ≤200 cGy; p = .04). Subglottic extension of the glottic cancer predicted poor outcome in T2 patients. The 5-year local control rates of patients with and without subglottic extension were 9% and 77%, respectively (p < .001). According to our results, radiotherapy with a fraction size of >200 cGy is recommended for T1 disease with anterior commissure involvement. For patients with T2 disease and subglottic extension, radiotherapy alone produces poor results. Further improvement of outcomes by other treatment strategies needs to be investigated.
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Affiliation(s)
- Miao-Fen Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Putz City, Chia-Yi, Taiwan
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