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Peelay Z, Saha S, Patil V, Menon N, Singh A, Shah M, Sahu A, Ubharay A, Chowdhury OR, Prabhash K, Noronha V. Neoadjuvant Chemotherapy in Locally Advanced Sinonasal Teratocarcinosarcoma a Rare Malignancy: An Audit From an Academic Tertiary Care Centre in India. Clin Oncol (R Coll Radiol) 2024; 36:e137-e145. [PMID: 38565457 DOI: 10.1016/j.clon.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/26/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
AIMS Sinonasal teratocarcinosarcomas (SNTCS) are rare sinonasal malignancies, the incidence of which is less than 1% of all tumors. There is limited data available on SNTCS's, often as case reports and small case series. The management of SNTCS is complicated because of its location, locally aggressive biology, difficulty in achieving complete resection, and limited data on chemotherapy in these malignancies. This audit was performed to understand the role of neoadjuvant chemotherapy (NACT) in SNTCS's, its ability to downstage the disease, achieve complete resection, and impact on long-term survival outcomes. METHODS This was a retrospective analysis of a prospectively maintained database approved by the Institutional Ethics Committee (IEC). The baseline characteristics, the extent of tumor, Kadish stage, NACT regimen, and adverse events were extracted from the Electronic Medical Records and the patient's case file. Patients with baseline extensive/inoperable disease were referred for NACT from the multidisciplinary joint clinic followed by response assessment (RECIST v1.1). Patients underwent skull-base surgery if respectable post-completion of NACT, however, if deemed unresectable were treated with non-surgical modalities or palliative therapies. RESULTS The data of 27 patients were evaluated from the year 2015-2022. The median age was 42 years (IQR:30-56) and 85.2% (n = 23) were males. The ECOG-PS was 0-1 in 88.8% (n = 24) patients. All 27 patients received NACT in view of extensive disease at presentation. 74.1% (n = 20) patients received Cisplatin-Etoposide and 25.9% (n = 7) received other chemotherapy regimens. The median number of chemotherapy cycles was 2(IQR:2-3). 96.3% patients (n = 26) completed the planned NACT cycles. 70.4% (n = 19) patients achieved a partial response in post-NACT imaging. 77.8% (n = 18) underwent surgery, 18.5% (n = 5) received CTRT, and 7.4% (n = 2) received definitive-RT alone. The median PFS and OS of the cohort was 19months (95%CI:12.0-25.6) and 23months (95%CI:5.94-40.06) respectively. CONCLUSION NACT is safe, feasible, and effective with significant response rates, leading to effective downstaging, resectability and improved survival in patients with locally advanced SNTCS's.
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Affiliation(s)
- Z Peelay
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - S Saha
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - V Patil
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - N Menon
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - A Singh
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - M Shah
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - A Sahu
- Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - A Ubharay
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - O R Chowdhury
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - K Prabhash
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - V Noronha
- Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
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Langenberg SMCH, van Herpen CML, van Opstal CCM, Wymenga ANM, van der Graaf WTA, Prins JB. Caregivers' burden and fatigue during and after patients' treatment with concomitant chemoradiotherapy for locally advanced head and neck cancer: a prospective, observational pilot study. Support Care Cancer 2019; 27:4145-4154. [PMID: 30796519 PMCID: PMC6803613 DOI: 10.1007/s00520-019-04700-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/11/2019] [Indexed: 11/25/2022]
Abstract
Purpose Knowledge of caregivers’ burden and fatigue before and after patients’ treatment for locally advanced head and neck cancer is scarce. Therefore, we aimed to explore caregivers’ fatigue and burden in relation to patients’ fatigue, distress, and quality of life. Methods For caregivers, burden and fatigue were assessed. For patients, fatigue severity, distress, and health-related quality of life (HRQoL) were assessed. Measurements were conducted prior to treatment, 1 week, and 3 months after chemoradiotherapy. Results Caregivers’ burden and fatigue followed patients’ high peak in distress, fatigue, and diminished HRQoL as a consequence of treatment. Caregivers’ baseline fatigue was a predictor for fatigue after chemoradiotherapy. Female spouses with higher baseline levels of fatigue and burden and caring for patients with lower levels of HRQoL seem risk factors for burden after chemoradiotherapy. Conclusions Attention should be paid to caregivers’ burden and fatigue before starting patients’ intense treatment with chemoradiotherapy, as both burden and fatigue before starting treatment may contribute to burden and fatigue after chemoradiotherapy.
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Affiliation(s)
- Simone M C H Langenberg
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Claudia C M van Opstal
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anke N M Wymenga
- Department of Medical Oncology, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen (840), The Netherlands.
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Green G, Kim E, Carmona R, Shen H, Murphy JD, Mell LK. Incidence of Long-Term Esophageal Dilation With Various Treatment Approaches in the Older Head and Neck Cancer Population. Front Oncol 2018; 8:466. [PMID: 30406032 PMCID: PMC6206230 DOI: 10.3389/fonc.2018.00466] [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: 08/15/2018] [Accepted: 10/03/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose: Treatments for locoregionally advanced head and neck cancer (LAHNC) negatively impact swallowing function, but the long-term incidence of severe toxicity requiring esophageal dilation is not well-documented in the population. The aim of this study was to compare the incidence of long-term esophageal dilation across varying treatments for LAHNC. Methods and Materials: We identified 5,223 patients with LAHNC diagnosed from 2000 to 2009 in the SEER-Medicare database. We compared the incidence of esophageal dilation for surgery alone vs. surgery plus adjuvant radiotherapy (RT) and chemoradiotherapy (CRT) vs. definitive RT or CRT. Results: The cumulative incidence of esophageal dilation for all sites at 10 years, according to treatment group were as follows: CRT, 14% (95% confidence interval (CI), 12–17%); definitive RT, 13% (95% CI, 10–16%); surgery alone, 5% (95% CI, 3–7%); surgery and CRT, 15% (95% CI, 11–19%); surgery and adjuvant RT: 10% (95% CI, 8–13%). There was no significant difference in the incidence of esophageal dilation between surgery plus adjuvant RT/CRT or definitive RT/CRT (p = 0.37), but the incidence was significantly increased in both groups compared to surgery alone (p = 0.003). On multivariable analysis, chemotherapy was associated with significantly increased incidence of esophageal dilation (HR 2.9, 95% CI 1.5–5.5, p < 0.001) in oropharyngeal cancers. Conclusions: The incidence of esophageal dilation is similar in LAHNC patients undergoing RT with or without surgery. Chemoradiotherapy increases the long-term risk of esophageal dilation events over surgery alone.
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Affiliation(s)
- Garrett Green
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Ellen Kim
- Department of Radiation Oncology, Vanderbilt University, Nashville, TN, United States
| | - Ruben Carmona
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Hanjie Shen
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
| | - Loren K Mell
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, United States
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Hauswald H, Jensen AD, Krauss J, Haselmann R, Lossner K, Hartmann S, Windemuth-Kieselbach C, Münter MW, Debus J. Phase II study of induction chemotherapy with docetaxel, cisplatin, 5-fluorouracil followed by radioimmunotherapy with cetuximab and intensity-modulated radiotherapy in combination with a carbon ion boost for locally advanced tumors of the oro-, hypopharynx and larynx. Clin Transl Radiat Oncol 2018; 13:64-73. [PMID: 30370340 PMCID: PMC6199783 DOI: 10.1016/j.ctro.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/30/2018] [Revised: 09/16/2018] [Accepted: 09/19/2018] [Indexed: 12/31/2022] Open
Abstract
Trimodal approach with carbon ions was tolerable and promising. No high-grade radiation adverse events were documented. No adverse events resulted in death of patients. Quality of life recovered for most aspects until the last follow-up visit.
Purpose This phase II trial was designed to evaluate efficacy and safety of a highly intensified therapy in locally advanced squamous cell carcinoma of the oro-, hypopharynx and larynx. Methods In this prospective, mono-centric, open-label, non-randomized phase II trial the single treatment arm consisted of a combined induction chemotherapy with docetaxel, cisplatin, 5-fluorouracil, followed by bioradiation with the monoclonal antibody cetuximab, carbon ion boost (24Gy(RBE) in 8 fractions) and IMRT (50 Gy in 25 fractions). The trial was closed early due to slow accrual. Results Eight patients (median age 52.5 years) were enrolled into the trial. The median follow-up was 13 months and the 12-months locoregional tumor control, progression-free survival and overall survival rates were 100.0% each. Complete remission was achieved in 7 patients. The most commonly late radiation adverse event was xerostomia (85.7% at 12 months). Five serious adverse events with recovery were documented in 4 patients: mucositis grade 3 (n = 2), decreased lymphocyte count grade 4, febrile neutropenia grade 4 and hypersensitivity grade 3 to cetuximab (n = 1 each). Most symptom scales had their worst value at the last treatment day and recovered until the 4th follow-up visit. Conclusion The study treatment was tolerable and promising. Reduced quality of life recovered for most aspects until the last follow-up visit.
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Affiliation(s)
- H Hauswald
- Department of Radiation Oncology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - A D Jensen
- Department of Radiation Oncology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - J Krauss
- Department of Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - R Haselmann
- Department of Radiation Oncology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - K Lossner
- Department of Radiation Oncology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - S Hartmann
- Alcedis GmbH, Winchesterstr. 3, 35394 Gießen, Germany
| | | | - M W Münter
- Department of Radiation Oncology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
| | - J Debus
- Department of Radiation Oncology, Heidelberg University Hospital, INF 400, 69120 Heidelberg, Germany
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Dhull AK, Atri R, Dhankhar R, Chauhan AK, Kaushal V. Major Risk Factors in Head and Neck Cancer: A Retrospective Analysis of 12-Year Experiences. World J Oncol 2018; 9:80-84. [PMID: 29988794 PMCID: PMC6031231 DOI: 10.14740/wjon1104w] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [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: 04/04/2018] [Accepted: 05/10/2018] [Indexed: 01/12/2023] Open
Abstract
Background Head and neck cancer (HNC) is the seventh most common type of cancer in the world and constitute 5% of the entire cancers worldwide. The global burden of HNC accounts for 650,000 new cases and 350,000 deaths worldwide every year and a major proportion of regional malignancies in India. More than 70% of squamous cell carcinoma of the head and neck are estimated to be avoidable by lifestyle changes, particularly by effective reduction of exposure to well-known risk factors such as tobacco smoking and alcohol drinking. Methods A retrospective analysis of 12 years (2001 - 2012) of HNC patients attending RCC, PGIMS Rohtak was done. Total numbers of cancer patients seen were 26,295 and out of these 9,950 patients were of HNCs, which were retrospectively analyzed for their associated risk factors in different HNC subtypes. Most of the patients, i.e. 92.3%, were presented as locally advanced HNC (stages III and IV). Results It has been observed that smoking and alcohol are the strongest independent risk factors responsible for increased risk of HNC and are further having synergetic correlations. Conclusion The present study confirms the principal role of alcohol consumption and smoking in HNC carcinogenesis, as well as the differential associations with HNC subtypes, and a significant, positive, multiplicative interaction with different risk factors.
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Affiliation(s)
- Anil Kumar Dhull
- Department of Radiation Oncology, Regional Cancer Centre, Pt. BDS Post Graduate Institute of Medical Science, Rohtak, Haryana, India
| | - Rajeev Atri
- Department of Radiation Oncology, Regional Cancer Centre, Pt. BDS Post Graduate Institute of Medical Science, Rohtak, Haryana, India
| | - Rakesh Dhankhar
- Department of Radiation Oncology, Regional Cancer Centre, Pt. BDS Post Graduate Institute of Medical Science, Rohtak, Haryana, India
| | - Ashok K Chauhan
- Department of Radiation Oncology, Regional Cancer Centre, Pt. BDS Post Graduate Institute of Medical Science, Rohtak, Haryana, India
| | - Vivek Kaushal
- Department of Radiation Oncology, Regional Cancer Centre, Pt. BDS Post Graduate Institute of Medical Science, Rohtak, Haryana, India
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Strom TJ, Naghavi AO, Trotti AM, Russell J, Kish JA, McCaffrey J, Otto KJ, Harrison LB, Caudell JJ. Increased acute mortality with chemoradiotherapy for locally advanced head and neck cancer in patients ≥70years. J Geriatr Oncol 2016; 8:50-55. [PMID: 27720129 DOI: 10.1016/j.jgo.2016.09.003] [Citation(s) in RCA: 17] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/22/2016] [Accepted: 09/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Concurrent chemoradiotherapy (CRT) is the standard of care for many sites of locally advanced head and neck squamous cell carcinomas (LAHNC). However, on meta-analysis, the addition of chemotherapy did not improve survival for patients >70years. We hypothesized that elderly patients treated with CRT would have increased toxicity without similar improvements in survival. METHODS A single-institution, IRB-approved retrospective study took place from 2005 to 2012 including 369 patients treated with CRT for LAHNC. Multivariate models for death at 3months and death over time were developed using logistic regression and Cox modeling, respectively. RESULTS Patients ≥70years were treated less often with concurrent cisplatin dosed every 3weeks (25.5% vs. 71.4%, respectively) and more often with weekly carboplatin (31.9% vs. 3.4%) than patients <70years (n=322; p<0.001). Patients ≥70years experienced increased toxicity during treatment with more frequently hospitalizations (36.2% vs. 21.1%; p=0.02) and a lower rate of PEG removal at last follow-up or death (77.1% vs. 92.9%; p=0.004). A higher proportion of patients ≥70years died within 3months (12.8% vs. 2.8%; p=0.001) following CRT. Patients ≥70 had an increased risk of death at 3months following CRT (odds ratio 5.19, 95% CI 1.64-16.41; p=0.005) and worse survival over time (hazard ratio 2.30, 95% CI 1.34-3.93; p=0.002). CONCLUSIONS Patients ≥70years were more often treated with less toxic chemotherapy, yet experienced higher rates of hospitalization during treatment and increased rates of acute mortality following CRT. The efficacy of chemoradiotherapy for elderly patients should be evaluated in a prospective setting.
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Affiliation(s)
- Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jeffery Russell
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Julie A Kish
- Department of Senior Adult Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Judith McCaffrey
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kristen J Otto
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
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