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Li R, Jiang W, Dou S, Zhong L, Sun J, Zhang C, Zhu G. A Phase 2 Trial of Chemoradiation Therapy Using Weekly Docetaxel for High-Risk Postoperative Oral Squamous Cell Carcinoma Patients. Int J Radiat Oncol Biol Phys 2020; 107:462-468. [PMID: 32126267 DOI: 10.1016/j.ijrobp.2020.02.464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/08/2020] [Accepted: 02/14/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of postoperative concurrent chemoradiation therapy using weekly docetaxel in patients with high-risk oral squamous cell carcinoma (OSCC). METHODS AND MATERIALS This is a prospective single-arm study from a single institute in Shanghai Ninth People's Hospital, Shanghai, China. Patients with locally stage III to IV OSCC who underwent radical surgery with at least 1 high-risk feature were enrolled for the study. High-risk features evaluated included (1) pathologically confirmed positive or close margins in the primary site or extracapsular nodal extension; (2) histologic involvement of ≥2 regional lymph nodes; and (3) locoregional recurrent OSCC (after initial surgery alone) treated with salvage surgery with curative intent. Docetaxel was administered at a dose of 20 mg/m2 concurrently with postoperative radiation therapy (total dose 60-66 Gy). The primary outcome was 2-year disease-free survival (DFS). Secondary endpoints included 2-year locoregional progress-free survival, 2-year overall survival (OS), and toxicities. RESULTS From March 2016 to February 2018, 91 patients (59 males, 32 females) were recruited. Median age was 59 years (range, 26-70). All patients were included in final analysis. Fifty-eight patients (63.7%) completed the 6 planned cycles of docetaxel, and all patients completed postoperative radiation therapy. With a median follow-up of 24 months, the 2-year DFS and OS were 75.3% (95% confidence interval, 65.7%-84.2%) and 82.4% (95% confidence interval, 73.0%-89.6%), respectively. Patterns of failure were 13 local recurrences, 2 regional lymph nodes recurrences, and 8 distant failures. Seven patients (7.7%) were recorded as having grade 3 oral cavity mucositis. Two patients had grade 3 hypersensitivity reaction. No other grade 3 or higher adverse events, including hematologic toxicities, were observed. CONCLUSIONS The addition of low-dose weekly docetaxel with concurrent radiation therapy is a tolerable regimen with favorable DFS and OS in patients with high-risk, resected OSCC.
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Affiliation(s)
- Rongrong Li
- Department of Oral and Maxillofacial Head & Neck Oncology, Division of Radiation Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Wen Jiang
- Department of Oral and Maxillofacial Head & Neck Oncology, Division of Radiation Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shengjin Dou
- Department of Oral and Maxillofacial Head & Neck Oncology, Division of Radiation Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Laiping Zhong
- National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; Department of Oral and Maxillofacial Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian Sun
- National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; Department of Oral and Maxillofacial Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenping Zhang
- National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China; Department of Oral and Maxillofacial Head & Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guopei Zhu
- Department of Oral and Maxillofacial Head & Neck Oncology, Division of Radiation Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China; National Clinical Research Center for Oral Diseases, Shanghai, China; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China.
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[Dose de-escalation during adjuvant chemoradiotherapy of HPV-associated oropharyngeal squamous cell carcinoma: the MC1273 phase II study]. Strahlenther Onkol 2020; 195:1110-1112. [PMID: 31612254 DOI: 10.1007/s00066-019-01527-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Geiger JL, Adelstein DJ. Chemotherapy in the definitive management of oral cancers: Where do we stand today? Oral Oncol 2020; 102:104584. [PMID: 32032863 DOI: 10.1016/j.oraloncology.2020.104584] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 01/08/2020] [Accepted: 01/26/2020] [Indexed: 11/15/2022]
Abstract
The treatment of locally advanced oral cavity cancer is often multimodal, involving surgical resection, radiotherapy (RT), and chemotherapy. Systemic therapy is the mainstay of treatment for recurrent/metastatic disease. While the concurrent use of cisplatin with post-operative RT is well established in patients with high risk features of extranodal extension and/or positive surgical margins following resection, the role of chemotherapy in other curative settings is not clear. Studies reporting success of induction chemotherapy or definitive chemoradiotherapy in absence of primary resection include all anatomic sites of head and neck cancer, and oral cavity cancer subset is rarely reported as a separate analysis, thus limiting the interpretation of results. This article will focus on the use of systemic therapy for locoregionally advanced oral cavity cancer.
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Affiliation(s)
- Jessica L Geiger
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, United States.
| | - David J Adelstein
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, United States
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54
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Huang SH, Hahn E, Chiosea SI, Xu ZY, Li JS, Shen L, O'Sullivan B. The role of adjuvant (chemo-)radiotherapy in oral cancers in the contemporary era. Oral Oncol 2020; 102:104563. [PMID: 31918174 DOI: 10.1016/j.oraloncology.2019.104563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 12/28/2022]
Abstract
Squamous cell carcinoma of oral cavity (OSCC) is predominantly managed with surgery. Post-operative radiotherapy (PORT) and chemoradiotherapy (POCRT) enhance disease control in OSCC patients with adverse anatomic and pathologic primary and nodal features. Knowledge about disease behavior, surgery and radiotherapy advances, and the emergence of new systemic agents prompt refinement of PORT volumes and POCRT regimens. Traditional and emerging prognostic models that include adverse histopathological features underpin such approaches. This review summarizes research over recent decades with emphasis on the 2015 to Feb 2019 period describing: (1) Indications for PORT and/or POCRT, addressing surgical "margin status" including the definition of a "clear" margin to permit withholding PORT/POCRT; these concepts include characterizing the specimen yielding these measurements, the optimal time point to assess these findings, and the putative value of a "revised margin" performed during the same operative procedure, (2) Emerging prognostic factors including nodal burden (total number of involved lymph nodes) and perineural invasion, (3) PORT volume design, dose/fractionation and optimal surgery-to-PORT interval, (4) Chemotherapy dose, schedule, and agents, and (5) On-going clinical trials involving systemic agents and combinations of chemotherapy with immunotherapy.
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Affiliation(s)
- Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada
| | - Simion I Chiosea
- Department of Pathology, University of Pittsburgh Medical Center, PA, USA
| | - Zhi-Yuan Xu
- Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, PR China
| | - Ji-Shi Li
- Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, PR China
| | - Lin Shen
- Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, PR China
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON, Canada; Department of Clinical Oncology, The University of Hong Kong - Shenzhen Hospital, Shenzhen, PR China.
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Pai SI, Cohen EEW, Lin D, Fountzilas G, Kim ES, Mehlhorn H, Baste N, Clayburgh D, Lipworth L, Resteghini C, Shara N, Fujii T, Zhang J, Stokes M, Wang H, Twumasi-Ankrah P, Wildsmith S, Khaliq A, Melillo G, Shire N. SUPREME-HN: a retrospective biomarker study assessing the prognostic value of PD-L1 expression in patients with recurrent and/or metastatic squamous cell carcinoma of the head and neck. J Transl Med 2019; 17:429. [PMID: 31878938 PMCID: PMC6933901 DOI: 10.1186/s12967-019-02182-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 12/18/2019] [Indexed: 12/17/2022] Open
Abstract
Background Programmed cell death ligand-1 (PD-L1) expression on tumor cells (TCs) is associated with improved survival in patients with head and neck squamous cell carcinoma (HNSCC) treated with immunotherapy, although its role as a prognostic factor is controversial. This study investigates whether tumoral expression of PD-L1 is a prognostic marker in patients with recurrent and/or metastatic (R/M) HNSCC treated with standard chemotherapy. Methods This retrospective, multicenter, noninterventional study assessed PD-L1 expression on archival R/M HNSCC tissue samples using the VENTANA PD-L1 (SP263) Assay. PD-L1 high was defined as PD-L1 staining of ≥ 25% TC, with exploratory scoring at TC ≥ 10% and TC ≥ 50%. The primary objective of this study was to estimate the prognostic value of PD-L1 status in terms of overall survival (OS) in patients with R/M HNSCC. Results 412 patients (median age, 62.0 years; 79.9% male; 88.2% Caucasian) were included from 19 sites in seven countries. 132 patients (32.0%) had TC ≥ 25% PD-L1 expression; 199 patients (48.3%) and 85 patients (20.6%) had TC ≥ 10% and ≥ 50%, respectively. OS did not differ significantly across PD-L1 expression (at TC ≥ 25% cutoff median OS: 8.2 months vs TC < 25%, 10.1 months, P = 0.55) or the ≥ 10% and ≥ 50% cutoffs (at TC ≥ 10%, median OS: 9.6 months vs TC < 10%, 9.4 months, P = 0.32, and at TC ≥ 50%, median OS 7.9 vs TC < 50%, 10.0 months, P = 0.39, respectively). Conclusions PD-L1 expression, assessed using the VENTANA PD-L1 (SP263) Assay, was not prognostic of OS in patients with R/M HNSCC treated with standard of care chemotherapies. Trial registration ClinicalTrials.gov, NCT02543476. Registered September 4, 2015.
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Affiliation(s)
- Sara I Pai
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, GRJ 9-904G, Boston, MA, 02114, USA.
| | - Ezra E W Cohen
- UC San Diego Health System, Moores Cancer Center, La Jolla, CA, USA
| | - Derrick Lin
- Massachusetts General Hospital Cancer Center, Harvard Medical School, 55 Fruit Street, GRJ 9-904G, Boston, MA, 02114, USA.,Massachusetts Eye and Ear, Boston, MA, USA
| | | | - Edward S Kim
- Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Holger Mehlhorn
- Universitaetsklinikum Leipzig, Klinik und Poliklinik fur HNO-Heilkunde, Leipzig, Germany
| | - Neus Baste
- Department of Oncology, Hospital Universitari Vall d'Hebron & Vall Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Loren Lipworth
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Nawar Shara
- MedStar Health Research Institute, Hyattsville, MD, USA
| | | | - Jun Zhang
- Baylor College of Medicine, Houston, TX, USA
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Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, Graner DE, Neben-Wittich M, Garces YI, Chintakuntlawar AV, Price DL, Van Abel KM, Kasperbauer JL, Janus JR, Waddle M, Miller RC, Shiraishi S, Mutter RW, Corbin KS, Park SS, Foote RL. Reply to A.S. Garden. J Clin Oncol 2019; 37:3559-3560. [PMID: 31557088 DOI: 10.1200/jco.19.02144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Daniel J Ma
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Katharine A Price
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Eric J Moore
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Samir H Patel
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Michael L Hinni
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Joaquin J Garcia
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Darlene E Graner
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Michelle Neben-Wittich
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Yolanda I Garces
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Ashish V Chintakuntlawar
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Daniel L Price
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Kathryn M Van Abel
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Jan L Kasperbauer
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Jeffrey R Janus
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Mark Waddle
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert C Miller
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Satomi Shiraishi
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert W Mutter
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Kimberly S Corbin
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Sean S Park
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
| | - Robert L Foote
- Daniel J. Ma, MD; Katharine A. Price, MD; and Eric J. Moore, MD, Mayo Clinic, Rochester, MN; Samir H. Patel, MD and Michael L. Hinni, MD, Mayo Clinic, Phoenix, AZ; Joaquin J. Garcia, MD; Darlene E. Graner, SLPD; Michelle Neben-Wittich, MD; Yolanda I. Garces, MD; Ashish V. Chintakuntlawar, MBBS, PhD; Daniel L. Price, MD; Kathryn M. Van Abel, MD; Jan L. Kasperbauer, MD; and Jeffrey R. Janus, MD, Mayo Clinic, Rochester, MN; Mark Waddle, MD, Mayo Clinic, Jacksonville, FL; Robert C. Miller, MD, University of Maryland School of Medicine, Baltimore, MD; and Satomi Shiraishi, PhD; Robert W. Mutter, MD; Kimberly S. Corbin, MD; Sean S. Park, MD, PhD; and Robert L. Foote, MD, Mayo Clinic, Rochester, MN
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Affiliation(s)
- Adam S Garden
- Adam S. Garden, MD, University of Texas MD Anderson Cancer Center, Houston, TX
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Weiss BG, Anczykowski MZ, Flach S, Spiegel JL, Kitz J, Bertlich M, Canis M, Jakob M, Ihler F. Benefit of postoperative radiotherapy for early tumors with single ipsilateral lymph node metastasis. Laryngoscope 2019; 130:E530-E538. [PMID: 31837151 DOI: 10.1002/lary.28394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/27/2019] [Accepted: 09/27/2019] [Indexed: 02/01/2023]
Abstract
OBJECTIVES/HYPOTHESIS Indication for postoperative radiotherapy in patients with locally circumscribed tumors (pT1-pT2) and a single ipsilateral lymph node metastasis (pN1) is debatable. The aim of this study was to evaluate the oncological long-term outcome of patients with pT1-pT2 pN1 squamous cell carcinoma (SCC) of the oral cavity, the oropharynx, and the hypopharynx without extracapsular spread (ECS) after a margin-negative surgical resection, who either received or did not receive postoperative (chemo)radiotherapy. STUDY DESIGN Retrospective case series. METHODS The oncological outcome of patients with pT1-pT2 pN1 SCC without ECS was evaluated retrospectively. All patients underwent primary tumor resection that included transoral laser microsurgery and neck dissection at an academic tertiary referral center. RESULTS Of 65 identified patients treated between 1986 and 2015 (18 oral cavity, 30 oropharynx, 17 hypopharynx), 21 (32%) received postoperative radiotherapy, and 44 (68%) were treated by surgery alone. The group of patients receiving postoperative treatment showed a significantly superior 5-year disease-specific (94.4% vs. 73.2%, P = .029) and recurrence-free survival (85.2% vs. 43.2%, P = .002), as well as a higher local control rate (90.2% vs. 64.9%, P = .042). The overall survival was 71.4% vs. 62.6% (P = .53). The mean follow-up was 80.7 months. CONCLUSIONS Patients with locally circumscribed carcinomas and a single ipsilateral ECS-negative lymph node metastasis seem to benefit from postoperative radiotherapy. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E530-E538, 2020.
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Affiliation(s)
- Bernhard G Weiss
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Mahalia Z Anczykowski
- Department of Otorhinolaryngology, University Medical Center Göttingen, Göttingen, Germany
| | - Susanne Flach
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Jennifer L Spiegel
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Julia Kitz
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| | - Mattis Bertlich
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Martin Canis
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Mark Jakob
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
| | - Friedrich Ihler
- Department of Otorhinolaryngology, University Hospital, Ludwig Maximilian University Munich, Munich, Germany.,German Center for Vertigo and Balance Disorders, University Hospital, Ludwig Maximilian University Munich, Munich, Germany
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Rath S, Khurana R, Sapru S, Rastogi M, Gandhi AK, Hadi R, Sahni K, Mishra SP, Srivastava AK, Syedkather F. Evaluation of purely accelerated six fractions per week radiotherapy in postoperative oral cavity squamous cell carcinoma. Asia Pac J Clin Oncol 2019; 16:14-22. [DOI: 10.1111/ajco.13244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 08/23/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Satyajeet Rath
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Rohini Khurana
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Shantanu Sapru
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Madhup Rastogi
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Ajeet K. Gandhi
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Rahat Hadi
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Kamal Sahni
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Surendra P. Mishra
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Anoop K. Srivastava
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
| | - Farzana Syedkather
- Department of Radiation OncologyDr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Uttar Pradesh India
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Oncological outcome following initiation of treatment for stage III and IV HPV negative oropharyngeal cancers with transoral robotic surgery (TORS). Eur J Surg Oncol 2019; 45:2137-2142. [DOI: 10.1016/j.ejso.2019.06.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/02/2019] [Accepted: 06/18/2019] [Indexed: 01/26/2023] Open
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Cramer JD, Burtness B, Le QT, Ferris RL. The changing therapeutic landscape of head and neck cancer. Nat Rev Clin Oncol 2019; 16:669-683. [PMID: 31189965 DOI: 10.1038/s41571-019-0227-z] [Citation(s) in RCA: 399] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2019] [Indexed: 12/27/2022]
Abstract
Head and neck cancers are a heterogeneous collection of malignancies of the upper aerodigestive tract, salivary glands and thyroid. In this Review, we primarily focus on the changing therapeutic landscape of head and neck squamous cell carcinomas (HNSCCs) that can arise in the oral cavity, oropharynx, hypopharynx and larynx. We highlight developments in surgical and non-surgical therapies (mainly involving the combination of radiotherapy and chemotherapy), outlining how these treatments are being used in the current era of widespread testing for the presence of human papillomavirus infection in patients with HNSCC. Finally, we describe the clinical trials that led to the approval of the first immunotherapeutic agents for HNSCC, and discuss the development of strategies to decrease the toxicity of different treatment modalities.
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Affiliation(s)
- John D Cramer
- Department of Otolaryngology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Barbara Burtness
- Department of Medicine and Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University, Palo Alto, CA, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA.
- UPMC Hillman Cancer Center, Pittsburgh, PA, USA.
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62
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Margalit DN, Haddad RI, Tishler RB, Chau NG, Schoenfeld JD, Bakst RL, Misiukiewicz KJ, Gupta V, Posner M, Hanna GJ, Mahmood U, Rawal B, Catalano PJ, Rath L, Bacay A, McHugh P, Rabinowits G. A Phase 1 Study of Afatinib in Combination with Postoperative Radiation Therapy with and Without Weekly Docetaxel in Intermediate- and High-Risk Patients with Resected Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2019; 105:132-139. [DOI: 10.1016/j.ijrobp.2019.04.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/04/2019] [Accepted: 04/26/2019] [Indexed: 11/25/2022]
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Szturz P, Cristina V, Herrera Gómez RG, Bourhis J, Simon C, Vermorken JB. Cisplatin Eligibility Issues and Alternative Regimens in Locoregionally Advanced Head and Neck Cancer: Recommendations for Clinical Practice. Front Oncol 2019; 9:464. [PMID: 31245288 PMCID: PMC6579895 DOI: 10.3389/fonc.2019.00464] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/15/2019] [Indexed: 11/13/2022] Open
Abstract
Well-designed randomized trials provide the highest level of scientific evidence to guide clinical decision making. In chemoradiotherapy of locally advanced squamous cell carcinoma of the head and neck (SCCHN), data support the use of three cycles of 100 mg/m2 cisplatin given every 3 weeks concurrently with conventionally fractionated external beam radiotherapy, although a full compliance with all three cycles is reserved to only about two thirds of initially eligible cases. On an individual patient level, practicing oncologists have to determine whether the patient is a suitable candidate for this treatment or whether contraindications exist. In the latter case, an adequate alternative has to be offered. In this regard, to facilitate triaging of medical information, we reviewed available publications on this topic and prepared practice-oriented recommendations for systemic treatment concurrent to definitive and post-operative radiotherapy. Even if no contraindications for the standard-of-care cisplatin apply, clinicians may opt for alternative regimens by adjusting the peak dose, cumulative dose, or timing of cisplatin. Relative contraindications pose the major issue in clinical practice, as very limited data is available in the literature and final decisions are usually based on an expert opinion or retrospective cohort studies. In the case of absolute interdiction of cisplatin, several alternative regimens incorporating carboplatin, 5-fluorouracil, cetuximab, and docetaxel are available. At the same time, it should be kept in mind that radiotherapy alone represents a viable option with hyperfractionation being particularly beneficial in the definitive management of limited nodal disease. Ideally, all treatment propositions should be discussed within multidisciplinary tumor boards taking into account the patient- and disease-related characteristics as well as local logistics and reimbursement policies.
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Affiliation(s)
- Petr Szturz
- Medical Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Valerie Cristina
- Medical Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | | | - Jean Bourhis
- Radiation Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Jan B Vermorken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
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Current Prospects of Molecular Therapeutics in Head and Neck Squamous Cell Carcinoma. Pharmaceut Med 2019; 33:269-289. [DOI: 10.1007/s40290-019-00288-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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65
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Ma DJ, Price KA, Moore EJ, Patel SH, Hinni ML, Garcia JJ, Graner DE, Foster NR, Ginos B, Neben-Wittich M, Garces YI, Chintakuntlawar AV, Price DL, Olsen KD, Van Abel KM, Kasperbauer JL, Janus JR, Waddle M, Miller R, Shiraishi S, Foote RL. Phase II Evaluation of Aggressive Dose De-Escalation for Adjuvant Chemoradiotherapy in Human Papillomavirus-Associated Oropharynx Squamous Cell Carcinoma. J Clin Oncol 2019; 37:1909-1918. [PMID: 31163012 DOI: 10.1200/jco.19.00463] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The purpose of this study was to determine if dose de-escalation from 60 to 66 Gy to 30 to 36 Gy of adjuvant radiotherapy (RT) for selected patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma could maintain historical rates for disease control while reducing toxicity and preserving swallow function and quality of life (QOL). PATIENTS AND METHODS MC1273 was a single-arm phase II trial testing an aggressive course of RT de-escalation after surgery. Eligibility criteria included patients with p16-positive oropharyngeal squamous cell carcinoma, smoking history of 10 pack-years or less, and negative margins. Cohort A (intermediate risk) received 30 Gy delivered in 1.5-Gy fractions twice per day over 2 weeks along with 15 mg/m2 docetaxel once per week. Cohort B included patients with extranodal extension who received the same treatment plus a simultaneous integrated boost to nodal levels with extranodal extension to 36 Gy in 1.8-Gy fractions twice per day. The primary end point was locoregional tumor control at 2 years. Secondary end points included 2-year progression-free survival, overall survival, toxicity, swallow function, and patient-reported QOL. RESULTS Accrual was from September 2013 to June 2016 (N = 80; cohort A, n = 37; cohort B, n = 43). Median follow-up was 36 months, with a minimum follow-up of 25 months. The 2-year locoregional tumor control rate was 96.2%, with progression-free survival of 91.1% and overall survival of 98.7%. Rates of grade 3 or worse toxicity at pre-RT and 1 and 2 years post-RT were 2.5%, 0%, and 0%. Swallowing function improved slightly between pre-RT and 12 months post-RT, with one patient requiring temporary feeding tube placement. CONCLUSION Aggressive RT de-escalation resulted in locoregional tumor control rates comparable to historical controls, low toxicity, and little decrement in swallowing function or QOL.
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66
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Taberna M, Oliva M, Mesía R. Cetuximab-Containing Combinations in Locally Advanced and Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma. Front Oncol 2019; 9:383. [PMID: 31165040 PMCID: PMC6536039 DOI: 10.3389/fonc.2019.00383] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/24/2019] [Indexed: 12/29/2022] Open
Abstract
Cetuximab remains to date the only targeted therapy approved for the treatment of head and neck squamous cell carcinoma (HNSCC). The EGFR pathway plays a key role in the tumorigenesis and progression of this disease as well as in the resistance to radiotherapy (RT). While several anti-EGFR agents have been tested in HNSCC, cetuximab, an IgG1 subclass monoclonal antibody against EGFR, is the only drug with proven efficacy for the treatment of both locoregionally-advanced (LA) and recurrent/metastatic (R/M) disease. The addition of cetuximab to radiotherapy is a validated treatment option in LA-HNSCC. However, its use has been limited to patients who are considered unfit for standard of care chemoradiotherapy (CRT) with single agent cisplatin given the lack of direct comparison of these two regimens in randomized phase III trials and the inferiority suggested by metanalysis and phase II studies. The current use of cetuximab in HNSCC is about to change given the recent results from randomized prospective clinical trials in both the LA and R/M setting. Two phase III studies evaluating RT-cetuximab vs. CRT in Human Papillomavirus (HPV)-positive LA oropharyngeal squamous cell carcinoma (De-ESCALaTE and RTOG 1016) showed inferior overall survival and progression-free survival for RT-cetuximab combination, and therefore CRT with cisplatin remains the standard of care in this disease. In the R/M HNSCC, the EXTREME regimen has been the standard of care as first-line treatment for the past 10 years. However, the results from the KEYNOTE-048 study will likely position the anti-PD-1 agent pembrolizumab as the new first line treatment either alone or in combination with chemotherapy in this setting based on PD-L1 status. Interestingly, cetuximab-mediated immunogenicity through antibody dependent cell cytotoxicity (ADCC) has encouraged the evaluation of combined approaches with immune-checkpoint inhibitors in both LA and R/M-HNSCC settings. This article reviews the accumulated evidence on the role of cetuximab in HNSCC in the past decade, offering an overview of its current impact in the treatment of LA and R/M-HNSCC disease and its potential use in the era of immunotherapy.
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Affiliation(s)
- Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology, ONCOBELL, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,Medicine Department, Barcelona University, Barcelona, Spain
| | - Marc Oliva
- Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Ricard Mesía
- B-ARGO Group, Medical Oncology Department, Catalan Institute of Oncology, Badalona, Spain
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Hosni A, Huang SH, Chiu K, Xu W, Su J, Lu L, Bayley A, Bratman SV, Cho J, Giuliani M, Kim J, O'Sullivan B, Ringash J, Waldron J, Spreafico A, de Almeida JR, Chepeha DB, Irish JC, Goldstein DP, Hope A. Validation of distant metastases risk-groups in oral cavity squamous cell carcinoma patients treated with postoperative intensity-modulated radiotherapy. Radiother Oncol 2019; 134:10-16. [DOI: 10.1016/j.radonc.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 12/06/2018] [Accepted: 01/13/2019] [Indexed: 10/27/2022]
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Gallitto M, Sindhu K, Wasserman I, De B, Gupta V, Miles BA, Genden EM, Posner M, Misiukiewicz K, Bakst RL. Trimodality therapy for oropharyngeal cancer in the TORS era: Is there a cohort that may benefit? Head Neck 2019; 41:3009-3022. [DOI: 10.1002/hed.25779] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 03/28/2019] [Accepted: 04/09/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Matthew Gallitto
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Kunal Sindhu
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Isaac Wasserman
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Brian De
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Vishal Gupta
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Brett A. Miles
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Eric M. Genden
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Marshall Posner
- Department of OtolaryngologyIcahn School of Medicine at Mount Sinai New York New York
| | - Krzysztof Misiukiewicz
- Department of Medicine, Hematology and Medical OncologyIcahn School of Medicine at Mount Sinai New York New York
| | - Richard L. Bakst
- Department of Radiation OncologyIcahn School of Medicine at Mount Sinai New York New York
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Mohamed A, Twardy B, Zordok MA, Ashraf K, Alkhoder A, Schrapp K, Steuer C, Chen Z, Pakkala S, Pillai R, Trad Wadsworth J, Higgins K, Beitler JJ, Ramalingam SS, Owonikoko TK, Khuri FR, Shin DM, Behera M, Saba NF. Concurrent chemoradiotherapy with weekly versus triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck: Comparative analysis. Head Neck 2019; 41:1490-1498. [PMID: 30835900 DOI: 10.1002/hed.25379] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 04/10/2018] [Accepted: 05/28/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Cisplatin-based chemoradiotherapy is standard of care for locally advanced squamous cell carcinoma of the head and neck. This systemic review compared efficacy and safety of weekly vs triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck. METHODS Among 1500 prospective studies published from 1970 to 2015, 39 (18 weekly, 21 triweekly) including 3668 patients qualified for inclusion. Clinical outcomes were analyzed using weighted estimates and 2-tailed t test for comparisons; significance level was 0.05. RESULTS Locoregional control was 58% (CI 53%-63%) vs 61% (CI 56%-65%; P = .7). The 2-year overall survival (OS) was 74% (CI 66%-80%) for weekly vs 67% (64%-69%) triweekly groups (P = .67). The 2-year progression-free survival (PFS) was 69% (CI 59%-77%) for weekly vs 62% (CI 58%-65%) triweekly groups (P = .9). Grade 3 to 5 toxicities were 36% vs 40% (P = .37) in weekly vs triweekly groups. CONCLUSIONS Weekly cisplatin was comparable in efficacy and safety to the triweekly regimen. Our analysis supports the use of weekly or triweekly cisplatin in locally advanced squamous cell carcinoma of the head and neck, with tolerability being a key factor in selection.
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Affiliation(s)
- Amr Mohamed
- Department of Medical Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Brandon Twardy
- Department of Medical Oncology, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Magdi A Zordok
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Khuram Ashraf
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Ayman Alkhoder
- Department of Medicine, Emory University, Atlanta, Georgia
| | - Kelly Schrapp
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia
| | - Conor Steuer
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Zhengjia Chen
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia
| | - Suchita Pakkala
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Rathi Pillai
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - J Trad Wadsworth
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Kristin Higgins
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | | | - Suresh S Ramalingam
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | - Dong M Shin
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
| | | | - Nabil F Saba
- Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia
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Abstract
The management of cancers of the head and neck focuses on primary site and regional (neck) disease control. Many patients are treated with surgery as the principal mode of treatment, and surgery often includes an elective or therapeutic neck dissection. Risk factors assessed for recurrence subsequent to neck dissection include nodal size, number, levels, and the presence of extranodal spread. Adjuvant radiation therapy (with or without chemotherapy) is offered to patients deemed at sufficient risk of recurrence based on assessment of these factors. However, randomized trials have not been performed to test the need and/or benefit of adjuvant postoperative radiation. The necessity of adjuvant radiation has been based on decades of clinical observations, retrospective studies, and indirect randomized trials. The case for postoperative radiation for patients with adverse features in the neck, and recommendations are made in the accompanying article.
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Affiliation(s)
- Adam S Garden
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX.
| | - Jay P Reddy
- Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TX
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Avkshtol V, Handorf EA, Ridge JA, Leachman BK, Liu JC, Bauman J, Galloway TJ. Examining adjuvant radiation dose in head and neck squamous cell carcinoma. Head Neck 2019; 41:2133-2142. [PMID: 30737968 DOI: 10.1002/hed.25680] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 11/16/2018] [Accepted: 01/09/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC). METHODS Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD-RT) was defined as an equivalent dose in 2 Gy (EQD2) ≥56.64 and ≤60 Gy and high-dose radiation (HD-RT) as an EQD2 >60 and <70 Gy. RESULTS HD-RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD-RT was associated with increased mortality (HR1.09; 95%CI 1.02-1.16). In nonoropharynx or human papillomavirus-negative oropharynx primary that had positive margins, ≥5 positive lymph nodes, and/or extranodal extension, HD-RT was still not associated with improved survival (HR 1.01, 95% CI 0.91-1.12). CONCLUSIONS There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high-risk cohort.
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Affiliation(s)
- Vladimir Avkshtol
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Elizabeth A Handorf
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - John A Ridge
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Brooke K Leachman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jeffrey C Liu
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Jessica Bauman
- Department Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania
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72
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Bauml JM, Vinnakota R, Anna Park YH, Bates SE, Fojo T, Aggarwal C, Di Stefano J, Knepley C, Limaye S, Mamtani R, Wisnivesky J, Damjanov N, Langer CJ, Cohen RB, Sigel K. Cisplatin versus cetuximab with definitive concurrent radiotherapy for head and neck squamous cell carcinoma: An analysis of Veterans Health Affairs data. Cancer 2019; 125:406-415. [PMID: 30341983 PMCID: PMC6886128 DOI: 10.1002/cncr.31816] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The addition of cisplatin or cetuximab to radiation therapy (RT) improves outcomes in comparison with RT alone in the nonoperative management of head and neck squamous cell carcinoma (HNSCC), but limited data exist for comparing these approaches. Using Veterans Health Affairs data, this study compared the outcomes of patients treated with RT plus cisplatin or cetuximab. METHODS Patients with stage III to IVb HNSCC who had been treated nonsurgically with RT and cisplatin or cetuximab from 2000 to 2016 within the Veterans Health Affairs system were identified. Patients were analyzed by the drug used in the first treatment cycle (intent to treat). Overall survival (OS) was compared by treatment group with Cox regression models, and propensity score (PS) methods were used to account for a treatment allocation bias. The risk of toxicities was determined, with logistic regression models fit into propensity-matched cohorts. RESULTS A total of 4520 patients were included in the analysis with a median follow-up of 3 years: 83% received cisplatin. Cisplatin patients were younger (P < .001) and had fewer comorbidities (P < .001). In an unmatched analysis, cetuximab was associated with inferior OS (P < .001). After PS matching, cetuximab treatment remained statistically significantly associated with inferior OS (1.7 vs 4.1 years; hazard ratio, 1.61; 95% confidence interval, 1.44-1.79; P < .001). These differences remained significant across all primary HNSCC subsites and in comparison with low- and high-dose cisplatin. CONCLUSIONS Cetuximab with RT yields inferior OS in comparison with cisplatin for the nonoperative management of stage III to IVb HNSCC. According to this study, cisplatin may be the most appropriate partner for RT in this setting.
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Affiliation(s)
- Joshua M Bauml
- Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ravi Vinnakota
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Yeun-Hee Anna Park
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
- College of Physicians and Surgeons at Columbia University, New York, New York
| | - Susan E Bates
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
- College of Physicians and Surgeons at Columbia University, New York, New York
| | - Tito Fojo
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
- College of Physicians and Surgeons at Columbia University, New York, New York
| | - Charu Aggarwal
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica Di Stefano
- Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Christina Knepley
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sewanti Limaye
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Ronac Mamtani
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Nevena Damjanov
- Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Corey J Langer
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger B Cohen
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Keith Sigel
- James J. Peters Veterans Affairs Medical Center, Bronx, New York
- Mount Sinai School of Medicine, New York, New York
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73
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Kirtane K, Rodriguez CP. Postoperative Combined Modality Treatment in High Risk Resected Locally Advanced Squamous Cell Carcinomas of the Head and Neck (HNSCC). Front Oncol 2018; 8:588. [PMID: 30564559 PMCID: PMC6288294 DOI: 10.3389/fonc.2018.00588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022] Open
Abstract
Patients who undergo upfront curative intent resection for locally advanced squamous cell carcinomas and who have adverse pathologic features benefit from adjuvant therapy. Concurrent cisplatin based chemoradiation is an established standard of care endorsed by national guidelines. Controversy now exists on the applicability of this strategy to the good risk human papilloma virus (HPV) related oropharynx cancer (OPC) patient. Ongoing clinical studies are exploring therapeutic de-escalation in the postoperative setting for this distinct patient population. The introduction of immune checkpoint inhibitors to the therapeutic armamentarium for recurrent/metastatic head and neck cancer patients has led to clinical investigation of incorporation of PD-1 inhibition in the postoperative setting.
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Affiliation(s)
| | - Cristina P Rodriguez
- Division of Oncology, Department of Medicine, University of Washington, Seattle, WA, United States
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74
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Survival for HPV-positive oropharyngeal squamous cell carcinoma with surgical versus non-surgical treatment approach: A systematic review and meta-analysis. Oral Oncol 2018; 86:121-131. [DOI: 10.1016/j.oraloncology.2018.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 02/07/2023]
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75
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Lee NC, Kelly JR, Park HS, An Y, Judson BL, Burtness BA, Husain ZA. Patterns of failure in high-metastatic node number human papillomavirus-positive oropharyngeal carcinoma. Oral Oncol 2018; 85:35-39. [DOI: 10.1016/j.oraloncology.2018.08.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/18/2018] [Accepted: 08/01/2018] [Indexed: 01/06/2023]
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76
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Predictors of Early Recurrence Prior to Planned Postoperative Radiation Therapy for Oral Cavity Squamous Cell Carcinoma and Outcomes Following Salvage Intensified Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 103:363-373. [PMID: 30244160 DOI: 10.1016/j.ijrobp.2018.09.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/07/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine predictors and outcomes for oral squamous cell carcinoma (OSCC) patients who had early recurrence before commencement of postoperative radiation therapy (PORT). METHODS Retrospective review was performed for patients with OSCC treated with PORT between 2003 and 2015 after curative-intent surgery. Early recurrence was defined as tumor recurrence after surgical resection and before initiating planned PORT. Patients were classified into the following groups: (1) adjuvant PORT group (no early recurrence), (2) salvage PORT group (locoregional early recurrence), and (3) palliative PORT group (locoregional and distant early recurrence). For the whole cohort, multivariable analysis (MVA) was applied to identify predictors of early recurrence. In the salvage group, the post-PORT recurrence-free rate was estimated, and MVA was used to identify predictors of recurrence-free rate, disease-free survival, and overall survival (OS). RESULTS Six hundred and one patients were identified, of whom 513 (85%) were treated with adjuvant PORT. Eighty-eight patients (15%) had early recurrence (28 of 88; 32% were biopsy proven) before PORT (70 in the salvage group and 18 in the palliative group). On MVA, oral tongue subsite, microscopic positive resection margin, pT3-4, and pN2-3 were associated with the development of early recurrence (P < .05 for all). The 3-year OS rates for patients with OSCC treated with adjuvant and salvage PORT were 71% (95% confidence interval [CI], 67%-75%) and 41% (95% CI, 30%-56%), respectively (P < .001; median follow-up was 3.4 and 2.9 years, respectively). After salvage PORT, the 3-year recurrence-free rate was 36% (95% CI, 23%-47%). On MVA, extranodal extension and volume of early recurrent gross disease were associated with poor recurrence-free rate, disease-free survival, and OS (P < .05 for all). CONCLUSION Early recurrences are not uncommon in patients with high-risk features, Further study is required to improve prediction and outcomes of this very high-risk group.
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Wang M, Hu Y, Yu T, Ma X, Wei X, Wei Y. Pan-HER-targeted approach for cancer therapy: Mechanisms, recent advances and clinical prospect. Cancer Lett 2018; 439:113-130. [PMID: 30218688 DOI: 10.1016/j.canlet.2018.07.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 02/05/2023]
Abstract
The Human Epidermal Growth Factor Receptor family is composed of 4 structurally related receptor tyrosine kinases that are involved in many human cancers. The efficacy and safety of HER inhibitors have been compared in a wide range of clinical trials, suggesting the superior inhibitory ability of multiple- HER-targeting blockade compared with single receptor antagonists. However, many patients are currently resistant to current therapeutic treatment and novel strategies are warranted to conquer the resistance. Thus, we performed a critical review to summarize the molecular involvement of HER family receptors in tumour progression, recent anti-HER drug development based on clinical trials, and the potential resistance mechanisms of anti-HER therapy.
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Affiliation(s)
- Manni Wang
- Lab of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan, 610041, PR China
| | - Yuzhu Hu
- Lab of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan, 610041, PR China
| | - Ting Yu
- Lab of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan, 610041, PR China
| | - Xuelei Ma
- Lab of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan, 610041, PR China
| | - Xiawei Wei
- Lab of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan, 610041, PR China.
| | - Yuquan Wei
- Lab of Aging Research and Nanotoxicology, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University and Collaborative Innovation Center, No. 17, Block 3, Southern Renmin Road, Chengdu, Sichuan, 610041, PR China
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Brøndum L, Alsner J, Sørensen BS, Maare C, Johansen J, Primdahl H, Evensen JF, Kristensen CA, Andersen LJ, Overgaard J, Eriksen JG. Associations between skin rash, treatment outcome, and single nucleotide polymorphisms in head and neck cancer patients receiving the EGFR-inhibitor zalutumumab: results from the DAHANCA 19 trial. Acta Oncol 2018; 57:1159-1164. [PMID: 29771169 DOI: 10.1080/0284186x.2018.1464664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To study the associations between development of moderate to severe skin rash, clinical outcome, and single nucleotide polymorphisms (SNPs) in candidate genes in head and neck cancer patients from the DAHANCA 19 trial receiving the EGFR-inhibitor zalutumumab concurrently with radiation treatment. MATERIAL AND METHODS 310 patients were included from the zalutumumab-arm of the DAHANCA 19 study. Nine SNPs in the candidate genes EGFR, EGF, AREG, FCGR2A, FCGR3A, and CCND1 were successfully determined in 294 patients. Clinical endpoints were moderate to severe skin rash within the first 3 weeks of treatment, loco-regional failure (LRF), disease-specific survival (DSS), and overall survival (OS). RESULTS During the first 3 weeks of treatment, 86% of the patients experienced any grade of rash and 17% experienced a moderate to severe rash. Development of moderate to severe rash was not associated with LRF or DSS but was associated with improved OS, HR 0.40 (95% CI: 0.19-0.82). The effect was similar for patients with p16-negative or p16-positive tumors (p = .90). After adjustment for comorbidity and performance status, the minor alleles of SNPs rs9996584 and rs13104811 located near the AREG gene were significantly associated with increased risk of moderate to severe rash with per-allele odds ratios of 1.61 (1.01-2.54) and 1.56 (1.00-2.44). SNP rs11942466 located close to rs9996584 had a borderline significant association, and none of the other SNPS were significantly associated with risk of skin rash. CONCLUSIONS Moderate to severe skin rash after zalutumumab during radiation treatment was associated with improved OS, independent of HPV/p16-status. Genetic variants in AREG (member of the EGF family) may be associated with increased risk of skin rash.
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Affiliation(s)
- Line Brøndum
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Maare
- Department of Oncology, Herlev Hospital, Copenhagen, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Odense, Denmark
| | - Jan Folkvard Evensen
- Department of Oncology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
| | | | | | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Nishimura G, Hatakeyama H, Shiono O, Taguri M, Komatsu M, Sano D, Sakuma N, Yabuki K, Arai Y, Shibata K, Chiba Y, Tanabe T, Oridate N. Postoperative Bio-Chemoradiotherapy Using Cetuximab and Docetaxel in Patients With Cis-Platinum-Intolerant Core High-Risk Head and Neck Cancer: Protocol of a Phase 2 Nonrandomized Clinical Trial. JMIR Res Protoc 2018; 7:e11003. [PMID: 30139721 PMCID: PMC6127497 DOI: 10.2196/11003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/18/2018] [Accepted: 06/19/2018] [Indexed: 11/28/2022] Open
Abstract
Background We confirmed the safety of postoperative bio-chemoradiotherapy using cetuximab and docetaxel in a small number of patients with cis-platinum–intolerant core high-risk head and neck cancer. Objective To assess treatment efficacy, we planned a phase 2 study of postoperative bio-chemoradiotherapy for patients with cis-platinum–intolerant core high-risk head and neck cancer and will compare the results to those of previously collected radiotherapy data. Methods Patients who underwent definitive surgery for oral cavity, laryngeal, oropharyngeal, or hypopharyngeal advanced cancer, whose postoperative pathological results indicated core high risk for recurrence (eg, positive margin in the primary site or extranodal extension) and who were cis-platinum–intolerant, will undergo postoperative bio-chemoradiotherapy. The primary end point is 2-year disease-free survival. Results The expected 2-year disease-free survival is set at 55%, and the calculated sample size is 35 patients, according to a statistical analysis based on previous reports. Conclusions This treatment method is expected to improve the survival rate of patients with severe head and neck cancer. Trial Registration UMIN Clinical Trials Registry UMIN000031835; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000036355 (Archived by WebCite at http://www.webcitation.org/71fejVjMr)
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Affiliation(s)
- Goshi Nishimura
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Hiromitsu Hatakeyama
- Department of Otorhinolaryngology, Yokohama City University Medical Center, Yokohama, Japan
| | - Osamu Shiono
- Department of Otorhinolaryngology, Yokohama Rosai Hospital, Yokohama, Japan
| | - Masataka Taguri
- Department of Data Science, School of Data Science, Yokohama City University, Yokohama, Japan
| | - Masanori Komatsu
- Department of Otorhinolaryngology, Yokohama City University Medical Center, Yokohama, Japan
| | - Daisuke Sano
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Naoko Sakuma
- Department of Otorhinolaryngology, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenichiro Yabuki
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Yasuhiro Arai
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Kunihiko Shibata
- Department of Otorhinolaryngology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshihiro Chiba
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Teruhiko Tanabe
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Nobuhiko Oridate
- Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Yokohama City University, Yokohama, Japan
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Sano D, Yabuki K, Takahashi H, Arai Y, Chiba Y, Tanabe T, Nishimura G, Oridate N. Lymph node ratio as a prognostic factor for survival in patients with head and neck squamous cell carcinoma. Auris Nasus Larynx 2018; 45:846-853. [DOI: 10.1016/j.anl.2017.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/10/2017] [Accepted: 11/21/2017] [Indexed: 12/19/2022]
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81
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Maihoefer C, Schüttrumpf L, Macht C, Pflugradt U, Hess J, Schneider L, Woischke C, Walch A, Baumeister P, Kirchner T, Zitzelsberger H, Belka C, Ganswindt U. Postoperative (chemo) radiation in patients with squamous cell cancers of the head and neck - clinical results from the cohort of the clinical cooperation group "Personalized Radiotherapy in Head and Neck Cancer". Radiat Oncol 2018; 13:123. [PMID: 29970111 PMCID: PMC6029020 DOI: 10.1186/s13014-018-1067-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/15/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Postoperative (chemo) radiation improves tumor control and survival in high-risk patients with head and neck squamous cell carcinoma based on established risk factors. The clinical cooperation group "Personalized Radiotherapy in Head and Neck Cancer" focuses on the identification and validation of new biomarkers, which are aimed at eventually stratifying and personalizing the therapy concept. Hence, we reviewed all patients with head and neck squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx, treated with postoperative (chemo) radiation from 06/2008 until 06/2015 at the Department of Radiation Oncology in the University Hospital, LMU Munich. Here we report the clinical results of the cohort, laying the foundation for further research within the framework of a clinical cooperation group. METHODS Patient data were retrospectively (until 2013) and prospectively (from 2013) collected and analyzed for outcome and treatment failures with regard to previously described and established risk factors. RESULTS We identified 302 patients (median follow-up 45 months, average age 60.7 years), having received postoperative (chemo)radiation (median 64 Gy). Chemotherapy was added in 58% of cases, mostly Cisplatin/5- Fluorouracil in concordance with the ARO 96-3 study. The 3-year overall survival, local, locoregional and distant failure estimates were 70.5, 9.7, 12.2 and 13.5%, respectively. Human papillomavirus-associated oropharyngeal cancer was associated with a significant improved overall survival, locoregional, distant and overall tumor control rates in multivariate analysis. Additionally, in multivariate analysis, for local failure, resection status and perineural invasion, for locoregional and distant failure extracapsular extension and for overall survival the presence of nodal disease were significant adverse factors. Moreover, 138 patients have been treated in concordance with the ARO 96-3 protocol, corroborating the results of this study. CONCLUSIONS Our cohort represents a large unselected cohort of patients with head and neck squamous cell carcinoma treated with postoperative (chemo)radiation. Tumor control rates and survival rates are consistent with the results of previously reported data.
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Affiliation(s)
- Cornelius Maihoefer
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. .,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Lars Schüttrumpf
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Corinna Macht
- Gemeinschaftspraxis für Strahlentherapie und Radioonkolgie am Klinikum Schwabing, Kölner Platz 1, 80804, Munich, Germany
| | - Ulrike Pflugradt
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Julia Hess
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, Neuherberg, 85764, Germany
| | - Ludmila Schneider
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, Neuherberg, 85764, Germany
| | - Christine Woischke
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Institute of Pathology, Faculty of Medicine, LMU Munich, Marchioninistr. 27, 81377, Munich, Germany
| | - Axel Walch
- Research Unit Analytical Pathology, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Philipp Baumeister
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Thomas Kirchner
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Institute of Pathology, Faculty of Medicine, LMU Munich, Marchioninistr. 27, 81377, Munich, Germany
| | - Horst Zitzelsberger
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, Neuherberg, 85764, Germany
| | - Claus Belka
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ute Ganswindt
- Clinical Cooperation Group 'Personalized Radiotherapy in Head and Neck Cancer', Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,Department of Radiation Oncology, University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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Bhattacharya P, Shetake NG, Pandey BN, Kumar A. Receptor tyrosine kinase signaling in cancer radiotherapy and its targeting for tumor radiosensitization. Int J Radiat Biol 2018; 94:628-644. [DOI: 10.1080/09553002.2018.1478160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Poushali Bhattacharya
- Radiation Signaling and Cancer Biology Section, Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Neena G. Shetake
- Radiation Signaling and Cancer Biology Section, Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Badri N. Pandey
- Radiation Signaling and Cancer Biology Section, Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Mumbai, India
| | - Amit Kumar
- Radiation Signaling and Cancer Biology Section, Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Mumbai, India
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Bhatia S, Sharma J, Bukkapatnam S, Oweida A, Lennon S, Phan A, Milner D, Uyanga N, Jimeno A, Raben D, Somerset H, Heasley L, Karam SD. Inhibition of EphB4-Ephrin-B2 Signaling Enhances Response to Cetuximab-Radiation Therapy in Head and Neck Cancers. Clin Cancer Res 2018; 24:4539-4550. [PMID: 29848571 DOI: 10.1158/1078-0432.ccr-18-0327] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/23/2018] [Accepted: 05/25/2018] [Indexed: 01/30/2023]
Abstract
Purpose: The clinical success of targeted therapies such as cetuximab and radiotherapy (RT) is hampered by the low response rates and development of therapeutic resistance. In the current study, we investigated the involvement of EphB4-ephrin-B2 protumorigenic signaling in mediating resistance to EGFR inhibition and RT in head and neck cancers.Experimental Design: We used patient-derived xenograft (PDX) models of head and neck squamous cell carcinoma (HNSCC) and HNSCC cell lines to test our hypothesis. Tumor tissues were subjected to PhosphoRTK array, and Western blotting to detect changes in EphB4-ephrin-B2 targets. mRNA sequencing and microarray data analysis were performed on PDX tumors and HNSCC cell lines, respectively, to determine differences in gene expression of molecules involved in tumor cell growth, proliferation, and survival pathways. Effects on cell growth were determined by MTT assay on HNSCC cells downregulated for EphB4/ephrin-B2 expression, with and without EGFR inhibitor and radiation.Results: Our data from locally advanced HNSCC patients treated with standard-of-care definitive chemo-RT show elevated EphB4 and ephrin-B2 levels after failure of treatment. We observed significant response toward cetuximab and RT following EphB4-ephrin-B2 inhibition, resulting in improved survival in tumor-bearing mice. Tumor growth inhibition was accompanied by a decrease in the levels of proliferation and prosurvival molecules and increased apoptosis.Conclusions: Our findings underscore the importance of adopting rational drug combinations to enhance therapeutic effect. Our study documenting enhanced response of HNSCC to cetuximab-RT with EphB4-ephrin-B2 blockade has the potential to translate into the clinic to benefit this patient population. Clin Cancer Res; 24(18); 4539-50. ©2018 AACR.
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Affiliation(s)
- Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Jaspreet Sharma
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Sanjana Bukkapatnam
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Ayman Oweida
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Shelby Lennon
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Andy Phan
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Dallin Milner
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Nomin Uyanga
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Antonio Jimeno
- Division of Medical Oncology, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - David Raben
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Hilary Somerset
- Department of Pathology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Lynn Heasley
- Department of Craniofacial Biology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado
| | - Sana D Karam
- Department of Radiation Oncology, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado.
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84
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Maghami E, Koyfman SA, Weiss J. Personalizing Postoperative Treatment of Head and Neck Cancers. Am Soc Clin Oncol Educ Book 2018; 38:515-522. [PMID: 30231315 DOI: 10.1200/edbk_201087] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Head and neck cancer (HNC) treatment is a complex multidisciplinary undertaking. Although overtreatment can result in functional and cosmetic defects, undertreatment can result in cancer recurrence. Surgery and chemoradiotherapy are both accepted standards for the curative intent treatment of locally advanced mucosal squamous cell carcinoma of the head and neck, but are often prioritized differently depending on the site of tumor origin (e.g., oral cavity/sinonasal vs. oropharynx/larynx), tumor burden, tumor biology, quality-life considerations, and patient preference. Regardless of modalities chosen, failure to cure remains a considerable problem in locally advanced disease. For patients treated with primary surgery, high-risk pathologic features portend higher recurrence rates, and adjuvant therapy can reduce these rates and improve outcomes. This report details which tumor- and nodal-related factors are indications for adjuvant therapy, examines the impact of tumor HPV status on adjuvant treatment paradigms, and considers which systemic therapies should be used for which patients when trimodality therapy is indicated.
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Affiliation(s)
- Ellie Maghami
- From the Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA; Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH; Department of Medical Oncology, University of North Carolina Hospitals, Chapel Hill, NC
| | - Shlomo A Koyfman
- From the Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA; Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH; Department of Medical Oncology, University of North Carolina Hospitals, Chapel Hill, NC
| | - Jared Weiss
- From the Division of Head and Neck Surgery, City of Hope National Medical Center, Duarte, CA; Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH; Department of Medical Oncology, University of North Carolina Hospitals, Chapel Hill, NC
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85
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Clues toward precision medicine in oral squamous cell carcinoma: utility of next-generation sequencing for the prognostic stratification of high-risk patients harboring neck lymph node extracapsular extension. Oncotarget 2018; 7:63082-63092. [PMID: 27590518 PMCID: PMC5325348 DOI: 10.18632/oncotarget.11762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/26/2016] [Indexed: 02/03/2023] Open
Abstract
Patients with resected oral squamous cell carcinoma (OSCC) harboring extracapsular extension (ECE) of the involved lymph node, show poor and heterogeneous outcomes. We aim to improve their prognostic stratification by combining genetic information from next-generation sequencing (NGS) using traditional clinicopathological prognosticators. The hotspot mutation regions of 45 cancer-related genes were investigated using NGS with an ultra-deep (>1000×) sequencing approach in formalin-fixed paraffin-embedded samples obtained from 201 patients with resected OSCC harboring ECE. Adjuvant chemoradiotherapy (CRT) and the number of nodes with ECE were the most important traditional prognosticators for disease-specific survival (DSS). The 5-year DSS for patients with CRT versus without, was 55% versus 21% (P < 0.001), and that for 1-3 versus ≥ 4 ECEs was 60% versus 25% (P = 0.001), respectively. Multivariate analysis in patients who received adjuvant CRT for 1-3 ECEs (i.e., those with a favorable expected prognosis) identified the following adverse prognostic factors: 1) margin of < 5 mm for locoregional failure (66% versus 30%, P = 0.007) and DSS (42% versus 63%, P = 0.039); 2) HRAS mutation for distant failure (55% versus 25%, P = 0.007) and DSS (36% versus 63%, P = 0.024); and 3) TP53 DNA-binding domain missense mutations for DSS (52% versus 71%, P = 0.025) and overall survival (39% versus 61%, P = 0.007).We conclude that genetic information from NGS may improve the prognostic stratification offered by traditional prognosticators in resected OSCC patients with ECE. Our findings will contribute to implementation of precision medicine in OSCC patients.
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86
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Fulcher CD, Haigentz M, Ow TJ. AHNS Series: Do you know your guidelines? Principles of treatment for locally advanced or unresectable head and neck squamous cell carcinoma. Head Neck 2018; 40:676-686. [PMID: 29171929 PMCID: PMC5849482 DOI: 10.1002/hed.25025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 10/16/2017] [Indexed: 12/11/2022] Open
Abstract
This article is a continuation of the "Do You Know Your Guidelines" series, initiated by the Education committee of the American Head and Neck Society. Treatment guidelines for advanced head and neck squamous cell carcinoma are reviewed here, including the critical roles of radiotherapy, chemotherapy, and the recent application of immunotherapy agents. We will be limiting this discussion to include cancers of the oral cavity, oropharynx, hypopharynx, and larynx. It should be noted that much of the article pertains to human papillomavirus (HPV)-negative oropharyngeal cancer where applicable, as HPV-positive oropharyngeal squamous cell carcinoma carries a different natural history, different prognosis, and now different staging criteria. Additionally, the article will not include information on nasopharyngeal or sinus cancers, as these latter topics are covered in separate "Do you know your guidelines?" installments and these diagnoses carry somewhat different approaches to diagnosis and management that diverge from the focus of this article.
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Affiliation(s)
- Cory D. Fulcher
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Missak Haigentz
- Department of Medicine (Oncology), Albert Einstein College of Medicine
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine
- Department of Medicine (Oncology), Morristown Medical Center, Morristown, NJ
| | - Thomas J. Ow
- Department of Otorhinolaryngology-Head and Neck Surgery and Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine
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Eder-Czembirek C, Sulzbacher I, Fuereder T, Selzer E. P16 positivity and regression grade predict survival after neoadjuvant radiotherapy of OSCC. Oral Dis 2018; 24:544-551. [DOI: 10.1111/odi.12814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 12/31/2022]
Affiliation(s)
- C Eder-Czembirek
- Department of Cranio-, Maxillofacial and Oral Surgery; Medical University of Vienna; Vienna Austria
| | - I Sulzbacher
- Clinical Institute of Pathology; Medical University of Vienna; Vienna Austria
| | - T Fuereder
- Department of Internal Medicine I; Division of Oncology & CCC; Medical University of Vienna; Vienna Austria
| | - E Selzer
- University Clinic of Radiotherapy; Medical University of Vienna; Vienna Austria
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88
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Thai AA, Rischin D. High-Dose Cisplatin for Head and Neck Cancer Lives On. J Clin Oncol 2018; 36:1055-1057. [PMID: 29394123 DOI: 10.1200/jco.2017.76.8614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Alesha A Thai
- Alesha A. Thai, Peter MacCallum Cancer Centre, Melbourne, Australia; and Danny Rischin, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia
| | - Danny Rischin
- Alesha A. Thai, Peter MacCallum Cancer Centre, Melbourne, Australia; and Danny Rischin, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia
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89
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Intraoral ultrasonography to measure tumor thickness of oral cancer: A systematic review and meta-analysis. Oral Oncol 2018; 77:29-36. [DOI: 10.1016/j.oraloncology.2017.12.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/20/2017] [Accepted: 12/09/2017] [Indexed: 12/29/2022]
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90
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Liang F, Zhang S, Xue H, Chen Q. Risk of second primary cancers in cancer patients treated with cisplatin: a systematic review and meta-analysis of randomized studies. BMC Cancer 2017; 17:871. [PMID: 29258467 PMCID: PMC5738212 DOI: 10.1186/s12885-017-3902-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 12/08/2017] [Indexed: 01/30/2023] Open
Abstract
Background Case reports, retrospective analyses, and observational studies have linked the use of cisplatin to increased risk of second cancers, especially life-threatening secondary leukemia. We therefore performed a systematic review and meta-analysis to evaluate the risk of second cancers associated with receipt of cisplatin-based chemotherapy in randomized controlled trials (RCTs). Methods We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, trial registers, conference proceedings, review articles, and reference lists of trial publications for all relevant RCTs comparing cisplatin- versus non-cisplatin-containing chemotherapy with data on second cancers. We extracted data about study characteristics and second cancers, especially leukemia/ myelodysplasia. The primary and secondary outcomes were the odds ratios (ORs) for all second cancers and for secondary leukemia/ myelodysplasia, respectively. Results We identified 28 eligible trials with 7403 patients. Second cancers were reported in 143 patients, including 75 patients in the cisplatin arm and 68 in the non-cisplatin arm (raw event rates of 1.91 and 1.96%, respectively). The pooled OR for risk of all second cancers associated with cisplatin-based chemotherapy was 0.95 (95% confidence interval (CI): 0.67–1.33, P = 0.76). Secondary leukemia/ myelodysplasia was reported in 14 patients on cisplatin arms and in 6 patients on non-cisplatin arms of 11 eligible RCTs with 2629 patients (raw event rates of 1.09 and 0.45%, respectively; pooled OR = 2.34, 95%CI 0.97–5.65, P = 0.06). Conclusion Cisplatin was not associated with a significantly increased risk of second cancers compared with non-cisplatin-based chemotherapy. There is a non-significant trend to increased risk of leukemia/ myelodysplasia and the absolute risk was low. The concern about risk of second cancers should not influence decisions to use an efficacious regimen containing cisplatin. Electronic supplementary material The online version of this article (10.1186/s12885-017-3902-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fei Liang
- Shanghai Cancer Center and Shanghai Medical College, Fudan University, Shanghai, China
| | - Sheng Zhang
- Shanghai Cancer Center and Shanghai Medical College, Fudan University, Shanghai, China. .,Medical Oncology, Shanghai Cancer Center, Fudan University, 270 Dongan Road, Shanghai, 200032, China.
| | - Hongxi Xue
- Rizhao City Hospital of Traditional Chinese Medicine, 35 Wanghai Road, Rizhao, China
| | - Qiang Chen
- Department of clinical biochemistry, School of public health Taishan medical university, Taishan, China
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91
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Makita C, Kodaira T, Daimon T, Tachibana H, Tomita N, Koide Y, Koide Y, Fukuda Y, Nishikawa D, Suzuki H, Hanai N, Hasegawa Y. Comparisons of the clinical outcomes of different postoperative radiation strategies for treatment of head and neck squamous cell carcinoma. Jpn J Clin Oncol 2017; 47:1141-1150. [PMID: 29036621 DOI: 10.1093/jjco/hyx137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/31/2017] [Indexed: 11/14/2022] Open
Abstract
Purpose We previously reported unfavorable locoregional control with limited field postoperative radiotherapy for head and neck squamous cell carcinoma patients and thus revised the strategy to cover the whole neck. Head and neck squamous cell carcinoma Patients' outcomes were retrospectively analyzed to compare the efficacy of two treatments. Material and methods Before 2010, the clinical target volume covered the tumor bed and/or involved the neck region. Since 2011, whole-neck irradiation was planned. Univariate analysis, multivariate analysis, and propensity score matching were performed. The study included 275 patients: 186 received limited field postoperative radiotherapy and 89 received whole-neck postoperative radiotherapy. The median follow-up time for the entire cohort was 40.8 months. Results In univariate analysis, the radiation strategy had no significant effect on overall survival and progression-free survival. In multivariate analysis, whole-neck postoperative radiotherapy was a favorable factor for overall survival, progression-free survival, and locoregional control. Propensity score matching resulted in a cohort comprising 118 well-matched patients evenly divided between the limited field postoperative radiotherapy and whole-neck postoperative radiotherapy groups. Whole-neck postoperative radiotherapy group achieved a significantly better 2-year overall survival (56.4% vs. 78.1%; P = 0.003), 2-year progression-free survival (34.7% vs. 59.8%; P = 0.009), and 2-year locoregional control (54.4% vs. 83.2%; P < 0.001). The limited field postoperative radiotherapy group developed significantly more locoregional recurrences both in-field (35.2% vs. 15.1%, P = 0.003) and out-of-field (25.0% vs. 0%, P < 0.001) in the matched-pair cohort. Conclusion Whole-neck postoperative radiotherapy is a more appropriate choice than limited field postoperative radiotherapy to improve overall survival, progression-free survival and locoregional control.
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Affiliation(s)
- Chiyoko Makita
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya
| | - Takashi Daimon
- Department of Biostatistics, Hyogo College of Medicine, Hyogo
| | | | - Natsuo Tomita
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya
| | - Yutaro Koide
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya
| | - Yusuke Koide
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya
| | - Yujiro Fukuda
- Department of Otolaryngology, Kawasaki Medical School, Okayama, Japan
| | - Daisuke Nishikawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya
| | - Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya
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92
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Bonomo P, Loi M, Desideri I, Olmetto E, Delli Paoli C, Terziani F, Greto D, Mangoni M, Scoccianti S, Simontacchi G, Francolini G, Meattini I, Caini S, Livi L. Incidence of skin toxicity in squamous cell carcinoma of the head and neck treated with radiotherapy and cetuximab: A systematic review. Crit Rev Oncol Hematol 2017; 120:98-110. [DOI: 10.1016/j.critrevonc.2017.10.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 09/28/2017] [Accepted: 10/29/2017] [Indexed: 12/27/2022] Open
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93
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Ng WT, Ngan RKC, Kwong DLW, Tung SY, Yuen KT, Kam MKM, Sze HCK, Yiu HHY, Chan LLK, Lung ML, Lee AWM. Prospective, Multicenter, Phase 2 Trial of Induction Chemotherapy Followed by Bio-Chemoradiotherapy for Locally Advanced Recurrent Nasopharyngeal Carcinoma. Int J Radiat Oncol Biol Phys 2017; 100:630-638. [PMID: 29413277 DOI: 10.1016/j.ijrobp.2017.11.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/20/2017] [Accepted: 11/24/2017] [Indexed: 12/09/2022]
Abstract
PURPOSE To evaluate, in a phase 2 study, whether induction docetaxel, cisplatin, and fluorouracil (TPF) followed by weekly docetaxel and cetuximab in concurrence with intensity modulated radiation therapy can improve the treatment outcome for patients with advanced locally recurrent nasopharyngeal carcinoma (rNPC). METHODS AND MATERIALS Thirty-three patients with rNPC (T3-T4, N0-N1, M0) were recruited. Of these, 19 patients (57.6%) had stage rT3 recurrence, and the rest had stage rT4. Eight patients also had rN1 at the time of relapse. Treatment outcomes and safety were evaluated. RESULTS Among these 33 patients, 1 died after 1 cycle of TPF, 5 patients withdrew from the study during the induction period because of grade ≥3 toxicities; 27 patients completed the whole course of treatment, but 1 died before any assessment could be made. The median follow-up period was 28.5 months. The progression-free survival and overall survival at 3 years for the whole group were 35.7% and 63.8%, respectively. Among the 26 patients who could be assessed after treatment, the complete response rate was 30.8%, and the locoregional control rate at 3 years was 49.2%. Temporal lobe necrosis (TLN) developed in 8 cases. The rates of grade ≥3 hearing loss, soft tissue necrosis, dysphagia, and trismus were 30.8%, 15.4%, 11.5%, and 19.2%, respectively. Overall, 5 patients died owing to acute (1 after cycle 1 TPF and 1 after completion of bio-chemoradiotherapy) or late (2 epistaxis and 1 TLN) treatment-related complications. CONCLUSIONS The proposed salvage treatment regimen for advanced locally recurrent NPC could achieve a better treatment outcome than seen in previous studies. However, poor tolerability of induction TPF and the high rate of TLN limit its applicability outside clinical trials.
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Affiliation(s)
- Wai-Tong Ng
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China.
| | - Roger K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Dora L W Kwong
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Stewart Y Tung
- Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China
| | - Kam-Tong Yuen
- Department of Clinical Oncology, Princess Margaret Hospital, Hong Kong, China
| | - Michael K M Kam
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China
| | - Henry C K Sze
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Harry H Y Yiu
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Lucy L K Chan
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Maria L Lung
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China
| | - Anne W M Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China; Department of Clinical Oncology, University of Hong Kong-Shenzhen Hospital, Hong Kong, China
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94
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Dahlstrom KR, Anderson KS, Field MS, Chowell D, Ning J, Li N, Wei Q, Li G, Sturgis EM. Diagnostic accuracy of serum antibodies to human papillomavirus type 16 early antigens in the detection of human papillomavirus-related oropharyngeal cancer. Cancer 2017; 123:4886-4894. [PMID: 28898394 DOI: 10.1002/cncr.30955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Because of the current epidemic of human papillomavirus (HPV)-related oropharyngeal cancer (OPC), a screening strategy is urgently needed. The presence of serum antibodies to HPV-16 early (E) antigens is associated with an increased risk for OPC. The purpose of this study was to evaluate the diagnostic accuracy of antibodies to a panel of HPV-16 E antigens in screening for OPC. METHODS This case-control study included 378 patients with OPC, 153 patients with nonoropharyngeal head and neck cancer (non-OPC), and 782 healthy control subjects. The tumor HPV status was determined with p16 immunohistochemistry and HPV in situ hybridization. HPV-16 E antibody levels in serum were identified with an enzyme-linked immunosorbent assay. A trained binary logistic regression model based on the combination of all E antigens was predefined and applied to the data set. The sensitivity and specificity of the assay for distinguishing HPV-related OPC from controls were calculated. Logistic regression analysis was used to calculate odds ratios with 95% confidence intervals for the association of head and neck cancer with the antibody status. RESULTS Of the 378 patients with OPC, 348 had p16-positive OPC. HPV-16 E antibody levels were significantly higher among patients with p16-positive OPC but not among patients with non-OPC or among controls. Serology showed high sensitivity and specificity for HPV-related OPC (binary classifier: 83% sensitivity and 99% specificity for p16-positive OPC). CONCLUSIONS A trained binary classification algorithm that incorporates information about multiple E antibodies has high sensitivity and specificity and may be advantageous for risk stratification in future screening trials. Cancer 2017;123:4886-94. © 2017 American Cancer Society.
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Affiliation(s)
- Kristina R Dahlstrom
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karen S Anderson
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Matthew S Field
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, Arizona
| | - Diego Chowell
- Center for Personalized Diagnostics, Biodesign Institute, Arizona State University, Tempe, Arizona.,Simon A. Levin Mathematical, Computational, and Modeling Sciences Center, Arizona State University, Tempe, Arizona
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nan Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Qingyi Wei
- Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Guojun Li
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Erich M Sturgis
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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95
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Trials in head and neck oncology: Evolution of perioperative adjuvant therapy. Oral Oncol 2017; 72:80-89. [PMID: 28797466 DOI: 10.1016/j.oraloncology.2017.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/02/2017] [Accepted: 07/08/2017] [Indexed: 11/22/2022]
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96
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Lymph node ratio relationship to regional failure and distant metastases in oral cavity cancer. Radiother Oncol 2017; 124:225-231. [DOI: 10.1016/j.radonc.2017.06.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/12/2017] [Accepted: 06/15/2017] [Indexed: 11/21/2022]
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97
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Quinlan-Davidson SR, Mohamed ASR, Myers JN, Gunn GB, Johnson FM, Skinner H, Beadle BM, Gillenwater AM, Phan J, Frank SJ, William WN, Wong AJ, Lai SY, Fuller CD, Morrison WH, Rosenthal DI, Garden AS. Outcomes of oral cavity cancer patients treated with surgery followed by postoperative intensity modulated radiation therapy. Oral Oncol 2017; 72:90-97. [PMID: 28797467 DOI: 10.1016/j.oraloncology.2017.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Although treatment paradigms have not changed significantly, radiotherapy, surgery, and imaging techniques have improved, leading us to investigate oncologic and survival outcomes for oral cavity squamous cell cancer (OCSCC) patients treated with surgery followed by postoperative IMRT. MATERIAL AND METHODS Records of patients with pathological diagnosis of OCSCC treated between 2000 and 2012 were retrospectively reviewed. Patients' demographic, disease, and treatment criteria were extracted. Kaplan-Meier method was used to calculate survival curves. RESULTS Two hundred eighty-nine patients were analyzed. Median follow-up was 35months. Two hundred sixty-eight had neck dissections (93%), of which 66% had nodal involvement, and 51% of those positive dissections had extracapsular extension. Forty patients received induction chemotherapy and 107 received concurrent chemotherapy. Median dose to high risk clinical target volume was 60Gy/30 fractions. The 5-year locoregional control and overall survival rates were 76% and 57%, respectively. Tumors with >1.5cm depth of invasion had significantly higher risk of local failure compared with ≤1.5cm (p<0.001). In multivariate analysis, positive and no neck dissection (p=0.01), positive lymphovascular invasion (p=0.006) and >1.5cm depth of invasion (p=0.003) were independent predictors of poorer survival. CONCLUSIONS Disease outcomes were consistent with historical data and did not appear compromised by the use of IMRT.
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Affiliation(s)
- Sean R Quinlan-Davidson
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Radiation Oncology, Allentown Radiation Oncology Associates, Allentown, PA, USA
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Jeffrey N Myers
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gary B Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Faye M Johnson
- Department of Thoracic/Head and Neck Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; The University of Texas Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Heath Skinner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ann M Gillenwater
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William N William
- Department of Thoracic/Head and Neck Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrew J Wong
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Rosenthal DI, Mohamed ASR, Garden AS, Morrison WH, El-Naggar AK, Kamal M, Weber RS, Fuller CD, Peters LJ. Final Report of a Prospective Randomized Trial to Evaluate the Dose-Response Relationship for Postoperative Radiation Therapy and Pathologic Risk Groups in Patients With Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2017; 98:1002-1011. [PMID: 28721881 DOI: 10.1016/j.ijrobp.2017.02.218] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/03/2017] [Accepted: 02/24/2017] [Indexed: 01/03/2023]
Abstract
PURPOSE To present the long-term and final report of a phase 3 trial designed to assess dose-response relationship for postoperative radiation therapy (PORT) and pathologic risk groups in head and neck cancer. METHODS AND MATERIALS Patients who underwent primary surgery for American Joint Committee on Cancer stage III or IV squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx and who required PORT were eligible. Patients' primary sites and involved necks were independently assigned to higher- or lower-risk categories based on a cumulative point score representing increasing risk of recurrence. The sites in the lower-risk group were randomized to receive 57.6 or 63 Gy and those in the higher-risk group were randomized to receive 63 or 68.4 Gy, all at 1.8 Gy per fraction. RESULTS A total of 264 patients were included. The actuarial 5-year locoregional control rate was 67%. A second primary cancer was documented in 27% of patients. The 5- and 10-year freedom-from-distant metastasis rates were 64% and 60%, respectively, whereas the 5- and 10-year overall survival rates were 32% and 20%, respectively. There was no statistically significant difference in tumor control between different dose levels in both the lower- and higher-risk groups. On multivariate analysis, nonwhite race (P=.0003), positive surgical margins (P=.009), extracapsular extension (ECE, P=.01), and treatment package time (TPT) ≥85 days (P=.002) were independent correlates of worse locoregional control, whereas age ≥57 years (P<.0001), positive surgical margins (P=.01), ECE (P=.026), and TPT ≥85 days (P=.003) were independently associated with worse overall survival. CONCLUSIONS This long-term report of PORT delivered at 1.8 Gy/d to total doses of 57.6 to 68.4 Gy without chemotherapy for head and neck squamous cell carcinoma demonstrated that increasing dose did not significantly improve tumor control. On multivariate analysis, the only significant treatment variable was TPT. The results confirm that positive surgical margins and/or nodal ECE remains the most significant predictive pathologic factors.
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Affiliation(s)
- David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adel K El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Ain Shams University, Cairo, Egypt
| | - Randal S Weber
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lester J Peters
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Corry J, Bressel M, Fua T, Herschtal A, Solomon B, Porceddu SV, Wratten C, Rischin D. Prospective Study of Cetuximab, Carboplatin, and Radiation Therapy for Patients With Locally Advanced Head and Neck Squamous Cell Cancer Unfit for Cisplatin. Int J Radiat Oncol Biol Phys 2017; 98:948-954. [DOI: 10.1016/j.ijrobp.2017.02.088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/31/2017] [Accepted: 02/17/2017] [Indexed: 02/04/2023]
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100
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Efficacy and safety of postoperative bio-chemoradiotherapy using cetuximab and docetaxel for high-risk head and neck cancer patients in Japan. Cancer Chemother Pharmacol 2017; 80:203-207. [DOI: 10.1007/s00280-017-3352-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/01/2017] [Indexed: 10/19/2022]
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