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Chen AM. De-escalated radiation for human papillomavirus virus-related oropharyngeal cancer: evolving paradigms and future strategies. Front Oncol 2023; 13:1175578. [PMID: 37576899 PMCID: PMC10413127 DOI: 10.3389/fonc.2023.1175578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/25/2023] [Indexed: 08/15/2023] Open
Abstract
The incidence of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma has increased dramatically in recent years reaching epidemic-like proportions. Data has emerged not only showing that these cancers are a unique entity with distinct molecular characteristics but that they also have a significantly improved prognosis as a result of their exquisite radiosensitivity compared to their HPV-negative counterparts. This, it has been increasingly suggested that these tumors can be targeted with de-escalated approaches using reduced doses of radiation. The overriding goal of de-escalation is to maintain the high cure and survival rates associated with traditional approaches while reducing the incidence of both short- and long-term toxicity. Although the exact reason for the improved radiosensitivity of HPV-positive oropharyngeal carcinoma is unclear, prospective studies have now been published demonstrating that de-escalated radiation can successfully maintain the high rates of cure and preserve quality of life for appropriately selected patients with this disease. However, these studies have been complicated by such factors as the relatively limited sample sizes, as well as the variability in treatment, inclusion criteria, and follow-up. As the data continues to mature on de-escalation, it is unquestionable that treatment paradigms for this disease will evolve. The ongoing quest to define a standard regimen comprises the subject of this review.
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Affiliation(s)
- Allen M. Chen
- Department of Radiation Oncology, Chao Family Comprehensive Cancer Center, School of Medicine, University of California- Irvine, Irvine, CA, United States
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Investigation of the Effect of Radiotherapy Dose on Chewing and Swallowing Structures in Head and Neck Cancer Patients Treated with Concomitant Chemoradiotherapy. Dysphagia 2022; 37:1400-1413. [PMID: 35075541 DOI: 10.1007/s00455-021-10398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/06/2021] [Indexed: 12/16/2022]
Abstract
Intensity-modulated radiotherapy (IMRT) is a treatment method that is used in the treatment of head and neck cancers. Impairment of chewing and swallowing functions in the early and late periods of radiotherapy is frequent. Therefore, revealing the dose-effect relationship is important. The main purpose of this study is to investigate the dose-effect relationship between chewing and swallowing structures objectively via a standardized videofluoroscopy protocol. The study included 35 participants treated with chemo-IMRT. A videofluoroscopic swallowing study (VFSS) was performed before IMRT, and 3 and 6 months after IMRT. VFSS results were scored according to the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Maximum interincisor mouth opening, body mass index (BMI), and Functional Oral Intake Scale levels were determined in these cases. The quality of life of participants was evaluated. There was a significant increase in PAS and MBSImP scores and a significant decrease in BMI scores of the patients after treatment. Xerotomy and sticky saliva complaints increased after treatment. The dose to the mastication muscles (> 40 Gy) and the temporomandibular joint (> 46 Gy) were found to be associated with a decrease in BMI; the dose to the superior pharyngeal constructor muscle (> 58 Gy) was found to be associated with pharyngeal stripping wave. The presence of aspiration was associated with the inferior pharyngeal constructor muscle, glottic larynx, supraglottic larynx, and upper esophageal sphincter. Important findings to emerge from this study include detected toxic dose limits. These findings may guide physicians to minimize the side effects of IMRT.
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Mathew A, Tirkey AJ, Li H, Steffen A, Lockwood MB, Patil CL, Doorenbos AZ. Symptom Clusters in Head and Neck Cancer: A Systematic Review and Conceptual Model. Semin Oncol Nurs 2021; 37:151215. [PMID: 34483015 PMCID: PMC8492544 DOI: 10.1016/j.soncn.2021.151215] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The two approaches to symptom-cluster research include grouping symptoms and grouping patients. The objective of this systematic review was to examine the conceptual approaches and methodologies used in symptom-cluster research in patients with head and neck cancer. DATA SOURCES Articles were retrieved from electronic databases (CINAHL, MEDLINE via Ovid, APA PsycINFO, Scopus, Embase, and Cochrane Central Register of Controlled Trials-CENTRAL), five grey literature portals, and Google Scholar. Seventeen studies met the eligibility criteria. Eight studies grouped symptoms to identify symptom clusters, of which two used qualitative methods. The number of symptom clusters ranged from two to five, and the number of symptoms in a cluster ranged from 2 to 11. Nine studies grouped patients based on their experiences with multiple symptoms. Cluster analysis and factor analysis were most commonly used. Despite variable names and composition of symptom clusters, synthesis revealed three prominent symptom clusters: general, head and neck cancer-specific, and gastrointestinal. Being female and quality of life were significantly associated with high symptom group or cluster severity. Biological mechanisms were sparsely examined. CONCLUSION Symptom cluster research in head and neck cancer is emerging. Consensus on nomenclature of a symptom cluster will facilitate deduction of core clinically relevant symptom clusters in head and neck cancer. Further research is required on understanding patients' subjective experiences, identifying predictors and outcomes, and underlying mechanisms for symptom clusters. IMPLICATIONS FOR NURSING PRACTICE Identification of clinically relevant symptom clusters would enable targeted symptom assessment and management strategies, thus improving treatment efficiencies and patient outcomes.
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Affiliation(s)
- Asha Mathew
- College of Nursing, University of Illinois, Chicago; Christian Medical College, Vellore, India.
| | | | - Hongjin Li
- College of Nursing, University of Illinois, Chicago; Christian Medical College, Vellore, India
| | | | | | | | - Ardith Z Doorenbos
- College of Nursing, University of Illinois, Chicago; University of Illinois Cancer Center, Chicago
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Luciani T, Wentzel A, Elgohari B, Elhalawani H, Mohamed A, Canahuate G, Vock DM, Fuller CD, Marai GE. A spatial neighborhood methodology for computing and analyzing lymph node carcinoma similarity in precision medicine. J Biomed Inform 2020; 112S:100067. [PMID: 34417010 PMCID: PMC10695270 DOI: 10.1016/j.yjbinx.2020.100067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/29/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
Precision medicine seeks to tailor therapy to the individual patient, based on statistical correlates from patients who are similar to the one under consideration. These correlates can and should go beyond genetics, and in general, beyond tabular or array data that can be easily represented computationally and compared. For example, in many types of cancer, cancer treatment and toxicity depend in large measure on the spatial disease spread-e.g., metastasizes to regional lymph nodes in head and neck cancer. However, there is currently a lack of methodology for integrating spatial information when considering patient similarity. We present a novel modeling methodology for the comparison of cancer patients within a cohort, based on the spatial spread of the lymph nodes affected in each patient. The method uses a topological map, bigrams, and hierarchical clustering to group patients based on their similarity. We compare this approach against a nonspatial (categorical) similarity approach where patients are binned solely by their affected nodes. We present similarity results on a 582 head and neck cancer patient cohort, along with two visual abstractions for analysis of the results, and we present clinician feedback. Our novel methodology partitions a patient cohort into clinically meaningful groups more susceptible to treatment side-effects. Such spatially-aware similarity approaches can help maximize the effectiveness of each patient's treatment.
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Affiliation(s)
- T Luciani
- Department of Computer Science, University of Illinois at Chicago, United States
| | - A Wentzel
- Department of Computer Science, University of Illinois at Chicago, United States
| | - B Elgohari
- MD Anderson Cancer Center, United States
| | | | - A Mohamed
- MD Anderson Cancer Center, United States
| | - G Canahuate
- Department of Computer Science, University of Iowa, United States
| | - D M Vock
- Department of Biostatistics, University of Minnesota, United States
| | - C D Fuller
- MD Anderson Cancer Center, United States
| | - G E Marai
- Department of Computer Science, University of Illinois at Chicago, United States.
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Hargreaves S, Beasley M, Hurt C, Jones TM, Evans M. Deintensification of Adjuvant Treatment After Transoral Surgery in Patients With Human Papillomavirus-Positive Oropharyngeal Cancer: The Conception of the PATHOS Study and Its Development. Front Oncol 2019; 9:936. [PMID: 31632901 PMCID: PMC6779788 DOI: 10.3389/fonc.2019.00936] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
PATHOS is a phase II/III randomized controlled trial (RCT) of risk-stratified, reduced intensity adjuvant treatment in patients undergoing transoral surgery (TOS) for human papillomavirus (HPV)-positive oropharyngeal squamous cell carcinoma (OPSCC). The study opened in the UK in October 2015 and, after successful recruitment into the phase II, transitioned into phase III in the autumn of 2018. PATHOS aims to establish whether the de-intensification of adjuvant treatment in patients with favorable prognosis HPV-positive OPSCC will confer improved swallowing outcomes, whilst maintaining high rates of cure. In this article, we will outline the rationale for the study and how it aims to answer fundamentally important questions about the safety, effectiveness and functional outcomes of minimally invasive TOS techniques followed by adjuvant radiotherapy (RT) or chemo-radiotherapy (CRT) in this patient population.
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Affiliation(s)
| | - Matthew Beasley
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Chris Hurt
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Terry M. Jones
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
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Gourin CG, Herbert RJ, Quon H, Fakhry C, Kiess AP, Eisele DW, Frick KD. Quality of care and short and long‐term outcomes of oropharyngeal cancer care in the elderly. Head Neck 2019; 41:3542-3550. [DOI: 10.1002/hed.25869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 06/04/2019] [Accepted: 06/26/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Christine G. Gourin
- Department of Otolaryngology ‐ Head and Neck SurgeryJohns Hopkins University Baltimore Maryland
| | - Robert J. Herbert
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public Health Baltimore Maryland
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University Baltimore Maryland
| | - Carole Fakhry
- Department of Otolaryngology ‐ Head and Neck SurgeryJohns Hopkins University Baltimore Maryland
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation SciencesJohns Hopkins University Baltimore Maryland
| | - David W. Eisele
- Department of Otolaryngology ‐ Head and Neck SurgeryJohns Hopkins University Baltimore Maryland
| | - Kevin D. Frick
- Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public Health Baltimore Maryland
- Johns Hopkins Carey Business School Baltimore Maryland
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Van den Steen L, Van Gestel D, Vanderveken O, Vanderwegen J, Lazarus C, Daisne J, Van Laer C, Specenier P, Van Rompaey D, Mariën S, Lawson G, Chantrain G, Desuter G, Van den Weyngaert D, Cvilic S, Beauvois S, Allouche J, Delacroix L, Vermorken JB, Peeters M, Dragan T, Van de Heyning P, De Bodt M, Van Nuffelen G. Evolution of self‐perceived swallowing function, tongue strength and swallow‐related quality of life during radiotherapy in head and neck cancer patients. Head Neck 2019; 41:2197-2207. [DOI: 10.1002/hed.25684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/14/2018] [Accepted: 01/10/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Leen Van den Steen
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Dirk Van Gestel
- Department of RadiotherapyInstitut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - Olivier Vanderveken
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Jan Vanderwegen
- Department of Speech, Language and AudiologyThomas More University College of Applied Sciences Antwerp Belgium
- Department of Otolaryngology and Head and Neck SurgeryCHU Saint‐Pierre Brussels Belgium
| | - Cathy Lazarus
- Department of Otolaryngology and Head and Neck SurgeryMount Sinai Beth Israel New York New York
- Department of OtorhinolaryngoloyAlbert Einstein College of Medicine New York New York
| | - Jean‐François Daisne
- Department of Radiation OncologyUniversité Catholique de Louvain, CHU‐UCL‐Namur Namur Belgium
| | - Carl Van Laer
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Pol Specenier
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Diane Van Rompaey
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
| | - Steven Mariën
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
| | - Georges Lawson
- ENT Head and Neck DepartmentUniversité Catholique de Louvain, CHU‐UCL‐Namur Namur Belgium
| | - Gilbert Chantrain
- Department of Otolaryngology and Head and Neck SurgeryCHU Saint‐Pierre Brussels Belgium
| | - Gauthier Desuter
- ENT Head and Neck Surgery DepartmentUniversité Catholique de Louvain Brussels Belgium
| | | | - Sophie Cvilic
- Department of RadiotherapyClinique Saint‐Jean Bruxelles Bruxelles Belgium
| | - Sylvie Beauvois
- Department of RadiotherapyInstitut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - Johan Allouche
- Department of Otolaryngology and Head and Neck SurgeryCHU Saint‐Pierre Brussels Belgium
| | - Laurence Delacroix
- ENT Head and Neck DepartmentUniversité Catholique de Louvain, CHU‐UCL‐Namur Namur Belgium
| | - Jan Baptist Vermorken
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Marc Peeters
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Department of Medical OncologyAntwerp University Hospital Antwerp Belgium
| | - Tatiana Dragan
- Department of RadiotherapyInstitut Jules Bordet, Université Libre de Bruxelles Brussels Belgium
| | - Paul Van de Heyning
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Marc De Bodt
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Faculty of Speech, Pathology and AudiologyGhent University Ghent Belgium
| | - Gwen Van Nuffelen
- Department of Otolaryngology and Head and Neck Surgery – Rehabilitation Center for Communication DisordersAntwerp University Hospital Antwerp Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
- Faculty of Speech, Pathology and AudiologyGhent University Ghent Belgium
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Charters EK, Bogaardt H, Freeman-Sanderson AL, Ballard KJ. Systematic review and meta-analysis of the impact of dosimetry to dysphagia and aspiration related structures. Head Neck 2019; 41:1984-1998. [PMID: 30680831 DOI: 10.1002/hed.25631] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 10/21/2018] [Accepted: 12/14/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Technological advances in radiotherapy have allowed investigations into new methods to spare healthy tissue in those treated for head and neck cancer. This systematic review with meta-analysis demonstrates the effect that radiation has on swallowing. METHODS Selection and analysis of studies examining the effect of radiation to swallowing structures. A fixed effects meta-analysis calculated the pooled proportions for select outcomes of dysphagia, common across many studies. RESULTS The majority of the papers found a correlation between radiation dose to the swallowing structures and dysphagia, however a meta-analysis found the studies carried a significant degree of heterogeneity. The appraisal demonstrates the need for large-scale studies using a randomized design and instrumental dysphagia assessments. CONCLUSIONS Radiation dose to dysphagia and aspiration structures is correlated with incidence of dysphagia and aspiration. The variables in this population contribute to the heterogeneity within and cross studies and future studies should consider controlling for this.
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Affiliation(s)
| | - Hans Bogaardt
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
| | | | - Kirrie J Ballard
- Faculty of Health Sciences, The University of Sydney, Sydney, Australia
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Mohamed AS, Bahig H, Aristophanous M, Blanchard P, Kamal M, Ding Y, Cardenas CE, Brock KK, Lai SY, Hutcheson KA, Phan J, Wang J, Ibbott G, Gabr RE, Narayana PA, Garden AS, Rosenthal DI, Gunn GB, Fuller CD. Prospective in silico study of the feasibility and dosimetric advantages of MRI-guided dose adaptation for human papillomavirus positive oropharyngeal cancer patients compared with standard IMRT. Clin Transl Radiat Oncol 2018; 11:11-18. [PMID: 30014042 PMCID: PMC6019867 DOI: 10.1016/j.ctro.2018.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/17/2018] [Accepted: 04/30/2018] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We aim to determine the feasibility and dosimetric benefits of a novel MRI-guided IMRT dose-adaption strategy for human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPC). MATERIALS/METHODS Patients with locally advanced HPV+ OPC underwent pre-treatment and in-treatment MRIs every two weeks using RT immobilization setup. For each patient, two IMRT plans were created (i.e. standard and adaptive). The prescription dose for the standard plans was 2.12 Gy/fx for 33 fractions to the initial PTV. For adaptive plans, a new PTVadaptive was generated based on serial MRIs in case of detectable tumor shrinkage. Prescription dose to PTVadaptive was 2.12 Gy/fx to allow for maximum dose to the residual disease. Any previously involved volumes received minimally a floor dose of 50.16 Gy. Uninvolved elective nodal volumes were prescribed 50.16 Gy in 1.52 Gy/fx. Dosimetric parameters of organs at risk (OARs) were recorded for standard vs. adaptive plans. Normal tissue complication probability (NTCP) for toxicity endpoints was calculated using literature-derived multivariate logistic regression models. RESULTS Five patients were included in this pilot study, 3 men and 2 women. Median age was 58 years (range 45-69). Three tumors originated at the tonsillar fossa and two at the base of tongue. The average dose to 95% of initial PTV volume was 70.7 Gy (SD,0.3) for standard plans vs. 58.5 Gy (SD,2.0) for adaptive plans. The majority of OARs showed decrease in dosimetric parameters using adaptive plans vs. standard plans, particularly swallowing related structures. The average reduction in the probability of developing dysphagia ≥ grade2, feeding tube persistence at 6-month post-treatment and hypothyroidism at 1-year post-treatment was 11%, 4%, and 5%, respectively. The probability of xerostomia at 6-month was only reduced by 1% for adaptive plans vs. standard IMRT. CONCLUSION These in silico results showed that the proposed MRI-guided adaptive approach is technically feasible and advantageous in reducing dose to OARs, especially swallowing musculature.
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Affiliation(s)
- 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
- MD Anderson Cancer Center/UT Health Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Houda Bahig
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM), Canada
| | - Michalis Aristophanous
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pierre Blanchard
- Department of Radiation Oncology, Institut de Cancérologie Gustave Roussy, Paris, France
| | - Mona Kamal
- 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 Ain Shams, Cairo, Egypt
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E. Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kristy K. Brock
- Department of Imaging Physics, 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
| | - Katherine A. Hutcheson
- Department of Head and Neck Surgery, 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
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Geoffrey Ibbott
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Refaat E. Gabr
- Department of Diagnostic & Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ponnada A. Narayana
- Department of Diagnostic & Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Adam S. Garden
- 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
| | - G. Brandon Gunn
- Department of Radiation Oncology, 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
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Late radiation-associated dysphagia in head and neck cancer patients: evidence, research and management. Oral Oncol 2018; 77:125-130. [DOI: 10.1016/j.oraloncology.2017.12.021] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 12/27/2017] [Accepted: 12/30/2017] [Indexed: 11/19/2022]
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11
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Patterns of dysphagia and acute toxicities in patients with head and neck cancer undergoing helical IMRT±concurrent chemotherapy. Oral Oncol 2017; 64:1-8. [DOI: 10.1016/j.oraloncology.2016.11.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/20/2016] [Indexed: 12/20/2022]
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12
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Is treatment de-escalation a reality in HPV related oropharyngeal cancer? Surgeon 2016; 14:180-3. [PMID: 27188245 DOI: 10.1016/j.surge.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 04/12/2016] [Indexed: 12/18/2022]
Abstract
The incidence of HPV related oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing. It is now well recognised as a distinct clinical and biologic entity, compared to traditional OPSCC. The majority of these patients have an excellent prognosis due to the chemo-radiosensitive nature of these tumours. The de-escalation of current treatment regimens have therefore been proposed in an attempt to reduce the long term treatment related morbidity of this much younger patient cohort. Several of the more pertinent points regarding safe de-escalation strategies are considered within this manuscript.
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Wall LR, Ward EC, Cartmill B, Hill AJ. Physiological changes to the swallowing mechanism following (chemo)radiotherapy for head and neck cancer: a systematic review. Dysphagia 2014; 28:481-493. [PMID: 24078216 DOI: 10.1007/s00455-013-9491-8] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 08/28/2013] [Indexed: 02/06/2023]
Abstract
Emerging research suggests that preventative swallowing rehabilitation, undertaken before or during (chemo)radiotherapy ([C]RT), can significantly improve early swallowing outcomes for head and neck cancer (HNC) patients. However, these treatment protocols are highly variable. Determining specific physiological swallowing parameters that are most likely to be impacted post-(C)RT would assist in refining clear targets for preventative rehabilitation. Therefore, this systematic review (1) examined the frequency and prevalence of physiological swallowing deficits observed post-(C)RT for HNC, and (2) determined the patterns of prevalence of these key physiological deficits over time post-treatment. Online databases were searched for relevant papers published between January 1998 and March 2013. A total of 153 papers were identified and appraised for methodological quality and suitability based on exclusionary criteria. Ultimately, 19 publications met the study’s inclusion criteria. Collation of reported prevalence of physiological swallowing deficits revealed reduced laryngeal excursion, base-of-tongue (BOT) dysfunction, reduced pharyngeal contraction, and impaired epiglottic movement as most frequently reported. BOT dysfunction and impaired epiglottic movement showed a collective prevalence of over 75 % in the majority of patient cohorts, whilst reduced laryngeal elevation and pharyngeal contraction had a prevalence of over 50 %. Subanalysis suggested a trend that the prevalence of these key deficits is dynamic although persistent over time. These findings can be used by clinicians to inform preventative intervention and support the use of specific, evidence-based therapy tasks explicitly selected to target the highly prevalent deficits post-(C)RT for HNC.
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Kiss N, Krishnasamy M, Everitt S, Gough K, Duffy M, Isenring E. Dosimetric factors associated with weight loss during (chemo)radiotherapy treatment for lung cancer. Eur J Clin Nutr 2014; 68:1309-14. [DOI: 10.1038/ejcn.2014.166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 07/16/2014] [Accepted: 07/17/2014] [Indexed: 11/09/2022]
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15
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Awan MJ, Mohamed ASR, Lewin JS, Baron CA, Gunn GB, Rosenthal DI, Holsinger FC, Schwartz DL, Fuller CD, Hutcheson KA. Late radiation-associated dysphagia (late-RAD) with lower cranial neuropathy after oropharyngeal radiotherapy: a preliminary dosimetric comparison. Oral Oncol 2014; 50:746-52. [PMID: 24906528 PMCID: PMC4158823 DOI: 10.1016/j.oraloncology.2014.05.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 05/13/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND OBJECTIVES Late radiation-associated dysphagia (late-RAD) is a rare delayed toxicity, in oropharyngeal cancer (OPC) survivors. Prevention of late-RAD is paramount because the functional impairment can be profound and refractory to standard therapies. The objective of this analysis is to identify candidate dosimetric predictors of late-RAD and associated lower cranial neuropathies after radiotherapy (RT) or chemo-RT (CRT) for OPC. MATERIALS AND METHODS An unmatched retrospective case-control analysis was conducted. Late-RAD cases were identified among OPC patients treated with definitive RT or CRT. Controls were selected with minimum of 6 years without symptoms of late-RAD. Dysphagia-aspiration related structures (DARS) and regions of interest containing cranial nerve paths (RCCNPs) were retrospectively contoured. Dose volume histograms were calculated. Non-parametric bivariate associations were analyzed with Bonferroni correction and multiple logistic regression models were fit. RESULTS Thirty-eight patients were included (12 late-RAD cases, 26 controls). Median latency to late-RAD was 5.8 years (range: 4.5-11.3 years). Lower cranial neuropathies were present in 10 of 12 late-RAD cases. Mean superior pharyngeal constrictor (SPC) dose was higher in cases relative to controls (median: 70.5 vs. 61.6 Gy). Mean SPC dose significantly predicted late-RAD (p = 0.036) and related cranial neuropathies (p = 0.019). RCCNPs did not significantly predict late-RAD or cranial neuropathies. CONCLUSIONS SPC dose may predict for late-RAD and related lower cranial neuropathies. These data, and those of previous studies that have associated SPC dose with classical dysphagia endpoints, suggest impetus to constrain dose to the SPCs when possible.
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Affiliation(s)
- Musaddiq J Awan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States; Department of Radiation Oncology, Case Western Reserve University Hospitals, Cleveland, OH 44106, United States.
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States; Department of Clinical Oncology, Faculty of Medicine, The University of Alexandria, Alexandria, Egypt.
| | - Jan S Lewin
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States.
| | - Charles A Baron
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States.
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States.
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States.
| | - F Christopher Holsinger
- Department of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Stanford, CA 94305, United States.
| | - David L Schwartz
- Department of Radiation Oncology, The University of Texas Southwestern, Dallas, TX, United States.
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77082, United States.
| | - Katherine A Hutcheson
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, United States.
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16
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Ottosson S, Söderström K, Kjellén E, Nilsson P, Zackrisson B, Laurell G. Weight and body mass index in relation to irradiated volume and to overall survival in patients with oropharyngeal cancer: a retrospective cohort study. Radiat Oncol 2014; 9:160. [PMID: 25052587 PMCID: PMC4112828 DOI: 10.1186/1748-717x-9-160] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 07/12/2014] [Indexed: 01/04/2023] Open
Abstract
Background Weight loss is a common problem in patients with Squamous Cell Carcinoma of the Head and Neck (SCCHN) treated with radiotherapy (RT). The aims of the present study were to determine if treated volume (TV), as a measure of the radiation dose burden, can predict weight loss in patients with oropharyngeal cancer and to analyze weight loss and body mass index (BMI) in the same patient group in relation to 5-year overall survival. Methods The ARTSCAN trial is a prospective, randomized, multicenter trial in patients with SCCHN. Nutritional data from the ARTSCAN trial were analyzed retrospectively using univariate and multivariate statistical methods based on information on percentage weight loss from the start of RT up to five months after the termination of RT (study cohort 1, n = 232) and information on patients’ BMI at the start of RT (study cohort 2, n = 203). TV was defined as the volume of the patient receiving at least 95% of the prescribed dose. TV64.6 Gy encompasses macroscopic tumor and TV43.7 Gy elective lymph nodes of the neck. Results TV64.6 Gy and TV43.7 Gy were both significantly correlated with higher weight loss up to five months after the termination of RT in study cohort 1 (p < 0.001 for both). BMI at the start of RT was shown to be a prognostic factor for 5-year overall survival in study cohort 2 but weight loss was not. The hazard ratios and 95% confidence intervals were 3.78 (1.46–9.75) and 2.57 (1.43–4.62) in patients with underweight and normal weight, respectively. Conclusions TV can predict weight loss during RT in patients with oropharyngeal cancer regardless of clinical stage. A high BMI (>25 kg/m2) at the start of RT is positively associated with survival in patients with oropharyngeal cancer.
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Affiliation(s)
- Sandra Ottosson
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden.
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17
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Erkal EY, Canoğlu D, Kaya A, Aksu G, Sarper B, Akansel G, Meydancı T, Erkal HS. Assessment of early and late dysphagia using videofluoroscopy and quality of life questionnaires in patients with head and neck cancer treated with radiation therapy. Radiat Oncol 2014; 9:137. [PMID: 24928361 PMCID: PMC4073176 DOI: 10.1186/1748-717x-9-137] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 06/07/2014] [Indexed: 11/27/2022] Open
Abstract
Backgorund The aim of this study was to evaluate dysphagia in patients with head and neck cancer (HNC) undergoing three-dimensional conformal radiation therapy using objective and subjective tools simultaneously and to associate the clinical correlates of dysphagia with dosimetric parameters. Methods Twenty patients were included in the study. The primary tumor and the involved lymph nodes (LN) were treated with 66-70 Gy, the uninvolved LN were treated with 46-50 Gy. Six swallowing structures were identified: the superior pharyngeal constrictor muscle (SPCM), the middle pharyngeal constrictor muscle (MPCM), the inferior pharyngeal constrictor muscle (IPCM), the base of tongue (BOT), the larynx and the proximal esophageal sphincter (PES). Dysphagia was evaluated using videofluoroscopy and European Organization for Research and Treatment of Cancer (EORTC) QoL questionnaire (QLQ-C30) and supplemental EORTC QoL module for HNC (QLQ-H&N35). The evaluations were performed before treatment, at 3 months and at 6 months following treatment. Results On objective evaluation, the Dmax for the larynx and the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness and proximal esophageal stricture at 3 months, whereas the V65, the V70and the Dmax for the larynx was correlated with BOT weakness and the V65, the V70, the Dmax or the Dmean for the sub-structures of the PCM were correlated with impaired lingual movement, BOT weakness, reduced laryngeal elevation, reduced epiglottic inversion and aspiration at 6 months following treatment. On subjective evaluation, the V60, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 3 months, whereas the V70 for SPCM were correlated with QoL scores for HNPA and the V60, the V65, the V70, the Dmax and the Dmean for SPCM were correlated with QoL scores for HNSO at 6 months following treatment. Conclusions The use of multiple dysphagia-related endpoints to complement eachother rather than to overlap with one another, as well as the use of multiple evaluations over time to represent a scale of early to late findings might provide a better insight in terms of the association of the clinical correlates of dysphagia with the dose-volume data for the dysphagia-related anatomical structures.
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Affiliation(s)
- Eda Yirmibeşoğlu Erkal
- Departments of Radiation Oncology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
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18
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Platek ME, Myrick E, McCloskey SA, Gupta V, Reid ME, Wilding GE, Cohan D, Arshad H, Rigual NR, Hicks WL, Sullivan M, Warren GW, Singh AK. Pretreatment weight status and weight loss among head and neck cancer patients receiving definitive concurrent chemoradiation therapy: implications for nutrition integrated treatment pathways. Support Care Cancer 2013; 21:2825-33. [PMID: 23743980 DOI: 10.1007/s00520-013-1861-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 05/21/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE The purpose was to examine the effect of pretreatment weight status on loco-regional progression for patients with squamous cell carcinoma of the head and neck (SCCHN) after receiving definitive concurrent chemoradiation therapy (CCRT). METHODS In an expanded cohort of 140 patients, we retrospectively reviewed weight status and loco-regional progression of SCCHN patients treated with CCRT between 2004 and 2010. RESULTS Pretreatment ideal body weight percentage (IBW%) was statistically significantly different for patients with disease progression than for those without progression (p = 0.02) but was not an independent predictor of progression. Median pretreatment IBW% was 118 (72-193) for the progression-free group and was 101.5 (73-163) for the group with progression. Both groups suffered clinically severe weight loss of approximately 9 % from baseline to end treatment. CONCLUSIONS Pretreatment weight status, a very crude indicator of nutrition status, may have prognostic value in patients with SCCHN undergoing definitive CCRT. Inadequate nutritional status in these patients has been associated with poor clinical outcomes and decreased quality of life. Based on this report and others, the best next steps include routine validated malnutrition screening and the testing of evidence-based nutrition care protocols with the goals of minimizing weight loss and improvement of quality of life.
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Affiliation(s)
- Mary E Platek
- Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Buffalo, NY, USA,
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