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Carsuzaa F, Chabrillac E, Marcy PY, Mehanna H, Thariat J. Advances and residual knowledge gaps in the neck management of head and neck squamous cell carcinoma patients with advanced nodal disease undergoing definitive (chemo)radiotherapy for their primary. Strahlenther Onkol 2024:10.1007/s00066-024-02228-4. [PMID: 38600366 DOI: 10.1007/s00066-024-02228-4] [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: 11/29/2023] [Accepted: 03/03/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE Substantial changes have been made in the neck management of patients with head and neck squamous cell carcinomas (HNSCC) in the past century. These have been fostered by changes in cancer epidemiology and technological progress in imaging, surgery, or radiotherapy, as well as disruptive concepts in oncology. We aimed to review changes in nodal management, with a focus on HNSCC patients with nodal involvement (cN+) undergoing (chemo)radiotherapy. METHODS A narrative review was conducted to review current advances and address knowledge gaps in the multidisciplinary management of the cN+ neck in the context of (chemo)radiotherapy. RESULTS Metastatic neck nodes are associated with poorer prognosis and poorer response to radiotherapy, and have therefore been systematically treated by surgery. Radical neck dissection (ND) has gradually evolved toward more personalized and less morbid approaches, i.e., from functional to selective ND. Omission of ND has been made feasible by use of positron-emission tomography/computed tomography to monitor the radiation response in cN+ patients. Human papillomavirus-driven oropharyngeal cancers and their cystic nodes have shown dramatically better prognosis than tobacco-related cancers, justifying a specific prognostic classification (AJCC) creation. Finally, considering the role of lymph nodes in anti-tumor immunity, de-escalation of ND and prophylactic nodal irradiation in combination are intense areas of investigation. However, the management of bulky cN3 disease remains an issue, as aggressive multidisciplinary strategies or innovative combined treatments have not yet significantly improved their prognosis. CONCLUSION Personalized neck management is an increasingly important aspect of the overall therapeutic strategies in cN+ HNSCC.
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Affiliation(s)
- Florent Carsuzaa
- Department of Oto-Rhino-Laryngology & Head and Neck Surgery, Poitiers University Hospital, Poitiers, France
| | - Emilien Chabrillac
- Department of Surgery, University Cancer Institute of Toulouse-Oncopole, Toulouse, France
| | - Pierre Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Hisham Mehanna
- Institute for Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - Juliette Thariat
- Department of radiotherapy, Centre François Baclesse, Caen, France.
- Laboratoire de physique Corpusculaire, IN2P3/ENSICAEN/CNRS, UMR 6534, Normandie Université, Caen, France.
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2
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Mohamad I, Glaun MDE, Prabhash K, Busheri A, Lai SY, Noronha V, Hosni A. Current Treatment Strategies and Risk Stratification for Oral Carcinoma. Am Soc Clin Oncol Educ Book 2023; 43:e389810. [PMID: 37200591 DOI: 10.1200/edbk_389810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Management of oral cavity squamous cell carcinoma (OSCC) involves a multidisciplinary team approach. Surgery is ideally the primary treatment option for nonmetastatic OSCC, and less invasive curative surgical approaches are preferred in early-stage disease to minimize surgical-related morbidity. For patients at high risk of recurrence, adjuvant treatment using radiation therapy or chemoradiation is often used. Systemic therapy may also be used in the neoadjuvant setting (for advanced-stage disease with the intent of mandibular preservation) or in the palliative setting (for nonsalvageable locoregional recurrence and/or distant metastases). Patient involvement in treatment decision is the key for patient-driven management, particularly in clinical situation with poor prognosis, for example, early postoperative recurrence before planned adjuvant therapy.
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Affiliation(s)
- Issa Mohamad
- Department of Radiation Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Mica D E Glaun
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ahmed Busheri
- Department of Radiation Oncology, Kuwait Cancer Control Center, Kuwait
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, Homi Bhabha National Institute, Mumbai, India
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
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3
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Chang L, Wang D, Kan S, Hao M, Liu H, Yang Z, Xia Q, Liu W. Ginsenoside Rd inhibits migration and invasion of tongue cancer cells through H19/miR-675-5p/CDH1 axis. J Appl Oral Sci 2022; 30:e20220144. [PMID: 36074434 PMCID: PMC9444189 DOI: 10.1590/1678-7757-2022-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/18/2022] [Indexed: 11/27/2022] Open
Abstract
Objective Tongue squamous cell carcinoma (TSCC) is an oral cancer, with high malignancy and frequent early migration and invasion. Only a few drugs can treat tongue cancer. Ginsenoside Rd is a ginseng extract with anti-cancer effects. Many noncoding RNAs are abnormally expressed in tongue cancer, thus influencing its occurrence and development. H19 and miR-675-5p can promote cancer cell growth. This study aimed to analyze the regulation effect of ginsenoside Rd on H19 and miR-675-5p in tongue cancer. Methodology We used CCK8 and flow cytometry to study the growth and apoptosis. Transwell assay was used to assess invasion; wound-healing assay to assess migration; and colony formation assays to test the ability of cells to form colonies. H19, miR-675-5p, and CDH1 expressions were analyzed by qPCR. E-cadherin expression was detected using western blot. CRISPR/cas9 system was used for CDH1 knockout. Results Ginsenoside Rd inhibited the growth and increased the apoptosis of SCC9 cells. Ginsenoside Rd also inhibited the migration and invasion of SCC9 cells. H19 and miR-675-5p were highly expressed, while CDH1 and E-cadherin expressions were low. H19 and miR-675-5p promoted SCC9 metastasis. In contrast, CDH1 and E-cadherin inhibited the metastasis of SCC9 cells. Bioinformatics analysis showed that miR-675-5p was associated with CDH1. H19 and miR-675-5p expressions decreased after ginsenoside Rd treatment, while CDH1 and E-cadherin expressions increased. Conclusions Ginsenoside Rd inhibits tongue cancer cell migration and invasion via the H19/miR-675-5p/CDH1 axis.
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Affiliation(s)
- Lu Chang
- Jilin University, Hospital of Stomatology, Department of Oral and Maxillofacial Surgery, Changchun, China.,Jilin University, College of Animal Science, Laboratory Animal Center, Changchun, China.,Jilin University, Hospital of Stomatology, Jilin Provincial Key Laboratory of Tooth Development and Bone Remodeling, Changchun, China
| | - Dongxu Wang
- Jilin University, College of Animal Science, Laboratory Animal Center, Changchun, China
| | - Shaoning Kan
- Jilin University, Hospital of Stomatology, Department of Oral and Maxillofacial Surgery, Changchun, China
| | - Ming Hao
- Jilin University, Hospital of Stomatology, Department of Oral and Maxillofacial Surgery, Changchun, China
| | - Huimin Liu
- Jilin University, Hospital of Stomatology, Department of Oral and Maxillofacial Surgery, Changchun, China
| | - Zhijing Yang
- Jilin University, Hospital of Stomatology, Department of Oral and Maxillofacial Surgery, Changchun, China
| | - Qianyun Xia
- Jilin University, College of Animal Science, Laboratory Animal Center, Changchun, China
| | - Weiwei Liu
- Jilin University, Hospital of Stomatology, Department of Oral and Maxillofacial Surgery, Changchun, China
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4
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Rao V, Subash A, Sinha P, Shetty S, Thakur S, Merchant Y, Kudpaje A, Arakeri G. Role of Adjuvant Radiotherapy in Early Stage Tongue Cancer: Need for Establishing Stringent Guidelines. Indian J Surg Oncol 2021; 12:549-553. [PMID: 34658584 DOI: 10.1007/s13193-021-01379-5] [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: 10/27/2020] [Accepted: 06/21/2021] [Indexed: 11/30/2022] Open
Abstract
The primary objective of this study was to determine, using population-based data, whether the addition of postoperative radiotherapy (RT) provides an overall survival benefit in patients with early primary squamous cell carcinoma (SCC) of tongue. The study included the data of tongue cancer patients treated between January 2016 and July 2019 retrieved from our hospital database. Tumours limited to pathologic T1 and T2 category managed with primary surgery with or without postoperative external beam RT were included. Overall survival (OS) and disease-free survival (DFS) were the main outcomes of interest. A total of 211 cases of oral cancer were evaluated and all the patients had clear surgical and pathological margins. Postoperative adjuvant therapy (PORT) was received by 16 patients. Comparison of DFS and OS at 2-year follow-up depicted a similar outcome (p = 0.582 and p = 0.312 respectively). Findings from our study suggest that in the absence of any absolute advantage on quantifiable survival and disease control, it is necessary to define stringent criteria when advocating PORT in early tongue cancer.
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Affiliation(s)
- Vishal Rao
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Anand Subash
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Piyush Sinha
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Sameep Shetty
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Shalini Thakur
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Yash Merchant
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Akshay Kudpaje
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
| | - Gururaj Arakeri
- Department of Head and Neck Oncology, HCG Cancer Centre, Sampangi Ram Nagar, Bengaluru, Karnataka India 560020.,Centre for Academic Research, HCG Cancer Centre, Bengaluru, India
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5
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Lin CY, Lee LY, Cheng NM, Lee SR, Tsai CY, Hsueh C, Fan KH, Wang HM, Hsieh CH, Ng SH, Yeh CH, Lin CH, Tsao CK, Fang TJ, Huang SF, Lee LA, Kang CJ, Fang KH, Wang YC, Lin WN, Hsin LJ, Yen TC, Liao CT. cN+pN0 disease does not portend a less favorable prognosis compared with cN0pN0 in patients with resected oral cavity squamous cell carcinoma. Cancer Med 2021; 10:6947-6958. [PMID: 34558224 PMCID: PMC8525126 DOI: 10.1002/cam4.4187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/22/2021] [Accepted: 06/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background We compared the clinical outcomes of patients with oral cavity squamous cell carcinoma (OCSCC) with cN+pN0 versus cN0pN0 disease. Methods A total of 1309 OCSCC patients with pN0 disease were included. Of them, 1019 and 290 cases had cN0pN0 and cN+pN0 disease, respectively. For comparison purposes, we also examined 799 patients with pN+disease (cN0pN+/cN+pN+, n = 239/560). Subgroup analysis was performed in a propensity score‐matched cohort with cN0pN0 and cN+pN0 disease (n = 284 each). Results Compared with cN0pN0, patients with cN+pN0 had a higher prevalence of the following variables: betel chewing, pT3−4, depth ≥10 mm, perineural invasion, and treatment with surgery and adjuvant therapy. The prognosis of patients with cN+pN0 (mean: 52 nodes) and cN0pN0 (mean: 39 nodes) disease was similar both in the original cohort and after propensity score matching. However, the 5‐year outcomes were more favorable for cN+pN0/cN0pN0 compared with cN0pN+/cN+pN+ (local control, 88%/88%/83%/81%; neck control, 94%/93%/82%/76%; distant metastases, 4%/3%/13%/31%; disease‐free survival, 84%/83%/68%/52%; disease‐specific survival, 92%/92%/77%/57%; overall survival, 81%/82%/59%/42%; all p values <0.001; cN+pN0 versus cN0pN0, all p values >0.05). cN+pN0 disease (vs. cN0pN0) was not significantly associated with local control, neck control, distant metastases, and survivals either in univariable or multivariable analyses. Conclusions Despite a higher risk factor burden, the prognosis of patients with cN+pN0 disease did not differ from that of cases with cN0pN0. The higher nodal yield and the more frequent use of adjuvant therapy in cN+pN0 disease may explain the lack of significant differences in terms of neck control compared with cN0pN0 disease.
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Affiliation(s)
- Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Nai-Ming Cheng
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu Ru Lee
- Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chi-Ying Tsai
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kang-Hsing Fan
- Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hung-Ming Wang
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hua Yeh
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chung-Kan Tsao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Shiang-Fu Huang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Ang Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chung-Jan Kang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ku-Hao Fang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Chien Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Wan-Ni Lin
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Jen Hsin
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tzu-Chen Yen
- Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chun-Ta Liao
- Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, ROC
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6
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Chegini S, Schilling C, Walgama ES, Yu KM, Thankappan K, Iyer S, Cariati P, Balasubramanian D, Kanatas A, Lai SY, McGurk M. Neck failure following pathologically node-negative neck dissection (pN0) in oral squamous cell carcinoma: a systematic review and meta-analysis. Br J Oral Maxillofac Surg 2021; 59:1157-1165. [PMID: 34281738 DOI: 10.1016/j.bjoms.2021.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 04/01/2021] [Indexed: 11/25/2022]
Abstract
Due to the risk of occult cervical metastasis, elective neck dissection (END) is recommended in the management of patients with early oral cavity squamous cell carcinoma (OSCC) and a clinically node-negative (cN0) neck. This paper presents a systematic review and meta-analysis of studies that recorded isolated regional recurrence (RR) in the pathologically node-negative neck dissection (pN0) neck following END in order to quantify the failure rate. Pubmed and Ovid databases were systematically searched for relevant articles published between January 2009 and January 2019. Studies reporting RR following END in patients with OSCC who had no pathological evidence of lymph node metastasis were eligible for inclusion in this meta-analysis. In addition, a selection of large head and neck units were invited to submit unpublished data. Search criteria produced a list of 5448 papers, of which 18 studies met the inclusion criteria. Three institutions contributed unpublished data. This included a total of 4824 patients with median follow-up of 34 months (2.8 years). Eight datasets included patients staged T1-T4 with RR 17.3% (469/2711), 13 datasets included patients staged T1-T2 with RR 7.5% (158/2113). Overall across all 21 studies, isolated neck recurrence was identified in 627 cases giving a RR of 13.0% (627/4824) on meta-analysis. Understanding the therapeutic effectiveness of END provides context for evaluation of clinical management of the cN0 in these patients. A pathologically negative neck does not guarantee against future recurrence.
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Affiliation(s)
- S Chegini
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom.
| | - C Schilling
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom
| | - E S Walgama
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K M Yu
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Thankappan
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - S Iyer
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - P Cariati
- Department of Oral and Maxillofacial Surgery, Hospital General Universitario de Albacete, Albacete, Spain
| | - D Balasubramanian
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India
| | - A Kanatas
- Leeds General Infirmary, Great George St, Leeds LS1 3EX, United Kingdom
| | - S Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M McGurk
- Head and Neck Academic Centre, University College London, Gower St, Bloomsbury, London WC1E 6BT, United Kingdom; Department of Oral and Maxillofacial Head and Neck Surgery, University College Hospital London, 235 Euston Rd, Bloomsbury, London NW1 2BU, United Kingdom
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7
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Amdur RJ, Lee NY, Dziegielewski PT, Wong RJ, Hitchcock KE, Dagan R, Mendenhall WM. Postoperative Radiation Therapy to Pathologically Negative Neck Nodal Stations in Patients With Indications for Radiation Therapy at the Primary Site. Pract Radiat Oncol 2020; 10:383-385. [DOI: 10.1016/j.prro.2020.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/18/2020] [Accepted: 06/09/2020] [Indexed: 12/01/2022]
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8
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Lang P, Contreras J, Kalman N, Paterson C, Bahig H, Billfalk-Kelly A, Brennan S, Rock K, Read N, Venkatesan V, Sathya J, Mendez LC, MacNeil SD, Nichols AC, Fung K, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Theurer JA, Palma DA. Preservation of swallowing in resected oral cavity squamous cell carcinoma: examining radiation volume effects (PRESERVE): study protocol for a randomized phase II trial. Radiat Oncol 2020; 15:196. [PMID: 32795322 PMCID: PMC7427897 DOI: 10.1186/s13014-020-01636-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with resected oral cavity squamous cell carcinoma (OCSCC) are often treated with adjuvant radiation (RT) ± concomitant chemotherapy based on pathological findings. Standard RT volumes include all surgically dissected areas, including the tumour bed and dissected neck. RT has significant acute and long-term toxicities including odynophagia, dysphagia, dermatitis and fibrosis. The goal of this study is to assess the rate of regional failure with omission of radiation to the surgically dissected pathologically node negative (pN0) hemi-neck(s) compared to historical control, and to compare oncologic outcomes, toxicity, and quality of life (QoL) profiles between standard RT volumes and omission of RT to the pN0 neck. METHODS This is a multicentre phase II study randomizing 90 patients with T1-4 N0-2 OCSCC with at least one pN0 hemi-neck in a 1:2 ratio between standard RT volumes and omission of RT to the pN0 hemi-neck(s). Patients will be stratified based on overall nodal status (nodal involvement vs. no nodal involvement) and use of concurrent chemotherapy. The primary endpoint is regional failure in the pN0 hemi-neck(s); we hypothesize that a 2-year regional recurrence of 20% or less will be achieved. Secondary endpoints include overall and progression-free survival, local recurrence, rate of salvage therapy, toxicity and QoL. DISCUSSION This study will provide an assessment of omission of RT to the dissected pN0 hemi-neck(s) on oncologic outcomes, QoL and toxicity. Results will inform the design of future definitive phase III trials. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03997643 . Date of registration: June 25, 2019, Current version: 2.0 on July 11 2020.
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Affiliation(s)
- Pencilla Lang
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada.
| | - Jessika Contreras
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Noah Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | | | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Sinead Brennan
- Saint Luke's Radiation Oncology Network, Dublin, Ireland
| | - Kathy Rock
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Nancy Read
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Varagur Venkatesan
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Jinka Sathya
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Lucas C Mendez
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Eric Winquist
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - Sara Kuruvilla
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - Paul Stewart
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Sylvia Mitchell
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Julie A Theurer
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
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9
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Schilling C, Lai SY, Chegini S, McGurk M. ASCO Neck Dissection Guidelines Response Letter. J Oncol Pract 2019; 15:560-561. [PMID: 31513477 DOI: 10.1200/jop.19.00331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Clare Schilling
- Clare Schilling, PhD, University College London Hospital, London, United Kingdom; Stephen Y. Lai, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; and Soudeh Chegini, BMBCh and Mark McGurk, MD, University College London Hospital, London, United Kingdom
| | - Stephen Y Lai
- Clare Schilling, PhD, University College London Hospital, London, United Kingdom; Stephen Y. Lai, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; and Soudeh Chegini, BMBCh and Mark McGurk, MD, University College London Hospital, London, United Kingdom
| | - Soudeh Chegini
- Clare Schilling, PhD, University College London Hospital, London, United Kingdom; Stephen Y. Lai, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; and Soudeh Chegini, BMBCh and Mark McGurk, MD, University College London Hospital, London, United Kingdom
| | - Mark McGurk
- Clare Schilling, PhD, University College London Hospital, London, United Kingdom; Stephen Y. Lai, MD, The University of Texas MD Anderson Cancer Center, Houston, TX; and Soudeh Chegini, BMBCh and Mark McGurk, MD, University College London Hospital, London, United Kingdom
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Schilling C, Stoeckli SJ, Vigili MG, de Bree R, Lai SY, Alvarez J, Christensen A, Cognetti DM, D'Cruz AK, Frerich B, Garrel R, Kohno N, Klop WM, Kerawala C, Lawson G, McMahon J, Sassoon I, Shaw RJ, Tvedskov JF, von Buchwald C, McGurk M. Surgical consensus guidelines on sentinel node biopsy (SNB) in patients with oral cancer. Head Neck 2019; 41:2655-2664. [PMID: 30896058 DOI: 10.1002/hed.25739] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/05/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The eighth international symposium for sentinel node biopsy (SNB) in head and neck cancer was held in 2018. This consensus conference aimed to deliver current multidisciplinary guidelines. This document focuses on the surgical aspects of SNB for oral cancer. METHOD Invited expert faculty selected topics requiring guidelines. Topics were reviewed and evidence evaluated where available. Data were presented at the consensus meeting, with live debate from panels comprising expert, nonexpert, and patient representatives followed by voting to assess the level of support for proposed recommendations. Evidence review, debate, and voting results were all considered in constructing these guidelines. RESULTS/CONCLUSION A range of topics were considered, from patient selection to surgical technique and follow-up schedule. Consensus was not achieved in all areas, highlighting potential issues that would benefit from prospective studies. Nevertheless these guidelines represent an up-to-date pragmatic recommendation based on current evidence and expert opinion.
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Affiliation(s)
- Clare Schilling
- Head and Neck Academic Centre, Department of Head and Neck Surgery, University College London Hospital, London, UK
| | - Sando J Stoeckli
- Department of Otorhinolaryngology-Head and Neck Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Maurizio G Vigili
- Department of Otorhinolaryngology-Head and Neck Surgery, Ospedale San Carlo, Rome, Italy
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephen Y Lai
- Department Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Julio Alvarez
- Department of Oral and Maxillofacial Surgery, Cruces University Hospital, Bilbao, Spain
| | - Anders Christensen
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David M Cognetti
- Department of Otolaryngology-Head & Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anil K D'Cruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - Bernhard Frerich
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Centre Rostock, Rostock, Germany
| | - Renaud Garrel
- Department of Head and Neck Surgery, University Hospital, Montpellier, France
| | - Naoyuki Kohno
- Department of Otolaryngology-Head and Neck Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Willem Martin Klop
- Department of Head and Neck Oncology/Surgery, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Cyrus Kerawala
- Department of Head and Neck Surgery, The Royal Marsden NHS Foundation Trust, London, UK
| | - Georges Lawson
- Department of Head and Neck Surgery, Université Catholique de Louvain, CHU UCL Namur, Namur, Belgium
| | - Jeremy McMahon
- Department of Head and Neck Surgery, Southern General Hospital, Glasgow, Scotland
| | - Isabel Sassoon
- Department of Infomatics, Kings College London, London, UK
| | - Richard J Shaw
- Institute of Translational Medicine, University of Liverpool, Cancer Research Centre, Liverpool, UK
| | - Jesper F Tvedskov
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otolaryngology, Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark McGurk
- Head and Neck Academic Centre, Department of Head and Neck Surgery, University College London Hospital, London, UK
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