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Lehrer EJ, Khunsriraksakul C, Garrett S, Trifiletti DM, Sheehan JP, Guckenberger M, Louie AV, Siva S, Ost P, Goodman KA, Dawson LA, Tchelebi LT, Yang JT, Showalter TN, Park HS, Spratt DE, Kishan AU, Gupta GP, Shah C, Fanti S, Calais J, Wang M, Schmitz K, Liu D, Abraham JA, Dess RT, Buvat I, Solomon B, Zaorsky NG. Future directions in the evaluation and management of newly diagnosed metastatic cancer. Crit Rev Oncol Hematol 2025; 208:104631. [PMID: 39864534 DOI: 10.1016/j.critrevonc.2025.104631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/14/2025] [Accepted: 01/19/2025] [Indexed: 01/28/2025] Open
Abstract
There is much debate regarding optimal selection in patients with metastatic cancer who should undergo local treatment (surgery or radiation treatment) to the primary tumor and/or metastases. Additionally, the optimal treatment of newly diagnosed metastatic cancer is largely unclear. Current prognostication systems to best inform these clinical scenarios are limited, as all metastatic patients are grouped together as having Stage IV disease without further incorporation of patient and disease-specific covariates that significantly impact patient outcomes. Therefore, improving current prognostic scoring systems and incorporation of these covariates is essential to best individualize treatment for patients with metastatic cancer. In this narrative review article, we provide a detailed review of prognostication systems that can be used for both the site of metastasis and primary site to best tailor treatment in these patients. Additionally, we discuss the incorporation and ongoing developments in radiographic, genomic, and biostatistical techniques that can be used as prognostication tools.
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Affiliation(s)
- Eric J Lehrer
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
| | | | - Sara Garrett
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | | | - Jason P Sheehan
- Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shankar Siva
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Piet Ost
- Department of Radiation Oncology, Iridium Network, GZA Ziekenhuizen, Wilrijk, Belgium; Department of Human Structure and Repair, Ghent University, Belgium, Iridium Network, GZA Ziekenhuizen, Wilrijk, Belgium
| | - Karyn A Goodman
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura A Dawson
- Department of Radiation Oncology, University of Toronto, Ontario, Canada
| | | | - Jonathan T Yang
- Department of Radiation Oncology, New York University School of Medicine, New York, NY, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale University, New Haven, CT, USA
| | - Daniel E Spratt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Gaorav P Gupta
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Chirag Shah
- Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Stefano Fanti
- Department of Nuclear Medicine, IRCCS AOU di Bologna, Italy
| | - Jeremie Calais
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kathryn Schmitz
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Dajiang Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - John A Abraham
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert T Dess
- Department of Radiation Oncology, University of Michigan, MI, USA
| | - Irène Buvat
- Laboratory of Translational Imaging in Oncology, Institut Curie, Inserm, PSL University, Orsay, France
| | - Benjamin Solomon
- Department of Medical Oncology, University of Melbourne- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Sutter OP, Maurer A, Stadler TM, Lanzer M, Huellner MW, Broglie MA. Recurrence Detection by Hybrid [ 18F]FDG-PET in Advanced Head and Neck Squamous Cell Carcinoma. Head Neck 2025; 47:936-943. [PMID: 39520038 PMCID: PMC11816556 DOI: 10.1002/hed.27997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 10/29/2024] [Accepted: 10/31/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND In the clinical management of advanced stage head and neck squamous cell carcinoma, the use of hybrid [18F]FDG-PET imaging is well established. However, there is ongoing debate regarding the optimal frequency of hybrid PET scans to be included in follow-up protocols, particularly if the initial post-therapeutic scan is negative. METHODS We conducted a single-center 10-year retrospective study involving all patients who underwent hybrid PET scans for the follow-up of advanced stage head and neck cancer. A total of 285 patients were included. RESULTS Out of 199 patients with a negative 3-month hybrid PET, 15% subsequently developed a recurrence during further follow-up. Notably, 90% of these recurrences were detected by hybrid PET. CONCLUSION Fifteen percent of patients with a negative 3-month hybrid PET experienced a recurrence. Given that the majority of recurrences were detected by hybrid PET scans, there is a compelling argument for incorporating regular repetitive scans during follow-up.
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Affiliation(s)
- Oliver P. Sutter
- Department of OtorhinolaryngologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Alexander Maurer
- Department of Nuclear MedicineUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Thomas M. Stadler
- Department of OtorhinolaryngologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Martin Lanzer
- Department of Cranio‐Maxillo‐Facial and Oral SurgeryUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Martin W. Huellner
- Department of Nuclear MedicineUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| | - Martina A. Broglie
- Department of OtorhinolaryngologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
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Nerich V, Falcoz A, Nadin L, Meurisse A, Pechery A, Bourhis J, Sun XS, Thariat J. Cost-minimization analysis of the GORTEC 2014-04 randomized phase II study of stereotactic ablative radiotherapy (SABR) or chemotherapy-SABR in oligometastatic head and neck cancer. Radiother Oncol 2025; 204:110726. [PMID: 39837424 DOI: 10.1016/j.radonc.2025.110726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Revised: 12/14/2024] [Accepted: 01/12/2025] [Indexed: 01/23/2025]
Abstract
PURPOSE The randomized phase II GORTEC 2014-04 and French Head and Neck Intergroup study showed deeper deterioration of the quality of life (HRQoL) and dramatically higher severe toxicity rates with similar overall survival rates using chemo-SABR compared to SABR alone in oligometastatic head and neck cancer (HNSCC) patients. We evaluated the costs associated with SABR-alone versus chemo-SABR and their associated costs (transportation, hospitalizations, etc). MATERIALS AND METHODS 69 HNSCC patients with 1-3 oligometastases and a controlled primary were randomized from September 2015 to October 2022. HRQoL by the QLQ-C30, QLQ-HN35, descriptive EQ5D-3L and visual EQ-VAS self-rated questionnaires were completed for clinical benefit and economic utility appraisal. Direct medical treatment-related costs (radiotherapy, anticancer drugs, hospital stays, serious adverse event management, medical imaging, biological surveillance and medical transports) were analyzed from randomization until 12 months (M12, including per protocol and salvage treatments) or death. Utility index scores and deterioration rates were used. Based on equivalent outcomes, a cost-minimization analysis was performed.. RESULTS Median EQ-5D-3L utility index scores were 0.84 at baseline and 0.87 at M12 for SABR-alone; corresponding to 0.85 and 0.57 for chemo-SABR. Rates of patients free of definitive EQ-VAS deterioration at M12 were 76.9 % and 63.8 % for SABR-alone and chemo-SABR. Mean quality-adjusted PFS was 12.1 and 11.0 months with SABR-alone and chemo-SABR. The mean total costs from the French Public health system perspective were €8,498 ± 3,599 for SABR-alone, and €48,034 ± 58,228 for chemo-SABR (p < 10-4). Sensitivity analyses confirmed cost savings around €35,000-€40,000 per patient using SABR-alone. Anticancer drugs and hospital stays were cost drivers. The economic burden increased by 269 ± 66 % with chemo-SABR compared to SABR-alone (p < 10-4). CONCLUSIONS in addition to clinical benefits, SABR-alone appears as the least costly option (by a factor of 5) for the management of oligometastases from HNSCC.
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Affiliation(s)
- Virginie Nerich
- Université de Franche-Comté, CHU Besançon, INSERM, EFS-BFC, UMR 1098, Pôle Pharmacie F-25030 Besançon, France
| | - Antoine Falcoz
- Université de Franche-Comté, CHU Besançon, INSERM, EFS-BFC, UMR 1098, Pôle cancérologie, Unité de Méthodologie et de Qualité de Vie en Cancérologie F-25030 Besançon, France
| | | | - Aurelia Meurisse
- Université de Franche-Comté, CHU Besançon, INSERM, EFS-BFC, UMR 1098, Pôle cancérologie, Unité de Méthodologie et de Qualité de Vie en Cancérologie F-25030 Besançon, France
| | | | | | - Xu-Shan Sun
- GORTEC 4 bis rue Emile Zola 37000 Tours, France; Department of Radiation Oncology, Nord Franche-Comté de Montbéliard & CHRU de Besançon, Besançon, France
| | - Juliette Thariat
- GORTEC 4 bis rue Emile Zola 37000 Tours, France; Department of Radiotherapy, Centre François-Baclesse, Corpuscular Physics Laboratory, IN2P3, ENSICAEN, CNRS UMR 6534, Université de Normandie, Caen, France.
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Patel AM, Haleem A, Revercomb L, Brant JA, Rajasekaran K, Sun LL, Brody RM, Carey RM. Primary site surgical resection in cM1 oral cavity squamous cell carcinoma. Laryngoscope Investig Otolaryngol 2024; 9:e70000. [PMID: 39281203 PMCID: PMC11401054 DOI: 10.1002/lio2.70000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/07/2024] [Indexed: 09/18/2024] Open
Abstract
Objective To investigate primary site surgical resection and overall survival (OS) in clinically distantly metastatic (cM1) oral cavity squamous cell carcinoma (OCSCC). Methods The 2006-2018 National Cancer Database was queried for patients presenting with cM1 OCSCC who underwent chemotherapy. Binary logistic, Kaplan-Meier, and multivariable Cox proportional hazards regression models were implemented. Results Of 278 patients satisfying inclusion criteria, 139 (50.0%) underwent chemotherapy alone, 80 (28.8%) underwent chemoradiotherapy, 25 (9.0%) underwent surgical resection + adjuvant chemotherapy, and 34 (12.2%) underwent surgical resection + adjuvant chemoradiotherapy; 5-year OS was 9.4%, 15.2%, 8.3%, and 23.8%, respectively (p < .001). Compared with those not undergoing surgical resection, patients undergoing surgical resection underwent radiotherapy more frequently (57.6% vs. 36.5%) but multiple-agent chemotherapy less frequently (40.7% vs. 74.4%) (p < .005). Twenty-one (36.2%) patients undergoing surgical resection had positive surgical margins. Academic facility (adjusted odds ratio [aOR] 3.19, 95% CI 1.54-6.62) and Charlson-Deyo comorbidity score ≥1 (aOR 2.82, 95% CI 1.25-6.32, p < .025) were associated with increased odds of undergoing surgical resection. Compared with chemotherapy alone, chemoradiotherapy (adjusted hazard ratio [aHR] 0.56, 95% CI 0.38-0.83) and surgical resection + adjuvant chemoradiotherapy (aHR 0.37, 95% CI 0.21-0.66) were associated with higher OS (p < .005). Immunotherapy (aHR 0.48, 95% CI 0.28-0.81, p = .006) was also independently associated with higher OS. Conclusion A minority of patients with cM1 OCSCC underwent primary site surgical resection. Despite the high rate of positive surgical margins, surgical resection + adjuvant chemoradiotherapy was associated with higher OS than chemotherapy alone, chemoradiotherapy, or surgical resection + adjuvant chemotherapy. Definitive local therapy may benefit select patients with cM1 OCSCC.Level of evidence: 4.
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Affiliation(s)
- Aman M Patel
- Department of Otolaryngology-Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Afash Haleem
- Department of Otolaryngology-Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Lucy Revercomb
- Department of Otolaryngology-Head and Neck Surgery Rutgers New Jersey Medical School Newark New Jersey USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA
- Department of Otolaryngology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA
| | - Karthik Rajasekaran
- Department of Otorhinolaryngology-Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA
| | - Lova L Sun
- Division of Hematology and Oncology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA
- Department of Otolaryngology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA
| | - Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery University of Pennsylvania Philadelphia Pennsylvania USA
- Department of Otolaryngology Corporal Michael J. Crescenz Veterans Affairs Medical Center Philadelphia Pennsylvania USA
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Lin CH, Que J, Ho SY. HyperArcTM volumetric modulated arc therapy for hypopharyngeal cancer with solitary recurrence in the cervical vertebra: A case report and literature review. Medicine (Baltimore) 2024; 103:e38427. [PMID: 38847726 PMCID: PMC11155512 DOI: 10.1097/md.0000000000038427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 05/10/2024] [Indexed: 06/10/2024] Open
Abstract
RATIONALE It is difficult to reirradiate head and neck cancers because of the toxicity from previous radiation dose delivery. Conventional volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy often have poor target coverage. The new HyperArcTM VMAT (HA-VMAT) planning approach reportedly has better target coverage, higher conformity, and can spare normal organs compared to conventional VMAT; however, research on recurrent head and neck cancers is limited. Here, we report the clinical outcomes of HA-VMAT for previously irradiated hypopharyngeal cancer with solitary recurrence in the first cervical vertebra (C1). PATIENT CONCERNS A 52-year-old Asian male was diagnosed with a hypopharyngeal cancer. The patient received concurrent chemoradiotherapy with a radiation dose of 70 Gy in 33 fractions and achieved complete clinical response. Two years later, solitary recurrence was observed in the C1 vertebra. DIAGNOSES Solitary recurrence in the C1 vertebra. INTERVENTIONS Owing to concerns regarding the toxicity to adjacent organs, we decided to use HA-VMAT to achieve better tumor coverage and critical organ sparing. OUTCOMES Tumor regression was observed on the imaging. At 9 months follow-up, the patient was disease-free and had no late toxicities. LESSONS This is the first report regarding the clinical outcomes of HA-VMAT for previously irradiated hypopharyngeal cancer with solitary recurrence over the C1 vertebra. HA-VMAT achieves highly conformal dose distribution and excellent sparing of critical organs. There was a favorable initial clinical response with no toxicity. Long-term follow-up is essential in such cases.
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Affiliation(s)
- Chia-Hui Lin
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
- Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jenny Que
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
| | - Sheng-Yow Ho
- Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan
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Tham JLM, Ng SP, Khor R, Wada M, Gan H, Thai AA, Corry J, Bahig H, Mäkitie AA, Nuyts S, De Bree R, Strojan P, Ng WT, Eisbruch A, Chow JCH, Ferlito A. Stereotactic Body Radiotherapy in Recurrent and Oligometastatic Head and Neck Tumours. J Clin Med 2024; 13:3020. [PMID: 38892731 PMCID: PMC11173254 DOI: 10.3390/jcm13113020] [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: 02/13/2024] [Revised: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 06/21/2024] Open
Abstract
The treatment of head and neck cancers (HNCs) encompasses a complex paradigm involving a combination of surgery, radiotherapy, and systemic treatment. Locoregional recurrence is a common cause of treatment failure, and few patients are suitable for salvage surgery. Reirradiation with conventional radiation techniques is challenging due to normal tissue tolerance limits and the risk of significant toxicities. Stereotactic body radiotherapy (SBRT) has emerged as a highly conformal modality that offers the potential for cure while limiting the dose to surrounding tissue. There is also growing research that shows that those with oligometastatic disease can benefit from curative intent local ablative therapies such as SBRT. This review will look at published evidence regarding the use of SBRT in locoregional recurrent and oligometastatic HNCs.
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Affiliation(s)
- Jodie L. M. Tham
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Richard Khor
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Morikatsu Wada
- Department of Radiation Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Hui Gan
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - Alesha A. Thai
- Department of Medical Oncology, Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne 3084, Australia
| | - June Corry
- GenesisCare, St Vincent’s Hospital, Melbourne 3065, Australia
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de L’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Research Program in Systems Oncology, Helsinki University Hospital, University of Helsinki, 00100 Helsinki, Finland
| | - Sandra Nuyts
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Remco De Bree
- Department of Otolaryngology—Head and Neck Surgery, VU University Medical Centre, 1081 HV Amsterdam, The Netherlands
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, 1000 Ljubljana, Slovenia
| | - Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, MI 48109, USA
| | - James C. H. Chow
- Department of Clinical Oncology, Queens Elizabeth Hospital, Hong Kong SAR, China
| | - Alfio Ferlito
- International Head and Neck Scientific Group, 35100 Padua, Italy
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Carey RM, Prasad A, Wei K, Brant JA, Brody RM, Leibowitz JM, Civantos FJ, Sweeny L. Primary Site Surgery in Distantly Metastatic Oropharyngeal Squamous Cell Carcinoma. Laryngoscope 2024; 134:2243-2251. [PMID: 37947342 DOI: 10.1002/lary.31177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Determine if intensive local therapy (i.e., local surgery or radiation) has a survival benefit for patients presenting with distantly metastatic oropharyngeal squamous cell carcinoma (OPSCC). METHODS Retrospective population-based cohort study of patients in the National Cancer Database presenting with distantly metastatic OPSCC. Overall survival (OS) was compared for patients receiving systemic therapy alone or in combination with local surgery or curative dose radiation, controlling for various clinicodemographic factors. RESULTS Between 2010 and 2015, 627 patients presented with newly diagnosed, metastatic OPSCC and an initial treatment course including systemic chemotherapy. Multivariable analysis demonstrated that local radiation therapy was independently associated with improved OS (OR 0.64, CI [0.51-0.81]); local surgery was not independently associated with improved OS (OR 0.99, CI [0.65-1.53]). Higher T stages were associated with worse OS (OR 1.69, CI [1.14-2.50] for T3 and OR 1.77, CI [1.22-2.58] for T4 compared to T1). HPV-positive (HPV+) tumors were associated with improved OS compared to HPV- (OR 0.79, CI [0.64-0.97]). Multiagent chemotherapy was associated with improved OS compared to single-agent (OR 0.78, CI [0.62-1.00]). The best survival for the entire cohort and for HPV+ patients was for radiation with systemic therapy and the worst survival for systemic therapy alone. CONCLUSIONS Curative dose local radiotherapy in addition to systemic therapy is associated with improved OS compared to systemic therapy alone in patients presenting with distantly metastatic OPSCC. There is not a significant survival benefit for local surgery in addition to systemic therapy in this patient population, regardless of HPV status. LEVEL OF EVIDENCE 3 Laryngoscope, 134:2243-2251, 2024.
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Affiliation(s)
- Ryan M Carey
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Aman Prasad
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kimberly Wei
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jason A Brant
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Robert M Brody
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Otolaryngology, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Jason M Leibowitz
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Francisco J Civantos
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Larissa Sweeny
- Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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8
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Liang QW, Zhuang SH, Li S. Identifying optimal candidates for primary tumor surgery in patients with metastatic head and neck cancer. Front Surg 2024; 11:1394809. [PMID: 38665696 PMCID: PMC11045248 DOI: 10.3389/fsurg.2024.1394809] [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: 03/02/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024] Open
Abstract
Background Primary tumor surgery (PTS) may enhance survival among part of patients with metastatic head and neck cancer (mHNC). Herein, a predictive model was needed to construct to identify who can gain benefit remarkably from tumor resection. Methods Data of patients with mHNC were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The best cut-off value of age were analyzed using the X-tile software. One-to-one PSM, Kaplan-Meier method, and log-rank test were performed for survival analysis.The independent factors determined using the multivariate Cox proportional hazard regression were used to construct the nomogram. Results A total of 1,614 patients diagnosed with mHNC were included; among them, 356 (22.0%) underwent a surgical procedure for the excision of the primary tumor. cancer-specific survival (CSS) was remarkably prolonged in the PTS group relative to the non-PTS group following PSM [Median:19 months vs. 9 months; hazard ratio (HR) 0.52, P < 0.001]. Patients with mHNC who were younger than 52 years old, had well-differentiated tumors, had T1 and N0 stages, and were married at the time of the study may have significantly benefited from PTS. In addition, we constructed a nomogram based on the factors that independently affect the CSS in multivariate Cox analysis. The nomogram showed excellent discrimination in both the training and validation sets (AUC: 0.732 and 0.738, respectively). Conclusion A practical predictive model was constructed to determine the appropriate patients with mHNC, who would benefit from surgical resection.
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Affiliation(s)
- Qi-Wei Liang
- Department of Otorhinolaryngology of Longgang Center Hospital, The Ninth People’s Hospital of Shenzhen, Shenzhen, China
- Department of Otorhinolaryngology Head and Neck Surgery, Department of Thyroid Center/Thyroid Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuang-Hao Zhuang
- Department of Otorhinolaryngology of Longgang Center Hospital, The Ninth People’s Hospital of Shenzhen, Shenzhen, China
| | - Sheng Li
- Department of Otorhinolaryngology of Longgang Center Hospital, The Ninth People’s Hospital of Shenzhen, Shenzhen, China
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Kim MJ, Kang SH, Kwon M, Jung YH, Choi SH, Nam SY, Lee YS. Clinical implication of neck dissection for metastatic lymph nodes originating from non-head and neck regions. Acta Otolaryngol 2024; 144:153-157. [PMID: 38491920 DOI: 10.1080/00016489.2024.2327406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Cervical lymph node metastasis (CLNM) from remote primary sites is rare in head and neck cancer. The efficacy of neck dissection is still being investigated for therapeutic benefits of local management in oligometastasis from non-head and neck cancer. OBJECTIVES To evaluate the clinical efficacy of neck dissection (ND) in CLNM from distant primary cancers and identify factors contributing to improved survival. MATERIALS AND METHODS This retrospective case-control study enrolled patients who underwent ND for CLNM from distant primary cancer at Asan Medical Centre between January 2010 and December 2020. We analysed overall survival and association between clinical covariate and survival. RESULTS The study included 31 (14 males, 17 females) among 114 patients. Ovarian cancer was the most common primary malignancy (32.3%). Patients with fewer than three metastatic lymph nodes, without extranodal extension and with adjuvant therapy after surgery had better survival rates. CONCLUSION AND SIGNIFICANCE In patients with CLNM from a distant primary cancer, ND is beneficial as local treatment. And adequate selection of patients for ND is pivotal to improve prognosis.
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Affiliation(s)
- Min Ji Kim
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - So Hee Kang
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - MinSu Kwon
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young Ho Jung
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Ho Choi
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Soon Yuhl Nam
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoon Se Lee
- Department of Otolaryngology-Head & Neck Surgery, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
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10
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Tonneau M, Nebbache R, Larnaudie A, Thureau S, Pointreau Y, Blanchard P, Thariat J. Management of head and neck carcinomas with synchronous or metachronous oligometastatic disease: Role of locoregional radiotherapy and metastasis-directed radiotherapy. Cancer Radiother 2024; 28:83-92. [PMID: 37620212 DOI: 10.1016/j.canrad.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/19/2023] [Accepted: 03/28/2023] [Indexed: 08/26/2023]
Abstract
Head and neck carcinomas are initially metastatic in about 15% of cases. Radiotherapy is a cornerstone in the multimodal strategy at the locoregional phase. In patients with head and neck cancer, often heavily pretreated and with comorbidities, who relapse locoregionally or at distant sites, radiotherapy has also become increasingly important at the metastatic phase. Data on the optimal sequence of systemic treatments and metastasis-directed treatments including stereotactic irradiation are still lacking. Several randomized head and neck trials have been initiated that should provide important answers, including one recent GORTEC trial.
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Affiliation(s)
- M Tonneau
- Service d'oncologie radiothérapie, CRLCC Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - R Nebbache
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - A Larnaudie
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France
| | - S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France; Unité QuantIF Litis EA 4108, université de Rouen, Rouen, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France
| | - Y Pointreau
- Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, centre de cancérologie de la Sarthe (CCS), 64, rue de Degré, 72000 Le Mans, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, université Paris Saclay, Inserm U1018 Oncostat, Villejuif, France
| | - J Thariat
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France; Laboratoire de physique corpusculaire/IN2P3-CNRS UMR 6534, Unicaen-université de Normandie, 14000 Caen, France.
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11
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Ampil F, Porter C, Sangster G, Toms J, Bozeman A. Correlation Between Oligometastatic Tumor in Two Other Visceral Organs and Prognosis in Patients With Brain Metastases. J Palliat Med 2023; 26:1715-1718. [PMID: 37917925 DOI: 10.1089/jpm.2022.0612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background and Objective: A recent report indicated that metastases to other body organs commonly develop after stereotactic body radiation treatment for cure in patients with oligometastases (OGM) confined to one organ. This study was undertaken to determine if the presence of metastatic disease in two other visceral organs (TVO) in patients with conventionally treated brain metastases (BRM) was associated with poorer prognosis. Methods: This retrospective clinical investigation included 26 patients treated for palliation of OGM-BRM between May 1996 and February 2020. These individuals were classified according to the presence (13 patients) or absence (13 patients) of metastases in TVO. Results: With an overall mean follow-up of 16 months, 20 patients were deceased, and 6 patients were alive. The median survivals for the OGM-BRM-TVO and non-OGM-BRM-TVO subsets were 4 and 12 months, respectively; the corresponding crude survival rates at 12 months were 0% and 46% (p < 0.01). Subgroup analysis correlating prognosis to the number of BRM (single vs. multiple) and OGM-BRM categories (synchronous vs. metachronous) failed to reveal a survival advantage favoring a certain subgroup. Conclusion: Although the evidence is speculative, we believe that an aggressive disease condition is more likely present in patients with OGM-BRM-TVO. With the notion of an overall poor survival, we suggest a more tailored, less or nonharmful management approach (i.e., palliative therapy or hospice) for this particular patient cohort.
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Affiliation(s)
- Federico Ampil
- Department of Radiology and Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Carrie Porter
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Guillermo Sangster
- Department of Radiology and Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Jamie Toms
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Amy Bozeman
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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12
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Lin MG, Zhu A, Read PW, Garneau J, McLaughlin C. Novel HPV Associated Oropharyngeal Squamous Cell Carcinoma Surveillance DNA Assay Cost Analysis. Laryngoscope 2023; 133:3006-3012. [PMID: 37070629 DOI: 10.1002/lary.30701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/15/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES We aim to propose a modified surveillance strategy using a novel blood assay that detects plasma circulating tumor-specific HPV DNA with reported 100% NPV and 94% PPV as the main method of detection to understand the cost implications of potentially avoiding routine imaging and surveillance visits at our institution. METHODS We performed a retrospective chart review focusing on recurrences in p16+ patients with OPSCC and defined two surveillance strategies: "Strategy A", follow-up visits with flexible laryngoscopy (FL) plus regular imaging studies; "Strategy B", follow-up visits with FL plus regular NavDx assays and imaging used at the discretion of the physician(s) in cases of high clinical suspicion. RESULTS Of the p16+ OPSCC patients (n = 214), 23 had confirmed recurrence (11%). Standard work-flow model determined 72 imaging studies and 2198 physical examinations with FL were needed to detect one recurrence. Potential individual patient cost reduction during surveillance was 42%. CONCLUSION Implementing NavDx for HPV + OPSCC surveillance would benefit patients by reducing costs and unnecessary diagnostic testing. LEVEL OF EVIDENCE Step/Level 3 Laryngoscope, 133:3006-3012, 2023.
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Affiliation(s)
- Michael G Lin
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Alexander Zhu
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Paul W Read
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
| | - Jonathan Garneau
- Department of Otolaryngology, University of Virginia, Charlottesville, Virginia, USA
| | - Christopher McLaughlin
- Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA
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13
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Wei C, Lan X, Qiu M, Cui R, Fu Q, Shinge SAU, Muluh TA, Jiang O. Expanding the role of combined immunochemotherapy and immunoradiotherapy in the management of head and neck cancer (Review). Oncol Lett 2023; 26:372. [PMID: 37965160 PMCID: PMC10641411 DOI: 10.3892/ol.2023.13958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 06/13/2023] [Indexed: 11/16/2023] Open
Abstract
Immunotherapy has become one of the most promising approaches in tumor therapy, and there are numerous associated clinical trials in China. As an immunosuppressive tumor, head and neck squamous cell carcinoma (HNSCC) carries a high mutation burden, making immune checkpoint inhibitors promising candidates in this field due to their unique mechanism of action. The present review outlines a comprehensive multidisciplinary cancer treatment approach and elaborates on how combining immunochemotherapy and immunoradiotherapy guidelines could enhance clinical efficacy in patients with HNSCC. Furthermore, the present review explores the immunology of HNSCC, current immunotherapeutic strategies to enhance antitumor activity, ongoing clinical trials and the future direction of the current immune landscape in HNSCC. Advanced-stage HNSCC presents with a poor prognosis, low survival rates and minimal improvement in patient survival trends over time. Understanding the potential of immunotherapy and ways to combine it with surgery, chemotherapy and radiotherapy confers good prospects for the management of human papillomavirus (HPV)-positive HNSCC, as well as other HPV-positive malignancies. Understanding the immune system and its effect on HNSCC progression and metastasis will help to uncover novel biomarkers for the selection of patients and to enhance the efficacy of treatments. Further research on why current immune checkpoint inhibitors and targeted drugs are only effective for some patients in the clinic is needed; therefore, further research is required to improve the overall survival of affected patients.
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Affiliation(s)
- Chun Wei
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Xiaojun Lan
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Maona Qiu
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Ran Cui
- Department of Oncology, The First People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
| | - Qiuxia Fu
- Department of General Medicine, The People's Hospital of Luzhou City, Luzhou, Sichuan 646000, P.R. China
| | - Shafiu A. Umar Shinge
- Department of Cardiothoracic Surgery, Sun Yat Sen Memorial Hospital, Sun Yat Sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Tobias Achu Muluh
- Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong 518060, P.R. China
| | - Ou Jiang
- Department of Oncology, The Second People's Hospital of Neijiang City, Neijiang, Sichuan 641000, P.R. China
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14
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Muhammed Ashique CT, Ramlan S, Basheer M. Patterns of Distant Metastasis in Head and Neck Cancer in a Tertiary Care Centre. Indian J Otolaryngol Head Neck Surg 2023; 75:2107-2111. [PMID: 37636661 PMCID: PMC10447309 DOI: 10.1007/s12070-023-03816-z] [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: 03/04/2023] [Accepted: 04/17/2023] [Indexed: 08/29/2023] Open
Abstract
Objectives/Hypothesis To find out the frequency and location of distant metastasis in head and neck malignancies. Our study also aims to find out the most common site leading to distant metastasis and the management of these distant metastasis cases. Methods 1558 patients treated for head and neck malignancy between 2017 and 2021 were retrospectively reviewed. The frequency and proportions were used to produce descriptive statistics. Results The highest number of head and neck malignancy cases were reported in the oral cavity which included 943 cases (60.52%). Patients with distant metastasis (M1) accounted for 4.73 percent of all cases (n = 90). Nasopharyngeal malignancy cases showed the highest M1 frequency (29.03%), whereas oral cavity patients had the lowest frequency (2.75%). The most common site of distant metastasis was in the lung (64%) followed by bone (18%) and the liver (11%). CT scan of the neck and thorax was the most commonly used diagnostic modality. The most common histopathological finding was squamous cell carcinoma (85%). Multimodality treatment was employed for most of the detected cases. Conclusion Distant metastasis at presentation is rare in head and neck cancer. The rate of distant metastasis in the present study was 4.73%, with the lung being the most common site. The overall survival of these patients depends on a variety of factors and more studies are needed in this regard.
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Affiliation(s)
| | - Sharwak Ramlan
- Yenepoya Medical College, BC Road, Deralakatte, Karnataka India
| | - Mubeena Basheer
- Yenepoya Medical College, BC Road, Deralakatte, Karnataka India
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15
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Kjems J, Laursen MRT, Kristensen CA, Gothelf AB, Bernsdorf M, Specht L, Berthelsen AK, Vogelius IR, Persson GF, Friborg J. The potential for local ablative therapy of oligometastases in head and neck squamous cell carcinoma: a real-world data analysis. Acta Oncol 2023; 62:1091-1095. [PMID: 37548193 DOI: 10.1080/0284186x.2023.2241986] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Julie Kjems
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Michael R T Laursen
- Department of Oncology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
| | - Claus A Kristensen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Anita B Gothelf
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mogens Bernsdorf
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Anne K Berthelsen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ivan R Vogelius
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Gitte F Persson
- Department of Oncology, Copenhagen University Hospital Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Jeppe Friborg
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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16
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Silva AJD, de Moura IA, da Gama MATM, Leal LRS, de Pinho SS, Espinoza BCF, dos Santos DL, Santos VEP, Sena MGAMD, Invenção MDCV, de Macêdo LS, de França Neto PL, de Freitas AC. Advancing Immunotherapies for HPV-Related Cancers: Exploring Novel Vaccine Strategies and the Influence of Tumor Microenvironment. Vaccines (Basel) 2023; 11:1354. [PMID: 37631922 PMCID: PMC10458729 DOI: 10.3390/vaccines11081354] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
The understanding of the relationship between immunological responses and cancers, especially those related to HPV, has allowed for the study and development of therapeutic vaccines against these neoplasias. There is a growing number of studies about the composition and influence of the tumor microenvironment (TME) in the progression or establishment of the most varied types of cancer. Hence, it has been possible to structure immunotherapy approaches based on therapeutic vaccines that are even more specific and directed to components of TME and the immune response associated with tumors. Among these components are dendritic cells (DCs), which are the main professional antigen-presenting cells (APCs) already studied in therapy strategies for HPV-related cancers. On the other hand, tumor-associated macrophages are also potential targets since the profile present in tumor infiltrates, M1 or M2, influences the prognosis of some types of cancer. These two cell types can be targets for therapy or immunomodulation. In this context, our review aims to provide an overview of immunotherapy strategies for HPV-positive tumors, such as cervical and head and neck cancers, pointing to TME immune cells as promising targets for these approaches. This review also explores the potential of immunotherapy in cancer treatment, including checkpoint inhibitors, cytokine immunotherapies, immunotherapy vaccines, and cell therapies. Furthermore, it highlights the importance of understanding the TME and its effect on the design and achievement of immunotherapeutic methods.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Antonio Carlos de Freitas
- Laboratory of Molecular Studies and Experimental Therapy—LEMTE, Department of Genetics, Federal University of Pernambuco, Recife 50670-901, Brazil; (A.J.D.S.); (I.A.d.M.); (M.A.T.M.d.G.); (L.R.S.L.); (S.S.d.P.); (B.C.F.E.); (D.L.d.S.); (V.E.P.S.); (M.G.A.M.D.S.); (M.D.C.V.I.); (L.S.d.M.); (P.L.d.F.N.)
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17
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Cabezas-Camarero S, Iglesias-Moreno MC, Cerezo Druet E, Sotelo MJ, Merino-Menéndez S, Cabrera-Martín MN, Plaza-Hernández JC, Pérez-Segura P. Durable complete remission with local therapies after neoadjuvant and adjuvant nivolumab in recurrent/metastatic head and neck cancer. Anticancer Drugs 2023; 34:695-698. [PMID: 36730545 DOI: 10.1097/cad.0000000000001422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Up to 10-15% of patients with first-line recurrent/metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) present with platinum-refractory disease. The anti-PD1 nivolumab is the first therapeutic option in this setting achieving a 19.2% objective response rate and a 7.7-month median overall survival (OS). Given the poor prognosis of platinum-refractory patients, those showing slow progressive disease with no functional status deterioration should maintain nivolumab beyond progression in the absence of severe or unmanageable toxicities. Another strategy is to use local therapies such as radiotherapy and surgical tumor resection in cases of oligometastatic or oligoprogressive disease. Both strategies may significantly improve disease control and OS in these populations. We present the case of a patient with platinum-refractory disease treated with first-line nivolumab beyond progression who achieved a durable complete response after palliative radiation and surgical resection of five tumor lesions. To our knowledge, this is the first reported case of an R/M HNSCC treated with such a strategy outside a clinical trial and contributes to the evidence for combining anti-PD1 agents and local therapies in selected patients with R/M HNSCC.
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Affiliation(s)
- Santiago Cabezas-Camarero
- Medical Oncology Department, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico Universitario San Carlos
| | | | - Elena Cerezo Druet
- Radiotherapy Department, Hospital Clínico Universitario San Carlos, Madrid, Spain
| | | | | | - María Nieves Cabrera-Martín
- Nuclear Medicine Department, Hospital Clínico Universitario San Carlos, Hospital Clínico Universitario San Carlos
| | | | - Pedro Pérez-Segura
- Medical Oncology Department, Instituto de Investigación Sanitaria San Carlos (IdISSC), Hospital Clínico Universitario San Carlos
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18
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Denaro N, Succo G, Ostellino O, Airoldi M, Merlano MC, Badellino S, Solinas C, Garrone O, Iorio GC. The oligometastatic setting in HNSCC: A critical review by the Rete Oncologica Piemonte e Valle d'Aosta multidisciplinary team. Crit Rev Oncol Hematol 2023; 185:103968. [PMID: 36965646 DOI: 10.1016/j.critrevonc.2023.103968] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION The oligometastatic disease is a low burden metastatic disease that might still benefit from curable treatment. Squamous cell carcinoma of the head and neck (HNSCC) is a complex group of malignancies, with high rates of loco-regional recurrences. Distant metastases are less frequent, and a single or few deposits are often observed (oligometastatic disease). The optimal management of oligometastatic HNSCC remains to be defined. MATERIALS AND METHODS Key references were derived from a PubMed query. Hand searching and clinicaltrials.gov were also used. RESULTS This paper contains a narrative report and a critical discussion of the available evidence on the management of oligometastatic HNSCC patients, with a focus on metastasis-directed therapy (MDT), particularly stereotactic ablative radiotherapy (SABR). CONCLUSIONS in line with literature data, the multidisciplinary evaluation emerged as the key element in the management of oligometastatic HNSCC patients.
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Affiliation(s)
- Nerina Denaro
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Giovanni Succo
- Oncology Department, Head & Neck Surgery, University of Turin, Turin, Italy
| | - Oliviero Ostellino
- Oncology Unit 2, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mario Airoldi
- Oncology Unit 2, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Marco Carlo Merlano
- Scientific Direction, Candiolo Cancer Institute, FPO-IRCCS Candiolo, 10060 Torino, Italy
| | - Serena Badellino
- Department of Oncology, University of Torino, 10125 Torino, Italy
| | - Cinzia Solinas
- Oncology Department AOU Cagliari, Policlinico di Monserrato, Monserrato (CA) Italy
| | - Ornella Garrone
- Department of Medical Oncology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
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19
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De Felice F, Bird T, Michaelidou A, Jeannon JP, Simo R, Oakley R, Lyons A, Fry A, Cascarini L, Asit A, Thavaraj S, Reis Ferreira M, Petkar I, Kong A, Lei M, Guerrero Urbano T. Clinical outcomes in relapsed oropharyngeal cancer after definitive (chemo) radiotherapy. Oral Dis 2023; 29:595-603. [PMID: 34338394 DOI: 10.1111/odi.13985] [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: 05/29/2021] [Revised: 07/05/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To report clinical outcomes of relapsed oropharyngeal squamous cell carcinoma (OPSCC) after definitive intensity-modulated (chemo)radiotherapy [(C)RT]. MATERIALS AND METHODS Data for all relapsed patients treated for OPSCC with definitive (C)RT between 2010 and 2016 were collected. Primary end-point was post-failure survival (PFS). RESULTS Overall, 273 OPSCC patients completed definitive (C)RT. Of these, 42 cases (n = 26 human papilloma virus (HPV)-negative; n = 16 HPV-positive) had relapsed (n = 23 persistent disease; n = 19 recurrent disease) and were included in the final analysis. Two-year PFS for the entire population was 30.6%; 20.5% for HPV-negative and 43.8% for HPV-positive patients. Salvage curative surgery was associated with a significantly higher 2 years PFS rate (56.2%) compared with palliative treatment (22.9%) and best supportive care (0%) (p < 0.001). A positive trend in 2 years PFS was recorded in the early complete response cases (49.5%) versus patients who did not achieve a complete response within 3 months of the end of (C)RT (23.0%) (p = 0.11). CONCLUSION A higher PFS rate is achieved when relapsed OPSCC cases are treated with salvage curative intent. HPV-positive disease and early complete response within 3 months from the end of (C)RT may be related to better PFS.
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Affiliation(s)
- Francesca De Felice
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK.,Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Thomas Bird
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, UK
| | | | - Jean-Pierre Jeannon
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Ricard Simo
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Richard Oakley
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Andrew Lyons
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Alastair Fry
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Luke Cascarini
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Arora Asit
- Department of Otorhinolaryngology Head and Neck Surgery, Guys and St Thomas' NHS Trust, Great Maze Pond, London, UK
| | - Selvam Thavaraj
- Department of Head and Neck Pathology, Guy's and St Thomas' NHS Trust, London, UK.,Centre for Oral, Clinical and Translational Science, King's College London, London, UK
| | | | - Imran Petkar
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK
| | - Anthony Kong
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK
| | - Mary Lei
- Department of Clinical Oncology, Guy's and St Thomas' NHS Trust, London, UK
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20
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de Bree R, Hardillo JA, de Ridder M. Oligometastases in head and neck squamous cell carcinoma patients. Expert Rev Anticancer Ther 2023; 23:1-3. [PMID: 36380722 DOI: 10.1080/14737140.2023.2148658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jose A Hardillo
- Department of Otorhinolaryngology and Head and Neck Surgery, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mischa de Ridder
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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21
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Zhou X, Wang X. Radioimmunotherapy in HPV-Associated Head and Neck Squamous Cell Carcinoma. Biomedicines 2022; 10:1990. [PMID: 36009537 PMCID: PMC9405566 DOI: 10.3390/biomedicines10081990] [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: 07/13/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 12/12/2022] Open
Abstract
HPV-associated head and neck squamous cell carcinoma (HNSCC) is a cancer entity with unique biological and clinical characteristics that requires more personalized treatment strategies. As the backbone of conventional therapeutics, radiation is now harnessed to synergize with immunotherapy in multiple malignancies. Accumulating preclinical and clinical data have suggested the potential of radioimmunotherapy in eliciting local and systemic anti-tumor response via direct killing of tumor cells and immunogenic cell death. However, this effect remains uncertain in HPV-associated HNSCC. Owing to its intrinsic radiosensitivity and distinct tumor microenvironment, HPV-associated HNSCC may represent a good candidate for radioimmunotherapy. In this review, we provide a detailed illustration of the biology, the genomic features, and immune landscapes of HPV-associated HNSCC that support the synergism between radiation and immune agents. The interaction between radiotherapy and immunotherapy is described. We also highlight the present evidence as well as ongoing trials using different combination strategies in the recurrent/metastatic or definitive settings. In addition, we have summarized the challenges and outlook for future trial design, with special emphasis on radiotherapy optimization and novel therapeutic options to incorporate.
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Affiliation(s)
- Xin Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai 200032, China
| | - Xiaoshen Wang
- Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai 200032, China
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22
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Borson S, Shuai Y, Branstetter BF, Nilsen ML, Hughes MA, Fenton M, Kubik M, Sridharan S, Clump DA, Skinner HD, Johnson JT, Chiosea SI, Ohr J, Duvvuri U, Kim S, Traylor KS, Ferris R, Zandberg DP. Definitive local therapy to head and neck squamous cell carcinoma with distant metastasis. Laryngoscope Investig Otolaryngol 2022; 7:757-765. [PMID: 35734044 PMCID: PMC9194988 DOI: 10.1002/lio2.807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/21/2022] [Accepted: 03/06/2022] [Indexed: 11/14/2022] Open
Abstract
Objectives Data on the efficacy of including definitive local therapy to the primary site for head and neck squamous cell carcinoma (HNSCC) patients with synchronous distant metastasis are lacking. In multiple different solid tumor types, there has been benefit when using systemic therapy followed by local consolidative therapy (stereotactic ablative radiotherapy or surgery) directed at metastases. We proposed to retrospectively evaluate patients at our institution that received definitive treatment to the primary. Methods Single institution retrospective study evaluating 40 patients with metastatic HNSCC treated with definitive surgery (55%) or chemoradiation (45%) to the primary site from 2000 to 2020. The major endpoints were overall survival (OS) and progression-free survival (PFS) for the total population and multiple sub-groups. Some variables were evaluated with multiple covariates Cox model. Results The median PFS was 8.6 months (95% CI, 6.4-11.6), and OS was 14.2 months (95% CI, 10.9-27.5). In 28% of patients that received induction therapy, there was a twofold increase in median overall survival to 27.5 months. In the 33% of patients that received anti-PD-1 mAb as part of their treatment course, the median OS was significantly increased to 41.7 months (95% CI, 8.7-NR) versus 12.1 months (95% CI, 8.4-14.4) with a 5-year OS of 39%. Multivariate analysis for OS showed significance for age at diagnosis, use of IO, and number of metastatic sites. Conclusion We observed impressive survival outcomes in metastatic HNSCC patients treated with definitive local therapy to the primary site in addition to induction and/or immunotherapy. Further study is warranted.Level of Evidence: 3.
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Affiliation(s)
- Steven Borson
- University of Pittsburgh Cancer InstitutePittsburghPennsylvaniaUSA
| | - Yongli Shuai
- University of Pittsburgh Cancer InstitutePittsburghPennsylvaniaUSA
| | - Barton F. Branstetter
- Department of RadiologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Marci Lee Nilsen
- Department of Acute and Tertiary CareSchool of NursingPittsburghPennsylvaniaUSA
| | - Marion A. Hughes
- Department of RadiologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Moon Fenton
- University of Pittsburgh Cancer InstitutePittsburghPennsylvaniaUSA
| | - Mark Kubik
- Department of OtolaryngologyUPMCPittsburghPennsylvaniaUSA
| | | | - David A. Clump
- Department of Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Heath D. Skinner
- Department of Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | - Jonas T. Johnson
- Department of Radiation OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
| | | | - James Ohr
- Department of OtolaryngologyUPMCPittsburghPennsylvaniaUSA
| | | | - Seungwon Kim
- Department of OtolaryngologyUPMCPittsburghPennsylvaniaUSA
| | - Katie S. Traylor
- Department of RadiologyUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Robert Ferris
- Department of OtolaryngologyUPMCPittsburghPennsylvaniaUSA
| | - Dan P. Zandberg
- Department of Hematology/OncologyUPMC Hillman Cancer CenterPittsburghPennsylvaniaUSA
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23
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Zarrabi KK, Galloway TJ, Flieder DB, Kumar SS, Judd J, Bauman JR. Assessing plasma circulating tumor human papillomavirus (HPV) DNA in determining treatment response in HPV-associated oropharyngeal cancer. Head Neck 2022; 44:E25-E30. [PMID: 35546490 DOI: 10.1002/hed.27081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/24/2022] [Accepted: 04/27/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-mediated oropharyngeal squamous cell carcinoma is a subset of head and neck cancer with a unique mechanism of carcinogenesis. Local disease is treated definitively with a multimodal approach. Navigating recurrences can be challenging, as they are sometimes indiscernible from de novo primary malignancies. Identification of dynamic biomarkers that are specific to HPV-mediated disease may assist in disease monitoring. We present a 78-year-old man who developed a squamous cell carcinoma in the lung 7 years after completing definitive chemoradiation for his p16+ head and neck squamous cell carcinoma. METHODS A novel assay for plasma circulating tumor HPV DNA was employed and provided a tool for longitudinal disease monitoring during therapy. CONCLUSION We bring attention to a novel assay and highlight its potential for use in the treatment paradigm of HPV-mediated oropharyngeal carcinoma.
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Affiliation(s)
- Kevin K Zarrabi
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Douglas B Flieder
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Sameera S Kumar
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Julia Judd
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - Jessica R Bauman
- Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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24
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Debbi K, Loganadane G, To NH, Kinj R, Husain ZA, Chapet S, Nguyen NP, Barillot I, Benezery K, Belkacemi Y, Calais G. Curative intent Stereotactic Ablative Radiation Therapy (SABR) for treatment of lung oligometastases from head and neck squamous cell carcinoma (HNSCC): a multi-institutional retrospective study. Br J Radiol 2022; 95:20210033. [PMID: 35143326 PMCID: PMC10993965 DOI: 10.1259/bjr.20210033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The aim of this retrospective study was to assess outcomes of SABR for metachronous isolated lung oligometastases from HNSCC. METHODS For patients who developed isolated, 1 or 2 lungs lesions (<5cm) consistent with metastases from HNSCC, the indication of SABR was validated in a multidisciplinary tumor board. All patients were monitored by CT or PET CT after SABR (Stereotactic Ablative Body Radiation) for HNSCC. RESULTS Between November 2007 and February 2018, 52 patients were treated with SABR for metachronous lung metastases. The median time from the treatment of the primary HNSCC to the development of lung metastases was 18 months (3-93). The cohort's median age was 65.5 years old (50-83). The vast majority (94.2%) received 60 Gy in three fractions. Forty-one patients (78.5%) presented a solitary lung metastasis, while 11 patients (21.5%) had two lung metastases. With a median follow-up of 45.3 months, crude local and metastatic control rates were 74 and 38%, respectively. 1 year and 2 year Overall Survival (OS) were 85.8 and 65.9%, respectively. The median OS was 46.8 months. About one-fourth of patients were retreated by SABR for distant pulmonary recurrence. The treatment was well tolerated with only one patient who reported ≥ grade 3 toxicity (1.9%). CONCLUSION In selected metastatic HNSCC patients, early detection and treatment of lung metastases with SABR is effective and safe. Prospective studies are required to validate this potential shift. ADVANCES IN KNOWLEDGE Patients with oligometastases and controlled primary HNSCC seem to benefit from metastasis directed therapies.
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Affiliation(s)
- Kamel Debbi
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | | | - Nhu Hanh To
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | - Remy Kinj
- Department of Radiation Oncology, Centre
Antoine-Lacassagne, Nice,
France
| | - Zain A Husain
- Department of Radiation Oncology, Odette Cancer Center,
Sunnybrook Health Sciences Centre, Toronto,
Ontario, Canada
| | - Sophie Chapet
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
| | - Nam P Nguyen
- Department of Radiation Oncology, Howard
University, Washington, DC,
USA
| | - Isabelle Barillot
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
| | - Karen Benezery
- Department of Radiation Oncology, Centre
Antoine-Lacassagne, Nice,
France
| | - Yazid Belkacemi
- Radiation Oncology Department, Henri Mondor University
Hospital, APHP, UPEC,
Créteil, France
| | - Gilles Calais
- Oncology-Radiotherapy Department, Henry-S.-Kaplan Cancer
Center, CHRU de Tours, Tours,
France
- University François-Rabelais,
Tours, France
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25
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Sakisuka T, Kashiwagi N, Doi H, Takahashi H, Arisawa A, Matsuo C, Masuda Y, Inohara H, Sato K, Outani H, Ishii K, Tomiyama N. Prognostic factors for bone metastases from head and neck squamous cell carcinoma: A case series of 97 patients. Mol Clin Oncol 2021; 15:246. [PMID: 34650813 PMCID: PMC8506565 DOI: 10.3892/mco.2021.2408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/04/2021] [Indexed: 12/11/2022] Open
Abstract
Although bone is the second-most frequent site of distant metastases of head and neck squamous cell carcinoma (HNSCC), variable prognostic factors in patients with bone metastases from HNSCC have not been fully investigated. The aim of the present study was to assess the prognostic factors affecting overall survival (OS) in these patients. The medical records of 97 patients at two institutions who developed bone metastases from HNSCC between January 2010 and December 2020 were retrospectively reviewed. A multivariate analysis using a Cox proportional hazards model was performed to identify potential clinical predictive factors for longer OS. The median OS was 7 months, and the 1- and 2-year OS rates for all patients were 35.4 and 19.2%, respectively. The independent predictive factors for longer OS were single bone metastasis, good performance status and administration of systemic chemotherapy. The median OS with each predictor was 10, 10 and 10.5 months, respectively. In a selected group of patients with these three factors, the OS was 14.5 months. In conclusion, single bone metastasis, a good performance status and systemic chemotherapy were independent predictors of longer OS in patients with HNSCC, but their contributions were limited.
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Affiliation(s)
- Takahisa Sakisuka
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Nobuo Kashiwagi
- Department of Future Diagnostic Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Hiroto Takahashi
- Center for Twin Research, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Atsuko Arisawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Chisato Matsuo
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Yu Masuda
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology-Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Kazuaki Sato
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Hidetatsu Outani
- Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Osakasayama, Osaka 589-8511, Japan
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
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26
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Mazzaschi G, Tommasi C, Pietri E, Corcione L, De Giorgi A, Bini P, Bui S. Abscopal effect as part of treatment of oligometastatic head and neck cancer: A case report. Clin Case Rep 2021; 9:1334-1338. [PMID: 33768839 PMCID: PMC7981670 DOI: 10.1002/ccr3.3758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 12/28/2022] Open
Abstract
A 66-year-old man with hypopharyngeal carcinoma with a single bone metastasis was treated with definitive chemo/radiotherapy omitting local treatment of the single bone lesion. He remained relapse-free for 6 years. We have concluded that radiotherapy-dependent abscopal effect might have allowed to avoid ablative treatment of metastatic site.
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Affiliation(s)
- Giulia Mazzaschi
- Department of Medical OncologyAzienda Ospedaliero‐Universitaria di ParmaParmaItaly
| | - Chiara Tommasi
- Department of Medical OncologyAzienda Ospedaliero‐Universitaria di ParmaParmaItaly
| | - Elisabetta Pietri
- Department of Medical OncologyAzienda Ospedaliero‐Universitaria di ParmaParmaItaly
| | - Luigi Corcione
- Department of Pathologic AnatomyAzienda Ospedaliero‐Universitario di ParmaParmaItaly
| | | | - Paola Bini
- Department of RadiologyAzienda Ospedaliero‐Universitaria di ParmaParmaItaly
| | - Simona Bui
- Department of Medical OncologyAzienda Ospedaliero‐Universitaria di ParmaParmaItaly
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27
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Mat Lazim N, Elliott M, Wykes J, Clark J. Oligometastases in head and neck carcinoma and their impact on management. ANZ J Surg 2021; 91:2617-2623. [PMID: 33634950 DOI: 10.1111/ans.16622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/14/2022]
Abstract
Historically, patients with head and neck squamous cell carcinoma (HNSCC) with distant metastases were regarded as palliative. Oligometastasis (OM) refers to patients with a limited number of distant metastatic deposits. Treatment of patients with OMs has been reported in patients with lung, colon, breast, prostate and brain malignancies. Selected patients with oligometastatic HNSCC have a higher probability of durable disease control and cure and these patients should be treated aggressively. Treatment options for patients with HNSCC OMs include single or combinations of the three arms of cancer treatment, that is surgery, radiotherapy and chemotherapy/immunotherapy. To date, there are limited studies reporting the management of OM with head and neck malignancy. This review will give insights into the management of OMs in HNSCC.
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Affiliation(s)
- Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Michael Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - James Wykes
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
| | - Jonathan Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia
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28
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Lorini L, Ardighieri L, Bozzola A, Romani C, Bignotti E, Buglione M, Guerini A, Lombardi D, Deganello A, Tomasoni M, Bonini SA, Sigala S, Farina D, Ravanelli M, Bossi P. Prognosis and management of recurrent and/or metastatic head and neck adenoid cystic carcinoma. Oral Oncol 2021; 115:105213. [PMID: 33578204 DOI: 10.1016/j.oraloncology.2021.105213] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/10/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
Adenoid cystic carcinoma (ACC) is a rare tumor, usually arising in the salivary gland, accounting for 1% of all head and neck cancers. ACC may have a long-term poor prognosis, as about 40% of radically treated patients will recur locoregionally and up to 60% will develop distant metastasis. Factors influencing risk of recurrence have been well studied, but few data exist about prognostic factors in Recurrent/Metastatic (RM) setting. Moreover, treatment of RM ACC is often a challenge for clinicians, in the context of a rare disease, which may have an indolent clinical behavior or less frequently a quicker growth and with a paucity of available clinical trials. This review critically analyzes pathological and molecular prognostic factors in RM ACC and make an overview on actual therapeutic choices and future direction of therapy. Recognized prognostic factors in RM ACC are the presence and site of distant metastasis (lung vs other), the presence of nodal metastasis and of extranodal extension, skull base recurrence, disease free interval, lymphovascular invasion, solid histotypes and grading of disease, and the presence of mutation of NOTCH1 family, PI3K, and TP53. Due to disappointing results with chemotherapy, new approaches are under study, also on the basis of biomolecular research. Ongoing clinical trials are evaluating treatment targeting MYB and NOTCH1 alterations, immunotherapy or combination of targeted treatments and immune checkpoint inhibitors.
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Affiliation(s)
- Luigi Lorini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Laura Ardighieri
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Anna Bozzola
- Department of Pathology, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Chiara Romani
- Angelo Nocivelli Institute of Molecular Medicine, University of Brescia and ASST-Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Eliana Bignotti
- Angelo Nocivelli Institute of Molecular Medicine, University of Brescia and ASST-Spedali Civili of Brescia, 25123 Brescia, Italy
| | - Michela Buglione
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Andrea Guerini
- Radiation Oncology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Alberto Deganello
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, ASST Spedali Civili of Brescia, Department of Medical and Surgical Specialties, Radiologic Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sara Anna Bonini
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Davide Farina
- Department of Radiology, University of Brescia, Italy
| | | | - Paolo Bossi
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy.
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29
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Qian JM, Schoenfeld JD. Radiotherapy and Immunotherapy for Head and Neck Cancer: Current Evidence and Challenges. Front Oncol 2021; 10:608772. [PMID: 33614492 PMCID: PMC7886974 DOI: 10.3389/fonc.2020.608772] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/16/2020] [Indexed: 12/25/2022] Open
Abstract
Immune checkpoint inhibitors (ICI) have revolutionized cancer treatment over the past decade. However, although the immune landscape suggests a strong rationale for the use of these agents in patients with head and neck squamous cell carcinoma, the available clinical evidence indicates that most patients currently do not respond to ICI monotherapy. Radiotherapy is a primary treatment modality for many patients with locally advanced head and neck cancer. While ionizing radiation traditionally has been thought to act in a purely cytotoxic fashion, a growing body of preclinical studies have demonstrated additional profound immunomodulatory effects. Consequently, there has been a surge of interest in the potential synergy between radiotherapy and immunotherapy, both the potential for radiotherapy to augment the systemic anti-tumor immune response and the potential for immunotherapy to improve in-field tumor response to radiation. In this review, we summarize the current preclinical and clinical evidence for radioimmunotherapy, with a particular focus on studies directly relevant to head and neck squamous cell carcinoma, as well as existing challenges and future directions for this emerging field.
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Affiliation(s)
- Jack M. Qian
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, United States
- Harvard Radiation Oncology Program, Massachusetts General Hospital/Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jonathan D. Schoenfeld
- Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer Center, Harvard Medical School, Boston, MA, United States
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30
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Franzese C, Badalamenti M, Teriaca A, De Virgilio A, Mercante G, Cavina R, Ferrari D, Santoro A, Spriano G, Scorsetti M. Metastasis-directed stereotactic body radiation therapy in the management of oligometastatic head and neck cancer. J Cancer Res Clin Oncol 2021; 147:1307-1313. [PMID: 33471186 DOI: 10.1007/s00432-021-03518-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/10/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Recently major efforts have been made to define the oligometastatic setting, but for head and neck cancer (HNC) limited data are available. We aimed to evaluate outcome of oligometastatic HNC treated with Stereotactic body radiotherapy (SBRT) as metastasis-directed therapy. MATERIALS AND METHODS We analyzed patients treated with SBRT on a maximum of five oligometastases from HNC, in up to two organs. Concomitant treatment was allowed. End points were toxicity, local control of treated metastases (LC), progression-free survival (PFS) and overall survival (OS). RESULTS 48 consecutive patients and 71 lesions were treated. With a follow-up of 20.2 months, most common primary tumors were larynx (29.2%) and salivary glands (29.2%), while common site of metastases was lung (59.1%). Median dose was 48 Gy (21-75) in 3-8 fractions. Treatment was well tolerated, with two patients reporting mild pain and nausea. LC rates at 1 and 2 years were 83.1% and 70.2%. Previous local therapy (HR 4.97; p = 0.002), oligoprogression (HR 4.07; p = 0.031) and untreated metastases (HR 4.19; p = 0.027) were associated with worse LC. PFS at 1 and 2 years were 42.2% and 20.0%. Increasing age (HR 1.03; p = 0.010), non-adenoid cystic carcinoma (HR 2.57; p = 0.034) and non-lung metastases (HR 2.20; p = 0.025) were associated with worse PFS. One- and 2-years OS were 81.0% and 67.1%. Worse performance status (HR 2.91; p = 0.049), non-salivary primary (HR 19.9; p = 0.005), non-lung metastases (HR 2.96; p = 0.040) were correlated with inferior OS. CONCLUSIONS SBRT can be considered a safe metastasis-directed therapy in oligometastatic HNC. Efficacy of the treatment seems to be higher when administered upfront in the management of metastatic disease; however, selection of patients need to be improved due to the relevant risk of appearance of new metastatic site after SBRT.
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Affiliation(s)
- Ciro Franzese
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy. .,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.
| | - M Badalamenti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - A Teriaca
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - A De Virgilio
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - G Mercante
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - R Cavina
- Department of Medical Oncology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - D Ferrari
- Medical Oncology Unit, ASST Santi Paolo e Carlo, Presidio Ospedaliero San Paolo, Milan, Italy
| | - A Santoro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,Department of Medical Oncology, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - G Spriano
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy.,Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, via Manzoni 56, 20089, Rozzano, MI, Italy
| | - M Scorsetti
- Department of Radiotherapy and Radiosurgery, Humanitas Clinical and Research Center, IRCCS, Humanitas University, via Manzoni 56, 20089, Rozzano, MI, Italy.,Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
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Szturz P, Nevens D, Vermorken JB. Oligometastatic Disease Management: Finding the Sweet Spot. Front Oncol 2020; 10:617793. [PMID: 33415080 PMCID: PMC7783387 DOI: 10.3389/fonc.2020.617793] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/16/2020] [Indexed: 12/25/2022] Open
Abstract
Hematogenous dissemination represents a common manifestation of squamous cell carcinoma of the head and neck, and the recommended therapeutic options usually consist of systemically administered drugs with palliative intent. However, mounting evidence suggests that patients with few and slowly progressive distant lesions of small size may benefit from various local ablation techniques, which have already been established as standard-of-care modalities for example in colorectal and renal cell carcinomas and in sarcomas. In principle, serving as radical approaches to eradicate cancer, these interventions can be curative. Their impact on local control and overall survival has been shown in numerous retrospective and prospective studies. The term oligometastatic refers to the number of distant lesions which should generally not surpass five in total, ideally in one organ. Currently, surgical resection remains the method of choice supported by the majority of published data. More recently, stereotactic (ablative) body radiotherapy (SABR/SBRT) has emerged as a viable alternative. In cases technically amenable to such local interventions, several other clinical variables need to be taken into account also, including patient-related factors (general health status, patient preferences, socioeconomic background) and disease-related factors (primary tumor site, growth kinetics, synchronous or metachronous metastases). In head and neck cancer, patients presenting with late development of slowly progressive oligometastatic lesions in the lungs secondary to human papillomavirus (HPV)-positive oropharyngeal cancer are the ideal candidates for metastasectomy or other local therapies. However, literature data are still limited to say whether there are other subgroups benefiting from this approach. One of the plausible explanations is that radiological follow-up after primary curative therapy is usually not recommended because its impact on survival has not been unequivocal, which is also due to the rarity of oligometastatic manifestations in this disease. At the same time, aggressive treatment of synchronous metastases early in the disease course should be weighed against the risk of futile interventions in a disease with already multimetastatic microscopic dissemination. Therefore, attentive treatment sequencing, meticulous appraisal of cancer extension, refinement of post-treatment surveillance, and understanding of tumor biology and kinetics are crucial in the management of oligometastases.
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Affiliation(s)
- Petr Szturz
- Medical Oncology, Department of Oncology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Daan Nevens
- Department of Radiation Oncology, IridiumNetwork, Wilrijk (Antwerp), Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - 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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Kumari S, Mukherjee S, Sinha D, Abdisalaam S, Krishnan S, Asaithamby A. Immunomodulatory Effects of Radiotherapy. Int J Mol Sci 2020; 21:E8151. [PMID: 33142765 PMCID: PMC7663574 DOI: 10.3390/ijms21218151] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 02/07/2023] Open
Abstract
Radiation therapy (RT), an integral component of curative treatment for many malignancies, can be administered via an increasing array of techniques. In this review, we summarize the properties and application of different types of RT, specifically, conventional therapy with x-rays, stereotactic body RT, and proton and carbon particle therapies. We highlight how low-linear energy transfer (LET) radiation induces simple DNA lesions that are efficiently repaired by cells, whereas high-LET radiation causes complex DNA lesions that are difficult to repair and that ultimately enhance cancer cell killing. Additionally, we discuss the immunogenicity of radiation-induced tumor death, elucidate the molecular mechanisms by which radiation mounts innate and adaptive immune responses and explore strategies by which we can increase the efficacy of these mechanisms. Understanding the mechanisms by which RT modulates immune signaling and the key players involved in modulating the RT-mediated immune response will help to improve therapeutic efficacy and to identify novel immunomodulatory drugs that will benefit cancer patients undergoing targeted RT.
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Affiliation(s)
- Sharda Kumari
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
| | - Shibani Mukherjee
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
| | - Debapriya Sinha
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
| | - Salim Abdisalaam
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, FL 32224, USA;
| | - Aroumougame Asaithamby
- Division of Molecular Radiation Biology, Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.K.); (D.S.); (S.A.)
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Plavc G, Jesenko T, Oražem M, Strojan P. Challenges in Combining Immunotherapy with Radiotherapy in Recurrent/Metastatic Head and Neck Cancer. Cancers (Basel) 2020; 12:E3197. [PMID: 33143094 PMCID: PMC7692120 DOI: 10.3390/cancers12113197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022] Open
Abstract
Immunotherapy with immune checkpoint inhibitors (ICI) has recently become a standard part of the treatment of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC), although the response rates are low. Numerous preclinical and clinical studies have now illuminated several mechanisms by which radiotherapy (RT) enhances the effect of ICI. From RT-induced immunogenic cancer cell death to its effect on the tumor microenvironment and vasculature, the involved mechanisms are diverse and intertwined. Moreover, the research of these interactions is challenging because of the thin line between immunostimulatory and the immunosuppressive effect of RT. In the era of active research of immunoradiotherapy combinations, the significance of treatment and host-related factors that were previously seen as being less important is being revealed. The impact of dose and fractionation of RT is now well established, whereas selection of the number and location of the lesions to be irradiated in a multi-metastatic setting is something that is only now beginning to be understood. In addition to spatial factors, the timing of irradiation is as equally important and is heavily dependent on the type of ICI used. Interestingly, using smaller-than-conventional RT fields or even partial tumor volume RT could be beneficial in this setting. Among host-related factors, the role of the microbiome on immunotherapy efficacy must not be overlooked nor can we neglect the role of gut irradiation in a combined RT and ICI setting. In this review we elaborate on synergistic mechanisms of immunoradiotherapy combinations, in addition to important factors to consider in future immunoradiotherapy trial designs in R/M HNSCC.
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Affiliation(s)
- Gaber Plavc
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.O.); (P.S.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Tanja Jesenko
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Miha Oražem
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.O.); (P.S.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.O.); (P.S.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
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Bollig CA, Newberry CI, Galloway TLI, Zitsch RP, Hanly EK, Zhu VL, Pagedar N, Nallani R, Bur AM, Spanos WC, Jorgensen JB. Prognostic Impact of Metastatic Site and Pattern in Patients with Metastatic Head and Neck Cancer. Laryngoscope 2020; 131:E1838-E1846. [PMID: 33098338 DOI: 10.1002/lary.29208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS Investigate the relationship between site and pattern of distant metastasis (DM) and overall survival (OS) in a multi-institutional cohort of patients with DM head and neck cancer (HNC). STUDY DESIGN Retrospective review. METHODS 283 patients treated at 4 academic centers in the Midwest HNC Consortium between 2000 and 2015 were retrospectively reviewed. Disease patterns were divided between solitary metastatic versus polymetastatic (≥2 sites) disease. Survival functions for clinically relevant variables were estimated using Kaplan-Meier and Cox proportional hazards models. RESULTS Median OS for all patients was 9.0 months (95% confidence interval [CI]: 7.4-10.6). Lung (n = 220, 77.7%) was the most common site of DM, followed by bone (n = 90, 31.8%), mediastinal lymph nodes (n = 55, 19.4%), liver (n = 41, 14.5%), and brain (n = 17, 6.0%). Bone metastases were independently associated with the worst prognosis (hazard ratio [HR] = 1.6, 95% CI: 1.3-2.1). On univariate analysis, brain metastases were associated with improved prognosis (HR = 0.5, 95% CI: 0.3-0.9), although this was not statistically significant on the multivariate analysis. Polymetastatic disease was present in the majority of patients (n = 230, 81.3%) and was associated with a worse prognosis compared to solitary metastatic disease (HR = 1.4, 95% CI: 1.0-2.0). CONCLUSION Our large, multi-institutional review indicates that both the metastatic pattern and site of DM impact OS. Polymetastatic disease and bone metastasis are associated with worse prognosis, independent of treatment received. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1838-E1846, 2021.
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Affiliation(s)
- Craig A Bollig
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, U.S.A
| | - Christopher I Newberry
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
| | - Tabitha L I Galloway
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Robert P Zitsch
- Department of Otolaryngology-Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, U.S.A
| | - Elyse K Hanly
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa School of Medicine, Iowa City, Iowa, U.S.A
| | - Vivian L Zhu
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa School of Medicine, Iowa City, Iowa, U.S.A
| | - Nitin Pagedar
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa School of Medicine, Iowa City, Iowa, U.S.A
| | - Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - Andres M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, Kansas City, Kansas, U.S.A
| | - William C Spanos
- Sanford Cancer Center, Sanford Health, Sioux Falls, South Dakota, U.S.A
| | - Jeffrey B Jorgensen
- Department of Otolaryngology-Head and Neck Surgery and Communication Disorders, University of Louisville School of Medicine, Louisville, Kentucky, U.S.A
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