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Witek ME, Ward MC, Bakst R, Chandra RA, Chang SSW, Choi KY, Galloway T, Hanna GJ, Hu KS, Robbins J, Shukla ME, Siddiqui F, Takiar V, Walker GV, Fu Y, Margalit DN. Paranasal Sinus and Nasal Cavity Cancers: Systematic Review and Executive Summary of the American Radium Society Appropriate Use Criteria. Head Neck 2025. [PMID: 40344605 DOI: 10.1002/hed.28177] [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: 12/08/2024] [Revised: 04/09/2025] [Accepted: 04/19/2025] [Indexed: 05/11/2025] Open
Abstract
Tumors of the paranasal sinus and nasal cavity (PNS/NC) are rare and exhibit diverse histology, anatomic subsite, and malignant potential. Early-stage disease is typically managed with surgery, and locally advanced disease is treated with a combination of surgery, radiotherapy, and chemotherapy. Clinical decision-making is commonly guided by limited retrospective evidence. To address this limitation, we performed a systematic review to inform evidence-based consensus for the management of common clinical scenarios, including the potential roles of radiation and systemic therapy to promote structural preservation, elective neck management, and radiation technique considerations. A librarian-mediated literature search identified 39 studies of adult patients with PNS/NC tumors treated with curative intent that met the study inclusion criteria. Search results were reported using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology. A modified-Delphi process was used to guide consensus for the appropriate use of various management strategies. Strong consensus existed for the appropriateness of primary surgery for early-stage disease, approaches to locally advanced disease with minimal periorbital fat invasion, and the use of induction chemotherapy with response-directed local therapy. Consensus regarding nodal treatment and the use of proton therapy in the adjuvant setting was less robust. The rarity and diversity of PNS/NC tumors limit randomized phase III trials to guide management. As such, this systematic review and appropriate-use consensus statements provide clinical guidance for the management of this challenging disease spectrum.
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Affiliation(s)
| | - Matthew C Ward
- Levine Cancer Institute Radiation Oncology, Atrium Health, Charlotte, North Carolina, USA
| | - Richard Bakst
- Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Ravi A Chandra
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Health, Rockville, Maryland, USA
| | - Steven Shih-Wei Chang
- Department of Otolaryngology Head and Neck Surgery, Henry Ford Cancer Institute and Hospital, Detroit, Michigan, USA
| | - Karen Y Choi
- Department of Otolaryngology Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas, USA
| | - Thomas Galloway
- Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania, USA
| | - Glenn J Hanna
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kenneth S Hu
- New York University Langone Hospitals, New York, New York, USA
| | - Jared Robbins
- Radiation Oncology, College of Medicine Tucson, University of Arizona, Tucson, Arizona, USA
| | - Monica E Shukla
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute and Hospital, Detroit, Michigan, USA
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gary V Walker
- Banner MD Anderson Cancer Center, Gilbert, Arizona, USA
| | - Yunting Fu
- Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland, USA
| | - Danielle N Margalit
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Sharma A, Deshmukh P, Jain S, Gaurkar SS, Sharma A. Factors Contributing to Postoperative Radiotherapy Delays in Head and Neck Cancer: A Comprehensive Review. Cureus 2024; 16:e67240. [PMID: 39301336 PMCID: PMC11412262 DOI: 10.7759/cureus.67240] [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: 07/29/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024] Open
Abstract
Head and neck cancer encompasses a diverse group of malignancies that pose significant challenges in their management due to their heterogeneity in clinical behavior and treatment response. Postoperative radiotherapy (PORT) is a critical component in the treatment regimen for head and neck cancer, aimed at reducing local recurrence and improving overall survival (OS). However, delays in the initiation of PORT can significantly compromise patient outcomes. This comprehensive review explores the factors contributing to such delays, categorizing them into patient-related, treatment-related, and systemic factors. Patient-related factors include health status, comorbidities, socioeconomic barriers, and psychological issues. Treatment-related factors involve surgical complications, complexities in treatment planning, and coordination challenges between surgical and radiation oncology teams. Systemic and institutional factors encompass hospital resources, staffing levels, administrative and insurance issues, and geographic barriers. The review also examined the impact of these delays on patient outcomes, highlighting the increased risk of recurrence and reduced survival rates. Strategies to mitigate delays are discussed, including improved preoperative and postoperative planning, enhanced multidisciplinary coordination, patient education, and systemic policy changes. Additionally, case studies and real-world examples of successful interventions are presented. Future directions for research and policy recommendations are also outlined, emphasizing the need for continued efforts to ensure timely PORT for head and neck cancer patients. This review aims to provide a comprehensive analysis that can inform clinical practice and policy, ultimately improving the standard of care and patient outcomes in head and neck cancer treatment.
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Affiliation(s)
- Abhijeet Sharma
- Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prasad Deshmukh
- Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shraddha Jain
- Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sagar S Gaurkar
- Otorhinolaryngology and Head and Neck Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ayushi Sharma
- Dental Sciences, People's College of Dental Science and Research Centre, Bhopal, IND
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3
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Hanna GJ, Chang SSW, Siddiqui F, Bain PA, Takiar V, Ward MC, Shukla ME, Hu KS, Robbins J, Witek ME, Bakst R, Chandra RA, Galloway T, Margalit DN. Imaging and Biomarker Surveillance for Head and Neck Squamous Cell Carcinoma: A Systematic Review and American Radium Society Appropriate Use Criteria Statement. Int J Radiat Oncol Biol Phys 2024; 119:786-802. [PMID: 38168554 DOI: 10.1016/j.ijrobp.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024]
Abstract
Surveillance for survivors of head and neck cancer (HNC) is focused on early detection of recurrent or second primary malignancies. After initial restaging confirms disease-free status, the use of surveillance imaging for asymptomatic patients with HNC is controversial. Our objective was to comprehensively review literature pertaining to imaging and biomarker surveillance of asymptomatic patients treated for head and neck squamous cell carcinoma and to convene a multidisciplinary expert panel to provide appropriate use criteria for surveillance in representative clinical scenarios. The evidence base for the appropriate use criteria was gathered through a librarian-mediated search of literature published from 1990 to 2022 focused on surveillance imaging and circulating tumor-specific DNA for nonmetastatic head and neck squamous cell carcinoma using MEDLINE (Ovid), Embase, Web of Science Core Collection, and the Cochrane Central Register of Controlled Trials. The systematic review was reported according to PRISMA guidelines. Using the modified Delphi process, the expert panel voted on appropriate use criteria, providing recommendations for appropriate use of surveillance imaging and human papillomavirus (HPV) circulating tumor DNA. Of 5178 studies identified, 80 met inclusion criteria (5 meta-analyses/systematic reviews, 1 randomized control trial, 1 post hoc analysis, 25 prospective, and 48 retrospective cohort studies [with ≥50 patients]), reporting on 27,525 patients. No large, randomized, prospective trials examined whether asymptomatic patients who receive surveillance imaging or HPV circulating tumor DNA monitoring benefit from earlier detection of recurrence or second primary tumors in terms of disease-specific or quality-of-life outcomes. In the absence of prospective data, surveillance imaging for HNC survivors should rely on individualized recurrence-risk assessment accounting for initial disease staging, HPV disease status, and tobacco use history. There is an emerging surveillance role for circulating tumor biomarkers.
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Affiliation(s)
- Glenn J Hanna
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
| | - Steven Shih-Wei Chang
- Department of Otolaryngology Head and Neck Surgery, Henry Ford Cancer Institute and Hospital, Detroit, Michigan
| | - Farzan Siddiqui
- Department of Radiation Oncology, Henry Ford Cancer Institute and Hospital, Detroit, Michigan
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - Matthew C Ward
- Atrium Health Levine Cancer Institute Radiation Therapy Center, Charlotte, North Carolina
| | - Monica E Shukla
- Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kenneth S Hu
- New York University Langone Hospitals, New York, New York
| | - Jared Robbins
- Radiation Oncology, College of Medicine Tucson, University of Arizona, Tucson, Arizona
| | - Matthew E Witek
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Richard Bakst
- Mount Sinai Icahn School of Medicine, New York, New York
| | - Ravi A Chandra
- Mid-Atlantic Permanente Medical Group, Kaiser Permanente Health, Rockville, Maryland
| | - Thomas Galloway
- Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania
| | - Danielle N Margalit
- Center for Head and Neck Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
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Katagiri K, Shiga K, Saito D, Oikawa SI, Ikeda A, Tsuchida K, Miyaguchi J, Kusaka T, Kusaka I, Ariga H, Seto I, Nakasato T, Koto M. Particle Beam Therapy and Surgery as Radical Treatments for Parotid Malignancies-A Single-Center Preliminary Case Study. J Clin Med 2024; 13:3314. [PMID: 38893025 PMCID: PMC11173212 DOI: 10.3390/jcm13113314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/20/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Particle beam therapy (PBT) was approved in April 2018 for head and neck malignancies and has since been introduced as a radical therapy for parotid malignancies. However, its prevalence and effectiveness in relation to surgical treatment have not been investigated. Methods: In this study, we evaluated 36 patients with parotid malignancy who underwent surgery (n = 26) or PBT (n = 10) and then analyzed the annual changes in the number of patients, survival rates, and clinical factors affecting prognosis. Results: Of the ten patients who opted for PBT, two and eight patients underwent PBT before and after 2018, respectively. There was a significant difference between these two groups of patients (p = 0.04). Of the ten patients who underwent PBT, five patients were recurrent cases; meanwhile, all twenty-six patients who underwent surgery were receiving initial treatment. Only one patient in each group had local recurrence after the treatment. Conclusions: The use of PBT as a radical therapy for parotid malignancies has been increasing since 2018, and patients with recurrent tumors tended to choose PBT. The outcome of the patients who underwent PBT did not seem to be inferior compared with those of the patients who underwent surgery. The histopathological type was a crucial issue in the outcomes of patients who underwent radical therapy for parotid malignancies.
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Affiliation(s)
- Katsunori Katagiri
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Kiyoto Shiga
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Daisuke Saito
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Shin-Ichi Oikawa
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Aya Ikeda
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Kodai Tsuchida
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Jun Miyaguchi
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Takahiro Kusaka
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Iori Kusaka
- Department of Head and Neck Surgery, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan; (K.K.); (D.S.); (S.-I.O.); (A.I.); (K.T.); (J.M.); (T.K.); (I.K.)
| | - Hisanori Ariga
- Department of Radiology, Iwate Medical University School of Medicine, 2-1-1 Idaidori, Yahaba 028-3695, Japan;
| | - Ichiro Seto
- Department of Radiation Therapy, Southern TOHOKU Proton Therapy Center, 7-172 Yatsuyamada, Koriyama 963-8052, Japan;
| | - Tatsuhiko Nakasato
- Department of Diagnostic Radiology, Southern TOHOKU General Hospital, 7-115 Yatsuyamada, Koriyama 963-8563, Japan;
| | - Masashi Koto
- Department of Radiation Therapy, QST Hospital, 4-9-1 Anagawa, Inage-ku, Chiba-shi 263-8555, Japan;
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Blache A, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, James D, Dejean C, Dapké S, Devauchelle B, Thariat J. [Issues and implementation of postoperative radiotherapy after flap reconstructive surgery in head and neck cancers]. Bull Cancer 2024; 111:496-504. [PMID: 38553286 DOI: 10.1016/j.bulcan.2024.02.002] [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: 11/05/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 05/13/2024]
Abstract
The management of head and neck cancers is multidisciplinary, often relying on the use of combined treatments to maximize the chances of cure. Combined treatments are however also responsible for cumulative side effects. The aim of reconstructive surgery with a flap is to restore a function lost with the loss of substance from the tumor resection. However, changes in reconstructive surgery have impact of postoperative radiotherapy planning. The optimization of imaging protocols for radiotherapy planning should make it possible to identify postoperative changes and to distinguish flaps from surrounding native tissues to delineate the flaps and document the spontaneous evolution of these flaps or dose-effect relationships in case of radiotherapy. Such changes include atrophy, fibrosis of soft tissue flaps and osteoradionecrosis of bone flaps. Radiotherapy optimization also involves standardization of the definition of target volumes in situations where a flap is present, a situation that is increasingly common in routine care. This evolution of practice, beyond the essential multidisciplinary consultation meetings defining treatment indications, requires a close radio surgical collaboration with respect to technical aspects of the two disciplines. Doing so, anticipation of relapse and toxicity profiles could possibly lead to propose strategies for personalized de-escalation of multimodal treatments through interdisciplinary trials.
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Affiliation(s)
- Alice Blache
- Département de radiothérapie, centre hospitalier universitaire Amiens-Picardie, 80000 Amiens, France.
| | - Florent Carsuzaa
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | | | - Sophie Deneuve
- Department of Otorhinolaryngology-Head and Neck Surgery, University Hospital of Rouen, Poitiers, France
| | - Pierre-Yves Marcy
- Polyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Quartier Quiez, 83189 Ollioules, France
| | - Dylan James
- Radiotherapy Department, University Hospital of Brest, Brest, France
| | | | - Stéphanie Dapké
- Departement of Maxillofacial Surgery, Research Unit, UR7516 CHIMERE, University of Picardy Jules-Verne, Institut Faire Faces, University Hospital of Amiens Picardy, Amiens Picardy, France
| | - Bernard Devauchelle
- Departement of Maxillofacial Surgery, Research Unit, UR7516 CHIMERE, University of Picardy Jules-Verne, Institut Faire Faces, University Hospital of Amiens Picardy, Amiens Picardy, France
| | - Juliette Thariat
- Department of radiotherapy, Centre François-Baclesse, Corpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Université de Normandie, GORTEC, Caen, France
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6
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Thariat J, Carsuzaa F, Beddok A, Deneuve S, Marcy PY, Merlotti A, Dejean C, Devauchelle B. Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy. Front Oncol 2024; 14:1379861. [PMID: 38665951 PMCID: PMC11043495 DOI: 10.3389/fonc.2024.1379861] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
Background Major advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy. Methods A systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT. Results Despite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap-tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications. Conclusion Flap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.
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Affiliation(s)
- Juliette Thariat
- Department of Radiotherapy, Centre François-Baclesse, Caen, France
- Corpuscular Physics Laboratory, IN2P3, Ensicaen, CNRS UMR 6534, Caen, France
- Faculté de Médecine de Caen, Université de Normandie, Caen, France
| | - Florent Carsuzaa
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, Orsay, France
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Sophie Deneuve
- Surgical Oncology Department, Centre Léon Bérard, UNICANCER, Lyon, France
- Inserm, U1296 Unit, “Radiation: Defense, Health and Environment”, Centre Léon Bérard, Lyon, France
| | - Pierre-Yves Marcy
- Polyclinics ELSAN Group, Department of Radiodiagnostics and Interventional Imaging, PolyClinics Les Fleurs, Ollioules, France
| | - Anna Merlotti
- Radiotherapy Department, S. Croce & Carle Teaching Hospital, Cuneo, Italy
| | | | - Bernard Devauchelle
- Departement of Maxillofacial Surgery, University Hospital of Amiens Picardy, Research Unit, UR7516 CHIMERE, University of Picardy Jules Verne, Institut Faire Faces, Amiens, France
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7
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Hsieh K, Hotca AE, Dickstein DR, Lehrer EJ, Hsieh C, Gupta V, Sindhu KK, Liu JT, Reed SH, Chhabra A, Misiukiewicz K, Roof S, Kahn MN, Kirke D, Urken M, Posner M, Genden E, Bakst RL. Adjuvant Reirradiation With Proton Therapy in Head and Neck Squamous Cell Carcinoma. Adv Radiat Oncol 2024; 9:101418. [PMID: 38778826 PMCID: PMC11110036 DOI: 10.1016/j.adro.2023.101418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/30/2023] [Indexed: 05/25/2024] Open
Abstract
Purpose For patients with head and neck squamous cell carcinoma (HNSCC), locoregional failure and second primary tumors are common indications for adjuvant reirradiation (re-RT). Given an absence of clear consensus on the role of adjuvant re-RT, we sought to assess histopathologic risk factors of patients with HNSCC and their resulting outcomes after adjuvant re-RT with proton therapy. Methods and Materials We conducted a retrospective analysis of patients with HNSCC who underwent salvage surgery at our institution followed by adjuvant re-RT with proton therapy over 1.5 years. All included patients received prior radiation therapy. The Kaplan-Meier method was used to evaluate locoregional recurrence-free survival and overall survival. Results The cohort included 22 patients, with disease subsites, including oropharynx, oral cavity, hypopharynx, larynx, and nasopharynx. Depending on adverse pathologic features, adjuvant re-RT to 66 Gy (32% of cohort) or 60 Gy (68%), with (59%) or without (41%) concurrent systemic therapy was administered. The majority (86%) completed re-RT with no reported treatment delay; 3 patients experienced grade ≥3 acute Common Terminology Criteria for Adverse Events toxicity and no patient required enteral feeding tube placement during re-RT. Median follow-up was 21.0 months (IQR, 11.7-25.2 months). Five patients had biopsy-proven disease recurrences a median of 5.9 months (IQR, 3.8-9.7 months) after re-RT. Locoregional recurrence-free survival was 95.2%, 70.2%, 64.8% at 6, 12, and 24 months, respectively. OS was 100%, 79.2%, and 79.2% at 6, 12, and 24 months, respectively. Four patients had osteoradionecrosis on imaging a median of 13.2 months (IQR, 8.7-17.4 months) after re-RT, with 2 requiring surgical intervention. Conclusions Adjuvant re-RT for patients with HNSCC was well-tolerated and offered reasonable local control in this high-risk cohort but appears to be associated with a risk of osteoradionecrosis. Additional study and longer follow-up could help define optimal patient management in this patient population.
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Affiliation(s)
- Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Elena Hotca
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Celina Hsieh
- Department of Diagnostic Imaging, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jerry T. Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samuel H. Reed
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Krzysztof Misiukiewicz
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Scott Roof
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mohemmed Nazir Kahn
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Diana Kirke
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Mark Urken
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall Posner
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eric Genden
- Department of Otolaryngology, Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L. Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
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Adding Concomitant Chemotherapy to Postoperative Radiotherapy in Oral Cavity Carcinoma with Minor Risk Factors: Systematic Review of the Literature and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14153704. [PMID: 35954368 PMCID: PMC9367295 DOI: 10.3390/cancers14153704] [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: 06/06/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022] Open
Abstract
When presenting with major pathological risk factors, adjuvant radio-chemotherapy for oral cavity cancers (OCC) is recommended, but the addition of chemotherapy to radiotherapy (POCRT) when only minor pathological risk factors are present is controversial. A systematic review following the PICO-PRISMA methodology (PROSPERO registration ID: CRD42021267498) was conducted using the PubMed, Embase, and Cochrane libraries. Studies assessing outcomes of POCRT in patients with solely minor risk factors (perineural invasion or lymph vascular invasion; pN1 single; DOI ≥ 5 mm; close margin < 2−5 mm; node-positive level IV or V; pT3 or pT4; multiple lymph nodes without ENE) were evaluated. A meta-analysis technique with a single-arm study was performed. Radiotherapy was combined with chemotherapy in all studies. One study only included patients treated with POCRT. In the other 12 studies, patients were treated with only PORT (12,883 patients) and with POCRT (10,663 patients). Among the patients treated with POCRT, the pooled 3 year OS rate was 72.9% (95%CI: 65.5−79.2%); the pooled 3 year DFS was 70.9% (95%CI: 48.8−86.2%); and the pooled LRFS was 69.8% (95%CI: 46.1−86.1%). Results are in favor of POCRT in terms of OS but not significant for DFS and LRFS, probably due to the heterogeneity of the included studies and a combination of different prognostic factors.
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Chang JYF, Tseng CH, Lu PH, Wang YP. Contemporary Molecular Analyses of Malignant Tumors for Precision Treatment and the Implication in Oral Squamous Cell Carcinoma. J Pers Med 2021; 12:jpm12010012. [PMID: 35055327 PMCID: PMC8780757 DOI: 10.3390/jpm12010012] [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: 12/07/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 12/12/2022] Open
Abstract
New molecular tests and methods, in addition to morphology-based diagnosis, are widely used as a new standard of care in many tumors. “One-size-fits-all medicine” is now shifting to precision medicine. This review is intended to discuss the key steps toward to development of precision medicine and its implication in oral squamous cell carcinoma. The challenges and opportunities of precision medicine in oral cancer will be sequentially discussed based on the four steps of precision medicine: identification/detection, diagnosis, treatment and monitoring.
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Affiliation(s)
- Julia Yu Fong Chang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10617, Taiwan; (J.Y.F.C.); (C.-H.T.); (P.H.L.)
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei 10617, Taiwan
| | - Chih-Huang Tseng
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10617, Taiwan; (J.Y.F.C.); (C.-H.T.); (P.H.L.)
- Division of Oral Pathology & Maxillofacial Radiology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Division Oral & Maxillofacial Imaging Center, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Pei Hsuan Lu
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10617, Taiwan; (J.Y.F.C.); (C.-H.T.); (P.H.L.)
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Yi-Ping Wang
- Graduate Institute of Clinical Dentistry, School of Dentistry, National Taiwan University, Taipei 10617, Taiwan; (J.Y.F.C.); (C.-H.T.); (P.H.L.)
- Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-2-23123456 (ext. 67987)
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10
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Chin RI, Schiff JP, Brenneman RJ, Gay HA, Thorstad WL, Lin AJ. A Rational Approach to Unilateral Neck RT for Head and Neck Cancers in the Era of Immunotherapy. Cancers (Basel) 2021; 13:5269. [PMID: 34771432 PMCID: PMC8582444 DOI: 10.3390/cancers13215269] [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: 08/06/2021] [Revised: 10/08/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
Radiotherapy plays an important role in the definitive and adjuvant treatment of head and neck squamous cell carcinoma (HNSCC). However, standard courses of radiation therapy may contribute to the depletion of circulating lymphocytes and potentially attenuate optimal tumor antigen presentation that may be detrimental to the efficacy of novel immunotherapeutic agents. This review explores the advantages of restricting radiation to the primary tumor/tumor bed and ipsilateral elective neck as it pertains to the evolving field of immunotherapy.
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Affiliation(s)
| | | | | | | | | | - Alexander J. Lin
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, MI 63110, USA; (R.-I.C.); (J.P.S.); (R.J.B.); (H.A.G.); (W.L.T.)
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11
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Carsuzaa F, Lapeyre M, Gregoire V, Maingon P, Beddok A, Marcy PY, Salleron J, Coutte A, Racadot S, Pointreau Y, Graff P, Beadle B, Benezery K, Biau J, Calugaru V, Castelli J, Chua M, Di Rito A, Dore M, Ghadjar P, Huguet F, Jardel P, Johansen J, Kimple R, Krengli M, Laskar S, Mcdowell L, Nichols A, Tribius S, Valduvieco I, Hu C, Liem X, Moya-Plana A, D'onofrio I, Parvathaneni U, Takiar V, Orlandi E, Psyrri A, Shenouda G, Sher D, Steuer C, Shan Sun X, Tao Y, Thomson D, Tsai MH, Vulquin N, Gorphe P, Mehanna H, Yom SS, Bourhis J, Thariat J. Recommendations for postoperative radiotherapy in head & neck squamous cell carcinoma in the presence of flaps: A GORTEC internationally-reviewed HNCIG-endorsed consensus. Radiother Oncol 2021; 160:140-147. [PMID: 33984351 DOI: 10.1016/j.radonc.2021.04.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Head and neck reconstructive surgery using a flap is increasingly common. Best practices and outcomes for postoperative radiotherapy (poRT) with flaps have not been specified. We aimed to provide consensus recommendations to assist clinical decision-making highlighting areas of uncertainty in the presence of flaps. MATERIAL AND METHODS Radiation, medical, and surgical oncologists were assembled from GORTEC and internationally with the Head and Neck Cancer International Group (HNCIG). The consensus-building approach covered 59 topics across four domains: (1) identification of postoperative tissue changes on imaging for flap delineation, (2) understanding of tumor relapse risks and target volume definitions, (3) functional radiation-induced deterioration, (4) feasibility of flap avoidance. RESULTS Across the 4 domains, international consensus (median score ≥ 7/9) was achieved only for functional deterioration (73.3%); other consensus rates were 55.6% for poRT avoidance of flap structures, 41.2% for flap definition and 11.1% for tumor spread patterns. Radiation-induced flap fibrosis or atrophy and their functional impact was well recognized while flap necrosis was not, suggesting dose-volume adaptation for the former. Flap avoidance was recommended to minimize bone flap osteoradionecrosis but not soft-tissue toxicity. The need for identification (CT planning, fiducials, accurate operative report) and targeting of the junction area at risk between native tissues and flap was well recognized. Experts variably considered flaps as prone to tumor dissemination or not. Discrepancies in rating of 11 items among international reviewing participants are shown. CONCLUSION International GORTEC and HNCIG-endorsed recommendations were generated for the management of flaps in head and neck radiotherapy. Considerable knowledge gaps hinder further consensus, in particular with respect to tumor spread patterns.
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Affiliation(s)
| | - Michel Lapeyre
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Philippe Maingon
- Department of Radiation Oncology, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Arnaud Beddok
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Pierre-Yves Marcy
- Department of Radiology, Clinique du Cap d'Or, La Seyne-sur-mer, France
| | - Julia Salleron
- Department of Biostatistics, Institut de cancérologie de Lorraine, France
| | - Alexandre Coutte
- Department of Radiation Oncology, Amiens Picardie University Medical Center, Amiens, France
| | - Severine Racadot
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Yoann Pointreau
- Department of Radiation Oncology, Centre Jean Bernard, Le Mans, France
| | - Pierre Graff
- Department or Radiation Oncology, Institut C. Regaud, Toulouse, France
| | - Beth Beadle
- Department of Radiation Oncology, Stanford University Medical Center, Stanford University Medical Center, USA
| | - Karen Benezery
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - Julian Biau
- Department of Radiation Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | | | - Joel Castelli
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France
| | - Melvin Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Duke-NUS Medical School, Singapore
| | - Alessia Di Rito
- Department of Radiation Oncology, OC Radioterapia Ospedale "Mons. A.R. Dimiccoli" di Barletta, Rome, Italy
| | - Melanie Dore
- Department of Radiation Oncology, Institut de cancérologie de l'Ouest, St Herblain, France
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité, Berlin, Germany
| | - Florence Huguet
- Department of Radiation Oncology, Hospital de Tenon, Paris, France
| | - Pauline Jardel
- Department of Radiation Oncology, CHU de la Milétrie, Poitiers, France
| | - Jorgen Johansen
- Department of Radiation Oncology, Odense University Hospital, Denmark
| | - Randall Kimple
- Department of Medical Oncology, University of Wisconsin-Madison, WI, USA
| | - Marco Krengli
- Department of Translational Medicine University of Piemonte Orientale, Novara, Italy
| | | | - Lachlan Mcdowell
- Department of Radiation Oncology, Peter McCallum Cancer Center, Melbourne, Australia
| | - Anthony Nichols
- Department of Head and Neck surgery, London Health Sciences Center, Ontario, Canada
| | - Silke Tribius
- Department of Radiation Oncology, Hermann-Holthusen-Institute for Radiation Oncology, Asklepios Hospital St. Georg, Hamburg, Germany
| | | | - Chaosu Hu
- Department of Radiation Oncology, Fundan University, Shanghai, China
| | - Xavier Liem
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | | | - Ida D'onofrio
- Department of Radiation Oncology, Hospital Naples, Italy
| | | | - Vinita Takiar
- Department of Radiation Oncology, University of Cincinaty, USA
| | - Ester Orlandi
- Department of Radiation Oncology, CNAO, Milan, Italy
| | - Amanda Psyrri
- Department of Medical Oncology, Attikon University Hospital, Athens, Greece
| | - George Shenouda
- Department of Radiation Oncology, McGill University Health Centre, Montreal, Canada
| | - David Sher
- Department of Radiation Oncology, UT Southwestern, Dallas, USA
| | - Conor Steuer
- Department of Head and Neck Surgery, Winship Cancer Institute, Atlanta, USA
| | - Xu Shan Sun
- Department of Radiation Oncology, University hospital CHBM, Montbéliard, France
| | - Yungan Tao
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - David Thomson
- Department of Radiation Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mu-Hung Tsai
- Department of Radiation Oncology, National Cheng Kung University Hospital, Tïnan, Taiwan
| | - Noemie Vulquin
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Philippe Gorphe
- Department of Head and Neck Surgery, Gustave Roussy, Villejuif, France
| | - Hisham Mehanna
- Department of Radiation Oncology, Institute for Global Innovation, Birmingham, UK
| | - Sue S Yom
- Department of Radiation Oncology, NRG Oncology Cancer Research Group, USA
| | - Jean Bourhis
- Department of Radiation Oncology, UNIL-CHUV, Lausanne, Switzerland
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François-Baclesse, Laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534. Normandie University, Caen, and GORTEC, France.
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12
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Amdur RJ, Harari PM, Dziegielewski PT, Mendenhall WM. Refining Guidelines Regarding Unilateral Treatment in Patients With Well-lateralized Squamous Cell Carcinoma of the Palatine Tonsil and Multiple Positive Nodes or Extranodal Extension. Pract Radiat Oncol 2021; 11:e247-e251. [PMID: 33434692 DOI: 10.1016/j.prro.2020.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Robert J Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida College of Medicine, Gainesville, Florida
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida
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13
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Margalit DN, Sacco AG, Cooper JS, Ridge JA, Bakst RL, Beadle BM, Beitler JJ, Chang SS, Chen AM, Galloway TJ, Koyfman SA, Mita C, Robbins JR, Tsai CJ, Truong MT, Yom SS, Siddiqui F. Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria. Head Neck 2021; 43:367-391. [PMID: 33098180 PMCID: PMC7756212 DOI: 10.1002/hed.26490] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios. METHODS An analysis of the medical literature from peer-reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Prospective studies and methodology-based systematic reviews and meta-analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier) using controlled vocabulary terms (ie, National Library of Medicine Medical Subject Headings [MeSH], EMTREE). Study screening and selection was performed with Covidence software and full-text review. The RAND/UCLA appropriateness method was used by the expert panel to rate the appropriate use of postoperative therapy, and the modified Delphi method was used to come to consensus. RESULTS A total of 5660 studies were identified and screened using the title and abstract, leading to 201 studies assessed for relevance using full-text review. After limitation to the eligibility criteria, 101 studies from 1977 to 2020 were identified, including 77 with oncologic endpoints and 24 with function and quality of life endpoints. All studies reported staging prior to the implementation of American Joint Committee on Cancer (AJCC-8). CONCLUSIONS Prospective clinical studies and systematic reviews identified through the PRISMA systematic review provided good evidence for consensus statements regarding the appropriate use of postoperative therapy for resected SCCHN. Further research is needed in domains where consensus by the expert panel could not be achieved for the appropriateness of specific postoperative therapeutic interventions.
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Affiliation(s)
- Danielle N. Margalit
- Dana‐Farber/Brigham & Women's Cancer Center, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | | | | | - Beth M. Beadle
- Stanford University School of MedicineStanfordCaliforniaUSA
| | | | | | | | | | | | - Carol Mita
- Countway Library, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | - Minh T. Truong
- Boston University School of MedicineBostonMassachusettsUSA
| | - Sue S. Yom
- University of CaliforniaSan FranciscoCaliforniaUSA
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