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Palumbo C, Benvenuto M, Focaccetti C, Albonici L, Cifaldi L, Rufini A, Nardozi D, Angiolini V, Bei A, Masuelli L, Bei R. Recent findings on the impact of ErbB receptors status on prognosis and therapy of head and neck squamous cell carcinoma. Front Med (Lausanne) 2023; 10:1066021. [PMID: 36817764 PMCID: PMC9932042 DOI: 10.3389/fmed.2023.1066021] [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: 10/10/2022] [Accepted: 01/13/2023] [Indexed: 02/05/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer type, has often an aggressive course and is poorly responsive to current therapeutic approaches, so that 5-year survival rates for patients diagnosed with advanced disease is lower than 50%. The Epidermal Growth Factor Receptor (EGFR) has emerged as an established oncogene in HNSCC. Indeed, although HNSCCs are a heterogeneous group of cancers which differ for histological, molecular and clinical features, EGFR is overexpressed or mutated in a percentage of cases up to about 90%. Moreover, aberrant expression of the other members of the ErbB receptor family, ErbB2, ErbB3 and ErbB4, has also been reported in variable proportions of HNSCCs. Therefore, an increased expression/activity of one or multiple ErbB receptors is found in the vast majority of patients with HNSCC. While aberrant ErbB signaling has long been known to play a critical role in tumor growth, angiogenesis, invasion, metastatization and resistance to therapy, more recent evidence has revealed its impact on other features of cancer cells' biology, such as the ability to evade antitumor immunity. In this paper we will review recent findings on how ErbB receptors expression and activity, including that associated with non-canonical signaling mechanisms, impacts on prognosis and therapy of HNSCC.
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Affiliation(s)
- Camilla Palumbo
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Monica Benvenuto
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy,Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Chiara Focaccetti
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Loredana Albonici
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Loredana Cifaldi
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy,Academic Department of Pediatrics (DPUO), Ospedale Pediatrico Bambino Gesù, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Alessandra Rufini
- Saint Camillus International University of Health and Medical Sciences, Rome, Italy,Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Daniela Nardozi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Angiolini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Arianna Bei
- Medical School, University of Rome “Tor Vergata”, Rome, Italy
| | - Laura Masuelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Roberto Bei
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy,*Correspondence: Roberto Bei,
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D’Urso P, Farneti A, Marucci L, Marzi S, Piludu F, Vidiri A, Sanguineti G. Predictors of Outcome after (Chemo)Radiotherapy for Node-Positive Oropharyngeal Cancer: The Role of Functional MRI. Cancers (Basel) 2022; 14:cancers14102477. [PMID: 35626084 PMCID: PMC9139324 DOI: 10.3390/cancers14102477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 02/04/2023] Open
Abstract
The prognosis of a subset of patients with locally advanced oropharyngeal cancer (LA-OPC) is still poor despite improvements in patient selection and treatment. Identifying specific patient- and tumor-related factors can help to select those patients who need intensified treatment. We aimed to assess the role of historical risk factors and novel magnetic resonance imaging (MRI) biomarkers in predicting outcomes in these patients. Patients diagnosed with LA-OPC were studied with diffusion-weighted imaging (DWI) and dynamic-contrast enhanced MRI at baseline and at the 10th radiotherapy (RT) fraction. Clinical information was collected as well. The endpoint of the study was the development of disease progression, locally or distantly. Of the 97 patients enrolled, 68 were eligible for analysis. Disease progression was recorded in 21 patients (11 had loco-regional progression, 10 developed distant metastases). We found a correlation between N diameter and disease control (p = 0.02); features such as p16 status and extranodal extension only showed a trend towards statistical significance. Among perfusion MRI features, higher median values of Kep both in primary tumor (T, p = 0.016) and lymph node (N, p = 0.003) and lower median values of ve (p = 0.018 in T, p = 0.004 in N) correlated with better disease control. Kep P90 and N diameter were identified by MRMR algorithm as the best predictors of outcome. In conclusion, the association of non-invasive MRI biomarkers and patients and tumor characteristics may help in predicting disease behavior and patient outcomes in order to ensure a more customized treatment.
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Affiliation(s)
- Pasqualina D’Urso
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
- Correspondence:
| | - Alessia Farneti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Laura Marucci
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
| | - Simona Marzi
- Medical Physics Laboratory, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Francesca Piludu
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (F.P.); (A.V.)
| | - Antonello Vidiri
- Radiology and Diagnostic Imaging Department, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (F.P.); (A.V.)
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Regina Elena National Cancer Institute, 00144 Rome, Italy; (A.F.); (L.M.); (G.S.)
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Straetmans JMJAA, Stuut M, Lacko M, Hoebers F, Speel EJM, Kremer B. Additional parameters to improve the prognostic value of the 8th edition of the UICC classification for human papillomavirus-related oropharyngeal tumors. Head Neck 2022; 44:1799-1815. [PMID: 35579041 PMCID: PMC9544856 DOI: 10.1002/hed.27084] [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: 09/28/2021] [Revised: 02/17/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background The prognostic reliability of the UICC's TNM classification (8th edition) for human papillomavirus (HPV)‐positive tonsillar squamous cell carcinomas (TSCCs) compared to the 7th edition was explored, and its improvement by using additional anatomical and nonanatomical parameters. Methods One hundred and ten HPV‐positive and 225 HPV‐negative TSCCs were retrospectively analyzed. Survival was correlated with patient and tumor characteristics (7th and 8th edition UICC TNM classification). Results In HPV‐positive TSCCs, the 8th edition UICC's TNM classification correlated better with prognosis than the 7th edition. Also, smoking status was a stronger prognosticator of survival than UICC staging. Non‐ or former smokers had a 5‐year overall survival of 95.1% regardless of tumor stage. Furthermore, age (>65 years), cN3, and M1 classification were significant prognostic factors. Conclusion The prognostic value of the 8th edition UICC's TNM classification improved significantly when compared to the 7th edition. Nonetheless, further improvement is possible by adding nonanatomical factors (smoking, age >65 year) and separating N0‐N2 from N3.
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Affiliation(s)
- Jos M J A A Straetmans
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Otorhinolaryngology and Head and Neck Surgery, Zuyderland Medical Center, Heerlen, the Netherlands
| | - Marijn Stuut
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Ernst-Jan M Speel
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Bernd Kremer
- Department of Otorhinolaryngology and Head and Neck Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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Saito Y, Homma A, Kiyota N, Tahara M, Hanai N, Asakage T, Matsuura K, Ota I, Yokota T, Sano D, Kodaira T, Motegi A, Yasuda K, Takahashi S, Tanaka K, Onoe T, Okano S, Imamura Y, Ariizumi Y, Hayashi R. Human papillomavirus-related oropharyngeal carcinoma. Jpn J Clin Oncol 2022; 52:700-706. [PMID: 35383359 DOI: 10.1093/jjco/hyac049] [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: 09/28/2021] [Accepted: 03/19/2022] [Indexed: 11/13/2022] Open
Abstract
It was not until around 2000 that human papillomavirus-related oropharyngeal carcinoma was recognized as carcinoma with clinical presentations different from nonrelated head and neck carcinoma. Twenty years after and with the revision of the tumor-node-metastasis classification in 2017, various clinical trials focused on human papillomavirus-related oropharyngeal carcinoma to improve the prognosis and quality of life of patients with this disease. However, the incidence of human papillomavirus-related cancers is increasing, which is expected to be particularly prominent in Japan, where human papillomavirus vaccination is not widely available. In this review, we describe the current status of clinical trials (mainly focused on initial surgery and radiation dose reduction) for, primary and secondary prevention of, and the present status of human papillomavirus-related oropharyngeal carcinoma in Japan.
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Affiliation(s)
- Yuki Saito
- Department of Otolaryngology and Head and Neck Surgery, University of Tokyo, Tokyo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naomi Kiyota
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takahiro Asakage
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Ichiro Ota
- Department of Otolaryngology-Head and Neck Surgery, Nara Medical University, Nara, Japan
| | - Tomoya Yokota
- Divisions of Gastrointestinal Oncology, Shizuoka Cancer Center, Kashiwa, Japan
| | - Daisuke Sano
- Department of Otorhinolaryngology, Head and Neck Surgery, Yokohama City University, School of Medicine, Yokohama, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Atsushi Motegi
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Tokyo, Japan
| | - Kaoru Tanaka
- Department of Medical Oncology, Kindai University Faculty of Medicine, Higashi-Osaka, Japan
| | - Takuma Onoe
- Division of Medical Oncology, Hyogo Cancer Center, Hyogo, Japan
| | - Susumu Okano
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yoshinori Imamura
- Department of Medical Oncology and Hematology, Cancer Center, Kobe University Hospital, Kobe, Japan
| | - Yosuke Ariizumi
- Department of Head and Neck Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
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Mirza FA, Johnson CZ, Byrd JK, Albergotti WG. Treatment trends for advanced oropharyngeal squamous cell carcinoma in the era of human papillomavirus. Head Neck 2021; 43:3476-3492. [PMID: 34499392 DOI: 10.1002/hed.26860] [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: 12/29/2020] [Revised: 05/21/2021] [Accepted: 08/12/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Given recent increase in prevalence of oropharyngeal squamous cell carcinoma (OPSCC) and advances in surgical capabilities, we sought to determine whether a change in frequency of surgery-based treatment for locally advanced OPSCC has occurred. METHODS Patients with T3-T4b OPSCC in the National Cancer Database diagnosed from 2010 to 2016 were categorized as receiving primary surgery or radiation-based therapy and stratified by human papillomavirus (HPV) status. Trends in treatment selection and factors associated with treatment type were examined. RESULTS 6566 patients with HPV-positive were included, of whom 489 (7.45%) received surgery and 4698 patients with HPV-negative, of whom 362 (7.71%) received surgery. The percentage of patients treated with surgery decreased from 11.8% to 5.9% for HPV-positive disease and from 9.8% to 6.3% for HPV-negative disease. Factors associated with surgery included younger age, health insurance, and treatment at academic centers. CONCLUSIONS In HPV-positive and HPV-negative disease, the percentage of locally advanced OPSCC undergoing surgery-based therapy has decreased.
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Affiliation(s)
- Faris A Mirza
- Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Christopher Z Johnson
- Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - James Kenneth Byrd
- Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - William Greer Albergotti
- Department of Otolaryngology - Head and Neck Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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Molecular Tumor Subtypes of HPV-Positive Head and Neck Cancers: Biological Characteristics and Implications for Clinical Outcomes. Cancers (Basel) 2021; 13:cancers13112721. [PMID: 34072836 PMCID: PMC8198180 DOI: 10.3390/cancers13112721] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 01/18/2023] Open
Abstract
Until recently, research on the molecular signatures of Human papillomavirus (HPV)-associated head and neck cancers mainly focused on their differences with respect to HPV-negative head and neck squamous cell carcinomas (HNSCCs). However, given the continuing high incidence level of HPV-related HNSCC, the time is ripe to characterize the heterogeneity that exists within these cancers. Here, we review research thus far on HPV-positive HNSCC molecular subtypes, and their relationship with clinical characteristics and HPV integration into the host genome. Different omics data including host transcriptomics and epigenomics, as well as HPV characteristics, can provide complementary viewpoints. Keratinization, mesenchymal differentiation, immune signatures, stromal cells and oxidoreductive processes all play important roles.
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EGFR Protein Expression Relates with Tumor Histology, Methylation Status of EGFR and HPV16 E6 Viral Load in Oropharyngeal Carcinoma. Head Neck Pathol 2021; 15:743-756. [PMID: 33428063 PMCID: PMC8385027 DOI: 10.1007/s12105-020-01261-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
The epidermal growth factor receptor (EGFR) pathway is important in tumorigenesis of oropharyngeal carcinoma (OPC). However, the molecular mechanisms contributing to EGFR expression in OPC are not well-known. To detect relating factors and clinicopathological impact of EGFR protein expression in OPC, gene amplification/loss, point mutations including synonymous mutations, and promoter methylation of EGFR, and the viral genome load of human papillomavirus type 16 (HPV16)-E5, -E6, and -E7, after extracting HPV16-related OPCs with qPCR of HPV16-E6 and E7, were investigated in 74 OPC surgical cases, including 52 HPV-related (HPV-OPC) and 22 HPV-unrelated (nHPV-OPC). Immunohistochemical (IHC) data of EGFR expression (high, weak, and negative), validated by the qPCR of EGFR mRNA, were compared with molecular, viral, and clinicopathological data of patients. All nHPV-OPC cases were EGFR-IHC-high, whereas 21.2%, 65.4%, and 13.5% of HPV-OPC cases showed EGFR-IHC-high, -weak, -negative (p < 0.01), respectively. In HPV-OPC cases, EGFR-IHC-weak/negative status was related to promoter methylation of EGFR (p = 0.009), but not with gene amplification/loss or the point mutation of EGFR and was more often seen in HPV16-OPC cases (p = 0.049). Among HPV16-OPC cases, EGFR-IHC-weak/negative was related to high E6 expression. EGFR protein-loss was related to the tumor histology of non-keratinizing squamous cell carcinoma (SCC) (p = 0.035) but not with patient prognosis. In conclusion, decreased EGFR protein expression was more frequent in HPV-OPC than in nHPV-OPC and was related to EGFR methylation, infection of HPV16, and the viral genome load of HPV16-E6. Clinicopathologically, it was related to the tumor histology of non-keratinizing SCC.
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Abstract
FDG PET-CT is one the main investigations for squamous cell (Sq) head and neck (H&N) cancer patients. FDG PET-CT has a key role for the staging of patients with T4 cancer of the hypopharynx and nasopharynx and patients with N3 nodal disease. It is effective in detecting recurrent disease accurately. In addition, it has an emerging role in the surveillance of Sq H&N cancer survivors. In patients with advanced neck nodal disease treated with chemoradiotherapy, there is compelling evidence that patients with no FDG uptake in the neck 12 weeks following completion of treatment do not require neck dissection. There is considerable interest in using FDG PET-CT for develop more effective clinical pathways for the surveillance of Sq H&N cancer. Currently, the detection rate of recurrence in patients who attend regular clinical follow-up is poor, less than 1% in asymptomatic patients. FDG PET-CT may enable survivors to be stratified into groups based on the likelihood of having recurrent disease. Optimal surveillance pathways can be developed, reserving most intense imaging regimes and most frequent follow-up for survivors at high risk of recurrence. FDG PET CT is sometimes considered for patients with non Sq H&N cancer. If used in this context, a baseline FDG PET-CT should be done to ensure that the tumour is avid. Most H&N malignant tumours are avid. However, salivary gland cancers, and tumours with muco-epidermoid, adenoid cystic and clear cell histology show paucity of FDG avidity, especially when they recur. In addition, peri-neural invasion cannot be detected reliably with FDG PET-CT.
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Affiliation(s)
- Wai Lup Wong
- Consultant Radiologist (Nuclear Medicine) Mount Vernon Hospital, Northwood, UK; PET-CT Clinical Lead Strickland Scanner Centre, Northwood, UK.
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Daniels CP, Liu HYH, Bernard A, Williams C, Foote MC, Ladwa R, McGrath M, Panizza BJ, Porceddu SV. The declining role of post-treatment neck dissection in human papillomavirus-associated oropharyngeal cancer. Radiother Oncol 2020; 151:242-248. [PMID: 32798595 DOI: 10.1016/j.radonc.2020.08.004] [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: 05/19/2020] [Revised: 07/29/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Human papillomavirus-associated oropharyngeal cancer (HPV+ OPC) with regional lymph node metastases has a good prognosis following (chemo)radiation therapy (C/RT) but lymph nodes may remain detectable for several months. Delayed [18F]-Fluorodeoxyglucose positron emission tomography/computed tomography (PET) can identify patients who may avoid post-treatment neck dissection (PTND). We investigated the rate of PTND in HPV+ OPC treated with C/RT and delayed PET-directed management of the neck. MATERIALS AND METHODS This is a retrospective cohort study from a prospectively updated institutional database. Eligible patients were treated between January 2005 and July 2017 with a minimum of 18 months follow up, had node-positive, non-distant metastatic HPV+ OPC and were treated with RT (70 Gy/35#/5 per week) with concurrent Cisplatin or Cetuximab, or accelerated RT alone (68 Gy/34#/6 per week). The primary endpoint was rate of PTND. Secondary endpoints were locoregional failure free survival (LRFFS), regional failure free survival (RFFS), distant metastatic failure free survival (DMFFS), overall survival (OS) and oropharyngeal cancer-specific survival (CSS). RESULTS 418 patients were eligible. Nineteen patients (4.5%) received a PTND. None of the tested variables were associated with an increased risk of PTND. Five-year probabilities for LRFFS, RFFS, DMFS, OS and CSS were, 91.2% (95% CI 88.3-94.2), 93.4% (95% CI 90.8-96.0), 91.2% (95% CI 88.3-94.2), 86.4% (95% CI 83.0-90.1) and 90.2% (95% CI 87.1-93.4), respectively. CONCLUSION In a large cohort with good median follow up and protocolized C/RT, delayed PET-directed management of the neck affords a lower rate of PTND than reported in historical series without compromising disease control and survival.
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Affiliation(s)
- Christopher P Daniels
- Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia.
| | - Howard Yu-Hao Liu
- Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia
| | - Anne Bernard
- QFAB Bioinformatics, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Christopher Williams
- Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia
| | - Matthew C Foote
- Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia
| | - Rahul Ladwa
- Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia
| | - Margaret McGrath
- Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Benedict James Panizza
- Faculty of Medicine, University of Queensland, St. Lucia, Australia; Department of Otolaryngology, Head and Neck Surgery, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Sandro Virgilio Porceddu
- Department of Cancer Services, Princess Alexandra Hospital, Woolloongabba, Australia; Faculty of Medicine, University of Queensland, St. Lucia, Australia
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Costa JM, Sumarroca A, Rodríguez C, Gutiérrez A, García J, López M, Quer M, León X. Prognostic Value of Nodal Involvement in Patients With Oropharyngeal Carcinoma According to the HPV Status. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020. [DOI: 10.1016/j.otoeng.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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11
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Cao MX, Zhang WL, Yu XH, Wu JS, Qiao XW, Huang MC, Wang K, Wu JB, Tang YJ, Jiang J, Liang XH, Tang YL. Interplay between cancer cells and M2 macrophages is necessary for miR-550a-3-5p down-regulation-mediated HPV-positive OSCC progression. J Exp Clin Cancer Res 2020; 39:102. [PMID: 32493454 PMCID: PMC7268480 DOI: 10.1186/s13046-020-01602-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/22/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV)-positive oral squamous cell carcinoma (OSCC) is increasing worldwide with typically higher grade and stage, while better prognosis. microRNAs (miRNAs) has been shown to play a critical role in cancer, however, their role in HPV-positive OSCC progression remains unclear. METHODS miRNA microarray was performed to identify differentially expressed miRNAs. qRT-PCR and FISH were performed to determine the relative expression of miR-550a-3-5p. CCK-8, Flow cytometry, Wound healing, Cell invasion assays and xenograft experiments were conducted to analyze the biological roles of miR-550a-3-5p. Tumor-associated macrophages (TAMs) generation, co-culturing of cancer cells with TAMs, Western blot, Dual-luciferase reporter gene assay, Immunohistochemistry and animal studies were performed to explore the mechanisms underlying the functions of miR-550a-3-5p. RESULTS We identified 19 miRNAs differentially expressed in HPV-positive OSCC specimens and miR-550a-3-5p was down-regulated. The low expression of miR-550a-3-5p correlated with higher tumor size and nodal metastasis of HPV-positive OSCC patients. Then, we found that miR-550a-3-5p suppressed the migration, invasion and EMT of HPV-positive OSCC cells dependent on decreasing M2 macrophages polarization. Moreover, miR-550a-3-5p, down-regulated by E6 oncoprotein, inhibited M2 macrophages polarization by YAP/CCL2 signaling, which in turn abrogating EMT program in HPV-positive OSCC cells. In addition, in both xenografts and clinical HPV-positive OSCC samples, miR-550a-3-5p levels were inversely associated with YAP, CCL2 expressions and the number of M2 macrophages. CONCLUSIONS E6/miR-550a-3-5p/YAP/CCL2 signaling induces M2 macrophages polarization to enhance EMT and progression, revealing a novel crosstalk between cancer cells and immune cells in HPV-positive OSCC microenvironment.
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Affiliation(s)
- Ming-Xin Cao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Wei-Long Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Xiang-Hua Yu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Jia-Shun Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Xin-Wei Qiao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Mei-Chang Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Ke Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Jing-Biao Wu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China
| | - Ya-Jie Tang
- State Key Laboratory of Microbial Technology, Shandong University, Qingdao, 266237, Shandong, China
| | - Jian Jiang
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610041, Sichuan, China
| | - Xin-Hua Liang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China.
| | - Ya-Ling Tang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, No.14, Sec.3, Renminnan Road, Chengdu, 610041, Sichuan, China.
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12
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Ference R, Liao D, Gao Q, Mehta V. Impact of Smoking on Survival Outcomes in HPV-Related Oropharyngeal Carcinoma: A Meta-analysis. Otolaryngol Head Neck Surg 2020; 163:1114-1122. [DOI: 10.1177/0194599820931803] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective Characterize the survival impact of smoking on HPV-related (human papillomavirus) oropharyngeal squamous cell carcinoma. Data Sources Articles from 2000 to 2019 in the PubMed, Embase, and Cochrane Library databases were systematically reviewed for content and inclusion/exclusion criteria. Review Methods Two reviewers independently analyzed the databases for eligibility and quality of the articles. Demographic data, smoking history, and survival outcomes were recorded. Hazard ratios and 95% CIs were collectively analyzed through a random effects meta-analysis model. Results Fifteen articles were included in the meta-analysis for overall survival, disease-specific survival, disease-free survival, progression-free survival, and locoregional recurrence outcomes. The overall survival hazard ratio was 2.4 for ever having smoked (95% CI, 1.4-4.0; P = .0006, I2 = .384) and 3.2 for current smoking (95% CI, 2.2-4.6; P < .0001, I2 = 0). The hazard ratio for disease-specific survival in current smokers was 6.3 (95% CI, 1.3-29.3; P = .0194, I2 = 0). Ever smoking had a larger impact on overall survival and disease-specific survival than the 10–pack year smoking threshold. Conclusion Smoking negatively affects survival in patients with HPV-related oropharyngeal carcinoma across all outcomes. Current smoking during treatment is associated with the greatest reduction in survival, possibly secondary to diminished radiation therapy efficacy.
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Affiliation(s)
- Ryan Ference
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - David Liao
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Qi Gao
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Vikas Mehta
- Department of Otorhinolaryngology–Head and Neck Surgery, Montefiore Medical Center, Bronx, New York, USA
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13
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Clinical relevance of CYFRA 21-1 as a tumour marker in patients with oropharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2020; 277:2561-2571. [PMID: 32285192 DOI: 10.1007/s00405-020-05962-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The role of Cytokeratin fraction 21-1 (CYFRA 21-1) as a tumour marker for head and neck cancer is still a matter of research. The aim of the present study was to evaluate the clinical impact of CYFRA 21-1 for patients with oropharyngeal squamous cell carcinoma (OSCC). PATIENTS AND METHODS Data of 180 patients with an initial diagnosis of OSCC of any stage between 2003 and 2017 were retrospectively analysed regarding the association between pretherapeutic CYFRA 21-1 levels, clinical characteristics, overall and disease-free survival. Additionally, the potential of CYFRA 21-1 for the detection of recurrent disease in the follow-up was evaluated. The cut-off value was set at 3.3 ng/ml. The median follow-up time was 2.85 years. RESULTS A significant correlation of the CYFRA 21-1 concentration at the time of diagnosis and the N-stage was detected (p = 0.01). Patients with CYFRA 21-1 levels > 3.3 ng/ml at first diagnosis showed a significantly shorter overall survival. In the case of disease-progression, a significant increase of CYFRA 21-1 value was found compared to post-therapeutic CYFRA 21-1 levels (9.1 ng/ml versus 5.1 ng/ml; p < 0.01). CYFRA 21-1 level after treatment showed only a low sensitivity of 32% and a specificity of 78% for tumour recurrence. CONCLUSION CYFRA 21-1 correlates with the tumour stage and, therefore, the survival of OSCC patients. Posttreatment CYFRA21-1 seems not to be a suitable predictor of tumour recurrence in the further course of the disease. However, a sudden increase of CYFRA 21-1 during follow-up may indicate a tumour recurrence in the individual patient.
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14
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Costa JM, Sumarroca A, Rodríguez C, Gutiérrez A, García J, López M, Quer M, León X. Prognostic value of nodal involvement in patients with oropharyngeal carcinoma according to the HPV status. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2020; 71:212-218. [PMID: 31924300 DOI: 10.1016/j.otorri.2019.08.002] [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: 06/02/2019] [Revised: 08/06/2019] [Accepted: 08/13/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Different studies performed in populations with a high incidence of HPV infection have found no prognostic capacity of clinical nodal involvement (cN+) in patients with HPV-positive oropharyngeal carcinomas. The objective of this study was to assess the prognostic ability of nodal involvement in patients with oropharyngeal carcinomas according to HPV status in a cancer population with a low incidence of HPV infection. MATERIAL AND METHODS Retrospective study of a cohort of 420 patients with oropharyngeal carcinomas treated during the period 1990-2016 for whom information on HPV status was available. RESULTS 14.8% of the patients included in the study had HPV-positive tumours. In relation to patients without nodal involvement (cN0), nodal involvement at diagnosis (cN+) significantly decreased the specific survival of patients with HPV-negative oropharyngeal carcinomas. Conversely, no differences in survival were found for patients with HPV-positive tumours according to the presence of nodal involvement. A history of toxic consumption did not change the absence of prognostic significance of nodal involvement for patients with HPV-positive tumours. CONCLUSIONS Regional involvement at the time of diagnosis is not a prognostic variable for patients with HPV-positive oropharyngeal carcinomas.
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Affiliation(s)
- Jose-Miguel Costa
- Servicio de ORL y Cirugía de Cabeza y Cuello, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España.
| | - Anna Sumarroca
- Servicio de ORL y Cirugía de Cabeza y Cuello, Hospital Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - Camilo Rodríguez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Alfons Gutiérrez
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jacinto García
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Montserrat López
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Quer
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | - Xavier León
- Servicio de Otorrinolaringología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Madrid, España
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15
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Hawkins PG, Mierzwa ML, Bellile E, Jackson WC, Malloy KM, Chinn SB, Spector ME, Shuman AG, Stucken CL, McLean SA, Bradford CR, Prince ME, Carey TE, Worden FP, Swiecicki PL, Taylor JMG, Wolf GT, Eisbruch A, Casper KA. Impact of American Joint Committee on Cancer Eighth Edition clinical stage and smoking history on oncologic outcomes in human papillomavirus-associated oropharyngeal squamous cell carcinoma. Head Neck 2019; 41:857-864. [PMID: 30775826 PMCID: PMC6420360 DOI: 10.1002/hed.25336] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/22/2018] [Accepted: 05/07/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the AJCC eighth edition clinical staging system for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma and to further understand how clinical stage and smoking history affect oncologic outcomes. The purpose of this study was to present the understanding of how clinical stage and smoking history affect oncologic outcomes in human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (SCC) is critical for selecting patients for treatment deintensification. METHODS Kaplan-Meier and Cox regression were used to evaluate overall survival (OS), locoregional recurrence-free survival (LRFS), and distant recurrence-free survival (DRFS). Concordance statistics (C-indices) were used to compare discriminating ability. RESULTS The OS and DRFS but not LRFS were significantly distributed using the American Joint Committee on Cancer (AJCC) seventh and eighth editions criteria. The C-indices for OS, LRFS, and DRFS were 0.57, 0.54, and 0.60, respectively, using the AJCC seventh edition, and 0.63, 0.53, and 0.65, respectively, using the AJCC eighth edition. On multivariate analysis, 1 + pack-year smoking history correlated with OS (hazard ratio [HR] 1.96; 95% confidence interval [CI] 1.2-3.1; P < .01) but not LRFS or DRFS. CONCLUSION These results support implementation of the AJCC eighth edition for HPV-associated oropharyngeal SCC. Clinical stage may be more important than smoking history in selection for deintensification.
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Affiliation(s)
- Peter G. Hawkins
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Michelle L. Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Emily Bellile
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - William C. Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Kelly M. Malloy
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven B. Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Matthew E. Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew G. Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Chaz L. Stucken
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Scott A. McLean
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Carol R. Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Mark E. Prince
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas E. Carey
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Francis P. Worden
- Department of Internal Medicine, Division of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Paul L. Swiecicki
- Department of Internal Medicine, Division of Medical Oncology, University of Michigan, Ann Arbor, MI, USA
| | | | - Gregory T. Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Keith A. Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
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16
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Ren J, Yang W, Su J, Ren X, Fazelzad R, Albert T, Habbous S, Goldstein DP, de Almeida JR, Hansen A, Jang R, Bratman SV, Hope A, Chen R, Wang J, Xu Y, Cheng D, Zhao Y, Xu W, Liu G. Human papillomavirus and p16 immunostaining, prevalence and prognosis of squamous carcinoma of unknown primary in the head and neck region. Int J Cancer 2019; 145:1465-1474. [PMID: 30698281 DOI: 10.1002/ijc.32164] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/19/2018] [Accepted: 12/21/2018] [Indexed: 02/05/2023]
Abstract
The prevalence of human papillomavirus (HPV) in squamous cell carcinoma of unknown primary in the head and neck (SCCUPHN), and prognosis by HPV status of SCCUPHN patients has been difficult to estimate because of the rarity of this subtype. In MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, EMBASE, Cochrane library and Web of Science searches, observational studies and clinical trials that reported survival rates of patients with SCCUPHN by HPV status were identified. Meta-analysis estimated the prevalence and prognosis (overall survival, OS; progression-free survival, PFS) of SCCUPHN by HPV status, and compared them to studies of oropharyngeal squamous cell carcinoma (OPSCC) from the same institutions and across continents. In 17 SCCUPHN studies (n = 1,149) and 17 institution-matched OPSCC studies (n = 6,522), the pooled HPV prevalence of SCCUPHN was 49%, which was only 10% (95%CI: 1-19%) lower than OPSCC prevalence in the underlying population. Estimated 5-year OS for HPV-negative SCCUPHN was 44% (95%CI: 36-51%) vs. HPV-positive SCCUPHN of 91% (95%CI: 86-96%); hazard ratio (HR) for OS was 3.25 (95%CI: 2.45-4.31) and PFS was 4.49 (95%CI: 2.88-7.02). HRs by HPV status for OPSCC were similar to that in SCCUPHN. While North American SCCUPHNs had higher HPV prevalence than European SCCUPHNs (OR = 2.68 (95%CI: 1.3-5.6)), HR of OS for HPV-negative vs. HPV-positive patients were similar in both continents (HRs of 3.78-4.09). Prevalence of HPV among SCCUPHN patients were lower than in OPSCC. The survival benefit conferred by being HPV-positive was similar in SCCUPHN as in OPSCCs, independent of continent.
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Affiliation(s)
- Jianjun Ren
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China.,Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Wen Yang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Xue Ren
- Department of Economic Statistics, School of Statistics and Management, Shanghai University of Finance and Economics, Shanghai, China
| | - Rouhi Fazelzad
- Library and Information Services, University Health Network, Toronto, ON, Canada
| | - Tiong Albert
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Steven Habbous
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology- Head and Neck Surgery, Princess Margaret Cancer Centre - University Health Network, University of Toronto, Toronto, ON, Canada
| | - Aaron Hansen
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Raymond Jang
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Scott V Bratman
- Department of Radiation Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Ruiqi Chen
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jing Wang
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yang Xu
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Danni Cheng
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan, China
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Geoffrey Liu
- Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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17
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Jiang X, Ye J, Dong Z, Hu S, Xiao M. Novel genetic alterations and their impact on target therapy response in head and neck squamous cell carcinoma. Cancer Manag Res 2019; 11:1321-1336. [PMID: 30799957 PMCID: PMC6371928 DOI: 10.2147/cmar.s187780] [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] [Indexed: 12/23/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is highly variable by tumor site, histologic type, molecular characteristics, and clinical outcome. During recent years, emerging targeted therapies have been focused on driver genes. HNSCC involves several genetic alterations, such as co-occurrence, multiple feedback loops, and cross-talk communications. These different kinds of genetic alterations interact with each other and mediate targeted therapy response. In the current review, it is emphasized that future treatment strategy in HNSCC will not solely be based on "synthetic lethality" approaches directed against overactivated genes. More importantly, biologic, genetic, and epigenetic alterations of HNSCC will be taken into consideration to guide the therapy. The emerging genetic alterations in HNSCC and its effect on targeted therapy response are discussed in detail. Hopefully, novel combination regimens for the treatment of HNSCC can be developed.
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Affiliation(s)
- Xiaohua Jiang
- Department of Otolaryngology Head and Neck Surgery, Sir Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,
| | - Jing Ye
- Department of Otolaryngology Head and Neck Surgery, Sir Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,
| | - Zhihuai Dong
- Department of Otolaryngology Head and Neck Surgery, Sir Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,
| | - Sunhong Hu
- Department of Otolaryngology Head and Neck Surgery, Sir Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,
| | - Mang Xiao
- Department of Otolaryngology Head and Neck Surgery, Sir Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,
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18
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Beesley LJ, Hawkins PG, Amlani LM, Bellile EL, Casper KA, Chinn SB, Eisbruch A, Mierzwa ML, Spector ME, Wolf GT, Shuman AG, Taylor JMG. Individualized survival prediction for patients with oropharyngeal cancer in the human papillomavirus era. Cancer 2019; 125:68-78. [PMID: 30291798 PMCID: PMC6309492 DOI: 10.1002/cncr.31739] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Accurate, individualized prognostication in patients with oropharyngeal squamous cell carcinoma (OPSCC) is vital for patient counseling and treatment decision making. With the emergence of human papillomavirus (HPV) as an important biomarker in OPSCC, calculators incorporating this variable have been developed. However, it is critical to characterize their accuracy prior to implementation. METHODS Four OPSCC calculators were identified that integrate HPV into their estimation of 5-year overall survival. Treatment outcomes for 856 patients with OPSCC who were evaluated at a single institution from 2003 through 2016 were analyzed. Predicted survival probabilities were generated for each patient using each calculator. Calculator performance was assessed and compared using Kaplan-Meier plots, receiver operating characteristic curves, concordance statistics, and calibration plots. RESULTS Correlation between pairs of calculators varied, with coefficients ranging from 0.63 to 0.90. Only 3 of 6 pairs of calculators yielded predictions within 10% of each other for at least 50% of patients. Kaplan-Meier curves of calculator-defined risk groups demonstrated reasonable stratification. Areas under the receiver operating characteristic curve ranged from 0.74 to 0.80, and concordance statistics ranged from 0.71 to 0.78. Each calculator demonstrated superior discriminatory ability compared with clinical staging according to the seventh and eighth editions of the American Joint Committee on Cancer staging manual. Among models, the Denmark calculator was found to be best calibrated to observed outcomes. CONCLUSIONS Existing calculators exhibited reasonable estimation of survival in patients with OPSCC, but there was considerable variability in predictions for individual patients, which limits the clinical usefulness of these calculators. Given the increasing role of personalized treatment in patients with OPSCC, further work is needed to improve accuracy and precision, possibly through the identification and incorporation of additional biomarkers.
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Affiliation(s)
- Lauren J Beesley
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Peter G Hawkins
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lahin M Amlani
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emily L Bellile
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Keith A Casper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Steven B Chinn
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Michelle L Mierzwa
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew E Spector
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Gregory T Wolf
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jeremy M G Taylor
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
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19
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Elicin O, Broglie MA, Fankhauser N, Stoeckli SJ, Pasche P, Reinhard A, Bongiovanni M, Huber GF, Morand GB, Soltermann A, Arnold A, Dettmer MS, Arnoux A, Stauffer E, Espeli V, Martucci F, Aebersold DM, Giger R. Comparison of contemporary staging systems for oropharynx cancer in a surgically treated multi‐institutional cohort. Head Neck 2018; 41:1395-1402. [DOI: 10.1002/hed.25574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 11/30/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University HospitalUniversity of Bern Bern Switzerland
| | - Martina A. Broglie
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital St. Gallen St. Gallen Switzerland
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Niklaus Fankhauser
- CTU Bern, and Institute of Social and Preventive Medicine (ISPM)University of Bern Bern Switzerland
| | - Sandro J. Stoeckli
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital St. Gallen St. Gallen Switzerland
| | - Philippe Pasche
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of Lausanne Lausanne Switzerland
| | - Antoine Reinhard
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital of Lausanne Lausanne Switzerland
| | - Massimo Bongiovanni
- Service of Clinical PathologyLausanne University Hospital, Institute of Pathology Lausanne Switzerland
| | - Gerhard F. Huber
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital St. Gallen St. Gallen Switzerland
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Grégoire B. Morand
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital Zurich Zurich Switzerland
| | - Alex Soltermann
- Institute of Surgical PathologyUniversity Hospital of Zurich Zurich Switzerland
| | - Andreas Arnold
- Department of Otorhinolaryngology, Head and Neck SurgeryInselspital, Bern University Hospital Bern Switzerland
| | | | - André Arnoux
- Department of Otorhinolaryngology, Head and Neck SurgeryKantonsspital Aarau Aarau Switzerland
| | | | - Vittoria Espeli
- Oncology Institute of Southern Switzerland (IOSI) Bellinzona Switzerland
| | - Francesco Martucci
- Department of RadiooncologyOncology Institute of Southern Switzerland (IOSI) Bellinzona Switzerland
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital, Bern University HospitalUniversity of Bern Bern Switzerland
| | - Roland Giger
- Department of Otorhinolaryngology, Head and Neck SurgeryInselspital, Bern University Hospital Bern Switzerland
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20
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Slavik M, Shatokhina T, Sana J, Ahmad P, Kazda T, Selingerova I, Hermanova M, Cervena R, Novotny T, Burkon P, Smilek P, Horakova Z, Slampa P, Slaby O. Expression of CD44, EGFR, p16, and their mutual combinations in patients with head and neck cancer: Impact on outcomes of intensity-modulated radiation therapy. Head Neck 2018; 41:940-949. [PMID: 30552846 DOI: 10.1002/hed.25533] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 07/18/2018] [Accepted: 09/28/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Progress in radiation treatment of head and neck squamous cell carcinoma (HNSCC) deserves the studies focused on molecular predictors that would help to enhance individually tailored treatment. METHODS p16/epidermal growth factor receptor (EGFR)/cluster of differentiation-44 (CD44) was immunohistochemically analyzed in 165 HNSCC patients. RESULTS In the entire group and the p16 negative cohort, better 3-year overall survival and locoregional control correlated with p16 positivity, CD44, and EGFR negativity were observed. Combined analysis revealed the worst results in the CD44+/p16-, EGFR+/p16-, and EGFR+/CD44+ groups and in the EGFR+/CD44+ within p16 negative cohort. Multivariate analysis found tumor stage, Karnofsky index, p16, and CD44 as prognostic factors of overall survival and clinical stage, and p16 as a prognostic factor for locoregional control. Clinical stage and Karnofsky index affected overall survival and tumor stage. EGFR affected locoregional control in the p16 negative subgroup. CONCLUSION Our study confirmed the negative effect of CD44 and EGFR and the positive effect of p16 on radiotherapy results.
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Affiliation(s)
- Marek Slavik
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Tetiana Shatokhina
- 1st Department of Pathological Anatomy, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Sana
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Parwez Ahmad
- Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Tomas Kazda
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Iveta Selingerova
- Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Department of Mathematics and Statistics, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Marketa Hermanova
- 1st Department of Pathological Anatomy, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Renata Cervena
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Tomas Novotny
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Petr Burkon
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Pavel Smilek
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Zuzana Horakova
- Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne's University Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Pavel Slampa
- Department of Radiation Oncology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Department of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
| | - Ondrej Slaby
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Brno, Czech Republic.,Central European Institute of Technology, Masaryk University, Brno, Czech Republic
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21
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Lewis JS, Beadle B, Bishop JA, Chernock RD, Colasacco C, Lacchetti C, Moncur JT, Rocco JW, Schwartz MR, Seethala RR, Thomas NE, Westra WH, Faquin WC. Human Papillomavirus Testing in Head and Neck Carcinomas: Guideline From the College of American Pathologists. Arch Pathol Lab Med 2018; 142:559-597. [PMID: 29251996 DOI: 10.5858/arpa.2017-0286-cp] [Citation(s) in RCA: 329] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context Human papillomavirus (HPV) is a major cause of oropharyngeal squamous cell carcinomas, and HPV (and/or surrogate marker p16) status has emerged as a prognostic marker that significantly impacts clinical management. There is no current consensus on when to test oropharyngeal squamous cell carcinomas for HPV/p16 or on which tests to choose. Objective To develop evidence-based recommendations for the testing, application, interpretation, and reporting of HPV and surrogate marker tests in head and neck carcinomas. Design The College of American Pathologists convened a panel of experts in head and neck and molecular pathology, as well as surgical, medical, and radiation oncology, to develop recommendations. A systematic review of the literature was conducted to address 6 key questions. Final recommendations were derived from strength of evidence, open comment period feedback, and expert panel consensus. Results The major recommendations include (1) testing newly diagnosed oropharyngeal squamous cell carcinoma patients for high-risk HPV, either from the primary tumor or from cervical nodal metastases, using p16 immunohistochemistry with a 70% nuclear and cytoplasmic staining cutoff, and (2) not routinely testing nonsquamous oropharyngeal carcinomas or nonoropharyngeal carcinomas for HPV. Pathologists are to report tumors as HPV positive or p16 positive. Guidelines are provided for testing cytologic samples and handling of locoregional and distant recurrence specimens. Conclusions Based on the systematic review and on expert panel consensus, high-risk HPV testing is recommended for all new oropharyngeal squamous cell carcinoma patients, but not routinely recommended for other head and neck carcinomas.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - William C Faquin
- From the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Lewis); the Department of Radiation Oncology, Stanford University Medical Center, Palo Alto, California (Dr Beadle); the Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland (Drs Bishop and Westra); the Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, Missouri (Dr Chernock); Surveys, the College of American Pathologists, Northfield, Illinois (Mss Colasacco and Thomas); Policy and Advocacy, American Society of Clinical Oncology, Alexandria, Virginia (Ms Lacchetti); the Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland (Dr Moncur); the Department of Otolaryngology-Head and Neck Surgery, Ohio State University Wexler Medical Center, Columbus (Dr Rocco); the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Schwartz); the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dr Seethala); and the Department of Pathology, Massachusetts General Hospital, Boston (Dr Faquin)
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22
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Bossi P, Resteghini C, Paielli N, Licitra L, Pilotti S, Perrone F. Prognostic and predictive value of EGFR in head and neck squamous cell carcinoma. Oncotarget 2018; 7:74362-74379. [PMID: 27556186 PMCID: PMC5342059 DOI: 10.18632/oncotarget.11413] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 08/12/2016] [Indexed: 01/30/2023] Open
Abstract
EGFR is an extensively studied biomarker in head and neck squamous cell carcinoma (HNSCC). In this review, we discuss the prognostic and predictive role of EGFR in HNSCC, focusing on the different molecular alterations in specific treatment modalities such as radiotherapy alone (RT), combination of surgery, RT and chemotherapy (CT), EGFR inhibitors. We considered EGFR at different molecular levels: protein expression, protein activation, gene copy number, polymorphisms, mutation, EGFRvIII expression and EGFR ligand expression. Considering RT alone, evidence supports the predictive and prognostic role of high EGFR expression only when evaluated by quantitative assays: this may help select the patients who can mostly benefit from accelerated treatment. Conversely, no predictive biomarkers are available when treatment is a combination of surgery, CT and RT. For this combined treatment, several studies indicate that EGFR expression represents a good prognostic parameter only when measured by a “quantitative” or at least semi-quantitative method. With respect to EGFR inhibitors, neither EGFR expression nor increased gene copy number represent prognostic/predictive factors. If validated, nuclear EGFR, TGFα levels, EGFR phopshorylation and polymorphisms could represent additional prognostic factors in relation to combination of surgery, CT and RT, while EGFR polymorphisms and high amphiregulin levels could have prognostic value in patients treated with EGFR inhibitors.
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Affiliation(s)
- Paolo Bossi
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Resteghini
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Nicholas Paielli
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Silvana Pilotti
- Laboratory of Experimental Molecular Pathology, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Perrone
- Laboratory of Experimental Molecular Pathology, Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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23
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Yin LX, D'Souza G, Westra WH, Wang SJ, van Zante A, Zhang Y, Rettig EM, Ryan WR, Ha PK, Wentz A, Koch W, Eisele DW, Fakhry C. Prognostic factors for human papillomavirus-positive and negative oropharyngeal carcinomas. Laryngoscope 2018. [PMID: 29536542 DOI: 10.1002/lary.27130] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES/HYPOTHESIS Human papillomavirus (HPV)-positive and HPV-negative oropharyngeal squamous cell carcinoma (OPSCC) are distinct disease entities. Prognostic factors specific to each entity have not been adequately explored. Goals for this study were: 1) to determine whether HPV-positive and HPV-negative OPSCCs have distinct prognostic factors, and 2) to explore the prognostic significance of sex and race in OPSCC after HPV stratification STUDY DESIGN: Retrospective case series. METHODS A retrospective review of 239 incident OPSCC patients from 1995 to 2012, treated at Johns Hopkins and University of California-San Francisco was conducted. Women and nonwhite races were oversampled. All analyses were stratified by tumor HPV in situ hybridization status. The effects of sex and race on survival were considered in Kaplan-Meier and unadjusted and adjusted Cox regression models. RESULTS One hundred thirty-four (56.1%) OPSCC patients were HPV positive. On univariate analysis, women had better overall survival than men among HPV-positive (hazard ratio [HR]: 0.47, 95% confidence interval [CI]: 0.20-1.07; P = .06) but not HPV-negative (HR: 0.73, 95% CI: 0.43-1.24; P = .24) OPSCCs. On multivariate analysis, women with HPV-positive OPSCCs remained at lower risk of death (adjusted hazard ratio [aHR]: 0.34, 95% CI: 0.12-0.96; P = .04). Survival did not vary significantly by race among HPV-positive patients. Among HPV-negative patients, Hispanic patients had significantly better survival in unadjusted (HR: 0.27, 95% CI: 0.08-0.91; P = .04) but not adjusted (aHR: 0.93, 95% CI: 0.11-7.36; P = .94) analysis. CONCLUSIONS Women with HPV-positive OPSCC may have improved overall survival compared to men. Sex does not play a prognostic role in HPV-negative OPSCC. There are no differences in prognosis by race among HPV-positive or HPV-negative patients. LEVEL OF EVIDENCE 4 Laryngoscope, E287-E295, 2018.
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Affiliation(s)
- Linda X Yin
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | - Gypsyamber D'Souza
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - William H Westra
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Steven J Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona
| | - Annemieke van Zante
- Department of Pathology, University of California-San Francisco, San Francisco, California, U.S.A
| | - Yuehan Zhang
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Eleni M Rettig
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - William R Ryan
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco, San Francisco, California, U.S.A
| | - Alicia Wentz
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
| | - Wayne Koch
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
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24
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Understanding Interactions of Smoking on Prognosis of HPV-Associated Oropharyngeal Cancers. Adv Ther 2018; 35:255-260. [PMID: 29511982 DOI: 10.1007/s12325-018-0682-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Indexed: 01/24/2023]
Abstract
The new 8th edition AJCC/UICC staging system for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC), developed to account for improved survival outcomes over HPV-negative cancers, includes anatomic features strictly associated with tumor-node-metastasis (TNM) and does not account for patient-specific characteristics that may impact prognosis. This commentary evaluates the evidence of smoking as an adverse prognostic factor in HPV-associated OPSCC. We review the multifactorial biological, clinical, and social/behavioral characteristics of smokers with OPSCC that impact outcomes, discuss current challenges with incorporating smoking history in prognostic classifications, and consider opportunities for future investigation.
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25
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Zenga J, Pipkorn P, Graboyes EM, Martin EJ, Rich JT, Moore EJ, Haughey BH, Jackson RS. Oncologic outcomes of extended neck dissections in human papillomavirus-related oropharyngeal squamous cell carcinoma. Head Neck 2018; 40:955-962. [PMID: 29377416 DOI: 10.1002/hed.25060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 09/12/2017] [Accepted: 11/22/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Oncologic outcomes of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (SCC) requiring resection of major muscular or neurovascular tissue during neck dissection for invasive nodal disease remain uncertain. METHODS Patients with HPV-related oropharyngeal SCC requiring resection of major muscular or neurovascular tissue during their neck dissections were retrospectively identified. RESULTS Seventy-two patients were included. Regional and distant recurrences occurred in 6% and 17% of patients. Advanced T classification, pathological node number of 5 or more, and omission of adjuvant therapy were associated with decreased disease-free survival (DFS). The addition of adjuvant chemotherapy was not associated with improved survival. CONCLUSION Patients with invasive nodal disease from HPV-related oropharyngeal SCC can be managed with up-front surgery and adjuvant therapy, as indicated with good regional control. Although distant recurrence was the primary site of failure, adjuvant chemotherapy was not associated with improved outcomes. The T classification, node number, and adjuvant radiotherapy are independent prognostic factors in this patient population.
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Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology - Head and Neck Surgery, Washington University, Saint Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University, Saint Louis, Missouri
| | - Evan M Graboyes
- Department of Otolaryngology - Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Eliot J Martin
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jason T Rich
- Department of Otolaryngology - Head and Neck Surgery, Washington University, Saint Louis, Missouri
| | - Eric J Moore
- Department of Otolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota
| | - Bruce H Haughey
- Department of Surgery, University of Auckland Faculty of Medicine, Auckland, New Zealand.,Head and Neck Surgery Center of Florida, Celebration Hospital, Celebration, Florida
| | - Ryan S Jackson
- Department of Otolaryngology - Head and Neck Surgery, Washington University, Saint Louis, Missouri
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26
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Mermod M, Hiou-Feige A, Bovay E, Roh V, Sponarova J, Bongiovanni M, Vermeer DW, Lee JH, Petrova TV, Rivals JP, Monnier Y, Tolstonog GV, Simon C. Mouse model of postsurgical primary tumor recurrence and regional lymph node metastasis progression in HPV-related head and neck cancer. Int J Cancer 2018; 142:2518-2528. [PMID: 29313973 DOI: 10.1002/ijc.31240] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/07/2017] [Indexed: 01/24/2023]
Abstract
HPV-positive head and neck squamous cell carcinoma (HNSCC) is increasingly frequent. Management is particularly debated in the case of postsurgical high-risk features, that is, positive surgical margins and extracapsular spread (ECS). In this increasingly complex emerging framework of HNSCC treatment, representative preclinical models are needed to support future clinical trials and advances in personalized medicine. Here, we present an immunocompetent mouse model based on the implantation of mouse tonsil epithelial HPV16-E6/E7-expressing cancer cells into the submental region of the floor-of-the-mouth. Primary tumors were found to replicate the patterns of human HNSCC local invasion and lymphatic dissemination. To study disease progression after surgery, tumors were removed likely leaving behind residual disease. Surgical resection of tumors was followed by a high rate of local recurrences (>90%) within the first 2-3 weeks. While only 50% of mice had lymph node metastases (LNM) at time of primary tumor excision, all mice with recurrent tumors showed evidence of LNM. To study the consecutive steps of LNM progression and distant metastasis development, LNs from tumor-bearing mice were transplanted into naïve recipient mice. Using this approach, transplanted LNs were found to recapitulate all stages and relevant histological features of regional metastasis progression, including ECS and metastatic spread to the lungs. Altogether, we have developed an immunocompetent HPV-positive HNSCC mouse model of postsurgical local recurrence and regional and distant metastasis progression suitable for preclinical studies.
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Affiliation(s)
- Maxime Mermod
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Agnès Hiou-Feige
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Esther Bovay
- Department of Fundamental Oncology, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Vincent Roh
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Jana Sponarova
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Massimo Bongiovanni
- Service of Clinical Pathology, Institute of Pathology, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Daniel W Vermeer
- Cancer Biology Research Center, Sanford Research, Sioux Falls, SD
| | - John H Lee
- Cancer Biology Research Center, Sanford Research, Sioux Falls, SD
| | - Tatiana V Petrova
- Department of Fundamental Oncology, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Jean-Paul Rivals
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Yan Monnier
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Genrich V Tolstonog
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Christian Simon
- Department of Otolaryngology - Head and Neck Surgery, CHUV, University of Lausanne, Lausanne, Switzerland
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27
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Kuno H, Qureshi MM, Chapman MN, Li B, Andreu-Arasa VC, Onoue K, Truong MT, Sakai O. CT Texture Analysis Potentially Predicts Local Failure in Head and Neck Squamous Cell Carcinoma Treated with Chemoradiotherapy. AJNR Am J Neuroradiol 2017; 38:2334-2340. [PMID: 29025727 DOI: 10.3174/ajnr.a5407] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/16/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND PURPOSE The accurate prediction of prognosis and failure is crucial for optimizing treatment strategies for patients with cancer. The purpose of this study was to assess the performance of pretreatment CT texture analysis for the prediction of treatment failure in primary head and neck squamous cell carcinoma treated with chemoradiotherapy. MATERIALS AND METHODS This retrospective study included 62 patients diagnosed with primary head and neck squamous cell carcinoma who underwent contrast-enhanced CT examinations for staging, followed by chemoradiotherapy. CT texture features of the whole primary tumor were measured using an in-house developed Matlab-based texture analysis program. Histogram, gray-level co-occurrence matrix, gray-level run-length, gray-level gradient matrix, and Laws features were used for texture feature extraction. Receiver operating characteristic analysis was used to identify the optimal threshold of any significant texture parameter. We used multivariate Cox proportional hazards models to examine the association between the CT texture parameter and local failure, adjusting for age, sex, smoking, primary tumor stage, primary tumor volume, and human papillomavirus status. RESULTS Twenty-two patients (35.5%) developed local failure, and the remaining 40 (64.5%) showed local control. Multivariate analysis revealed that 3 histogram features (geometric mean [hazard ratio = 4.68, P = .026], harmonic mean [hazard ratio = 8.61, P = .004], and fourth moment [hazard ratio = 4.56, P = .048]) and 4 gray-level run-length features (short-run emphasis [hazard ratio = 3.75, P = .044], gray-level nonuniformity [hazard ratio = 5.72, P = .004], run-length nonuniformity [hazard ratio = 4.15, P = .043], and short-run low gray-level emphasis [hazard ratio = 5.94, P = .035]) were significant predictors of outcome after adjusting for clinical variables. CONCLUSIONS Independent primary tumor CT texture analysis parameters are associated with local failure in patients with head and neck squamous cell carcinoma treated with chemoradiotherapy.
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Affiliation(s)
- H Kuno
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Department of Diagnostic Radiology (H.K.), National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - M M Qureshi
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - M N Chapman
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - B Li
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - V C Andreu-Arasa
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - K Onoue
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.)
| | - M T Truong
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.).,Radiation Oncology (M.M.Q., M.T.T., O.S.)
| | - O Sakai
- From the Departments of Radiology (H.K., M.M.Q., M.N.C., B.L., V.C.A.A., K.O., M.T.T., O.S.) .,Radiation Oncology (M.M.Q., M.T.T., O.S.).,Otolaryngology-Head and Neck Surgery (O.S.), Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
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28
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VanKoevering KK, Marchiano E, Walline HM, Carey TE, McHugh JB, Brenner JC, Goudsmit CM, Belille E, Spector ME, Shuman AG. An Algorithm to Evaluate Suspected Lung Metastases in Patients with HPV-Associated Oropharyngeal Cancer. Otolaryngol Head Neck Surg 2017; 158:118-121. [PMID: 28949800 DOI: 10.1177/0194599817733677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Distinguishing between distantly metastatic and metachronous lung primary carcinoma is challenging for patients with a history of head and neck cancer. There are implications for registry data, prognosis and related counseling, and management options, including eligibility for precision oncology trials. Patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma who were treated under a uniform clinical protocol and achieved a complete response were identified in a single-institution prospective head and neck cancer epidemiology database (n = 205). Fifteen patients presented with pulmonary nodule(s) after completion of therapy. We describe our algorithm for the evaluation of these patients, including histopathology, p16 immunohistochemistry, and HPV in situ hybridization.
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Affiliation(s)
- Kyle K VanKoevering
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily Marchiano
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Heather M Walline
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Thomas E Carey
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Jonathan B McHugh
- 2 Department of Pathology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - J Chad Brenner
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Christine M Goudsmit
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Emily Belille
- 3 Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew E Spector
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Andrew G Shuman
- 1 Department of Otolaryngology-Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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29
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Methods for Reducing Normal Tissue Complication Probabilities in Oropharyngeal Cancer: Dose Reduction or Planning Target Volume Elimination. Int J Radiat Oncol Biol Phys 2017; 96:645-52. [PMID: 27681761 DOI: 10.1016/j.ijrobp.2016.06.2456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/15/2016] [Accepted: 06/23/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Strategies to reduce the toxicities of head and neck radiation (ie, dysphagia [difficulty swallowing] and xerostomia [dry mouth]) are currently underway. However, the predicted benefit of dose and planning target volume (PTV) reduction strategies is unknown. The purpose of the present study was to compare the normal tissue complication probabilities (NTCP) for swallowing and salivary structures in standard plans (70 Gy [P70]), dose-reduced plans (60 Gy [P60]), and plans eliminating the PTV margin. METHODS AND MATERIALS A total of 38 oropharyngeal cancer (OPC) plans were analyzed. Standard organ-sparing volumetric modulated arc therapy plans (P70) were created and then modified by eliminating the PTVs and treating the clinical tumor volumes (CTVs) only (C70) or maintaining the PTV but reducing the dose to 60 Gy (P60). NTCP dose models for the pharyngeal constrictors, glottis/supraglottic larynx, parotid glands (PGs), and submandibular glands (SMGs) were analyzed. The minimal clinically important benefit was defined as a mean change in NTCP of >5%. The P70 NTCP thresholds and overlap percentages of the organs at risk with the PTVs (56-59 Gy, vPTV56) were evaluated to identify the predictors for NTCP improvement. RESULTS With the P60 plans, only the ipsilateral PG (iPG) benefited (23.9% vs 16.2%; P<.01). With the C70 plans, only the iPG (23.9% vs 17.5%; P<.01) and contralateral SMG (cSMG) (NTCP 32.1% vs 22.9%; P<.01) benefited. An iPG NTCP threshold of 20% and 30% predicted NTCP benefits for the P60 and C70 plans, respectively (P<.001). A cSMG NTCP threshold of 30% predicted for an NTCP benefit with the C70 plans (P<.001). Furthermore, for the iPG, a vPTV56 >13% predicted benefit with P60 (P<.001) and C70 (P=.002). For the cSMG, a vPTV56 >22% predicted benefit with C70 (P<.01). CONCLUSIONS PTV elimination and dose-reduction lowered the NTCP of the iPG, and PTV elimination lowered the NTCP of the cSMG. NTCP thresholds and the percentage of overlap of the PTV with organs at risk can predict which patients will benefit and inform future clinical trial design.
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30
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Szturz P, Vermorken JB. Immunotherapy in head and neck cancer: aiming at EXTREME precision. BMC Med 2017; 15:110. [PMID: 28571578 PMCID: PMC5455211 DOI: 10.1186/s12916-017-0879-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/19/2017] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Locoregionally advanced, recurrent, and metastatic squamous cell carcinomas of the head and neck (SCCHN) remain difficult to treat disease entities, in which systemic treatment often forms an integral part of their management. Immunotherapy is based on functional restoration of the host immune system, helping to counteract various tumour evasion strategies. Broadly, immunotherapeutic approaches encompass tumour-specific antibodies, cancer vaccines, cytokines, adoptive T-cell transfer, and immune-modulating agents. Until 2015, the epidermal growth factor receptor inhibitor cetuximab, a tumour-specific antibody, represented the only Food and Drug Administration (FDA)-approved targeted therapy for SCCHN. Subsequently, in 2016, the results from two prospective trials employing the immune-modulating antibodies nivolumab and pembrolizumab heralded a new era of anticancer treatment. DISCUSSION Nivolumab and pembrolizumab are monoclonal antibodies against programmed cell death protein-1 (PD-1), an 'immune checkpoint' receptor. Found on the surface of T-cells, PD-1 negatively regulates their activation and can thus be exploited during carcinogenesis. The second-line phase III trial CheckMate-141 randomly assigned 361 patients with recurrent and/or metastatic SCCHN in a 2:1 ratio to receive either single-agent nivolumab (3 mg/kg intravenously every 2 weeks) or standard monotherapy (methotrexate, docetaxel, or cetuximab). Nivolumab improved the objective response rate (13% versus 6%) and median overall survival (OS; 7.5 versus 5.1 months, p = 0.01) without increasing toxicity. Exploratory biomarker analyses indicated that patients treated with nivolumab had longer OS than those given standard therapy, regardless of tumour PD-1 ligand (PD-L1) expression or p16 status. In the non-randomised, multicohort phase Ib study KEYNOTE-012, treatment with pembrolizumab achieved comparable results. Importantly, most of the responding patients had a long-lasting response. CONCLUSION Based on recent results, nivolumab and pembrolizumab have been approved by the FDA as new standard-of-care options for the second-line treatment of recurrent and/or metastatic SCCHN. Generally well tolerated, these novel drugs demonstrated modest response rates, with tumour regressions usually being durable, even in platinum-resistant/refractory cases. The next step will be to extend the observed benefit to first-line treatment, currently dominated by the EXTREME regimen (platinum/5-fluorouracil/cetuximab), and to the locoregionally advanced setting, where concurrent chemoradiation with cisplatin is standard. Regimens combining immunotherapy with other modalities will probably further improve outcomes.
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Affiliation(s)
- Petr Szturz
- Department of Internal Medicine, Hematology, and Oncology, University Hospital Brno, Brno, Czech Republic.,School of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
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Stenmark MH, Shumway D, Guo C, Vainshtein J, Mierzwa M, Jagsi R, Griggs JJ, Banerjee M. Influence of human papillomavirus on the clinical presentation of oropharyngeal carcinoma in the United States. Laryngoscope 2017; 127:2270-2278. [PMID: 28304083 DOI: 10.1002/lary.26566] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/23/2017] [Accepted: 02/06/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Much of what is known about the significance of human papillomavirus (HPV) in oropharyngeal squamous cell carcinoma is derived from single-institution retrospective studies, post hoc analyses of tissue specimens from clinical trials, and tissue bank studies with a small sample size. The objective of this study is to investigate the impact of HPV on the frequency and clinical presentation of oropharyngeal carcinoma in a large, national sample with information from patients who underwent HPV testing. STUDY DESIGN Retrospective, cross-sectional study. METHODS We identified a comprehensive national sample of 8,359 patients with oropharyngeal carcinoma and known HPV status diagnosed between 2010 and 2011 within the National Cancer Database. Multivariable logistic regression was used to assess correlates of patient and tumor characteristics on HPV status. RESULTS Among patients with oropharyngeal carcinoma, the frequency of HPV-related squamous cell carcinoma in the United States was 65.4%. HPV-related oropharyngeal carcinoma was associated with younger age, male sex, and white race (P < 0.001). Advanced primary tumor stage was associated with HPV-negative disease (P < 0.001), whereas increasing nodal burden was associated with HPV-positive disease (P < 0.001). Despite less-advanced nodal disease, HPV-negative tumors were associated with a higher likelihood of metastasis at presentation (P < 0.001). CONCLUSION HPV now accounts for the majority of newly diagnosed oropharyngeal carcinoma in the United States and is associated with a distinct clinical profile, supporting efforts to re-evaluate the staging and treatment paradigm for HPV-associated oropharyngeal cancer. LEVEL OF EVIDENCE 4. Laryngoscope, 127:2270-2278, 2017.
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Affiliation(s)
- Matthew H Stenmark
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A
| | - Dean Shumway
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A
| | - Cui Guo
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, U.S.A
| | - Jeffrey Vainshtein
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A
| | - Jennifer J Griggs
- Department of Internal Medicine, Hematology and Oncology Division, University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A
| | - Mousumi Banerjee
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, U.S.A
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Porceddu SV, Milne R, Brown E, Bernard A, Rahbari R, Cartmill B, Foote M, McGrath M, Coward J, Panizza B. Validation of the ICON-S staging for HPV-associated oropharyngeal carcinoma using a pre-defined treatment policy. Oral Oncol 2017; 66:81-86. [DOI: 10.1016/j.oraloncology.2017.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/17/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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Zenga J, Haughey BH, Jackson RS, Adkins DR, Aranake-Chrisinger J, Bhatt N, Gay HA, Kallogjeri D, Martin EJ, Moore EJ, Paniello RC, Rich JT, Thorstad WL, Nussenbaum B. Outcomes of surgically treated human papillomavirus-related oropharyngeal squamous cell carcinoma with N3 disease. Laryngoscope 2016; 127:2033-2037. [PMID: 28008626 DOI: 10.1002/lary.26455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 10/29/2016] [Accepted: 11/14/2016] [Indexed: 01/20/2023]
Affiliation(s)
- Joseph Zenga
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Bruce H. Haughey
- Department of Surgery; University of Auckland Faculty of Medicine; Auckland New Zealand
- Head and Neck Surgery Center of Florida; Celebration Hospital, Celebration; Florida U.S.A
| | - Ryan S. Jackson
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Douglas R. Adkins
- Department of Medical Oncology; Washington University; St. Louis Missouri U.S.A
| | | | - Neel Bhatt
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Hiram A. Gay
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Dorina Kallogjeri
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Eliot J. Martin
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Randal C. Paniello
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Jason T. Rich
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
| | - Wade L. Thorstad
- Department of Radiation Oncology; Washington University; St. Louis Missouri U.S.A
| | - Brian Nussenbaum
- Department of Otolaryngology-Head and Neck Surgery; Washington University; St. Louis Missouri U.S.A
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Human Papilloma Virus in Oral Cavity Cancer and Relation to Change in Quality of Life Following Treatment-a Pilot Study from Northern India. Indian J Surg Oncol 2016; 7:386-391. [PMID: 27872524 DOI: 10.1007/s13193-016-0559-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/06/2016] [Indexed: 01/09/2023] Open
Abstract
Human papilloma virus (HPV)-associated head and neck cancer (HNC) has generated significant amount of research interest in recent times with focus shifted to oral cavity squamous cell cancer (OCSCC) after oropharyngeal cancer. Due to high incidence of OCSCC and anecdotal reports on association of HPV infection from northern region of India, this study was conceived to investigate HPV infection and establish its association with lifestyle habits such as tobacco, alcohol consumption, oro-genital sex, number of sexual contacts, and change in quality of life posttreatment. A total of 43 primary OCSCC biopsy specimens were collected. These samples were analyzed for HPV DNA genotyping which was done by using 13 high-risk HPV real-time PCR kits. Quality of life was assessed using University of Washington questionnaire for HNC patients, which was administered pretreatment and 3-months posttreatment. HPV presence was confirmed in only three patients (7.0 %). HPV positivity did not find any statistical correlation with age, gender, residence, addiction habit, stage, tumor size, nodal status, tumor grade, and number of sexual contacts. There was no significant (p > 0.05) difference in the average percent change in QOL parameters from pretreatment to posttreatment when correlated with HPV status.
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Management of advanced nodal disease in patients treated with primary chemoradiotherapy. Curr Opin Oncol 2016; 28:201-4. [DOI: 10.1097/cco.0000000000000283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Horne ZD, Glaser SM, Vargo JA, Ferris RL, Balasubramani GK, Clump DA, Heron DE, Beriwal S. Confirmation of proposed human papillomavirus risk-adapted staging according to AJCC/UICC TNM criteria for positive oropharyngeal carcinomas. Cancer 2016; 122:2021-30. [DOI: 10.1002/cncr.30021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Zachary D. Horne
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Scott M. Glaser
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - John A. Vargo
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Robert L. Ferris
- Department of Otolaryngology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Goundappa K. Balasubramani
- Epidemiology Data Center, Department of Epidemiology; University of Pittsburgh Graduate School of Public Health; Pittsburgh Pennsylvania
| | - David A. Clump
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Dwight E. Heron
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
| | - Sushil Beriwal
- Department of Radiation Oncology; University of Pittsburgh Cancer Institute; Pittsburgh Pennsylvania
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Saito Y, Ando M, Omura G, Yasuhara K, Yoshida M, Takahashi W, Yamasoba T. Induction Chemotherapy for p16 Positive Oropharyngeal Squamous Cell Carcinoma. Laryngoscope Investig Otolaryngol 2016; 1:28-32. [PMID: 28894801 PMCID: PMC5527349 DOI: 10.1002/lio2.18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/05/2016] [Accepted: 02/20/2016] [Indexed: 12/14/2022] Open
Abstract
Objectives/Hypothesis We aimed to determine the effectiveness of induction chemotherapy for treating p16‐positive oropharyngeal cancer in our department. Study Design This was a retrospective case series to assess treatment effectiveness. Methods We administered induction chemotherapy to patients with stage III to IV oropharyngeal p16‐positive squamous cell carcinoma between 2008 and 2013. Induction chemotherapy was administered using combinations of docetaxel, cisplatin, and 5‐fluorouracil. We measured the survival rates using the Kaplan‐Meier method and log‐rank test. Results We reviewed 23 patients (18 men and 5 women; age, 42–79 years). Induction chemotherapy resulted in partial or complete remission (20 patients) and in stable (2 patients) or progressive (1 patient) disease. In partial or complete remission, subsequent radiotherapy was performed in 16 patients, chemoradiotherapy in two, and transoral resection in two. In stable or progressive disease, subsequent open surgery was performed. Overall, one patient died of cervical lymph node metastasis, one died of kidney cancer, and one died of myocardial infarction. Event‐free, distant‐metastasis–free survival was present for 20 patients. The 3‐year disease‐specific survival was 95%; the overall survival was 87%. Two patients required gastrostomies during chemoradiotherapy and three required tracheotomies, but these were closed in all patients. Conclusion The therapeutic response to induction chemotherapy for p16‐positive oropharyngeal cancer was good. Partial or complete remission was achieved in almost 90% patients, and control of local and distant metastases was possible when it was followed by radiotherapy alone or with transoral resection of the primary tumor. A multicenter study is required to confirm these findings. Level of Evidence 4.
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Affiliation(s)
- Yuki Saito
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | - Mizuo Ando
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | - Go Omura
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | - Kazuo Yasuhara
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | - Masafumi Yoshida
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
| | | | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery (y.s., m.a., g.o., k.y., m.y., t.y.)
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O'Sullivan B, Huang SH, Su J, Garden AS, Sturgis EM, Dahlstrom K, Lee N, Riaz N, Pei X, Koyfman SA, Adelstein D, Burkey BB, Friborg J, Kristensen CA, Gothelf AB, Hoebers F, Kremer B, Speel EJ, Bowles DW, Raben D, Karam SD, Yu E, Xu W. Development and validation of a staging system for HPV-related oropharyngeal cancer by the International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S): a multicentre cohort study. Lancet Oncol 2016; 17:440-451. [PMID: 26936027 DOI: 10.1016/s1470-2045(15)00560-4] [Citation(s) in RCA: 480] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 11/27/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Human papillomavirus-related (HPV+) oropharyngeal cancer is a rapidly emerging disease with generally good prognosis. Many prognostic algorithms for oropharyngeal cancer incorporate HPV status as a stratification factor, rather than recognising the uniqueness of HPV+ disease. The International Collaboration on Oropharyngeal cancer Network for Staging (ICON-S) aimed to develop a TNM classification specific to HPV+ oropharyngeal cancer. METHODS The ICON-S study included patients with non-metastatic oropharyngeal cancer from seven cancer centres located across Europe and North America; one centre comprised the training cohort and six formed the validation cohorts. We ascertained patients' HPV status with p16 staining or in-situ hybridisation. We compared overall survival at 5 years between training and validation cohorts according to 7th edition TNM classifications and HPV status. We used recursive partitioning analysis (RPA) and adjusted hazard ratio (AHR) modelling methods to derive new staging classifications for HPV+ oropharyngeal cancer. Recent hypotheses concerning the effect of lower neck lymph nodes and number of lymph nodes were also investigated in an exploratory training cohort to assess relevance within the ICON-S classification. FINDINGS Of 1907 patients with HPV+ oropharyngeal cancer, 661 (35%) were recruited at the training centre and 1246 (65%) were enrolled at the validation centres. 5-year overall survival was similar for 7th edition TNM stage I, II, III, and IVA (respectively; 88% [95% CI 74-100]; 82% [71-95]; 84% [79-89]; and 81% [79-83]; global p=0·25) but was lower for stage IVB (60% [53-68]; p<0·0001). 5-year overall survival did not differ among N0 (80% [95% CI 73-87]), N1-N2a (87% [83-90]), and N2b (83% [80-86]) subsets, but was significantly lower for those with N3 disease (59% [51-69]; p<0·0001). Stage classifications derived by RPA and AHR models were ranked according to survival performance, and AHR-New was ranked first, followed by AHR-Orig, RPA, and 7th edition TNM. AHR-New was selected as the proposed ICON-S stage classification. Because 5-year overall survival was similar for patients classed as T4a and T4b, T4 is no longer subdivided in the re-termed ICON-S T categories. Since 5-year overall survival was similar among N1, N2a, and N2b, we re-termed the 7th edition N categories as follows: ICON-S N0, no lymph nodes; ICON-S N1, ipsilateral lymph nodes; ICON-S N2, bilateral or contralateral lymph nodes; and ICON-S N3, lymph nodes larger than 6 cm. This resembles the N classification of nasopharyngeal carcinoma but without a lower neck lymph node variable. The proposed ICON-S classification is stage I (T1-T2N0-N1), stage II (T1-T2N2 or T3N0-N2), and stage III (T4 or N3). Metastatic disease (M1) is classified as ICON-S stage IV. In an exploratory training cohort (n=702), lower lymph node neck involvement had a significant effect on survival in ICON-S stage III but had no effect in ICON-S stage I and II and was not significant as an independent factor. Overall survival was similar for patients with fewer than five lymph nodes and those with five or more lymph nodes, within all ICON-S stages. INTERPRETATION Our proposed ICON-S staging system for HPV+ oropharyngeal cancer is suitable for the 8th edition of the Union for International Cancer Control/American Joint Committee on Cancer TNM classification. Future work is needed to ascertain whether T and N categories should be further refined and whether non-anatomical factors might augment the full classification. FUNDING None.
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Affiliation(s)
- Brian O'Sullivan
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
| | - Shao Hui Huang
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Jie Su
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | | | - Nancy Lee
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem Riaz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xin Pei
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David Adelstein
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Brian B Burkey
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA
| | - Jeppe Friborg
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anita B Gothelf
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Frank Hoebers
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Bernd Kremer
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Ernst-Jan Speel
- GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | - David Raben
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Sana D Karam
- University of Colorado Cancer Center, Aurora, CO, USA
| | - Eugene Yu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Wei Xu
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Samuels SE, Tao Y, Lyden T, Haxer M, Spector M, Malloy KM, Prince ME, Bradford CR, Worden FP, Schipper M, Eisbruch A. Comparisons of dysphagia and quality of life (QOL) in comparable patients with HPV-positive oropharyngeal cancer receiving chemo-irradiation or cetuximab-irradiation. Oral Oncol 2016; 54:68-74. [PMID: 26776757 DOI: 10.1016/j.oraloncology.2015.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/08/2015] [Accepted: 12/15/2015] [Indexed: 12/30/2022]
Abstract
PURPOSE Compare functional outcomes of radiotherapy (RT) concurrent with cetuximab (cet-RT) or with chemotherapy (chemo-RT) for comparable, good prognosis patients with human papillomavirus related (HPV+) oropharyngeal cancer (OPC). METHODS Outcomes of patients with stage III/IV HPV+ OPC patients with minimal smoking history and non-T4/N3/N2C, treated on prospective protocol of RT concurrent with cetuximab (cet-RT), were compared to similar patients on prospective chemo-RT protocols. In both groups, videofluoroscopy (VF), observer rated dysphagia (ORD), and validated QOL questionnaires: xerostomia questionnaire (XQ), head and neck QOL, and University of Washington QOL, were performed periodically and compared to pretreatment. Mixed effects models with adjustment for baseline assessed differences between groups. RESULTS 26 cet-RT patients were compared to 27 chemo-RT patients with similar baseline characteristics. In the chemo-RT group, no recurrences occurred. In the cet-RT group, 1 patient had persistent microscopic disease on salvage neck dissection and 1 distant failure. Both groups had mild VF-based swallowing dysfunction pre-treatment, worsened at 3 months (P<0.02) and persisted at 12 months, not differing between groups (P>0.11). For both groups ORD was very low pretreatment, worsened at 3 months and improved at 12 months, without differences between treatment groups (P=0.26). QOL Summary and domain scores for eating were good pretreatment, worse at 3 mo, and then improved to near baseline at 12 months, without differences between the groups in any QOL domains (P>0.10). CONCLUSION Both groups had excellent clinical outcomes without significant differences in objective or subjective functions. These data question using cetuximab instead of chemotherapy for treatment de-intensification for HPV+ OPC.
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Affiliation(s)
- Stuart E Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States
| | - Yebin Tao
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Teresa Lyden
- Department of Speech Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Marc Haxer
- Department of Speech Pathology, University of Michigan, Ann Arbor, MI, United States
| | - Matthew Spector
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Kelly M Malloy
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Mark E Prince
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Carol R Bradford
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, United States
| | - Francis P Worden
- Department of Medicine - Medical Oncology Division, University of Michigan, United States
| | - Matthew Schipper
- Department of Radiation Oncology and Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States.
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Nien HH, Sturgis EM, Kies MS, El-Naggar AK, Morrison WH, Beadle BM, Johnson FM, Gunn GB, Fuller CD, Phan J, Gold KA, Frank SJ, Skinner H, Rosenthal DI, Garden AS. Comparison of systemic therapies used concurrently with radiation for the treatment of human papillomavirus-associated oropharyngeal cancer. Head Neck 2015; 38 Suppl 1:E1554-61. [DOI: 10.1002/hed.24278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/26/2015] [Accepted: 09/08/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hsin-Hua Nien
- Department of Radiation Oncology; Cathay General Hospital; Taipei Taiwan
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Erich M. Sturgis
- Department of Head and Neck Surgery; The University of Texas MD Anderson Cancer Center; Houston Texas
- Department of Epidemiology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Merrill S. Kies
- Department of Thoracic/Head and Neck Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Adel K. El-Naggar
- Department of Pathology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - William H. Morrison
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Beth M. Beadle
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Faye M. Johnson
- Department of Thoracic/Head and Neck Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
- The University of Texas Graduate School of Biomedical Sciences; Houston Texas
| | - Gary B. Gunn
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Clifton D. Fuller
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Jack Phan
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Kathryn A. Gold
- Department of Thoracic/Head and Neck Medicine; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Steven J. Frank
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Heath Skinner
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - David I. Rosenthal
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
| | - Adam S. Garden
- Department of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston Texas
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Kumar R, Rai AK, Das D, Das R, Kumar RS, Sarma A, Sharma S, Kataki AC, Ramteke A. Alcohol and Tobacco Increases Risk of High Risk HPV Infection in Head and Neck Cancer Patients: Study from North-East Region of India. PLoS One 2015; 10:e0140700. [PMID: 26473489 PMCID: PMC4608822 DOI: 10.1371/journal.pone.0140700] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 09/28/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Human papilloma virus (HPV) associated Head and Neck Cancers (HNCs) have generated significant amount of research interest in recent times. Due to high incidence of HNCs and lack of sufficient data on high-risk HPV (hr-HPV) infection from North -East region of India, this study was conceived to investigate hr-HPV infection, its types and its association with life style habits such as tobacco, alcohol consumption etc. METHODS A total of one hundred and six primary HNC tumor biopsy specimens were collected. These samples were analyzed for hr-HPV DNA (13 HPV types) using hybrid capture 2 (HC2) assay and genotyping was done by E6 nested multiplex PCR (NMPCR). RESULTS The presence of hr-HPV was confirmed in 31.13% (n = 33) and 24.52% (n = 26) of the HNC patients by nested multiplex PCR (NMPCR) and HC2 assay respectively. Among hr-HPV positive cases, out of thirteen hr- HPV types analyzed, only two prevalent genotypes, HPV-16 (81.81%) followed by HPV-18 (18.18%) were found. Significant association was observed between hr-HPV infection with alcohol consumption (p <0.001) and tobacco chewing (p = 0.02) in HNC cases. Compared to HPV-18 infection the HPV-16 was found to be significantly associated with tobacco chewing (p = 0.02) habit. CONCLUSIONS Our study demonstrated that tobacco chewing and alcohol consumption may act as risk factors for hr-HPV infection in HNCs from the North-East region of India. This was the first study from North-East India which also assessed the clinical applicability of HC2 assay in HNC patient specimens. We suggest that alcohol, tobacco and hr- HPV infection act synergistically or complement each other in the process of HNC development and progression in the present study population.
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Affiliation(s)
- Rupesh Kumar
- Cancer Genetics and Chemoprevention Research Group, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
| | - Avdhesh Kumar Rai
- DBT center for Molecular Biology and Cancer Research, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Debabrata Das
- DBT center for Molecular Biology and Cancer Research, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Rajjyoti Das
- Department of Head and Neck Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - R. Suresh Kumar
- Division of Molecular Genetics, Institute of Cytology and Preventive Oncology (ICMR), I-7, Sector 39, Noida, Uttar Pradesh, India
| | - Anupam Sarma
- Department of Pathology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Shashi Sharma
- Division of Epidemiology and Biostatistics, Institute of Cytology and Preventive Oncology (ICMR), I-7, Sector 39, Noida, Uttar Pradesh, India
| | - Amal Chandra Kataki
- Department of Gynecologic oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India
| | - Anand Ramteke
- Cancer Genetics and Chemoprevention Research Group, Department of Molecular Biology and Biotechnology, Tezpur University, Tezpur, Assam, India
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Samuels SE, Eisbruch A, Beitler JJ, Corry J, Bradford CR, Saba NF, van den Brekel MWM, Smee R, Strojan P, Suárez C, Mendenhall WM, Takes RP, Rodrigo JP, Haigentz M, Rapidis AD, Rinaldo A, Ferlito A. Management of locally advanced HPV-related oropharyngeal squamous cell carcinoma: where are we? Eur Arch Otorhinolaryngol 2015; 273:2877-94. [PMID: 26463714 DOI: 10.1007/s00405-015-3771-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/25/2015] [Indexed: 12/13/2022]
Abstract
HPV-related (HPV+) oropharyngeal cancer (OPC) has a better prognosis compared to HPV unrelated (HPV-) OPC. This review summarizes and discusses several of the controversies regarding the management of HPV+ OPC, including the mechanism of its treatment sensitivity, modern surgical techniques, chemotherapy regimens, and treatment de-intensification protocols. We also discuss and reconsider potential adverse prognostic factors such as tumor EGFR expression, tumor hypoxia, and patient smoking history, as well as the significance of retropharyngeal adenopathy. Finally, we discuss elective nodal treatment of uninvolved lymph node stations. While this review does not exhaust all controversies related to the management of HPV+ OPC, it aims to highlight some of the most clinically relevant ones.
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Affiliation(s)
- Stuart E Samuels
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - Jonathan J Beitler
- Departments of Radiation Oncology, Otolaryngology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - June Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Carol R Bradford
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nabil F Saba
- Department of Hematology and Medical Oncology, The Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Michiel W M van den Brekel
- Department of Head and Neck Surgery and Oncology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Carlos Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | | | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Missak Haigentz
- Division of Oncology, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Alexander D Rapidis
- Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece
| | | | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy.
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The rationale for HPV-related oropharyngeal cancer de-escalation treatment strategies. Contemp Oncol (Pozn) 2015; 19:313-22. [PMID: 26557780 PMCID: PMC4631307 DOI: 10.5114/wo.2015.54389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/08/2015] [Accepted: 03/09/2015] [Indexed: 02/06/2023] Open
Abstract
The treatment paradigms for head and neck squamous cell cancer (HNSCC) are changing due to the emergence of human papillomavirus-associated tumors (HPV-related), possessing distinct molecular profiles and responses to therapy. Retrospective studies have suggested that HPV-related HNSCCs are more frequently cured than those caused by tobacco. Current clinical trials focus on the reduction of treatment-related toxicity and the development of HPV-targeted therapies. New treatment strategies include: 1) dose reduction of radiotherapy, 2) the use of cetuximab instead of cisplatin for chemo-radiation 3) less invasive surgical options, i.e. trans-oral robotic surgery and trans-oral laser microlaryngoscopy, and 4) more specific treatment attempts, including immunotherapeutic strategies, thanks to increasing comprehension of the molecular background of HPV-related HNSCC. Whereas recently published data shed light on immune mechanisms, other studies have focused on specific vaccination against HPV-related HNSCC. A crucial problem is patient selection to the chosen bias. Truly HPV-related cancers (p16-positive and HPV DNA-positive) with biomarkers for good response to therapy could be included in randomized trials aiming for less severe and better tailored therapy.
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44
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Wang HM, Cheng NM, Lee LY, Fang YHD, Chang JTC, Tsan DL, Ng SH, Liao CT, Yang LY, Yen TC. Heterogeneity of (18)F-FDG PET combined with expression of EGFR may improve the prognostic stratification of advanced oropharyngeal carcinoma. Int J Cancer 2015; 138:731-8. [PMID: 26311121 DOI: 10.1002/ijc.29811] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/14/2015] [Indexed: 01/03/2023]
Abstract
The Ang's risk profile (based on p16, smoking and cancer stage) is a well-known prognostic factor in oropharyngeal squamous cell carcinoma (OPSCC). Whether heterogeneity in (18)F-fluorodeoxyglucose (FDG) positron emission tomographic (PET) images and epidermal growth factor receptor (EGFR) expression could provide additional information on clinical outcomes in advanced-stage OPSCC was investigated. Patients with stage III-IV OPSCC who completed primary therapy were eligible. Zone-size nonuniformity (ZSNU) extracted from pretreatment FDG PET scans was used as an index of image heterogeneity. EGFR and p16 expression were examined by immunohistochemistry. Disease-specific survival (DSS) and overall survival (OS) served as outcome measures. Kaplan-Meier estimates and Cox proportional hazards regression models were used for survival analysis. A bootstrap resampling technique was applied to investigate the stability of outcomes. Finally, a recursive partitioning analysis (RPA)-based model was constructed. A total of 113 patients were included, of which 28 were p16-positive. Multivariate analysis identified the Ang's profile, EGFR and ZSNU as independent predictors of both DSS and OS. Using RPA, the three risk factors were used to devise a prognostic scoring system that successfully predicted DSS in both p16-positive and -negative cases. The c-statistic of the prognostic index for DSS was 0.81, a value which was significantly superior to both AJCC stage (0.60) and the Ang's risk profile (0.68). In patients showing an Ang's high-risk profile (N = 77), the use of our scoring system clearly identified three distinct prognostic subgroups. It was concluded that a novel index may improve the prognostic stratification of patients with advanced-stage OPSCC.
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Affiliation(s)
- Hung-Ming Wang
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Nai-Ming Cheng
- Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, 33305, Taiwan.,Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu City, 30071, Taiwan
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Yu-Hua Dean Fang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan City, 70101, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Din-Li Tsan
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Chun-Ta Liao
- Department of Otolaryngology, Head & Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, 33305, Taiwan
| | - Lan-Yan Yang
- Chang Gung Memorial Hospital, Biostatistics Unit, Clinical Trial Center, Taoyuan City, 33305, Taiwan
| | - Tzu-Chen Yen
- Department of Nuclear Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan City, 33305, Taiwan
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The association of (18)F-FDG PET and glucose metabolism biomarkers GLUT1 and HK2 in p16 positive and negative head and neck squamous cell carcinomas. Radiother Oncol 2015; 117:118-24. [PMID: 26328941 DOI: 10.1016/j.radonc.2015.08.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 08/11/2015] [Accepted: 08/21/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To investigate the relationship between FDG-PET maximum standard uptake value (SUVmax), p16, EGFR, GLUT1 and HK2 expression in head and neck squamous cell carcinomas (HNSCC). MATERIALS AND METHODS Immunohistochemical staining of p16, EGFR, GLUT1 and HK2 was performed on primary tumor tissue from 97 locally advanced HNSCC patients treated with definitive chemoradiation. SUVmax along with p16, EGFR, GLUT1 and HK2 expression were analyzed for associations including local control, locoregional control and disease free survival. RESULTS Pretreatment SUVmax in primary tumors did not differ when stratified by p16, EGFR or GLUT1 expression but SUVmax was significantly higher in HK2 expressing tumors (p=0.021) and in tumors with higher T-stage (p=0.022). GLUT1 expression was significantly higher in p16 negative (p<0.001) and EGFR positive tumors (p<0.01). HK2 expressing tumors were associated with EGFR positive tumors (p=0.022) but not with p16 or GLUT1 expression. EGFR positive, p16 negative and high GLUT1 expressing tumors were associated with worse local control and disease free survival on univariate analyses. After adjusting for patient and treatment characteristics p16 status was the only factor that predicted for outcome on multivariate analysis. CONCLUSIONS High GLUT1 expression was associated with EGFR positive and p16 negative HNSCC tumors. GLUT1 maybe an important biomarker in HNSCC but its expression appears dependent on p16 status.
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46
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Sjövall J, Wahlberg P, Almquist H, Kjellén E, Brun E. A prospective study of positron emission tomography for evaluation of neck node response 6 weeks after radiotherapy in patients with head and neck squamous cell carcinoma. Head Neck 2015; 38 Suppl 1:E473-9. [DOI: 10.1002/hed.24021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 11/20/2014] [Accepted: 02/23/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Johanna Sjövall
- Department of ORL-Head and Neck Surgery; Clinical Sciences, Skane University Hospital, Lund University; Sweden
| | - Peter Wahlberg
- Department of ORL-Head and Neck Surgery; Clinical Sciences, Skane University Hospital, Lund University; Sweden
| | - Helen Almquist
- Department of Clinical Physiology and Nuclear Medicine; Skane University Hospital, Lund University; Sweden
| | - Elisabeth Kjellén
- Department of Oncology; Clinical Sciences, Skane University Hospital, Lund University; Sweden
| | - Eva Brun
- Department of Oncology; Clinical Sciences, Skane University Hospital, Lund University; Sweden
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47
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Vainshtein JM, Spector ME, Ibrahim M, Bradford CR, Wolf GT, Stenmark MH, Worden FP, McHugh JB, Prince ME, Carey T, Chepeha DB, Eisbruch A. Matted nodes: High distant-metastasis risk and a potential indication for intensification of systemic therapy in human papillomavirus-related oropharyngeal cancer. Head Neck 2015; 38 Suppl 1:E805-14. [PMID: 25914344 DOI: 10.1002/hed.24105] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The purpose of this study was to determine whether matted nodes uniquely identify patients with human papillomavirus (HPV)-positive oropharyngeal cancer at disproportionately high distant failure risk who may benefit from intensified systemic therapy. METHODS One hundred seventy-eight patients with stage III/IV HPV-positive oropharyngeal cancer who completed definitive chemoradiotherapy were stratified by risk group (low-risk = T1-3/N0-2c/<10 pack-years; intermediate-risk = T1-3/N0-2c/≥10 pack-years; and high-risk = T4 or N3). Prognostic impact of matted nodes was assessed. RESULTS At the 52-month median follow-up, event rates with and without matted nodes were: locoregional failure: 23.3% versus 12.8% (p = .16), distant failure: 50.0% versus 1.4% (p < .01), any failure: 73.3% versus 14.2% (p < .01); cause-specific mortality: 56.7% versus 5.4% (p < .01), and death: 56.7% versus 13.5% (p < .01). In multivariate analyses, including risk group and individual risk factors, matted nodes were the strongest predictor for all endpoints except locoregional failure. Among patients without matted nodes, risk-group discriminated locoregional failure (at 3 years: low-risk = 2.0%; intermediate-risk = 14.4%; and high-risk = 24.2%; p < .01), but not distant failure (low-risk = 0.0%; intermediate-risk = 2.1%; and high-risk = 3.8%; p = .53). CONCLUSION Matted nodes portended dramatically increased distant failure and death risks in HPV-positive oropharyngeal cancer, identifying a candidate population for consideration of chemo-intensification. © 2015 Wiley Periodicals, Inc. Head Neck 38: E805-E814, 2016.
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Affiliation(s)
| | - Matthew E Spector
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mohannad Ibrahim
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Carol R Bradford
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Gregory T Wolf
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Matthew H Stenmark
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Francis P Worden
- Division of Hematology Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan, Ann Arbor, Michigan
| | - Mark E Prince
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Thomas Carey
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Douglas B Chepeha
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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48
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Impact of retropharyngeal adenopathy on distant control and survival in HPV-related oropharyngeal cancer treated with chemoradiotherapy. Radiother Oncol 2015; 116:75-81. [PMID: 26094074 DOI: 10.1016/j.radonc.2015.06.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/05/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE Retropharyngeal adenopathy (RPA) is poor prognostic factor in head and neck (HN) cancer. However, the prognostic significance of RPA in Human Papillomavirus-related (HPV+) oropharyngeal cancer (OPC) is unknown. PATIENTS AND METHODS 185 patients with HPV+OPC were assessed. Pre-therapy images reviewed by a HN radiologist to determine presence of RPA. Doses to the RPAs were determined from treatment plans. Outcomes analyzed using Kaplan-Meier method, log-rank tests, and correlations determined using Spearman's rank analyses. RESULTS 29 (16%) of the HPV+patients had RPA. At median follow-up 49months, 5-year overall survival (OS), failure-free survival (FFS) and distant failure-free survival (DFFS) were 57% vs. 81% (P=0.02), 63% vs 80% (P=0.015) and 70% vs 91% (P=0.002) for patients with/without RPA, respectively. No differences observed in local/ regional control rates, exceeding 90% in both groups, and No RPA recurrences were observed. In multivariable analysis, stages T4 or N3, and RPA, were independently, statistically significantly associated with both OS and distant failure, while N2c, age, disease site, and smoking status, were not. CONCLUSION RPA in HPV+OPC is an independent prognostic factor for distant failure, translating into worse OS. Patients with RPA may not be suitable candidates for trials of systemic treatment de-escalation.
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Vainshtein JM, Moon DH, Feng FY, Chepeha DB, Eisbruch A, Stenmark MH. Long-term quality of life after swallowing and salivary-sparing chemo-intensity modulated radiation therapy in survivors of human papillomavirus-related oropharyngeal cancer. Int J Radiat Oncol Biol Phys 2015; 91:925-33. [PMID: 25832685 DOI: 10.1016/j.ijrobp.2014.12.045] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 12/16/2014] [Accepted: 12/24/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE To evaluate long-term health-related quality of life (HRQOL) in 2 prospective studies of chemo-intensity modulated radiation therapy (chemo-IMRT) for oropharyngeal cancer (OPC). METHODS AND MATERIALS Of 93 patients with stage III/IV OPC treated on prospective studies of swallowing and salivary organ-sparing chemo-IMRT, 69 were eligible for long-term HRQOL assessment. Three validated patient-reported instruments, the Head and Neck QOL (HNQOL) questionnaire, the University of Washington quality of life (UWQOL) questionnaire, and the Xerostomia Questionnaire (XQ), previously administered from baseline through 2 years in the parent studies, were readministered at long-term follow-up, along with the Short-Form 36. Long-term changes in HRQOL from before treatment and 2 years were evaluated. RESULTS Forty patients (58%) with a median follow-up of 6.5 years participated, 39 of whom (97.5%) had confirmed human papillomavirus-positive OPC. Long term, no clinically significant worsening was detected in mean HRQOL scores compared with 2 years, with stable or improved HRQOL from before treatment in nearly all domains. "Moderate" or greater severity problems were uncommon, reported by 5% of patients for eating, 5% for swallowing, and 2.5% and 5% by HNQOL and UWQOL summary scores, respectively. Freedom from percutaneous endoscopic gastrostomy tube dependence and stricture dilation beyond 2 years was 97.5% and 95%, respectively. Eleven percent and 14% of patients reported "moderate" or "severe" long-term worsening in HNQOL Pain and Overall Bother domains, respectively, which were associated with mean dose to the cervical esophagus, larynx, and pharyngeal constrictors. CONCLUSIONS At more than 6 years' median follow-up, OPC patients treated with swallowing and salivary organ-sparing chemo-IMRT reported stable or improved HRQOL in nearly all domains compared with both before treatment and 2-year follow-up. New late toxicity after 2 years was uncommon. Further emphasis on sparing the swallowing organs may yield additional HRQOL gains for long-term OPC survivors.
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Affiliation(s)
| | - Dominic H Moon
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
| | - Matthew H Stenmark
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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50
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Regional recurrence of oropharyngeal cancer after definitive radiotherapy: a case control study. Radiat Oncol 2015; 10:117. [PMID: 26014350 PMCID: PMC4490759 DOI: 10.1186/s13014-015-0422-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/15/2015] [Indexed: 11/24/2022] Open
Abstract
Background Elective treatment of lymph nodes in oropharyngeal cancer (OPC) has impact on both regional recurrences (RR) and risk of late side effects. This study was performed to quantify the dose-dependent impact on RR and overall survival (OS) in a prospectively collected cohort of OPC from the ARTSCAN study with emphasis on elective treatment. Methods ARTSCAN is a previously published prospective, randomized, multicentre study of altered radiotherapy (RT) fractionation in head and neck cancer. In ARTSCAN the elective treatment volume for node positive OPC varied significantly between centres due to local treatment principles. All patients with OPC in complete response after primary treatment were eligible for the present case–control study. Cases were patients with RR during five years follow-up. Patients with no recurrence were eligible as controls. Four controls per case were matched according to T- and N-stage. Mean (Dmean) and median (D50%) dose for the lymph node level (LNL) of RR in the cases and the corresponding LNL in the controls were analysed with conditional logistic regression. OS was estimated with the Kaplan-Meier method and evaluated by multivariate Cox regression analysis. Results There was a dose-dependent risk reduction for D50% in the interval that represented elective treatment (40–50 Gy) (OR = 0.18, p < 0.05) and a trend in the same dose interval for Dmean (OR = 0.19, p = 0.07). OS rates at five years were 0.39 (0.24-0.65) for cases and 0.70 (0.62–0.81) for controls (p < 0.001). The Kaplan-Meier and the Cox regression analysis for cases categorised by delivered dose showed an inverse relationship between dose and survival. The cases with RR in a LNL outside planning target volume (PTV) (Dmean < 40 Gy) had an OS rate comparable to that of all patients, and those with RR in a LNL in PTVelective (Dmean 40–60 Gy) or PTVtumour (Dmean >60 Gy) did significantly worse (p < 0.05). The same inverse relationship was also shown for a small subset of patient with known HPV-status, defined by over expression of p16 (p < 0.05). Conclusions There was a significant risk reduction for RR of elective treatment. However the OS for patients with RR outside target volumes was not affected, with similar results for patients with HPV-positive OPC. This could be an argument for a prospective randomized study on limited elective target volumes in OPC.
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