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Farber NI, Li Y, Solis RN, Chen J, Masheeb Z, Wilson M, Bewley AF, Abouyared M, Rao S, Rong Y, Birkeland AC. Tumor and Nodal Disease Growth Rates in Patients with Oropharyngeal Squamous Cell Carcinoma. Cancers (Basel) 2023; 15:3865. [PMID: 37568681 PMCID: PMC10416867 DOI: 10.3390/cancers15153865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Though specific growth rate (SGR) has potential prognostic value for oropharyngeal squamous cell carcinoma (OPSCC), there is sparse literature defining these rates. Our aims were to establish the SGRs of primary tumors (PTs) and lymph nodes (LNs) in OPSCC and to correlate SGR with oncologic outcome. A pilot study was designed with a retrospective analysis examining 54 patients from the University of California, Davis with OPSCC (diagnosed 2012-2019). Radiation oncology software and pretreatment serial CT scans were used to measure PT and LN volumes to calculate SGR and doubling time (DT). The mean PT-SGR was 1.2 ± 2.2%/day and the mean LN-SGR was 1.6 ± 1.9%/day. There was no statistically significant difference between slow-growing and fast-growing cohorts in terms of age, gender, smoking status, tumor subsite, HPV status (as determined with p16 staining), initial volume, or overall stage. SGR had no impact on 2-year overall survival, disease-free survival, or disease-specific survival. We found the average daily growth rates for OPSCC to be 1.2%/day and 1.6%/day. Our findings suggest PT- and LN-SGR are independent factors, not heavily influenced by known biomarkers and patient characteristics, without a statistical impact on prognosis. This information has value in patient counseling regarding tumor growth and in providing patients worried about fast-growing tumors the appropriate reassurance.
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Affiliation(s)
- Nicole I. Farber
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Yimin Li
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen 361005, China
| | - Roberto N. Solis
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Joy Chen
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Zahrah Masheeb
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Machelle Wilson
- Davis-School of Medicine, University of California, Sacramento, CA 94720, USA
| | - Arnaud F. Bewley
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Marianne Abouyared
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
| | - Shyam Rao
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
| | - Yi Rong
- Department of Radiation Oncology, University of California Davis, Sacramento, CA 94720, USA (S.R.)
- Department of Radiation Oncology, Mayo Clinic, Pheonix, AZ 85054, USA
| | - Andrew C. Birkeland
- Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Sacramento, CA 95817, USA (A.F.B.)
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Minami R, Iizuka T, Tachibana A, Moriguchi Y, Noma E, Onishi T, Arakawa T, Horiguchi S. Rapidly growing oropharyngeal cancer with a 6-month course. Clin J Gastroenterol 2023:10.1007/s12328-023-01796-9. [PMID: 37055609 DOI: 10.1007/s12328-023-01796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/30/2023] [Indexed: 04/15/2023]
Abstract
A male patient in his 70s who had undergone a regular upper gastrointestinal endoscopy noted a flat, erythematous area on the right soft palate of the oropharynx 9 months after his treatment of oropharyngeal cancer. Six months after noticing the lesion, endoscopy revealed that the lesion had rapidly developed into a thick, erythematous, bump. Endoscopic submucosal dissection was performed. Pathological analysis of the resected tissue found a squamous cell carcinoma with a thickness of 1400 μm invading the subepithelial layer. There are few reports on the growth speed of pharyngeal cancer and it remains unclear. In some cases, the growth of the pharyngeal cancer may be rapid, and it is important to follow up the patient in a short period of time.
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Affiliation(s)
- Ryogo Minami
- Department of Gastroenterology, Komagome Hospital, Tokyo Metropolitan Cancer and Infectious Diseases Center, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Komagome Hospital, Tokyo Metropolitan Cancer and Infectious Diseases Center, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan.
| | - Ayu Tachibana
- Department of Gastroenterology, Komagome Hospital, Tokyo Metropolitan Cancer and Infectious Diseases Center, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Yoshiaki Moriguchi
- Department of Gastroenterology, Komagome Hospital, Tokyo Metropolitan Cancer and Infectious Diseases Center, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Eriko Noma
- Department of Gastroenterology, Komagome Hospital, Tokyo Metropolitan Cancer and Infectious Diseases Center, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Tomoko Onishi
- Department of Gastroenterology, Komagome Hospital, Tokyo Metropolitan Cancer and Infectious Diseases Center, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Takeo Arakawa
- Department of Gastroenterology, Komagome Hospital, Tokyo Metropolitan Cancer and Infectious Diseases Center, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan
| | - Shinichiro Horiguchi
- Department of Pathology, Komagome Hospital, Tokyo Metropolitan Cancer and Infectious Diseases Center, Bunkyo-Ku, Tokyo, Japan
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Clinical Characteristics and Predictive Outcomes of Recurrent Nasopharyngeal Carcinoma-A Lingering Pitfall of the Long Latency. Cancers (Basel) 2022; 14:cancers14153795. [PMID: 35954458 PMCID: PMC9367553 DOI: 10.3390/cancers14153795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose: To investigate the clinical characteristics, risk factors, and clinical outcomes of long-latent recurrence (>five years) of nasopharyngeal carcinoma (NPC). Methods: This retrospective study enrolled newly diagnosed NPC patients from the Chang Gung Research Database between January 2007 and December 2019. We analyzed the patients’ characteristics and survival outcomes after recurrence. Results: A total of 2599 NPC patients were enrolled. The overall recurrence rate was 20.5%, while 8.1% of patients had long-latent recurrence (>five years). These patients had a higher percentage of initial AJCC (The American Joint Committee on Cancer) stage I/II (60.5%, p = 0.001) and local recurrence (46.5%, p < 0.001). Unresectable rT3 and rT4 were found in 60% of patients when recurrence and 30% of local recurrence occurred in the skull base, which could not be detected by the regular endoscopy. The five-year overall survival rate of long-latent recurrence was 19.7%. Alive patients tended to be asymptomatic but have regular follow-ups with the interval less than six months. Multivariate analysis showed age and initial advanced AJCC stages were independent risk factors of death after recurrence. In contrast, patients with recurrence between two and five years, salvage surgeries, and regional recurrence had favorable survival outcomes. Conclusion: Long-latent NPC recurrence is not rare, and the survival outcome is poor. Regular follow-up for early detection of NPC recurrence is necessary even after five years of disease-free period.
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Žumer B, Pohar Perme M, Jereb S, Strojan P. Impact of delays in radiotherapy of head and neck cancer on outcome. Radiat Oncol 2020; 15:202. [PMID: 32819389 PMCID: PMC7441656 DOI: 10.1186/s13014-020-01645-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 08/13/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND In head and neck cancer (HNC), the relationship between a delay in starting radiotherapy (RT) and the outcome is unclear. The aim of the present study was to determine the impact of the amount of time before treatment intervention (TTI) and the growth kinetics of individual tumors on treatment outcomes and survival. METHODS Two hundred sixty-two HNC patients with 273 primary tumors, treated with definitive (chemo) RT, were retrospectively analyzed. The TTI was defined as the time interval between the date of histopathologic diagnosis and the first day of the RT course. Volumetric data on 57 tumors were obtained from diagnostic and RT planning computer tomography (CT) scans in order to calculate the tumor growth kinetic parameters. RESULTS No significant association between locoregional control or cause-specific hazards and TTI was found. The log hazard for locoregional recurrence linearly increased during the first 40 days of waiting for RT, although this was not significant. The median tumor volume relative increase rate and tumor volume doubling time was 3.2%/day and 19 days, respectively, and neither had any impact on locoregional control or cause-specific hazards. CONCLUSION The association between a delay in starting RT and the outcome is complex and does not harm all patients waiting for RT. Further research into imaging-derived kinetic data on individual tumors is warranted in order to identify patients at an increased risk of adverse outcomes due to a delay in starting RT.
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Affiliation(s)
- Barbara Žumer
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000, Ljubljana, Slovenia
| | - Maja Pohar Perme
- Institute of Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Simona Jereb
- Department of Radiology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Zaloška 2, SI-1000, Ljubljana, Slovenia. .,Chair of Oncology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Hsieh MCW, Lee CC, Lu PL, Kuo YR. Covid-19 guidance algorithm for advanced head and neck cancer reconstruction. Microsurgery 2020; 40:724-725. [PMID: 32442328 PMCID: PMC7280603 DOI: 10.1002/micr.30603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 05/04/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Meng-Chien Willie Hsieh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Chia-Chen Lee
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Po-Liang Lu
- Division of Infectious Disease, Department of Internal Medicine, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yur-Ren Kuo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Chung Ho Memorial Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
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6
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Schutte HW, Heutink F, Wellenstein DJ, van den Broek GB, van den Hoogen FJA, Marres HAM, van Herpen CML, Kaanders JHAM, Merkx TMAW, Takes RP. Impact of Time to Diagnosis and Treatment in Head and Neck Cancer: A Systematic Review. Otolaryngol Head Neck Surg 2020; 162:446-457. [PMID: 32093572 DOI: 10.1177/0194599820906387] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE An increased interval between symptomatic disease and treatment may negatively influence oncologic and/or functional outcomes in head and neck cancer (HNC). This systematic review aims to provide insight into the effects of time to treatment intervals on oncologic and functional outcomes in oral cavity, pharyngeal, and laryngeal cancer. DATA SOURCES PubMed, EMBASE, and Cochrane library were searched. REVIEW METHODS All studies on delay or time to diagnosis or treatment in oral, pharyngeal, and laryngeal cancer were included. Quality assessment was performed with an adjusted version of the Newcastle-Ottawa scale. Outcomes of interest were tumor volume, stage, recurrence, survival, patient-reported outcome measures (PROMs), toxicity, and functionality after treatment. RESULTS A total of 51 studies were included. Current literature on the influence of delay in HNC is inconsistent but indicates higher stage and worse survival with longer delay. The effects on PROMs, toxicity, and functional outcome after treatment have not been investigated. The inconsistencies in outcomes were most likely caused by factors such as heterogeneity in study design, differences in the definitions of delay, bias of results, and incomplete adjustment for confounding factors in the included studies. CONCLUSION Irrespective of the level of evidence, the unfavorable effects of delay on oncologic, functional, and psychosocial outcomes are undisputed. Timely treatment while maintaining high-quality diagnostic procedures and decision making reflects good clinical practice in our opinion. This review will pose practical and logistic challenges that will have to be overcome.
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Affiliation(s)
- Henrieke W Schutte
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Floris Heutink
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - David J Wellenstein
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Frank J A van den Hoogen
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Henri A M Marres
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Carla M L van Herpen
- Department of Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Thijs M A W Merkx
- Department of Oral and Maxillofacial Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
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7
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Roldan CS, Chen JJ, Fareed MM, Hameed MY, Churilla TM, Lango MN, Galloway TJ. Impact of primary tumor-specific growth rate on treatment failure for nonoropharyngeal head and neck cancers. Laryngoscope 2019; 130:2378-2384. [PMID: 31714626 DOI: 10.1002/lary.28393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 09/26/2019] [Accepted: 10/10/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To investigate the prognostic impact of primary tumor-specific growth rate (TSGR) on treatment outcomes after definitive radiation therapy (RT) for nonoropharyngeal squamous cell carcinoma (non-OPSCC). METHODS The diagnostic tumor and nodal volumes of 39 non-OPSCC patients were contoured and compared to corresponding RT planning scan volumes to determine TSGR. Overall survival (OS), disease-free survival (DFS), and local recurrence-free survival were evaluated according to the Kaplan-Meier method; and hazard ratios (HR) were estimated using Cox regression. Based on the 75th percentile TSGR of 2.18%, we stratified patients into a high TSGR group (≥ 2.18% per day) and low TSGR group (< 2.18% per day). RESULTS The median follow-up was 22 months (range: 1-86 months) and median time between diagnostic and simulation computed tomography scans was 22 days (range: 7-170 days). Median RT dose was 70 Gy (range: 60-79.2 Gy). Based on the 75th percentile TSGR, OS at median follow-up was 50.0% for the high TSGR group compared to 92.5% for the low TSGR group (HR [95% confidence interval (CI)] = 2.12[1.16-11.42], P = 0.018). There was a trend toward worse DFS at median follow-up for the high versus low TSGR groups, at 55.6% and 82.3%, respectively (HR [95% CI] = 2.29[0.82-6.38], P = 0.103). CONCLUSION Our study contributes to growing literature on TSGR as a temporal biomarker in patients with non-OPSCC. Patients with high TSGR ≥2.18% per day have significantly worse OS compared to those with TSGR below this threshold. Efforts to address treatment initiation delays may benefit patients with particularly aggressive and rapidly growing tumors. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2378-2384, 2020.
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Affiliation(s)
| | - Jie Jane Chen
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - M Mohsin Fareed
- Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts
| | | | - Thomas M Churilla
- the Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
| | - Miriam N Lango
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
| | - Thomas J Galloway
- the Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, U.S.A
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8
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Fareed MM, Galloway TJ. Time abides long enough for those who make use of it. CANCERS OF THE HEAD & NECK 2019; 3:11. [PMID: 31093364 PMCID: PMC6460542 DOI: 10.1186/s41199-018-0038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/09/2018] [Indexed: 01/29/2023]
Abstract
Increased treatment package time is an independent poor prognostic factor for outcomes in head and neck squamous cell carcinoma (HNSCC). Similarly the timeliness of treatment initiation is a risk factor for disease recurrence. Despite these well-known issues, the timeliness of treatment initiation is actually worsening in the United States and the expeditious completion of radiation treatments continues to be difficult secondary to a number of patients and treatment related issues. This analysis evaluates the current data on treatment intervals in the management of head and neck cancer. Rapid staging/diagnosis of head and neck cancer, appropriate referrals to providers qualified to treat said cancer, and expeditious treatment completion remains the most cost-effective, widely applicable method to improve outcomes in head and neck cancer.
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Affiliation(s)
- Muhammad M Fareed
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111 USA
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9
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Dejaco D, Steinbichler T, Schartinger VH, Fischer N, Anegg M, Dudas J, Posch A, Widmann G, Riechelmann H. Specific growth rates calculated from CTs in patients with head and neck squamous cell carcinoma: a retrospective study performed in Austria. BMJ Open 2019; 9:e025359. [PMID: 30782931 PMCID: PMC6367981 DOI: 10.1136/bmjopen-2018-025359] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To provide data on specific growth rates (SGRs) of primary tumours (PT-SGR) and largest pathological cervical lymph nodes (LN-SGR) for head and neck squamous cell carcinoma (HNSCC). To explore PT-SGR's and LN-SGR's correlation with selected biomarkers epidermal growth factor receptor (EGFR), Ki67 and CD44. DESIGN AND SETTING Retrospective study performed at a tertiary oncological referral centre in Innsbruck, Austria. PARTICIPANTS Adult patients with incident HNSCC treated with primary radiotherapy (RT) or radiochemotherapy (RCT). OUTCOME MEASURES Volumes of the primary tumour (PT-volume) and largest pathological cervical lymph node (LN-volume) were measured in CT scans obtained at time of diagnosis and subsequent planning CTs immediately prior to RT or RCT. SGRs were calculated assuming an exponential growth function. PT-SGR's and LN-SGR's correlation with EGFR, Ki67 and CD44 were explored. RESULTS In 123 patients, mean interval between diagnostic and planning CT was 29±21 days. PT-SGR was 1.8±1.8% (mean±SD) per day and was positively correlated with EGFR, Ki67 and CD44 expression (p=0.02; p=0.02; p=0.03). LN-SGR was 1.7±2.0% per day and increased with larger initial LN-volume, was lower in laryngeal cancer (p=0.003) and slowed down with time. LN-SGR was not correlated with EGFR, Ki67 or CD44 expression in primary tumours (p>0.12). New cartilage or bone infiltration occurred in 10 patients and new central lymph node necrosis in 8 patients. CONCLUSIONS HNSCCs are fast-growing tumours for which treatment must not be delayed. Clinical tumour growth rates are influences by EGFR, KI67 and CD44 expression.
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Affiliation(s)
- Daniel Dejaco
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Teresa Steinbichler
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Volker Hans Schartinger
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Natalie Fischer
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Maria Anegg
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Joszef Dudas
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Posch
- Department of Radiation Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerlig Widmann
- Medical University of Innsbruck, Department of Radiology, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology–Head and Neck Surgery, Medical University of Innsbruck, Innsbruck, Austria
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10
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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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Amsbaugh MJ, Yusuf M, Cash E, Silverman C, Potts K, Dunlap N. Effect of time to simulation and treatment for patients with oropharyngeal cancer receiving definitive radiotherapy in the era of risk stratification using smoking and human papillomavirus status. Head Neck 2018; 40:687-695. [DOI: 10.1002/hed.24963] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 08/03/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mark J. Amsbaugh
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Mehran Yusuf
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Elizabeth Cash
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders; University of Louisville; Louisville Kentucky
| | - Craig Silverman
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
| | - Kevin Potts
- Department of Otolaryngology - Head and Neck Surgery and Communicative Disorders; University of Louisville; Louisville Kentucky
| | - Neal Dunlap
- Department of Radiation Oncology; University of Louisville; Louisville Kentucky
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Forster JC, Douglass MJJ, Harriss-Phillips WM, Bezak E. Simulation of head and neck cancer oxygenation and doubling time in a 4D cellular model with angiogenesis. Sci Rep 2017; 7:11037. [PMID: 28887560 PMCID: PMC5591194 DOI: 10.1038/s41598-017-11444-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/18/2017] [Indexed: 11/09/2022] Open
Abstract
Tumor oxygenation has been correlated with treatment outcome for radiotherapy. In this work, the dependence of tumor oxygenation on tumor vascularity and blood oxygenation was determined quantitatively in a 4D stochastic computational model of head and neck squamous cell carcinoma (HNSCC) tumor growth and angiogenesis. Additionally, the impacts of the tumor oxygenation and the cancer stem cell (CSC) symmetric division probability on the tumor volume doubling time and the proportion of CSCs in the tumor were also quantified. Clinically relevant vascularities and blood oxygenations for HNSCC yielded tumor oxygenations in agreement with clinical data for HNSCC. The doubling time varied by a factor of 3 from well oxygenated tumors to the most severely hypoxic tumors of HNSCC. To obtain the doubling times and CSC proportions clinically observed in HNSCC, the model predicts a CSC symmetric division probability of approximately 2% before treatment. To obtain the doubling times clinically observed during treatment when accelerated repopulation is occurring, the model predicts a CSC symmetric division probability of approximately 50%, which also results in CSC proportions of 30-35% during this time.
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Affiliation(s)
- Jake C Forster
- Department of Physics, University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia. .,Department of Medical Physics, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia.
| | - Michael J J Douglass
- Department of Physics, University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia.,Department of Medical Physics, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Wendy M Harriss-Phillips
- Department of Physics, University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia.,Department of Medical Physics, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Eva Bezak
- Department of Physics, University of Adelaide, North Terrace, Adelaide, South Australia, 5005, Australia.,Sansom Institute for Health Research and the School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
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Abstract
PURPOSE OF REVIEW Management of advanced head and neck cancer (HNC) is characterized by high mortality. Furthermore, the treatment involves significant burden to patients and high costs to healthcare systems. Recognizing the risks of early death in patients with a high probability of noncurable disease is important for each individual treatment decision-making. It is thus critical to consider the benefits and side-effects of the planned treatment in relation to the expected survival and to discuss these factors with the patient. However, only few studies have documented early death in HNC patients, that is, during the first posttreatment 6 months. We performed a systematic literature review to find the incidence of this phenomenon and to outline the probable cause. RECENT FINDINGS Early mortality in patients with HNC can be explained either by direct effect of malignant disease, may be related to comorbidities, or secondary to the treatment. These factors act together resulting in expected or unexpected early death. SUMMARY The present review provides information on the mechanisms leading to early phase mortality (<6 months) after management of HNC. It also reports the incidence of this phenomenon among Finnish and Swedish patient populations.
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