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Agurto MG, Carpenter GH, Bozorgi SS, Koller G, Fenlon M, Warburton F, Bruce K, Burke M, Banerjee A. Analysis of the association between salivary proteins and oral mucositis in patients with head and neck cancer undergoing IMRT: a longitudinal study. BMC Oral Health 2024; 24:630. [PMID: 38811865 PMCID: PMC11134661 DOI: 10.1186/s12903-024-04400-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/23/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION This longitudinal study assessed the association between salivary protein composition and the clinical onset/severity of oral mucositis (OM) in patients with head and neck tumours treated with intensity-modulated-radiotherapy (IMRT). METHODS Saliva samples/clinical data were obtained from 40 head and neck cancer patients treated at Guy's Hospital before -IMRT(T0) and after-IMRT (T1 = 6 m, T2 = 12 m) (ethics approval/consent). Salivary flow rate, total protein concentration, and secretion rate were determined from saliva samples and compared with pre-treatment values. OM was assessed, total/specific salivary proteins, including mucin 5B and 7, IgA, cystatin-S, albumin, and α-amylase, were quantified. RESULTS 95% patients experienced OM during IMRT, with 33 subjects reaching grade 2&3. At T1, there was a significant reduction in salivary flow rate, total protein secretion rate, α-amylase and cystatin-S compared to baseline. Remarkably IMRT did not significantly alter mucin 5B and 7, or the IgA secretion rate at any time point. At T1, all the analyzed proteins were associated with the OM outcomes. In addition, there was a significant inverse correlation between IgA concentration at T0 and the severity of OM during IMRT. CONCLUSION This study revealed significant associations between several salivary proteins and OM in patients with head and neck cancer undergoing IMRT. Further longitudinal studies are needed to confirm these results. CLINICAL SIGNIFICANCE The study contributes to the understanding of certain salivary proteins association with OM. This could be the first step towards identifying potential salivary markers that could offer perspectives for personalized medicine approaches to improve their quality of life (QoL). RESEARCH QUESTION What is the association between salivary proteins and the occurrence and severity of OM in head and neck cancer patients? AIM To assess the association between salivary protein composition with the clinical onset/severity of oral mucositis (OM) in head and neck cancer patients treated with intensity modulated radiotherapy. NULL HYPOTHESIS There is no association between salivary proteins and onset/severity of OM in HNC patients.
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Affiliation(s)
| | - Guy H Carpenter
- Faculty of Dental, Salivary Research, Centre for Host-Microbiome Interactions, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Sophie S Bozorgi
- Faculty of Dental, Salivary Research, Centre for Host-Microbiome Interactions, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Garrit Koller
- Department of Endodontics, Faculty of Dentistry, Centre for Host Microbiome Interactions, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Michael Fenlon
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Guy's Hospital, Floor 22, London, UK
| | - Fiona Warburton
- Faculty of Dental, Oral Clinical Research Unit, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Kenneth Bruce
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, King's College London, London, UK
| | - Mary Burke
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Avijit Banerjee
- Centre of Oral Clinical Translational Sciences, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Conservative & MI Dentistry, London, UK
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Zhang L, Jin S, Wang Y, Zhang Z, Jia H, Li D, Lu Q. Predict nutrition-related adverse outcomes in head and neck cancer patients undergoing radiotherapy: A systematic review. Radiother Oncol 2024; 197:110339. [PMID: 38795812 DOI: 10.1016/j.radonc.2024.110339] [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: 01/31/2024] [Revised: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Acute nutrition-related adverse outcomes are common in head and neck cancer patients undergoing radiotherapy. Predictive models can assist in identifying high-risk patients to enable targeted intervention. We aimed to systematically evaluate predictive models for predicting severe acute nutritional symptoms, insufficient intake, tube feeding, sarcopenia, and weight loss. METHODS We searched PubMed, Web of Science, EBSCO, Embase, WanFang, CNKI, and SinoMed. We selected studies developing predictive models for the aforementioned outcomes. Data were extracted using a predefined checklist. Risk of bias and applicability assessment were assessed using the Prediction model Risk of Bias Assessment Tool. A narrative synthesis was conducted to summarize the model characteristics, risk of bias, and performance. RESULTS A total of 2941 studies were retrieved and 19 were included. Study outcome measure were different symptoms (n = 11), weight loss (n = 5), tube feeding (n = 3), and symptom or tube feeding (n = 1). Predictive factors mainly encompassed sociodemographic data, disease-related data, and treatment-related data. Seventeen studies reported area under the curve or C-index values ranging from 0.610 to 0.96, indicating moderate to good predictive performance. However, candidate predictors were incomplete, outcome measures were diverse, and the risk of bias was high. Most of them used traditional model development methods, and only two used machine learning. CONCLUSIONS Most current models showed moderate to good predictive performance. However, predictors are incomplete, outcome are inconsistent, and the risk of bias is high. Clinicians could carefully select the models with better model performance from the available models according to their actual conditions. Future research should include comprehensive and modifiable indicators and prioritize well-designed and reported studies for model development.
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Affiliation(s)
- Lichuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, 100191, China
| | - Shuai Jin
- Department of Adult Care, School of Nursing, Capital Medical University, Beijing, 100069, China
| | - Yujie Wang
- Department of Nursing, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Henan University People's Hospital, Henan Provincial Key Medicine Laboratory of Nursing, Zhengzhou, 450003, China
| | - Zijuan Zhang
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, 100191, China
| | - Huilin Jia
- School of Nursing, Hebei University, Baoding, 071000, China
| | - Decheng Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Qian Lu
- Division of Medical & Surgical Nursing, School of Nursing, Peking University, Beijing, 100191, China.
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Camarda AM, Vincini MG, Russo S, Comi S, Emiro F, Bazani A, Ingargiola R, Vischioni B, Vecchi C, Volpe S, Orecchia R, Jereczek-Fossa BA, Orlandi E, Alterio D. Dosimetric and NTCP analyses for selecting parotid gland cancer patients for proton therapy. TUMORI JOURNAL 2024:3008916241252544. [PMID: 38769916 DOI: 10.1177/03008916241252544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
PURPOSE/OBJECTIVE To perform a dosimetric and a normal tissue complication probability (NTCP) comparison between intensity modulated proton therapy and photon volumetric modulated arc therapy in a cohort of patients with parotid gland cancers in a post-operative or radical setting. MATERIALS AND METHODS From May 2011 to September 2021, 37 parotid gland cancers patients treated at two institutions were eligible. Inclusion criteria were as follows: patients aged ⩾ 18 years, diagnosis of parotid gland cancers candidate for postoperative radiotherapy or definitive radiotherapy, presence of written informed consent for the use of anonymous data for research purposes. Organs at risk (OARs) were retrospectively contoured. Target coverage goal was defined as D95 > 98%. Six NTCP models were selected. NTCP profiles were calculated for each patient using an internally-developed Python script in RayStation TPS. Average differences in NTCP between photon and proton plans were tested for significance with a two-sided Wilcoxon signed-rank test. RESULTS Seventy-four plans were generated. A lower Dmean to the majority of organs at risk (inner ear, cochlea, oral cavity, pharyngeal constrictor muscles, contralateral parotid and submandibular gland) was obtained with intensity modulated proton therapy vs volumetric modulated arc therapy with statistical significance (p < .05). Ten (27%) patients had a difference in NTCP (photon vs proton plans) greater than 10% for hearing loss and tinnitus: among them, seven qualified for both endpoints, two patients for hearing loss only, and one for tinnitus. CONCLUSIONS In the current study, nearly one-third of patients resulted eligible for proton therapy and they were the most likely to benefit in terms of prevention of hearing loss and tinnitus.
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Affiliation(s)
- Anna Maria Camarda
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Russo
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesca Emiro
- Unit of Medical Physics, European Institute of Oncology IRCCS, Milan, Italy
| | - Alessia Bazani
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
| | | | - Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology IRCCS, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences,University of Pavia, Italy
| | - Daniela Alterio
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy
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Agheli R, Siavashpour Z, Reiazi R, Azghandi S, Cheraghi S, Paydar R. Predicting severe radiation-induced oral mucositis in head and neck cancer patients using integrated baseline CT radiomic, dosimetry, and clinical features: A machine learning approach. Heliyon 2024; 10:e24866. [PMID: 38317933 PMCID: PMC10839875 DOI: 10.1016/j.heliyon.2024.e24866] [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: 02/27/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose To establish the early prediction models of radiation-induced oral mucositis (RIOM) based on baseline CT-based radiomic features (RFs), dosimetric data, and clinical features by machine learning models for head and neck cancer (HNC) patients. Methods In this single-center prospective study, 49 HNCs treated with curative intensity modulated radiotherapy (IMRT) were enrolled. Baseline CT images (i.e., CT simulation), dosimetric, and clinical features were collected. RIOM was assessed using CTCAE v.5.0. RFs were extracted from manually-contoured oral mucosa structures. Minimum-redundancy-maximum-relevance (mRMR) method was applied to select the most informative radiomics, dosimetric, and clinical features. Then, binary prediction models were constructed for predicting acute RIOM based on the top mRMR-ranked radiomics, dosimetric, and clinical features alone or in combination, using random forest classifier algorithm. The predictive performance of models was assessed using the area under the receiver operating curve (AUC), accuracy, weighted-average based sensitivity, precision, and F1-measure. Results Among extracted features, the top 10 RFs, the top 5 dose-volume features, and the top 5 clinical features were selected using mRMR method. The model exploiting the integrated features (10-radiomics + 5-dosimetric + 5-clinical) achieved the best prediction with AUC, accuracy, sensitivity, precision, and F1-measure values of 91.7 %, 90.0 %, 83.0 % 100.0 %, and 91.0 %, respectively. The model developed using baseline CT RFs alone provided the best performance compared to dose-volume features or clinical features alone, with an AUC of 87.0 %. Conclusion Our results suggest that the integration of baseline CT radiomic features with dosimetric and clinical features showed promising potential to improve the performance of machine learning models in early prediction of RIOM. The ultimate goal is to personalize radiotherapy for HNC patients.
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Affiliation(s)
- Razieh Agheli
- Radiation Sciences Department, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Siavashpour
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Reiazi
- Department of Radiation Physics, Division of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Samira Azghandi
- Department of Radiation Oncology, Shohada-e Tajrish Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Susan Cheraghi
- Radiation Sciences Department, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Paydar
- Radiation Sciences Department, Faculty of Allied Medicine, Iran University of Medical Sciences, Tehran, Iran
- Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
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Iovoli AJ, Turecki L, Qiu ML, Khan M, Smith K, Yu H, Ma SJ, Farrugia MK, Singh AK. Severe Oral Mucositis After Intensity-Modulated Radiation Therapy for Head and Neck Cancer. JAMA Netw Open 2023; 6:e2337265. [PMID: 37819659 PMCID: PMC10568356 DOI: 10.1001/jamanetworkopen.2023.37265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Oral mucositis (OM) is a common and debilitating adverse effect observed in patients with head and neck cancer (HNC) receiving radiation therapy (RT). Previous studies examining associations between OM and clinical outcomes were performed in the era of 3-dimensional conformal RT planning with low rates of concurrent chemotherapy, and thus may not reflect current practice. Objective To prospectively assess patient-reported OM and identify its associations with clinical outcomes and quality of life. Design, Setting, and Participants This cohort study performed at a single institution included 702 consecutive patients who underwent definitive or adjuvant intensity-modulated RT (IMRT) for primary HNC from February 9, 2015, to May 27, 2022. Data were analyzed from November 28, 2022, to August 18, 2023. Main Outcomes and Measures Severity of OM was assessed based on highest reported mouth and throat soreness (MTS) score during radiotherapy according to the Oral Mucositis Weekly Questionnaire-Head and Neck Cancer survey, which was administered weekly during IMRT. Linear mixed models were used to compare mean MTS scores grouped by disease site and chemotherapy regimen. Fisher exact tests and 1-way analysis of variance tests were performed to identify associations between severity of OM and clinical outcomes. Results Among 576 eligible patients, the median age was 62.5 (IQR, 56.3-69.1) years, and 451 patients (78.3%) were men. In terms of race and ethnicity, 6 patients (1.0%) were American Indian or Alaska Native; 2 (0.3%), Asian; 31 (5.4%), Black; 8 (1.4%), Hispanic or Latino; 509 (88.4%), White; and 28 (4.9%), unknown. The most common treatment site was oropharynx (268 [46.5%]), and most patients received concurrent chemotherapy (464 [80.6%]). By the end of treatment, 360 patients (62.5%) developed severe OM and 568 (98.6%) developed some degree of OM. Linear mixed models found no significant differences in OM between HNC disease sites. Groups with greater highest severity of OM reported had higher rates of measured outcomes (listed respectively by MTS score 0, 1, 2, 3, and 4): feeding tube placement (0%, 3.6% [2 of 56], 6.6% [10 of 152], 14.7% [40 of 272], and 21.6% [19 of 88]; P = .001), hospitalization (12.5% [1 of 8], 10.7% [6 of 56], 15.1% [23 of 152], 23.9% [65 of 272], and 28.4% [25 of 88]; P = .02), opiate use (0%, 19.6% [11 of 56], 42.8%[65 of 152], 61.4% [167 of 272], and 64.8% [57 of 88]; P < .001) and experienced greater weight loss (median, -0.7 [IQR, -1.7 to -0.4] kg; median, 3.9 [IQR, 1.1 to 6.1] kg; median, 5.0 [IQR, 2.2 to 7.7] kg; median, 4.7 [IQR, 2.1 to 7.7] kg; and median, 7.7 [IQR, 2.8 to 10.6] kg; P < .001). Conclusions and Relevance In this cohort study of patients with HNC, 62.5% developed severe OM. Higher severity of OM was associated with feeding tube placement, hospitalization, opiate use, and weight loss. Improvements in OM prevention and management are needed.
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Affiliation(s)
- Austin J. Iovoli
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Lauren Turecki
- currently a medical student at Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Michelle L. Qiu
- currently a medical student at Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Michael Khan
- currently a medical student at Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Kelsey Smith
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Han Yu
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sung Jun Ma
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
- currently affiliated with Department of Radiation Oncology, The Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Mark K. Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, New York
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Dong Y, Zhang J, Lam S, Zhang X, Liu A, Teng X, Han X, Cao J, Li H, Lee FK, Yip CW, Au K, Zhang Y, Cai J. Multimodal Data Integration to Predict Severe Acute Oral Mucositis of Nasopharyngeal Carcinoma Patients Following Radiation Therapy. Cancers (Basel) 2023; 15:cancers15072032. [PMID: 37046693 PMCID: PMC10093711 DOI: 10.3390/cancers15072032] [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: 02/23/2023] [Revised: 03/21/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: Acute oral mucositis is the most common side effect for nasopharyngeal carcinoma patients receiving radiotherapy. Improper or delayed intervention to severe AOM could degrade the quality of life or survival for NPC patients. An effective prediction method for severe AOM is needed for the individualized management of NPC patients in the era of personalized medicine. (2) Methods: A total of 242 biopsy-proven NPC patients were retrospectively recruited in this study. Radiomics features were extracted from contrast-enhanced CT (CECT), contrast-enhanced T1-weighted (cT1WI), and T2-weighted (T2WI) images in the primary tumor and tumor-related area. Dosiomics features were extracted from 2D or 3D dose-volume histograms (DVH). Multiple models were established with single and integrated data. The dataset was randomized into training and test sets at a ratio of 7:3 with 10-fold cross-validation. (3) Results: The best-performing model using Gaussian Naive Bayes (GNB) (mean validation AUC = 0.81 ± 0.10) was established with integrated radiomics and dosiomics data. The GNB radiomics and dosiomics models yielded mean validation AUC of 0.6 ± 0.20 and 0.69 ± 0.14, respectively. (4) Conclusions: Integrating radiomics and dosiomics data from the primary tumor area could generate the best-performing model for severe AOM prediction.
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Affiliation(s)
- Yanjing Dong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jiang Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Saikt Lam
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xinyu Zhang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Anran Liu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xinzhi Teng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Xinyang Han
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jin Cao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Hongxiang Li
- Department of Radiology, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 350000, China
| | - Francis Karho Lee
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Celia Waiyi Yip
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Kwokhung Au
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Yuanpeng Zhang
- Department of Medical Informatics, Nantong University, Nantong 226000, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen 518000, China
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Winters TA, Cassatt DR, Harrison-Peters JR, Hollingsworth BA, Rios CI, Satyamitra MM, Taliaferro LP, DiCarlo AL. Considerations of Medical Preparedness to Assess and Treat Various Populations During a Radiation Public Health Emergency. Radiat Res 2023; 199:301-318. [PMID: 36656560 PMCID: PMC10120400 DOI: 10.1667/rade-22-00148.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023]
Abstract
During a radiological or nuclear public health emergency, given the heterogeneity of civilian populations, it is incumbent on medical response planners to understand and prepare for a potentially high degree of interindividual variability in the biological effects of radiation exposure. A part of advanced planning should include a comprehensive approach, in which the range of possible human responses in relation to the type of radiation expected from an incident has been thoughtfully considered. Although there are several reports addressing the radiation response for special populations (as compared to the standard 18-45-year-old male), the current review surveys published literature to assess the level of consideration given to differences in acute radiation responses in certain sub-groups. The authors attempt to bring clarity to the complex nature of human biology in the context of radiation to facilitate a path forward for radiation medical countermeasure (MCM) development that may be appropriate and effective in special populations. Consequently, the focus is on the medical (as opposed to logistical) aspects of preparedness and response. Populations identified for consideration include obstetric, pediatric, geriatric, males, females, individuals of different race/ethnicity, and people with comorbidities. Relevant animal models, biomarkers of radiation injury, and MCMs are highlighted, in addition to underscoring gaps in knowledge and the need for consistent and early inclusion of these populations in research. The inclusion of special populations in preclinical and clinical studies is essential to address shortcomings and is an important consideration for radiation public health emergency response planning. Pursuing this goal will benefit the population at large by considering those at greatest risk of health consequences after a radiological or nuclear mass casualty incident.
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Affiliation(s)
- Thomas A Winters
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - David R Cassatt
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - Jenna R Harrison-Peters
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - Brynn A Hollingsworth
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - Carmen I Rios
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - Merriline M Satyamitra
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - Lanyn P Taliaferro
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
| | - Andrea L DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), Division of Allergy, Immunology and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Rockville, Maryland
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Deneuve S, Bastogne T, Duclos M, Mirjolet C, Bois P, Bachmann P, Nokovitch L, Roux PE, Girodet D, Poupart M, Zrounba P, Claude L, Ferella L, Iacovelli NA, Foray N, Rancati T, Pereira S. Predicting acute severe toxicity for head and neck squamous cell carcinomas by combining dosimetry with a radiosensitivity biomarker: a pilot study. TUMORI JOURNAL 2022; 109:173-185. [PMID: 35578746 DOI: 10.1177/03008916221078061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Radiotherapy (RT) against head and neck squamous cell carcinomas (HNSCC) may lead to severe toxicity in 30-40% of patients. The normal tissue complication probability (NTCP) models, based on dosimetric data refined the normal tissue dose/volume tolerance guidelines. In parallel, the radiation-induced nucleoshuttling (RIANS) of the Ataxia-Telangiectasia Mutated protein (pATM) is a predictive approach of individual intrinsic radiosensitivity. Here, we combined NTCP with RADIODTECT©, a blood assay derived from the RIANS model, to predict RT toxicity in HNSCC patients. METHODS RADIODTECT© cutoff values (i.e. 57.8 ng/mL for grade⩾2 toxicity and 46 ng/mL for grade⩾3 toxicity) have been previously assessed. Validation was performed on a prospective cohort of 36 HNSCC patients treated with postoperative RT. Toxicity was graded with the Common Terminology Criteria for Adverse Events (CTCAE) scale and two criteria were considered: grade⩾2 oral mucositis (OM2), grade⩾3 mucositis (OM3) and grade⩾2 dysphagia (DY2), grade⩾3 dysphagia (DY3). pATM quantification was assessed in lymphocytes of HNSCC patients. The discrimination power of the pATM assay was evaluated through the Area Under the Receiver Operator Characteristics Curve (AUC-ROC). Two previously described NTCP models were considered, including the dose to the oral cavity and the mean dose to the parotid glands (OM2 and OM3) and the dose to the oral cavity, to the larynx and the volume of pharyngeal constrictor muscles (DY2 and DY3). RESULTS Combining NTCP models with RADIODTECT© blood test improved the AUC-ROC. Considering the prediction of mucositis, AUC-ROCNTCP+RADIODTECT©=0.80 was for OM2, and AUC-ROCNTCP+RADIODTECT©=0.78 for OM3. Considering the prediction of acute dysphagia, AUC-ROCNTCP+RADIODTECT©=0.71 for DY2 and for DY3. CONCLUSIONS Combining NTCP models with a radiosensitivity biomarker might significantly improve the prediction of toxicities for HNSCC patients.
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Affiliation(s)
- Sophie Deneuve
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France.,INSERM, U1296 Unit, Centre Léon Bérard, Lyon, France
| | - Thierry Bastogne
- Institut De Cancérologie de Lorraine - Alexis Vautrin, Vandoeuvre-lès-Nancy, France.,CRAN, CNRS UMR 7039, INRIA BIGS, Vandoeuvre-lès-Nancy, France.,CYBERnano, Villers-lès-Nancy, France
| | | | - Céline Mirjolet
- Centre Georges François Leclerc, UNICANCER, Dijon, France.,INSERM UMR 1231, Cadir Team, Dijon, France
| | - Pascaline Bois
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France
| | - Patrick Bachmann
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France
| | - Lara Nokovitch
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France
| | - Pierre-Eric Roux
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France
| | - Didier Girodet
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France
| | - Marc Poupart
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France
| | - Philippe Zrounba
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France
| | - Line Claude
- Centre Regional de Lutte Contre le Cancer Léon-Bérard, Département de Chirurgie Oncologique, Lyon, France.,INSERM, U1296 Unit, Centre Léon Bérard, Lyon, France
| | - Letizia Ferella
- Departement of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | - Nicolas Foray
- INSERM, U1296 Unit, Centre Léon Bérard, Lyon, France
| | - Tiziana Rancati
- Prostate Cancer Program, Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sandrine Pereira
- INSERM, U1296 Unit, Centre Léon Bérard, Lyon, France.,Neolys Diagnostics, Lyon, France
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Ferreira AS, Macedo C, Silva AM, Delerue-Matos C, Costa P, Rodrigues F. Natural Products for the Prevention and Treatment of Oral Mucositis-A Review. Int J Mol Sci 2022; 23:ijms23084385. [PMID: 35457202 PMCID: PMC9030892 DOI: 10.3390/ijms23084385] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/11/2022] [Accepted: 04/14/2022] [Indexed: 02/06/2023] Open
Abstract
Cancer, a major world public health problem, is associated with chemotherapy treatments whose administration leads to secondary concerns, such as oral mucositis (OM). The OM disorder is characterized by the presence of ulcers in the oral mucosa that cause pain, bleeding, and difficulty in ingesting fluids and solids, or speaking. Bioactive compounds from natural sources have arisen as an effective approach for OM. This review aims to summarize the new potential application of different natural products in the prevention and treatment of OM in comparison to conventional ones, also providing a deep insight into the most recent clinical studies. Natural products, such as Aloe vera, Glycyrrhiza glabra, Camellia sinensis, Calendula officinalis, or honeybee crops, constitute examples of sources of bioactive compounds with pharmacological interest due to their well-reported activities (e.g., antimicrobial, antiviral, anti-inflammatory, analgesic, or wound healing). These activities are associated with the bioactive compounds present in their matrix (such as flavonoids), which are associated with in vivo biological activities and minimal or absent toxicity. Finally, encapsulation has arisen as a future opportunity to preserve the chemical stability and the drug bioa vailability of bioactive compounds and, most importantly, to improve the buccal retention period and the therapeutic effects.
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Affiliation(s)
- Ana Sofia Ferreira
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Catarina Macedo
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Ana Margarida Silva
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Cristina Delerue-Matos
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
| | - Paulo Costa
- UCIBIO—Applied Molecular Biosciences Unit, MedTech-Laboratory of Pharmaceutical Technology, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal;
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Francisca Rodrigues
- REQUIMTE/LAQV—Instituto Superior de Engenharia do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal; (A.S.F.); (C.M.); (A.M.S.); (C.D.-M.)
- Correspondence: ; Tel.: +351-22-83-40-500
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10
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Impact of Parenteral Glutamine Supplement on Oncologic Outcomes in Patients with Nasopharyngeal Cancer Treated with Concurrent Chemoradiotherapy. Nutrients 2022; 14:nu14050997. [PMID: 35267972 PMCID: PMC8912271 DOI: 10.3390/nu14050997] [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: 02/05/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Oral mucositis (OM) is a common toxic side effect in nasopharyngeal carcinoma (NPC) patients receiving concurrent chemoradiotherapy (CCRT) that has a negative impact on treatment outcomes and patients’ survival. Our study aimed to evaluate the impact of parenteral glutamine supplement (dipeptiven) on oncologic outcomes in patients with NPC treated with CCRT. Methods: Patients who were diagnosed with pathologically proved NPC and treated with CCRT were enrolled into our study. Patients were classified as dipeptiven (+) and dipeptiven (−). Oncologic outcomes were measured, and multivariate regression analysis was performed. Grade 3−4 treatment related toxicities were also documented. Results: A total of 144 patients with NPC were recruited in this study to evaluate oncologic outcomes, with 41 dipeptiven (+) and 103 dipeptiven (−). CCRT interruption rate and severe adverse effect (SAE) rate were significant lower in the dipeptiven (+) group than in the dipeptiven (−) group. The median overall survival (OS) was not mature yet in the dipeptiven (+) group and 30 months in the dipeptiven (−) group (p < 0.01). Multivariate analysis demonstrated that dipeptiven supplementation and CCRT interruption were independent predictors associated with better survival. The OS was longest in patients with a dipeptiven supplement and patients who had CCRT interruption had significantly worst OS. As for safety profiles, grade 3 to 4 adverse effects were fewer in dipeptiven (+) than in dipeptiven (−). Conclusion: Dipeptiven supplementation is crucial in NPC patients treated with CCRT, which can ameliorate treatment-related toxicity and augment treatment efficacy. Further prospective clinical trials are warranted to validate our results.
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11
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Vai A, Molinelli S, Rossi E, Iacovelli NA, Magro G, Cavallo A, Pignoli E, Rancati T, Mirandola A, Russo S, Ingargiola R, Vischioni B, Bonora M, Ronchi S, Ciocca M, Orlandi E. Proton Radiation Therapy for Nasopharyngeal Cancer Patients: Dosimetric and NTCP Evaluation Supporting Clinical Decision. Cancers (Basel) 2022; 14:cancers14051109. [PMID: 35267415 PMCID: PMC8909055 DOI: 10.3390/cancers14051109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: we proposed an integrated strategy to support clinical allocation of nasopharyngeal patients between proton and photon radiotherapy. (2) Methods: intensity-modulated proton therapy (IMPT) plans were optimized for 50 consecutive nasopharyngeal carcinoma (NPC) patients treated with volumetric modulated arc therapy (VMAT), and differences in dose and normal tissue complication probability (ΔNTCPx-p) for 16 models were calculated. Patient eligibility for IMPT was assessed using a model-based selection (MBS) strategy following the results for 7/16 models describing the most clinically relevant endpoints, applying a model-specific ΔNTCPx-p threshold (15% to 5% depending on the severity of the complication) and a composite threshold (35%). In addition, a comprehensive toxicity score (CTS) was defined as the weighted sum of all 16 ΔNTCPx-p, where weights follow a clinical rationale. (3) Results: Dose deviations were in favor of IMPT (ΔDmean ≥ 14% for cord, esophagus, brainstem, and glottic larynx). The risk of toxicity significantly decreased for xerostomia (-12.5%), brain necrosis (-2.3%), mucositis (-3.2%), tinnitus (-8.6%), hypothyroidism (-9.3%), and trismus (-5.4%). There were 40% of the patients that resulted as eligible for IMPT, with a greater advantage for T3-T4 staging. Significantly different CTS were observed in patients qualifying for IMPT. (4) Conclusions: The MBS strategy successfully drives the clinical identification of NPC patients, who are most likely to benefit from IMPT. CTS summarizes well the expected global gain.
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Affiliation(s)
- Alessandro Vai
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
- Correspondence: (A.V.); (N.A.I.); Tel.: +39-0382-078-505 (A.V.)
| | - Silvia Molinelli
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Eleonora Rossi
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Nicola Alessandro Iacovelli
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
- Correspondence: (A.V.); (N.A.I.); Tel.: +39-0382-078-505 (A.V.)
| | - Giuseppe Magro
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Anna Cavallo
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
| | - Emanuele Pignoli
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
| | - Tiziana Rancati
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
| | - Alfredo Mirandola
- Radiotherapy Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano (INT), 20133 Milan, Italy; (A.C.); (E.P.); (T.R.); (A.M.)
| | - Stefania Russo
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Rossana Ingargiola
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Barbara Vischioni
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Maria Bonora
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Sara Ronchi
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Mario Ciocca
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
| | - Ester Orlandi
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy; (S.M.); (E.R.); (G.M.); (S.R.); (R.I.); (B.V.); (M.B.); (S.R.); (M.C.); (E.O.)
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12
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Cavallo A, Iacovelli NA, Facchinetti N, Rancati T, Alfieri S, Giandini T, Cicchetti A, Fallai C, Ingargiola R, Licitra L, Locati L, Cavalieri S, Pignoli E, Romanello DA, Valdagni R, Orlandi E. Modelling Radiation-Induced Salivary Dysfunction during IMRT and Chemotherapy for Nasopharyngeal Cancer Patients. Cancers (Basel) 2021; 13:cancers13163983. [PMID: 34439136 PMCID: PMC8392585 DOI: 10.3390/cancers13163983] [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: 05/16/2021] [Revised: 07/24/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Radiation-induced xerostomia is one of the most prevalent adverse effects of head and neck cancer treatment, and it could seriously affect patients' qualities of life. It results primarily from damage to the salivary glands, but its onset and severity may also be influenced by other patient-, tumour-, and treatment-related factors. We aimed to build and validate a predictive model for acute salivary dysfunction (aSD) for locally advanced nasopharyngeal carcinoma (NPC) patients by combining clinical and dosimetric factors. METHODS A cohort of consecutive NPC patients treated curatively with IMRT and chemotherapy at 70 Gy (2-2.12 Gy/fraction) were utilised. Parotid glands (cPG, considered as a single organ) and the oral cavity (OC) were selected as organs-at-risk. The aSD was assessed at baseline and weekly during RT, grade ≥ 2 aSD chosen as the endpoint. Dose-volume histograms were reduced to the Equivalent Uniform Dose (EUD). Dosimetric and clinical/treatment features selected via LASSO were inserted into a multivariable logistic model. Model validation was performed on two cohorts of patients with prospective aSD, and scored using the same schedule/scale: a cohort (NPC_V) of NPC patients (as in model training), and a cohort of mixed non-NPC head and neck cancer patients (HNC_V). RESULTS The model training cohort included 132 patients. Grade ≥ 2 aSD was reported in 90 patients (68.2%). Analyses resulted in a 4-variables model, including doses of up to 98% of cPG (cPG_D98%, OR = 1.04), EUD to OC with n = 0.05 (OR = 1.11), age (OR = 1.08, 5-year interval) and smoking history (OR = 1.37, yes vs. no). Calibration was good. The NPC_V cohort included 38 patients, with aSD scored in 34 patients (89.5%); the HNC_V cohort included 93 patients, 77 with aSD (92.8%). As a general observation, the incidence of aSD was significantly different in the training and validation populations (p = 0.01), thus impairing calibration-in-the-large. At the same time, the effect size for the two dosimetric factors was confirmed. Discrimination was also satisfactory in both cohorts: AUC was 0.73, and 0.68 in NPC_V and HNC_V cohorts, respectively. CONCLUSION cPG D98% and the high doses received by small OC volumes were found to have the most impact on grade ≥ 2 acute xerostomia, with age and smoking history acting as a dose-modifying factor. Findings on the development population were confirmed in two prospectively collected validation populations.
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Affiliation(s)
- Anna Cavallo
- Department of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (A.C.); (T.G.); (E.P.)
| | - Nicola Alessandro Iacovelli
- Department of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (N.A.I.); (N.F.); (C.F.); (R.I.); (D.A.R.); (E.O.)
| | - Nadia Facchinetti
- Department of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (N.A.I.); (N.F.); (C.F.); (R.I.); (D.A.R.); (E.O.)
- National Center for Oncological Hadrontherapy (CNAO), Clinical Trial Center, 27100 Pavia, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (A.C.); (R.V.)
- Correspondence:
| | - Salvatore Alfieri
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.A.); (L.L.); (L.L.); (S.C.)
- Centro di Riferimento Oncologico di Aviano (PN) CRO IRCCS, Department of Medical Oncology, 33018 Aviano, Italy
| | - Tommaso Giandini
- Department of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (A.C.); (T.G.); (E.P.)
| | - Alessandro Cicchetti
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (A.C.); (R.V.)
| | - Carlo Fallai
- Department of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (N.A.I.); (N.F.); (C.F.); (R.I.); (D.A.R.); (E.O.)
| | - Rossana Ingargiola
- Department of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (N.A.I.); (N.F.); (C.F.); (R.I.); (D.A.R.); (E.O.)
- National Center for Oncological Hadrontherapy (CNAO), Radiation Oncology Clinical Department, 27100 Pavia, Italy
| | - Lisa Licitra
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.A.); (L.L.); (L.L.); (S.C.)
- Department of Oncolgy and Hemato-Oncology, Università Degli Studi di Milano, 20122 Milan, Italy
| | - Laura Locati
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.A.); (L.L.); (L.L.); (S.C.)
| | - Stefano Cavalieri
- Department of Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (S.A.); (L.L.); (L.L.); (S.C.)
| | - Emanuele Pignoli
- Department of Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (A.C.); (T.G.); (E.P.)
| | - Domenico Attilio Romanello
- Department of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (N.A.I.); (N.F.); (C.F.); (R.I.); (D.A.R.); (E.O.)
| | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (A.C.); (R.V.)
- Department of Oncolgy and Hemato-Oncology, Università Degli Studi di Milano, 20122 Milan, Italy
- Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Ester Orlandi
- Department of Radiation Oncology 2, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (N.A.I.); (N.F.); (C.F.); (R.I.); (D.A.R.); (E.O.)
- National Center for Oncological Hadrontherapy (CNAO), Radiation Oncology Clinical Department, 27100 Pavia, Italy
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13
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Sharabiani M, Clementel E, Andratschke N, Collette L, Fortpied C, Grégoire V, Overgaard J, Willmann J, Hurkmans C. Independent external validation using the EORTC HNCG-ROG 1219 DAHANCA trial data of NTCP models for acute oral mucositis. Radiother Oncol 2021; 161:35-39. [PMID: 33872641 DOI: 10.1016/j.radonc.2021.04.006] [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: 09/02/2020] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To externally validate previously published Normal Tissue Complication Probability (NTCP) models developed by separate teams for grade 3 oral mucositis (g3OM). MATERIALS AND METHODS Two models were validated: a logistic model, based on 144 head and neck cancer (HNC) patients receiving induction chemotherapy followed by chemo-IMRT; a multivariable logistic model for prediction of g3OM for 253 patients receiving radical treatment for the head and neck squamous cell carcinoma (HNSCC). The EORTC HNCG-ROG 1219 DAHANCA trial dataset, consisting of 169 patients was used as the validation cohort. This cohort was treated with accelerated fractionated chemo-IMRT, with/without the hypoxic radiosensitizer Nimorazole for HNSCC. External validity was assessed using the scaled Brier score. Calibration was assessed in terms of calibration curves as well as measures of mean and weak calibration. Hosmer-Lemeshow was used for goodness-of-fit test. Discrimination was calculated using the area under the receiver operating curve (AUC-ROC). RESULTS The prevalence of g3OM in the validation cohort (35.5%) was similar to that of two development cohorts, i.e. 38.7% and 31.9% for Bhide logistic and Otter multivariable logistic models respectively. The scaled Brier scores showed good overall model performance. Perfect calibration was observed in the prevalence range of 20% to 40%. AUC-ROC was acceptable in external validation (0.67). The Hosmer-Lemeshow test showed good agreement between predicted and observed outcomes for two models. CONCLUSION The NTCP models were validated and lead to valid predictions in a wide range of diverse treatment techniques and patient characteristics, also when Nimorazole is added as hypoxic radiosensitizer.
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Affiliation(s)
| | | | - N Andratschke
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Switzerland
| | - L Collette
- Department of Biostatistics, International Drug Development Institute, Louvain-la-Neuve, Belgium
| | | | - V Grégoire
- Radiation Oncology Department, Léon Bérard Cancer Center, Lyon, France
| | - J Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - J Willmann
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Switzerland
| | - C Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
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14
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Nicolatou-Galitis O, Bossi P, Orlandi E. The role of benzydamine in prevention and treatment of chemoradiotherapy-induced mucositis. Support Care Cancer 2021; 29:5701-5709. [PMID: 33649918 PMCID: PMC8410701 DOI: 10.1007/s00520-021-06048-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/04/2021] [Indexed: 02/04/2023]
Abstract
Purpose To discuss the role of benzydamine in the prevention and treatment of radiation-induced oral mucositis (OM) in head and neck (H&N) cancer patients. This document represents an expert opinion paper on indications and key-role aspects in OM pathogenesis, prevention and treatment. Oral mucositis OM represents a common side effect of chemotherapy (CHT) and radiotherapy (RT). It consists in a painful erythema involving the oral cavity mucosa, which may progress to ulceration. Five biologically dynamic phases are considered crucial in mucositis: “initiation, signalling, amplification, ulceration and healing”. Oral environment and microbiota are fundamental in mucositis development being involved in susceptibility to infections and in ulceration consequences. Different agents against mucositis have been studied and the use of benzydamine is strongly supported in literature. The Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO) guidelines recommend its use for the prevention of OM in H&N patients undergoing RT and RT/CHT. Benzydamine Benzydamine is a local anti-inflammatory drug with analgesic properties. It can decrease TNF-α, IL-1β and prostaglandin synthesis, also inhibiting leukocyte-endothelial interactions, neutrophil degranulation, vasodilation and vascular permeability. Literature agrees on the beneficial effects of benzydamine in preventing and reducing oral mucositis severity in H&N cancer patients undergoing RT/CHT. Conclusions Mucositis represents a major concern in H&N cancer patients and a clinical and economical issue. A multimodal and multidisciplinary approach is needed for its management. International guidelines recommend benzydamine for OM prevention and treatment in H&N cancer patients, but further “real world” trials should be designed.
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Affiliation(s)
| | - Paolo Bossi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, University of Brescia, ASST-Spedali Civili, Brescia, Italy.
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
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15
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Franzese C, Fogliata A, Loi M, Badalamenti M, Franceschini D, Comito T, Cozzi L, Reggiori G, Tomatis S, Scorsetti M. Dosimetric impact of volumetric modulated arc therapy for nasopharyngeal cancer treatment. ACTA ACUST UNITED AC 2021; 26:101-110. [PMID: 34046220 DOI: 10.5603/rpor.a2021.0017] [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: 06/02/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
Background The purpose of the study was to evaluate the toxicity and outcome of nasopharyngeal carcinoma patients treated using 3-dimensional conformal radiotherapy (3DCRT) or volumetric modulated arc therapy (VMAT) technique. Materials and methods 68 patients treated between 2006 and 2018 were retrospectively analysed. Since 2009 patients received 3DCRT with 50/70 Gy to the elective/boost volumes in 35 fractions; from then, VMAT with simultaneous integrated boost (SIB) with 54.45/69.96 Gy in 33, or 54/66 Gy in 30 fractions. Induction chemotherapy was administered in 74% of the patients, concomitant cisplatinum in 87%. Acute and late toxicity data, progression-free survival PSF and overall survival OS, and toxicity correlations with dose metrics were reported. Results With a median follow-up of 64 months, complete remission at the last evaluation was in 68% of the patients, while 28% and 9% had locoregional relapse and distant disease, respectively. The 5- and 10-year progression free survival (PFS) rates were 62.7 ± 6.5% and 53.2 ± 8.7%, respectively. The 5- and 10-year OS rates were 78.9 ± 5.5% and 61.4 ± 9.2%, respectively. At the multivariate Cox analysis TNM stage (p = 0.02) and concomitant chemotherapy (p = 0.01) resulted significant for PFS, concomitant chemotherapy (p = 0.04) for OS.Improvements in acute toxicity were presented for VMAT patients due to its ability to spare OARs. Odds ratio (OR) for acute salivary toxicity, between VMAT and 3DCRT, was 4.67 (p = 0.02). Dosimetrically, salivary toxicity correlated with mean parotid dose (p = 0.05), dysphagia with laryngeal (p = 0.04) and mean oral cavity (p = 0.06) doses, when dose-volume histograms (DVHs) are corrected for fractionation. Conclusion This study is a proof of a significant benefit of the VMAT technique compared with 3DCRT in terms of side effects in nasopharynx patients, and adds dosimetric correlations.
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Affiliation(s)
- Ciro Franzese
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy.,Humanitas University, Biomedical Science Dept, Milan-Rozzano, Italy
| | - Antonella Fogliata
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Mauro Loi
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Marco Badalamenti
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Davide Franceschini
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Tiziana Comito
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Luca Cozzi
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy.,Humanitas University, Biomedical Science Dept, Milan-Rozzano, Italy
| | - Giacomo Reggiori
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Stefano Tomatis
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Marta Scorsetti
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy.,Humanitas University, Biomedical Science Dept, Milan-Rozzano, Italy
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16
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Tao HY, Zhan ZJ, Qiu WZ, Liao K, Yuan YW, Yuan TZ, Zheng RH. Clinical value of docetaxel plus cisplatin (TP) induction chemotherapy followed by TP concurrent chemoradiotherapy in locoregionally advanced nasopharyngeal carcinoma. J Cancer 2021; 12:18-27. [PMID: 33391399 PMCID: PMC7738834 DOI: 10.7150/jca.49944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/25/2020] [Indexed: 12/28/2022] Open
Abstract
Objective: To investigate the clinical value of induction chemotherapy (IC) with docetaxel plus cisplatin (TP) followed by concurrent chemoradiotherapy (CCRT) with TP in locoregionally advanced nasopharyngeal carcinoma (NPC). Methods: A total of 544 patients with locoregionally advanced NPC that was newly diagnosed from January 2009 to December 2015 were included in this study. Among these patients, 251 were treated with TP induction chemotherapy followed by CCRT with cisplatin (DDP) alone (TP + DDP group), 167 were treated with TP followed by CCRT with TP (TP + TP group), and 126 were treated with docetaxel, DDP and fluorouracil (TPF) followed by CCRT with DDP alone (TPF + DDP group). Overall survival (OS), distant metastasis-free survival (DMFS), progression-free survival (PFS) and locoregional relapse-free survival (LRRFS) were analyzed using the Kaplan-Meier method and a Cox proportional hazards model. Results: Survival analysis showed that the 5-year OS, PFS and DMFS rates in the TP + DDP group were significantly lower than those in the TP + TP group after propensity score matching (PSM). Multivariate analysis revealed that CCRT with TP was an independent prognostic factor for OS, PFS and DMFS. During CCRT, the incidence rates of grade 3/4 nausea/vomiting, oral mucositis, leukocytopenia and neutropenia were significantly increased in the TP + TP group compared with the TP + DDP group (all P < 0.05). To further explore the value of TP + TP, we performed PSM again with the TPF + DDP group. After PSM, there were 100 patients in each group. Survival analysis showed no significant differences in the 5-year OS, PFS, DMFS and LRRFS rates between the two groups. During IC and CCRT, the rate of grade 3/4 nausea/vomiting in the TPF + DDP group was higher than that in the TP+TP group (9.0% vs. 2.0%, P = 0.030; 18.0% vs. 8.0%, P = 0.036, respectively). No significant difference in the incidence of grade 3/4 hematologic toxicity was found between the two groups (all P > 0.05). Conclusion: TP + TP can reduce the distant metastasis of locoregionally advanced NPC and improve OS compared with TP + DDP; TP + TP has the same effect as TPF + DDP and is clinically feasible.
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Affiliation(s)
- Hao-Yun Tao
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510090, Guangdong, P. R. China
| | - Ze-Jiang Zhan
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510090, Guangdong, P. R. China
| | - Wen-Ze Qiu
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510090, Guangdong, P. R. China
| | - Kai Liao
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510090, Guangdong, P. R. China
| | - Ya-Wei Yuan
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510090, Guangdong, P. R. China
| | - Tai-Ze Yuan
- Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, 510045, Guangdong, P. R. China
| | - Rong-Hui Zheng
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, 510090, Guangdong, P. R. China
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17
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Patient-reported outcome measures in patients undergoing radiotherapy for head and neck cancer. Support Care Cancer 2020; 29:2537-2547. [DOI: 10.1007/s00520-020-05778-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/11/2020] [Indexed: 12/15/2022]
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18
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Prediction of mucositis risk secondary to cancer therapy: a systematic review of current evidence and call to action. Support Care Cancer 2020; 28:5059-5073. [PMID: 32592033 DOI: 10.1007/s00520-020-05579-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/12/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE Despite advances in personalizing the efficacy of cancer therapy, our ability to identify patients at risk of severe treatment side effects and provide individualized supportive care is limited. This is particularly the case for mucositis (oral and gastrointestinal), with no comprehensive risk evaluation strategies to identify high-risk patients. We, the Multinational Association for Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO) Mucositis Study Group, therefore aimed to systematically review current evidence on that factors that influence mucositis risk to provide a foundation upon which future risk prediction studies can be based. METHODS We identified 11,018 papers from PubMed and Web of Science, with 197 records extracted for full review and 113 meeting final eligibility criteria. Data were then synthesized into tables to highlight the level of evidence for each risk predictor. RESULTS The strongest level of evidence supported dosimetric parameters as key predictors of mucositis risk. Genetic variants in drug-metabolizing pathways, immune signaling, and cell injury/repair mechanisms were also identified to impact mucositis risk. Factors relating to the individual were variably linked to mucositis outcomes, although female sex and smoking status showed some association with mucositis risk. CONCLUSION Mucositis risk reflects the complex interplay between the host, tumor microenvironment, and treatment specifications, yet the large majority of studies rely on hypothesis-driven, single-candidate approaches. For significant advances in the provision of personalized supportive care, coordinated research efforts with robust multiplexed approaches are strongly advised.
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19
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Ai QY, King AD, So TY, Lam WKJ, Mo FKF, Tse IOL, Woo JKS, Chan KCA. MRI of benign hyperplasia in the nasopharynx: is there an association with Epstein-Barr virus? Clin Radiol 2020; 75:711.e13-711.e18. [PMID: 32571521 DOI: 10.1016/j.crad.2020.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
AIM To evaluate whether there is an association between persistently positive plasma Epstein-Barr virus (EBV) DNA and the presence and the change in benign hyperplasia. MATERIALS AND METHODS One hundred and seventeen participants with positive-plasma EBV-DNA, but without NPC from previous nasopharyngeal carcinoma (NPC) screening, underwent follow-up magnetic resonance imaging (MRI) and plasma EBV-DNA after 2 years. Logistic regression was used to analyse associations between MRI (benign hyperplasia on the follow-up MRI and change from 2 years earlier), and plasma EBV-DNA, smoking, and age. RESULTS At follow-up, EBV-DNA positivity and smoking were independent parameters for the presence of benign hyperplasia (p=0.027 and 0.023 respectively). Compared with participants in whom EBV-DNA became negative (n=44/117 37.6%), those in whom EBV-DNA remained positive (n=73/117 62.4%) had a greater risk of benign hyperplasia developing (previous MRI normal), being stable or processing (52/73 71.2% versus 18/44 40.9%; p=0.001). CONCLUSION These results suggest a potential link between benign hyperplasia on MRI and the EBV. As EBV contributes to NPC oncogenesis, future MRI research is warranted to determine if persistent benign hyperplasia is a risk marker for development of NPC.
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Affiliation(s)
- Q-Y Ai
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - A D King
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
| | - T Y So
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - W K J Lam
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - F K F Mo
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Department of Clinical Oncology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - I O L Tse
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - J K S Woo
- Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China
| | - K C A Chan
- Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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20
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Du M, Haag D, Song Y, Lynch J, Mittinty M. Examining Bias and Reporting in Oral Health Prediction Modeling Studies. J Dent Res 2020; 99:374-387. [DOI: 10.1177/0022034520903725] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Recent efforts to improve the reliability and efficiency of scientific research have caught the attention of researchers conducting prediction modeling studies (PMSs). Use of prediction models in oral health has become more common over the past decades for predicting the risk of diseases and treatment outcomes. Risk of bias and insufficient reporting present challenges to the reproducibility and implementation of these models. A recent tool for bias assessment and a reporting guideline—PROBAST (Prediction Model Risk of Bias Assessment Tool) and TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis)—have been proposed to guide researchers in the development and reporting of PMSs, but their application has been limited. Following the standards proposed in these tools and a systematic review approach, a literature search was carried out in PubMed to identify oral health PMSs published in dental, epidemiologic, and biostatistical journals. Risk of bias and transparency of reporting were assessed with PROBAST and TRIPOD. Among 2,881 papers identified, 34 studies containing 58 models were included. The most investigated outcomes were periodontal diseases (42%) and oral cancers (30%). Seventy-five percent of the studies were susceptible to at least 4 of 20 sources of bias, including measurement error in predictors ( n = 12) and/or outcome ( n = 7), omitting samples with missing data ( n = 10), selecting variables based on univariate analyses ( n = 9), overfitting ( n = 13), and lack of model performance assessment ( n = 24). Based on TRIPOD, at least 5 of 31 items were inadequately reported in 95% of the studies. These items included sampling approaches ( n = 15), participant eligibility criteria ( n = 6), and model-building procedures ( n = 16). There was a general lack of transparent reporting and identification of bias across the studies. Application of the recommendations proposed in PROBAST and TRIPOD can benefit future research and improve the reproducibility and applicability of prediction models in oral health.
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Affiliation(s)
- M. Du
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - D. Haag
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
| | - Y. Song
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, Australia
| | - J. Lynch
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
- Population Health Sciences, University of Bristol, Bristol, UK
| | - M. Mittinty
- School of Public Health, The University of Adelaide, Adelaide, Australia
- Robinson Research Institute, The University of Adelaide, Adelaide, Australia
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21
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Weng J, Wei J, Li M, Lu J, Qin Y, Liu F, Xiong W, Qu S. Clinical outcomes of patients with nasopharyngeal carcinoma treated with antibiotics for radiation-induced mucositis: a retrospective study. J Int Med Res 2019; 48:300060519874899. [PMID: 31840546 PMCID: PMC7607210 DOI: 10.1177/0300060519874899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To examine the effects of antibiotic administration on radiation-induced oral
and oropharyngeal mucositis, and on the prognosis of patients with
nasopharyngeal carcinoma (NPC). Methods We retrospectively analyzed data for patients with NPC with grade 1/2 or 3/4
mucositis. Forty-two patients with grade 3/4 mucositis received antibiotics.
Univariate survival analysis was assessed by Kaplan–Meier survival curves,
survival curves were compared using log-rank tests, and multivariate
analysis was carried out by Cox regression. Results A total of 463 patients with NPC were included in the study (194 grade 1/2
mucositis, 269 grade 3/4 mucositis). Univariate analyses identified T-stage,
N-stage, clinical stage, type of treatment, and antibiotic use as factors
affecting overall and disease-free survival. Multivariate analysis also
determined that T-stage, N-stage stage, type of treatment, and antibiotic
usage were independent factors affecting overall and disease-free survival.
Mucositis improved in 32 of the 42 patients who received antibiotics
(76.19%). However, red blood cell count and hemoglobin levels decreased in
all patients after antibiotic treatment. Conclusions Antibiotics may be effective for the treatment of severe radiation-induced
mucositis (grade 3/4) during chemoradiotherapy, but may potentially
adversely affect the prognosis of patients with NPC.
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Affiliation(s)
- JingJin Weng
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jiazhang Wei
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Min Li
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Jinlong Lu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Yangda Qin
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Fei Liu
- Research Center of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Weiming Xiong
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Shenhong Qu
- Department of Otolaryngology & Head and Neck, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
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22
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Orlandi E, Iacovelli NA, Tombolini V, Rancati T, Polimeni A, De Cecco L, Valdagni R, De Felice F. Potential role of microbiome in oncogenesis, outcome prediction and therapeutic targeting for head and neck cancer. Oral Oncol 2019; 99:104453. [PMID: 31683170 DOI: 10.1016/j.oraloncology.2019.104453] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/11/2019] [Accepted: 10/19/2019] [Indexed: 12/13/2022]
Abstract
In the last decade, human microbiome research is rapidly growing involving several fields of clinical medicine and population health. Although the microbiome seems to be linked to all sorts of diseases, cancer has the biggest potential to be investigated. Following the publication of the National Institute of Health - Human Microbiome Project (NIH-HMP), the link between Head and Neck Cancer (HNC) and microbiome seems to be a fast-moving field in research area. However, robust evidence-based literature is still quite scarce. Nevertheless the relationship between oral microbiome and HNC could have important consequences for prevention and early detection of this type of tumors. The aims of the present review are: (i) to discuss current pre-clinical evidence of a role of oral microbiome in HNC; (ii) to report recent developments in understanding the human microbiome's relationship with HNC oncogenesis; (iii) to explore the issue of treatment response and treatment toxicity; (iv) to describe the role of microbiota as potentially modifiable factor suitable for targeting by therapeutics. Further studies are needed to better establish the causal relationship between oral microbiome and HNC oncogenesis. Future trials should continue to explore oral microbiome in order to build the scientific and clinical rationale of HNC preventative and ameliorate treatment outcome.
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Affiliation(s)
- Ester Orlandi
- Department of Radiotherapy 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Department of Radiotherapy 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
| | | | - Vincenzo Tombolini
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillo Facial Sciences, Policlinico Umberto I, "Sapienza" University of Rome, Italy
| | - Loris De Cecco
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Riccardo Valdagni
- Department of Radiotherapy 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
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23
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Organs at risk's tolerance and dose limits for head and neck cancer re-irradiation: A literature review. Oral Oncol 2019; 98:35-47. [PMID: 31536844 DOI: 10.1016/j.oraloncology.2019.08.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/18/2019] [Accepted: 08/25/2019] [Indexed: 01/01/2023]
Abstract
Re-irradiation is becoming an established treatment option for recurrent or second primary head and neck cancer(HNC). However, acute and long-term RT-related toxicities could dramatically impact patients' quality of life. Due to the sparse literature regarding HNC re-irradiation, data on tolerance doses for various organs at risk (OARs) are scarce. Our aim was to systematically review the clinical literature regarding HNC re-irradiation, focusing on treatment toxicity, OARs tolerance, and dose limit recommendations. Thirty-nine studies (three randomized, five prospective, 31 retrospective) including 3766 patients were selected. The median interval time between the first course and re-irradiation was 28 months (range, 6-90). In 1043 (27.6%) patients, postoperative re-irradiation was performed. Re-irradiation doses ranged from 30 Gy in 3 fractions using stereotactic technique to 72 Gy in conventional fractionation using intensity-modulated radiotherapy. Pooled acute and late toxicityrates ≥G3 were 32% and 29.3%, respectively. The most common grade 3-4 toxic effects were radionecrosis, dysphagia requiring feeding tube placement and trismus. In 156 (4.1%) patients, carotid blowout was reported. Recommendations for limiting toxicity included the time interval between radiation treatments, the fractionation schedules, and the re-irradiation treatment volumes. Cumulative dose limit suggestions were found and discussed for the carotid arteries, temporal lobes, and mandible.
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24
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Bai XH, Chen ZM, Ma LH, He Z, Li G. Prevention effect of low-temperature atomization inhalation for radiation induced oral mucositis in patients with head and neck cancer undergoing radiotherapy. Cancer Manag Res 2019; 11:4327-4333. [PMID: 31190997 PMCID: PMC6512953 DOI: 10.2147/cmar.s206921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/18/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: To investigate the prevention effect of low-temperature atomization inhalation for radiation induced oral mucositis (OM) in patients with head and neck cancer (HNC) undergoing radiotherapy. Patients and methods: A total of 68 patients with HNC (including nasopharyngeal cancer) undergoing radiotherapy were divided into an intervention group (33 cases) and a control group (35 cases). During radiotherapy, the intervention group received low-temperature (between 4°C and 8°C) atomization inhalation; while the control group received normal temperature (between 18°C and 24°C) atomization inhalation. Atomization inhalation was performed twice a day, 20 minutes per time, using distilled water. The incidence and severity of OM was evaluated every week during radiotherapy. The comparation was made between the two groups. Results: The two groups were comparable among age, sex, Eastern Cooperative Oncology group (ECOG) score, body mass index (BMI) before radiotherapy, BMI loss during radiotherapy, original tumor site, pathological type, TNM stage, and mean oral cavity irradiated dose. There was a significant difference in the incidence of OM between the two groups (P<0.05). There were fewer patients with severe OM in the intervention group compared to the control group (P<0.05). The onset time of OM in the intervention group was delayed by about 4 days compared to that in the control group (P<0.05). Low-temperature atomization inhalation helped to avoid radiotherapy interruption in the intervention group. No patient in the intervention group suffered any adverse reaction for low-temperature atomization inhalation treatment. Conclusions: Low-temperature atomization inhalation can reduce the incidence and severity of OM, and slow down the progression process of it. It can be used as a new prevention method during radiotherapy, and should be promoted in clinical practice.
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Affiliation(s)
- Xing-Hua Bai
- Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Zi-Min Chen
- Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Liang-Hua Ma
- Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Zheng He
- Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
| | - Guang Li
- Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
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Lafin JT, Sarsour EH, Kalen AL, Wagner BA, Buettner GR, Goswami PC. Methylseleninic Acid Induces Lipid Peroxidation and Radiation Sensitivity in Head and Neck Cancer Cells. Int J Mol Sci 2019; 20:ijms20010225. [PMID: 30626124 PMCID: PMC6337472 DOI: 10.3390/ijms20010225] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/17/2018] [Accepted: 01/04/2019] [Indexed: 12/20/2022] Open
Abstract
Combination radiation and chemotherapy are commonly used to treat locoregionally advanced head and neck squamous cell carcinoma (HNSCC). Aggressive dosing of these therapies is significantly hampered by side effects due to normal tissue toxicity. Selenium represents an adjuvant that selectively sensitizes cancer cells to these treatments modalities, potentially by inducing lipid peroxidation (LPO). This study investigated whether one such selenium compound, methylseleninic acid (MSA), induces LPO and radiation sensitivity in HNSCC cells. Results from 4,4-difluoro-4-bora-3a,4a-diaza-S-indacene (BODIPY) C11 oxidation and ferric thiocyanate assays revealed that MSA induced LPO in cells rapidly and persistently. Propidium iodide (PI) exclusion assay found that MSA was more toxic to cancer cells than other related selenium compounds; this toxicity was abrogated by treatment with α-tocopherol, an LPO inhibitor. MSA exhibited no toxicity to normal fibroblasts at similar doses. MSA also sensitized HNSCC cells to radiation as determined by clonogenic assay. Intracellular glutathione in cancer cells was depleted following MSA treatment, and supplementation of the intracellular glutathione pool with N-acetylcysteine sensitized cells to MSA. The addition of MSA to a cell-free solution of glutathione resulted in an increase in oxygen consumption, which was abrogated by catalase, suggesting the formation of H2O2. Results from this study identify MSA as an inducer of LPO, and reveal its capability to sensitize HNSCC to radiation. MSA may represent a potent adjuvant to radiation therapy in HNSCC.
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Affiliation(s)
- John T Lafin
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
| | - Ehab H Sarsour
- The University of Iowa Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA.
| | - Amanda L Kalen
- The University of Iowa Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA.
| | - Brett A Wagner
- The University of Iowa Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA.
| | - Garry R Buettner
- The University of Iowa Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA.
| | - Prabhat C Goswami
- The University of Iowa Free Radical and Radiation Biology Program, Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, USA.
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