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Liu TPJ, David M, Clark JR, Low THH, Batstone MD. Prediction nomogram development and validation for postoperative radiotherapy in the management of oral squamous cell carcinoma. Head Neck 2023; 45:1503-1510. [PMID: 37019874 DOI: 10.1002/hed.27363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/11/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Predictive nomograms are useful tools to guide clinicians in estimating disease course. Oral squamous cell carcinoma (OSCC) patients would benefit from an interactive prediction calculator that defines their levels of survival-risk specific to their tumors to guide the use of postoperative radiotherapy (PORT). METHODS Patients with OSCC surgically treated with curative intent at four Head and Neck Cancer Centres were recruited retrospectively for development and validation of nomograms. Predictor variables include PORT, age, T and N classification, surgical margins, perineural invasion, and lymphovascular invasion. Outcomes were disease-free, disease-specific, and overall survivals over 5 years. RESULTS 1296 patients with OSCC were in training cohort for nomogram analysis. Algorithms were developed to show relative benefit of PORT in survivals for higher-risk patients. External validation on 1212 patients found the nomogram to be robust with favorable discrimination and calibration. CONCLUSION The proposed calculator can assist clinicians and patients in the decision-making process for PORT.
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Affiliation(s)
- Timothy P J Liu
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Bowen Bridge Road & Butterfield Street, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Level 2, Mayne Medical Building, 288 Herston Road, Herston, Queensland, Australia
| | - Michael David
- School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- The Daffodil Centre, University of Sydney (A Joint Venture With Cancer Council), Kings Cross, New South Wales, Australia
| | - Jonathan R Clark
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, New South Wales, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Tsu-Hui Hubert Low
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, New South Wales, Australia
| | - Martin D Batstone
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women's Hospital, Bowen Bridge Road & Butterfield Street, Herston, Queensland, Australia
- Faculty of Medicine, University of Queensland, Level 2, Mayne Medical Building, 288 Herston Road, Herston, Queensland, Australia
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2
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Marwah R, Goonetilleke D, Smith J, Chilkuri M. Evaluating delays in patients treated with post-operative radiation therapy for head and neck squamous cell carcinoma. J Med Imaging Radiat Oncol 2022; 66:840-846. [PMID: 35726770 PMCID: PMC9544161 DOI: 10.1111/1754-9485.13449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/07/2022] [Indexed: 11/30/2022]
Abstract
Introduction Delays in commencing post‐operative radiation therapy (PORT) and prolongation of overall treatment times (OTT) are associated with reduced overall survival and higher recurrence rates in patients with head and neck squamous cell carcinoma (HNSCC). The objective of this study was to evaluate treatment delays, factors contributing to those delays and to explore strategies to mitigate them. Methods This retrospective study included patients with mucosal HNSCC at Townsville University Hospital treated with curative intent surgery and PORT between June 2011 and June 2019. The proportion of patients who experienced delays in commencing PORT (>6 weeks) and OTT were evaluated and reasons for these delays were explored. Results The study included 94 patients of which 70% experienced PORT delay. Surgery at an external facility (81% vs 56%, P = 0.006) and longer post‐operative length of stay (P = 0.011) were significantly associated with a higher incidence of PORT delay. Aboriginal and Torres Strait Islander patients had a higher rate of PORT delay (89% vs 68.2%, P = 0.198). Significant delays were noted from time of surgery to radiation oncology (RO) consult and from RO consult to commencement of radiation treatment. Conclusion This study demonstrates that the prevalence of PORT delay for patients with HNSCC remains high with room for improvement. Potential strategies to improve delays include developing effective care coordination, addressing specific needs of Indigenous patients, implementing reliable automated tracking and communication systems between teams and harnessing existing electronic referral systems.
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Affiliation(s)
- Ravi Marwah
- Townsville University Hospital, Townsville, Queensland, Australia
| | | | - Justin Smith
- Townsville University Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
| | - Madhavi Chilkuri
- Townsville University Hospital, Townsville, Queensland, Australia.,James Cook University, Townsville, Queensland, Australia
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Gilling L, Ali O. Organ dose from Varian XI and Varian OBI systems are clinically comparable for pelvic CBCT imaging. Phys Eng Sci Med 2022; 45:279-285. [PMID: 35143026 DOI: 10.1007/s13246-021-01090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
Pelvic cone-beam computed tomography (CBCT) occurs daily in many radiotherapy clinics as a part of image-guided verification before treatment. These images are acquired by the use of ionizing radiation. The dose received by CBCT imaging is often not quantified in a patient's radiation therapy prescription. The purpose of this work was to quantify the dose from a TrueBeam XI pelvic CBCT imaging system. The dose to organs from this imaging protocol was then compared with published dose data for OBI v1.4 pelvic CBCT imaging. A model of the Varian XI imager was constructed using GATE Monte Carlo scripting language. The model was calibrated by correlation with experimental measurements. An IBA 3D water tank was used to perform relative dose measurements in water. An adult anthropomorphic Alderson phantom with embedded thermolumeniscent dosimeters was used to evaluate dose from prostate CBCT imaging. Following the calibration, the GATE model was used to simulate the dose from the XI pelvic CBCT protocol to the ICRP computational anthropomorphic phantom. The Monte Carlo model constructed in GATE was validated for use in dose estimates for the XI pelvic imaging protocol. The D50 and D10 values tabulated the pelvic CBCT protocol show that doses to organs in the pelvic region are comparable for both systems. For a clinician who intends to evaluate the dose to organs as a result of CBCT imaging of the pelvis from the TrueBeam XI system, for the purposes of treatment planning, the doses reported for OBI v1.4 given in AAPM TG-180 provide a valid estimate.
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Affiliation(s)
- Luke Gilling
- Medical Physics Department, Waikato District Health Board, Hamilton, New Zealand.
| | - Omer Ali
- Medical Physics Department, Waikato District Health Board, Hamilton, New Zealand
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Margalit DN, Sacco AG, Cooper JS, Ridge JA, Bakst RL, Beadle BM, Beitler JJ, Chang SS, Chen AM, Galloway TJ, Koyfman SA, Mita C, Robbins JR, Tsai CJ, Truong MT, Yom SS, Siddiqui F. Systematic review of postoperative therapy for resected squamous cell carcinoma of the head and neck: Executive summary of the American Radium Society appropriate use criteria. Head Neck 2021; 43:367-391. [PMID: 33098180 PMCID: PMC7756212 DOI: 10.1002/hed.26490] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The aims of this systematic review are to (a) evaluate the current literature on the impact of postoperative therapy for resected squamous cell carcinoma of the head and neck (SCCHN) on oncologic and non-oncologic outcomes and (b) identify the optimal evidence-based postoperative therapy recommendations for commonly encountered clinical scenarios. METHODS An analysis of the medical literature from peer-reviewed journals was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline. Prospective studies and methodology-based systematic reviews and meta-analyses of postoperative therapy for SCCHN were identified by searching Medline (OVID) and EMBASE (Elsevier) using controlled vocabulary terms (ie, National Library of Medicine Medical Subject Headings [MeSH], EMTREE). Study screening and selection was performed with Covidence software and full-text review. The RAND/UCLA appropriateness method was used by the expert panel to rate the appropriate use of postoperative therapy, and the modified Delphi method was used to come to consensus. RESULTS A total of 5660 studies were identified and screened using the title and abstract, leading to 201 studies assessed for relevance using full-text review. After limitation to the eligibility criteria, 101 studies from 1977 to 2020 were identified, including 77 with oncologic endpoints and 24 with function and quality of life endpoints. All studies reported staging prior to the implementation of American Joint Committee on Cancer (AJCC-8). CONCLUSIONS Prospective clinical studies and systematic reviews identified through the PRISMA systematic review provided good evidence for consensus statements regarding the appropriate use of postoperative therapy for resected SCCHN. Further research is needed in domains where consensus by the expert panel could not be achieved for the appropriateness of specific postoperative therapeutic interventions.
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Affiliation(s)
- Danielle N. Margalit
- Dana‐Farber/Brigham & Women's Cancer Center, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | | | | | - Beth M. Beadle
- Stanford University School of MedicineStanfordCaliforniaUSA
| | | | | | | | | | | | - Carol Mita
- Countway Library, Harvard Medical SchoolBostonMassachusettsUSA
| | | | | | - Minh T. Truong
- Boston University School of MedicineBostonMassachusettsUSA
| | - Sue S. Yom
- University of CaliforniaSan FranciscoCaliforniaUSA
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Yun JA, Kim HC, Kim SH, Cho YB, Yun SH, Lee WY, Chun HK. Prognostic significance of perineural invasion in stage IIA colon cancer. ANZ J Surg 2014; 86:1007-1013. [PMID: 25113398 DOI: 10.1111/ans.12810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND Perineural invasion (PNI) may influence the prognosis of colon cancer, but little is known about its predictive value. The aim of this study was to reveal the role of PNI in predicting prognosis after curative resection of colon cancer, especially T3N0. METHODS Two hundred and fifty-five patients who underwent curative resection for colon cancer at Samsung Medical Center and were later diagnosed with stage T3N0 by a pathological report between November 2004 and December 2007 were retrospectively recruited into the study. RESULTS Among the 255 patients, 156 were male and 99 were female. The mean age was 61 years (range, 25 to 88 years). The most common tumour location was the sigmoid colon (93 patients, 36.5%). The median follow-up period was 61 months (range, 1 to 98 months). PNI was detected in 18 patients (7.1%). Adjuvant chemotherapy was performed in 205 patients (80.4%). The 5-year disease-free survival rate was greater for patients with PNI negative tumours compared with those with PNI positive tumours (92.0% versus 76.0%, P = 0.025). Adjuvant chemotherapy was not associated with significant differences in survival rate (94.8% versus 96.9%, P = 0.625). On multivariate analysis, PNI was an independent prognostic factor for disease-free and overall survival (P = 0.046, hazard ratio (HR) = 3.113, 95% confidence interval (CI) = 1.020-9.505 and P = 0.019, HR = 9.395, 95% CI = 1.453-60.755 respectively). CONCLUSIONS PNI is the only significant prognostic factor affecting disease-free and overall survival in patients with T3N0 colon cancer.
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Affiliation(s)
- Jung-A Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seok-Hyung Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Kyung Chun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chatzistefanou I, Lubek J, Markou K, Ord RA. The role of neck dissection and postoperative adjuvant radiotherapy in cN0 patients with PNI-positive squamous cell carcinoma of the oral cavity. Oral Oncol 2014; 50:753-8. [DOI: 10.1016/j.oraloncology.2014.05.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 05/16/2014] [Indexed: 01/18/2023]
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Wygoda A, Składowski K, Rutkowski T, Hutnik M, Goleń M, Pilecki B, Przeorek W, Lukaszczyk-Wideł B. Acute mucosal radiation reactions in patients with head and neck cancer. Patterns of mucosal healing on the basis of daily examinations. Strahlenther Onkol 2012; 188:686-91. [PMID: 22729281 DOI: 10.1007/s00066-012-0146-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 04/23/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The goal of this research was to evaluate the healing processes of acute mucosal radiation reactions (AMRR) in patients with head and neck cancer. MATERIALS AND METHODS In 46 patients with oral and oropharyngeal cancer patients irradiated with conventional (n = 25) and accelerated (n = 21) dose fractionation AMRR was evaluated daily during and after radiotherapy. Complex of morphological and functional symptoms according to the Dische score were collected daily until complete healing. RESULTS Duration of healing after the end of radiotherapy ranged widely (12-70 days). It was on the average 8 days longer for accelerated than for conventional radiotherapy (p = 0.016). Duration of dysphagia was also longer for accelerated irradiation (11 days, p = 0.027). Three types of morphological symptoms were observed as the last symptom at the end of AMRR healing: spotted and confluent mucositis, erythema, and edema. Only a slight correlation between healing duration and area of irradiation fields (r = 0.23) was noted. In patients with confluent mucositis, two morphological forms of mucosal healing were observed, i.e., marginal and spotted. The spotted form was noted in 71% of patients undergoing conventional radiotherapy and in 38% of patients undergoing accelerated radiotherapy. The symptoms of mucosal healing were observed in 40% patients during radiotherapy. CONCLUSION The wide range of AMRR healing reflects individual potential of mucosa recovery with longer duration for accelerated radiotherapy. Two morphological forms of confluent mucositis healing were present: marginal and spotted. Healing of AMRR during radiotherapy can be observed in a significant proportion of patients.
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Affiliation(s)
- A Wygoda
- 1st Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Ul. Wybrzeże Armii Krajowej 15, 44-101, Gliwice, Poland.
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8
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Pauloski BR, Rademaker AW, Logemann JA, Lundy D, Bernstein M, McBreen C, Santa D, Campanelli A, Kelchner L, Klaben B, Discekici-Harris M. Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer. Head Neck 2010; 33:774-9. [PMID: 20737496 DOI: 10.1002/hed.21542] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute oral mucositis is associated with pain and impaired swallowing. Little information is available on the effects of chronic mucositis on swallowing. METHODS Sixty patients treated for cancer of the head and neck were examined during the first year after their cancer treatment. Oral mucosa was rated with the Oral Mucositis Assessment Scale. Stimulated whole-mouth saliva, oral pain rating, percent of oral intake, and 2 subscales of the Performance Status Scale for Head and Neck (PSS-HN) cancer were also collected. RESULTS Mucositis scores and pain ratings decreased over time while functional measures of eating improved over time. Reduction in chronic mucositis was correlated with improved oral intake and diet. CONCLUSION Lack of association with pain was attributed to the absence of ulcerations. Continued impairment of oral intake during the first year posttreatment may be related to oral mucosal changes and other factors.
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Affiliation(s)
- Barbara Roa Pauloski
- Communication Sciences and Disorders, Northwestern University, Evanston, Illinois, USA.
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9
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Abstract
Perineural invasion (PNI) is the process of neoplastic invasion of nerves and is an under-recognized route of metastatic spread. It is emerging as an important pathologic feature of many malignancies, including those of the pancreas, colon and rectum, prostate, head and neck, biliary tract, and stomach. For many of these malignancies, PNI is a marker of poor outcome and a harbinger of decreased survival. PNI is a distinct pathologic entity that can be observed in the absence of lymphatic or vascular invasion. It can be a source of distant tumor spread well beyond the extent of any local invasion; and, for some tumors, PNI may be the sole route of metastatic spread. Despite increasing recognition of this metastatic process, there has been little progress in the understanding of molecular mechanisms behind PNI and, to date, no targeted treatment modalities aimed at this pathologic entity. The objectives of this review were to lay out a clear definition of PNI to highlight its significance in those malignancies in which it has been studied best. The authors also summarized current theories on the molecular mediators and pathogenesis of PNI and introduced current research models that are leading to advancements in the understanding of this metastatic process.
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Affiliation(s)
- Catherine Liebig
- Department of Surgery, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas 77030, USA
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10
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Liao CT, Chang JTC, Wang HM, Ng SH, Hsueh C, Lee LY, Lin CH, Chen IH, Huang SF, Cheng AJ, See LC, Yen TC. Does Adjuvant Radiation Therapy Improve Outcomes In pT1-3N0 Oral Cavity Cancer With Tumor-Free Margins and Perineural Invasion? Int J Radiat Oncol Biol Phys 2008; 71:371-6. [DOI: 10.1016/j.ijrobp.2007.10.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Revised: 08/30/2007] [Accepted: 10/09/2007] [Indexed: 11/26/2022]
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Wyatt RM, Jones BJ, Dale RG. Radiotherapy treatment delays and their influence on tumour control achieved by various fractionation schedules. Br J Radiol 2008; 81:549-63. [PMID: 18378526 DOI: 10.1259/bjr/94471640] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
There is often a considerable delay from initial tumour diagnosis to the start of radiotherapy treatment. This paper extends the calculations of a previous paper on the effects of delays before the initiation of radiotherapy treatment to include results from a variety of practical fractionation regimes for three different types of tumour: squamous cell carcinoma (head and neck), breast and prostate. The linear quadratic model of radiation effect, logarithmic tumour growth (coupled with delay times where relevant) and the Poisson model for tumour control probability (TCP) are used to calculate the change in TCP for delays between diagnosis and treatment. Within the limitations of radiobiological modelling, these data can be used to tentatively assess the interactions between delays, dose fractionation and TCP. The results show that delays in the start of radiotherapy treatment do have an adverse effect on tumour control for fast-growing tumours. For example, calculations predict a reduction in local tumour control of up to 1.5% per week's delay for head and neck cancers treated following surgery. In addition, there may be a variety of fractionation regimes that will yield very similar clinical results for each tumour type. It is shown theoretically that, for the tumour types considered here, it is possible to increase the dose per fraction and decrease the number of fractions while maintaining or increasing TCP relative to standard 2 Gy fractionation regimes, although there may be some advantage to using hyperfractionated regimes for head and neck cancers in order to reduce normal tissue effects.
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Affiliation(s)
- R M Wyatt
- Department of Radiotherapy Physics, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK.
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12
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Abstract
PURPOSE Head and neck cancers are rapidly proliferating and relatively radiosensitive tumors. The increase in the number of daily fractions and the decrease in total treatment time give promising results in clinical practice. PATIENTS AND METHODS 20 patients diagnosed with head and neck cancer between August 2000 and July 2001 participated in this study. Median age was 63 years (range: 42-78). The tumors were mainly located in the larynx (40%), and in the hypopharynx (25%). Daily doses of 1.5 Gy thrice a day in 6-h intervals were given on each of 12 consecutive days with the exception of weekends. RESULTS Median follow-up was 22 months (range: 1-62). The overall response rate was 90%, and grade IIII early toxicity was 24%. No grade IV early toxicity was observed. Grade IV late toxicity was observed just in 1 case. 5-year rates for locoregional recurrence, distant metastasis, progression-free survival, and overall survival were 45, 20, 20, and 25%, respectively. CONCLUSION Our schedule was acceptable regarding the toxicity. However, the high incidence of locoregional failures urges us to modify the treatment modality.
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Affiliation(s)
- Adnan Yoney
- Department of Radiation Oncology, Okmeydani Training and Research Hospital, Sisli, Istanbul, Turkey.
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Brown JS, Blackburn TK, Woolgar JA, Lowe D, Errington RD, Vaughan ED, Rogers SN. A comparison of outcomes for patients with oral squamous cell carcinoma at intermediate risk of recurrence treated by surgery alone or with post-operative radiotherapy. Oral Oncol 2007; 43:764-73. [PMID: 17174140 DOI: 10.1016/j.oraloncology.2006.09.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2006] [Revised: 09/15/2006] [Accepted: 09/22/2006] [Indexed: 10/23/2022]
Abstract
Controversy remains about which patients at intermediate risk of recurrence of oral squamous cell carcinoma would benefit from radiotherapy. A retrospective review of computerised database and medical records for 462 consecutive patients at the Regional Maxillofacial Unit in Liverpool who were treated with primary surgery with or without post-operative radiotherapy was carried out. We classified 29% (134) of patients as being at 'low' risk of disease recurrence (pT1-2, N0 with clear margins), 29% (135) at 'high' risk (involved margins or lymph node extracapsular spread) and the remaining 42% (193) at 'intermediate' risk. Of those at intermediate risk, 41% (80/193) received adjuvant radiotherapy and their 5 year survival (SE) was 54% (6%) compared to 71% (5%) for those with primary surgery alone (P=0.002). A higher proportion of patients having radiotherapy had loco-regional recurrence (19/80 24%) compared to those treated by surgery alone (17/113 15%). The improved salvage rate for recurrent disease in the surgery alone group (8/17 53%), compared to those receiving radiotherapy (2/19 13%, P=0.05), indicates an advantage in withholding radiotherapy for patients at intermediate risk of recurrence. This study indicates a potential disadvantage associated with the use of postoperative radiotherapy for patients at intermediate risk of recurrence. A randomised trial comparing a watch and wait policy to postoperative radiotherapy in patients with an intermediate risk of recurrence is required to confirm the trend indicated in this retrospective data.
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Affiliation(s)
- J S Brown
- Regional Maxillofacial Unit, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, United Kingdom.
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Blackburn TK, Bakhtawar S, Brown JS, Lowe D, Vaughan ED, Rogers SN. A questionnaire survey of current UK practice for adjuvant radiotherapy following surgery for oral and oropharyngeal squamous cell carcinoma. Oral Oncol 2007; 43:143-9. [PMID: 16807074 DOI: 10.1016/j.oraloncology.2006.01.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Accepted: 01/30/2006] [Indexed: 10/24/2022]
Abstract
A postal questionnaire was sent to 281 members of the British Association of Head and Neck Oncologists (BAHNO) to survey, which patients should receive adjuvant radiotherapy following primary surgery for oral and oropharyngeal squamous cell carcinoma (O&OSCC). Two hundred and one clinicians were involved in decision making for adjuvant radiotherapy in O&OSCC, of which, 132 (66%) responded. Apart from general agreement that patients with involved margins or extracapsular spread (ECS) should have adjuvant radiotherapy and that in patients with small tumours with clear margins and no neck metastasis, radiotherapy should be avoided, opinion was divided. Considerable variation in opinion in the UK was identified for a subgroup of intermediate risk patients as to whether they should have adjuvant radiotherapy. The majority of respondents (95%) would consider submitting patients to a prospective multi-centre trial. There is a need for research regarding adjuvant radiotherapy for O&OSCC patients at intermediate risk of relapse following primary surgery.
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Affiliation(s)
- Tim K Blackburn
- Merseyside Head and Neck Cancer Centre, Regional Maxillofacial Unit, University Hospital Aintree, Lower Lane, Liverpool, Merseyside L9 7AL, United Kingdom.
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Sun SP, Liu YZ, Ye T, Zhang W, Shen WB, Shi JL, Xu HT, Wang WD. Randomized clinical trial on seven-day-per-week continuous accelerated irradiation for patients with esophageal carcinoma: Preliminary report on tumor response and acute toxicity. World J Gastroenterol 2006; 12:7047-50. [PMID: 17109504 PMCID: PMC4087353 DOI: 10.3748/wjg.v12.i43.7047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: Tumor response and normal tissue toxicity of seven-day-per-week continuous accelerated irradiation (CAIR) for patients with esophageal carcinoma were evaluated and compared to conventional irradiation (CR).
METHODS: Sixty patients with squamous cell carcinoma of the esophagus were randomized into two groups: the CAIR group (30 patients) and the CR group (30 patients). Patients in the CAIR group received radiotherapy (RT) with 2 Gy/fraction per day at 7 d/wk with a total dose of 50-70 Gy (average dose 64.2 Gy). The overall time of irradiation was 3.6-5.0 wk (average 4.6 wk). RT in the CR group was 2 Gy/fraction per day at 5 d/wk with a total dose of 40-70 Gy (average dose 61.7 Gy). The overall time of irradiation was 4.0-7.0 wk (average 6.4 wk).
RESULTS: The data showed that the immediate tumor response to RT was better in the CAIR group than in the CR group. Efficiency rates (CR plus PR) were 82.8% (24/29) and 58.6% (17/29), respectively (P = 0.047). In both groups the incidences of esophagitis and tracheitis were insignificant (P = 0.376, 0.959), and no patient received toxicity that could not be tolerated.
CONCLUSION: CAIR shortens overall treatment time and is well tolerated by patients. It may be superior to CR in enhancing the local response of tumor, but its remote effect for esophageal carcinoma awaits further follow-up.
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Affiliation(s)
- Su-Ping Sun
- Department of Radiation Oncology, Changzhou Second Hospital - The Affiliated Hospital of Nanjing Medical University, 29# Xing Long Xiang, Changzhou 213003, Jiangsu Province, China.
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Bernier J, Pfister DG, Cooper JS. Adjuvant chemo- and radiotherapy for poor prognosis head and neck squamous cell carcinomas. Crit Rev Oncol Hematol 2005; 56:353-64. [PMID: 15979887 DOI: 10.1016/j.critrevonc.2005.04.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2004] [Revised: 04/25/2005] [Accepted: 04/26/2005] [Indexed: 11/30/2022] Open
Abstract
The treatment of squamous cell carcinomas of the head and neck is multidisciplinary, especially when the disease is diagnosed at an intermediate or advanced stage. Very often the clinician chooses between surgery, chemo- and radiotherapy options on the basis of the most recent data from the literature, prior experience in head and neck oncology and patient preferences. Nevertheless, for operable tumors, primary surgery, combined in poor-risk patients with radiation, is traditionally considered as the approach offering the best opportunity of cure. Randomized controlled trials and meta-analyses conducted in the 1990s have demonstrated major improvements not only in loco-regional tumor control, but also in terms of survival when chemotherapy is added to radiotherapy in the post-operative setting. The therapeutic index yielded by the co-administration of cytotoxic agents and ionizing radiation following primary surgery as compared with radiotherapy alone has nevertheless been at the center of many debates recently. Notwithstanding the fact that two randomized trials have recently provided new evidence that adjuvant chemo-radiation in poor-risk patients improves loco-regional control and disease-free survival, a number of questions regarding the optimization of the post-operative approaches remain unanswered. There is remaining need for further research efforts that would enable scientists and clinicians to improve, in the next decade, the management of this complex entity of diseases.
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Affiliation(s)
- Jacques Bernier
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland, San Giovanni Hospital, CH-6504 Bellinzona, Switzerland.
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Zouhair A, Azria D, Pasche P, Stupp R, Chevalier J, Betz M, Mirimanoff RO, Ozsahin M. Accelerated postoperative radiotherapy with weekly concomitant boost in patients with locally advanced head and neck cancer. Radiother Oncol 2004; 70:183-8. [PMID: 15028406 DOI: 10.1016/j.radonc.2003.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2003] [Revised: 11/06/2003] [Accepted: 11/13/2003] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE To assess the feasibility and efficacy of accelerated 66-Gy postoperative radiotherapy (PORT) using a single-fraction regimen from Mondays to Thursdays and a concomitant boost on Friday afternoon sessions in patients with locally advanced head and neck cancer (LAHNC). PATIENTS AND METHODS Between December 1997 and June 2002, 89 consecutive patients with pT1-pT4 and/or pN0-pN3 LAHNC were included. PORT was indicated in patients with positive surgical margins, T4 tumors, or extracapsular nodal infiltration. RT consisted of 66 Gy (2 Gy/fr) in 5 weeks and 3 days. Median follow-up was 21 months (range 2-59). RESULTS Acute morbidity was acceptable: grade 3 mucositis in 20 (22%) patients, grade 3 dysphagia in 22 (25%) patients, and grade 3 skin erythema in 18 (20%) patients. Median weight loss was 2 kg (range 0-14.5). No grade 4 toxicity was observed. Late effects included grade 3 xerostomia in 6 (7%) patients, and grade 3 edema in 2 (2%) patients. Median time to locoregional relapse was 10 months (range 2-21). Two-year overall, cause-specific, and disease-free survival rates were 70% (95% confidence interval (CI) 59-81), 75% (95% CI 64-86), and 63% (95% CI 52-74), respectively. The 2-year actuarial locoregional control rate was 80% (95% CI 70-90). Distant metastasis probability at 4 years was 38% (95% CI 20-56). Multivariate analysis revealed that pT-classification (pT1-2 vs. pT3-4) and extranodal extension (0, 1 vs. 2 or more) were the two factors independently influencing the outcome. CONCLUSIONS We conclude that reducing the overall treatment time using an accelerated PORT schedule including a once-weekly concomitant boost (six fractions per week) is easily feasible with excellent local control. Acute and late RT-related morbidity is acceptable. Given the disease progression pattern (distant metastases), adjuvant chemotherapy should be considered.
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Affiliation(s)
- Abderrahim Zouhair
- Department of Radiation Oncology, Centre Hospitalier Universitaire Vaudois, Bugnon 46, CH-1011 Lausanne, Switzerland
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Zouhair A, Coucke PA, Azria D, Pache P, Stupp R, Moeckli R, Mirimanoff RO, Ozsahin M. [Prospective study of accelerated postoperative radiation therapy in patients with squamous-cell carcinoma of the head and neck]. Cancer Radiother 2003; 7:231-6. [PMID: 12914856 DOI: 10.1016/s1278-3218(03)00041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the feasibility and efficacy of accelerated postoperative radiation therapy (RT) in patients with squamous-cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS Between December 1997 and July 2001, 68 patients (male to female ratio: 52/16; median age: 60-years (range: 43-81) with pT1-pT4 and/or pN0-pN3 SCCHN (24 oropharynx, 19 oral cavity, 13 hypopharynx, 5 larynx, 3 unknown primary, 2 maxillary sinus, and 2 salivary gland) were included in this prospective study. Postoperative RT was indicated because extracapsular infiltration (ECI) was observed in 20 (29%), positive surgical margins (PSM) in 20 (29%) or both in 23 patients (34%). Treatment consisted of external beam RT 66 Gy in 5 weeks and 3 days. Median follow-up was 15 months. RESULTS According to CTC 2.0, acute morbidity was acceptable: grade 3 mucositis was observed in 15 (22%) patients, grade 3 dysphagia in 19 (28%) patients, grade 3 skin erythema in 21 (31%) patients with a median weight loss of 3.1 kg (range: 0-16). No grade 4 toxicity was observed. Median time to relapse was 13 months; we observed only three (4%) local and four (6%) regional relapses, whereas eight (12%) patients developed distant metastases without any evidence of locoregional recurrence. The 2 years overall-, disease-free survival, and actuarial locoregional control rates were 85, 73 and 83% respectively. CONCLUSION The reduction of the overall treatment time using postoperative accelerated RT with weekly concomitant boost (six fractions per week) is feasible with local control rates comparable to that of published data. Acute RT-related morbidity is acceptable.
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Affiliation(s)
- A Zouhair
- Service de radio-oncologie, centre hospitalier universitaire vaudois CHUV, 1011, Lausanne, Suisse.
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Jones B, Aird E, Colyer H, Dobbs J, Harris R, Hoskin P, McKenzie A, West C. United Kingdom Radiation Oncology 1 Conference (UKRO 1): accuracy and uncertainty in radiotherapy. Br J Radiol 2002; 75:297-306. [PMID: 12000690 DOI: 10.1259/bjr.75.892.750297] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- B Jones
- Oncology Centre, Hammersmith Hospital, London, UK
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