1
|
Rosenberg AJ, Agrawal N, Juloori A, Cursio J, Gooi Z, Blair E, Chin J, Ginat D, Pasternak-Wise O, Hasina R, Starus A, Jones FS, Izumchenko E, MacCracken E, Wolk R, Cipriani N, Lingen MW, Pearson AT, Seiwert TY, Haraf DJ, Vokes EE. Neoadjuvant Nivolumab Plus Chemotherapy Followed By Response-Adaptive Therapy for HPV+ Oropharyngeal Cancer: OPTIMA II Phase 2 Open-Label Nonrandomized Controlled Trial. JAMA Oncol 2024; 10:923-931. [PMID: 38842838 PMCID: PMC11157444 DOI: 10.1001/jamaoncol.2024.1530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/02/2024] [Indexed: 06/07/2024]
Abstract
Importance Immune checkpoint inhibitors improve survival in recurrent and/or metastatic head and neck cancer, yet their role in curative human papillomavirus-positive oropharyngeal cancer (HPV+ OPC) remains undefined. Neoadjuvant nivolumab and chemotherapy followed by response-adaptive treatment in HPV+ OPC may increase efficacy while reducing toxicity. Objective To determine the deep response rate and tolerability of the addition of neoadjuvant nivolumab to chemotherapy followed by response-adapted locoregional therapy (LRT) in patients with HPV+ OPC. Design, Setting, and Participants This phase 2 nonrandomized controlled trial conducted at a single academic center enrolled 77 patients with locoregionally advanced HPV+ OPC from 2017 to 2020. Data analyses were performed from February 10, 2021, to January 9, 2023. Interventions Addition of nivolumab to neoadjuvant nab-paclitaxel and carboplatin (studied in the first OPTIMA trial) followed by response-adapted LRT in patients with HPV+ OPC stages III to IV. Main Outcomes and Measures Primary outcome was deep response rate to neoadjuvant nivolumab plus chemotherapy, defined as the proportion of tumors with 50% or greater shrinkage per the Response Evaluation Criteria in Solid Tumors 1.1. Secondary outcomes were progression-free survival (PFS) and overall survival (OS). Swallowing function, quality of life, and tissue- and blood-based biomarkers, including programmed death-ligand 1 (PD-L1) expression and circulating tumor HPV-DNA (ctHPV-DNA), were also evaluated. Results The 73 eligible patients (median [range] age, 61 [37-82] years; 6 [8.2%] female; 67 [91.8%] male) started neoadjuvant nivolumab and chemotherapy. Deep responses were observed in 51 patients (70.8%; 95% CI, 0.59-0.81). Subsequent risk- and response-adaptive therapy was assigned as follows: group A, single-modality radiotherapy alone or transoral robotic surgery (28 patients); group B, intermediate-dose chemoradiotherapy of 45 to 50 Gray (34 patients); and group C, regular-dose chemoradiotherapy of 70 to 75 Gray (10 patients). Two-year PFS and OS were 90.0% (95% CI, 0.80-0.95) and 91.4% (95% CI, 0.82-0.96), respectively. By response-adapted group, 2-year PFS and OS for group A were 96.4% and 96.4%, and group B, 88.0% and 91.0%, respectively. Lower enteral feeding rates and changes in weight, as well as improved swallowing, were observed among patients who received response-adapted LRT. Pathologic complete response rate among patients who underwent transoral robotic surgery was 67.0%. PD-L1 expression was nonsignificantly higher for deeper responses and improved PFS, and ctHPV-DNA clearance was significantly associated with improved PFS. Conclusions and Relevance This phase 2 nonrandomized controlled trial found that neoadjuvant nivolumab and chemotherapy followed by response-adapted LRT is feasible and has favorable tolerability, excellent OS, and improved functional outcomes in HPV+ OPC, including among patients with high-risk disease. Moreover, addition of nivolumab may benefit high PD-L1 expressors, and sensitive dynamic biomarkers (eg, ctHPV-DNA) are useful for patient selection. Trial Registration ClinicalTrials.gov Identifier: NCT03107182.
Collapse
Affiliation(s)
- Ari J. Rosenberg
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Nishant Agrawal
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Aditya Juloori
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - John Cursio
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | - Zhen Gooi
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Elizabeth Blair
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Jeffrey Chin
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Daniel Ginat
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Olga Pasternak-Wise
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Radiology, University of Chicago, Chicago, Illinois
| | - Rifat Hasina
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | | | | | - Evgeny Izumchenko
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Ellen MacCracken
- Section of Otolaryngology−Head and Neck Surgery, University of Chicago, Chicago, Illinois
| | - Rachelle Wolk
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Nicole Cipriani
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Mark W. Lingen
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Alexander T. Pearson
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| | - Tanguy Y. Seiwert
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, Maryland
| | - Daniel J. Haraf
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Everett E. Vokes
- Section of Hematology and Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
- University of Chicago Comprehensive Cancer Center, Chicago, Illinois
| |
Collapse
|
2
|
Agrawal M, Konduru V, Riju J, Singh A, Joel A, Karuppusami R, Tirkey AJ. Definitive Surgery after Neoadjuvant Chemotherapy for Locally Advanced Oral Cavity Cancers: Experience from a Tertiary Care Center. South Asian J Cancer 2023; 12:341-348. [PMID: 38130286 PMCID: PMC10733068 DOI: 10.1055/s-0043-1768038] [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] [Indexed: 12/23/2023] Open
Abstract
Mansi AgrawalVidya KonduruBackground Oral cavity cancers require definitive surgical resection as the primary treatment, but with advanced T stage, complete resection with pathologically negative margins might be difficult to achieve. Induction chemotherapy helps achieve the balance between resection and morbidity in locally advanced technically unresectable tumors. The aim of this study was to analyze the impact of surgery in locally advanced, technically unresectable oral cavity cancers after neoadjuvant chemotherapy (NACT). Materials and Methods A retrospective analysis of patients with borderline resectable, locally advanced oral cavity cancers who were given NACT between February 2017 and December 2021 was conducted. Data regarding clinical and pathological characteristics, NACT, surgery, adjuvant therapy, and recurrences was analyzed. Results Of the 69 patients in the study, 69.6% had tongue cancer, rest were gingivobuccal complex cancers. All tumors were resected based on the post-NACT tumor volume and clear margins were achieved in 42% of cases. About 85.4% of the tongue cancers required a lesser resection than anticipated, thereby following the concept of organ and functional preservation post-NACT as proposed by Licitra et al. About 30.4% had ypT0 and 17.4% had ypN0. Recurrence and survival rates noted in our study were comparable to those reported in literature. Lymph node density of more than or equal to 0.07 was found in all recurrent cases. Conclusions Induction chemotherapy offers a chance of achieving adequate surgical resection while reducing morbidity and improving functional outcomes for patients with technically unresectable oral cavity cancers. Nodal disease may not respond to chemotherapy as well as the primary tumor. There is a need for comprehensive evaluation of prognostic factors, which could help identify the patients who will most benefit with NACT.
Collapse
Affiliation(s)
- Mansi Agrawal
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vidya Konduru
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Jeyashanth Riju
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashish Singh
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reka Karuppusami
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Amit Jiwan Tirkey
- Department of Head and Neck Surgery, Unit-2, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
3
|
Li H, Zhang X, Chen W, Zhang Q, Li Q, Chen S, Yang Z, Su X, Yan S, Yang A, Song M. Analysis of T1-T2 stage oropharyngeal squamous cell carcinoma treated with transoral robotic surgery. Laryngoscope Investig Otolaryngol 2023; 8:103-112. [PMID: 36846425 PMCID: PMC9948596 DOI: 10.1002/lio2.1005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/07/2022] [Accepted: 11/15/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Transoral robotic surgery (TORS) has become an effective treatment for early-stage oropharyngeal squamous cell carcinomas (OPSCCs). We aimed to analyze the clinical safety and efficacy of TORS for human papilloma virus (HPV)-positive and HPV-negative OPSCC in China. Methods Patients with OPSCC of pT1-T2 stage who underwent TORS from March 2017 to December 2021 were analyzed. Results A total of 83 patients (HPV-positive, n = 25; HPV-negative, n = 58) were included. The median age of the patients was 57.0 years and 71 were men. The majority of primary tumor sites were palatine tonsils (52, 62.7%) and base of tongues (20, 24.1%). Three patients have a positive margin. A total of 12 (14.5%) patients received tracheotomies, the average duration of tracheostomy tube use was 9.4 days, and nasogastric tube was 14.5 days. No patient had a long-term tracheotomy. The 3-year overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) for all 83 patients were 89.5%, 80.1%, and 83.3%, respectively. The OS at 3 years between the HPV-positive group and HPV-negative group were 100% versus 84.3% (P = .07), while the DFS and RFS between two groups also showed no significant difference. Among multivariate cox regression analysis of all potential risk factors, smoking was the significant risk factors for disease recurrence (P < .05). Conclusion Transoral robotic surgery achieved encouraging oncologic outcomes and safety in T1-T2 stage OPSCC treatment, regardless of HPV status. Level of Evidence 4.
Collapse
Affiliation(s)
- Hui Li
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xing Zhang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Wenkuan Chen
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Quan Zhang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Qiuli Li
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shuwei Chen
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Zhongyuan Yang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Xuan Su
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Shida Yan
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ankui Yang
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| | - Ming Song
- Collaborative Innovation Center for Cancer MedicineState Key Laboratory of Oncology in South China, Sun Yat‐sen University Cancer CenterGuangzhouChina
- Department of Head and Neck SurgerySun Yat‐sen University Cancer CenterGuangzhouChina
| |
Collapse
|
4
|
Mishra BK, Kapoor A, Gupta A, Sansar B, Singh A, Roy S, Mandal T, Srinivas S, Das S, Mishra A, Mukherjee A, Nanda S, Sambasivaiah K. Neoadjuvant chemotherapy in technically unresectable head and neck cancers: a retrospective audit. Ecancermedicalscience 2022; 16:1460. [PMID: 36819802 PMCID: PMC9934875 DOI: 10.3332/ecancer.2022.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 02/24/2023] Open
Abstract
Background The data regarding the use of neoadjuvant chemotherapy in technically unresectable head and neck cancer (HNC) is limited and real-world studies are needed to look for the efficacy and toxicities of this approach. Patients and methods This is a retrospective study conducted in the Medical Oncology department of our hospital. All technically unresectable HNC patients who underwent neoadjuvant chemotherapy between May 2018 and May 2020 were included in this analysis. Patients received three-drug regimen docetaxel, cisplatin and 5-fluorouracil (DCF) regimen, two-drug regimens included docetaxel + cisplatin, paclitaxel + carboplatin both weekly and 3-weekly. The resectability assessment was done clinically and radiologically after completing three neoadjuvant cycles. Overall survival was calculated from the first day of chemotherapy to the date of last follow-up or date of death. Results A total of 119 patients received neoadjuvant chemotherapy during the specified time. Response assessment showed partial response in 41.9% of patients with three-drug regimens and 37.5% of patients with other regimens. Out of 119 patients, 56 (47%) patients were offered radical intent therapy. Resectability was achieved in 32.3% of three-drug regimen patients and 26.1% of other patients. Surgery was feasible in 33 (27.7%) patients, and postoperative radiotherapy and concurrent chemotherapy were done in 30 patients (25.2%), and surgery with only postoperative radiotherapy was done in 3 patients (2.5%). Radical chemoradiotherapy was done in 23 patients (19.3%). The estimated median survival for patients who could undergo surgery was 18 months [95% confidence interval (CI), 14.9-21.0], and nonsurgical patients were 9 months (95% CI, 7.3-10.6) (p = 0.0001). Conclusion Our study shows that neoadjuvant chemotherapy in technically unresectable HNC patients can make the disease resectable in around one-third of the patients. The patients who could undergo surgery after neoadjuvant chemotherapy had significantly improved survival as compared to those who could not.
Collapse
Affiliation(s)
- Bal Krishna Mishra
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Akhil Kapoor
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Anuj Gupta
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Bipinesh Sansar
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Arpita Singh
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Somnath Roy
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Tanmoy Mandal
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Sujay Srinivas
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Sudeep Das
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Aseem Mishra
- Department of Head and Neck Surgery, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Ashutosh Mukherjee
- Department of Radiation Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Sambit Nanda
- Department of Radiation Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| | - Kurupathy Sambasivaiah
- Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre & Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, 221005, India
| |
Collapse
|
5
|
Rosenberg AJ, Agrawal N, Pearson A, Gooi Z, Blair E, Cursio J, Juloori A, Ginat D, Howard A, Chin J, Kochanny S, Foster C, Cipriani N, Lingen M, Izumchenko E, Seiwert TY, Haraf D, Vokes EE. Risk and response adapted de-intensified treatment for HPV-associated oropharyngeal cancer: Optima paradigm expanded experience. Oral Oncol 2021; 122:105566. [PMID: 34662771 PMCID: PMC9295443 DOI: 10.1016/j.oraloncology.2021.105566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Favorable prognosis for Human papillomavirus-associated (HPV+) oropharyngeal cancer (OPC) led to investigation of response-adaptive de-escalation, yet long-term outcomes are unknown. We present expanded experience and follow-up of risk/response adaptive treatment de-intensification in HPV+ OPC. METHODS A phase 2 trial (OPTIMA) and subsequent cohort of sequential off-protocol patients treated from September 2014 to November 2018 at the University of Chicago were reviewed. Eligible patients had T3-T4 or N2-3 (AJCC 7th edition) HPV+ OPC. Patients were stratified by risk: High-risk (HR) (T4, ≥N2c, or >10PYH), all others low-risk (LR). Induction chemotherapy (IC) included 3 cycles of carboplatin and nab-paclitaxel (OPTIMA) or paclitaxel (off-protocol). LR with ≥50% response received low-dose radiotherapy (RT) alone to 50 Gy (RT50). LR with 30-50% response and HR with ≥50% response received intermediate-dose chemoradiotherapy (CRT) to 45 Gy (CRT45). All others received full-dose CRT to 75 Gy (CRT75). RESULTS 91 patients consented and 90 patients were treated, of which 31% had >10PYH, 34% had T3/4 disease, and 94% had N2b/N2c/N3 disease. 49% were LR and 51% were HR. Overall response rate to induction was 88%. De-escalated treatment was administered to 83%. Median follow-up was 4.2 years. Five-year OS, PFS, LRC, and DC were 90% (95% CI 81,95), 90% (95% CI 80,95), 96% (95% CI 90,99), and 96% (88,99) respectively. G-tube placement rates in RT50, CRT45, and CRT75 were 3%, 33%, and 80% respectively (p < 0.05). CONCLUSION Risk/response adaptive de-escalated treatment for an inclusive cohort of HPV+ OPC demonstrates excellent survival with reduced toxicity with long-term follow-up.
Collapse
Affiliation(s)
- Ari J Rosenberg
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA.
| | - Nishant Agrawal
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Alexander Pearson
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Zhen Gooi
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Elizabeth Blair
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - John Cursio
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Aditya Juloori
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Daniel Ginat
- Department of Radiology, University of Chicago, Chicago, IL, USA
| | - Adam Howard
- Section of Otolaryngology-Head and Neck Surgery, University of Chicago, Chicago, IL, USA
| | - Jeffrey Chin
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Sara Kochanny
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Corey Foster
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicole Cipriani
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Mark Lingen
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Evgeny Izumchenko
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| | - Tanguy Y Seiwert
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, USA
| | - Daniel Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Everett E Vokes
- Department of Medicine, Section of Hematology and Oncology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
6
|
Szturz P, Vinches M, Remenár É, van Herpen CML, Abdeddaim C, Stewart JS, Fortpied C, Vermorken JB. Prognostic factor analysis and long-term results of the TAX 323 (EORTC 24971) study in unresectable head and neck cancer patients. Eur J Cancer 2021; 156:109-118. [PMID: 34425403 DOI: 10.1016/j.ejca.2021.07.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/19/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the TAX 323 (EORTC 24971) phase III trial enrolling patients with unresectable locoregionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN), the addition of docetaxel (T) to cisplatin and 5-fluorouracil (PF)-based induction chemotherapy prior to definite radiotherapy significantly improved progression-free survival (PFS) and overall survival (OS). METHODS The data were updated for PFS, OS and treatment-related long-term side-effects. Baseline clinical and laboratory data of 17 variables were collected and subjected to univariate and multivariate prognostic factor analyses for OS. RESULTS All 358 patients randomised between 1999 and 2002 were included in the long-term analysis with a median follow-up of 8.6 years. The primary end-point of PFS remained significantly improved with TPF compared with PF (adjusted hazard ratio [HR], 0.70; 95% CI, 0.56-0.88, p = 0.002), translating into a persisting benefit in OS (adjusted HR, 0.75; 95% CI, 0.60-0.95, p = 0.015). Long-term side-effects in the TPF/PF arms comprised tracheostomy (7%/5%), feeding tube dependency (3%/6%) and gastrostomy (11%/11%). Second malignancy occurred in 8%/3%, respectively. Out of 177 patients randomised to the TPF arm, 160 were included in the multivariate analysis. Grade 2 or more dysphagia (p = 0.002) and grade 2 or more pain (p = 0.004) at baseline were identified as independent negative prognostic factors. In addition, OS differed across primary tumour sites (p = 0.027) and was worse in patients with a higher N-stage (p = 0.025). CONCLUSIONS In LA-SCCHN patients treated with sequential chemoradiotherapy, TPF induction chemotherapy demonstrated long-lasting efficacy, superior to the PF regimen. Higher-grade dysphagia and pain are unfavourable prognosticators.
Collapse
Affiliation(s)
- Petr Szturz
- Medical Oncology, Department of Oncology, University of Lausanne (UNIL) and Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Marie Vinches
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Éva Remenár
- Hospitalier Order of Saint John of God Hospital Buda, Budapest, Hungary
| | - Carla M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | | | - Catherine Fortpied
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| |
Collapse
|
7
|
Ng WT, Tsang RKY, Beitler JJ, de Bree R, Coca-Pelaz A, Eisbruch A, Guntinas-Lichius O, Lee AWM, Mäkitie AA, Mendenhall WM, Nuyts S, Rinaldo A, Robbins KT, Rodrigo JP, Silver CE, Simo R, Smee R, Strojan P, Takes RP, Ferlito A. Contemporary management of the neck in nasopharyngeal carcinoma. Head Neck 2021; 43:1949-1963. [PMID: 33780074 DOI: 10.1002/hed.26685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/29/2021] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
Up to 85% of the patients with nasopharyngeal carcinoma present with regional nodal metastasis. Although excellent nodal control is achieved with radiotherapy, a thorough understanding of the current TNM staging criteria and pattern of nodal spread is essential to optimize target delineation and minimize unnecessary irradiation to adjacent normal tissue. Selective nodal irradiation with sparing of the lower neck and submandibular region according to individual nodal risk is now emerging as the preferred treatment option. There has also been continual refinement in staging classification by incorporating relevant adverse nodal features. As for the uncommon occurrence of recurrent nodal metastasis after radiotherapy, surgery remains the standard of care.
Collapse
Affiliation(s)
- Wai Tong Ng
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Raymond K Y Tsang
- Department of Otorhinolaryngology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jonathan J Beitler
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Otolaryngology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA.,Department of Hematology/Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | | | - Anne W M Lee
- Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Clinical Oncology Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sandra Nuyts
- Department of Radiation Oncology, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium.,Laboratory of Experimental Radiotherapy, Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Alessandra Rinaldo
- Department of Otolaryngology, University of Udine School of Medicine, Udine, Italy
| | - K Thomas Robbins
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University Medical School, Springfield, Illinois, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias, IUOPA, CIBERONC, Oviedo, Spain
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Ricard Simo
- Departement of Otorhinolaryngology, Head and Neck Surgery, Head and Neck and Thyroid Oncology Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Robert Smee
- Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, New South Wales, Australia
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
| |
Collapse
|
8
|
Chang YF, Su NW, Tsai KJ, Leu YS, Lee JC, Liu CJ, Cheng CY, Lin JS, Chen YJ, Liu SH, Chen CH. Modified 3-weekly cisplatin or cisplatin-5-fluorouracil 5-day infusion as the concurrent chemoradiotherapy regimen in locally advanced squamous cell carcinoma of the head and neck: Comparison of efficacy and toxicity. JOURNAL OF CANCER RESEARCH AND PRACTICE 2020. [DOI: 10.4103/jcrp.jcrp_27_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
9
|
Cho WK, Oh D, Lee E, Kim TG, Lee H, Nam H, Noh JM, Ahn YC. Feasibility of Selective Neck Irradiation with Lower Elective Radiation Dose in Treating Nasopharynx Cancer Patients. Cancer Res Treat 2018; 51:603-610. [PMID: 30025444 PMCID: PMC6473294 DOI: 10.4143/crt.2018.240] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/16/2018] [Indexed: 01/14/2023] Open
Abstract
Purpose This study aimed to report the clinical outcomes following selective neck irradiation (SNI) with lower elective radiation therapy (RT) dose in treating nasopharyngeal cancer (NPC) patients. Materials and Methods A total of 347 NPC patients received definitive RT according to our SNI policy and were retrospectively analyzed. The clinical target volumes (CTVs) were subdivided into CTV at high risk (CTV-HR) and CTV at low risk (CTV-LR). The typical doses to gross tumor volume (GTV), CTV-HR, and CTV-LR were 68.4-70.0 Gy, 54.0-60.0 Gy, and 36.0 Gy. Results With the median follow-up of 68.1 months (range, 2.3 to 197.1 months), the 5-year rates of loco-regional control and progression-free survival in all the patients were 85.0% and 70.8%, respectively. Thirty patients developed regional failure and the regional control rates at 3 and 5 years were 92.6% and 91.4%, respectively. The sites of regional failure in relation to the target volume were exclusively inside GTV/CTV-HR in 20, inside and outside GTV/CTVHR in three, and exclusively outside GTV/CTV-HR in seven, which were 5.7%, 0.9%, and 2.0% of total patients, respectively. Conclusion The clinical outcomes by the current SNI policy were feasible and comparable to those following classic elective nodal irradiation policy.
Collapse
Affiliation(s)
- Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eonju Lee
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Tae Gyu Kim
- Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyebin Lee
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heerim Nam
- Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
10
|
Hreib M, Krause M. [No evidence for reduced late toxicity with dose reduction in the elective lymph node region in primary radiochemotherapy of head and neck tumors]. Strahlenther Onkol 2018; 194:697-698. [PMID: 29777266 DOI: 10.1007/s00066-018-1312-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Mohammad Hreib
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Carl Gustav Carus, Technische Univeristät Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
| | - Mechthild Krause
- Klinik und Poliklinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Carl Gustav Carus, Technische Univeristät Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
| |
Collapse
|
11
|
Kiong KL, de Souza NN, Sultana R, Iyer NG. Meta-analysis of induction chemotherapy as a selection marker for chemoradiation in the head and neck. Laryngoscope 2017; 128:1594-1601. [PMID: 29171671 DOI: 10.1002/lary.27011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Many trials incorporate induction chemotherapy (IC) in selecting for organ preservation in head and neck squamous cell carcinomas (HNSCC). However, few studies examine IC response in predicting for chemoradiation therapy (CRT) response. This meta-analysis aims to determine the predictive accuracy of IC for subsequent response to CRT and overall survival (OS). DATA SOURCES Medline, EMBASE, Cochrane register. METHODS A systematic search identified studies from database inception to October 2016 that used IC prior to CRT as definitive treatment for advanced HNSCC. The sensitivities and specificities of IC response predicting for complete CRT response were calculated, and the results were pooled in a summary receiver operating curve. One-, 2- and 5-year OS data were extracted. RESULTS Seven studies (n = 423 patients) were analyzed for response and six (n = 439) for OS. Pooled median sensitivity and specificity of IC response predicting CRT response were 0.95 (95% confidence interval [CI]: 0.72-0.98) and 0.43 (95% CI: 0.00-0.61), respectively. Patients were more likely to respond to CRT given previous response to IC (positive likelihood ratio = 1.6; 95% CI: 1.21-2.11) and less likely to respond to CRT if they failed to respond to IC (negative likelihood ratio = 0.16; 95% CI: 0.07-0.38). At 2 years, good response to IC was a statistically significant prognostic marker with a risk ratio of 1.35 (95% CI: 1.12-1.64). CONCLUSION Our data suggests that patients with poor IC response will have poorer response to CRT and should be directed to other modalities. In contrast, good IC response does not guarantee a favorable outcome to CRT; however, because these patients are likely to have better prognoses, they should be offered salvage therapies of curative intent despite treatment failure. LEVEL OF EVIDENCE NA. Laryngoscope, 128:1594-1601, 2018.
Collapse
Affiliation(s)
| | - Nurun Nisa de Souza
- Duke-NUS Medical School, Singapore.,Singapore Clinical Research Institute, Singapore
| | | | - N Gopalakrishna Iyer
- Singhealth/Duke-NUS Head and Neck Centre, Singapore.,National Cancer Centre Singapore, Singapore
| |
Collapse
|
12
|
Elective nodal dose of 60 Gy or 50 Gy in head and neck cancers: A matched pair analysis of outcomes and toxicity. Adv Radiat Oncol 2017; 2:339-345. [PMID: 29114601 PMCID: PMC5605312 DOI: 10.1016/j.adro.2017.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 05/04/2017] [Accepted: 06/20/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose The main objective of this study was to evaluate appropriate doses for elective nodal irradiation (ENI) in head and neck squamous cell carcinoma (HNSCC) patients to optimize the therapeutic ratio. Methods and materials A matched pair analysis of 2 similar cohorts of HNSCC treated with intensity modulated radiation therapy with different dose prescriptions to the elective nodal regions was conducted. One group received 60 Gy, whereas the other received 50 Gy (ENI60 and ENI50 groups, respectively). Isolated regional recurrences (IRR) and locoregional control were evaluated. Doses received by the parotid and thyroid glands were compared among both groups and were clinically correlated with the trend of salivary function recovery and incidence of hypothyroidism. Results Of the 110 patients studied, 97 were eligible for analysis after matching based on propensity scores. The 3-year locoregional control rate was similar in ENI60 and ENI50 (78.7% and 77%, respectively; P = .93). There were no IRR in ENI regions in either group. The mean ipsilateral parotid dose in ENI60 was significantly higher compared with ENI50 (42 vs 35.7 Gy, P = .03). There was no significant difference in the mean contralateral parotid doses (32.5 vs 31.7 Gy, P = .6). The mean thyroid doses were high in ENI60 compared with ENI50 (54.7 vs 43.3 Gy, P < .001). A significant difference in ipsilateral parotid salivary excretory fraction ratio at 1 year (P = .03) was observed with quicker recovery of salivary function. The salivary excretory fractions were poorer in the ENI60 group with higher mean parotid doses (P = .009). At 2 years, 26 patients (54%) in the ENI60 group and 13 patients (26.5%) in the ENI50 group developed biochemical hypothyroidism (P = .007). Conclusions Doses of 50 Gy equivalent are sufficient to sterilize the uninvolved nodal regions because the rates of IRR are extremely low. Using ENI50 results in clinically meaningful reduction in salivary and thyroid toxicity in HNSCC.
Collapse
|
13
|
Yang H, Wang Y, Zhan J, Xia Y, Sun P, Bi XW, Liu PP, Li ZM, Li S, Zou BY, Jiang WQ. Puquitinib mesylate, an inhibitor of phosphatidylinositol 3-kinase p110δ, for treating relapsed or refractory non-Hodgkin's lymphoma. Oncotarget 2016; 6:44049-56. [PMID: 26510909 PMCID: PMC4791286 DOI: 10.18632/oncotarget.5833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/24/2015] [Indexed: 11/29/2022] Open
Abstract
Objectives To determine the safety of Puquitinib Mesylate (XC-302), an oral inhibitor of phosphatidylinositol 3-kinase, in treating relapsed or refractory non-Hodgkin's lymphoma (NHL). Methods Between October 2013 and July 2015, 21 patients from Sun Yat-sen University Cancer Center were treated twice daily on each day of a 28-day cycle (median number of cycles, 2; maximum, 20) with XC-302 at a post prandial dose of 25 mg, 37.5 mg, or 50 mg. Adverse events (AEs), AUClast and Cmax, response rates, and overall survival were assessed. Results Patients had received a median (range) of 1 (1 to 3) previous cancer treatments. At the latest follow-up, two patients were still benefitting from the study. The most common drug-related AEs were elevations in alanine transaminase (ALT, 14 of 21 patients) and aspartate transaminase (AST, 7 of 21 patients). Four patients, both in the-50-mg group, had dose-limiting toxicities, and therapy was discontinued in a fifth because of persistent abnormal liver function. The overall response rate was 2 of19. Serum concentrations of XC-302 increased in a dose-dependent pattern. Median progression-free survival in all patients was 1.9 (95% CI, 1.7 to 2.0) months. Conclusion XC-302 has an acceptable safety profile and offers potential therapeutic value to patients with relapsed or refractory non-Hodgkin lymphoma.
Collapse
Affiliation(s)
- Hang Yang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yu Wang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Jing Zhan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Clinical Trial Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Yi Xia
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Peng Sun
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xi-Wen Bi
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Pan-Pan Liu
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Zhi-Ming Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Su Li
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Clinical Trial Center, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Ben-Yan Zou
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Nursing Department, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Wen-Qi Jiang
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China.,Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| |
Collapse
|
14
|
Nevens D, Duprez F, Daisne JF, Dok R, Belmans A, Voordeckers M, Van den Weyngaert D, De Neve W, Nuyts S. Reduction of the dose of radiotherapy to the elective neck in head and neck squamous cell carcinoma; a randomized clinical trial. Effect on late toxicity and tumor control. Radiother Oncol 2016; 122:171-177. [PMID: 27528118 DOI: 10.1016/j.radonc.2016.08.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE A multi-center prospective randomized clinical trial has been performed investigating whether a reduction of the dose to the elective nodal sites in head and neck cancer delivered by intensity modulated radiotherapy (IMRT) would result in a reduction of late side effects without compromising tumor control. MATERIALS AND METHODS Two hundred patients were included. The prescription dose to the elective nodal volumes was a normalized iso-effective dose in 2Gy fractions (NID2Gy) of 50Gy in the standard arm and of 40Gy in the experimental arm. Late toxicity was scored at 6, 12, 18 and 24months using the RTOG scoring system. RESULTS We observed a trend toward less dysphagia at 6months in the experimental arm, however this was not confirmed after longitudinal analysis. Regarding moderate salivary gland toxicity we observed lower incidence of salivary gland toxicity ⩾grade 1, at 6 (p=0.01) and 18months (p=0.03). After two years of follow up, we did not observe significant differences in estimated local failure rate (14.1% in the 40Gy arm vs 14.4% in the 50Gy arm), estimated regional failure rate (13.0% vs 5.5% in the 40 and the 50Gy arm respectively), estimated metastatic recurrence (13.4% vs 18.5% in the 40 and the 50Gy arm respectively), estimated disease-free survival (57.9% vs 65.3% in the 40 and the 50Gy arm respectively) nor estimated overall survival (72.0% vs 73.2% in the 40 and the 50Gy arm respectively). CONCLUSIONS In our study population there was no statistically significant difference regarding survival and estimated recurrence rates between both arms of this study. We found a trend toward less dysphagia at 6months (however not significant after longitudinal analysis) and found a significant reduction of any salivary gland toxicity at 6 and 18months in the 40Gy arm.
Collapse
Affiliation(s)
- Daan Nevens
- Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven, Belgium.
| | - Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Belgium
| | - Jean Francois Daisne
- Department of Radiation Oncology, Clinique et Maternité Sainte-Elisabeth, Namur, Belgium
| | - Ruveyda Dok
- Laboratory of Experimental Radiotherapy, Department of Oncology, Katholieke Universiteit Leuven (KU Leuven), Belgium
| | - Ann Belmans
- Leuven Biostatistics and Statistical Bioinformatics Centre, University of Leuven, Belgium
| | - Mia Voordeckers
- Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel, Belgium
| | | | | | - Sandra Nuyts
- Department of Radiation Oncology, KU Leuven - University of Leuven, University Hospitals Leuven, Belgium
| |
Collapse
|
15
|
Seiwert TY, Melotek JM, Blair EA, Stenson KM, Salama JK, Witt ME, Brisson RJ, Chawla A, Dekker A, Lingen MW, Kocherginsky M, Villaflor VM, Cohen EEW, Haraf DJ, Vokes EE. Final Results of a Randomized Phase 2 Trial Investigating the Addition of Cetuximab to Induction Chemotherapy and Accelerated or Hyperfractionated Chemoradiation for Locoregionally Advanced Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2016; 96:21-9. [PMID: 27511844 DOI: 10.1016/j.ijrobp.2016.04.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 04/27/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE The role of cetuximab in the treatment of locoregionally advanced head and neck squamous cell cancer (LA-HNSCC) remains poorly defined. In this phase 2 randomized study, we investigated the addition of cetuximab to both induction chemotherapy (IC) and hyperfractionated or accelerated chemoradiation. METHODS AND MATERIALS Patients with LA-HNSCC were randomized to receive 2 cycles of weekly IC (cetuximab, paclitaxel, carboplatin) and either Cetux-FHX (concurrent cetuximab, 5-fluorouracil, hydroxyurea, and 1.5 Gy twice-daily radiation therapy every other week to 75 Gy) or Cetux-PX (cetuximab, cisplatin, and accelerated radiation therapy with delayed concomitant boost to 72 Gy in 42 fractions). The primary endpoint was progression-free survival (PFS), with superiority compared with historical control achieved if either arm had 2-year PFS ≥70%. RESULTS 110 patients were randomly assigned to either Cetux-FHX (n=57) or Cetux-PX (n=53). The overall response rate to IC was 91%. Severe toxicity on IC was limited to rash (23% grade ≥3) and myelosuppression (38% grade ≥3 neutropenia). The 2-year rates of PFS for both Cetux-FHX (82.5%) and Cetux-PX (84.9%) were significantly higher than for historical control (P<.001). The 2-year overall survival (OS) was 91.2% for Cetux-FHX and 94.3% for Cetux-PX. With a median follow-up time of 72 months, there were no significant differences in PFS (P=.35) or OS (P=.15) between the treatment arms. The late outcomes for the entire cohort included 5-year PFS, OS, locoregional failure, and distant metastasis rates of 74.1%, 80.3%, 15.7%, and 7.4%, respectively. The 5-year PFS and OS were 84.4% and 91.3%, respectively, among human papillomavirus (HPV)-positive patients and 65.9% and 72.5%, respectively, among HPV-negative patients. CONCLUSIONS The addition of cetuximab to IC and chemoradiation was tolerable and produced long-term control of LA-HNSCC, particularly among poor-prognosis HPV-negative patients. Further investigation of cetuximab may be warranted in the neoadjuvant setting and with non-platinum-based chemoradiation.
Collapse
Affiliation(s)
- Tanguy Y Seiwert
- Departments of Medicine, University of Chicago, Chicago, Illinois.
| | - James M Melotek
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Elizabeth A Blair
- Department of Otolaryngology, University of Chicago, Chicago, Illinois
| | | | - Joseph K Salama
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Mary Ellyn Witt
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Ryan J Brisson
- Departments of Medicine, University of Chicago, Chicago, Illinois
| | - Apoorva Chawla
- Departments of Medicine, University of Chicago, Chicago, Illinois
| | - Allison Dekker
- Departments of Medicine, University of Chicago, Chicago, Illinois
| | - Mark W Lingen
- Department of Pathology, University of Chicago, Chicago, Illinois
| | - Masha Kocherginsky
- Department of Public Health Sciences, University of Chicago, Chicago, Illinois
| | | | - Ezra E W Cohen
- Moores Cancer Center, University of California, San Diego, San Diego, California
| | - Daniel J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois
| | - Everett E Vokes
- Departments of Medicine, University of Chicago, Chicago, Illinois
| |
Collapse
|
16
|
Response-adapted volume de-escalation (RAVD) in locally advanced head and neck cancer. Ann Oncol 2016; 27:908-13. [DOI: 10.1093/annonc/mdw051] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 01/31/2016] [Indexed: 11/15/2022] Open
|
17
|
van den Bosch S, Dijkema T, Verhoef LCG, Zwijnenburg EM, Janssens GO, Kaanders JHAM. Patterns of Recurrence in Electively Irradiated Lymph Node Regions After Definitive Accelerated Intensity Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2015; 94:766-74. [PMID: 26972649 DOI: 10.1016/j.ijrobp.2015.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 11/25/2015] [Accepted: 12/04/2015] [Indexed: 11/17/2022]
Abstract
PURPOSE To provide a comprehensive risk assessment on the patterns of recurrence in electively irradiated lymph node regions after definitive radiation therapy for head and neck cancer. METHODS AND MATERIALS Two hundred sixty-four patients with stage cT2-4N0-2M0 squamous cell carcinoma of the oropharynx, larynx, or hypopharynx treated with accelerated intensity modulated radiation therapy between 2008 and 2012 were included. On the radiation therapy planning computed tomography (CT) scans from all patients, 1166 lymph nodes (short-axis diameter ≥5 mm) localized in the elective volume were identified and delineated. The exact sites of regional recurrences were reconstructed and projected on the initial radiation therapy planning CT scan by performing coregistration with diagnostic imaging of the recurrence. RESULTS The actuarial rate of recurrence in electively irradiated lymph node regions at 2 years was 5.1% (95% confidence interval 2.4%-7.8%). Volumetric analysis showed an increased risk of recurrence with increasing nodal volume. Receiver operating characteristic analysis demonstrated that the summed long- and short-axis diameter is a good alternative for laborious volume calculations, using ≥17 mm as cut-off (hazard ratio 17.8; 95% confidence interval 5.7-55.1; P<.001). CONCLUSIONS An important risk factor was identified that can help clinicians in the pretreatment risk assessment of borderline-sized lymph nodes. Not overtly pathologic nodes with a summed diameter ≥17 mm may require a higher than elective radiation therapy dose. For low-risk elective regions (all nodes <17 mm), the safety of dose de-escalation below the traditional 45 to 50 Gy should be investigated.
Collapse
Affiliation(s)
- Sven van den Bosch
- Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
| | - Tim Dijkema
- Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Lia C G Verhoef
- Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Ellen M Zwijnenburg
- Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Geert O Janssens
- Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Johannes H A M Kaanders
- Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
18
|
Vokes EE, Agrawal N, Seiwert TY. HPV-Associated Head and Neck Cancer. J Natl Cancer Inst 2015; 107:djv344. [PMID: 26656751 DOI: 10.1093/jnci/djv344] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 12/13/2022] Open
Abstract
Over the last two decades, it has been recognized that head and neck cancers, primarily in the oropharynx, can be a distinct entity that is causally related to human papilloma virus (HPV). Fakhry et al. established in 2008 that such tumors have a strikingly better prognosis with improved responsiveness to chemotherapy as well as chemoradiotherapy and favorable survival rates. Since then, new studies have contributed to our increased understanding of this new entity, ranging from a detailed understanding of the genetic fingerprint and risk modifiers such as smoking to successful early attempts to personalize therapy with de-escalation in the definitive intent treatment setting and specific evaluation of targeted therapies in this patient population. This Commentary seeks to summarize the state of the art of our understanding of HPV-associated head and neck cancers that has emerged since the publication of seminal findings by Fakhry et al.
Collapse
Affiliation(s)
- Everett E Vokes
- Section of Hematology-Oncology, Department of Medicine (EEV, TYS), Section of Otolaryngology and Head and Neck Surgery, Department of Surgery (NA), and The University of Chicago Comprehensive Cancer Center (EEV, TYS), The University of Chicago, Chicago, IL.
| | - Nishant Agrawal
- Section of Hematology-Oncology, Department of Medicine (EEV, TYS), Section of Otolaryngology and Head and Neck Surgery, Department of Surgery (NA), and The University of Chicago Comprehensive Cancer Center (EEV, TYS), The University of Chicago, Chicago, IL
| | - Tanguy Y Seiwert
- Section of Hematology-Oncology, Department of Medicine (EEV, TYS), Section of Otolaryngology and Head and Neck Surgery, Department of Surgery (NA), and The University of Chicago Comprehensive Cancer Center (EEV, TYS), The University of Chicago, Chicago, IL
| |
Collapse
|
19
|
Diavolitsis V, Quon H. Treatment De-intensification in HPV-Associated Oropharyngeal Cancer: Evidence, Controversies, and Strategies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2015. [DOI: 10.1007/s40136-015-0084-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
20
|
Cohen EEW, Kocherginsky M, Karrison T, Seiwert TY, Haraf DJ, Brockstein B, Vokes EE. Reply to s. Chakraborty et al. J Clin Oncol 2015; 33:968. [PMID: 25667282 DOI: 10.1200/jco.2014.59.6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
21
|
Das LC, Karrison TG, Witt ME, Muller C, Stenson K, Blair EA, Cohen EEW, Seiwert TY, Haraf DJ, Vokes EE. Comparison of outcomes of locoregionally advanced oropharyngeal and non-oropharyngeal squamous cell carcinoma over two decades. Ann Oncol 2015; 26:198-205. [PMID: 25361984 DOI: 10.1093/annonc/mdu511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) has emerged as a causative agent and positive prognostic factor for oropharyngeal (OP) head and neck squamous cell cancer (HNSCC). This prompts inquiry into whether therapy improvements or increasing incidence of HPV drives the apparent improvements in HNSCC outcomes observed in non-randomized clinical trials. PATIENTS AND METHODS We reviewed all locoregionally advanced HNSCC patients treated with chemotherapy and radiation in prospective institutional trials at a single institution. Patients were divided into three groups (1, 2, 3) according to treatment time period (1993-1998, 1999-2003, 2004-2010, respectively). We reasoned that if a favorable trend was observed over time in OP but not non-OP patients, HPV status may be confounding treatment effects, whereas this would be unlikely if both subgroups improved over time. RESULTS Four hundred and twenty-two patients were identified with OP (55.7%) and non-OP (44.3%) HNSCC. Five-year OP overall survival (OS) improved from 42.3% (group 1) to 72.5% (group 2), and 78.4% (group 3), adjusted P = 0.0084. Non-OP 5-year OS was 51.0% (group 1), 58.8% (group 2), and 66.3% (group 3), adjusted P = 0.51. Five-year recurrence-free survival (RFS) improved for OP groups from 42.3% to 68.4% to 75.8% (adjusted P = 0.017). Non-OP 5-year RFS was 42.9%, 53.6%, and 61.7% for sequential groups (adjusted P = 0.30). Five-year OP distant failure-free survival (DFFS) improved from 42.3% to 71.1% to 77.8% (adjusted P = 0.011). Five-year non-OP DFFS was 46.9%, 57.1%, and 66.0% for sequential groups (adjusted P = 0.38). CONCLUSIONS Over the past two decades, OP HNSCC outcomes improved significantly, while non-OP outcomes only trended toward improvement. Although our patients are not stratified by HPV status, improving OP outcomes are likely at least partly due to the increasing HPV incidence. These data further justify trial stratification by HPV status, investigations of novel approaches for carcinogen-related HNSCC, and current de-intensification for HPV-related HNSCC.
Collapse
Affiliation(s)
- L C Das
- Department of Radiation and Cellular Oncology.
| | | | - M E Witt
- Department of Radiation and Cellular Oncology
| | - C Muller
- Department of Medicine, University of Chicago Medical Center, Chicago
| | - K Stenson
- Department of Otolaryngology, Rush University Medical Center, Chicago
| | - E A Blair
- Department of Otolaryngology, University of Chicago Medical Center, Chicago; The University of Chicago Medicine Comprehensive Cancer Center, Chicago
| | - E E W Cohen
- Moores Cancer Center, University of California San Diego, La Jolla, USA
| | - T Y Seiwert
- Department of Medicine, University of Chicago Medical Center, Chicago; The University of Chicago Medicine Comprehensive Cancer Center, Chicago
| | - D J Haraf
- Department of Radiation and Cellular Oncology; The University of Chicago Medicine Comprehensive Cancer Center, Chicago
| | - E E Vokes
- Department of Medicine, University of Chicago Medical Center, Chicago; The University of Chicago Medicine Comprehensive Cancer Center, Chicago
| |
Collapse
|
22
|
Patil VM, Prabhash K, Noronha V, Joshi A, Muddu V, Dhumal S, Arya S, Juvekar S, Chaturvedi P, Chaukar D, Pai P, Kane S, Patil A, Agarwal JP, Ghosh-Lashkar S, Dcruz A. Neoadjuvant chemotherapy followed by surgery in very locally advanced technically unresectable oral cavity cancers. Oral Oncol 2014; 50:1000-4. [PMID: 25130412 DOI: 10.1016/j.oraloncology.2014.07.015] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 01/16/2023]
Abstract
BACKGROUND The median survival of technically unresectable oral-cavity cancers (T4a and T4b) with non surgical therapy is 2-12 months. We hypothesized that neoadjuvant chemotherapy (NACT) could reduce the tumour size and result in successful resection and ultimately improved outcomes. We present a retrospective analysis of consecutive patients who received NACT at our centre between January 2008 and August 2012. PATIENTS AND METHODS All patients with technically unresectable oral cancers were assessed in a multidisciplinary clinic and received 2 cycles of NACT. After 2 cycles, patients were reassessed and planned for either surgery with subsequent CTRT or nonsurgical therapy including CT-RT, RT or palliation. SPSS version 16 was used for analysis of locoregional control and overall survival (OS). Univariate and multivariate analysis was done for factors affecting the OS. RESULTS 721 patients with stage IV oral-cavity cancer received NACT. 310 patients (43%) had sufficient reduction in tumour size and underwent surgical resection. Of the remaining patients, 167 received chemoradiation, 3 radical radiation and 241 palliative treatment alone The locoregional control rate at 24 months was 20.6% for the overall cohort, 32% in patients undergoing surgery and 15% in patients undergoing non surgical treatment (p=0.0001). The median estimated OS in patients undergoing surgery was 19.6 months (95% CI, 9.59-25.21 months) and 8.16 months (95%, CI 7.57-8.76) in patients treated with non surgical treatment (p=0.0001). CONCLUSION In our analysis, NACT led to successful resection and improved overall survival in a significant proportion of technically unresectable oral-cancer patients.
Collapse
Affiliation(s)
- V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India.
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - V Muddu
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - S Dhumal
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai 400012, India
| | - S Arya
- Department of Radio Diagnosis, Tata Memorial Hospital, Mumbai, India
| | - S Juvekar
- Department of Radio Diagnosis, Tata Memorial Hospital, Mumbai, India
| | - P Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - D Chaukar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - P Pai
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - S Kane
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - A Patil
- Department of Pathology, Tata Memorial Hospital, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - S Ghosh-Lashkar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Dcruz
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| |
Collapse
|
23
|
Cohen EEW, Karrison TG, Kocherginsky M, Mueller J, Egan R, Huang CH, Brockstein BE, Agulnik MB, Mittal BB, Yunus F, Samant S, Raez LE, Mehra R, Kumar P, Ondrey F, Marchand P, Braegas B, Seiwert TY, Villaflor VM, Haraf DJ, Vokes EE. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer. J Clin Oncol 2014; 32:2735-43. [PMID: 25049329 DOI: 10.1200/jco.2013.54.6309] [Citation(s) in RCA: 345] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease. PATIENTS AND METHODS Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m(2) on day 1, cisplatin 75 mg/m(2) on day 1, and fluorouracil 750 mg/m(2) on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS). RESULTS A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival. CONCLUSION IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN.
Collapse
Affiliation(s)
- Ezra E W Cohen
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France.
| | - Theodore G Karrison
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Masha Kocherginsky
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Jeffrey Mueller
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Robyn Egan
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Chao H Huang
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Bruce E Brockstein
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Mark B Agulnik
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Bharat B Mittal
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Furhan Yunus
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Sandeep Samant
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Luis E Raez
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Ranee Mehra
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Priya Kumar
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Frank Ondrey
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Patrice Marchand
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Bettina Braegas
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Tanguy Y Seiwert
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Victoria M Villaflor
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Daniel J Haraf
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| | - Everett E Vokes
- Ezra E.W. Cohen, Theodore G. Karrison, Masha Kocherginsky, Jeffrey Mueller, Robyn Egan, Tanguy Y. Seiwert, Victoria M. Villaflor, Daniel J. Haraf, and Everett E. Vokes, University of Chicago, Chicago; Bruce E. Brockstein, North Shore University Health System, Evanston; Mark B. Agulnik and Bharat B. Mittal, Northwestern University, Chicago, IL; Chao H. Huang, University of Kansas and Veterans Affairs Medical Center, Kansas City, KS; Furhan Yunus and Sandeep Samant, University of Tennessee, Memphis, TN; Luis E. Raez, University of Miami, Miami, FL; Ranee Mehra, Fox Chase Cancer Center, Philadelphia, PA; Priya Kumar and Frank Ondrey, University of Minnesota, Minneapolis, MN; and Patrice Marchand and Bettina Braegas, Nuvisan Oncology, Le Kremlin-Bicêtre, France
| |
Collapse
|
24
|
Seiwert TY, Wang X, Heitmann J, Villegas-Bergazzi V, Sprott K, Finn S, O'Regan E, Farrow AD, Weichselbaum RR, Lingen MW, Cohen EEW, Stenson K, Weaver DT, Vokes EE. DNA repair biomarkers XPF and phospho-MAPKAP kinase 2 correlate with clinical outcome in advanced head and neck cancer. PLoS One 2014; 9:e102112. [PMID: 25019640 PMCID: PMC4096922 DOI: 10.1371/journal.pone.0102112] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/14/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Induction chemotherapy is a common therapeutic option for patients with locoregionally-advanced head and neck cancer (HNC), but it remains unclear which patients will benefit. In this study, we searched for biomarkers predicting the response of patients with locoregionally-advanced HNC to induction chemotherapy by evaluating the expression pattern of DNA repair proteins. METHODS Expression of a panel of DNA-repair proteins in formalin-fixed paraffin embedded specimens from a cohort of 37 HNC patients undergoing platinum-based induction chemotherapy prior to definitive chemoradiation were analyzed using quantitative immunohistochemistry. RESULTS We found that XPF (an ERCC1 binding partner) and phospho-MAPKAP Kinase 2 (pMK2) are novel biomarkers for HNSCC patients undergoing platinum-based induction chemotherapy. Low XPF expression in HNSCC patients is associated with better response to induction chemoradiotherapy, while high XPF expression correlates with a worse response (p = 0.02). Furthermore, low pMK2 expression was found to correlate significantly with overall survival after induction plus chemoradiation therapy (p = 0.01), suggesting that pMK2 may relate to chemoradiation therapy. CONCLUSIONS We identified XPF and pMK2 as novel DNA-repair biomarkers for locoregionally-advanced HNC patients undergoing platinum-based induction chemotherapy prior to definitive chemoradiation. Our study provides insights for the use of DNA repair biomarkers in personalized diagnostics strategies. Further validation in a larger cohort is indicated.
Collapse
Affiliation(s)
- Tanguy Y. Seiwert
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - XiaoZhe Wang
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Jana Heitmann
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
| | | | - Kam Sprott
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Stephen Finn
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Esther O'Regan
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Allan D. Farrow
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Ralph R. Weichselbaum
- Department of Radiation Oncology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Mark W. Lingen
- Department of Pathology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Ezra E. W. Cohen
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| | - Kerstin Stenson
- Department of Surgery, Section of Head and Neck Surgery, The University of Chicago, Chicago, Illinois, United States of America
| | - David T. Weaver
- On-Q-ity Inc., Waltham, Massachusetts, United States of America
| | - Everett E. Vokes
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago, Chicago, Illinois, United States of America
- The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, United States of America
| |
Collapse
|
25
|
Doornaert P, Dahele M, Verbakel WFAR, Bohoudi O, Slotman BJ, Langendijk JA. The effect of induction chemotherapy on tumor volume and organ-at-risk doses in patients with locally advanced oropharyngeal cancer. Radiother Oncol 2013; 109:269-74. [PMID: 24252276 DOI: 10.1016/j.radonc.2013.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 07/18/2013] [Accepted: 07/24/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To retrospectively report changes in gross tumor volume (GTV) and organ-at-risk (OAR) doses after induction chemotherapy (IC) in oropharyngeal cancer using different contouring strategies. MATERIALS AND METHODS GTV and OARs were delineated on pre- and post-IC planning CT. Two post-IC GTV contours were made: (1) a 'consensus set' using published guidelines (GTVconsensus), and (2) 'visible set', delineating only visible post-IC GTV (GTVvisible). Pre-IC interactively optimized volumetric modulated arc therapy plans were generated. The pre-IC planning constraints served as the starting point for both post-IC plans. Results reflect pooled data from all 10 patients. RESULTS Mean reduction in volume post-IC was 24% and 47% for consensus and visible primary tumor and 57% and 60% for consensus and visible nodes. Compared to pre-IC plans, average mean OAR dose for post-IC GTVconsensus plans was significantly lower for CL parotid. For GTVvisible plans both parotids, upper/lower larynx, inferior pharyngeal constrictor and cricopharyngeal muscles were significantly lower. However reductions compared with post-IC GTVconsensus plans were modest (1.6/1.5/1.2/3.7/5.9/2.6Gy, respectively). CONCLUSION IC in patients with oropharyngeal carcinoma results in substantial reductions in GTVs. If post-IC GTVs are used, which is contrary to current consensus, statistically significant but relatively small OAR dose reductions are observed.
Collapse
Affiliation(s)
- Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | | | | | | | | | | |
Collapse
|
26
|
Comparison of carboplatin-paclitaxel to docetaxel-cisplatin-5-flurouracil induction chemotherapy followed by concurrent chemoradiation for locally advanced head and neck cancer. Oral Oncol 2013; 50:52-8. [PMID: 24055193 DOI: 10.1016/j.oraloncology.2013.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/27/2013] [Accepted: 08/28/2013] [Indexed: 11/21/2022]
Abstract
OBJECTIVES In head and neck squamous cell carcinoma (HNSCC), docetaxel, cisplatin and 5-fluorouracil (TPF) has become an accepted induction chemotherapy regimen. However, carboplatin-paclitaxel (CT) regimens have shown comparable outcomes. Here, we compared the outcomes of patients treated with either TPF or CT as induction chemotherapy followed by definitive chemoradiation. PATIENTS AND METHODS We performed a single-institution retrospective analysis of patients with Stage III-IV HNSCC. From a database of 803 patients, we identified 143 patients treated with TPF or CT induction chemotherapy between 1999 and 2012. RESULTS 53 patients and 90 patients received TPF or CT induction chemotherapy, respectively. The median follow-up was 18.9 months. The 1 year locoregional control was 80.5% for CT compared to 55.5% for TPF (HR 0.32, P=.0002). The 1 year progression free survival was 73.2% for CT compared to 60.7% for TPF (HR 0.57; P=.02). On multivariable analysis, CT remained significant for LRC (HR 0.28; P=0.04). TPF induction chemotherapy was associated with worse renal toxicity as measured by peak creatinine increases during induction chemotherapy (P=0.001). TPF was also associated with a trend toward more chemotherapy dose reductions or changes in systemic agents during concurrent chemoradiation (43.4% for TPF vs. 27.8% for CT; P=0.06). CONCLUSIONS Compared to TPF induction chemotherapy, CT induction chemotherapy had at least similar if not better LRC and PFS in patients while having less renal toxicity. Thus, CT induction chemotherapy may benefit patients with locally advanced HNSCC by facilitating adequate chemoradiation regimens that enhanced disease control.
Collapse
|
27
|
Nuyts S, Lambrecht M, Duprez F, Daisne JF, Van Gestel D, Van den Weyngaert D, Platteaux N, Geussens Y, Voordeckers M, Madani I, De Neve W. Reduction of the dose to the elective neck in head and neck squamous cell carcinoma, a randomized clinical trial using intensity modulated radiotherapy (IMRT). Dosimetrical analysis and effect on acute toxicity. Radiother Oncol 2013; 109:323-9. [PMID: 23953410 DOI: 10.1016/j.radonc.2013.06.044] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 06/13/2013] [Accepted: 06/21/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE A randomized trial was initiated to investigate whether a reduction of the dose to the elective nodal sites and the swallowing apparatus delivered by IMRT would result in a reduction of acute and late side effects without compromising tumor control. The aim of this paper is to report on dosimetrical analysis and acute toxicity. MATERIALS & METHODS Two-hundred patients were randomized. In the standard arm, elective nodal volumes (PTVelect) were irradiated up to an equivalent dose of 50Gy. In the experimental arm an equivalent dose of 40Gy was prescribed to the PTVelect. The dose to the swallowing apparatus was kept as low as possible without compromising therapeutic PTV (PTVther) coverage. RESULTS No significant difference was seen between both arms concerning PTVther coverage. The median D95 of the PTVelect was significantly lower in the experimental arm (39.5 vs 49.8Gy; p<0.001). Concerning the organs at risk, the dose to swallowing structures and spinal cord was significantly reduced. There was no significant difference in acute toxicity. Three months after radiotherapy there was significantly less grade ⩾3 dysphagia in the experimental arm (2% vs 11%; p=0.03). With a median follow-up of 6months no significant differences were observed in locoregional control, disease free survival or overall survival. CONCLUSIONS Using IMRT we were able to significantly reduce the dose to the PTVelect and several organs at risk without compromising PTVther coverage. This resulted in a significant reduction of severe dysphagia 3months after radiotherapy. Further follow-up is necessary to investigate whether these observations translate into a benefit on late treatment related dysphagia without affecting treatment outcome.
Collapse
Affiliation(s)
- Sandra Nuyts
- Department of Experimental Radiotherapy KU Leuven, Campus Gasthuisberg, Belgium.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Survival and selected outcomes of older adults with locally advanced head/neck cancer treated with chemoradiation therapy. J Geriatr Oncol 2013; 4:327-33. [PMID: 24472475 DOI: 10.1016/j.jgo.2013.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 03/10/2013] [Accepted: 05/16/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Chemoradiation therapy (CRT) remains a potentially curative treatment in patients with locally advanced head/neck cancer (LA-HNC). However, survival and other outcomes in older patients with head/neck cancer receiving chemoradiotherapy are not well established. This study was performed to elucidate selected outcomes in this patient population. MATERIALS AND METHODS Retrospective study of LA-HNC patients ≥ 70 years of age who had received 5-fluorouracil-hydoxyurea-based CRT with a minimum of 3 years of follow up after therapy initiation was performed. Pre-treatment patient- and cancer-related characteristics were recorded. Survival data in addition to gastrostomy tube utilization, swallowing function, and hematologic toxicity were captured. RESULTS Eighty-nine patients treated between 1997 and 2009 were eligible for analysis (median age, 76 years; range, 70-94; male, 61%; ECOG PS, 0-1 43%; stage IVA/B, 71%). 86 were evaluable for survival analysis. 5-year overall and event-free survival were both at 32% with a median follow-up time of 39.2 months. The majority (86.5%) were able to complete all planned treatment cycles. A significant proportion of patients, however, required gastrostomy tube during CRT (62%) and developed aspiration during swallowing evaluation post-treatment (44%). Several patients required hospice (9%) or skilled nursing facility (13%) referrals during treatment. CONCLUSION Select older adults with LA-HNC can still experience long-term benefits despite 5-year survival rates lower than those historically reported in younger patients undergoing identical CRT regimens although potentially at higher risk for acute toxicities. Assessment and selection of those who can tolerate more intense combined-modality strategies and their long-term outcomes merit further larger, prospective studies.
Collapse
|
29
|
Golden D, Rudra S, Witt M, Nwizu T, Cohen E, Blair E, Stenson K, Vokes E, Haraf D. Outcomes of induction chemotherapy followed by concurrent chemoradiation for nasopharyngeal carcinoma. Oral Oncol 2013; 49:277-82. [DOI: 10.1016/j.oraloncology.2012.10.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 09/30/2012] [Accepted: 10/01/2012] [Indexed: 11/25/2022]
|
30
|
Saloura V, Langerman A, Rudra S, Chin R, Cohen EEW. Multidisciplinary care of the patient with head and neck cancer. Surg Oncol Clin N Am 2013; 22:179-215. [PMID: 23453331 DOI: 10.1016/j.soc.2012.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Head and neck cancer is a heterogeneous group of cancers, which require a multidisciplinary approach to achieve excellent treatment results. This article focuses on current treatment guidelines and controversies in the management of head and neck cancer. It also provides insight into future directions and newest advances in the treatment of head and neck cancer.
Collapse
Affiliation(s)
- Vassiliki Saloura
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago, Chicago, IL 60637-1470, USA.
| | | | | | | | | |
Collapse
|
31
|
Haigentz M, Cohen EEW, Wolf GT, Strojan P, Eisbruch A, Ferlito A. The future of induction chemotherapy for head and neck squamous cell carcinoma. Oral Oncol 2012; 48:1065-7. [PMID: 22981388 DOI: 10.1016/j.oraloncology.2012.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/17/2012] [Indexed: 11/15/2022]
|
32
|
Kao J, Lau KHV, Tong CCL, Chen CT. Competing causes of death in patients with oropharyngeal cancer treated with radiotherapy. Exp Ther Med 2012; 3:835-840. [PMID: 22969978 DOI: 10.3892/etm.2012.494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 01/19/2012] [Indexed: 11/06/2022] Open
Abstract
Radiation with or without chemotherapy is considered the mainstay of treatment for the majority of patients with oropharyngeal cancer. The goal of this study was to analyze competing causes of mortality in patients with oropharyngeal cancer with long-term follow-up. We queried the Surveillance, Epidemiology and End Results (SEER) database and identified 3728 patients with oropharyngeal cancer treated between 1988 and 2001 with definitive radiotherapy. We analyzed predictors of overall survival and risks of mortality from index oropharyngeal cancer, second primary cancer, cardiovascular disease and other causes using a cumulative incidence analysis and Cox multivariate analysis. With a median follow-up of 6.8 years, the 5- and 10-year overall survival was 37 and 22%, respectively. At 5 years, the risk of mortality from primary oropharyngeal cancer was 35%. Between years 3 and 10, 69% of mortalities were attributed to causes other than the index cancer. Despite advances in the non-surgical treatment of oropharyngeal cancer, patients remain at significant risk of cancer- and non-cancer-related mortality.
Collapse
|
33
|
Induction chemotherapy in locally advanced pharyngolaryngeal cancers with stridor: is it feasible and safe? CHEMOTHERAPY RESEARCH AND PRACTICE 2012; 2012:549170. [PMID: 22924129 PMCID: PMC3424664 DOI: 10.1155/2012/549170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 07/05/2012] [Accepted: 07/06/2012] [Indexed: 11/25/2022]
Abstract
Background. The standard initial management of patients with locally advanced pharyngolaryngeal presenting with stridor is tracheostomy. Tracheostomy has been shown to negatively impact cancer-related outcomes. Methods. Retrospective analysis of prospectively collected data of 9 patients, who underwent induction chemotherapy with the aim of prevention of tracheostomy. Presenting features, time to resolution of stridor, and further management are reported. Results. Eight out of 9 patient received chemotherapy within 12 hours of presentation with stridor. There were 4 patients each with primary hypopharynx and larynx. The stage was IVA in 6 patients and IVB in 2 patients. In all patients receiving immediate chemotherapy, clinical stridor resolved within 48 hours. The radiological response rate was 62.5%. The median reduction in size of tumor was 37%.
Conclusion. Immediate neoadjuvant chemotherapy is a feasible and safe option for patients presenting with early stridor and helps in resolution of stridor and avoiding tracheostomy.
Collapse
|
34
|
Thariat J, Bensadoun RJ, Etienne-Grimaldi MC, Grall D, Penault-Llorca F, Dassonville O, Bertucci F, Cayre A, De Raucourt D, Geoffrois L, Finetti P, Giraud P, Racadot S, Morinière S, Sudaka A, Van Obberghen-Schilling E, Milano G. Contrasted Outcomes to Gefitinib on Tumoral IGF1R Expression in Head and Neck Cancer Patients Receiving Postoperative Chemoradiation (GORTEC Trial 2004-02). Clin Cancer Res 2012; 18:5123-33. [DOI: 10.1158/1078-0432.ccr-12-1518] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
35
|
Mouw KW, Solanki AA, Stenson KM, Witt ME, Blair EA, Cohen EEW, Vokes EE, List M, Haraf DJ, Salama JK. Performance and quality of life outcomes for T4 laryngeal cancer patients treated with induction chemotherapy followed by chemoradiotherapy. Oral Oncol 2012; 48:1025-1030. [PMID: 22621836 DOI: 10.1016/j.oraloncology.2012.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 04/08/2012] [Accepted: 04/11/2012] [Indexed: 11/18/2022]
Abstract
Organ-sparing approaches with chemoradiotherapy are often used in the treatment of patients with laryngeal cancer, and the oncologic outcomes of these patients are similar to patients who undergo laryngectomy. However, chemoradiotherapy for laryngeal cancer patients with large or locally-invasive (T4) tumors has been more slowly incorporated due to concern for poor post-treatment function of the preserved larynx. Here, we characterize acute and long-term performance and quality-of-life (QOL) outcomes of T4 laryngeal cancer patients treated with induction chemotherapy followed by combined chemoradiotherapy. Using several validated metrics, we find patients experience a decline in most measures of performance and QOL during and immediately following treatment. However, the majority of patients improve to baseline over varying lengths of time following completion of treatment, and many go on to exceed pre-treatment levels of function. Gender, race, alcohol, and tobacco usage were found to be associated with differences in performance and QOL scores across time points. This study suggests that patients with advanced laryngeal tumors who historically had been considered poor candidates for organ-sparing treatment are able to return to, and in many cases exceed pre-treatment performance and QOL following induction chemotherapy and combined chemoradiotherapy.
Collapse
Affiliation(s)
- Kent W Mouw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States.
| | - Abhishek A Solanki
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States
| | - Kerstin M Stenson
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| | - Mary Ellyn Witt
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States
| | - Elizabeth A Blair
- Section of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| | - Ezra E W Cohen
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| | - Everett E Vokes
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| | - Marcy List
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| | - Daniel J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| | - Joseph K Salama
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, United States; Comprehensive Cancer Center, University of Chicago, Chicago, IL, United States
| |
Collapse
|
36
|
de Souza JA, Davis DW, Zhang Y, Khattri A, Seiwert TY, Aktolga S, Wong SJ, Kozloff MF, Nattam S, Lingen MW, Kunnavakkam R, Stenson KM, Blair EA, Bozeman J, Dancey JE, Vokes EE, Cohen EEW. A phase II study of lapatinib in recurrent/metastatic squamous cell carcinoma of the head and neck. Clin Cancer Res 2012; 18:2336-43. [PMID: 22371453 DOI: 10.1158/1078-0432.ccr-11-2825] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE This study sought to determine the efficacy and safety profile of lapatinib in patients with recurrent/metastatic squamous cell carcinoma of the head and neck (SCCHN). EXPERIMENTAL DESIGN This phase II multiinstitutional study enrolled patients with recurrent/metastatic SCCHN into two cohorts: those without (arm A) and those with (arm B) before exposure to an epidermal growth factor receptor (EGFR) inhibitor. All subjects were treated with lapatinib 1,500 mg daily. Primary endpoints were response rate (arm A) and progression-free survival (PFS; arm B). The biologic effects of lapatinib on tumor growth and survival pathways were assessed in paired tumor biopsies obtained before and after therapy. RESULTS Forty-five patients were enrolled, 27 in arm A and 18 in arm B. Diarrhea was the most frequent toxicity occurring in 49% of patients. Seven patients experienced related grade 3 toxicity (3 fatigue, 2 hyponatremia, 1 vomiting, and 1 diarrhea). In an intent-to-treat analysis, no complete or partial responses were observed, and stable disease was the best response observed in 41% of arm A (median duration, 50 days, range, 34-159) and 17% of arm B subjects (median, 163 days, range, 135-195). Median PFS was 52 days in both arms. Median OS was 288 (95% CI, 62-374) and 155 (95% CI, 75-242) days for arms A and B, respectively. Correlative analyses revealed an absence of EGFR inhibition in tumor tissue. CONCLUSION Lapatinib as a single agent in recurrent/metastatic SCCHN, although well tolerated, appears to be inactive in either EGFR inhibitor naive or refractory subjects.
Collapse
Affiliation(s)
- Jonas A de Souza
- Section of Hematology/Oncology, Department of Medicine, The University of Chicago Medical Center, Chicago, Illinois, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Molecular targeting agents in the context of primary chemoradiation strategies. Head Neck 2012; 35:738-46. [DOI: 10.1002/hed.22012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2011] [Indexed: 01/01/2023] Open
|
38
|
Villaflor V, Haraf D, Salama J, Kocherginsky M, Langerman A, Gomez-Abuin G, Beniwal P, Blair E, Stenson K, Portugal L, Seiwert T, Williams R, Dekker A, Witt M, Vokes E, Cohen E. Phase II trial of pemetrexed-based induction chemotherapy followed by concomitant chemoradiotherapy in previously irradiated patients with squamous cell carcinoma of the head and neck. Ann Oncol 2011; 22:2501-2507. [DOI: 10.1093/annonc/mdq785] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
39
|
Salama J, Haraf D, Stenson K, Blair E, Witt M, Williams R, Kunnavakkam R, Cohen E, Seiwert T, Vokes E. A randomized phase II study of 5-fluorouracil, hydroxyurea, and twice-daily radiotherapy compared with bevacizumab plus 5-fluorouracil, hydroxyurea, and twice-daily radiotherapy for intermediate-stage and T4N0-1 head and neck cancers. Ann Oncol 2011; 22:2304-9. [DOI: 10.1093/annonc/mdq736] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
40
|
Pederson AW, Salama JK, Witt ME, Stenson KM, Blair EA, Vokes EE, Haraf DJ. Concurrent Chemotherapy and Intensity-Modulated Radiotherapy for Organ Preservation of Locoregionally Advanced Oral Cavity Cancer. Am J Clin Oncol 2011; 34:356-61. [DOI: 10.1097/coc.0b013e3181e8420b] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
41
|
|
42
|
|
43
|
Ansari M, Omidvari S, Mosalaei A, Ahmadloo N, Mosleh-Shirazi MA, Mohammadianpanah M. A Phase II Study of Docetaxel, Cisplatin and 5- Fluorouracil (TPF) In Patients with Locally Advanced Head and Neck Carcinomas. IRANIAN RED CRESCENT MEDICAL JOURNAL 2011; 13:187-91. [PMID: 22737461 PMCID: PMC3371950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 08/01/2010] [Accepted: 09/27/2010] [Indexed: 12/02/2022]
Abstract
BACKGROUND The combination of cisplatin and 5-fluorouracil (PF) is currently considered a standard and effective regimen for the treatment of advanced head and neck carcinomas. The aim of this study was to evaluate the efficacy and safety of docetaxel, cisplatin and 5-fluorouracil (TPF) in patients with unresectable head and neck carcinomas. METHODS Forty-six patients with previously untreated non-metastatic stage IV head and neck carcinomas were enrolled. All patients received three cycles of induction chemotherapy with docetaxel (75 mg/m(2)), cisplatin (40 mg/m(2)) (days 1-2), and 5-FU (500 mg/m(2), days 1-3), repeated every 21 days. Following induction chemotherapy, all patients underwent concurrent chemoradiotherapy using weekly cisplatin (30 mg/m(2)) and a median total dose of 70 Gy was delivered. Clinical response rate and toxicity were the primary and secondary end-points of the study. RESULTS There were 31 men and 15 women. All patients had non-metastatic stage IV (T2-3N2-3 or T4N0-3) of disease. Overall and complete response rates were 74% and 24% respectively. Advanced T4 classification was associated with poorer response rate (p value=0.042). The major (grade 3-4) treatment-related toxicities were myelosuppression (78%), anorexia (13%), diarrhea (7%), emesis (11%) and stomatitis/pharyngitis (24%). CONCLUSION In comparison with the data of historical published trials of the PF regimen, the TPF regimen was more effective. However, the TPF regimen appears to be associated with a higher incidence of major toxicities. Therefore, our limited findings support the TPF regimen as an alternative chemotherapeutic regimen for advanced head and neck carcinomas.
Collapse
Affiliation(s)
- M Ansari
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - S Omidvari
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A Mosalaei
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - N Ahmadloo
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M A Mosleh-Shirazi
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - M Mohammadianpanah
- Department of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Mohammad Mohammadianpanah, MD, Associate Professor of Radiation Oncology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran. Postcode: 71936-15311. Tel.: +98-711-6474320, Fax: +98-711-6474320, E-mail:
| |
Collapse
|
44
|
Pederson AW, Haraf DJ, Witt ME, Stenson KM, Vokes EE, Blair EA, Salama JK. Chemoradiotherapy for locoregionally advanced squamous cell carcinoma of the base of tongue. Head Neck 2011; 32:1519-27. [PMID: 20187015 DOI: 10.1002/hed.21360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Our aim was to report the outcomes of base of tongue cancers treated with chemoradiotherapy. METHODS Between 1990 and 2004, 127 patients with stage III or IV base of tongue cancer were treated with chemoradiotherapy on protocol. Indications included nodal involvement, T3/T4 tumors, positive margins, those patients refusing surgery, or were medically inoperable. The most common regimen was paclitaxel (100 mg/m2 on day 1), infusional 5-fluorouracil (600 mg/m2/day × 5 days), hydroxyurea (500 mg prescribed orally [PO] 2 × daily [BID]), and 1.5 Gy twice daily irradiation followed by a 9-day break without treatment. RESULTS Median follow-up was 51 months. The median dose to gross tumor was 72.5 Gy (range, 40-75.5 Gy). Five-year locoregional progression-free survival, overall survival, and disease-free survival was 87.0%, 58.2%, and 46.0%, respectively. CONCLUSION Concurrent chemoradiotherapy results in promising locoregional control for base of tongue cancer. As distant relapse was common, further investigation of systemic therapy with novel agents may be warranted.
Collapse
Affiliation(s)
- Aaron W Pederson
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | | | | | | | | | | | | |
Collapse
|
45
|
|
46
|
Boscolo-Rizzo P, Gava A, Marchiori C, Baggio V, Da Mosto MC. Functional organ preservation in patients with locoregionally advanced head and neck squamous cell carcinoma treated by platinum-based multidrug induction chemotherapy and concurrent chemoradiotherapy. Ann Oncol 2011; 22:1894-901. [PMID: 21273343 DOI: 10.1093/annonc/mdq681] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the feasibility, safety, and efficacy in terms of functional organ preservation of multidrug induction chemotherapy and concurrent chemoradiotherapy (IC-CCRT) protocol in patients with locoregionally advanced head and neck squamous cell carcinoma (LA-HNSCC). PATIENTS AND METHODS Patients with previously untreated, inoperable, histologically proven nonmetastatic stage III or IV HNSCC were eligible. Following one cycle of IC, two cycles of cisplatinum and 5-fluorouracil CCRT with conventional fractionated radiotherapy up to a dose of 66-70 Gy were administrated. RESULTS Between January 2000 and July 2007, a total of 139 patients were candidates to receive IC-CCRT for LA-HNSCC. Overall, 83% of the patients completed the treatment. Three-year overall survival estimate was 68% [95% confidence interval (CI) 57% to 79%]. Three-year progression-free survival (PFS) estimate was 62% (95% CI 50% to 74%). Three-year functional PFS was 57% (95% CI 44% to 69%). There were no cases of treatment-related deaths. The most frequent severe acute toxicity was pharyngeal mucositis. CONCLUSIONS Cisplatinum-based multidrug IC-CCRT can result in functional organ preservation and curative treatment in most patients with LA-HNSCC. The toxicity profile and patients' compliance to treatment confirmed the safety and tolerability of this approach.
Collapse
Affiliation(s)
- P Boscolo-Rizzo
- Department of Medical and Surgical Specialties, Regional Center for Head and Neck Cancer, University of Padua, School of Medicine, Treviso Regional Hospital, Italy.
| | | | | | | | | |
Collapse
|
47
|
Weekly paclitaxel in patients with recurrent or metastatic head and neck cancer. Cancer Chemother Pharmacol 2010; 68:769-76. [DOI: 10.1007/s00280-010-1550-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
|
48
|
Choe KS, Salama JK, Stenson KM, Blair EA, Witt ME, Cohen EE, Haraf DJ, Vokes EE. Adjuvant chemotherapy prior to postoperative concurrent chemoradiotherapy for locoregionally advanced head and neck cancer. Radiother Oncol 2010; 97:318-21. [DOI: 10.1016/j.radonc.2010.09.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 08/19/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
|
49
|
Phase 2 trial of concurrent 5-fluorouracil, hydroxyurea, cetuximab, and hyperfractionated intensity-modulated radiation therapy for locally advanced head and neck cancer. Cancer 2010; 117:318-26. [DOI: 10.1002/cncr.25374] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 12/29/2009] [Accepted: 03/03/2010] [Indexed: 11/07/2022]
|
50
|
Duprez F, De Neve W, De Gersem W, Coghe M, Madani I. Adaptive dose painting by numbers for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2010; 80:1045-55. [PMID: 20643512 DOI: 10.1016/j.ijrobp.2010.03.028] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Revised: 03/05/2010] [Accepted: 03/17/2010] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate the feasibility of adaptive intensity-modulated radiation therapy (IMRT) using dose painting by numbers (DPBN) for head-and-neck cancer. METHODS AND MATERIALS Each patient's treatment used three separate treatment plans: fractions 1-10 used a DPBN ([(18)-F]fluoro-2-deoxy-D-glucose positron emission tomography [(18)F-FDG-PET]) voxel intensity-based IMRT plan based on a pretreatment (18)F-FDG-PET/computed tomography (CT) scan; fractions 11-20 used a DPBN plan based on a (18)F-FDG-PET/CT scan acquired after the eighth fraction; and fractions 21-32 used a conventional (uniform dose) IMRT plan. In a Phase I trial, two dose prescription levels were tested: a median dose of 80.9 Gy to the high-dose clinical target volume (CTV(high_dose)) (dose level I) and a median dose of 85.9 Gy to the gross tumor volume (GTV) (dose level II). Between February 2007 and August 2009, 7 patients at dose level I and 14 patients at dose level II were enrolled. RESULTS All patients finished treatment without a break, and no Grade 4 acute toxicity was observed. Treatment adaptation (i.e., plans based on the second (18)F-FDG-PET/CT scan) reduced the volumes for the GTV (41%, p = 0.01), CTV(high_dose) (18%, p = 0.01), high-dose planning target volume (14%, p = 0.02), and parotids (9-12%, p < 0.05). Because the GTV was much smaller than the CTV(high_dose) and target adaptation, further dose escalation at dose level II resulted in less severe toxicity than that observed at dose level I. CONCLUSION To our knowledge, this represents the first clinical study that combines adaptive treatments with dose painting by numbers. Treatment as described above is feasible.
Collapse
Affiliation(s)
- Fréderic Duprez
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
| | | | | | | | | |
Collapse
|