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Evrard D, Dumont C, Gatineau M, Delord JP, Fayette J, Dreyer C, Tijeras-Raballand A, de Gramont A, Delattre JF, Granier M, Aissat N, Garcia-Larnicol ML, Slimane K, Chibaudel B, Raymond E, Le Tourneau C, Faivre S. Targeting the Tumor Microenvironment through mTOR Inhibition and Chemotherapy as Induction Therapy for Locally Advanced Head and Neck Squamous Cell Carcinoma: The CAPRA Study. Cancers (Basel) 2022; 14:cancers14184509. [PMID: 36139669 PMCID: PMC9496893 DOI: 10.3390/cancers14184509] [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: 08/07/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/16/2022] Open
Abstract
Simple Summary The PI3K-AKT-mTOR pathway is dysregulated in 70% of head and neck squamous cell carcinoma (HNSCC) and linked to the tumor microenvironment. This weekly induction treatment combined the mTOR inhibitor everolimus with carboplatin-paclitaxel chemotherapy for locally advanced T3-4/N0-3 HNSCC. In 41 patients, safety profile was favorable and overall response rate was 75.6%. Translational data demonstrated specific target engagement with p-S6K decrease in tumor tissue and pro-immunogenic cytokine release in peripheral blood. Induction treatment with chemotherapy and mTOR inhibitors may provide new therapeutic options and rationale for combinations with immune oncology agents for locally advanced HNSCC. Abstract Mammalian target of rapamycin (mTOR) regulates cellular functions by integrating intracellular signals and signals from the tumor microenvironment (TME). The PI3K-AKT-mTOR pathway is activated in 70% of head and neck squamous cell carcinoma (HNSCC) and associated with poor prognosis. This phase I-II study investigated the effect of mTOR inhibition using weekly everolimus (30 mg for dose level 1, 50 mg for dose level 2) combined with weekly induction chemotherapy (AUC2 carboplatin and 60 mg/m2 paclitaxel) in treatment-naïve patients with locally advanced T3-4/N0-3 HNSCC. Patients received 9 weekly cycles before chemoradiotherapy. Objectives were safety and antitumor activity along with tissue and blood molecular biomarkers. A total of 50 patients were enrolled. Among 41 evaluable patients treated at the recommended dose of 50 mg everolimus weekly, tolerance was good and overall response rate was 75.6%, including 20 major responses (≥50% reduction in tumor size). A significant decrease in expression of p-S6K (p-value: 0.007) and Ki67 (p-value: 0.01) was observed in post-treatment tumor tissue. Pro-immunogenic cytokine release (Th1 cytokines IFN-γ, IL-2, and TNF-β) was observed in the peripheral blood. The combination of everolimus and chemotherapy in HNSCC was safe and achieved major tumor responses. This strategy favorably impacts the TME and might be combined with immunotherapeutic agents.
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Affiliation(s)
- Diane Evrard
- Department of Otorhinolaryngology, Bichat University Hospital, Université Paris Cité, 75018 Paris, France
- Correspondence:
| | - Clément Dumont
- Medical Oncology Department, Saint-Louis Hospital, Université Paris Cité, 75010 Paris, France
| | - Michel Gatineau
- Medical Oncology Department, Paris-St Joseph Hospital, 75014 Paris, France
| | | | | | | | | | | | - Jean-François Delattre
- Medical Oncology Department, Saint-Louis Hospital, Université Paris Cité, 75010 Paris, France
| | | | | | | | | | | | - Eric Raymond
- Medical Oncology Department, Paris-St Joseph Hospital, 75014 Paris, France
| | - Christophe Le Tourneau
- Department of Drug Development and Innovation (D3i), Institut Curie, INSERM U909 Research Unit, Paris-Saclay University, 75005 Paris, France
| | - Sandrine Faivre
- Medical Oncology Department, Saint-Louis Hospital, Université Paris Cité, 75010 Paris, France
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2
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Leal TA, Sharifi MN, Chan N, Wesolowski R, Turk AA, Bruce JY, O'Regan RM, Eickhoff J, Barroilhet LM, Malhotra J, Mehnert J, Girda E, Wiley E, Schmitz N, Andrews S, Liu G, Wisinski KB. A phase I study of talazoparib (BMN 673) combined with carboplatin and paclitaxel in patients with advanced solid tumors (NCI9782). Cancer Med 2022; 11:3969-3981. [PMID: 35396812 PMCID: PMC9636507 DOI: 10.1002/cam4.4724] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/21/2022] [Accepted: 03/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background Inhibitors of poly(ADP‐ribose) polymerase (PARP) proteins potentiate antitumor activity of platinum chemotherapy. This study sought to determine the safety and tolerability of PARP inhibitor talazoparib with carboplatin and paclitaxel. Methods We conducted a phase I study of talazoparib with carboplatin AUC5‐6 and paclitaxel 80 mg/m2 days 1, 8, 15 of 21‐day cycles in patients with advanced solid tumors. Patients enrolled using a 3 + 3 design in two cohorts with talazoparib for 7 (schedule A) or 3 days (schedule B). After induction with 4–6 cycles of triplet therapy, patients received one of three maintenance options: (a) continuation of triplet (b) carboplatin/talazoparib, or (c) talazoparib monotherapy. Results Forty‐three patients were treated. The MTD for both schedules was talazoparib 250mcg daily. The main toxicity was myelosuppression including grade 3/4 hematologic treatment‐related adverse events (TRAEs). Dose modification occurred in 87% and 100% of patients for schedules A and B, respectively. Discontinuation due to TRAEs was 13% in schedule A and 10% in B. Ten out of 22 evaluable patients in schedule A and 5/16 patients in schedule B had a complete or partial response. Twelve out of 43 patients received ≥6 cycles of talazoparib after induction, with a 13‐month median duration of maintenance. Conclusion We have established the recommended phase II dose of Talazoparib at 250mcg on a 3‐ or 7‐day schedule with carboplatin AUC6 and paclitaxel 80 mg/m2 on days 1, 8, 15 of 21‐day cycles. This regimen is associated with significant myelosuppression, and in addition to maximizing supportive care, modification of the chemotherapy component would be a consideration for further development of this combination with the schedules investigated in this study.
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Affiliation(s)
| | - Marina N Sharifi
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Nancy Chan
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Robert Wesolowski
- Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Anita A Turk
- Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Justine Y Bruce
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Ruth M O'Regan
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Jens Eickhoff
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lisa M Barroilhet
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jyoti Malhotra
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Janice Mehnert
- Perlmutter Cancer Center, New York University Grossman School of Medicine, New York, New York City, USA
| | - Eugenia Girda
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Elizabeth Wiley
- Ohio State University Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Natalie Schmitz
- School of Pharmacy, University of Wisconsin, Madison, Wisconsin, USA
| | - Shannon Andrews
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Glenn Liu
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Kari B Wisinski
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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3
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Scirocco E, Cellini F, Zamagni A, Macchia G, Deodato F, Cilla S, Strigari L, Buwenge M, Rizzo S, Cammelli S, Morganti AG. Clinical Studies on Ultrafractionated Chemoradiation: A Systematic Review. Front Oncol 2021; 11:748200. [PMID: 34868948 PMCID: PMC8635188 DOI: 10.3389/fonc.2021.748200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023] Open
Abstract
Aim The efficacy of low-dose fractionated radiotherapy (LDFRT) and chemotherapy (CHT) combination has large preclinical but little clinical evidence. Therefore, the aim of this review was to collect and analyze the clinical results of LDRT plus concurrent CHT in patients with advanced cancers. Methods A systematic literature search was conducted on PubMed using the PRISMA methodology. Only studies based on the combination of LDFRT (< 1 Gy/fraction) and CHT were included. Endpoints of the analysis were tumor response, toxicity, and overall survival, with particular focus on any differences between LDFRT-CHT and CHT alone. Results Twelve studies (307 patients) fulfilled the selection criteria and were included in this review. Two studies were retrospective, one was a prospective pilot trial, six were phase II studies, two were phase I trials, and one was a phase I/II open label study. No randomized controlled trials were found. Seven out of eight studies comparing clinical response showed higher rates after LDFRT-CHT compared to CHT alone. Three out of four studies comparing survival reported improved results after combined treatment. Three studies compared toxicity of CHT and LDFRT plus CHT, and all of them reported similar adverse events rates. In most cases, toxicity was manageable with only three likely LDFRT-unrelated fatal events (1%), all recorded in the same series on LDFRT plus temozolomide in glioblastoma multiforme patients. Conclusion None of the analyzed studies provided level I evidence on the clinical impact of LDFRT plus CHT. However, it should be noted that, apart from two small series of breast cancers, all studies reported improved therapeutic outcomes and similar tolerability compared to CHT alone. Systematic Review Registration www.crd.york.ac.uk/prospero/, identifier CRD42020206639.
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Affiliation(s)
- Erica Scirocco
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Francesco Cellini
- Università Cattolica del Sacro Cuore, Dipartimento Universitario Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy.,Fondazione Policlinico Universitario "A. Gemelli" Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Roma, Italy
| | - Alice Zamagni
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Gabriella Macchia
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Savino Cilla
- Medical Physic Unit, Gemelli Molise Hospital, Catholic University of Sacred Heart, Campobasso, Italy
| | - Lidia Strigari
- Medical Physics Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Stefania Rizzo
- Service of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Silvia Cammelli
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
| | - Alessio Giuseppe Morganti
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine-Alma Mater Studiorum Bologna University, Bologna, Italy
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Jelinek MJ, Foster NR, Zoroufy AJ, Schwartz GK, Munster PN, Seiwert TY, de Souza JA, Vokes EE. A phase I trial adding poly(ADP-ribose) polymerase inhibitor veliparib to induction carboplatin-paclitaxel in patients with head and neck squamous cell carcinoma: Alliance A091101. Oral Oncol 2021; 114:105171. [PMID: 33513474 DOI: 10.1016/j.oraloncology.2020.105171] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/22/2020] [Accepted: 12/26/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We report the results of this phase I study to evaluate the maximum tolerated dose (MTD) and safety of veliparib, a poly(ADP-ribose) polymerase (PARP) inhibitor, combined with carboplatin and paclitaxel induction chemotherapy (IC) for locoregionally advanced head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS In a 3 + 3 cohort design, patients with stage IVA-B human papillomavirus-negative HNSCC received 2 cycles of carboplatin (AUC 6, day 1), paclitaxel (100 mg/m2, days 1, 8, 15) and veliparib (days 1-7) every 21 days followed by standard curative-intent chemoradiotherapy. Primary endpoint: MTD and recommended phase II dose (RP2D) as determined by the first IC cycle. RESULTS Twenty patients enrolled. Two withdrew before treatment; 18 patients were analyzed. Median age was 63 years. Primary disease sites included hypopharynx (n = 5), larynx (n = 5), oral cavity (n = 4), oropharynx (n = 3), and nasal cavity (n = 1). Through all of IC, the most common grade 3 + adverse events (AEs) were neutropenia (33%), thrombocytopenia (33%), anemia (11%), and white blood cell decrease (11%). One patient experienced a hematologic DLT at 350 mg BID. The RP2D for veliparib combined with carboplatin/paclitaxel is 350 mg BID. With 40.9 month median follow-up across dose levels for all patients, the 24-month overall and progression free survival was 77.8% (95% CI 60.8-99.6%) and 66.7% (95% CI 48.1-92.4%), respectively. Medians have not been reached. CONCLUSION Addition of veliparib to carboplatin and paclitaxel IC was well tolerated in patients with advanced HNSCC. Hematologic toxicities were the most common AEs.
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Affiliation(s)
- Michael J Jelinek
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA; Department of Medicine, Division of Hematology, Oncology, and Cell Therapy, Rush University Medical Center, Chicago, IL, USA(1).
| | - Nathan R Foster
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Alex J Zoroufy
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Gary K Schwartz
- Department of Medicine, Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Pamela N Munster
- Department of Medicine, Section of Hematology/Oncology, UCSF Helen Diller Family Comprehensive Cancer Center, UCSF Medical Center-Mount Zion, San Francisco, CA, USA
| | - Tanguy Y Seiwert
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
| | - Jonas A de Souza
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medicine and Biological Sciences, Chicago, IL, USA
| | - Everett E Vokes
- Department of Medicine, Section of Hematology/Oncology, The University of Chicago Comprehensive Cancer Center, Chicago, IL, USA
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5
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Onderdonk BE, Vokes EE, Gwede M, Blair E, Agrawal N, Haraf DJ. Adjuvant treatment for high-risk salivary gland malignancies and prognostic stratification based on a 20-year single institution experience. Health Sci Rep 2020; 3:e195. [PMID: 33043152 PMCID: PMC7539565 DOI: 10.1002/hsr2.195] [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: 04/28/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIM Retrospective analysis of the utility of adjuvant radiation (RT) or chemoradiation (CRT) and identify prognostic features for patients with high-risk head and neck salivary gland cancers. METHODS From 1/1997 to 12/2017, 108 patients underwent surgery, and RT (n = 50) or CRT (n = 58) for positive lymph node(s), extracapsular extension, perineural invasion, lymphovascular space invasion, positive/close margin, and/or grade 3 disease. Outcomes were estimated with the Kaplan-Meier method. Significant predictors identified through regression analyses were incorporated into multivariable regression (MVA). Toxicities were compared using chi-square. RESULTS The median follow-up was 52 months (range: 3-226). The number of risk factors (RFs) between RT and CRT groups were: 0 to 1 (44% vs 7%), 2 to 3 (48% vs 41%), or 4 to 6 (8% vs 52%), respectively (P < .01). On MVA, stage 3 or 4 disease predicted worse outcomes including overall survival (HR 4.55, P = .01). Increasing number of RFs predicted worse disease-free survival, distant metastasis-free survival, and overall survival (2-3 RFs: HR 3.38, P = .03; 4-6 RFs: HR 5.78, P < .01), but not locoregional control (P = .54). So, adjuvant CRT may have provided comparable locoregional control for patients with more adverse features, but the CRT did not translate into improved distant control. There was no difference in acute or late grade 3+ toxicities, or parenteral nutrition (P = .98, P = .85, and P = .83), respectively. CONCLUSIONS Adjuvant CRT provides adequate locoregional control in patients with more adverse RFs. The absolute number of RFs serves prognostic significance and should be considered in future prospective trials.
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Affiliation(s)
| | - Everett E. Vokes
- Department of Medicine, Section of Hematology/OncologyUniversity of ChicagoChicagoIllinois
| | - Michael Gwede
- Pritzker School of MedicineUniversity of ChicagoChicagoIllinois
| | - Elizabeth Blair
- Department of OtolaryngologyUniversity of ChicagoChicagoIllinois
| | - Nishant Agrawal
- Department of OtolaryngologyUniversity of ChicagoChicagoIllinois
| | - Daniel J. Haraf
- Department of Radiation and Cellular OncologyUniversity of ChicagoChicagoIllinois
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Induction chemotherapy in nonlaryngeal human papilloma virus-negative high-risk head and neck cancer: a real-world experience. Anticancer Drugs 2020; 31:1074-1083. [PMID: 32932276 DOI: 10.1097/cad.0000000000000977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The role of induction chemotherapy in the multidisciplinary treatment of locally advanced, nonlaryngeal high-risk human papilloma virus (HPV)-negative head and neck squamous cells carcinoma (HNSCC) is uncertain in terms of overall survival (OS). The primary objective of this study was to identify possible predictive factors of survival and outcome in patients with HNSCC who were treated with induction chemotherapy. Fifty-nine patients with stage IVa/b HPV-negative non-laryngeal HNSCC (mostly originating from the oral cavity) who underwent induction chemotherapy at Policlinico Umberto I were reviewed. Treatment outcomes in term of objective response rate (ORR), progression-free survival (PFS), OS and toxicities were analyzed. A significant association between nodal status, ORR, ongoing smoking use, toxicities and OS was demonstrated. ORR (obtained in 61% of patients) was associated with a reduction in mortality of 80% (P< 0.0001). Early discontinuation after just one cycle of induction chemotherapy was associated to a significantly shorter OS. In oral cavity radical surgery with negative margins was obtained in 15/16 patients. In 42% of patients G3-G4 toxicity occurred. Toxicity requiring hospitalization occurred in 42% and 21% of patients with oropharyngeal and oral cavity carcinoma, respectively. Five patients died of treatment-related causes. No treatment-related mortality occurred in oral cavity patients. G5 toxicities were different according to the sub-sites of disease (P = 0.05). Induction chemotherapy in non-laryngeal high-risk HNSCC is an active strategy, most importantly in oral cavity cancer, even though burdened with a high (G ≥ 3) toxicity and early discontinuation rate. These data will however need to be confirmed in further and larger studies.
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7
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Randomized phase-III-trial of concurrent chemoradiation for locally advanced head and neck cancer comparing dose reduced radiotherapy with paclitaxel/cisplatin to standard radiotherapy with fluorouracil/cisplatin: The PacCis-trial. Radiother Oncol 2020; 144:209-217. [PMID: 32044419 DOI: 10.1016/j.radonc.2020.01.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE This multicenter, phase 3 trial investigates whether the incorporation of concurrent paclitaxel and cisplatin together with a reduced total dose of radiotherapy is superior to standard fluorouracil-cisplatin based CRT. MATERIALS AND METHODS Patients with SCCHN, stage III-IVB, were randomized to receive paclitaxel/cisplatin (PacCis)-CRT (arm A; paclitaxel 20 mg/m2 on days 2, 5, 8, 11 and 25, 30, 33, 36; cisplatin 20 mg/m2, days 1-4 and 29-32; RT to a total dose of 63.6 Gy) or fluorouracil/cisplatin (CisFU)-CRT (arm B; fluorouracil 600 mg/m2; cisplatin 20 mg/m2, days 1-5 and 29-33; RT: 70.6 Gy). Endpoint was 3-year-disease free survival (3y-DFS). RESULTS A total of 221 patients were enrolled between 2010 and 2015. With a median follow-up of 3.7 years, 3y-DFS in the CisFU arm and PacCis arm was 58.2% and 48.4%, respectively (HR 0.82, 95% CI 0.56-1.21, p = 0.52). The 3y-OS amounted to 64.6% in the CisFU arm, and to 59.2% in the PacCis arm (HR 0.82, 95% CI 0.54-1.24, p = 0.43). In the subgroup of p16-positive oropharyngeal carcinomas, 3y-DFS and 3y-OS was 84.6% vs 83.9% (p = 0.653), and 92.3% vs. 83.5% (p = 0.76) in arm A and B, respectively. Grade 3-4 hematological toxicities were significantly reduced in arm A (anemia, p = 0.01; leukocytopenia, p = 0.003), whereas grade 3 infections were reduced in arm B (p = 0.01). CONCLUSION Paclitaxel/cisplatin-CRT with a reduced RT-dose is not superior to standard fluorouracil/cisplatin-CRT. Subgroup analyses indicate that a reduced radiation dose seems to be sufficient for p16+ oropharyngeal cancer or non-smokers. CLINICAL TRIAL INFORMATION NCT01126216; EudraCT Number 2005-003484-23.
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8
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Stein MN, Goodin S, Gounder M, Gibbon D, Moss R, Portal D, Lindquist D, Zhao Y, Takebe N, Tan A, Aisner J, Lin H, Ready N, Mehnert JM. A phase I study of AT-101, a BH3 mimetic, in combination with paclitaxel and carboplatin in solid tumors. Invest New Drugs 2019; 38:855-865. [PMID: 31388792 DOI: 10.1007/s10637-019-00807-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/31/2019] [Indexed: 02/05/2023]
Abstract
Background AT-101 is a BH3 mimetic that inhibits the heterodimerization of Bcl-2, Bcl-xL, Bcl-W, and Mcl-1 with pro-apoptotic proteins, thereby lowering the threshold for apoptosis. This phase I trial investigated the MTD of AT-101 in combination with paclitaxel and carboplatin in patients with advanced solid tumors. Methods Patients were treated with AT-101 (40 mg) every 12 h on days 1, 2 and 3 of each cycle combined with varying dose levels (DL) of paclitaxel and carboplatin [DL1: paclitaxel (150 mg/m2) and carboplatin (AUC 5) on day 1 of each cycle; DL2: paclitaxel (175 mg/m2) and carboplatin (AUC 6) on day 1 of each cycle]. Secondary objectives included characterizing toxicity, efficacy, pharmacokinetics, and pharmacodynamics of the combination. Results Twenty-four patients were treated across two DLs with a planned expansion cohort. The most common tumor type was prostate (N = 11). Two patients experienced DLTs: grade 3 abdominal pain at DL1 and grade 3 ALT increase at DL2; however, the MTD was not determined. Moderate hematologic toxicity was observed. One CR was seen in a patient with esophageal cancer and 4 patients achieved PRs (1 NSCLC, 3 prostate). PD studies did not yield statistically significant decreases in Bcl-2 and caspase 3 protein levels, or increased apoptotic activity induced by AT-101. Conclusion The combination of AT-101 at 40 mg every 12 h on days 1, 2 and 3 combined with paclitaxel and carboplatin was safe and tolerable. Based on the modest clinical efficacy seen in this trial, this combination will not be further investigated. Clinical Trial Registration: NCT00891072, CTEP#: 8016.
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Affiliation(s)
- Mark N Stein
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA. .,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA. .,Herbert Irving Comprehensive Cancer Center, 177 Fort Washington Ave, New York, NY, 10032, USA.
| | - Susan Goodin
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Murugeson Gounder
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Darlene Gibbon
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Rebecca Moss
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Daniella Portal
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Diana Lindquist
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Yujie Zhao
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Naoko Takebe
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | - Antoinette Tan
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Joseph Aisner
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Hongxia Lin
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA
| | - Neal Ready
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Janice M Mehnert
- Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, 08903, USA. .,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, 08903, USA. .,Rutgers Cancer Institute of New Jersey, 195 Little Albany St, New Brunswick, NJ, 08901, USA.
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Furqan M, Snyders TP, Saqlain MU, Mott SL, Laux D, Snow A, Anderson CM, Watkins JM, Clamon GH. Comparing high-dose cisplatin with cisplatin-based combination chemotherapy in definitive concurrent chemoradiation setting for locally advanced head and neck squamous cell carcinoma (LAHNSCC). Cancer Med 2019; 8:2730-2739. [PMID: 30968604 PMCID: PMC6558467 DOI: 10.1002/cam4.2139] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND High-dose cisplatin (Cis) is a preferred systemic agent for concurrent chemoradiation (CRT) in locally advanced head and neck squamous cell cancer (LAHNSCC) patients. As some patients are unable to tolerate Cis, this study compares the toxicity and efficacy of weekly cisplatin-paclitaxel (CP) regimen with Cis. METHODS Patients with LAHNSCC receiving definitive chemoradiation either with Cis (Cisplatin-100 mg/m2 q3w x 3) or CP (Cisplatin-20 mg/m2 ; Paclitaxel-30 mg/m2 qw x7) were included. RESULTS Cis and CP groups were comprised of 114 and 111 subjects, respectively. Complete response for Cis versus CP groups was 88% versus 88%, respectively. Median follow-up for the study was 58.5 months. After adjusting for potential treatment selection bias, no significant differences were evident between Cis and CP groups for overall survival (hazard ratios [HR] 0.85, 95% CI 0.59-1.21, P = 0.36), progression free survival (HR 0.88, 95% CI 0.62-1.24, P = 0.46), locoregional control (HR 0.77, 95% CI 0.52-1.15, P = 0.21), and distant control (HR 0.87, 95% CI 0.61-1.23, P = 0.42). Patients in the CP group had less acute and chronic toxicities. CONCLUSIONS Weekly CP regimen can serve as an alternative systemic therapy with radiation in patients with LAHNSCC who are not fit for Cis.
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Affiliation(s)
- Muhammad Furqan
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Travis P Snyders
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Mohammed U Saqlain
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Sarah L Mott
- Biostatistics Core, Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Douglas Laux
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Anthony Snow
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Carryn M Anderson
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John M Watkins
- Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Gerald H Clamon
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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10
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Any place left for induction chemotherapy for locally advanced head and neck squamous cell carcinoma? Anticancer Drugs 2019; 29:287-294. [PMID: 29420335 DOI: 10.1097/cad.0000000000000595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The issue of induction chemotherapy (ICT) interest in locoregionally advanced squamous cell cancer of the head and neck is a real epic that has been carried out over four phase III studies: PARADIGM, DECIDE, NCT01086826 and lastly the conclusive GORTEC 2007-02. With no significant benefit in overall survival of ICT, followed by concurrent chemoradiation over the standard chemoradiotherapy alone, in three of these studies, and a significant number of treatment-related deaths with the standard regimen docetaxel, cisplatin, and fluorouracil, ICT is no longer a hot topic. However, this strategy might still be useful in the aim of limiting the metastatic extension affecting up to 30% of patients: ICT is systematically associated with a reduced metastatic relapse even though the survival effect is never statistically significant when compared directly with concomitant radiochemotherapy. This review summarizes the major studies with their limits and discusses how the ICT could improve the patients' prognosis in the future.
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11
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Seiwert TY, Foster CC, Blair EA, Karrison TG, Agrawal N, Melotek JM, Portugal L, Brisson RJ, Dekker A, Kochanny S, Gooi Z, Lingen MW, Villaflor VM, Ginat DT, Haraf DJ, Vokes EE. OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer. Ann Oncol 2019; 30:297-302. [PMID: 30481287 DOI: 10.1093/annonc/mdy522] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with HPV+ oropharyngeal squamous cell carcinoma were assigned to dose and volume de-escalated radiotherapy (RT) or chemoradiotherapy (CRT) based on response to induction chemotherapy in an effort to limit treatment-related toxicity while preserving efficacy. PATIENTS AND METHODS Patients were classified as low-risk (≤T3, ≤N2B, ≤10 pack-year history) or high-risk (T4 or ≥N2C or >10 PYH). After three cycles of carboplatin/nab-paclitaxel, response was assessed using Response Evaluation Criteria in Solid Tumors 1.1. Low-risk patients with ≥50% response received 50 Gray (Gy) RT (RT50) while low-risk patients with 30%-50% response or high-risk patients with ≥50% response received 45 Gy CRT (CRT45). Patients with lesser response received standard-of-care 75 Gy CRT (CRT75). RT/CRT was limited to the first echelon of uninvolved nodes. The primary end point was 2-year progression-free survival compared with a historic control of 85%. Secondary end points included overall survival and toxicity. RESULTS Sixty-two patients (28 low risk/34 high risk) were enrolled. Of low-risk patients, 71% received RT50 while 21% received CRT45. Of high-risk patients, 71% received CRT45. With a median follow-up of 29 months, 2-year PFS and OS were 95% and 100% for low-risk patients and 94% and 97% for high-risk patients, respectively. The overall 2-year PFS was 94.5% and within the 11% noninferiority margin for the historic control. Grade 3+ mucositis occurred in 30%, 63%, and 91% of the RT50, CRT45, and CRT75 groups, respectively (P = 0.004). Rates of any PEG-tube use were 0%, 31%, and 82% for RT50, CRT45, and CRT75 groups, respectively (P < 0.0001). CONCLUSIONS Induction chemotherapy with response and risk-stratified dose and volume de-escalated RT/CRT for HPV+ OPSCC is associated with favorable oncologic outcomes and reduced acute and chronic toxicity. Further evaluation of induction-based de-escalation in large multicenter studies is justified. CLINICAL TRIAL REGISTRATION Clinical trials.gov identifier: NCT02258659.
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Affiliation(s)
- T Y Seiwert
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - C C Foster
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, USA
| | - E A Blair
- Department of Otolaryngology, University of Chicago, Chicago, USA
| | - T G Karrison
- Department of Public Health Sciences, University of Chicago, Chicago, USA
| | - N Agrawal
- Department of Otolaryngology, University of Chicago, Chicago, USA
| | - J M Melotek
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, USA
| | - L Portugal
- Department of Otolaryngology, University of Chicago, Chicago, USA
| | - R J Brisson
- Oakland University William Beaumont School of Medicine, Rochester, USA
| | - A Dekker
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - S Kochanny
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA
| | - Z Gooi
- Department of Otolaryngology, University of Chicago, Chicago, USA
| | - M W Lingen
- Department of Pathology, University of Chicago, Chicago, USA
| | - V M Villaflor
- Department of Medicine, Division of Hematology/Oncology, Northwestern Memorial Hospital, Chicago, USA
| | - D T Ginat
- Department of Radiology, University of Chicago, Chicago, USA
| | - D J Haraf
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, USA
| | - E E Vokes
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, USA.
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12
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Nilsen ML, Mady LJ, Hodges J, Wasserman-Wincko T, Johnson JT. Burden of treatment: Reported outcomes in a head and neck cancer survivorship clinic. Laryngoscope 2019; 129:E437-E444. [PMID: 30648277 DOI: 10.1002/lary.27801] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE With the intensification and utilization of multimodal treatment, acute toxicities have increased; however, the frequency of treatment sequelae in long-term head and neck cancer (HNC) survivors are poorly described. The purpose of this analysis was to determine the prevalence and predictors of patient-reported late and long-term treatment-related sequelae in HNC survivors. METHODS We performed a cross-sectional analysis of patient-reported outcomes from 228 survivors attending a multidisciplinary HNC survivorship clinic. The primary outcomes comprised quality of life (QOL), symptoms of anxiety and depression, and swallowing dysfunction. RESULTS Male gender, tumor sites in the oropharynx and larynx, longer time since treatment, and treatment with surgery alone were associated with higher physical QOL (P < .05). Male gender, longer time since treatment, and treatment with surgery alone were associated with higher social-emotional QOL (P < .05). A reduction in anxiety symptoms and a higher QOL were related to longer time since treatment; however, a reduction in swallowing dysfunction symptoms was only related to longer time since treatment until approximately 6 years. After 6 years, survivors reported worse swallowing dysfunction (P < .05). One hundred thirty-two survivors (56%) reported at least three treatment-related effects that impacted their daily life. Finally, advanced stage disease at diagnosis (stage III-IV) was also associated with severe swallowing dysfunction (P = .004). CONCLUSION These data indicate the remarkable prevalence of treatment-related effects in HNC survivors. These results highlight the need for de-intensification of therapies, where appropriate, and for a better understanding of pathophysiology and new approaches to mitigating treatment effects. LEVEL OF EVIDENCE 4 Laryngoscope, 129:E437-E444, 2019.
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Affiliation(s)
- Marci Lee Nilsen
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A.,Department of Acute and Tertiary Care, Pittsburgh, Pennsylvania, U.S.A.,The University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Leila J Mady
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jacob Hodges
- UPMC Wolff Center, Pittsburgh, Pennsylvania, U.S.A
| | - Tamara Wasserman-Wincko
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, U.S.A
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13
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Yen C, Tsou H, Hsieh C, Chu C, Chiu C, Chen C, Tsao C, Tsai K, Tsai S, Chang J, Chang K. Sequential therapy of neoadjuvant biochemotherapy with cetuximab, paclitaxel, and cisplatin followed by cetuximab‐based concurrent bioradiotherapy in high‐risk locally advanced oral squamous cell carcinoma: Final analysis of a phase 2 clinical trial. Head Neck 2019; 41:1703-1712. [DOI: 10.1002/hed.25640] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/18/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023] Open
Affiliation(s)
- Chia‐Jui Yen
- Division of Hematology/Oncology, Department of Internal MedicineNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| | - Hsiao‐Hui Tsou
- Institute of Population Health Sciences, National Health Research Institutes Miaoli Taiwan
- Graduate Institute of BiostatisticsCollege of Public Health, China Medical University Taichung Taiwan
| | - Ching‐Yun Hsieh
- Division of Hematology and Oncology, Department of Internal MedicineChina Medical University Hospital Taichung Taiwan
| | - Chang‐Yao Chu
- Department of PathologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| | - Chang‐Fang Chiu
- Division of Hematology and Oncology, Department of Internal MedicineChina Medical University Hospital Taichung Taiwan
| | - Chih‐Cheng Chen
- Department of Hematology and OncologyChang Gung Memorial Hospital at Chiayi Chiayi Taiwan
| | - Chao‐Jung Tsao
- Division of Hematology and Oncology, Department of Internal MedicineChi‐Mei Medical Center Tainan Taiwan
| | - Kuo‐Yang Tsai
- Department of Oral and Maxillofacial SurgeryChanghua Christian Hospital Changhua Taiwan
| | - Sen‐Tien Tsai
- Department of OtolaryngologyNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
| | - Jang‐Yang Chang
- Division of Hematology/Oncology, Department of Internal MedicineNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
- National Institute of Cancer Research, National Health Research Institutes Tainan Taiwan
| | - Kwang‐Yu Chang
- Division of Hematology/Oncology, Department of Internal MedicineNational Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Tainan Taiwan
- National Institute of Cancer Research, National Health Research Institutes Tainan Taiwan
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14
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Head and Neck Cancers. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-97145-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
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15
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Singh S, Prasad SN, Korde M, Kumar S, Elhence A, Shakya V. A Comparative Study of Two Chemo-Radiation Regimens for the Cancer of Larynx. Asian Pac J Cancer Prev 2018; 19:3265-3270. [PMID: 30486630 PMCID: PMC6318399 DOI: 10.31557/apjcp.2018.19.11.3265] [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: 11/29/2022] Open
Abstract
The region of head and neck is critical for respiration, nutrition, and speech. The management of laryngeal tumours can stimulate mutilations and cosmetic deformities and worsen the life. A “non-operative approach” is preferred for patients to whom radiation following surgery, possibly, will direct severe functional destruction predominantly in advanced stage patients having a bulk of carcinoma larynx. The case material for the study was selected from the cross-section of patients registered at the J. K. Cancer Institute, Kanpur. Histologically squamous cell carcinoma 64 patients were registered and equally and randomly placed into Arm I and Arm II. “Arm I” patients and “Arm II” was comprised of randomly selected 64 patients, having histopathologically proven squamous cell carcinoma of the larynx. All patients (32 patients) belonging to “Arm I” received concurrent chemoradiotherapy of Inj. Cisplatin 100 mg/m2 for three-weekly underwent EBRT with 60 Co/LINAC and photon radiation of 70 Gy in 35 fractions for 7 weeks (2 parallel opposed fields). All the patients (32 patients) belongs to “Arm II” received chemo boost as Inj. Cisplatin 6 mg/m2 on last 15 fractions of treatment underwent EBRT with 60 Co/ LINAC photon radiation of 70 Gy in 35 fractions for 7 weeks. Radiotherapy was delivered in supine position by parallel opposing fields including the primary tumour, disease extension, and neck nodes. The study concluded that the loco-regional responses are analogous in Arm I and Arm 2, however Arm II had additional treatment allied toxicities and resulting from numerous of treatment breaks.
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Affiliation(s)
- Sharad Singh
- Department of Radiation Oncology, Super speciality Cancer Institute, Lucknow, India.
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16
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A prospective longitudinal assessment of MRI signal intensity kinetics of non-target muscles in patients with advanced stage oropharyngeal cancer in relationship to radiotherapy dose and post-treatment radiation-associated dysphagia: Preliminary findings from a randomized trial. Radiother Oncol 2018; 130:46-55. [PMID: 30206020 DOI: 10.1016/j.radonc.2018.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess quantitative signal intensity (SI) kinetics obtained from serial MRI of swallowing muscles as a potential imaging biomarker of radiation-induced dysphagia in oropharyngeal cancer (OPC) patients receiving radiotherapy (RT). METHODS Patients were enrolled under an IRB approved Phase II/III randomized trial. Patients underwent serial MRIs at pre-, mid-, and post-RT. Normalized T1, T1+ contrast (T1 + C), and T2 SI for swallowing muscle volumes-of-interest (VOIs) were collected and delta SI changes (Δ) were calculated. Mid- and post-RT SI relative to baseline were assessed and correlations between radiation dose and percent change in SI were calculated. Independent samples' t-tests were used to compare the percent change of SI between patients divided into two groups based on dysphagia status post-RT. RESULTS Forty-six patients with stage III/IV HPV+ OPC were included in this study. Relative to baseline, mean T2 and T1 + C SIs for middle pharyngeal constrictor were both significantly higher at mid- and post-RT (p < 0.004 for all). Superior pharyngeal constrictor also showed a significant increase in T1 + C SI at mid-RT (p = 0.0004). Additional muscle VOIs showed significant changes post-RT, but not earlier at mid-RT. Both mid- and post-RT doses were significantly correlated with the percent change of normalized T2 and T1 + C SI for examined muscle VOIs (p < 0.002). Mean percent changes of normalized T2 SI at mid-RT relative to baseline for all muscle VOIs were significantly higher in patients who developed grade ≥2 dysphagia relative to patients with no/mild dysphasia (mean Δ%: 8.2% vs 1.9%; respectively, p = 0.002). However, at post-RT, these changes were only significant in T1 SI (11.2% vs -1.3%; p < 0.0001). CONCLUSION Signal intensity kinetics of radiation injury can be broadly correlated with the functional muscular defect. Serial MRI during the course of RT may provide an opportunity to quantitatively track muscular pathology for subclinical detection of patients at high risk to develop dysphagia.
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17
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Naghavi AO, Echevarria MI, Grass GD, Strom TJ, Abuodeh YA, Ahmed KA, Kim Y, Trotti AM, Harrison LB, Yamoah K, Caudell JJ. Having Medicaid insurance negatively impacts outcomes in patients with head and neck malignancies. Cancer 2016; 122:3529-3537. [PMID: 27479362 DOI: 10.1002/cncr.30212] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients covered by Medicaid insurance appear to have poorer cancer outcomes. Herein, the authors sought to test whether Medicaid was associated with worse outcomes among patients with head and neck cancer (HNC). METHODS The records of 1698 patients with squamous cell HNC without distant metastatic disease were retrospectively reviewed from an institutional database between 1998 and 2011. At the time of diagnosis, insurance status was categorized as Medicaid, Medicare/other government insurance, or private insurance. Outcomes including locoregional control (LRC) and overall survival (OS) were estimated using the Kaplan-Meier method and Cox regression multivariate analysis (MVA). RESULTS The median follow-up for all patients was 35 months. Medicaid patients comprised 11% of the population; the remaining patients were privately insured (56%) or had Medicare/government insurance (34%). On MVA, Medicaid patients were younger, were current smokers, had higher tumor T and N classifications, and experienced a longer time from diagnosis to treatment initiation (all P<.005). Medicaid insurance status was associated with a deficit of 13% in LRC (69% vs 82%) and 26% in OS (46% vs 72%) at 3 years (all with P<.001). A time from diagnosis to treatment initiation of >45 days was found to be associated with worse 3-year LRC (77% vs 83%; P = .009) and OS (68% vs 71%; P = .008). On MVA, Medicaid remained associated with a deficit in LRC (P = .002) and OS (P<.001). CONCLUSIONS Patients with Medicaid insurance more often present with locally advanced HNC and experience a higher rate of treatment delays compared with non-Medicaid patients. Medicaid insurance status appears to be independently associated with deficits in LRC and OS. Improvements in the health care system, such as expediting treatment initiation, may improve the outcomes of patients with HNC. Cancer 2016;122:3529-3537. © 2016 American Cancer Society.
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Affiliation(s)
- Arash O Naghavi
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Michelle I Echevarria
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - G Daniel Grass
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Tobin J Strom
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Yazan A Abuodeh
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kamran A Ahmed
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Youngchul Kim
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Andy M Trotti
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Louis B Harrison
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Kosj Yamoah
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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18
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Arnold SM, Kudrimoti M, Dressler EV, Gleason JF, Silver NL, Regine WF, Valentino J. Using low-dose radiation to potentiate the effect of induction chemotherapy in head and neck cancer: Results of a prospective phase 2 trial. Adv Radiat Oncol 2016; 1:252-259. [PMID: 28740895 PMCID: PMC5514161 DOI: 10.1016/j.adro.2016.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/08/2022] Open
Abstract
Purpose Low-dose fractionated radiation therapy (LDFRT) induces effective cell killing through hyperradiation sensitivity and potentiates effects of chemotherapy. We report our second investigation of LDFRT as a potentiator of the chemotherapeutic effect of induction carboplatin and paclitaxel in locally advanced squamous cell cancer of the head and neck (SCCHN). Experimental design Two cycles of induction therapy were given every 21 days: paclitaxel (75 mg/m2) on days 1, 8, and 15; carboplatin (area under the curve 6) day 1; and LDFRT 50 cGy fractions (2 each on days 1, 2, 8, and 15). Objectives included primary site complete response rate; secondary included overall survival, progression-free survival (PFS), disease-specific survival, and toxicity. Results A total of 24 evaluable patients were enrolled. Primary sites included oropharynx (62.5%), larynx (20.8%), oral cavity (8.3%), and hypopharynx (8.3%). Grade 3/4 toxicities included neutropenia (20%), leukopenia (32%), dehydration/hypotension (8%), anemia (4%), infection (4%), pulmonary/allergic rhinitis (4%), and diarrhea (4%). Primary site response rate was 23/24 (95.8%): 15/24 (62.5%) complete response, 8/24 (33.3%) partial response, and 1/24 (4.2%) stable disease. With median follow-up of 7.75 years, 9-year rates for overall survival were 49.4% (95% confidence interval [CI], 30.5-79.9), PFS was 72.2% (CI, 55.3-94.3), and disease-specific survival was 65.4% (44.3-96.4). Conclusion Chemopotentiating LDFRT combined with paclitaxel and carboplatin is effective in SCCHN and provided an excellent median overall survival of 107.2 months, with median PFS not yet reached in this locally advanced SCCHN cohort. This compares favorably to prior investigations and caused fewer grade 3 and 4 toxicities than more intensive, 3-drug induction regimens. This trial demonstrates the innovative use of LDFRT as a potentiator of chemotherapy.
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Affiliation(s)
- Susanne M Arnold
- Department of Internal Medicine, Division of Medical Oncology, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | - Mahesh Kudrimoti
- Department of Radiation Medicine, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | - Emily V Dressler
- Division of Cancer Biostatistics, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
| | | | | | - William F Regine
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Joseph Valentino
- Department of Otolaryngology Head and Neck Surgery, University of Kentucky, Markey Cancer Center, Lexington, Kentucky
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19
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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.
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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
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Kim HR, Lee CG, Choi EC, Kim JH, Koh YW, Cho BC. Induction docetaxel and S-1 followed by concomitant radiotherapy with low-dose daily cisplatin in locally advanced head and neck carcinoma. Head Neck 2016; 38 Suppl 1:E1653-9. [PMID: 26890965 DOI: 10.1002/hed.24294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 06/22/2015] [Accepted: 09/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the efficacy and safety of induction chemotherapy with docetaxel-S-1, and radiotherapy (RT) with concurrent daily cisplatin in locally advanced head and neck carcinoma. METHOD Fifty patients received 2 cycles of induction chemotherapy with induction chemotherapy with docetaxel and S-1, followed by 7 cycles of RT with concurrent daily cisplatin. RESULTS The most frequent grade 3 to 4 hematologic toxicity was neutropenia (14%). Forty of 50 patients who completed induction chemotherapy with docetaxel and S-1 subsequently started RT with concurrent daily cisplatin, all within 3 to 4 weeks after the start of the second cycle of induction chemotherapy with docetaxel and S-1. The best response to induction chemotherapy with docetaxel and S-1 and after completion of RT with concurrent daily cisplatin was partial response (PR) in 52.5% and complete response in 47.5%, respectively. With a median follow-up of 61 months, 5-year progression-free survival (PFS) and overall survival (OS) were 63.3% and 65.7%, respectively. CONCLUSION Administration of induction chemotherapy with docetaxel and S-1 before RT with concurrent daily cisplatin chemoradiotherapy (CRT) resulted in a high response rate with good tolerability, and did not compromise subsequent CRT. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1653-E1659, 2016.
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Affiliation(s)
- Hye Ryun Kim
- Yonsei Cancer Center, Division of Medical Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joo Hang Kim
- Yonsei Cancer Center, Division of Medical Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Chul Cho
- Yonsei Cancer Center, Division of Medical Oncology, Yonsei University College of Medicine, Seoul, Korea
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Pauloski BR, Rademaker AW, Logemann JA, Discekici-Harris M, Mittal BB. Comparison of swallowing function after intensity-modulated radiation therapy and conventional radiotherapy for head and neck cancer. Head Neck 2015; 37:1575-82. [PMID: 24909649 PMCID: PMC4258519 DOI: 10.1002/hed.23796] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/18/2014] [Accepted: 06/04/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Intensity-modulated radiotherapy (IMRT) is hoped to protect structures important for swallow function. We compared posttreatment swallow function in 7 pairs of patients with head and neck cancer treated with either IMRT or conventional radiotherapy (RT). METHODS Patients were matched on tumor characteristics. Swallowing function was evaluated with the modified barium swallow procedure pretreatment and at 3 and 6 months postcancer treatment completion. Swallows were analyzed for bolus transit times, bolus residues, laryngeal closure (LAC) duration, cricopharyngeal opening (CPO) duration, and oropharyngeal swallow efficiency (OPSE). Data were analyzed using multifactor repeated measures analysis of variance and adjusted for baseline function. RESULTS Main effect of radiation type was significant for all measures on at least 1 bolus type. Patients treated with IMRT demonstrated shorter bolus transit times, less oral and pharyngeal residue, longer LAC, and larger OPSE. CONCLUSION Patients treated with IMRT demonstrated faster, more efficient swallows, and greater airway protection.
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Affiliation(s)
- Barbara Roa Pauloski
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Alfred W Rademaker
- Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jerilyn A Logemann
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | | | - Bharat B Mittal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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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.
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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
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23
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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.
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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
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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.
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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
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Cisplatin-based chemotherapy versus cetuximab in concurrent chemoradiotherapy for locally advanced head and neck cancer treatment. BIOMED RESEARCH INTERNATIONAL 2014; 2014:904341. [PMID: 25110705 PMCID: PMC4109223 DOI: 10.1155/2014/904341] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 06/14/2014] [Accepted: 06/14/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to analyze survival, clinical responses, compliance, and adverse effects in locally advanced head and neck cancer (LAHNC) patients treated with split-dose cisplatin-based concurrent chemoradiation therapy (SD-CCRT) or cetuximab with concurrent radiation therapy (BioRT). MATERIALS AND METHODS We retrospectively evaluated 170 LAHNC patients diagnosed between January 1, 2009, and July 31, 2012: 116 received CCRT and 54 received BioRT. RESULTS Complete response rates were similar in the SD-CCRT and BioRT groups (63.8% versus 59.3%; P = 0.807), and locoregional relapse rates were 18.1% and 13.0%, respectively (P = 0.400). The 3-year relapse-free survival rate was 65.8% in the SD-CCRT group and 65.5% in the BioRT group, respectively (P = 0.647). The 3-year overall survival rate was 78.5% in the SD-CCRT group and 70.9% in the BioRT group, respectively (P = 0.879). Hematologic side effects were significantly more frequent in the SD-CCRT than in the BioRT group. Mucositis frequency was similar. CONCLUSIONS Primary SD-CCRT and BioRT both showed good clinical response and survival. Hematologic toxicities were more frequent, but tolerable, in the SD-CCRT group. Both groups showed good compliance.
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Flavill E, Fang YV, Miles B, Truelson J, Perkins S. Induction chemotherapy followed by concurrent chemoradiotherapy for advanced stage oropharyngeal squamous cell carcinoma with HPV and P16 testing. Ann Otol Rhinol Laryngol 2014; 123:365-73. [PMID: 24687594 DOI: 10.1177/0003489414526685] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective was to report our experience with advanced stage oropharyngeal squamous cell carcinoma treated sequentially with induction chemotherapy followed by concurrent chemoradiotherapy. METHODS Retrospective chart review identified 49 eligible patients with advanced stage oropharyngeal squamous cell carcinoma treated with induction chemotherapy followed by concurrent chemoradiotherapy. HPV and p16(INK4A) testing was performed on pathology specimens. Follow-up of over 11 months was required unless a death or treatment failure occurred before that time. RESULTS Treatment with induction chemotherapy followed by concurrent chemoradiotherapy resulted in 44/48 (90%) complete durable response. One death occurred from pulmonary embolism. Toxicity profiles were comparable to other published data. Average follow-up was 3.9 years. Oncologic failure rates among subgroups showed 5.7% failure for HPV+/p16+ cancer, 9.1% failure for HPV-/p16+ cancer, 100% failure for HPV-/p16- cancer, 0% failure for nonsmokers, and 17.9% failure for smokers. CONCLUSIONS This study showed favorable outcomes in terms of durable oncologic response and acceptable toxicity profiles. It is notable that 36/49 patients were HPV+/p16+ and 11/49 were HPV-/p16+. Only 2 patients were HPV-/p16-, and both died as a result of oncologic failures. This highlights the importance of obtaining HPV and p16 testing in studies evaluating the efficacy of treatments for oropharyngeal squamous cell carcinoma.
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Affiliation(s)
- Eric Flavill
- Department of Otolaryngology/Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Laskar SG, Agarwal JP, Srinivas C, Dinshaw KA. Radiotherapeutic management of locally advanced head and neck cancer. Expert Rev Anticancer Ther 2014; 6:405-17. [PMID: 16503857 DOI: 10.1586/14737140.6.3.405] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Head and neck cancer management has undergone several paradigm shifts for several relevant reasons. From the dismal experience with the use of radiotherapy as the sole modality in the treatment of this group of patients with advanced disease, radiotherapy has been evaluated as an adjuvant for the same group of patients who had undergone successful surgery. Although there is no level 1 evidence to support postoperative adjuvant radiation, several studies have demonstrated that adjuvant radiotherapy reduces the local failures and, thereby, improves survival. Predictors of recurrence after surgical resection are: positive margins of resection; extranodal spread in involved nodes; perineural invasion; and presence of two or more involved regional lymph nodes. Realization of the advantages of a combination of chemotherapy with radiotherapy has had a major impact on the management of these cancers. There is emerging evidence for the use of adjuvant concurrent chemoradiotherapy in the group with high-risk features. Multiple organ conservation strategies in the management of locally advanced head and neck cancers have evolved over the years. However, the meta-analyses of impact of chemotherapy in various settings reveal that concomitant chemoradiotherapy is superior to any of the other regimens. Increasing use of computed tomography, magnetic resonance imaging and positron emission tomography scan images has resulted in better visualization of target volumes and critical structures. Delineation of these structures is of paramount importance and has resulted in a profound change in conformal treatment planning. Better understanding of the physical aspects of delivery of radiotherapy and the advent of modern treatment planning systems have led to the development of conformal techniques. Although the benefit of these techniques on survival have yet to be demonstrated, there is evidence to suggest that they reduce treatment-related toxicities significantly and facilitate dose escalation. Increased knowledge of radiobiology has led to the development of various altered fractionation regimens in the management of locally advanced head and neck cancers. Discovery of cell-cycle kinetics and signal transduction pathways has led to the unearthing of several potential targets for targeted therapy. The epidermal growth factor receptor gene has emerged as the most promising target. The role of biological radiation response modifiers is evolving. All of these approaches to improve the therapeutic gain would be incomplete without evaluating their effect on the quality of life of these patients.
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Affiliation(s)
- S Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Ernest Borges Marg, Parel, Mumbai, Maharashtra, 400012, India.
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Race and competing mortality in advanced head and neck cancer. Oral Oncol 2014; 50:40-4. [DOI: 10.1016/j.oraloncology.2013.09.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/16/2013] [Accepted: 09/23/2013] [Indexed: 11/18/2022]
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Joo YH, Cho KJ, Park JO, Nam IC, Kim CS, Cho HJ, Kim MS. Surgery with postoperative radiotherapy for pN2 head and neck squamous cell carcinoma. Acta Otolaryngol 2013; 133:1104-9. [PMID: 24032573 DOI: 10.3109/00016489.2013.811751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Factors that affected prognosis were T stage and extracapsular spread in patients that underwent primary surgery with postoperative radiotherapy for pN2 head and neck carcinoma. OBJECTIVES The purpose of this study was to examine treatment outcomes and define prognostic factors for pN2 head and neck carcinoma. METHODS A total of 209 patients underwent surgery with postoperative radiotherapy between 1994 and 2011. Primary tumor sites were the oropharynx (n = 70), hypopharynx (n = 48), larynx (n = 47), and oral cavity (n = 44). There were 21, 83, 60, and 45 patients with stage T1 to T4 cancers, respectively. The N stages were 20 N2a, 129 N2b, and 60 N2c. RESULTS The recurrence rate was 40% (83/209) over a mean observation period of 39 months. The 5-year disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS) rates in our cohort were 44%, 60%, and 56%, respectively. The presence of advanced T stage or extracapsular spread had a significant adverse effect on 5-year DFS, DSS, and OS rates according to Kaplan-Meier survival curves. Multivariate Cox regression analysis confirmed the significant association between 5-year DSS rate and advanced T stage (hazard ratio (HR), 2.20; 95% confidence interval (CI), 1.26-3.82; p = 0.005) and extracapsular spread (HR, 2.29; 95% CI, 1.24-4.21; p = 0.008).
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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.
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Cohen EEW, Ahmed O, Kocherginsky M, Shustakova G, Kistner-Griffin E, Salama JK, Yefremenko V, Novosad V. Study of functional infrared imaging for early detection of mucositis in locally advanced head and neck cancer treated with chemoradiotherapy. Oral Oncol 2013; 49:1025-31. [PMID: 23988569 DOI: 10.1016/j.oraloncology.2013.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/18/2013] [Accepted: 07/23/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Chemoradiotherapy (CRT) has led to improved efficacy in treating locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN) but has led to almost universal in-field mucositis. Patients treated with the same regimen often have differences in mucositis occurrence and severity. Mucositis induced via radiation is known to represent an intense inflammatory response histologically. We hypothesized that patients destined to display severe mucocutaneous toxicity would demonstrate greater alterations in thermal intensity early in therapy than identically treated counterparts. This will allow identification of patients that will require more intensive supportive care using thermal imaging technology. MATERIALS AND METHODS Subjects with LA-SCCHN (oral cavity or oropharynx) being treated with the identical chemoradiotherapy regimen underwent baseline and weekly thermal imaging. Changes in skin temperature caused by mucositis and dermatitis compared with a reference area (ΔT were calculated and correlated to grade of mucositis based on NCI-CTCAE 3.0. RESULTS Thirty-four subjects were enrolled. Grade 3 mucositis and dermatitis was observed in 53% and 21%, respectively. We observed a statistically significant positive association between an early rise in ΔT and mucositis grade (p value=0.03). CONCLUSIONS Thermal imaging is able to detect small and early changes in skin surface temperature that may be associated with development of mucositis in patients being treated with chemoradiotherapy.
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Affiliation(s)
- Ezra E W Cohen
- Department of Medicine, University of Chicago, United States; University of Chicago Comprehensive Cancer Center, United States.
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Chung EJ, Lee JJ, Kim HS, Lee DJ, Jung CH, Chang YJ, Rho YS. Alternative treatment option for hypopharyngeal cancer: clinical outcomes after conservative laryngeal surgery with partial pharyngectomy. Acta Otolaryngol 2013; 133:866-73. [PMID: 23647464 DOI: 10.3109/00016489.2013.785018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The oncological and functional outcomes of hypopharyngeal cancer after conservative laryngeal surgery are fairly acceptable, making this a reasonable initial treatment option for selected patients. OBJECTIVE The purpose of this study was to assess the clinical outcomes of patients with hypopharyngeal squamous cell carcinoma (SCC) treated with conservative laryngeal surgery with partial pharyngectomy. METHODS Fifty-eight patients with hypopharyngeal SCC who underwent laryngeal preservation surgery were enrolled. The tumors were classified as cT1 in 5 (8.6%) patients, cT2 in 35 (60.3%), cT3 in 14 (24.1%), and cT4a in 4 (6.9%) patients. RESULTS Surgical outcomes: 5-year overall and disease-specific survival rates were 78% and 77.6%. Recurrent disease developed in 13 patients (22.4%). Multivariate analysis revealed that level VI metastasis confirmed by histopathological analysis, close (< 5 mm) histologic margin, advanced N stage, and posterior pharyngeal wall tumor were independent factors associated with poor disease-specific survival. Functional outcomes: 50 patients (86.2%) could obtain all their nutritional needs orally. Eight patients needed the assistance of a percutaneous endoscopic gastrostomy tube. Oral re-alimentation was achieved within a mean of 26.1 days after surgery. Fifty-one patients (87.9%) could be decannulated after a mean of 43.8 days postoperatively.
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Affiliation(s)
- Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsong Memorial Institute of Head and Neck Cancer, Hallym University, College of Medicine, Seoul, Korea
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Hutcheson KA, Lewin JS, Holsinger FC, Steinhaus G, Lisec A, Barringer DA, Lin HY, Villalobos S, Garden AS, Papadimitrakopoulou V, Kies MS. Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck. Head Neck 2013; 36:474-80. [PMID: 23780650 DOI: 10.1002/hed.23330] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2013] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate long-term outcomes after induction chemotherapy followed by "risk-based" local therapy for locally-advanced squamous cell carcinoma of the head and neck (SCCHN). METHODS Forty-seven patients (stage IV; ≥N2b) were enrolled in a phase II trial. Baseline and 24-month functional measures included modified barium swallow (MBS) studies, oropharyngeal swallow efficiency (OPSE), and the MD Anderson Dysphagia Inventory (MDADI). Functional status was assessed at 5 years. RESULTS Five-year overall survival (OS) was 89% (95% confidence interval [CI], 81% to 99%). A nonsignificant 13% average reduction in swallowing efficiency (OPSE) was observed at 24 months relative to baseline (p = .191). MDADI scores approximated baseline at 24 months. Among 42 long-term survivors (median, 5.9 years), 3 patients (7.1%) had chronic dysphagia. The rate of final gastrostomy dependence was 4.8% (2 of 42). CONCLUSION Sequential chemoradiotherapy achieved favorable outcomes among patients with locally advanced SCCHN, mainly of oropharyngeal origin. MBS and MDADI scores found modest swallowing deterioration at 2 years, and chronic aspiration was uncommon in long-term survivors.
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Affiliation(s)
- Katherine A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
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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.
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Low-dose fractionated radiation with induction chemotherapy for locally advanced head and neck cancer: 5 year results of a prospective phase II trial. ACTA ACUST UNITED AC 2012; 2:35-42. [PMID: 26052405 DOI: 10.1007/s13566-012-0074-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This study aims to report the long-term outcomes of a novel treatment approach utilizing induction low-dose fractionated radiation therapy (LDFRT) and chemotherapy for locally advanced squamous cell carcinoma of head and neck (SCCHN). METHODS We prospectively enrolled 40 patients with locally advanced SCCHN (77 % stage IV) on a phase II clinical trial and treated with induction paclitaxel (225 mg/m2), carboplatin (AUC 6), and LDFRT (80 cGy BID on days 1 and 2) every 21 days for two cycles. RESULTS Forty patients enrolled; 39 were evaluable. The acute toxicity and response data have been previously reported; overall response rate (RR) was 82 %. After induction, definitive therapy was concurrent chemoradiation (CRT) in 51 %, XRT alone in 39 %, surgery in 5 %, and surgery and XRT in 5 %. The long-term outcomes are now reported with a median follow-up of 83 months. Locoregional control (LRC) is 80 % and distant control (DC) is 77 %. Five-year overall survival (OS), disease-specific survival, and progression-free survival (PFS) are 62 %, 66 %, and 58 %, respectively. CONCLUSION Induction chemotherapy with LDFRT has a high initial RR, comparable toxicity to two-drug induction regimens, but adds a third novel and effective agent, LDFRT. Five-year follow-up shows favorable outcomes compared to historical controls and excellent compliance with definitive therapy. This novel treatment approach is now planned for phase 3 trial evaluation.
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Treatment of hypopharyngeal carcinoma with primary chemoradiotherapy: functional morbidity. Curr Opin Otolaryngol Head Neck Surg 2012; 20:89-96. [PMID: 22249169 DOI: 10.1097/moo.0b013e32834fa72c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review aims at unravelling the medical literature which has reported on the treatment of 'larynx preserving' chemoradiotherapy strategies and separating the treatment sites, larynx and hypopharynx, from each other and reporting on the adverse effects and functional outcomes of patients with hypopharyngeal cancer. RECENT FINDINGS The literature reports on the treatment of advanced laryngeal and hypopharyngeal cancer with chemoradiotherapy together as a 'common cancer site'. Although the chemotherapeutic drugs affect the tumour and the normal tissues similarly in both the larynx and hypopharynx, their effects on the patient groups are different, mainly affecting swallow, airway protection mechanisms and voice/speech to a greater or lesser extent. Pretreatment symptoms and function should be documented subjectively and objectively prior to commencing nonsurgical treatment. Hypopharyngeal cancer should be reported separately, and preferably stratified into the three subsites, according to the T stage of disease rather than TNM stage. Equipment for such testing and the process for such documentation are available in most clinical areas, worldwide. SUMMARY Future analysis relies on the conscientious monitoring of adverse effects of all treatment modalities and an assessment of function as well as quality of life impact on the patient. Thus, the specialty can make informed decisions on the most appropriate and most suitable mode of treatment for individual patients based upon their tumour, their preoperative organ function, their likely future organ function and the likelihood of cure.
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Singer S, Arraras JI, Baumann I, Boehm A, Chie WC, Galalae R, Langendijk JA, Guntinas-Lichius O, Hammerlid E, Pinto M, Nicolatou-Galitis O, Schmalz C, Sen M, Sherman AC, Spiegel K, Verdonck-de Leeuw I, Yarom N, Zotti P, Hofmeister D. Quality of life in patients with head and neck cancer receiving targeted or multimodal therapy - Update of the EORTC QLQ-H&N35, Phase I. Head Neck 2012; 35:1331-8. [DOI: 10.1002/hed.23127] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2012] [Indexed: 11/12/2022] Open
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Bhide SA, Newbold KL, Harrington KJ, Nutting CM. Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers. Br J Radiol 2012; 85:487-94. [PMID: 22556403 DOI: 10.1259/bjr/85942136] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional two-dimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. Intensity-modulated radiotherapy (IMRT) can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This article reviews the current role of IMRT in head and neck cancer from the point of view of normal tissue sparing, and also reviews the current published literature by individual head and neck cancer subsites. In addition, we briefly discuss the role of image guidance in head and neck IMRT, and future directions in this area.
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, Royal Marsden Hospital, Sutton, Surrey, UK
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Is the combination of Cetuximab with chemo-radiotherapy regimens worthwhile in the treatment of locally advanced head and neck cancer? A review of current evidence. Crit Rev Oncol Hematol 2012; 85:112-20. [PMID: 22743346 DOI: 10.1016/j.critrevonc.2012.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 05/12/2012] [Accepted: 05/31/2012] [Indexed: 12/27/2022] Open
Abstract
The administration of Cetuximab in combination with radiotherapy and chemotherapy has shown clear survival improvements within the locally advanced and the relapsed/metastatic settings respectively. These results have provided the clinical rational for the inclusion of Cetuximab into chemo-radiation regimens. Trials assessing the combination of Cetuximab with induction chemotherapy, concomitant chemo-radiotherapy or both are reviewed. Taken together, their results suggest that the addition of Cetuximab is promising in trials of induction chemotherapy, showing almost uniformly response rates higher than historical controls. In combination with concomitant hyperfractionated radiotherapy and Cisplatin the results of the RTOG 0522 trial do not suggest any benefit. However a positive effect cannot be excluded with other schedules. Although feasibility has been universally suggested, adding Cetuximab implies some toxicity enhancement. Single local and systemic toxicities are more frequent and supposedly the overall treatment intensity is increased. Moreover the drug-specific toxicities are potentially severe and deserve timely recognition and management.
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Cmelak AJ. Current issues in combined modality therapy in locally advanced head and neck cancer. Crit Rev Oncol Hematol 2012; 84:261-73. [PMID: 22595517 DOI: 10.1016/j.critrevonc.2012.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/05/2012] [Accepted: 04/13/2012] [Indexed: 02/08/2023] Open
Abstract
Curative treatment for patients with locally advanced squamous cell carcinomas of the head and neck (SCCHN) is complex and multidisciplinary. Our understanding of the optimal management of this disease has improved over the years, incorporating refined surgical approaches, better radiotherapy delivery methods, and greater use of systemic therapies. Investigation into shifting epidemiology patterns has uncovered two biologically and clinically distinct diseases: the smoking-related entity and the increasingly common malignancy associated with human papilloma virus (HPV). Prognosis favors the latter, driving newer investigations into dose de-intensification to limit toxicities in patients with HPV-driven disease, and alternatively intensifying treatment to improve tumor control in those with a significant smoking history. In this review, I describe the most recent progress in the multi-modal integration of radiotherapy and chemoradiotherapy, and the role of targeted agents and personalized therapy, and conclude with a discussion of the relevance of these innovations with respect to HPV tumor status.
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Affiliation(s)
- Anthony J Cmelak
- Department of Radiation Oncology, Vanderbilt Ingram Cancer Center, Nashville, TN 37232-5671, USA.
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Weekly paclitaxel and carboplatin induction chemotherapy followed by concurrent chemoradiotherapy in locally advanced squamous cell carcinoma of the head and neck. Am J Clin Oncol 2012; 35:6-12. [PMID: 21293244 DOI: 10.1097/coc.0b013e3182019ee3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To perform a phase II trial evaluating dose dense induction chemotherapy for locally advanced head and neck cancer. PATIENTS AND METHODS Thirty-five patients received 6 weekly doses of carboplatin (area under the curve=2) and paclitaxel (135 mg/m) followed by concurrent weekly paclitaxel (40 mg/m) and carboplatin (area under the curve=1) and daily radiation (66-72 Gy). RESULTS There was 1 induction death from neutropenic sepsis and 1 sudden death during chemoradiotherapy. The overall response rate with induction was 79%. With >40 months of follow-up, the 36-month overall survival was 67% and squamous cell carcinoma of the head and neck survival 84%. Patients undergoing biopsy of the primary tumor site after the therapies had 17/18 (94%) pathologic complete response rate. The locoregional relapse rate was 40% (24 mo 28%) and distant relapse rate was 8% with only 1 distant site. CONCLUSIONS Therapy was active but patients must be carefully selected and monitored. Compared with the historical controls, dose dense and intense induction chemotherapy decreased distant failure rate without compromising the locoregional control.
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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
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Factors influencing the outcomes of primary surgery with postoperative radiotherapy for pN2 oropharyneal squamous cell carcinoma. Oral Oncol 2012; 48:90-4. [DOI: 10.1016/j.oraloncology.2011.08.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 11/22/2022]
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Pergolizzi S, Santacaterina A, Adamo B, Franchina T, Denaro N, Ferraro P, Ricciardi GRR, Settineri N, Adamo V. Induction chemotherapy with paclitaxel and cisplatin to concurrent radiotherapy and weekly paclitaxel in the treatment of loco-regionally advanced, stage IV (M0), head and neck squamous cell carcinoma. Mature results of a prospective study. Radiat Oncol 2011; 6:162. [PMID: 22108341 PMCID: PMC3235077 DOI: 10.1186/1748-717x-6-162] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 11/22/2011] [Indexed: 11/24/2022] Open
Abstract
Background to evaluate activity and toxicity of a sequential treatment in advanced, non metastatic, mostly unresectable, head and neck squamous cell carcinoma. Methods Patients with loco-regionally advanced or unresectable, head and neck cancer, were prospectively treated with 3 courses of induction chemotherapy followed by concurrent chemoradiation. Induction chemotherapy consisted of paclitaxel 175 mg/m2 day 1 and cisplatin 75 mg/m2 day 2, given every 3 weeks, to a total of three courses. Curative radiotherapy started 4 weeks after the last cycle of chemotherapy with the goal of delivering a total dose ≥ 66 Gy. During RT weekly paclitaxel (40 mg/m2) was administered. Results The trial accrued 43 patients from January 1999 to December 2002. All patients received 3 courses of induction chemotherapy and the planned dose of radiotherapy. Thirty-eight patients were able to tolerate weekly paclitaxel during irradiation at least for 4 courses. After induction therapy there were 32 overall responses, 74.4% (23 partial and 9 complete); at completion of concomitant treatment overall responses were 42, 97.7% (20 partial and 22 complete). Median time to treatment failure was 20 months and the disease progression rate at 3 and 5 years was 33% and 23%, respectively. The median overall survival time was 24 months and 3 and 5 years overall survival rates were 37% and 26%, respectively. The major toxicity was mucositis. Conclusions This combined treatment was found to be feasible and active in advanced or unresectable, head and neck squamous cell carcinoma patients. Long-term results observed in this trial encourage to consider this approach in further investigation using newer radiation delivering technique and new molecularly agents.
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Affiliation(s)
- Stefano Pergolizzi
- Department of Radiological Science, University of Messina, Messina, Italy
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Argiris A, Karamouzis MV, Smith R, Kotsakis A, Gibson MK, Lai SY, Kim S, Branstetter BF, Shuai Y, Romkes M, Wang L, Grandis JR, Ferris RL, Johnson JT, Heron DE. Phase I trial of pemetrexed in combination with cetuximab and concurrent radiotherapy in patients with head and neck cancer. Ann Oncol 2011; 22:2482-2488. [PMID: 21363880 PMCID: PMC3200222 DOI: 10.1093/annonc/mdr002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 12/28/2010] [Accepted: 12/31/2010] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We studied the combination of pemetrexed, a multi-targeted antifolate, and cetuximab, an mAb against the epidermal growth factor receptor, with radiotherapy in poor prognosis head and neck cancer. PATIENTS AND METHODS Patients received pemetrexed on days 1, 22, and 43 on a dose-escalation scheme with starting level (0) 350 mg/m(2) (level -1, 200 mg/m(2); level +1, 500 mg/m(2)) with concurrent radiotherapy (2 Gy/day) and cetuximab in two separate cohorts, not previously irradiated (A) and previously irradiated (B), who received 70 and 60-66 Gy, respectively. Genetic polymorphisms of thymidylate synthase and methylenetetrahydrofolate reductase were evaluated. RESULTS Thirty-two patients were enrolled. The maximum tolerated dose of pemetrexed was 500 mg/m(2) in cohort A and 350 mg/m(2) in cohort B. Prophylactic antibiotics were required. In cohort A, two dose-limiting toxicities (DLTs) occurred (febrile neutropenia), one each at levels 0 and +1. In cohort B, two DLTs occurred at level +1 (febrile neutropenia; death from perforated duodenal ulcer and sepsis). Grade 3 mucositis was common. No association of gene polymorphisms with toxicity or efficacy was evident. CONCLUSION The addition of pemetrexed 500 mg/m(2) to cetuximab and radiotherapy is recommended for further study in not previously irradiated patients.
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MESH Headings
- Adult
- Aged
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/adverse effects
- Antibodies, Monoclonal, Humanized
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/genetics
- Carcinoma, Squamous Cell/radiotherapy
- Cetuximab
- Combined Modality Therapy
- Dose-Response Relationship, Drug
- Female
- Glutamates/administration & dosage
- Glutamates/adverse effects
- Guanine/administration & dosage
- Guanine/adverse effects
- Guanine/analogs & derivatives
- Head and Neck Neoplasms/drug therapy
- Head and Neck Neoplasms/genetics
- Head and Neck Neoplasms/radiotherapy
- Humans
- Male
- Methylenetetrahydrofolate Reductase (NADPH2)/genetics
- Middle Aged
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/radiotherapy
- Pemetrexed
- Polymorphism, Genetic
- Squamous Cell Carcinoma of Head and Neck
- Thymidylate Synthase/genetics
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Affiliation(s)
- A Argiris
- University of Pittsburgh Cancer Institute; Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine; Department of Otolaryngology.
| | - M V Karamouzis
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine
| | - R Smith
- University of Pittsburgh Cancer Institute; Department of Radiation Oncology
| | - A Kotsakis
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine
| | - M K Gibson
- University of Pittsburgh Cancer Institute; Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh School of Medicine
| | - S Y Lai
- Department of Otolaryngology
| | - S Kim
- University of Pittsburgh Cancer Institute; Department of Otolaryngology
| | - B F Branstetter
- Department of Otolaryngology; Department of Radiology, University of Pittsburgh School of Medicine
| | - Y Shuai
- University of Pittsburgh Cancer Institute
| | - M Romkes
- University of Pittsburgh Cancer Institute; Division of Clinical Pharmacology, Department of Medicine, University of Pittsburgh School of Medicine
| | - L Wang
- Department of Otolaryngology; Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - J R Grandis
- University of Pittsburgh Cancer Institute; Department of Otolaryngology
| | - R L Ferris
- University of Pittsburgh Cancer Institute; Department of Otolaryngology; Department of Immunology, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - J T Johnson
- University of Pittsburgh Cancer Institute; Department of Otolaryngology
| | - D E Heron
- University of Pittsburgh Cancer Institute; Department of Radiation Oncology
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Posner MR. Integrating systemic agents into multimodality treatment of locally advanced head and neck cancer. Ann Oncol 2011; 21 Suppl 7:vii246-51. [PMID: 20943623 DOI: 10.1093/annonc/mdq291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Although highly debated in the 1980s, randomized clinical trials have provided undeniable evidence that systemic chemotherapy, as part of a multimodality treatment collaboration, is effective in improving survival, organ preservation and local-regional control in locally advanced head and neck cancer (HNC). We are entering an exciting period in which new chemotherapy agents, new paradigms of treatment, new surgical and radiation technology, and new prognostic factors are rapidly becoming available. Information on how to integrate these new tools and on how they affect long-term outcomes are lacking, making decision making and treatment planning more difficult. With unprecedented survival and the changing demographics of HNC we must now consider long-term consequences in addition to survival and local and regional control as important factors in therapeutic decision making. The availability of different treatment plans that incorporate systemic chemotherapy, radiotherapy and surgery give us many tools with which to craft a treatment for each individual patient. Today, in this exciting and chaotic period, a multidisciplinary and collaborative approach for each HNC patient at the start of decision making and planning is a necessity and the absolute standard of medical treatment for excellent patient care.
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Affiliation(s)
- M R Posner
- Mount Sinai School of Medicine, Mount Sinai Medical Center, Tisch Cancer Institute, New York, NY 10029-6574, USA.
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Kang JH, Cho SH, Kim JP, Kang KM, Cho KS, Kim W, Seol YM, Lee S, Park HS, Hur WJ, Choi YJ, Oh SY. Treatment outcomes between concurrent chemoradiotherapy and combination of surgery, radiotherapy, and/or chemotherapy in stage III and IV maxillary sinus cancer: multi-institutional retrospective analysis. J Oral Maxillofac Surg 2011; 70:1717-23. [PMID: 21945430 DOI: 10.1016/j.joms.2011.06.221] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 06/20/2011] [Accepted: 06/22/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The incidence of maxillary sinus cancer (MSC) is extremely rare, representing less than 1% of all cancers. Because of its rarity, the management of locally advanced MSC is a challenging issue. The objective of the present study was to retrospectively compare the efficacy of 2 traditional treatment strategies, concurrent chemoradiotherapy (CCRT) versus combination of surgery and radiotherapy and/or chemotherapy (SRCT) in MSC. PATIENTS AND METHODS From 1989 to 2010, 65 patients with histologically confirmed stage III or IVA/IVB were retrospectively analyzed. RESULTS The median age of our subjects was 60 years (range 36 to 81). The present study involved 18 women (27.7%) and 47 men (72.3%). Of the 65 patients, 52 (80.0%) had squamous cell carcinoma. The TNM stage was stage III, as determined by the American Joint Committee on Cancer, 6th edition, in 27 patients (41.5%). Stage IVA or IVB was observed in 38 patients (58.5%). Of the 65 patients, 41 underwent treatment. Of these 41 patients, 26 and 15 patients underwent SRCT and CCRT, respectively. During the 75.6 months (range 6.4 to 249.4) of median follow-up, the median progression-free survival duration was 45.1 months (95% confidence interval 0.0 to 142.7). The 5-year overall survival rate was 64.8%. However, the patients who had undergone surgery had better progression-free survival (hazard ratio 2.363, 95% confidence interval 1.098 to 5.085, P = .028) and overall survival (hazard ratio 4.989, 95% confidence interval 1.646 to 15.118, P = .004). The SRCT group had a better progression-free survival (P = .043) and overall survival (P = .029) duration than did the CCRT group. CONCLUSION SRCT might be superior to CCRT for locally advanced MSC. Additional studies comparing the treatment outcomes of CCRT with SRCT are warranted.
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Affiliation(s)
- Jung Hun Kang
- Department of Internal Medicine, Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
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Role of larynx-preserving partial hypopharyngectomy with and without postoperative radiotherapy for squamous cell carcinoma of the hypopharynx. Oral Oncol 2011; 48:168-72. [PMID: 21930416 DOI: 10.1016/j.oraloncology.2011.08.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 11/24/2022]
Abstract
The purpose of this study was to examine the treatment outcomes of larynx-preserving partial hypopharyngectomies for hypopharyngeal carcinoma. Forty-three patients underwent partial hypopharyngectomy and reconstruction using faciocutaneous free flaps with and without postoperative radiotherapy between 1998 and 2009. Primary tumor sites were pyriform sinus in 35 and posterior pharyngeal wall in 8 patients. Thirty patients received postoperative radiotherapy. The 5-year overall and disease-specific survival rates were 63% and 67%, respectively. A significant positive correlation was found between pathologic N stage and primary site and disease-specific survival rates (N0/N1 stage; 93% vs. N2/N3 stage; 43%, p<0.001 and pyriform sinus; 80% vs. posterior pharyngeal wall; 29%, p=0.012, respectively). Recurrences occurred in 15 (35%) patients. Among them, two patients were successfully rescued. Primary partial hypopharyngectomy with laryngeal preservation can be achieved with favorable oncologic outcomes. Factors that affected prognosis were advanced stage neck disease and posterior pharyngeal wall carcinoma.
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Genden EM, Kotz T, Tong CCL, Smith C, Sikora AG, Teng MS, Packer SH, Lawson WL, Kao J. Transoral robotic resection and reconstruction for head and neck cancer. Laryngoscope 2011; 121:1668-74. [DOI: 10.1002/lary.21845] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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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.
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Affiliation(s)
- Aaron W Pederson
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
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