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Tonneau M, Nebbache R, Larnaudie A, Thureau S, Pointreau Y, Blanchard P, Thariat J. Management of head and neck carcinomas with synchronous or metachronous oligometastatic disease: Role of locoregional radiotherapy and metastasis-directed radiotherapy. Cancer Radiother 2024; 28:83-92. [PMID: 37620212 DOI: 10.1016/j.canrad.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/19/2023] [Accepted: 03/28/2023] [Indexed: 08/26/2023]
Abstract
Head and neck carcinomas are initially metastatic in about 15% of cases. Radiotherapy is a cornerstone in the multimodal strategy at the locoregional phase. In patients with head and neck cancer, often heavily pretreated and with comorbidities, who relapse locoregionally or at distant sites, radiotherapy has also become increasingly important at the metastatic phase. Data on the optimal sequence of systemic treatments and metastasis-directed treatments including stereotactic irradiation are still lacking. Several randomized head and neck trials have been initiated that should provide important answers, including one recent GORTEC trial.
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Affiliation(s)
- M Tonneau
- Service d'oncologie radiothérapie, CRLCC Oscar-Lambret, 3, rue Frédéric-Combemale, Lille, France
| | - R Nebbache
- Service d'oncologie radiothérapie, hôpital européen Georges-Pompidou, Paris, France
| | - A Larnaudie
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France
| | - S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, Rouen, France; Unité QuantIF Litis EA 4108, université de Rouen, Rouen, France; Département d'imagerie, centre Henri-Becquerel, Rouen, France
| | - Y Pointreau
- Institut inter-régional de cancérologie (ILC), centre Jean-Bernard, centre de cancérologie de la Sarthe (CCS), 64, rue de Degré, 72000 Le Mans, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, université Paris Saclay, Inserm U1018 Oncostat, Villejuif, France
| | - J Thariat
- Département d'oncologie radiothérapie, centre François-Baclesse, Caen, France; Laboratoire de physique corpusculaire/IN2P3-CNRS UMR 6534, Unicaen-université de Normandie, 14000 Caen, France.
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Liatsou E, Tsilimigras DI, Malandrakis P, Gavriatopoulou M, Ntanasis-Stathopoulos I. Current status and novel insights into the role of metastasectomy in the era of immunotherapy. Expert Rev Anticancer Ther 2023; 23:57-66. [PMID: 36527305 DOI: 10.1080/14737140.2023.2160323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION New perspectives on the role of metastasectomy have emerged along with the advances in cancer immunotherapy. Despite accumulating evidence that encourages the use of immunotherapy in the metastatic setting, current data regarding its combination with surgical resection of secondary lesions, as well as the best timeline and sequence of such a therapeutic approach is limited. AREAS COVERED We review the currently available literature on the role of metastasectomy in the era of novel immunotherapeutic agents and provide comprehensive evidence from ongoing trials about the available treatment strategies. In metastatic melanoma, immune checkpoint inhibitors (ICIs) play a key role both in the neoadjuvant and adjuvant setting to achieve long-term disease control. In metastatic renal cell carcinoma, investigation is ongoing regarding the emerging role of ICIs before metastasectomy. ICIs have improved outcomes in patients with metastatic colorectal and head and neck cancer. EXPERT OPINION In the neoadjuvant setting, the high response rates and the durability of responses to immunotherapy may enable the resectability of metastatic lesions. In the adjuvant setting post metastasectomy, immunotherapy constitutes a safe and efficacious approach to support immune tumor surveillance and delay or even prevent disease relapse. Patient participation in relevant clinical trials should be encouraged.
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Affiliation(s)
- Efstathia Liatsou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, the Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, USA
| | - Panagiotis Malandrakis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Lee RH, Wai KC, Chan JW, Ha PK, Kang H. Approaches to the Management of Metastatic Adenoid Cystic Carcinoma. Cancers (Basel) 2022; 14:cancers14225698. [PMID: 36428790 PMCID: PMC9688467 DOI: 10.3390/cancers14225698] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
High rates of recurrence and distant metastasis are a foremost challenge in the management of adenoid cystic carcinoma (ACC), occurring in approximately 40% of all ACC patients. Despite the morbidity and mortality resulting from recurrent/metastatic (R/M) disease, there are no FDA-approved systemic agents for these patients. In this review, we summarize pertinent ACC pathophysiology and its implications for different systemic treatment regimens in R/M ACC. We review the evidence for the most widely used systemic agents - cytotoxic chemotherapy and tyrosine kinase inhibitors (TKIs) targeting VEGFR - in addition to immune checkpoint inhibitors and non-TKI biologic agents. Exciting emerging targets for R/M ACC, including inhibitors of Notch signaling, stemness, PRMT5, and Axl, are also discussed. Lastly, we review local therapies for small-volume lung disease in patients with oligometastatic ACC, specifically pulmonary metastasectomy and stereotactic body radiation therapy (SBRT). Future development of targeted molecular agents which exploit the underlying biology of this disease may yield novel therapeutic options to improve clinical outcomes in patients with R/M ACC.
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Affiliation(s)
- Rex H. Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Katherine C. Wai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA 94304, USA
| | - Jason W. Chan
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Patrick K. Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Hyunseok Kang
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
- Correspondence:
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4
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Kuroda H, Koyama S, Mun M, Nakajima J, Funai K, Yoshino I, Yamauchi Y, Kawamura M. Survival Outcomes of Complete Pulmonary Metastasectomy for Head and Neck Squamous Cell Carcinomas. Cancer Manag Res 2022; 14:3095-3103. [PMID: 36311682 PMCID: PMC9597667 DOI: 10.2147/cmar.s383787] [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: 08/02/2022] [Accepted: 10/05/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Metastatic head and neck squamous cell carcinoma (HNSCC) is relatively poor; however, depending on the selected cases, pulmonary metastasectomy can be a practical therapeutic option. This study aimed to identify the outcomes of complete metastasectomy based on each primary site and to investigate unfavorable prognostic factors. Patients and Methods We used the database from the Metastatic Lung Tumour Study Group of Japan. Between November 1980 and April 2017, 231 patients were deemed eligible. According to anatomy and the current epidemiology of HNSCC, the patients were divided into three groups: nasopharynx, oropharynx, and salivary gland (n = 40, Group 1), oral cavity, tongue, and paranasal sinuses (n = 69, Group 2), and larynx and hypopharynx (n = 122, Group 3). Results The 5-year overall survival after complete pulmonary metastasectomy was 58.5%, 25.0%, and 46.9% in G1, 2, and 3, respectively (p < 0.01). Multivariate analyses revealed unfavourable prognostic factors to be G2, and pathological maximum diameter was >20 mm. Therefore, on dividing group 1 and 3 with or without diameter, the 5-year overall survival was significantly worse in HNSCC with a diameter >20 mm (n = 74) than that in the remnant (n = 88; 61.9% vs 35.5%; p < 0.01). Conclusion According to the multi-institutional Japanese data, pulmonary metastasectomy from HNSCC indicates a potential survival benefit. Oral cavity, tongue, and paranasal sinuses cancer, and tumour size (>20 mm) were poor prognostic factors for pulmonary metastasectomy from head and neck cancer.
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Affiliation(s)
- Hiroaki Kuroda
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan,Correspondence: Hiroaki Kuroda, Department of Thoracic Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan, Tel +81-52-762-6111, Fax +81-52-763-5233, Email
| | - Shin Koyama
- Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Mingyon Mun
- Department of Thoracic Surgical Oncology, Cancer Institute Hospital Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshikane Yamauchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masafumi Kawamura
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Patients with Pulmonary Metastases from Head and Neck Cancer Benefit from Pulmonary Metastasectomy, A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081000. [PMID: 35893115 PMCID: PMC9332790 DOI: 10.3390/medicina58081000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The incidence of distant metastases in patients with head and neck cancer (HNC) is approximately 10%. Pulmonary metastases are the most frequent distant location, with an incidence of 70-85%. The standard treatment options are chemo-, immuno- and radiotherapy. Despite a benefit for long-term survival for patients with isolated pulmonary metastases, pulmonary metastasectomy (PM) is not the treatment of choice. Furthermore, many otorhinolaryngologists are not sufficiently familiar with the concept of PM. This work reviews the recent studies of pulmonary metastatic HNC and the results after pulmonary metastasectomy. Materials and Methods: PubMed, Medline, Embase, and the Cochrane library were checked for the case series' of patients undergoing metastasectomy with pulmonary metastases published since 1 January 2000. Results: We included the data of 15 studies of patients undergoing PM. The 5-year survival rates varied from 21% to 59%, with median survival from 10 to 77 months after PM. We could not identify one specific prognostic factor for long-term survival after surgery. However, at least most studies stated that PM should be planned if a complete (R0) resection is possible. Conclusions: PM showed reliable results and is supposedly the treatment of choice for patients with isolated pulmonary metastases. Patients not suitable for surgery may benefit from other non-surgical therapy. Every HNC patient with pulmonary metastases should be discussed in the multidisciplinary tumor board to optimize the therapy and the outcome.
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Wise-Draper TM, Bahig H, Karivedu V, Burtness B. Current Therapy for Metastatic Head and Neck Cancer: Evidence, Opportunities, and Challenges. Am Soc Clin Oncol Educ Book 2022; 42:1-14. [PMID: 35486888 DOI: 10.1200/edbk_350442] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Management of metastatic head and neck squamous cell carcinoma is evolving as new systemic therapies have led to improvements in survival, and as advances in locoregional therapy and the increased numbers of patients with HPV-associated cancers who develop oligometastases raise the possibility of ablation of limited numbers of metastases. We review the data regarding first-line immunotherapy in PD-L1-expressing metastatic head and neck squamous cell carcinoma, the experience with aggressive local management of oligometastases, and promising novel immunotherapies, targeted therapies, and HPV-specific treatments. For patients with metastatic head and neck squamous cell carcinoma that is PD-L1 expressing, first-line systemic therapy is pembrolizumab or pembrolizumab with chemotherapy. Inclusion of chemotherapy is associated with higher objective response proportion in all biomarker subgroups and may have a greater impact on survival in HPV-associated cancers. For patients with oligometastatic disease, particularly when metastases are metachronous, current evidence supporting the role of local ablation is limited to a small number of retrospective studies. Based on retrospective data, patients with a smaller number of metastases, lung metastases, and/or virally associated head and neck squamous cell carcinoma are most likely to benefit from an aggressive ablative approach. Additionally, we review emerging evidence for targeted therapy in metastatic head and neck squamous cell carcinoma, including with agents that inhibit mutant HRAS or NOTCH1, or overexpressed EGFR. Studies of antiangiogenic agents in combination with immune checkpoint blockade, and combination immunotherapy, are also under study.
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Affiliation(s)
| | - Houda Bahig
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Vidhya Karivedu
- Division of Medical Oncology, The Ohio State University, Columbus, OH
| | - Barbara Burtness
- Yale University School of Medicine and Yale Cancer Center, New Haven, CT
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Yang H, Qin G, Luo Z, Kong X, Gan C, Zhang R, Jiang W. MFSD4A inhibits the malignant progression of nasopharyngeal carcinoma by targeting EPHA2. Cell Death Dis 2022; 13:332. [PMID: 35410462 PMCID: PMC9001682 DOI: 10.1038/s41419-022-04793-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/03/2022] [Accepted: 03/22/2022] [Indexed: 11/23/2022]
Abstract
DNA Methylation can lead to abnormal gene expression. In the present study, we investigated whether the expression of methylated MFSD4A (major facilitator superfamily domain containing 4 A) was downregulated in nasopharyngeal carcinoma (NPC) and whether it is associated with malignant progression and poor prognosis of NPC. Bioinformatic analysis, bisulfite pyrosequencing, quantitative real-time reverse transcription PCR, and western blotting assays were performed to explore the relationship between hypermethylation of MFSD4A and its expression in NPC. The role of MFSD4A in NPC was verified by Cell Cycle Kit 8, transwell assays and flow cytometry in vitro and by animal experiments in vivo. Mass spectrometry, co-immunoprecipitation, and immunofluorescence assays were applied to explore the mechanism by which MFSD4A inhibits NPC. The prognostic significance of MFSD4A or EPHA2 was investigated by immunohistochemical analysis of clinical specimens. Hypermethylation of the promoter region of MFSD4A led to decreased expression of MFSD4A. When MFSD4A expression was upregulated or downregulated, the proliferation, apoptosis, migration, and invasion abilities of NPC cells were altered accordingly. Mechanistically, MFSD4A could specifically bind to and degrade EPH receptor A2 (EPHA2) by recruiting ring finger protein 149 (RNF149), which led to alterations in the EPHA2-mediated PI3K-AKT-ERK1/2 pathway and epithelial-mesenchymal transition (EMT), thereby affecting NPC progression. Clinically, high MFSD4A expression or low-EPHA2 expression was associated with better prognosis for patients with NPC. In all, reduced MFSD4A expression in NPC is caused by promoter hypermethylation. MFSD4A or EPHA2 expression is associated with the malignant biological behavior and prognosis of NPC. MFSD4A is a promising potential therapeutic target for NPC.
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6529440. [DOI: 10.1093/ejcts/ezac098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/10/2022] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
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Sekido K, Imaue S, Tomihara K, Tachinami H, Yamagishi K, Okazawa S, Ikeda A, Fujiwara K, Noguchi M. Durable complete response to immunotherapy with anti-PD-1 antibody nivolumab in a patient with oral squamous cell carcinoma presenting with lung metastasis: A case report. Clin Case Rep 2021; 9:e04545. [PMID: 34484745 PMCID: PMC8405368 DOI: 10.1002/ccr3.4545] [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: 04/05/2021] [Revised: 05/25/2021] [Accepted: 06/16/2021] [Indexed: 11/13/2022] Open
Abstract
Although the optimal treatment method for metastatic oral cancer remains largely unknown, the present case suggests that immunotherapy is a potentially promising alternative for metastatic oral cancer in which other therapies are no longer effective.
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Affiliation(s)
- Katsuhisa Sekido
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineUniversity of ToyamaToyama CityJapan
- Department of Oral and Maxillofacial SurgeryToyama Red Cross HospitalToyama CityJapan
| | - Shuichi Imaue
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineUniversity of ToyamaToyama CityJapan
| | - Kei Tomihara
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineUniversity of ToyamaToyama CityJapan
| | - Hidetake Tachinami
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineUniversity of ToyamaToyama CityJapan
| | - Kentaro Yamagishi
- Department of RadiologyFaculty of MedicineUniversity of ToyamaToyama CityJapan
| | - Seisuke Okazawa
- First Department of Internal MedicineFaculty of MedicineUniversity of ToyamaToyama CityJapan
| | - Atsushi Ikeda
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineUniversity of ToyamaToyama CityJapan
| | - Kumiko Fujiwara
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineUniversity of ToyamaToyama CityJapan
| | - Makoto Noguchi
- Department of Oral and Maxillofacial SurgeryFaculty of MedicineUniversity of ToyamaToyama CityJapan
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Markowiak T, Dakkak B, Loch E, Großer C, Klinkhammer-Schalke M, Hofmann HS, Ried M. Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival. J Cardiothorac Surg 2021; 16:84. [PMID: 33858453 PMCID: PMC8048191 DOI: 10.1186/s13019-021-01460-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 04/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background Surgical resection of pulmonary metastases leads to prolonged survival if strictly indicated. Usually, thoracotomy with manual palpation of the entire lung with lymph node dissection or sampling is performed. The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in pulmonary metastectomy with curative intent. Methods In this study, all patients with suspected pulmonary metastasis (n = 483) who visited the Center for Thoracic Surgery in Regensburg, between January 2009 and December 2017 were analysed retrospectively. Results A total of 251 patients underwent metastectomy with curative intent. VATS was performed in 63 (25.1%) patients, 54 (85.7%) of whom had a solitary metastasis. Wedge resection was the most performed procedure in patients treated with VATS (82.5%, n = 52) and thoracotomy (72.3%, n = 136). Postoperative revisions were necessary in nine patients (4.8%), and one patient died of pulmonary embolism after thoracotomy (0.5%). Patients were discharged significantly faster after VATS than after thoracotomy (p < 0.001). Complete (R0) resection was achieved in 89% of patients. The median recurrence-free survival was 11 months (95% confidence interval 7.9–14.1). During follow-up, eight (12.7%) patients in the VATS group and 42 (22.3%) patients in the thoracotomy group experienced recurrence (p = 0.98). The median overall survival was 61 months (95% confidence interval 46.1–75.9), and there was no significant difference with regard to the surgical method used (p = 0.34). Conclusions VATS metastasectomy can be considered in patients with a solitary lung metastasis. An open surgical approach with palpation of the lung showed no advantage in terms of surgical outcome or survival.
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Affiliation(s)
- Till Markowiak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Beshir Dakkak
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Elena Loch
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christian Großer
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Monika Klinkhammer-Schalke
- Tumor Center, University Institute of Quality Assurance and Health Services Research, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Kanzaki R, Fukui E, Kanou T, Ose N, Funaki S, Minami M, Shintani Y, Okumura M. Preoperative evaluation and indications for pulmonary metastasectomy. J Thorac Dis 2021; 13:2590-2602. [PMID: 34012607 PMCID: PMC8107542 DOI: 10.21037/jtd-19-3791] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Pulmonary metastasectomy (PM) is an established treatment that can provide improved long-term survival for patients with metastatic tumor(s) in the lung. In the current era, where treatment options other than PM such as stereotactic body radiation therapy (SBRT), immunotherapy, and molecular-targeted therapy are available, thoracic surgeons should review the approach to the preoperative evaluation and the indications. Preoperative evaluation consists of history and physical examinations, physiological tests, and radiological examinations. Radiological examinations serve to identify the differential diagnosis of the pulmonary nodules, evaluate their precise number, location, and features, and search for extra thoracic metastases. The indication of PM should be considered from both physiological and oncological points of view. The general criteria for PM are as follows; (I) the patient has a good general condition, (II) the primary malignancy is controlled, (III) there is no other extrapulmonary metastases, and (IV) the pulmonary lesion(s) are thought to be completely resectable. In addition to the general eligibility criteria of PM, prognostic factors of each tumor type should be considered when deciding the indication for PM. When patients have multiple poor prognostic factors and/or a short disease-free interval (DFI), thoracic surgeons should not hesitate to observe the patient for a certain period before deciding on the indication for PM. A multidisciplinary discussion is needed in order to decide the indication for PM.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of General Thoracic Surgery, National Hospital Organization Toneyama Hospital, Toyonaka, Japan
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Abstract
Lymph node (LN) removal during pulmonary metastasectomy is a prerequisite to achieve complete resection or at least collect prognostic information, but is not yet generally accepted. On average, the rate of unexpected lymph node involvement (LNI) is less than 10% in sarcoma, 20% in colorectal cancer (CRC) and 30% in renal cell carcinoma (RCC) when radical LN dissection is performed. LNI is a negative prognostic factor and presence of preoperative mediastinal disease usually leads to exclusion of the patient from metastasis surgery. Nonetheless, some authors found excellent prognoses even with mediastinal LNI in colorectal and RCC metastases when radical LN dissection was performed (median survival of 37 and 36 months, respectively). Multiple metastases, central location of the lesion followed by anatomical resections are associated with a higher LNI rate. The real prognostic influence of systematic LN dissection remains unclear. Two positive effects were described after radical lymphadenectomy: a trend for improved survival in RCC patients and a reduction of mediastinal recurrences from 23% to 0% in CRC patients. Unfortunately, there is a great number of studies that do not demonstrate any positive effect of lymphadenectomy during pulmonary metastasectomy except a pseudo stage migration effect. Future studies should not only focus on survival, but also on local and LN recurrence.
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Affiliation(s)
- Stefan Welter
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
| | - Varun Gupta
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
| | - Ioannis Kyritsis
- Department of Thoracic Surgery, Lung Clinic Hemer, Theo-Funccius-Str. 1, 58675 Hemer, Germany
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Abstract
The incidence rate of distant metastasis from head and neck (HN) cancers is 4.2-58.8%. The lung is the most common site of distant metastasis, and pulmonary metastasectomy (PM) can be performed in selected patients with pulmonary metastasis originating from HN cancers. However, due to the small number of study objectives, the knowledge on PM treatment of pulmonary metastasis from HN cancers remains insufficient, and the optimal management of pulmonary metastasis from HN cancer is unclear. Patients with pulmonary metastasis from HN cancer who underwent PM have a better prognosis than those who did not, with reported 5-year overall survival rates after PM of 20.9-59.4%. A histology of squamous cell carcinoma, incomplete resection, a short disease-free interval (DFI), and the oral cancer have been identified as factors predicting a worse prognosis after PM in this patient population. As a systemic therapy, longer overall survival has been achieved using immune check point inhibitors compared with standard single-agent therapies. Since the clinical and morphological diagnoses of pulmonary metastasis from HN cancers are often difficult, molecular techniques can provide useful information for the differential diagnosis between pulmonary metastasis from HN cancers and primary lung cancers. In cases of suspected pulmonary metastasis from HN cancer, the surgical strategy should be determined based on the patient's clinical background.
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Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
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14
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Baldes N, Eberlein M, Bölükbas S. Multimodal and palliative treatment of patients with pulmonary metastases. J Thorac Dis 2021; 13:2686-2691. [PMID: 34012617 PMCID: PMC8107530 DOI: 10.21037/jtd-2019-pm-09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Pulmonary metastasectomy has become an important part of the multimodality treatment. Surgical practice is based on observational studies published during the last decades, since no randomized clinical trials exist on the topic. However, the overall survival can be improved after pulmonary metastasectomy in carefully selected patients. The objective of resection of pulmonary metastases is to remove all tumor while preserving as much normal pulmonary parenchyma as possible and reduce invasiveness. Contrary, nonsurgical local treatment options for pulmonary metastases include thermal ablation techniques and stereotactic ablative body radiation. Thermal ablation techniques include microwave, cryotherapy and radiofrequency ablation. The present review article gives an overview on the topic and should help thoracic surgeons to make the right decisions in their daily practice.
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Affiliation(s)
- Natalie Baldes
- Department of Thoracic Surgery, Evang. Kliniken Essen-Mitte, Essen, Germany
| | - Michael Eberlein
- Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Servet Bölükbas
- Department of Thoracic Surgery, Evang. Kliniken Essen-Mitte, Essen, Germany
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15
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Ochi T, Wada H, Nakajima T, Tanaka K, Yamamoto T, Sakairi Y, Suzuki H, Yonekura S, Hanazawa T, Yoshino I. Surgical outcomes of pulmonary metastasectomy for head and neck cancer in the current era of advances in chemotherapy and immunotherapy. Gen Thorac Cardiovasc Surg 2021; 69:1214-1221. [PMID: 33754238 DOI: 10.1007/s11748-021-01611-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The innovation of novel systemic chemo/immunotherapy for metastatic head and neck cancer might contribute to prognostic improvement. We aimed to clarify the recent characteristics and outcomes of pulmonary metastasectomy for head and neck cancer. METHODS Twenty-five patients who underwent pulmonary metastasectomy from January 2011 to December 2016 were included. The clinicopathological factors and survival were assessed by retrospective chart reviews. RESULTS The median follow-up period was 39 months (range, 7-94 months). The median age was 66 years (range, 20-89 years), and 23 males were included. The primary tumor locations were as follows: pharynx (n = 12), nasal/paranasal cavity (n = 5), larynx (n = 4), and others (n = 4). The 5-year overall survival rate was 49%. In the univariate analysis, a history of local recurrence before pulmonary metastasis was an independent predictor of a poor prognosis. In 90% of patients with recurrence after pulmonary metastasectomy, the site of recurrence was the lung. Eight patients achieved long-term survival without any evidence of recurrence (median: 45 months). Molecular targeting chemotherapy and immune-checkpoint inhibitors were used in five patients with systemic recurrence after pulmonary metastasectomy, leading to preferable survival. CONCLUSIONS In the current era of advances in systemic chemotherapy and immunotherapy, surgical indication has not changed for resectable pulmonary metastases and selected patients can still benefit from pulmonary metastasectomy. Further investigation is needed to clarify the significance of systemic therapy in patients with pulmonary metastasis of head and neck cancer.
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Affiliation(s)
- Takahiro Ochi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hironobu Wada
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Takahiro Nakajima
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takayoshi Yamamoto
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Syuji Yonekura
- Department of Otorhinolaryngology/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toyoyuki Hanazawa
- Department of Otorhinolaryngology/Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chuo-ku, Chiba, 260-8670, Japan
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16
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Oliveira TB, Mesía R, Falco A, Hsieh JCH, Yokota T, Saada-Bouzid E, Schmitz S, Elicin O, Giacomelli L, Bossi P. Defining the needs of patients with recurrent and/or metastatic head and neck cancer: An expert opinion. Crit Rev Oncol Hematol 2020; 157:103200. [PMID: 33321152 DOI: 10.1016/j.critrevonc.2020.103200] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/08/2023] Open
Abstract
The clinical and biological heterogeneity of head and neck cancer (HNC) is paralleled by a plethora of different symptoms that affect the patient's quality of life. These symptoms include, for instance, pain, fatigue, nutritional issues, airways obstruction, voice alterations and psychological distress. In addition, patients with HNC are prone to a high risk of infection, and may also suffer from acute complications, such as hypercalcemia, spine compression by bone metastasis or bleeding. Prolonging survival is also an inherent expectation for all patients. Addressing the above needs is crucial in all patients with HNC, and especially in those with recurrent and/or metastatic (RM) disease. However, research on how to address patients' needs in RM-HNC remains scarce. This paper defines patients' needs for RM HNC and presents an Expert Opinion on how to address them, proposing also some lines of research.
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Affiliation(s)
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology - Badalona, B-ARGO Group, IGTP, Barcelona, Spain
| | - Agustin Falco
- Medical Oncology Department, Instituto Alexander Fleming, Buenos Aires, Argentina
| | - Jason Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, 333, Taiwan
| | - Tomoya Yokota
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Esma Saada-Bouzid
- Medical Oncology Department, Centre Antoine Lacassagne, Nice, France
| | - Sandra Schmitz
- Departments of Medical Oncology and Head and Neck Surgery, Institut Roi Albert II, Institut de Recherche Clinique et Expérimentale (Pole MIRO), Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Woluwe-Saint-Lambert, Belgium
| | - Olgun Elicin
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Luca Giacomelli
- Polistudium srl, Milan, Italy; Department of Surgical Sciences and Integrated Diangostics, University of Genoa, Genoa, Italy
| | - Paolo Bossi
- Medical Oncology, Department of Medical & Surgical Specialties, Radiological Sciences & Public Health, University of Brescia, ASST Spedali Civili, 25123, Brescia, Italy.
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17
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Lardinois I, Dequanter D, Lechien JR, Bouland C, Javadian R, Rodriguez A, Loeb I, Journe F, Saussez S. Survival and treatment outcome of head and neck cancer patients with pulmonary oligometastases. Clin Otolaryngol 2020; 46:311-317. [PMID: 33190393 DOI: 10.1111/coa.13668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to determine the outcome of head and neck squamous cell carcinoma (HNSCC) patients developing lung metastasis. DESIGN Retrospective study. PARTICIPANTS HNSCC patients with lung metastasis treated between 2001 and 2018 were included. MEAN OUTCOMES MEASURES Statistical analyses described the relationship between patient survival, treatment efficacy and pulmonary metastasis occurrence. RESULTS One hundred HNSCC patients were included in the study. The median overall survival (OS) was 21 months. The median recurrence-free survival (RFS) was seven months. Patient survival with only lung metastases was significantly longer compared to patients with lung metastases and lymph nodes involvement or other metastases. Moreover, patients with a single metastasis had longer post-RFS and OS than patients with multiple metastases. The local control of metastasis was better when patients presented only lung metastases, and it was more effective in single metastasis. The surgery allowed better metastases local control than supportive care or radio and/or chemotherapy. In case of specific therapy, pulmonary resection was associated with a longer post-RFS and a longer OS compared to supportive care or radio and/or chemotherapy. CONCLUSIONS We confirmed, in the current study, the significant survival benefit for HNSCC patients treated by surgery for their pulmonary metastasis. While treatment of multiple metastases required palliative chemotherapy or best supportive care in most of the cases, specific surgical treatment in selected HNSCC patients should be considered.
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Affiliation(s)
- Ines Lardinois
- Department of Thoracic Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Didier Dequanter
- Department of Otolaryngology-Head & Neck surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jérôme R Lechien
- Department of Thoracic Surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Department of Otolaryngology-Head & Neck surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Mons, Belgium
| | - Cyril Bouland
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Rokneddine Javadian
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alexandra Rodriguez
- Department of Otolaryngology-Head & Neck surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Loeb
- Department of Stomatology-Maxillofacial surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fabrice Journe
- Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Mons, Belgium.,Laboratory of Oncology and Experimental Surgery, Bordet Institute, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Sven Saussez
- Department of Otolaryngology-Head & Neck surgery, CHU Saint Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium.,Laboratory of Human Anatomy and Experimental Oncology, Faculty of Medicine and Pharmacy, Research Institute for Health Sciences and Technology, University of Mons (UMONS), Mons, Belgium
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18
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The Role of Obesity in Early and Long-Term Outcomes after Surgical Excision of Lung Oligometastases from Colorectal Cancer. J Clin Med 2020; 9:jcm9113566. [PMID: 33167545 PMCID: PMC7694523 DOI: 10.3390/jcm9113566] [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: 09/10/2020] [Revised: 10/20/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Obesity correlates with better outcomes in many neoplastic conditions. The aim of this study was to assess its role in the prognosis and morbidity of patients submitted to resection of lung oligometastases from colorectal cancer. Seventy-six patients undergoing a first pulmonary metastasectomy were retrospectively included in the study. Seventeen (22.3%) were obese (body mass index (BMI) >30 kg/m2). Assessed outcomes were overall survival, time to recurrence, and incidence of post-operative complications. Median follow-up was 33 months (IQR 16-53). At follow-up, 37 patients (48.6%) died, whereas 39 (51.4%) were alive. A significant difference was found in the 3-year overall survival (obese 80% vs. non-obese 56.8%, p = 0.035). Competing risk analysis shows that the cumulative incidence of recurrence was not different between the two groups. Multivariate analysis reveals that the number of metastases (p = 0.028), post-operative pneumonia (p = 0.042), and DFS (p = 0.007) were significant predictors of death. Competing risk regression shows that no independent risk factor for recurrence has been identified. The complication rate was not different between the two groups (17.6% vs. 13.6%, p = 0.70). Obesity is a positive prognostic factor for survival after pulmonary metastasectomy for colorectal cancer. Overweight patients do not experience more post-operative complications. Our results need to be confirmed by large multicenter studies.
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19
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Nguy S, Oh C, Karp JM, Wu SP, Li Z, Persky MJ, Hu KS, Givi B, Tam MM. Radiotherapy in Metastatic Oropharyngeal Cancer. Laryngoscope 2020; 131:E1847-E1853. [PMID: 33141455 DOI: 10.1002/lary.29245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The role of locoregional radiotherapy for metastatic oropharyngeal squamous cell cancer (OPSCC) is unclear. We investigated the impact of head and neck radiotherapy on survival in de novo metastatic OPSCC patients who received systemic therapy. METHODS We queried the NCDB from 2004-2015 for metastatic OPSCC patients at diagnosis with known HPV-status who received systemic therapy. The association of head and neck radiotherapy with overall survival was analyzed using the Kaplan-Meier method, Cox proportional hazards model, and propensity score-matched analysis adjusting for demographic and disease-specific prognostic factors. RESULTS Of the 2,139 patients with metastatic OPSCC who presented with metastases and received systemic treatment, we identified 556 patients with known HPV-status. Among these 556 patients, 49% were HPV-positive and 56% received head and neck radiotherapy. With a median follow-up of 17.5 months (IQR 6.0-163.4 months), radiotherapy was associated with significantly improved 1-year OS (67% vs 58%, log-rank P < .001) which remained significant on MVA (HR 0.78 95% CI 0.62-0.97 P = .029). In HPV-status subgroup analysis, a survival benefit was identified in HPV-positive patients (1-year OS 77% vs 67%, log-rank P < .001) but not in HPV-negative patients. Results were consistent on a propensity score-matched analysis of 212 HPV-positive matched patients (HR 0.66, 95% CI 0.49-0.83, P < .001). CONCLUSION The survival of metastatic OPSCC remains limited. In this large series of patients with known HPV-status, head and neck radiotherapy was associated with longer survival in those with HPV-associated disease. These data could guide management of this challenging group of patients for head and neck cancer practitioners. LEVEL OF EVIDENCE 3 Laryngoscope, 131:E1847-E1853, 2021.
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Affiliation(s)
- Susanna Nguy
- Department of Radiation Oncology, NYU Langone Health, New York, New York, U.S.A
| | - Cheongeun Oh
- Division of Biostatistics, NYU Langone Health, New York, New York, U.S.A
| | - Jerome M Karp
- Department of Radiation Oncology, NYU Langone Health, New York, New York, U.S.A
| | - Shengyang Peter Wu
- Department of Radiation Oncology, NYU Langone Health, New York, New York, U.S.A
| | - Zujun Li
- Department of Hematology and Medical Oncology, NYU Langone Health, New York, New York, U.S.A
| | - Michael J Persky
- Department of Otolaryngology, NYU Langone Health, New York, New York, U.S.A
| | - Kenneth S Hu
- Department of Radiation Oncology, NYU Langone Health, New York, New York, U.S.A
| | - Babak Givi
- Department of Otolaryngology, NYU Langone Health, New York, New York, U.S.A
| | - Moses M Tam
- Department of Radiation Oncology, NYU Langone Health, New York, New York, U.S.A
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20
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Plavc G, Jesenko T, Oražem M, Strojan P. Challenges in Combining Immunotherapy with Radiotherapy in Recurrent/Metastatic Head and Neck Cancer. Cancers (Basel) 2020; 12:E3197. [PMID: 33143094 PMCID: PMC7692120 DOI: 10.3390/cancers12113197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022] Open
Abstract
Immunotherapy with immune checkpoint inhibitors (ICI) has recently become a standard part of the treatment of recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC), although the response rates are low. Numerous preclinical and clinical studies have now illuminated several mechanisms by which radiotherapy (RT) enhances the effect of ICI. From RT-induced immunogenic cancer cell death to its effect on the tumor microenvironment and vasculature, the involved mechanisms are diverse and intertwined. Moreover, the research of these interactions is challenging because of the thin line between immunostimulatory and the immunosuppressive effect of RT. In the era of active research of immunoradiotherapy combinations, the significance of treatment and host-related factors that were previously seen as being less important is being revealed. The impact of dose and fractionation of RT is now well established, whereas selection of the number and location of the lesions to be irradiated in a multi-metastatic setting is something that is only now beginning to be understood. In addition to spatial factors, the timing of irradiation is as equally important and is heavily dependent on the type of ICI used. Interestingly, using smaller-than-conventional RT fields or even partial tumor volume RT could be beneficial in this setting. Among host-related factors, the role of the microbiome on immunotherapy efficacy must not be overlooked nor can we neglect the role of gut irradiation in a combined RT and ICI setting. In this review we elaborate on synergistic mechanisms of immunoradiotherapy combinations, in addition to important factors to consider in future immunoradiotherapy trial designs in R/M HNSCC.
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Affiliation(s)
- Gaber Plavc
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.O.); (P.S.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Tanja Jesenko
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Experimental Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Miha Oražem
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.O.); (P.S.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia; (M.O.); (P.S.)
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
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21
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Tselikas L, Garzelli L, Mercier O, Auperin A, Lamrani L, Deschamps F, Yevich S, Roux C, Mussot S, Delpla A, Varin F, Hakime A, Teriitehau C, Le Péchoux C, Pradère P, Caramella C, Besse B, Fadel E, de Baere T. Radiofrequency ablation versus surgical resection for the treatment of oligometastatic lung disease. Diagn Interv Imaging 2020; 102:19-26. [PMID: 33020025 DOI: 10.1016/j.diii.2020.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/13/2020] [Accepted: 09/01/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to compare efficacy and tolerance between radiofrequency ablation (RFA) and surgery for the treatment of oligometastatic lung disease. MATERIALS AND METHODS This retrospective study reviewed patients treated in two institutions for up to 5 pulmonary metastases with a maximal diameter of 4cm and without associated pleural involvement or thoracic lymphadenopathy. Patient demographics, tumor characteristics, treatment outcome, and length of hospital stay were compared between the two groups. Efficacy endpoints were overall survival (OS), progression-free survival (PFS) and pulmonary or local tumor progression rates. RESULTS Among 204 patients identified, 78 patients (42 men, 36 women; mean age, 53.3±14.9 [SD]; age range: 15-81 years) were treated surgically, while 126 patients (59 men, 67 women; mean age, 62.2±10.8 [SD]; age range: 33-80 years) were treated by RFA. In the RFA cohort, patients were significantly older (P<0.0001), with more extra-thoracic localisation (P=0.015) and bilateral tumour burden (P=0.0014). In comparison between surgery and RFA cohorts, respectively, the 1- and 3-year OS were 94.8 and 67.2% vs. 94 and 72.1% (P=0.46), the 1- and 3-year PFS were 49.4% and 26.1% vs. 38.9% and 14.8% (P=0.12), the pulmonary progression rates were 39.1% and 56% vs. 41.2% and 65.3% (P>0.99), and the local tumour progression rates were 5.4% and 10.6% vs. 4.8% and 18.6% (P=0.07). Tumour size>2cm was associated with a significantly higher local tumor progression in the RFA group (P=0.010). Hospitalisation stay was significantly shorter in the RFA group (median of 3 days; IQR=2 days; range: 2-12 days) than in the surgery group (median of 9 days; IQR=2 days; range: 6-21 days) (P<0.01). CONCLUSION RFA should be considered a minimally-invasive alternative with similar OS and PFS to surgery in the treatment of solitary or multiple lung metastases measuring less than 4cm in diameter without associated pleural involvement or thoracic lymphadenopathy.
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Affiliation(s)
- L Tselikas
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France.
| | - L Garzelli
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - O Mercier
- University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France; Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - A Auperin
- Biostatistics and Epidemiology Unit, Gustave-Roussy INSERM 1018, 94805 Villejuif, France
| | - L Lamrani
- Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - F Deschamps
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - S Yevich
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France; Interventional Radiology, MD-Anderson, 77030 Houston, TX, USA
| | - C Roux
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - S Mussot
- Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France; Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - A Delpla
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - F Varin
- Department of Anesthesiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - A Hakime
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - C Teriitehau
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - C Le Péchoux
- Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Radiation Therapy, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - P Pradère
- Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - C Caramella
- Institut d'Oncologie thoracique, 94805 Villejuif, France; Radiology Department, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - B Besse
- University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Cancer Medicine, Gustave-Roussy Cancer Campus, 94805 Villejuif, France
| | - E Fadel
- University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France; Department of Thoracic and Vascular Surgery, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France; Research and Innovation Unit, INSERM U999, DHU Torino, Marie-Lannelongue Hospital, 92350 Le Plessis-Robinson, France
| | - T de Baere
- Interventional Radiology, Gustave-Roussy Cancer Campus, 94805 Villejuif, France; University of Paris-Saclay, 91190 Saint-Aubin, France; Institut d'Oncologie thoracique, 94805 Villejuif, France
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Abstract
The lung is one of the most common sites of metastatic disease. Assessing patients for pulmonary metastasectomy includes ensuring they are suitable surgical candidates for single-lung ventilation and pulmonary resection. Complete resection of metastases and control of primary tumor and oligometastatic disease are key tenets for metastasectomy. Negative prognostic factors include short disease-free interval, presence of lymphadenopathy, and multiple lesions. Primary tumors are associated with excellent outcomes. With modern high-resolution scans, minimally invasive approaches to metastasectomy are preferred. Consideration of extended resections should take place in a multidisciplinary manner. Nonoperative options include stereotactic body radiation therapy, radiofrequency ablation, and microwave ablation.
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Yonezawa N, Murakami H, Demura S, Kato S, Yoshioka K, Shinmura K, Yokogawa N, Shimizu T, Oku N, Kitagawa R, Handa M, Annen R, Kurokawa Y, Tsuchiya H. Perioperative Complications and Prognosis of Curative Surgical Resection for Spinal Metastases in Elderly Patients. World Neurosurg 2020; 137:e144-e151. [DOI: 10.1016/j.wneu.2020.01.093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 01/01/2023]
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Surgery versus stereotactic radiotherapy for treatment of pulmonary metastases. A systematic review of literature. Future Sci OA 2020; 6:FSO471. [PMID: 32518686 PMCID: PMC7273364 DOI: 10.2144/fsoa-2019-0120] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
It is not clear as to which is the best treatment among surgery and stereotactic radiotherapy (SBRT) for lung oligometastases. A systematic review of literature with a priori selection criteria was conducted on articles on the treatment of pulmonary metastases with surgery or SBRT. Only original articles with a population of patients of more than 50 were selected. After final selection, 61 articles on surgical treatment and 18 on SBRT were included. No difference was encountered in short-term survival between pulmonary metastasectomy and SBRT. In the long-term surgery seems to guarantee better survival rates. Mortality and morbidity after treatment are 0–4.7% and 0–23% for surgery, and 0–2% and 4–31% for SBRT. Surgical metastasectomy remains the treatment of choice for pulmonary oligometastases. Patients with metastatic cancer with a limited number of deposits may benefit from surgical removal or irradiation of tumor nodules in addiction to chemotherapy. Surgical resection has been demonstrated to improve survival and, in some cases, can be curative. Stereotactic radiotherapy is emerging as a less invasive alternative to surgery, but settings and implications of the two treatments are profoundly different. The two techniques show similar results in the short-term, with lower complications rates for radiotherapy, while in the long-term surgery seems to guarantee higher survival rates.
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Pisani P, Airoldi M, Allais A, Aluffi Valletti P, Battista M, Benazzo M, Briatore R, Cacciola S, Cocuzza S, Colombo A, Conti B, Costanzo A, della Vecchia L, Denaro N, Fantozzi C, Galizia D, Garzaro M, Genta I, Iasi GA, Krengli M, Landolfo V, Lanza GV, Magnano M, Mancuso M, Maroldi R, Masini L, Merlano MC, Piemonte M, Pisani S, Prina-Mello A, Prioglio L, Rugiu MG, Scasso F, Serra A, Valente G, Zannetti M, Zigliani A. Metastatic disease in head & neck oncology. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2020; 40:S1-S86. [PMID: 32469009 PMCID: PMC7263073 DOI: 10.14639/0392-100x-suppl.1-40-2020] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The head and neck district represents one of the most frequent sites of cancer, and the percentage of metastases is very high in both loco-regional and distant areas. Prognosis refers to several factors: a) stage of disease; b) loco-regional relapses; c) distant metastasis. At diagnosis, distant metastases of head and neck cancers are present in about 10% of cases with an additional 20-30% developing metastases during the course of their disease. Diagnosis of distant metastases is associated with unfavorable prognosis, with a median survival of about 10 months. The aim of the present review is to provide an update on distant metastasis in head and neck oncology. Recent achievements in molecular profiling, interaction between neoplastic tissue and the tumor microenvironment, oligometastatic disease concepts, and the role of immunotherapy have all deeply changed the therapeutic approach and disease control. Firstly, we approach topics such as natural history, epidemiology of distant metastases and relevant pathological and radiological aspects. Focus is then placed on the most relevant clinical aspects; particular attention is reserved to tumours with distant metastasis and positive for EBV and HPV, and the oligometastatic concept. A substantial part of the review is dedicated to different therapeutic approaches. We highlight the role of immunotherapy and the potential effects of innovative technologies. Lastly, we present ethical and clinical perspectives related to frailty in oncological patients and emerging difficulties in sustainable socio-economical governance.
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Affiliation(s)
- Paolo Pisani
- ENT Unit, ASL AT, “Cardinal Massaja” Hospital, Asti, Italy
| | - Mario Airoldi
- Medical Oncology, Città della Salute e della Scienza, Torino, Italy
| | | | - Paolo Aluffi Valletti
- SCDU Otorinolaringoiatria, AOU Maggiore della Carità di Novara, Università del Piemonte Orientale, Italy
| | | | - Marco Benazzo
- SC Otorinolaringoiatria, Fondazione IRCCS Policlinico “S. Matteo”, Università di Pavia, Italy
| | | | | | - Salvatore Cocuzza
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, Italy
| | - Andrea Colombo
- ENT Unit, ASL AT, “Cardinal Massaja” Hospital, Asti, Italy
| | - Bice Conti
- Department of Drug Sciences, University of Pavia, Italy
- Polymerix S.r.L., Pavia, Italy
| | | | - Laura della Vecchia
- Unit of Otorhinolaryngology General Hospital “Macchi”, ASST dei Settelaghi, Varese, Italy
| | - Nerina Denaro
- Oncology Department A.O.S. Croce & Carle, Cuneo, Italy
| | | | - Danilo Galizia
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Italy
| | - Massimiliano Garzaro
- SCDU Otorinolaringoiatria, AOU Maggiore della Carità di Novara, Università del Piemonte Orientale, Italy
| | - Ida Genta
- Department of Drug Sciences, University of Pavia, Italy
- Polymerix S.r.L., Pavia, Italy
| | | | - Marco Krengli
- Dipartimento Medico Specialistico ed Oncologico, SC Radioterapia Oncologica, AOU Maggiore della Carità, Novara, Italy
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | | | - Giovanni Vittorio Lanza
- S.O.C. Chirurgia Toracica, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | | | - Maurizio Mancuso
- S.O.C. Chirurgia Toracica, Azienda Ospedaliera Nazionale “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Roberto Maroldi
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Italy
| | - Laura Masini
- Dipartimento Medico Specialistico ed Oncologico, SC Radioterapia Oncologica, AOU Maggiore della Carità, Novara, Italy
| | - Marco Carlo Merlano
- Oncology Department A.O.S. Croce & Carle, Cuneo, Italy
- Medical Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo,Italy
| | - Marco Piemonte
- ENT Unit, University Hospital “Santa Maria della Misericordia”, Udine, Italy
| | - Silvia Pisani
- Immunology and Transplantation Laboratory Fondazione IRCCS Policlinico “S. Matteo”, Pavia, Italy
| | - Adriele Prina-Mello
- LBCAM, Department of Clinical Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin 8, Ireland
- Centre for Research on Adaptive Nanostructures and Nanodevices (CRANN), Trinity College Dublin, Dublin 2, Ireland
| | - Luca Prioglio
- Department of Otorhinolaryngology, ASL 3 “Genovese”, “Padre Antero Micone” Hospital, Genoa, Italy
| | | | - Felice Scasso
- Department of Otorhinolaryngology, ASL 3 “Genovese”, “Padre Antero Micone” Hospital, Genoa, Italy
| | - Agostino Serra
- University of Catania, Italy
- G.B. Morgagni Foundation, Catania, Italy
| | - Guido Valente
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Micol Zannetti
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, Novara, Italy
| | - Angelo Zigliani
- Department of Radiology, University of Brescia, ASST Spedali Civili Brescia, Italy
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Ampil F, Previgliano C, Porter C, Richards T, Takalkar A. Metachronous mediastinal and lung metastases from head and neck cancer: A case series, literature review and considerations for treatment. Oral Oncol 2019; 102:104518. [PMID: 31862239 DOI: 10.1016/j.oraloncology.2019.104518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 10/25/2022]
Abstract
Metachronous mediastinal and lung metastases (MMLM), important sources of morbidity and mortality, in people with head and neck cancer (HNC) have received little attention. Between 1980 and 2004, 37 patients with treated HNC and MMLM diagnosed on follow-up imaging (with histological confirmation in 14 cases) were identified. The median interval from diagnosis of HNC to the appearance of MMLM was 14.5 months. The overall median survival was 4 months, and the 1-year crude survival rate (CSR) was 16%. A meaningful difference in the 1-year CSRs between the palliative radiation treated and untreated subjects (39% and 4%, respectively, p < 0.01) was observed. Because associated costs of health care utilization are considerable, and yet survival is limited, optimum management of MMLM-HNC with improvement of prognosis remains a challenge.
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Affiliation(s)
- Federico Ampil
- Department of Radiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, USA.
| | - Carlos Previgliano
- Department of Radiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, USA
| | - Carrie Porter
- Feist-Weiller Cancer Center, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, USA
| | - Troy Richards
- Department of Radiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, USA
| | - Amol Takalkar
- Department of Radiology, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, USA
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Pulmonary metastasis of head and neck cancer: surgical removal outcomes from a tertiary care center. Indian J Thorac Cardiovasc Surg 2019; 36:199-206. [PMID: 33061126 DOI: 10.1007/s12055-019-00866-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 01/15/2023] Open
Abstract
Purpose There has been no clear data on the effectiveness of pulmonary metastasectomy on several original cancers, including head and neck. We aim to collect data about the metastasectomies performed in our center for eligible patients and elaborate more on predictors and prognosis. Methods A retrospective analysis of 56 patients who underwent metastasectomy from head and neck cancers at our facility between January 2000 and January 2016 (16 years). Statistical analysis was performed based on gender, disease-free interval (DFI), location of the original tumor, and histological subtypes to assess their effect and relevance to the prognosis and disease recurrence. Results Twenty-nine males and 27 females had lung metastasis from head and neck. The primary lesions of the lung metastasis were more often found in the thyroid (34%), followed by nasopharynx (32%). As for histology, the most common one was papillary cancer (34%), followed by squamous cell carcinomas (29%). The DFI was more than 2 years in 32 patients (57%). The survival rates were 79.5% at 3 years and 71.7% at 5 years. In the univariate analysis, histology was the only independent prognostic factor (p = 0.05). On the other hand, age (p = 0.6), DFI (p = 0.24), and site of the primary tumor (p = .06) showed no effect on the prognosis of head and neck cancers metastasizing to the lungs. Conclusion Pulmonary metastasectomy for lesions originating from head and neck provides good long-term survival. Histological subtype was the only statistically significant prognostic factor.
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Lu HJ, Hsieh CC, Yeh CC, Yeh YC, Wu CC, Wang FS, Lai JM, Yang MH, Wang CH, Huang CYF, Chang PMH. Clinical, pathophysiologic, and genomic analysis of the outcomes of primary head and neck malignancy after pulmonary metastasectomy. Sci Rep 2019; 9:12913. [PMID: 31501464 PMCID: PMC6733860 DOI: 10.1038/s41598-019-49212-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/20/2019] [Indexed: 12/12/2022] Open
Abstract
The median overall survival (OS) of some head and neck malignancies, such as head and neck squamous cell carcinoma (HNSCC), with metastatic lesions was only 12 months. Whether aggressive pulmonary metastasectomy (PM) improves survival is controversial. Patients with primary head and neck malignancy undergoing PM were enrolled. Clinical outcomes were compared among different histological types. Whole-exome sequencing was used for matched pulmonary metastatic samples. The genes where genetic variants have been identified were sent for analysis by DAVID, IPA, and STRING. Forty-nine patients with primary head and neck malignancies were enrolled. Two-year postmetastasectomy survival (PMS) rates of adenoid cystic carcinoma, thyroid carcinoma, nasopharyngeal carcinoma, and HNSCC were 100%, 88.2%, 71.4%, and 59.2%, respectively (P = 0.024). In HNSCC, the time to distant metastasis was an independent predictive factor of the efficacy of PM. Several pathways, such as branched-chain amino acid (BCAA) consumption, were significantly associated with the progression of HNSCC [P < 0.001, fold enrichment (FE) = 5.45]. Moreover, metabolism-associated signaling pathways also seemed to be involved in cancer metastasis. Histological types and time to distant metastasis were important factors influencing the clinical outcomes of PM. For HNSCC, metabolic-associated signaling pathways were significantly associated with tumor progression and distant metastasis. Future validations are warranted.
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Affiliation(s)
- Hsueh-Ju Lu
- Division of Medical Oncology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Program in Molecular Medicine, School of Life Sciences, National Yang Ming University, Taipei, Taiwan
| | - Chih-Cheng Hsieh
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
| | | | - Yi-Chen Yeh
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan.,Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Chi Wu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Feng-Sheng Wang
- Department of Chemical Engineering, National Chung Cheng University, Chiayi, Taiwan
| | - Jin-Mei Lai
- Department of Life Science, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming University, Taipei, Taiwan
| | - Cheng-Hsu Wang
- Cancer Center, Keelung Chang Gang Memorial Hospital, Keelung, Taiwan
| | - Chi-Ying F Huang
- Program in Molecular Medicine, School of Life Sciences, National Yang Ming University, Taipei, Taiwan. .,Institute of Biopharmaceutical Sciences, National Yang Ming University, Taipei, Taiwan.
| | - Peter Mu-Hsin Chang
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan. .,Division of Medical Oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Garg M, Tudor-Green B, Bisase B. Current thinking in the management of adenoid cystic carcinoma of the head and neck. Br J Oral Maxillofac Surg 2019; 57:716-721. [PMID: 31420189 DOI: 10.1016/j.bjoms.2019.07.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/22/2019] [Indexed: 12/29/2022]
Abstract
Adenoid cystic carcinoma (ACC) is an aggressive, rare, malignant tumour that accounts for about 1% of all head and neck neoplasms and 10% of all salivary gland tumours. It is characterised by frequent local recurrences and distant metastases. Growth is slow but relentless, and progression poses a challenge to head and neck clinicians. Many small retrospective studies have described its clinical management, but the lack of multicentre, randomised, controlled trials has resulted in inconsistencies in management globally. We have focused on three key management-related controversies: the role of elective neck dissection (END) for the N0 neck; the role of adjuvant treatment or radiotherapy; and finally, the follow-up protocol, particularly cross-sectional surveillance imaging of the full body or chest computed tomography (CT) alone, and options for treatment if metastases are found. The paucity of published studies may reflect the inconsistencies that exist in the management of ACC of the head and neck in the UK. The collaboration of head and neck centres would, we think, help to correct the imbalance in these three domains of care.
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Affiliation(s)
- Montey Garg
- Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, RH19 3DZ.
| | - Ben Tudor-Green
- Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, RH19 3DZ.
| | - Brian Bisase
- Department of Oral and Maxillofacial Surgery, Queen Victoria Hospital NHS Foundation Trust, Holtye Road, East Grinstead, RH19 3DZ.
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30
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Su W, Yang HY. [Treatment plan and prognosis of salivary adenoid cystic carcinoma with lung metastasis]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2019; 37:214-219. [PMID: 31168990 DOI: 10.7518/hxkq.2019.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Salivary adenoid cystic carcinoma (SACC) is a common malignant tumor in the oral and maxillofacial region and accounts for approximately 3%-5% of all head and neck carcinomas. SACC always occurs in the palatal salivary gland and parotid gland. The tumor has the characteristics of strong invasion, perineural invasion, high hematogenous metastasis, and low lymph node metastasis rate. The biological characteristics of SACC determine the specificity of clinical treatment. Thus far, few clinical trials have investigated the efficacy of systemic therapy owing to the rarity of SACC with lung metastasis. Moreover, long-term results are poor, and no consensus on standard treatment has been reached yet. This systematic review aims to provide a retrospective analysis of treatment options and prognosis for SACC with lung metastasis and evidence for future clinical treatment.
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Affiliation(s)
- Wen Su
- Dept. of Stomatology, Anhui Medical University, Hefei 230032, China;Dept. of Oral and Maxillofacial Surgery, Shenzhen Hospital, Peking University, Shenzhen 518036, China
| | - Hong-Yu Yang
- Dept. of Stomatology, Anhui Medical University, Hefei 230032, China;Dept. of Oral and Maxillofacial Surgery, Shenzhen Hospital, Peking University, Shenzhen 518036, China
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31
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Handy JR, Bremner RM, Crocenzi TS, Detterbeck FC, Fernando HC, Fidias PM, Firestone S, Johnstone CA, Lanuti M, Litle VR, Kesler KA, Mitchell JD, Pass HI, Ross HJ, Varghese TK. Expert Consensus Document on Pulmonary Metastasectomy. Ann Thorac Surg 2018; 107:631-649. [PMID: 30476477 DOI: 10.1016/j.athoracsur.2018.10.028] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/09/2018] [Indexed: 12/17/2022]
Affiliation(s)
- John R Handy
- Thoracic Surgery, Providence Health & Services, Portland, Oregon.
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Todd S Crocenzi
- Medical Oncology, Providence Cancer Center, Providence Health & Services, Portland, Oregon
| | - Frank C Detterbeck
- Section of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Hiran C Fernando
- Inova Cardiac and Thoracic Surgery, Department of Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia
| | - Panos M Fidias
- Medical Oncology, Center for Cancer Care, Exeter Hospital, Exeter, New Hampshire
| | | | - Candice A Johnstone
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Michael Lanuti
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Virginia R Litle
- Department of Surgery, Boston University Medical Center, Boston, Massachusetts
| | - Kenneth A Kesler
- Section of Thoracic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, Langone Medical Center, New York University School of Medicine, New York, New York
| | - Helen J Ross
- Division of Hematology/Medical Oncology, Mayo Clinic, Phoenix, Arizona
| | - Thomas K Varghese
- Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
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32
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Subramaniam NR, Reddy R, Balasubramanian D, Thankappan K, Iyer S. Is pulmonary metastasectomy beneficial in head and neck squamous cell carcinoma? A review of literature. Indian J Cancer 2018; 54:2-5. [PMID: 29199651 DOI: 10.4103/ijc.ijc_170_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Metastatic head and neck squamous cell carcinoma (HNSCC) has traditionally carried a dismal prognosis; however with advances in care, it has been shown that pulmonary metastasectomy is a viable therapeutic option in selected patients, palliating symptoms and improving survival. With the increasing incidence of human papilloma virus-related HNSCC and better availability of minimal access surgery, there is a need to better understand the role of pulmonary metastasectomy in the treatment of HNSCC. This article summarizes the literature on indications, results, surgical options and approaches, clinical dilemmas, and controversies associated with pulmonary metastasectomy in HNSCC, to identify suitable candidates and optimize outcomes.
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Affiliation(s)
- N R Subramaniam
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - R Reddy
- Department of Surgery, University of Sydney, Sydney, Australia
| | - D Balasubramanian
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - K Thankappan
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
| | - S Iyer
- Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita University, Kochi, Kerala, India
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Grønhøj C, Jakobsen KK, Jensen DH, Rasmussen J, Andersen E, Friborg J, von Buchwald C. Pattern of and survival following loco-regional and distant recurrence in patients with HPV+ and HPV- oropharyngeal squamous cell carcinoma: A population-based study. Oral Oncol 2018; 83:127-133. [PMID: 30098768 DOI: 10.1016/j.oraloncology.2018.06.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/07/2018] [Accepted: 06/13/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The incidence of human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing. Currently, data is sparse on the pattern and timing of recurrence. This long-term study concerning both HPV- and p16-status aimed to report predictive factors, pattern, timing of loco-regional recurrence (LRR) and distant recurrence (DR), and survival following recurrence in patients diagnosed with OPSCC. MATERIAL AND METHODS We included patients diagnosed with OPSCC from 2000 to 2014 in Eastern Denmark, who were treated with curative intent. Tumors were defined as HPV-positive when they were both HPV-DNA and p16-positive. Time-to-failure and -death were estimated by the Kaplan-Meier method. Cox proportional hazards models were used to evaluate predictors of failure. RESULTS The cohort consisted of 1244 consecutive patients with OPSCC of which 288 patients (23%) experienced recurrence. Of these patients, the majority (n = 197/1244; 16%) experienced LRR and the remaining (n = 91/1244; 7%) DR. Significantly more HPV-negative patients experienced recurrence (n = 170/486; 35%) compared to HPV-positive patient (n = 112/726; 15%). DR occurred for both groups predominantly to the lung (n = 63/91; 69.2%) followed by the liver and bone. Factors influencing risk of LRR included gender, T-classification, and HPV-status. The same variables influenced risk of DR in addition to the UICC-8 classification, N-classification, pack years of smoking, and performance status. HPV-status was the strongest risk factor for LRR and DR. CONCLUSION LRR and DR occur significantly less often in HPV-positive patients compared with HPV-negative patients. HPV-status is an independent and strong predictor of recurrence. DR most commonly occurs to the lungs, irrespective of HPV-status.
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Affiliation(s)
- Christian Grønhøj
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Kathrine Kronberg Jakobsen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - David H Jensen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Rasmussen
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Jeppe Friborg
- Department of Oncology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian von Buchwald
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.
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34
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Sun XS, Michel C, Babin E, De Raucourt D, Péchery A, Gherga E, Géry B, Florescu C, Bourhis J, Thariat J. Approach to oligometastatic disease in head and neck cancer, on behalf of the GORTEC. Future Oncol 2018; 14:877-889. [DOI: 10.2217/fon-2017-0468] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Median survival for recurrent/metastatic head and neck squamous cell cancer (HNSCC) patients is about 10 months after first-line best systemic treatment. We aimed to assess current approaches of oligometastatic HNSCC patients by the analysis of current concept and published data (1995–2017) in this population. Five-year survival rates are over 20% in selected patients who undergo metastasis-directed therapy by either surgery or stereotactic irradiation. Human papillomavirus(+) HNSCC patients have more disseminated metastases but respond more favorably and also benefit from ablative treatments. Treatments of oligometastases are expanding rapidly. Unmet needs include revised imaging follow-up strategies to detect metastases earlier, identification of predictive noninvasive biomarkers for treatment guidance, assessment and corrections of biases in current studies and randomized clinical trials.
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Affiliation(s)
- Xu Shan Sun
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Cécile Michel
- GORTEC, Hôpital Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France
| | - Emmanuel Babin
- CHU – Normandie Université, Department of Head & Neck Surgery, 14000 Caen, France
| | - Dominique De Raucourt
- Center François Baclesse – Normandie Université, Department of Head & Neck Surgery, 3 Avenue Général Harris, 14000 Caen, France
| | - Adeline Péchery
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Elisabeta Gherga
- CH Belfort-Montbéliard, Department of Radiation Therapy, Boulevard du Maréchal Juin, 25209 Montbéliard, France
| | - Bernard Géry
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
| | - Carmen Florescu
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
| | - Jean Bourhis
- CHUV. Lausanne, Department of Radio-oncology, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Juliette Thariat
- Center François Baclesse – Normandie Université, Department of Radiation Therapy, 3 Avenue Général Harris, 14000 Caen, France
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35
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Wang HM, Lin TL, Kuo YC, Li HP, Chang KP, Lin CY, Fan HC, Lin AC, Hsieh CH, Tsang NM, Lee LY, Chan SC, Lui KW, Chang YS, Hsu CL. Correlation between overall survival and differential plasma and tissue tumor marker expression in nasopharyngeal carcinoma patients with different sites of organ metastasis. Oncotarget 2018; 7:53217-53229. [PMID: 27448966 PMCID: PMC5288180 DOI: 10.18632/oncotarget.10676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 06/09/2016] [Indexed: 11/25/2022] Open
Abstract
Differential overall survival of nasopharyngeal carcinoma (NPC) with different organ site metastases has been documented. Here, we attempted to determine the underlying mechanisms by assessing plasma and tumor tissue markers in relation to patient survival. Pretreatment plasma Epstein-Barr virus (EBV) DNA concentrations, cytokines and tissue macrophages, proliferation and apoptosis markers were determined in 178 patients with metastatic NPC. The median overall survival (OS) was 19 months. Patients with single organ metastases had better outcomes than those with multiple organ metastases (median OS: 26 months vs. 16 months), with statistical significance. Among the single organ involvement cases, patients with lung metastasis only showed longer survival than those with bone or liver involvement (median OS: 50 months vs. 21 months vs. 18 months; P < 0.001). Pretreatment plasma EBV DNA concentrations were lower in patients with lung metastasis than bone or liver metastasis among single organ site groups. Plasma interferon-γ-inducible protein-10 (IP-10) and monocyte chemotactic protein-1 (MCP-1) expression levels were correlated with differential single organ site metastasis OS and EBV DNA load. Liver metastatic tissue had higher density of infiltrating macrophages and proliferative index than the lung metastatic group. Low pretreatment plasma EBV DNA load, expression of cytokines, such as IP-10 and MCP-1, tissue macrophage infiltration, and proliferative index may contribute to the differences in overall survival.
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Affiliation(s)
- Hung-Ming Wang
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Tung-Liang Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yung-Chia Kuo
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hsin-Pai Li
- Department of Cell and Molecular Biology, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kai-Ping Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chien-Yu Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Hsien-Chi Fan
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - An-Chi Lin
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ngan-Ming Tsang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Li-Yu Lee
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Sheng-Chieh Chan
- Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Kar-Wai Lui
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Yu-Sun Chang
- Department of Cell and Molecular Biology, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Cheng-Lung Hsu
- Division of Hematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, ROC
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Leeman JE, Li JG, Pei X, Venigalla P, Zumsteg ZS, Katsoulakis E, Lupovitch E, McBride SM, Tsai CJ, Boyle JO, Roman BR, Morris LGT, Dunn LA, Sherman EJ, Lee NY, Riaz N. Patterns of Treatment Failure and Postrecurrence Outcomes Among Patients With Locally Advanced Head and Neck Squamous Cell Carcinoma After Chemoradiotherapy Using Modern Radiation Techniques. JAMA Oncol 2017; 3:1487-1494. [PMID: 28542679 DOI: 10.1001/jamaoncol.2017.0973] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Even though 15% to 50% of patients with head and neck squamous cell carcinoma (HNSCC) experience recurrence, relatively little is known regarding patterns of treatment failure and postrecurrence outcomes after chemoradiotherapy using modern radiation techniques (intensity-modulated radiotherapy [IMRT]). Recurrence patterns are significantly affected by variations in the quality of radiotherapy, which may confound findings from multicenter trials. Objective To assess patterns of treatment failure and postrecurrence outcomes for patients with HNSCC treated with contemporary radiotherapy techniques. Design, Setting, and Participants This large single-institution cohort study reviewed the outcomes of 1000 consecutive patients with stage III to IVB oropharyngeal carcinoma (n = 703), laryngeal carcinoma (n = 126), or hypopharyngeal carcinoma (n = 46) treated with definitive IMRT with or without concurrent chemotherapy, as well as patients with oral cavity carcinoma (n = 125) treated with postoperative IMRT with or without concurrent systemic therapy, from December 1, 2001, to December 31, 2013, with a median follow-up of 65.1 months among surviving patients. Data analysis was performed from January 31, 2016, to February 17, 2017. Main Outcomes and Measures Patterns of treatment failure and overall survival following locoregional failure or distant metastasis. Results Among the 1000 patients (186 women and 814 men; mean [SD] age, 59.3 [10.8] years), there were no marginal or isolated out-of-radiation-field failures. Among subsites, the cumulative incidence of local failure was highest among patients with oral cavity carcinoma vs those with oropharyngeal carcinoma (hazard ratio, 5.2; 95% CI, 3.1-8.6; P < .001). Furthermore, patients with oral cavity carcinoma experienced significantly shorter survival following distant metastasis (hazard ratio, 3.66; 95% CI, 1.98-6.80; P < .001). Patients with oropharyngeal carcinoma positive for human papillomavirus or p16 lived longer after locoregional failure compared with patents with oropharyngeal carcinoma negative for human papillomavirus or p16 (median survival, 36.5 vs 13.6 months; P = .007) but not after distant metastasis. Salvage surgery was associated with improved overall survival following locoregional failure (hazard ratio, 0.51; 95% CI, 0.34-0.77; P = .001); oligometastatic disease (1 vs ≥2 lesions: hazard ratio, 0.32; 95% CI, 0.16-0.63; P = .001) was associated with improved overall survival following distant metastasis. Conclusions and Relevance Overall survival after recurrence of HNSCC is influenced by the HNSCC subsite and human papillomavirus or p16 status, as well surgical and systemic interventions. An oligometastatic phenotype characterizes patients with solitary metastasis after chemoradiotherapy. These findings have important implications for clinical trial designs for HNSCC in the recurrent and oligometastatic setting.
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Affiliation(s)
- Jonathan E Leeman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jin-Gao Li
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, China
| | - Xin Pei
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Praveen Venigalla
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zachary S Zumsteg
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Evangelia Katsoulakis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eitan Lupovitch
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean M McBride
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chiaojung J Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jay O Boyle
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Benjamin R Roman
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Luc G T Morris
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lara A Dunn
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric J Sherman
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
Metastasectomy is the most frequent surgical resection undertaken by thoracic surgeons, being the lung the second common site of metastases. The present oncological criteria for pulmonary metastasectomy are: (I) the primary cancer need to be controlled or controllable; (II) no extrathoracic metastasis-that is not controlled or controllable-exists; (III) all of the tumor must be resectable, with adequate pulmonary reserve; (IV) there are no alternative medical treatment options with lower morbidity. General favourable prognostic features in patients with pulmonary metastases are: (I) one or few metastases; (II) long disease free interval; (III) normal CEA levels in colorectal cancers. Negative predictive features in patients candidate to pulmonary metastasectomies are: (I) active primary cancer; (II) extrathoracic metastases; (III) inability to obtain surgical radicality; (IV) mediastinal lymphatic spread. The lack of controlled trials and studies limited by short follow-up and small cohorts did not allow to overcome some skepticism; moreover, the heterogeneity of these patients in terms of demographic, biologic and histologic characteristics represents a clear limit even in the largest series. On the basis of present knowledge, without results coming from on-going randomized trials, radical resection, histology, and disease free interval seem to be independent prognostic factors identifying a cohort of patients maximally benefitting from lung metastasectomy.
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Affiliation(s)
- Francesco Petrella
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Cristina Diotti
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Arianna Rimessi
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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38
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Du C, Wan C, Ding J, Zhang G, Zhang Y, Hu C, Ying H. Management of indeterminate pulmonary nodules (<1 cm) newly detected during the follow-up of nasopharyngeal carcinoma patients. Asia Pac J Clin Oncol 2017; 14:e15-e20. [PMID: 28792116 DOI: 10.1111/ajco.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 06/11/2017] [Indexed: 12/01/2022]
Abstract
AIM To investigate the management for the indeterminate pulmonary nodules newly detected during the follow-up for nasopharyngeal carcinoma (NPC) patients. METHODS Indeterminate pulmonary lesions were identified by searching medical records of NPC patients, who were followed-up with thoracic CT between April 2008 and February 2014. Indeterminate pulmonary nodules were defined as opacities that may be solitary or multiple, which were <1 cm in size and not calcified. Nodules which were followed-up for at least two years, were included into analysis. The nodules with growth were considered as metastatic lesions and those which remained stable or regressed were defined as benign. The relations between the risk of the nodules to develop into metastatic lesions and clinical features and characteristics of nodules were analyzed. RESULTS Through a median follow-up of 50 months, the majority (81 of 102, 79.4%) had no change in the size of nodules. The nodules have regressed in 11 patients. There were 10 (9.8%) cases with progression at the follow-up. The 10 patients were considered to have lung metastases, for whom continuous increases of lesions were revealed. The volume doubling time of the increasing nodules ranged from 34 to 105 days. The nodules emerging within two years after primary therapies were more likely to develop into metastatic lesions (P = 0.043). CONCLUSION Ten percent of the indeterminate pulmonary nodules represent metastatic diseases. A short-interval follow-up is recommended and if the nodules remain stable after six months follow-up, it may be proper to prolong the interval of follow-up.
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Affiliation(s)
- Chengrun Du
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Caifeng Wan
- Department of Ultrasound, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Jianhui Ding
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Guangyuan Zhang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Youwang Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, P.R. China
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39
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Muñoz-Largacha JA, Gower AC, Sridhar P, Deshpande A, O'Hara CJ, Yamada E, Godfrey TE, Fernando HC, Litle VR. miRNA profiling of primary lung and head and neck squamous cell carcinomas: Addressing a diagnostic dilemma. J Thorac Cardiovasc Surg 2017; 154:714-727. [DOI: 10.1016/j.jtcvs.2017.02.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 01/31/2017] [Accepted: 02/25/2017] [Indexed: 12/12/2022]
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40
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Palliative systemic therapy for recurrent or metastatic nasopharyngeal carcinoma – How far have we achieved? Crit Rev Oncol Hematol 2017; 114:13-23. [DOI: 10.1016/j.critrevonc.2017.03.030] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/28/2017] [Indexed: 02/05/2023] Open
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41
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Nakajima Y, Iijima Y, Kinoshita H, Akiyama H, Beppu T, Uramoto H, Hirata T. Surgical Treatment for Pulmonary Metastasis of Head and Neck Cancer: Study of 58 Cases. Ann Thorac Cardiovasc Surg 2017; 23:169-174. [PMID: 28484151 DOI: 10.5761/atcs.oa.16-00269] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Although the number of surgeries performed for pulmonary metastasis of head and neck cancer has been increasing, there have been few reports of the surgical effectiveness. We collected the data of surgeries performed in our facility in order to discuss the surgical performance and indication. METHODS We retrospectively examined the prognosis and predictors for 58 patients with pulmonary metastasis of head and neck cancer who underwent a surgery in our facility during the 15-year period, from January 2000 to December 2015. RESULTS The 3-year and 5-year survival rates were 54.2% and 35.7%, respectively, and the median survival time was 42.2 months. The disease-free interval (DFI) was less than 24 months and patients with oral cavity cancer were poor prognostic factors. CONCLUSION The effectiveness of surgical treatment for pulmonary metastasis of head and neck cancer was suggested.
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Affiliation(s)
- Yuki Nakajima
- Division of Thoracic Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
| | - Yoshihito Iijima
- Division of Thoracic Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
| | - Hiroyasu Kinoshita
- Division of Thoracic Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
| | - Hirohiko Akiyama
- Division of Thoracic Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
| | - Takeshi Beppu
- Division of Head and Neck Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
| | - Hidetaka Uramoto
- Division of Thoracic Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan.,Division of Thoracic Surgery, Kanazawa Medical University, Kanazawa, Ishikawa, Japan
| | - Tomomi Hirata
- Division of Thoracic Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan
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42
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Keating J, Newton A, Venegas O, Nims S, Zeh R, Predina J, Deshpande C, Kucharczuk J, Nie S, Delikatny EJ, Singhal S. Near-Infrared Intraoperative Molecular Imaging Can Locate Metastases to the Lung. Ann Thorac Surg 2017; 103:390-398. [PMID: 27793401 PMCID: PMC11024498 DOI: 10.1016/j.athoracsur.2016.08.079] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 08/16/2016] [Accepted: 08/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulmonary metastasectomy is widely accepted for many tumor types because it may prolong survival and potentially cure some patients. However, intraoperative localization of pulmonary metastases can be technically challenging. We propose that intraoperative near-infrared (NIR) molecular imaging can be used as an adjunct during disease localization. METHODS We inoculated 50 C57BL/6 mice with Lewis lung carcinoma (LLC) flank tumors. After flank tumor growth, mice were injected through the tail vein with indocyanine green (ICG) before operation, and intraoperative imaging was used to detect pulmonary metastases. On the basis of these experiments, we enrolled 8 patients undergoing pulmonary metastasectomy into a pilot and feasibility clinical trial. Each patient received intravenous ICG 1 day before operation, followed by wedge or segmental resection. Samples were imaged on the back table with an NIR camera to confirm disease presence and margins. All murine and human tumors and margins were confirmed by pathologic examination. RESULTS Mice had an average of 4 ± 2 metastatic tumors on both lungs, with an average size of 5.1 mm (interquartile range [IQR] 2.2 mm to 7.6 mm). Overall, 200 of 211 (95%) metastatic deposits were markedly fluorescent, with a mean tumor-to-background ratio (TBR) of 3.4 (IQR 3.1 to 4.1). The remaining tumors had a TBR below 1.5. In the human study, intraoperative NIR imaging identified six of the eight preoperatively localized lesions. Intraoperative back table NIR imaging identified all metastatic lesions, which were confirmed by pathologic examination. The average tumor size was 1.75 ± 1.4 cm, and the mean ex vivo TBR was 3.3 (IQR 3.1 to 3.7). Pathologic examination demonstrated melanoma (n = 4), osteogenic sarcoma (n = 2), renal cell carcinoma (n = 2), chondrosarcoma (n = 1), leiomyosarcoma (n = 1), and colorectal carcinoma (n = 1). CONCLUSIONS Systemic ICG identifies subcentimeter tumor metastases to the lung in murine models, and this work provides proof of principle in humans. Future research is focused on improving depth of penetration into the lung parenchyma.
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Affiliation(s)
- Jane Keating
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Andrew Newton
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ollin Venegas
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sarah Nims
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ryan Zeh
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jarrod Predina
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Charuhas Deshpande
- Department of Pathology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John Kucharczuk
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Shuming Nie
- Departments of Biomedical Engineering and Chemistry, Emory University, Atlanta, Georgia
| | - E James Delikatny
- Department of Radiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sunil Singhal
- Division of Thoracic Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Center for Precision Surgery, Abramson Cancer Center, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
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43
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Cho JK, Hyun SH, Choi JY, Choi N, Kim MJ, Lee SH, Baek KH, Jeong HS. Prognostic significance of clinical and 18 F-FDG PET/CT parameters for post-distant metastasis survival in head and neck squamous cell carcinoma patients. J Surg Oncol 2016; 114:888-894. [PMID: 27546387 DOI: 10.1002/jso.24412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Distant metastasis (M1) to vital organs remains a major cause of death in patients with head and neck squamous cell carcinomas (HNSCC). Clinically the survival periods vary in individual M1 HNSCC patients and a prognostic indicator has not been fully studied. Here, we evaluated the prognostic factors for survival including 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters in M1 HNSCC patients. METHODS The study included 108 patients with newly diagnosed M1 HNSCC (68 during clinical courses, 40 at presentation) who underwent FDG PET/CT. Maximum standardized uptake value (SUVmax) of metastatic tumors was measured by FDG PET/CT. Associations of primary tumor or metastatic tumor variables with overall survival were assessed with Cox regression models. RESULTS Multivariate analyses demonstrated that nasopharynx primary and incomplete response of loco-regional disease to treatment were significant prognostic factors. In addition, adverse prognostic factors included short distant metastasis-free period (<10 months), high number (≥5), and high PET SUVmax (≥6.3) of metastatic lesions. The patients with at least one of these adverse features had a median survival <14 months. CONCLUSION PET SUVmax of the metastatic tumors in M1 HNSCC patients can be a good predictor for survival. J. Surg. Oncol. 2016;114:888-894. © 2016 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Jae-Keun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Inje University Ilsan Paik Hospital, Inje University School of Medicine, Goyang, Republic of Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nayeon Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Min-Ji Kim
- Biostatistics and Clinical Epidemiology Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kwan-Hyuck Baek
- Department of Molecular and Cellular Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi, Republic of Korea.
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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45
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Ichinose J, Shinozaki-Ushiku A, Takai D, Fukayama M, Nakajima J. Differential diagnosis between primary lung squamous cell carcinoma and pulmonary metastasis of head and neck squamous cell carcinoma. Expert Rev Anticancer Ther 2016; 16:403-10. [PMID: 26813704 DOI: 10.1586/14737140.2016.1147352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Differentiation between lung squamous cell carcinoma and pulmonary metastasis of head and neck squamous cell carcinoma is clinically important because the prognoses and therapeutic options are considerably different. However, the clinical, pathological, and immunohistochemical diagnostic methods have not yet been fully established. Although various molecular methods have been developed, they have not yet been practically applied. A combined approach involving molecular and immunohistochemical analysis, such as one that uses antibodies selected on the basis of comprehensive genetic analysis results, may be effective. We suggest a new diagnostic criteria using the clinical characteristics and the result of immunohistochemical analysis. However, there are two underlying problems in the development of new diagnostic methods: tumor heterogeneity and determination of the diagnostic accuracy.
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Affiliation(s)
- Junji Ichinose
- a Department of Thoracic Surgery , the University of Tokyo Hospital , Tokyo , Japan
| | | | - Daiya Takai
- c Department of Clinical Laboratory , the University of Tokyo Hospital , Tokyo , Japan
| | - Masashi Fukayama
- b Department of Pathology , the University of Tokyo Hospital , Tokyo , Japan
| | - Jun Nakajima
- a Department of Thoracic Surgery , the University of Tokyo Hospital , Tokyo , Japan
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46
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Predictive factors for long-term survival in head and neck squamous cell carcinoma patients with distant metastasis after initial definitive treatment. J Cancer Res Clin Oncol 2015; 142:295-304. [DOI: 10.1007/s00432-015-2043-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
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47
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Young E, Diakos E, Khalid-Raja M, Mehanna H. Resection of subsequent pulmonary metastases from treated head and neck squamous cell carcinoma: systematic review and meta-analysis. Clin Otolaryngol 2015; 40:208-18. [DOI: 10.1111/coa.12348] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- E.R. Young
- Institute of Head and Neck Studies and Education; School of Cancer Sciences; University of Birmingham; Birmingham UK
| | - E. Diakos
- Institute of Head and Neck Studies and Education; School of Cancer Sciences; University of Birmingham; Birmingham UK
| | - M. Khalid-Raja
- Institute of Head and Neck Studies and Education; School of Cancer Sciences; University of Birmingham; Birmingham UK
| | - H. Mehanna
- Institute of Head and Neck Studies and Education; School of Cancer Sciences; University of Birmingham; Birmingham UK
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48
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Yin D, Zhang G, Zhao L, Chai Y. Pulmonary resection and systemic lymph node dissection in a patient with breast cancer who had a 33-year disease-free interval. World J Surg Oncol 2015; 13:150. [PMID: 25889825 PMCID: PMC4403715 DOI: 10.1186/s12957-015-0565-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 02/17/2015] [Indexed: 01/10/2023] Open
Abstract
Objective Breast cancer metastasis to the lung is common. The resection of lung metastases in patients with breast cancer has been controversial. Here, we present a very rare case of pulmonary and mediastinal lymph node metastases in a patient with breast cancer who had a disease-free interval (DFI) of more than 33 years. Methods An involved lobectomy and systematic mediastinal lymph node dissection were performed. Results The histological examination confirmed pulmonary metastasis from the breast cancer associated with mediastinal lymph nodes metastasis. Conclusions To our knowledge, this is the first case reported of a patient with a 33-year DFI after a radical mastectomy for breast cancer who presented with pulmonary metastasis with mediastinal lymph node involvement. This case indicates that a long-term follow-up of breast cancer patients is necessary. Systematic mediastinal lymph node dissection should be considered as a prognostic study during pulmonary metastasectomy for breast cancer.
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Affiliation(s)
- Degang Yin
- Department of Thoracic Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, # 88 Jiefang Road, Hangzhou, 310009, China.
| | - Guofei Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, # 88 Jiefang Road, Hangzhou, 310009, China.
| | - Lufeng Zhao
- Department of Thoracic Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, # 88 Jiefang Road, Hangzhou, 310009, China.
| | - Ying Chai
- Department of Thoracic Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, # 88 Jiefang Road, Hangzhou, 310009, China.
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Yotsukura M, Kinoshita T, Kohno M, Asakura K, Kamiyama I, Emoto K, Hayashi Y, Ohtsuka T. Survival predictors after resection of lung metastases of head or neck cancers. Thorac Cancer 2015; 6:579-83. [PMID: 26445606 PMCID: PMC4567002 DOI: 10.1111/1759-7714.12225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/07/2014] [Indexed: 01/20/2023] Open
Abstract
Background Pulmonary metastasectomies are performed for a variety of cancers, though few reports have examined their merit for head and neck cancers. This study examined the relationship between clinical and pathological characteristics and survival after resection of lung metastases of these cancers. Methods Between 1986 and 2013, 34 patients presenting with pulmonary metastases of primary head or neck cancers underwent surgical resections at our institution. We retrospectively analyzed their clinical and pathological characteristics and the patients’ survival after metastasectomy in search of adverse prognostic factors. Results The primary sites of cancer were: the tongue in eight patients, the pharynx and salivary glands each in seven, the larynx in five, and miscellaneous sites in seven patients. Squamous cell carcinoma (SCC) was present in 19, adenoid cystic carcinomas in 10, and other diagnoses in five patients. The median disease-free interval (DFI) between the initial surgery and the metastasectomies was 40 months. The overall five-year survival rate was 57.9%, and median survival time was 77 months. By single variable analysis, a DFI of ≤26 months, age ≥60 years, and histology of SCC were predictors; by multiple variable analysis, a short DFI (P = 0.018) and older age (P = 0.046) remained independent predictors of poor clinical outcomes. Conclusions Young age and a long DFI are factors in favor of pulmonary metastasectomy after surgical treatment of primary head or neck cancers.
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Affiliation(s)
- Masaya Yotsukura
- Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine Tokyo, Japan
| | - Tomonari Kinoshita
- Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine Tokyo, Japan
| | - Mitsutomo Kohno
- Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine Tokyo, Japan
| | - Keisuke Asakura
- Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine Tokyo, Japan
| | - Ikuo Kamiyama
- Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine Tokyo, Japan
| | - Katsura Emoto
- Department of Pathology, Keio University Hospital Tokyo, Japan
| | | | - Takashi Ohtsuka
- Division of General Thoracic Surgery, Department of Surgery, Keio University School of Medicine Tokyo, Japan
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Guenne C, Fayette J, Cosmidis A, Fuchsmann C, Tartas S, Favrel V, Céruse P. Curative treatment can be an option for patients with metastatic squamous cell cancer of the head and neck. DRUG DESIGN DEVELOPMENT AND THERAPY 2014; 8:2549-53. [PMID: 25548517 PMCID: PMC4271786 DOI: 10.2147/dddt.s70451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background No specific study has focused on patients with metastatic squamous cell carcinoma of the head and neck (SCCHN) at diagnosis. Due to high response rates of induction chemotherapy in chemo-naïve patients with localized disease, their prognosis should be better than patients with recurrent disease. Methods From January 1, 2008 to July 1, 2012, we retrospectively collected all patients’ records with SCCHN diagnosed as metastatic. Patients, disease, treatment and its results were analyzed. Survival was calculated using the Kaplan–Meier method. Results Of the 749 new patients treated for SCCHN in our institution, 16 (2.1%) were metastatic at diagnosis, of whom five had cytological results to prove it. Six patients died before treatment or had palliative care and ten received initial chemotherapy and then surgery and/or radiotherapy according to the primary response. Four patients treated with first-line chemotherapy with docetaxel-5FU-cisplatin (TPF) showed a complete response of metastatic lesions allowing locoregional treatment. The overall survival at 1 year and 3 years was 50% and 24%, respectively. The median survival was 7 months (1–72 months). Seven patients (43.7%) had a higher survival at 12 months, including five (31.5%) who are still alive without recurrence with a mean follow-up of 30 months. There was a significant difference in overall survival (P<0.01) between patients who had chemotherapy with TPF versus other therapeutic protocols. The median survival of patients with lung metastases only was 15 months (1–72 months), significantly higher than that of patients with liver and/or bone localizations, which was 2 months (1–9 months). Conclusion Patients with metastatic SCCHN treated by TPF followed by multimodal treatment could achieve long survival.
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Affiliation(s)
- Clémence Guenne
- Head and Neck Surgery Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Jérôme Fayette
- Medicine Department, Lyon-I University, Centre Léon Bérard, Lyon, France
| | - Alain Cosmidis
- Head and Neck Surgery Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Carine Fuchsmann
- Head and Neck Surgery Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Sophie Tartas
- Medical Oncology Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Véronique Favrel
- Radiotherapy Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
| | - Philippe Céruse
- Head and Neck Surgery Department, Lyon-I University, Hospices Civils de Lyon, Lyon Sud Hospital, Pierre-Bénite, France
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