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Cerbon DA, Seldon Taswell CS, Azzam G, Yang F, Carmona R, Abramowitz MC, Samuels MA, Kubicek GJ, Freedman LM, Samuels S. Dosimetric Parameters Correlate with Taste Alterations in Head and Neck Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e220. [PMID: 37784901 DOI: 10.1016/j.ijrobp.2023.06.1121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Dysgeusia is an acute and chronic side effect of head and neck chemoradiation, with persistent taste dysfunction 1-2 years post radiotherapy occurring in 23-50% of patients. Several head and neck clinical trials set oral cavity mean doses between 30 to 40 Gy, however, there are no set guidelines accurately defining the composite structure and anatomic boundaries for the oral cavity or separating the tongue into specific quadrants. In this single institution cross sectional study, we sought to determine the effects of radiation doses to specific regions of the oral cavity and tongue on patient-reported long term dysgeusia. We hypothesize that radiation Dose to specific structures in the oral cavity will correlate with long-term dysgeusia in patients who have received head and neck radiotherapy. MATERIALS/METHODS Patients with primary head and neck cancer receiving definitive intensity modulated radiation therapy (RT) completed quality of life assessments that included patient-reported gustatory function, 1 year post RT. Dosimetric data from RT plans were collected for specific regions and organs at risk within the oral cavity. These structures included the anterior, posterior, superior and inferior tongue (OT), pharyngeal constrictors (as a surrogate for the corda-tympani) and the oral cavity. A forward binary logistic regression model was performed using these data points with scoring from the QLQ-H&N43 questionnaire subsection on taste (Q45) to determine the most predictive values for dysgeusia and the OR for moderate/severe alterations in taste. RESULTS A total of 78 patients were included in this study, of these patients, 63 had dosimetric data for the pharyngeal constrictors. The Oral Cavity Volume percentage receiving 50Gy (OC V50) and Pharyngeal Constrictors Volume percentage receiving 55Gy (PC V55) were the most predictive constraints for dysgeusia. (0.042, p = 0.011 and 0.041, p = 0.033). Holding all other variables constant in a forward binary logistic regression including 78 patients, the odds of having moderate to severe taste alterations increased by 56% (OR 1.045, 95% CI 1.012-1.079) for a 1% increase in OCV50. When analyzing the 68 patients with available pharyngeal constrictors data, taste alteration increased 20% for every 1% increase in PCV55 (OR 1.042, 95% CI 1.003-1.082). There was no correlation with taste alterations in any of the dose parameters tested (Dmax, mean and V50 up to V70) for superior, inferior, anterior or posterior regions of the tongue. CONCLUSION Dosimetric parameters for the oral cavity (OC V50) and pharyngeal constrictors (PC V55) were positively correlated with taste alterations, however, no other specific regions within the oral tongue predicted taste disfunction. Normal tissue complication probability modeling curves to identify OC V50 and PC V55 constraints for dysgeusia are needed.
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Affiliation(s)
- D A Cerbon
- Department of Radiation Oncology, University of Miami/Sylvester Cancer Center, Miami, FL
| | - C S Seldon Taswell
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - G Azzam
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL
| | - F Yang
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - R Carmona
- Douglas and Nancy Barnhart Cancer Center at Sharp Chula Vista Medical Center, San Diego, CA
| | - M C Abramowitz
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - M A Samuels
- Department of Radiation Oncology, Banner MD Anderson Cancer Center at Banner Gateway Medical Center, Gilbert, AZ
| | - G J Kubicek
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, FL
| | - L M Freedman
- Department of Radiation Oncology, University of Miami/Sylvester Comprehensive Cancer Center, Miami, FL
| | - S Samuels
- Department of Radiation Oncology, University of Miami, Miami, FL
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Dragun AE, Modi C, Henson CF, Jain S, Ahlawat S, Eastwick G, Kubicek GJ, Mezera MA, Mulvihill DJ, Perri J, Juneja B, Ennis RD, Haffty BG. A Statewide Multi-institutional Study of Asymptomatic Pre-Treatment Testing of Radiation Therapy Patients for SARS-CoV-2 in a High-Incidence Region of the United States. Int J Radiat Oncol Biol Phys 2020; 108:1401-1402. [PMID: 33427661 PMCID: PMC7671924 DOI: 10.1016/j.ijrobp.2020.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- A E Dragun
- MD Anderson Cancer Center at Cooper University Hospital, Department of Radiation Oncology, Camden, NJ
| | - C Modi
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - C F Henson
- Trinitas Comprehensive Cancer Center, Elizabeth, NJ
| | - S Jain
- Holy Redeemer Hospital, Meadowbrook, PA
| | - S Ahlawat
- MD Anderson Cancer Center at Cooper University Hospital, Department of Radiation Oncology, Camden, NJ
| | - G Eastwick
- MD Anderson Cancer Center at Cooper University Hospital, Department of Radiation Oncology, Camden, NJ
| | - G J Kubicek
- MD Anderson Cancer Center at Cooper University Hospital, Department of Radiation Oncology, Camden, NJ
| | - M A Mezera
- MD Anderson Cancer Center at Cooper University Hospital, Department of Radiation Oncology, Camden, NJ
| | - D J Mulvihill
- MD Anderson Cancer Center at Cooper University Hospital, Department of Radiation Oncology, Camden, NJ
| | - J Perri
- MD Anderson Cancer Center at Cooper University Hospital, Department of Radiation Oncology, Camden, NJ
| | - B Juneja
- MD Anderson Cancer Center at Cooper University Hospital, Department of Radiation Oncology, Camden, NJ
| | - R D Ennis
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
| | - B G Haffty
- Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, New Brunswick, NJ
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Argiris A, Bauman JE, Ohr J, Gooding WE, Heron DE, Duvvuri U, Kubicek GJ, Posluszny DM, Vassilakopoulou M, Kim S, Grandis JR, Johnson JT, Gibson MK, Clump DA, Flaherty JT, Chiosea SI, Branstetter B, Ferris RL. Phase II randomized trial of radiation therapy, cetuximab, and pemetrexed with or without bevacizumab in patients with locally advanced head and neck cancer. Ann Oncol 2016; 27:1594-600. [PMID: 27177865 DOI: 10.1093/annonc/mdw204] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/04/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND We previously reported the safety of concurrent cetuximab, an antibody against epidermal growth factor receptor (EGFR), pemetrexed, and radiation therapy (RT) in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN). In this non-comparative phase II randomized trial, we evaluated this non-platinum combination with or without bevacizumab, an inhibitor of vascular endothelial growth factor (VEGF). PATIENTS AND METHODS Patients with previously untreated stage III-IVB SCCHN were randomized to receive: conventionally fractionated radiation (70 Gy), concurrent cetuximab, and concurrent pemetrexed (arm A); or the identical regimen plus concurrent bevacizumab followed by bevacizumab maintenance for 24 weeks (arm B). The primary end point was 2-year progression-free survival (PFS), with each arm compared with historical control. Exploratory analyses included the relationship of established prognostic factors to PFS and quality of life (QoL). RESULTS Seventy-eight patients were randomized: 66 oropharynx (42 HPV-positive, 15 HPV-negative, 9 unknown) and 12 larynx; 38 (49%) had heavy tobacco exposure. Two-year PFS was 79% [90% confidence interval (CI) 0.69-0.92; P < 0.0001] for arm A and 75% (90% CI 0.64-0.88; P < 0.0001) for arm B, both higher than historical control. No differences in PFS were observed for stage, tobacco history, HPV status, or type of center (community versus academic). A significantly increased rate of hemorrhage occurred in arm B. SCCHN-specific QoL declined acutely, with marked improvement but residual symptom burden 1 year post-treatment. CONCLUSIONS RT with a concurrent non-platinum regimen of cetuximab and pemetrexed is feasible in academic and community settings, demonstrating expected toxicities and promising efficacy. Adding bevacizumab increased toxicity without apparent improvement in efficacy, countering the hypothesis that dual EGFR-VEGF targeting would overcome radiation resistance, and enhance clinical benefit. Further development of cetuximab, pemetrexed, and RT will require additional prospective study in defined, high-risk populations where treatment intensification is justified.
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Affiliation(s)
- A Argiris
- Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio
| | - J E Bauman
- Division of Hematology/Oncology, Department of Medicine
| | - J Ohr
- Department of Medicine, Division of Hematology/Oncology
| | | | - D E Heron
- Department of Medicine, Division of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh
| | - U Duvvuri
- Division of Otolaryngology, Department of Medicine, University of Pittsburgh, Pittsburgh
| | - G J Kubicek
- Division of Radiation Oncology, Department of Medicine, Cooper University Healthcare, Camden
| | - D M Posluszny
- Division of Biobehavioral Oncology, Department of Medicine, University of Pittsburgh Cancer Institute, Pittsburgh, USA
| | - M Vassilakopoulou
- Division of Hematology/Oncology, Department of Medicine, Hopital de la Pitie-Salpetriere, Paris, France
| | - S Kim
- Division of Otolaryngology, Department of Medicine, University of Pittsburgh, Pittsburgh
| | - J R Grandis
- Division of Otolaryngology, Department of Medicine, University of California, San Francisco
| | - J T Johnson
- Division of Otolaryngology, Department of Medicine, University of Pittsburgh, Pittsburgh
| | - M K Gibson
- Division of Hematology/Oncology, Department of Medicine, UH Case Medical Center, Cleveland
| | - D A Clump
- Department of Medicine, Division of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh
| | - J T Flaherty
- Division of Hematology/Oncology, Department of Medicine
| | - S I Chiosea
- Division of Pathology, Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - B Branstetter
- Department of Medicine, Division of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh
| | - R L Ferris
- Division of Otolaryngology, Department of Medicine, University of Pittsburgh, Pittsburgh
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Tomlinson M, Kubicek GJ, Ferreira N, Marais LC. Case report: A typical presentation of giant cell tumour (GCT) of bone in the distal humerus of a child. SA orthop j 2016. [DOI: 10.17159/2309-8309/2016/v15n1a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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McDermott M, Hughes M, Rath T, Johnson JT, Heron DE, Kubicek GJ, Kim SW, Ferris RL, Duvvuri U, Ohr JP, Branstetter BF. Negative predictive value of surveillance PET/CT in head and neck squamous cell cancer. AJNR Am J Neuroradiol 2013; 34:1632-6. [PMID: 23639557 DOI: 10.3174/ajnr.a3494] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Optimizing the utilization of surveillance PET/CT in treated HNSCC is an area of ongoing research. Our aim was to determine the negative predictive value of PET/CT in patients with treated head and neck squamous cell cancer and to determine whether negative PET/CT reduces the need for further imaging surveillance. MATERIALS AND METHODS We evaluated patients with treated HNSCC who underwent posttreatment surveillance PET/CT. During routine clinical readouts, scans were categorized as having negative, probably negative, probably malignant, or malignant findings. We followed patients clinically and radiographically for at least 12 months from their last PET/CT (mean, 26 months; median, 28 months; range, 12-89 months) to determine recurrence rates. All suspected recurrences underwent biopsy for confirmation. RESULTS Five hundred twelve patients (1553 scans) were included in the study. Two hundred fourteen patients had at least 1 PET/CT with negative findings. Of the 214 patients with a scan with negative findings, 19 (9%) eventually experienced recurrence, resulting in a NPV of 91%. In addition, a subgroup of 114 patients with 2 consecutive PET/CT examinations with negative findings within a 6-month period was identified. Only 2 recurrences were found in this group, giving a NPV of 98%. CONCLUSIONS In patients treated for HNSCC, a single PET/CT with negative findings carries a NPV of 91%, which is not adequate to defer further radiologic surveillance. Two consecutive PET/CT examinations with negative findings within a 6-month period, however, resulted in a NPV of 98%, which could obviate further radiologic imaging in the absence of clinical signs of recurrence.
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Affiliation(s)
- M McDermott
- Department of Radiology, New York University, New York, NY, USA
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Axelrod RS, Ahn PH, Kubicek GJ, Anne PR, Cognetti D, Dicker A, Machtay M. Mature results of a phase I trial of bortezomib, cisplatin, and radiotherapy for advanced or recurrent head and neck cancer. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ferris RL, Kotsakis AP, Heron DE, Kim S, Duvvuri U, Kubicek GJ, Grandis JR, Johnson JT, Argiris A. A phase II trial of postoperative radiotherapy (RT), cisplatin, and panitumumab in patients with high-risk, resected locally advanced squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps262] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kotsakis AP, Heron DE, Kubicek GJ, Ferris RL, Kim S, Gibson MK, Duvvuri U, Grandis JR, Johnson JT, Argiris A. Phase II randomized trial of radiotherapy (RT), cetuximab (E), and pemetrexed (Pem) with or without bevacizumab (B) in locally advanced squamous cell carcinoma of the head and neck (SCCHN). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.tps264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kubicek GJ, Kubicek GJ, Brown S, Redfield S. Combined brachytherapy and external beam radiation for prostate cancer in a community setting. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16147 Background: Prostate cancer is the most common male malignancy, and there is no one standard treatment modality. One treatment option is the combination of external beam radiotherapy and permanent transperineal brachytherapy seed implant Methods: Retrospective review of prostate cancer and side effect outcomes at a single institution in the community setting. All patients were treated with a combination of low dose rate transperineal brachytherapy seed placement and external beam radiation. Results: A total of 897 patients were analyzed, 781 had a minimum follow-up of one year. Median pre-treatment PSA was 8.1 (range 0.3 to 106) and the median Gleason score was 6. With a median follow-up of 3.6 years, 33 (3.4 %) patients had biochemical failure based on the phoenix definition of Nadir + 2. Not including impotence, acute toxicity greater than or equal to Grade 2 was seen in 115 patients (102 GU and 13 GI) and 193 patients had late toxicity greater than or equal to Grade 2 (155 GU and 38 GI). 563 patients received hormone therapy prior to or concurrent with the radiation. Conclusions: This is the largest series reporting on the outcome of combination brachytherpay implant and external beam radiation in the treatment of prostate cancer. Combination treatment using brachytherapy and external beam radiation is well tolerated, with a low rate of biochemical failure and should be considered one of the treatment options for prostate cancer. No significant financial relationships to disclose.
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Affiliation(s)
- G. J. Kubicek
- Thomas Jefferson University, Philadelphia, PA; Ariston Radiology Association, LLC, Totowa, NJ
| | - G. J. Kubicek
- Thomas Jefferson University, Philadelphia, PA; Ariston Radiology Association, LLC, Totowa, NJ
| | - S. Brown
- Thomas Jefferson University, Philadelphia, PA; Ariston Radiology Association, LLC, Totowa, NJ
| | - S. Redfield
- Thomas Jefferson University, Philadelphia, PA; Ariston Radiology Association, LLC, Totowa, NJ
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Kubicek GJ, Machtay M, Axelrod RA, Curran WJ, Keane WM, Anne R, Mallon G, Myers T, Dicker AP. Phase I trial of bortezomib (VELCADE), cisplatin and radiotherapy for advanced head and neck cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Fogh SE, Champ C, Kubicek GJ, Intenzo C, Axelrod RA, Keane WM, Machtay M. Value of FDG-PET for detecting metastatic lesions in head and neck cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
The positron emitter 18F continues to be one of the most important imaging radionuclides in diagnostic nuclear medicine. Assays of radiopharmaceuticals containing this nuclide are often performed in the clinic using commercial reentrant ionization chambers, or "dose calibrators". Meaningful quantitative clinical studies require accurate knowledge of the injected activity which requires proper calibration of these instruments. Radioassays were performed at the National Institute of Standards and Technology (NIST) on a solution of 18F produced at the National Institutes of Health (NIH) using 4pibeta liquid scintillation (fS) counting with 3H-standard efficiency tracing. Cocktails containing water fractions of approximately 0.9 and 9% (both as saline) were used. The massic activity values were measured to be 2.52+/-0.06 and 2.50+/-0.03 MBq g(-1), respectively, for the 0.9 and 9% water cocktails as of the reference time. The uncertainties on the activity measurements are expanded (k = 2) uncertainties. The largest uncertainty component was found to be the repeatability on a single LS source, with the cocktails containing 0.9% water fraction exhibiting a larger variability by nearly a factor of two. Reproducibility between LS cocktails with the same water fraction was also found to be a large uncertainty component, but with a value less than half that due to measurement repeatability. Radionuclidic impurities consisted of 48V and 46Sc, at levels of 0.11+/-0.08% (expanded uncertainties) and approximately 2 x 10(-3)% (upper limit) relative to the activity of the 18F, as of the reference time. Dose calibrator dial settings for measuring solutions of 18F were experimentally determined for Capintec CRC-12 and CRC-35R dose calibrators in three measurement geometries: a 5-ml standard NIST ampoule (two ampoules measured), a 12-ml plastic syringe containing 9 ml of solution and a 10-ml Mallinckrodt molded dose vial filled with 5 ml of solution. The experimental dial settings (and the corresponding expanded uncertainties) for these geometries were found to be 477+/-7, 474+/-6, 482+/-6 and 463+/-7 for the two ampoules, the syringe and the dose vial, respectively, in the CRC-12. The dial settings determined for the CRC-35R were 472+/-7, 470+/-7, 464+/-6 and 456+/-6 for the two ampoules, the syringe, and the dose vial, respectively. The uncertainties in the dial settings are expanded uncertainties. Comparisons between the empirically determined dial settings and the manufacturer's recommended setting of "439" indicate that use of the manufacturer's setting overestimates the activity by between 3 and 6%, depending upon the geometry used.
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Affiliation(s)
- B E Zimmerman
- Physics Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA.
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