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Anderson AC, Stewart RD, Sponseller PA, Wairiri LW, Goff PH, Panjwani N, Laramore GE, Parvathaneni U, Emery R, Marchiano EJ, Futran N, Rodriguez CP, Liao JJ. Intensity-Modulated Neutron Therapy (IMNT) for Head and Neck Cancer: Early Toxicity Outcomes. Int J Radiat Oncol Biol Phys 2023; 117:e561-e562. [PMID: 37785722 DOI: 10.1016/j.ijrobp.2023.06.1881] [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) Locally advanced head & neck cancers (HNC) are challenging to treat due to abutment of critical, dose-limiting structures. Fast neutron radiotherapy (NT) is a high linear energy transfer (LET) modality that provides better local control than photons for radioresistant cancers such as salivary gland tumors, but there have been concerns of toxicity with 3D conformal neutron therapy in the past. Recent technological advances have enabled the planning and delivery of IMNT, which improves target conformality and may reduce toxicity compared to 3D conformal NT. We report the first clinical evaluation of early toxicity outcomes of IMNT for HNC. MATERIALS/METHODS Study is a single-institution retrospective review of all HNC patients treated with curative-intent IMNT from 10/2022 to 2/2023, using a hospital-based cyclotron (50.5 MeV 1H+ beam incident on a Be target) equipped with an isocentric gantry and multileaf collimator (MLC). A commercial treatment planning system with custom neutron-specific scattering kernels was used for IMNT planning using 4-6 fields. Patient-specific quality assurance included ionization chamber measurements and a novel 12C(n,2n)11C positron emission portal imaging system. kV portal imaging was used to confirm patient setup prior to each treatment session. All patients were prescribed 18.4 Gy at 1.15 Gy/fraction, delivered 4 days/week, which is equivalent to an x-ray EQD2 of approximately 70 Gy (RBE ∼ 3.8). Clinical observations suggest the RBE for radioresistant HNC may be as large as 8. Patients underwent weekly toxicity assessment, and acute toxicities were graded (G) by CTCAE v5.0. RESULTS Ten patients received IMNT, median age 61 (range 34-78). Primary tumor sites were base of tongue (n = 3), sinonasal (n = 3), parotid (n = 2), submandibular (n = 1), larynx (n = 1). Tumor histologies included adenoid cystic carcinoma (n = 7), other salivary gland carcinomas (n = 2) and mucosal melanoma (n = 1). Most had T4 disease (n = 8) and one had N3b disease. Six had surgical resection with high-risk features, and 6 had gross measurable disease prior to IMNT. None had concurrent systemic therapy. Uninvolved salivary glands were spared in most patients. All patients completed treatment. Median follow up was 22 days (0-48). Acute toxicities (n, G 1, 2, 3) included skin (8, 3, 0), dysgeusia (1, 6, 0), xerostomia (3, 5, 0), mucositis (2, 0, 5), nausea (3, 0, 1). One patient had >10% weight loss and brief admission for supportive care and PEG placement; one patient had prophylactic PEG; both regained oral independence during follow-up. There was no Grade 4+ toxicity. CONCLUSION IMNT improves the therapeutic ratio compared to 3D conformal NT and expands indications for NT in patients with radiorefractory tumors. Acute toxicity compares favorably with photons. Longer clinical and toxicity follow-up is anticipated. A prospective trial is planned to evaluate quality of life measures.
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Affiliation(s)
- A C Anderson
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - R D Stewart
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - P A Sponseller
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - L W Wairiri
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - P H Goff
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - N Panjwani
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - G E Laramore
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - U Parvathaneni
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - R Emery
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
| | - E J Marchiano
- Department of Otolaryngology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - N Futran
- Department of Otolaryngology, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - C P Rodriguez
- Division of Oncology, Department of Medicine, University of Washington/ Fred Hutchinson Cancer Center, Seattle, WA
| | - J J Liao
- Department of Radiation Oncology, University of Washington - Fred Hutchinson Cancer Center, Seattle, WA
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Chang S, Parvathaneni U, Laramore G, Humphreys I, Moe K, Patel A, Ferreira M, Rodriguez C, Cranmer L, Futran N, Barber B, Houlton J, Abuzeid W, Jafari A, Rizvi Z, Cash H, Liao J. Surgical Resection and Intensity Modulated Proton Therapy for Esthesioneuroblastoma. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Rodriguez C, Fromm J, Liao J, Laramore G, Lo S, Goff P, Santana-Davila R, Martins R, Futran N, Houlton J, Barber B, Parvathaneni U. Dual Immune Checkpoint Blockade and Hypofractionated Radiation in Recurrent/Metastatic Squamous Cell Carcinomas of the Head and Neck Previously Treated with Immune Checkpoint Inhibitors. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Lui A, Parvathaneni U, Laramore G, Rodriguez C, Rostomily R, Silbergeld D, Ferreira M, Futran N, Moe K, Davis G, Humphreys I, Houlton J, Schaub S, Liao J. Management and Long Term Outcomes of Esthesioneuroblastoma at a Single Institution. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1451] [Citation(s) in RCA: 2] [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: 11/17/2022]
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Dillon J, Jones S, Villing A, Futran N, Brockhoff H, Ward B. What Is the Ideal Management of Buccal Squamous Cell Carcinoma - a Rare Oral Cancer? J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.joms.2015.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Smoot T, Pennau K, McDonald T, Brown C, Futran N, Dillon J. The Impact of Surgical Margins of Oral Squamous Cell Carcinoma on Local Recurrence and Disease-Specific Survival. J Oral Maxillofac Surg 2013. [DOI: 10.1016/j.joms.2013.06.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hayes DN, Raez LE, Sharma AK, Papagikos MA, Yunus F, Parvathaneni U, Eaton KD, Futran N, Wallace SG, Martins R. Multicenter randomized phase II trial of combined radiotherapy and cisplatin with or without erlotinib in patients with locally advanced squamous cell carcinoma of the head and neck (SCCAHN): Preliminary toxicity results. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.5580] [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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Choi S, Futran N, Farwell D, Weymuller E, Austin-Seymour M, Schwartz D. Radiotherapy does not impact complication rates following free flap reconstructive surgery for head and neck cancer. Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)01346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Futran N. Definitive management of severe facial trauma utilizing free tissue transfer. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-5998(03)00829-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- C R Bradford
- Department of Otolaryngology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
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Abstract
BACKGROUND The purpose of this study was to determine the functional disabilities and overall quality of life (QOL) of patients successfully treated (ie, without evidence of disease at two years) for laryngeal or hypopharyngeal cancer by a total laryngectomy. METHODS The University of Washington QOL questionnaire was administered to 10 patients prior to laryngectomy, at one year postlaryngectomy, and at two years postlaryngectomy. RESULTS Postlaryngectomy QOL scores were not significantly different from prelaryngectomy scores. In all QOL domains the severity of functional disability was not significantly correlated with its importance. Ninety percent of patients (9/10) reported that compared with one year prior to the diagnosis of cancer their general health was the same or better at two years postlaryngectomy. Seventy percent of patients (7/10) reported having a good to excellent overall QOL. CONCLUSIONS Though the loss of voice is disabling, the functional limitations caused by a laryngectomy do not necessarily translate into a worse overall QOL. Future research is needed to determine whether the importance of individual QOL domains changes as patients adjust to the experience of having and surviving cancer.
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Affiliation(s)
- F W Deleyiannis
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, USA.
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Muro-Cacho CA, Holt T, Klotch D, Mora L, Livingston S, Futran N. Cyclin D1 expression as a prognostic parameter in papillary carcinoma of the thyroid. Otolaryngol Head Neck Surg 1999; 120:200-7. [PMID: 9949353 DOI: 10.1016/s0194-5998(99)70407-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Papillary carcinoma of the thyroid is the most common thyroid cancer. At the time of clinical presentation, most papillary carcinomas are still confined to the thyroid gland, and appropriate surgical treatment achieves a 95% 5-year survival rate. Certain carcinomas, however, behave in a much more aggressive fashion. Because specific therapies do not exist, for those tumors that have escaped local control, patients with disseminated disease have little or no chance of permanent cure or long-term survival. Cyclin D1, a protein that plays a critical role in the control of the cell cycle, has been shown to be overexpressed in a variety of human neoplasias and may serve as a prognostic parameter of disease progression. To explore the role played by cyclin D1 in the pathogenesis of thyroid papillary carcinoma, we have quantitated, by computerized image analysis, the immunohistochemical expression of cyclin D1 in formalin-fixed, paraffin-embedded tissue from 35 conventional papillary carcinomas of the thyroid and correlated the results with established clinicopathologic parameters and available survival data.
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Affiliation(s)
- C A Muro-Cacho
- Department of Pathology, University of South Florida, College of Medicine, USA
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Grant GA, Wener MH, Yaziji H, Futran N, Bronner MP, Mandel N, Mayberg MR. Destructive tophaceous calcium hydroxyapatite tumor of the infratemporal fossa. Case report and review of the literature. J Neurosurg 1999; 90:148-52. [PMID: 10413170 DOI: 10.3171/jns.1999.90.1.0148] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tophaceous pseudogout is one of the rarest forms of crystal deposition disease, typically presenting as a destructive and invasive mass involving the temporomandibular joint or the infratemporal fossa region in the absence of any other articular manifestations. Previous cases have been assumed to be caused by calcium pyrophosphate dihydrate (CPPD) crystal deposition, based on finding weakly birefringent crystals in the involved tissues. The authors present the unique case of a 65-year-old woman with a destructive and invasive facial mass extending to the middle cranial fossa with microscopic and clinical features consistent with tophaceous pseudogout. High-resolution x-ray crystallographic powder diffraction and Fourier transformed infrared spectroscopy subsequently revealed that the crystals were composed of calcium hydroxyapatite without CPPD. The patient was later found to have primary hyperparathyroidism and mild hypercalcemia. This case demonstrates that tissue deposits of calcium hydroxyapatite can cause a destructive and invasive mass containing weakly birefringent crystals and raises the question of whether previous cases attributed to tophaceous pseudogout resulting from CPPD actually were composed of birefringent calcium hydroxyapatite.
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Affiliation(s)
- G A Grant
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, USA
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Affiliation(s)
- R Alsarraf
- Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle 98195, USA
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Urken ML, Futran N, Moscoso JF, Biller HF. A modified design of the buried radial forearm free flap for use in oral cavity and pharyngeal reconstruction. Arch Otolaryngol Head Neck Surg 1994; 120:1233-9. [PMID: 7917207 DOI: 10.1001/archotol.1994.01880350041008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We present a new design for the radial forearm flap that includes a small monitor segment that is connected to the primary skin paddle by a fascial subcutaneous segment of tissue. This design modification permits buried flaps to be easily monitored and provides vascularized tissue coverage of the flap vessels as well as the great vessels in the neck. Immediate augmentation of the radical neck deformity can be achieved. SETTING This study was conducted at a referral center. PATIENTS Fifteen patients with squamous cell cancer of the pharynx and tongue base were included in this study. The defects in these patients were judged to be best reconstructed with a radial forearm free flap. RESULTS All free flaps in this series survived. There was one case, described in detail, in which the fascial subcutaneous portion of the flap was exposed to salivary contamination. The flap vessels remained well protected and flap viability was unimpaired.
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Affiliation(s)
- M L Urken
- Department of Otolaryngology, Mount Sinai Medical Center, New York, NY
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Urken ML, Catalano PJ, Sen C, Post K, Futran N, Biller HF. Free Tissue Transfer for Skull Base Reconstruction Analysis of Complications and a Classification Scheme for Defining Skull Base Defects. ACTA ACUST UNITED AC 1993; 119:1318-25. [PMID: 17431985 DOI: 10.1001/archotol.1993.01880240054007] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The role of free flaps in skull base reconstruction is discussed in detail. Twenty-six microvascular free tissue transfers performed in 22 patients are reviewed in detail. A classification scheme for skull base defects is presented. SETTING Tertiary referral center. PATIENTS Twenty-two patients with neoplasms that involve the skull base underwent a combined craniotomy and facial approach for resection. The resultant defects were reconstructed with a variety of microvascular free flaps. RESULTS All 22 patients were ultimately successfully reconstructed with a free flap. One patient required a second free flap following ablative surgery for a recurrent tumor. The initial free flaps in three patients were unsuccessful and a second flap was required. The classification scheme was applied to all defects. CONCLUSIONS The creation of a functional separation of the intracranial and extracranial cavities can be extremely difficult to accomplish, especially when multiple cavities (nasal, oral, pharyngeal) are violated. Free flaps provide a solution to this problem in select cases. Skull base defects can and should be classified for the purpose of communication, treatment planning, prognosis of reconstruction, and judging therapeutic outcome.
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Affiliation(s)
- M L Urken
- Department of Otolaryngology, Mount Sinai School of Medicine, New York, NY 10029, USA
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Herold RC, Futran N. Effect of cortisol on medial edge epithelium of organ-cultured single palatal shelves from steroid-susceptible mouse strains. Arch Oral Biol 1980; 25:423-9. [PMID: 6255918 DOI: 10.1016/0003-9969(80)90009-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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