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Meredith EG, Filion E, Faria S, Kundapur V, Thuc TVTT, Lok BH, Raman S, Bahig H, Laba JM, Lang P, Louie AV, Hope A, Rodrigues GB, Bezjak A, Campeau MP, Duclos M, Bratman S, Swaminath A, Salunkhe R, Warner A, Palma DA. Stereotactic Radiation for Ultra-Central Non-Small Cell Lung Cancer: A Safety and Efficacy Trial (SUNSET). Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00480-2. [PMID: 38614279 DOI: 10.1016/j.ijrobp.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/22/2024] [Accepted: 03/30/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION The use of stereotactic body radiotherapy (SBRT) for tumors in close proximity to the central mediastinal structures has been associated with a high risk of toxicity. This study (BLINDED FOR REVIEW) aimed to determine the maximally tolerated dose (MTD) of SBRT for ultra-central (UC) non-small cell lung carcinoma (NSCLC), using a time-to-event continual reassessment methodology (TITE-CRM). METHODS Patients with T1-3N0M0 (≤ 6 cm) NSCLC were eligible. The MTD was defined as the dose of radiotherapy associated with a ≤ 30% rate of grade (G) 3-5 pre-specified treatment-related toxicity occurring within 2 years of treatment. The starting dose level was 60 Gy in 8 daily fractions. The dose-maximum hotspot was limited to 120% and within the planning tumor volume (PTV); tumors with endobronchial invasion were excluded. This primary analysis occurred two years after completion of accrual. RESULTS Between March 2018 and April 2021, 30 patients were enrolled at 5 institutions. The median age was 73 years (range: 65-87) and 17 (57%) were female. PTV was abutting proximal bronchial tree in 19 (63%), esophagus 5 (17%), pulmonary vein 1 (3.3%) and pulmonary artery 14 (47%). All patients received 60 Gy in 8 fractions. The median follow-up was 37 months (range: 8.9-51). Two patients (6.7%) experienced G3-5 adverse events related to treatment: 1 patient with G3 dyspnea and 1 G5 pneumonia; the latter had CT findings consistent with a background of interstitial lung disease. Three-year overall survival was 72.5% (95% confidence interval [CI]: 52.3-85.3%), progression-free survival 66.1% (95% CI: 46.1-80.2%), local control 89.6% (95% CI: 71.2-96.5%), regional control 96.4% (95% CI: 77.2-99.5%) and distant control 85.9% (95% CI: 66.7-94.5%). Quality of life scores declined numerically over time, but the decreases were not clinically or statistically significant. CONCLUSIONS 60 Gy in 8 fractions, planned and delivered with only a moderate hotspot, has a favorable adverse event rate within the pre-specified acceptability criteria, and results in excellent control for UC tumors.
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Affiliation(s)
| | - Edith Filion
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Sergio Faria
- McGill University Health Centre, Montréal, Canada
| | | | | | | | | | - Houda Bahig
- Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Joanna M Laba
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Pencilla Lang
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | - Alexander V Louie
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Hope
- Princess Margaret Cancer Centre, Toronto, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
| | | | | | - Marie Duclos
- McGill University Health Centre, Montréal, Canada
| | | | | | | | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada.
| | - David A Palma
- Division of Radiation Oncology, London Health Sciences Centre and Western University, London, Canada
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Palma DA, Bahig H, Hope A, Harrow S, Debenham BJ, Louie AV, Vu TTT(T, Filion E, Bezjak A, Campeau MP, Duimering A, Giuliani ME, Laba JM, Lang P, Lok BH, Qu XM, Raman S, Rodrigues GB, Goodman CD, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson CJ. Stereotactic Radiation Therapy in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease: A Nonrandomized Clinical Trial. JAMA Oncol 2024:2815670. [PMID: 38451491 PMCID: PMC10921346 DOI: 10.1001/jamaoncol.2023.7269] [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] [Received: 08/16/2023] [Accepted: 09/25/2023] [Indexed: 03/08/2024]
Abstract
Importance Patients with interstitial lung disease (ILD) and early-stage non-small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options. Objective To prospectively assess the benefits and toxic effects of SABR in this patient population. Design, Setting, and Participants This prospective cohort study was conducted at 6 academic radiation oncology institutions, 5 in Canada and 1 in Scotland, with accrual between March 7, 2019, and January 12, 2022. Patients aged 18 years or older with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgical resection were enrolled. Intervention Patients were treated with SABR to a dose of 50 Gy in 5 fractions every other day. Main Outcomes and Measures The study prespecified that SABR would be considered worthwhile if median overall survival-the primary end point-was longer than 1 year, with a grade 3 to 4 risk of toxic effects less than 35% and a grade 5 risk of toxic effects less than 15%. Secondary end points included toxic effects, progression-free survival (PFS), local control (LC), quality-of-life outcomes, and changes in pulmonary function. Intention-to-treat analysis was conducted. Results Thirty-nine patients enrolled and received SABR. Median age was 78 (IQR, 67-83) years and 59% (n = 23) were male. At baseline, 70% (26 of 37) of patients reported dyspnea, median forced expiratory volume in first second of expiration was 80% (IQR, 66%-90%) predicted, median forced vital capacity was 84% (IQR, 69%-94%) predicted, and median diffusion capacity of the lung for carbon monoxide was 49% (IQR, 38%-61%) predicted. Median follow-up was 19 (IQR, 14-25) months. Overall survival at 1 year was 79% (95%, CI 62%-89%; P < .001 vs the unacceptable rate), and median overall survival was 25 months (95% CI, 14 months to not reached). Median PFS was 19 months (95% CI, 13-28 months), and 2-year LC was 92% (95% CI, 69%-98%). Adverse event rates (highest grade per patient) were grade 1 to 2: n = 12 (31%), grade 3: n = 4 (10%), grade 4: n = 0, and grade 5: n = 3 (7.7%, all due to respiratory deterioration). Conclusions and Relevance In this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Trial Registration ClinicalTrials.gov Identifier: NCT03485378.
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Affiliation(s)
- David A. Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Brock J. Debenham
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Alexander V. Louie
- Department of Radiation Oncology, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Thi Trinh Thuc (Toni) Vu
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Marie-Pierre Campeau
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Adele Duimering
- Department of Radiation Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Meredith E. Giuliani
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joanna M. Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Benjamin H. Lok
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - X. Melody Qu
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Srinivas Raman
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - George B. Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher D. Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Physics, Western University, London, Ontario, Canada
| | - Julie Morisset
- Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Inderdeep Dhaliwal
- Department of Respirology, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher J. Ryerson
- Department of Medicine and Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Aziz SJ, Dickson BC, Lang P, Zeman CE. TLE1 Expression in NUT Carcinoma: A Case Report Highlighting a Potential Diagnostic Pitfall for the Pathologist. Int J Surg Pathol 2024:10668969231217750. [PMID: 38233028 DOI: 10.1177/10668969231217750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
NUT carcinoma is a rare, aggressive malignancy defined as a carcinoma with a chromosomal rearrangement affecting the nuclear protein in testis (NUTM1) gene. This small round blue cell tumor classically exhibits focal abrupt keratinization and immunohistochemical positivity for keratin and squamous markers. However, keratinization is not always present and reports of positivity for other markers that may obscure the diagnosis are increasing. It is also noteworthy that gene fusions involving NUTM1 are not restricted to NUT carcinoma. Herein, we report a NUT carcinoma arising in the mediastinum of a male patient in his 40 s with morphological and immunohistochemical overlap with Ewing family sarcoma and poorly differentiated synovial sarcoma given a round cell morphology, diffuse strong immunoreactivity for CD99, and patchy strong immunoreactivity for TLE1. Squamous differentiation by morphology and p40 expression were notably absent in this case. Classification as NUT carcinoma was ultimately possible when the morphological and immunohistochemical findings were considered in the context of a BRD4::NUTM1 gene fusion identified by next-generation sequencing. While the patient initially responded to palliative radiotherapy, he died approximately one month later. To our knowledge, this is the first report of TLE1 immunoreactivity in NUT carcinoma. This case highlights a potential diagnostic pitfall and emphasizes the need for molecular confirmation in equivocal situations.
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Affiliation(s)
- Sarah J Aziz
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Brendan C Dickson
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Cady E Zeman
- Department of Pathology and Laboratory Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
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Gulstene S, Lang P, Melody Qu X, Laba JM, Yaremko BP, Rodrigues GB, Yu E, Qiabi M, Nayak R, Malthaner RA, Fortin D, Warner A, Inculet RI, Palma DA. What is the predictive value of RECIST criteria following stereotactic lung radiation? Radiother Oncol 2024; 190:109976. [PMID: 37918636 DOI: 10.1016/j.radonc.2023.109976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/13/2023] [Accepted: 10/27/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Response EvaluationCriteriain Solid Tumors (RECIST) is commonly used to assess response to anti-cancer therapies. However, its application after lung stereotactic ablative radiotherapy (SABR) is complicated by radiation-induced lung changes. This study assesses the frequency of progressive disease (PD) by RECIST following lung SABR and correlates this with actual treatment outcomes as determined by longitudinal follow-up. METHODS AND MATERIALS We reviewed patients treated with lung SABR for primary lung tumors or oligometastases between 2010 and 2015. Patients were treated with SABR doses of 54-60 Gy in 3-8 fractions. All follow-up scans were assessed and the treated lesion was serially measured over time, with the maximum diameter on axial CT slices used for RECIST calculations. Lesions demonstrating PD by RECIST criteria were identified and subsequently followed for long-term outcomes. The final 'gold-standard' assessment of response was based on size changes after PD and, as available, positron emission tomography scan and/or biopsy. RESULTS Eighty-eight lesions met inclusion criteria. Seventy-five were lung primaries and thirteen were lung metastases. Median follow-up was 52 months (interquartile range: 33-68). Two-thirds (66 %, 58/88) of treated lesions met RECIST criteria for PD; however, local recurrence was only confirmed in 16 % (9/58) of cases. Most lesions that triggered PD by RECIST (47/58, 81 %) were ultimately found not to represent recurrence, while a minority (2/58, 3 %) had an uncertain response. The positive predictive value [PPV] of a RECIST defined PD event was 0.16. If PD was triggered within 12-months post-treatment, PPV was 0.08, compared to 0.21 for lesions triggering PD after 12-months. CONCLUSION Using RECIST criteria, two-thirds of patients treated with lung SABR met criteria for PD. However, only a minority had recurrence, leading to a poor PPV of RECIST. This highlights the limitations of RECIST in this setting and provides context for physicians when interpreting post-lung SABR imaging.
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Affiliation(s)
- Stephanie Gulstene
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - X Melody Qu
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Joanna M Laba
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Brian P Yaremko
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - George B Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Edward Yu
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Mehdi Qiabi
- Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Rahul Nayak
- Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Richard A Malthaner
- Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Dalilah Fortin
- Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
| | - Richard I Inculet
- Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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Chinnery TA, Lang P, Nichols AC, Mattonen SA. Predicting the need for a replan in oropharyngeal cancer: A radiomic, clinical, and dosimetric model. Med Phys 2023. [PMID: 38100260 DOI: 10.1002/mp.16893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/21/2023] [Accepted: 11/19/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Patients with oropharyngeal cancer (OPC) treated with chemoradiation can experience weight loss and tumor shrinkage, altering the prescribed treatment. Treatment replanning ensures patients do not receive excessive doses to normal tissue. However, it is a time- and resource-intensive process, as it takes 1 to 2 weeks to acquire a new treatment plan, and during this time, overtreatment of normal tissues could lead to increased toxicities. Currently, there are limited prognostic factors to determine which patients will require a replan. There remains an unmet need for predictive models to assist in identifying patients who could benefit from the knowledge of a replan prior to treatment. PURPOSE We aimed to develop and evaluate a CT-based radiomic model, integrating clinical and dosimetric information, to predict the need for a replan prior to treatment. METHODS A dataset of patients (n = 315) with OPC treated with chemoradiation was used for this study. The dataset was split into independent training (n = 220) and testing (n = 95) datasets. Tumor volumes and organs at risk (OARs) were contoured on planning CT images. PyRadiomics was used to compute radiomic image features (n = 1218) on the original and filtered images from each of the primary tumor, nodal volumes, and ipsilateral and contralateral parotid glands. Nine clinical features and nine dose features extracted from the OARs were collected and those significantly (p < 0.05) associated with the need for a replan in the training dataset were used in a baseline model. Random forest feature selection was applied to select the optimal radiomic features to predict replanning. Logistic regression, Naïve Bayes, support vector machine, and random forest classifiers were built using the non-correlated selected radiomic, clinical, and dose features on the training dataset and performance was assessed in the testing dataset. The area under the curve (AUC) was used to assess the prognostic value. RESULTS A total of 78 patients (25%) required a replan. Smoking status, nodal stage, base of tongue subsite, and larynx mean dose were found to be significantly associated with the need for a replan in the training dataset and incorporated into the baseline model, as well as into the combined models. Five predictive radiomic features were selected (one nodal volume, one primary tumor, two ipsilateral and one contralateral parotid gland). The baseline model comprised of clinical and dose features alone achieved an AUC of 0.66 [95% CI: 0.51-0.79] in the testing dataset. The random forest classifier was the top-performing radiomics model and achieved an AUC of 0.82 [0.75-0.89] in the training dataset and an AUC of 0.78 [0.68-0.87] in the testing dataset, which significantly outperformed the baseline model (p = 0.023, testing dataset). CONCLUSIONS This is the first study to use radiomics from the primary tumor, nodal volumes, and parotid glands for the prediction of replanning for patients with OPC. Radiomic features augmented clinical and dose features for predicting the need for a replan in our testing dataset. Once validated, this model has the potential to assist physicians in identifying patients that may benefit from a replan, allowing for better resource allocation and reduced toxicities.
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Affiliation(s)
- Tricia A Chinnery
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Baines Imaging Research Laboratory, London, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology, Western University, London, Ontario, Canada
| | - Sarah A Mattonen
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Baines Imaging Research Laboratory, London, Ontario, Canada
- Department of Oncology, Western University, London, Ontario, Canada
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Arendt AM, Heubach F, Maier CP, Giardino S, Jung G, Kowalewski E, Rabsteyn A, Amorelli G, Seitz C, Schlegel P, Handgretinger R, Lang P. Targeting GD2 after allogeneic SCT: effector cell composition defines the optimal use of ch14.18 and the bispecific antibody construct NG-CU (GD2-CD3). Cancer Immunol Immunother 2023; 72:3813-3824. [PMID: 37742286 PMCID: PMC10576705 DOI: 10.1007/s00262-023-03536-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
We investigated whether T cell-recruiting bispecific anti-CD3/GD2 antibody NG-CU might be an alternative to therapeutic anti-GD2 monoclonal antibody (mAb) ch14.18, mediating complement-dependent cytotoxicity (CDC) and antibody-dependent cell-mediated cytotoxicity (ADCC) through natural killer (NK) cells for immunotherapy in high-risk/relapsed neuroblastoma after autologous/allogeneic stem cell transplantation (auto/alloSCT). Different antibody concentrations and effector-to-target ratios (E:T) were evaluated using xCELLigence RTCA system, peripheral blood mononuclear cells (PBMCs) (healthy donors and patients after alloSCT), and neuroblastoma cell lines (LS/LAN-1). Mean specific lysis of LS cells utilizing PBMCs from healthy donors and ch14.18 (1 µg/ml) was 40/66/75% after 12/24/48 h compared to 66/93/100% in the presence of NG-CU (100 ng/ml). NG-CU showed enhanced cytotoxicity compared to ch14.18, even at lower concentrations and E:T ratios, and completely eradicated LS cells after 72 h. To decipher the influence of effector cell subsets on lysis, different ratios of T and NK cells were tested. At a ratio of 1:1, ch14.18 was more effective than NG-CU. Using patient PBMCs taken at different time points posttransplant, significant lysis with both constructs was detectable depending on percentages and total numbers of T and NK cells; in the early posttransplant phase, NK cells were predominant and ch14.18 was superior, whereas later on, T cells represented the majority of immune cells and NG-CU was more effective. Our study highlights the importance of analyzing effector cell subsets in patients before initiating antibody-based therapy. Consequently, we propose an adjusted administration of both antibody constructs, considering the state of posttransplant immune recovery, to optimize anti-tumor activity.
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Affiliation(s)
- A-M Arendt
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany.
| | - F Heubach
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - C P Maier
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
- Department of Hematology/Oncology, Center for Internal Medicine, University Hospital, Tübingen, Germany
| | - S Giardino
- Hematopoietic Stem Cell Transplantation Unit, Department of Hematology and Oncology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - G Jung
- Interfaculty Institute for Cell Biology, Department of Immunology, Eberhard Karls University Tuebingen, Tübingen, Germany
| | - E Kowalewski
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - A Rabsteyn
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - G Amorelli
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - C Seitz
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - P Schlegel
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - R Handgretinger
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
| | - P Lang
- Department of General Pediatrics, Oncology/Hematology, Children's University Hospital Tuebingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany
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Palma DA, Bahig H, Hope AJ, Harrow S, Debenham BJ, Louie A, Vu T, Filion EJ, Bezjak A, Campeau MP, Duimering A, Giuliani M, Laba JM, Lang P, Lok BH, Qu MX, Raman S, Rodrigues G, Goodman C, Gaede S, Morisset J, Warner A, Dhaliwal I, Ryerson C. Assessment of Precision Irradiation in Early Non-Small Cell Lung Cancer and Interstitial Lung Disease (ASPIRE-ILD): Primary Analysis of a Phase II Trial. Int J Radiat Oncol Biol Phys 2023; 117:S28-S29. [PMID: 37784467 DOI: 10.1016/j.ijrobp.2023.06.289] [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) The use of stereotactic ablative radiotherapy (SABR) in patients with fibrotic interstitial lung disease (ILD) has been associated with an increased risk of toxicity, but patients with ILD and lung cancer may have no other options for curative-intent treatment. The goal of the ASPIRE-ILD trial was to assess the benefits and toxicities of SABR in patients with fibrotic ILD. MATERIALS/METHODS We enrolled patients with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgery. All patients were centrally reviewed prior to enrollment to confirm the presence and subtype of ILD. After stratification by the ILD-GAP score (a measure of ILD severity and prognosis), patients were treated with SABR to a dose of 50 Gy in 5 fractions EOD (BED = 100 Gy10), with a built-in de-escalation protocol in case of unacceptable toxicity. The primary endpoint was overall survival (OS), powered to distinguish 1-year OS >70% vs. an unacceptable rate of ≤50%. Secondary endpoints included toxicity (CTC-AE version 4.0), progression-free survival (PFS), local control (LC), patient-reported outcomes (FACT-L quality of life and cough severity), and changes in pulmonary function tests (PFTs). The study pre-specified that SABR would be considered worthwhile if median OS was >1 year, with a grade 3-4 toxicity risk <35% and a grade 5 toxicity risk <15%. Target accrual was 39 treated patients. RESULTS Thirty-nine patients were enrolled and treated with SABR between March 2019 and January 2022, all to a dose of 50 Gy in 5 fractions, at 5 institutions in Canada and 1 in Scotland. Median age was 78 years (interquartile range: 67-83), 59% were male, and 92% had a history of smoking (median 43 pack-years). At baseline, 70% reported dyspnea, median FEV1 was 80% predicted and median DLCO was 49% predicted. ILD-GAP scores were as follows: ≤2 (i.e., best ILD status): n = 14; 3-5: n = 23; ≥6 (i.e., worst ILD status): n = 2. Median follow-up was 19 months. OS at 1-year was 78.9% (p<0.001 by binomial test vs. the unacceptable rate). Median OS was 25 months, median PFS was 19 months, and 2-year LC was 92%. AE rates (possibly, probably or definitely related) were as follows (highest grade per patient): grade 1-2: n = 12 (31%); grade 3: n = 4 (10%); grade 4; n = 0; grade 5 n = 3 (7.7%, all due to respiratory deterioration). AE rates did not differ by ILD-GAP category or ILD subtype. FACT-L scores trended downward over time (p = 0.07), and cough severity scale scores worsened over time (p = 0.02). Comparing last-available PFTs with baseline, DLCO declined (median: -4%; p = 0.046), FVC trended downward (median: -2.5%; p = 0.11), and FEV1 remained stable (median change: 0%). CONCLUSION The use of SABR in patients with ILD met the pre-specified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits. Further studies exploring pharmacologic options to reduce toxicity may be beneficial in this population. ().
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Affiliation(s)
- D A Palma
- Department of Oncology, Western University, London, ON, Canada
| | - H Bahig
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - A J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - S Harrow
- Edinburgh Cancer Centre, Edinburgh, United Kingdom
| | | | - A Louie
- Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - T Vu
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - E J Filion
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada
| | - A Bezjak
- Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - M P Campeau
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - M Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J M Laba
- London Health Sciences Centre, London, ON, Canada
| | - P Lang
- Department of Oncology, Western University, London, ON, Canada
| | - B H Lok
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - M X Qu
- London Regional Cancer Centre, London, ON, Canada
| | - S Raman
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - G Rodrigues
- London Health Sciences Centre, London, ON, Canada
| | - C Goodman
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - S Gaede
- Department of Medical Physics, Western University, London, ON, Canada
| | - J Morisset
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - A Warner
- London Health Sciences Centre, London, ON, Canada
| | - I Dhaliwal
- London Health Sciences Centre, London, ON, Canada
| | - C Ryerson
- University of British Columbia, Vancouver, BC, Canada
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8
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Wang E, Abdallah H, Snir J, Chong J, Palma DA, Mattonen SA, Lang P. Predicting Dosimetry of Stereotactic Ablative Radiotherapy for the Treatment of Multiple Lung Lesions. Int J Radiat Oncol Biol Phys 2023; 117:e732. [PMID: 37786130 DOI: 10.1016/j.ijrobp.2023.06.2254] [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) Stereotactic ablative radiotherapy (SABR) has recently been used to treat increasing numbers of lung metastases, either synchronously or over multiple courses of treatment. Selecting the optimal dose and fractionation to balance risk of local failure and treatment toxicity is challenging. This project uses machine learning to provide rapid dosimetry predictions of SABR to multiple lung lesions, allowing exploration of different dose prescription options prior to the radiation (RT) planning process. MATERIALS/METHODS A generative adversarial network (GAN) was trained to predict the dosimetry of multi-lesion thoracic SABR treatment from the planning CT scan, target and organ at risk contours, and the prescribed dose-fractionation without the need to carry out treatment planning. RT plans of patients who received at least one SABR treatment for ≥2 lung lesions between 2014-2020 at a single tertiary center were included in the analysis. All prescriptions were converted to their equivalent doses in two Gray fractions (EQD2). SABR treatments received at different timepoints were registered, and EQD2 doses were accumulated with no repair. Model performance was assessed using 5-fold cross validation. Plans were randomly divided into 5 folds, stratified by the number of lesions (no patients crossed folds). Each fold served as the testing set once, with the model trained on the other 4 folds. The model was evaluated on the difference in the volume of lung receiving above 20 Gray (V20) of the predicted dosimetry compared to the true dosimetry. RESULTS Treatment plans (n = 103) were included from 81 patients with 280 lesions (62, 23, 8, and 10 plans had 2, 3, 4, and ≥5 lesions respectively). Fifty-five, 18, and 4 patients had a single, 2 and 3 courses of RT respectively. Fifty-two patients were treated for primary lung cancer, 28 patients treated for metastases from other sites, and 1 patient for both. Seven patients (8.6%) developed ≥ Grade 2 pneumonitis. Doses prescribed were 60/8 (n = 136), 55/5 (n = 49), 54/3 (n = 27), 24/1 (n = 21), 35/5 (n = 13), 30/5 (n = 9), and other (n = 25). The mean lung V20 for all patients was 11.3% [1.5%-29.6%]; the mean lung V20 was 9.3%, 12.2%, 13.5% and 20.4% for plans with 2, 3, 4, ≥ 5 lesions respectively. The mean absolute difference (MAD) in lung V20 between the predicted dosimetry and true dosimetry over all 5-folds was 1.9% [0.0%-13.4%]; the MAD in lung V20 between the predicted and actual dosimetry was 1.6%, 2.1%, 2.9% and 2.6% for plans with 2, 3, 4, ≥ 5 lesions respectively. CONCLUSION The GAN-based model created in this study can predict the dosimetry of any number of lesions in the thorax treated with SABR. The model can be used to quickly determine the feasibility of SABR treatment for multiple synchronous lesions, or in the retreatment setting. The ability to explore the dosimetry of different prescription options for a given patient prior to RT planning may allow for personalized risk-adapted treatment if combined with local control and toxicity modelling.
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Affiliation(s)
- E Wang
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - H Abdallah
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - J Snir
- London Regional Cancer Program, London Health Sciences Centre, London, ON, Canada
| | - J Chong
- Department of Medical Imaging, Western University, London, ON, Canada
| | - D A Palma
- Department of Oncology, Western University, London, ON, Canada
| | - S A Mattonen
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - P Lang
- Department of Oncology, Western University, London, ON, Canada
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9
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Guevorguian P, Chinnery T, Lang P, Nichols A, Mattonen SA. External validation of a CT-based radiomics signature in oropharyngeal cancer: Assessing sources of variation. Radiother Oncol 2023; 178:109434. [PMID: 36464179 DOI: 10.1016/j.radonc.2022.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/02/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND AND PURPOSE Radiomics is a high-throughput approach that allows for quantitative analysis of imaging data for prognostic applications. Medical images are used in oropharyngeal cancer (OPC) diagnosis and treatment planning and these images may contain prognostic information allowing for treatment personalization. However, the lack of validated models has been a barrier to the translation of radiomic research to the clinic. We hypothesize that a previously developed radiomics model for risk stratification in OPC can be validated in a local dataset. MATERIALS AND METHODS The radiomics signature predicting overall survival incorporates features derived from the primary gross tumor volume of OPC patients treated with radiation +/- chemotherapy at a single institution (n = 343). Model fit, calibration, discrimination, and utility were evaluated. The signature was compared with a clinical model using overall stage and a model incorporating both radiomics and clinical data. A model detecting dental artifacts on computed tomography images was also validated. RESULTS The radiomics signature had a Concordance index (C-index) of 0.66 comparable to the clinical model's C-index of 0.65. The combined model significantly outperformed (C-index of 0.69, p = 0.024) the clinical model, suggesting that radiomics provides added value. The dental artifact model demonstrated strong ability in detecting dental artifacts with an area under the curve of 0.87. CONCLUSION This work demonstrates model performance comparable to previous validation work and provides a framework for future independent and multi-center validation efforts. With sufficient validation, radiomic models have the potential to improve traditional systems of risk stratification, treatment personalization and patient outcomes.
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Affiliation(s)
- Philipp Guevorguian
- Department of Medical Biophysics, Western University, 1151 Richmond Street, London, ON, Canada; Baines Imaging Research Laboratory, 800 Commissioners Road East, London, ON, Canada.
| | - Tricia Chinnery
- Department of Medical Biophysics, Western University, 1151 Richmond Street, London, ON, Canada; Baines Imaging Research Laboratory, 800 Commissioners Road East, London, ON, Canada.
| | - Pencilla Lang
- Department of Oncology, Western University, 1151 Richmond Street, London, ON, Canada.
| | - Anthony Nichols
- Department of Otolaryngology, Western University, 1151 Richmond Street, London, ON, Canada.
| | - Sarah A Mattonen
- Department of Medical Biophysics, Western University, 1151 Richmond Street, London, ON, Canada; Baines Imaging Research Laboratory, 800 Commissioners Road East, London, ON, Canada; Department of Oncology, Western University, 1151 Richmond Street, London, ON, Canada.
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10
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Mensour EA, Alam S, Mawani S, Bahig H, Lang P, Nichols A, Palma DA, Jasper K. What is the future of treatment de-escalation for HPV-positive oropharyngeal cancer? A review of ongoing clinical trials. Front Oncol 2022; 12:1067321. [PMID: 36620554 PMCID: PMC9816564 DOI: 10.3389/fonc.2022.1067321] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
Background Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) has increased in incidence in recent decades. With higher cure rates in younger populations, long-term survivors may live with acute- and long-term toxicity, leading to increased interest in de-escalation treatment strategies for HPV-related OPSCC. Herein, we have examined the current landscape of clinical trials in this context. Methods A review of active clinical trials related to de-escalation of HPV-associated OPSCC treatment was performed using the clinicaltrials.gov database from inception to January 2022. A search using the key words "oropharyngeal cancer" and "HPV" was completed. Three investigators independently reviewed each trial, with any discrepancies settled by a fourth. Data collected from each study included study phase, study design, primary, and secondary endpoints, and de-escalation treatment strategies. A final 24 articles were selected for full text review. Results Many trials (n=19, 79%) were non-randomized, and most studies employed a phase II design (n=14, 58%). Only 13% (n=3) were randomized trials, and 8% (n=2) included a phase III component. The most frequent primary endpoint was progression-free survival (PFS) (n=9, 37.5%). With regards to the identified de-escalation strategies, all the studies (n=24) had at least one component assessing changes in RT dose/fractionation and/or a reduction in RT volumes. A smaller percentage of trials assessed surgical interventions (n=9, 37.5%) and/or changes in systemic therapy (n=8, 33.3%). Conclusion A small number of randomized trials are underway, and a transition to more randomized phase III trials in the future will be important to change clinical practice.
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Affiliation(s)
- Emma A. Mensour
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Shintha Alam
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Seliya Mawani
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | - Houda Bahig
- Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, QC, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
| | - Anthony Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON, Canada
| | - David A. Palma
- Department of Radiation Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada,*Correspondence: David A. Palma,
| | - Katie Jasper
- Department of Radiation Oncology, London Health Sciences Centre, University of Western Ontario, London, ON, Canada
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11
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Zeng PYF, Cecchini MJ, Barrett JW, Shammas-Toma M, De Cecco L, Serafini MS, Cavalieri S, Licitra L, Hoebers F, Brakenhoff RH, Leemans CR, Scheckenbach K, Poli T, Wang X, Liu X, Laxague F, Prisman E, Poh C, Bose P, Dort JC, Shaikh MH, Ryan SEB, Dawson A, Khan MI, Howlett CJ, Stecho W, Plantinga P, Daniela da Silva S, Hier M, Khan H, MacNeil D, Mendez A, Yoo J, Fung K, Lang P, Winquist E, Palma DA, Ziai H, Amelio AL, Li SSC, Boutros PC, Mymryk JS, Nichols AC. Immune-based classification of HPV-associated oropharyngeal cancer with implications for biomarker-driven treatment de-intensification. EBioMedicine 2022; 86:104373. [PMID: 36442320 PMCID: PMC9706534 DOI: 10.1016/j.ebiom.2022.104373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is significant interest in treatment de-escalation for human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) patients given the generally favourable prognosis. However, 15-30% of patients recur after primary treatment, reflecting a need for improved risk-stratification tools. We sought to develop a molecular test to risk stratify HPV+ OPSCC patients. METHODS We created an immune score (UWO3) associated with survival outcomes in six independent cohorts comprising 906 patients, including blinded retrospective and prospective external validations. Two aggressive radiation de-escalation cohorts were used to assess the ability of UWO3 to identify patients who recur. Multivariate Cox models were used to assess the associations between the UWO3 immune class and outcomes. FINDINGS A three-gene immune score classified patients into three immune classes (immune rich, mixed, or immune desert) and was strongly associated with disease-free survival in six datasets, including large retrospective and prospective datasets. Pooled analysis demonstrated that the immune rich group had superior disease-free survival compared to the immune desert (HR = 9.0, 95% CI: 3.2-25.5, P = 3.6 × 10-5) and mixed (HR = 6.4, 95% CI: 2.2-18.7, P = 0.006) groups after adjusting for age, sex, smoking status, and AJCC8 clinical stage. Finally, UWO3 was able to identify patients from two small treatment de-escalation cohorts who remain disease-free after aggressive de-escalation to 30 Gy radiation. INTERPRETATION With additional prospective validation, the UWO3 score could enable biomarker-driven clinical decision-making for patients with HPV+ OPSCC based on robust outcome prediction across six independent cohorts. Prospective de-escalation and intensification clinical trials are currently being planned. FUNDING CIHR, European Union, and the NIH.
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Affiliation(s)
- Peter Y F Zeng
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Matthew J Cecchini
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Matthew Shammas-Toma
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Loris De Cecco
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy
| | - Mara S Serafini
- Integrated Biology Platform, Department of Applied Research and Technology Development, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy
| | - Stefano Cavalieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Lisa Licitra
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), Research Institute GROW, Maastricht University, Maastricht, the Netherlands
| | - Ruud H Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, the Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology/Head and Neck Surgery, Cancer Center Amsterdam, the Netherlands
| | - Kathrin Scheckenbach
- Department of Otolaryngology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tito Poli
- Unit of Maxillofacial Surgery, Department of Medicine and Surgery, University of Parma-University Hospital of Parma, Parma, Italy
| | - Xiaowei Wang
- Department of Pharmacology and Regenerative Medicine, The University of Illinois at Chicago, Chicago, IL, USA
| | - Xinyi Liu
- Department of Pharmacology and Regenerative Medicine, The University of Illinois at Chicago, Chicago, IL, USA
| | - Francisco Laxague
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Eitan Prisman
- Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Catherine Poh
- Division of Otolaryngology- Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada; Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pinaki Bose
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Joseph C Dort
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Mushfiq H Shaikh
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Sarah E B Ryan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Alice Dawson
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mohammed I Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Christopher J Howlett
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - William Stecho
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Paul Plantinga
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | | | - Michael Hier
- Department of Otolaryngology Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - Halema Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Eric Winquist
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antonio L Amelio
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Cell Biology and Physiology, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shawn S-C Li
- Department of Biochemistry, University of Western Ontario, London, Ontario, Canada
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA, USA; Institute for Precision Health, University of California, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA, USA
| | - Joe S Mymryk
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada.
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12
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Gulstene S, Lang P, Qu M, Laba J, Yaremko B, Rodrigues G, Yu E, Warner A, Palma D. Assessing Treatment Response after Lung SABR: An Evaluation of the Predictive Value of RECIST Criteria. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1510] [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: 11/27/2022]
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13
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Laxague F, Dzioba A, Jasani D, Warner A, Palma DA, Lang P, Venkatesan V, Read N, Nichols AC, Fung K, Yoo J, Mendez A, MacNeil SD. Risk Factors for Poor Survival Outcomes in Parotid Metastatic Cutaneous Squamous Cell Carcinoma. Laryngoscope 2022; 133:1163-1168. [PMID: 35880608 DOI: 10.1002/lary.30289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We aimed to analyze risk factors associated with poor survival outcomes for metastatic cutaneous head-and-neck SCC to the parotid. METHODS All patients undergoing surgery for metastatic cutaneous SCC to the parotid with curative intent between 2011 and 2018, were reviewed. Demographic and clinical characteristics were evaluated. Histopathological data including tumor size and histology, tumor grade, TNM stage, resection margins, lymphovascular invasion, and perineural invasion, were analyzed. Overall survival (OS), disease-specific survival (DSS), and freedom from locoregional recurrence (LRR) were assessed. RESULTS Ninety patients were included (mean age, 77 years; 75 men [83.3%]). A total parotidectomy was performed in 48 patients (53.3%), and 42 (46.7%) underwent a superficial parotidectomy. Seventy patients (77.8%) underwent adjuvant RT. The median follow-up was 31 months (20-39 months). Tumor volume ≥ 50 cm3 and a shorter RT duration (<20 days) were associated with reduced OS (p = 0.002 and p = 0.01, p = 0.02 and p = 0.009, respectively), and DSS (p = 0.004 and p = 0.02, p = 0.04 and p = 0.02, respectively) on univariable and multivariable analysis, respectively. Only a shorter RT duration was associated with worse freedom from LRR on univariable and multivariable analysis, (p = 0.04 and p < 0.001, respectively). However, with death as a competing risk, a shorter duration of RT was not significantly associated with freedom from LRR. CONCLUSION A shorter duration of adjuvant RT, and excised tumor volume ≥50 cm3 were predictive factors of reduced OS and DSS, and a shorter duration of RT was also associated with reduced freedom from LRR in patients with metastatic SCC to the parotid gland. LEVEL OF EVIDENCE Level 4 Laryngoscope, 2022.
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Affiliation(s)
- Francisco Laxague
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Agnieszka Dzioba
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Dhruv Jasani
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Andrew Warner
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - David A Palma
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - Varagur Venkatesan
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - Nancy Read
- Department of Radiation Oncology, Western University, Ontari, London, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, Western University, Ontari, London, Canada
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14
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Kuruvilla S, Meyers BM, Parker C, Nichols AC, Smoragiewicz M, Hotte SJ, Pond GR, Louie AV, Stewart P, Black M, Carreau C, Lee J, Read N, Sathya J, Lang P, Kevin F, Venkatesan V, Kim RB, Palma DA, Winquist E. The RADIO trial: Randomized assessment of cisplatin dosing interval for ototoxicity with curative concurrent chemo-radiation for locally advanced head and neck squamous cell carcinoma. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps12144] [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
TPS12144 Background: Patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) receive curative chemoradiation (CRT) with Cisplatin, as a standard of care. A meta-analysis of 52 randomized trials comparing Low Dose (LD) and High Dose (HD) schedules demonstrated differing toxicity profiles but hearing effects were not rigorously studied. Hearing loss associated with HD Cisplatin can result in survivorship challenges. A local study suggested a protective effect for LD Cisplatin in relation to ototoxicity and pharmacogenomic markers, MATE1 and COMT, to be associated with risk for ototoxicity. We hypothesize that LD cisplatin is associated with reduced frequency of hearing loss when compared to the standard HD cisplatin in LASCCHN patients on CRT and that differences in MATE1/COMT can predict for cisplatin-related ototoxicity and be identified prior to treatment. Our goal is to develop an innovative personalized treatment pathway incorporating predictive pharmacogenomics markers to improve the tolerability and survivorship outcomes of curative CRT for LASCCHN. Methods: This is a prospective, open-label, randomized clinical trial. Following informed consent, eligible LASCCHN patients planned for primary CRT will be stratified by tumor p16 status and then randomized in 1:1 fashion to either concurrent LD Cisplatin (40mg/m2 every week) or HD cisplatin (100mg/m2 every 3 weeks). The primary outcome is to measure the change in incidence of CTCAE grade ≥2 hearing loss and hearing-related quality of life (QOL) at 1 year. As part of secondary and exploratory outcomes, differences in survival, loco-regional control, global QOL and other toxicities (e.g. nephrotoxicity, neurotoxicity) will be assessed. The relationship between MATE1 and COMT, as predictors for cisplatin-related ototoxicity will be evaluated. Cost-effectiveness analyses comparing the two regimens will be assessed. Statistical plan: Based on rates of CTCAE grade ≥2 hearing loss in an earlier study (Winquist et al., 2016), assuming a conservative rate of hearing loss, amongst treated patients, of 60% with HD cisplatin and 30% with LD cisplatin, a total sample size of 92 patients would achieve > 80% statistical power, (two-sided, alpha = 0.05 test of two proportions) to detect these differences. 100 patients would be targeted to accrual for an assumed 5% noncompliance rate. For hearing related QOL, a two-sided, alpha = 0.05, two-sample t-test with 50 patients per group would achieve > 80% statistical power to detect an effect size of 0.60 and > 95% power to detect an effect size of 0.75. All analyses will be based primarily on the intent-to-treat population. An arms-length data and safety monitoring committee (DSMC) will review safety data bi-annually. Trial accrual status: 60 participants have been accrued. Clinical trial information: NCT03649048.
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Affiliation(s)
| | | | | | - Anthony C. Nichols
- Western University and London Health Sciences Centre, London, ON, Canada
| | | | | | | | - Alexander V. Louie
- Odette Cancer Center-Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Paul Stewart
- Western University, Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Morgan Black
- Department of Oncology, Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University and London Regional Cancer Program, London, ON, Canada
| | | | - Justin Lee
- Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Nancy Read
- London Health Sciences Centre, London, ON, Canada
| | - Jinka Sathya
- London Health Sciences Centre, London, ON, Canada
| | | | - Fung Kevin
- University of Western Ontario, London, ON, Canada
| | | | | | | | - Eric Winquist
- Department of Oncology, University of Western Ontario, London, ON, Canada
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15
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McCready A, Quinn M, Francis P, Stortz R, Kuruvilla S, Stewart P, Palma D, Lang P, Read N, Sathya J, Venkatesan V, Nichols A, MacNeil D, Fung K, Mendez A, Carreau C, Hawkins S, Parker C, Warner L, Winquist E. Impact of a Head and Neck Cancer Chemoradiation (HNC CRT) Nurse Practitioner (NP) on Patient Outcomes. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.12.143] [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: 11/26/2022]
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16
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Kim HAJ, Zeng PYF, Sorgini A, Shaikh MH, Khan H, MacNeil D, Khan MI, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Patel KB, Boutros PC, Nichols AC. Tumor molecular differences associated with outcome disparities of Black patients with head and neck cancer. Head Neck 2022; 44:1124-1135. [PMID: 35187756 PMCID: PMC9047510 DOI: 10.1002/hed.27007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Numerous studies of head and neck squamous cell carcinoma (HNSCC) have demonstrated disparate outcomes by race and ethnicity. Beyond known associations with socioeconomic variables, whether these are also associated with differences in tumor molecular composition has thus far been poorly explored. METHODS We downloaded clinical and multiplatform molecular data from The Cancer Genome Atlas and other published studies. These were compared between non-Hispanic Black (n = 43) and White (n = 354) patients with non-HPV-related tumors, using multivariable models. Publicly available validation cohorts were used. RESULTS Black patients had poorer progression-free survival than White patients. Tumors of Black patients had greater copy number aberrations, and increased SFRP1 methylation and miRNA-mediated PRG4 silencing associated with poor survival. PI3K/AkT/mTOR pathway proteins were differentially expressed. CONCLUSIONS There are molecular differences between tumors of Black and White patients that may partially account for differences in survival. These may inform targeted treatment decisions to achieve equitable outcomes.
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Affiliation(s)
- Hugh A J Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Alana Sorgini
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mushfiq H Shaikh
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Halema Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Mohammed I Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Joe S Mymryk
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - John W Barrett
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - Krupal B Patel
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, California, USA.,Department of Urology, University of California, Los Angeles, California, USA.,Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, California, USA.,Institute for Precision Health, University of California, Los Angeles, California, USA.,Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, California, USA
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada.,Department of Oncology, University of Western Ontario, London, Ontario, Canada
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Zayed S, Lin C, Boldt G, Lang P, Read N, Venkatesan V, Sathya J, Fung K, MacNeil D, Mendez A, Yoo J, Warner A, Nichols A, Palma D. Survival Outcomes in Primary Head and Neck Adult Sarcoma: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1115] [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: 10/20/2022]
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18
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Zayed S, Lin C, Boldt G, Lang P, Read N, Venkatesan V, Sathya J, Fung K, MacNeil D, Mendez A, Yoo J, Warner A, Nichols A, Palma D. Survival Outcomes in Primary Angiosarcoma of the Head and Neck: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Kim HAJ, Shaikh MH, Lee M, Zeng PYF, Sorgini A, Akintola T, Deng X, Jarycki L, Khan H, MacNeil D, Khan MI, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Patel K, Mymryk JS, Barrett JW, Boutros PC, Morris LGT, Nichols AC. 3p Arm Loss and Survival in Head and Neck Cancer: An Analysis of TCGA Dataset. Cancers (Basel) 2021; 13:5313. [PMID: 34771477 PMCID: PMC8582539 DOI: 10.3390/cancers13215313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/16/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Loss of the 3p chromosome arm has previously been reported to be a biomarker of poorer outcome in both human papillomavirus (HPV)-positive and HPV-negative head and neck cancer. However, the precise operational measurement of 3p arm loss is unclear and the mutational profile associated with the event has not been thoroughly characterized. We downloaded the clinical, single nucleotide variation (SNV), copy number aberration (CNA), RNA sequencing, and reverse phase protein assay (RPPA) data from The Cancer Genome Atlas (TCGA) and The Cancer Proteome Atlas HNSCC cohorts. Survival data and hypoxia scores were downloaded from published studies. In addition, we report the inclusion of an independent Memorial Sloan Kettering cohort. We assessed the frequency of loci deletions across the 3p arm separately in HPV-positive and -negative disease. We found that deletions on chromosome 3p were almost exclusively an all or none event in the HPV-negative cohort; patients either had <1% or >97% of the arm deleted. 3p arm loss, defined as >97% deletion in HPV-positive patients and >50% in HPV-negative patients, had no impact on survival (p > 0.05). However, HPV-negative tumors with 3p arm loss presented at a higher N-category and overall stage and developed more distant metastases (p < 0.05). They were enriched for SNVs in TP53, and depleted for point mutations in CASP8, HRAS, HLA-A, HUWE1, HLA-B, and COL22A1 (false discovery rate, FDR < 0.05). 3p arm loss was associated with CNAs across the whole genome (FDR < 0.1), and pathway analysis revealed low lymphoid-non-lymphoid cell interactions and cytokine signaling (FDR < 0.1). In the tumor microenvironment, 3p arm lost tumors had low immune cell infiltration (FDR < 0.1) and elevated hypoxia (FDR < 0.1). 3p arm lost tumors had lower abundance of proteins phospho-HER3 and ANXA1, and higher abundance of miRNAs hsa-miR-548k and hsa-miR-421, which were all associated with survival. There were no molecular differences by 3p arm status in HPV-positive patients, at least at our statistical power level. 3p arm loss is largely an all or none phenomenon in HPV-negative disease and does not predict poorer survival from the time of diagnosis in TCGA cohort. However, it produces tumors with distinct molecular characteristics and may represent a clinically useful biomarker to guide treatment decisions for HPV-negative patients.
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Affiliation(s)
- Hugh Andrew Jinwook Kim
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Mushfiq Hassan Shaikh
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Mark Lee
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY 10065, USA; (M.L.); (L.G.T.M.)
| | - Peter Y. F. Zeng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Alana Sorgini
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Temitope Akintola
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Xiaoxiao Deng
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Laura Jarycki
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Halema Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Danielle MacNeil
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Mohammed Imran Khan
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Adrian Mendez
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - John Yoo
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Kevin Fung
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Pencilla Lang
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - David A. Palma
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Krupal Patel
- Moffitt Cancer Center, Department of Otolaryngology, Tampa, FL 33612, USA;
| | - Joe S. Mymryk
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
- Department of Microbiology & Immunology, University of Western Ontario, London, ON N6A3K7, Canada
| | - John W. Barrett
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
| | - Paul C. Boutros
- Department of Human Genetics, University of California, Los Angeles, CA 90095, USA;
- Department of Urology, University of California, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA 90095, USA
- Institute for Precision Health, University of California, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA 90095, USA
| | - Luc G. T. Morris
- Memorial Sloan Kettering Cancer Center, Department of Surgery, New York, NY 10065, USA; (M.L.); (L.G.T.M.)
| | - Anthony C. Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, ON N6A3K7, Canada; (H.A.J.K.); (M.H.S.); (P.Y.F.Z.); (A.S.); (T.A.); (X.D.); (L.J.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A3K7, Canada;
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Wegener D, Lang P, Paulsen F, Weidner N, Zips D, Ebinger M, Holzer U, Döring M, Heinzelmann F. Primary immunosuppressive TNI-based conditioning regimens in pediatric patients treated with haploidentical hematopoietic cell transplantation. Strahlenther Onkol 2021; 198:66-72. [PMID: 34476532 PMCID: PMC8760200 DOI: 10.1007/s00066-021-01840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/09/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE This retrospective analysis aims to address the toxicity and efficacy of a modified total nodal irradiation (TNI)-based conditioning regimen before haploidentical hematopoietic cell transplantation (HCT) in pediatric patients. MATERIALS AND METHODS Patient data including long-term follow-up were evaluated of 7 pediatric patients with malignant (n = 2) and non-malignant diseases (n = 5) who were treated by a primary TNI-based conditioning regimen. TNI was performed using anterior/posterior opposing fields. All patients received 7 Gy single-dose TNI combined with systemic agents followed by an infusion of peripheral blood stem cells (n = 7). All children had haploidentical family donors. RESULTS Engraftment was reached in 6/7 children after a median time of 9.5 days; 1 child had primary graft failure but was successfully reconditioned shortly thereafter. After an average follow-up time of 103.5 months (range 8.8-138.5 months), event-free (EFS) and overall survival (OS) rates were 71.4% and 85.7%, respectively. One child with a non-malignant disease died 8.8 months after transplantation due to a relapse and a multiple organ failure. Follow-up data was available for 5/6 long-term survivors with a median follow-up (FU) of 106.2 months (range 54.5-138.5 months). Hypothyroidism and deficiency of sexual hormones was present in 3/5 patients each. Mean forced expiratory volume in 1 s (FEV1) after TNI was 71%; mean vital capacity (VC) was 78%. Growth failure (< 10th percentile) occurred in 2/5 patients (height) and 1/5 patient (weight). No secondary malignancies were reported. CONCLUSION In this group of patients, a primary single-dose 7 Gy TNI-based conditioning regimen before HCT in pediatric patients allowed sustained engraftment combined with a tolerable toxicity profile leading to long-term OS/EFS. Late toxicity after a median FU of over 9 years includes growth failure, manageable hormonal deficiencies, and acceptable decrease in lung function.
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Affiliation(s)
- D Wegener
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany.
| | - P Lang
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - F Paulsen
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - N Weidner
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - D Zips
- Department of Radiation Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - M Ebinger
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - U Holzer
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - M Döring
- Department of Paediatrics I, Hematology and Oncology, University Clinic of Tuebingen, Tuebingen, Germany
| | - F Heinzelmann
- Department of Radiation Oncology, Clinic of Esslingen, Esslingen, Germany
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Affiliation(s)
- Pencilla Lang
- Division of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - David Palma
- Division of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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Thiel U, Schober SJ, Ranft A, Gassmann H, Jabar S, Gall K, von Lüttichau I, Wawer A, Koscielniak E, Diaz MA, Ussowicz M, Kazantsev I, Afanasyev B, Merker M, Klingebiel T, Prete A, Gruhn B, Bader P, Jürgens H, Dirksen U, Handgretinger R, Burdach S, Lang P. Correction to: No difference in survival after HLA mismatched versus HLA matched allogeneic stem cell transplantation in Ewing sarcoma patients with advanced disease. Bone Marrow Transplant 2021; 56:2320. [PMID: 34373590 PMCID: PMC8410592 DOI: 10.1038/s41409-021-01421-8] [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: 12/03/2022]
Affiliation(s)
- U Thiel
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany.
| | - S J Schober
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - A Ranft
- Pediatrics III, West German Cancer Centre Essen, University Hospital Essen, Essen, Germany
| | - H Gassmann
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - S Jabar
- Pediatrics III, West German Cancer Centre Essen, University Hospital Essen, Essen, Germany
| | - K Gall
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - I von Lüttichau
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - A Wawer
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - E Koscielniak
- Department of Pediatric Oncology, Hematology and Immunology, Olgahospital, Stuttgart, Germany
| | - M A Diaz
- Department of Pediatric Hematology-Oncology and Hematopoietic Stem Cell Transplantation, Hospital Infantil Universitario Niño Jesus, Madrid, Spain
| | - M Ussowicz
- Department of Pediatric Hematology, Oncology and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - I Kazantsev
- Raisa Gorbacheva Memorial Institute for Pediatric Oncology, Hematology and Transplantat, Pavlov First St. Petersburg State Universityion, St. Petersburg, Russia
| | - B Afanasyev
- Raisa Gorbacheva Memorial Institute for Pediatric Oncology, Hematology and Transplantat, Pavlov First St. Petersburg State Universityion, St. Petersburg, Russia
| | - M Merker
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - T Klingebiel
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - A Prete
- Department of Pediatric Hematology and Oncology, Ospedale S Orsola Malpighi, Bologna, Italy
| | - B Gruhn
- Department of Pediatrics, Jena University Hospital, Jena, Germany
| | - P Bader
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Frankfurt, Frankfurt, Germany
| | - H Jürgens
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Münster, Münster, Germany
| | - U Dirksen
- Pediatrics III, West German Cancer Centre Essen, University Hospital Essen, Essen, Germany
| | - R Handgretinger
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Tübingen, Tübingen, Germany
| | - S Burdach
- Department of Pediatrics and Children's Cancer Research Center, School of Medicine, Kinderklinik München Schwabing, Technical University of Munich, Munich, Germany
| | - P Lang
- Department of Pediatric Hematology and Oncology, Universitätsklinikum Tübingen, Tübingen, Germany
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Dahan LS, Giorgi R, Vergez S, Le Taillandier de Gabory L, Costes-Martineau V, Herman P, Poissonnet G, Mauvais O, Malard O, Garrel R, Uro-Coste E, Barry B, Bach C, Chevalier D, Mouawad F, Merol JC, Bastit V, Thariat J, Gilain L, Dufour X, Righini CA, Moya-Plana A, Even C, Radulesco T, Michel J, Baujat B, Fakhry N, Albert S, Andry G, Babin E, Bach C, Badet JM, Badoual C, Baglin A, Banal A, Barry B, Baudin E, Baujat B, Bensadoun R, Bertolus C, Bessède JP, Blanchard D, Borel C, Bozorg-Grayeli A, Breheret R, Breton P, Brugel L, Calais G, Casiraghi O, Cassagnau E, Castillo L, Ceruse P, Chabolle F, Chevalier D, Chobaut J, Choussy O, Cosmidis A, Coste A, Costes V, Crampette L, Darrouzet V, Demez P, Dessi P, Devauchelle B, Dolivet G, Dubrulle F, Duflo S, Dufour X, Faivre S, Fakhry N, Ferron C, Floret F, de Gabory L, Garrel R, Geoffrois L, Gilain L, Giovanni A, Girod A, Guerrier B, Hans S, Herman P, Hofman P, Housset M, Jankowski R, Jegoux F, Juliéron M, Kaminsky MC, Kolb F, St Guily JL, Laccoureye L, Lallemant B, Lang P, Lartigau E, Lavieille JP, Lefevre M, Leroy X, Malard O, Massip F, Mauvais O, Merol JC, Michel J, Mom T, Morinière S, de Monès E, Moulin G, Noel G, Poissonnet G, Prades JM, Radulesco T, de Raucourt D, Reyt E, Righini C, Robin YM, Rolland F, Ruhin B, Sarroul N, Schultz P, Serrano E, Sterkers O, Strunski V, Sudaka A, Tassart M, Testelin S, Thariat J, Timochenko A, Toussaint B, Coste EU, Valette G, Van den Abbeele T, Varoquaux A, Veillon F, Vergez S, Wassef M. Mucoepidermoid carcinoma of salivary glands: A French Network of Rare Head and Neck Tumors (REFCOR) prospective study of 292 cases. Eur J Surg Oncol 2021; 47:1376-1383. [DOI: 10.1016/j.ejso.2020.11.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/31/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
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Zayed S, Lin C, Boldt G, Lang P, Read N, Venkatesan V, Sathya J, Kevin F, MacNeil D, Mendez A, Yoo J, Warner A, Nichols AC, Palma DA. Survival outcomes in primary head and neck adult sarcoma: A systematic review and meta-analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6055] [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
6055 Background: Head and neck sarcomas (HNS) are rare entities and confer substantial morbidity and mortality. Yet, the optimal management of HNS remains unclear. This study aimed to describe the epidemiology of HNS and to identify the most favorable treatment approach. Methods: We performed a systematic review and meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the PubMed (Medline), EMBASE, and Cochrane Library databases, queried from 1990 until present. Articles in the English language reporting on survival outcomes of adult primary HNS patients treated with curative-intent were included. All estimates were weighted based on sample size. Analysis of variance (ANOVA) and two-sample t-tests were used as appropriate. Meta-analyses were performed using random effects models. This study was registered with PROSPERO, CRD42021220970. Results: A total of 3652 articles were identified, with 42 articles reporting on 21228 patients, meeting inclusion criteria. Mean ± SD age was 56.7 ± 14.6 years with 14170 (67.0%) men and 6991 (33.0%) women. The most common locations included skin and soft tissues (n = 12749, 63.3%), bones of skull and face (n = 2256, 11.2%), and oral cavity (n = 1775, 8.8%). The most common histologies included undifferentiated pleomorphic sarcoma (n = 5065, 24.8%), osteosarcoma (n = 2578, 12.6%), Kaposi sarcoma (n = 2316, 11.3%), chondrosarcoma (n = 2141, 10.5%), and hemangiosarcoma (n = 2072, 10.1%). 5459 patients had early stage I-II disease (76.9%) whereas 1643 had late stage III-IV disease (23.1%). Most received surgery alone (n = 10968, 61.0%), 3917 (21.8%) received surgery and radiotherapy (RT), 2173 (12.1%) received definitive RT/chemoradiotherapy (CRT), 811 (4.5%) received surgery and CRT, and 98 (0.5%) received surgery and chemotherapy. Negative margins were achieved in 6081 (76.5%). Mean ± SD follow-up was 55.3 ± 42.8 months. Weighted mean, 2-, 5-, and 10-year overall survival (OS) were 78.5 months, 75.9%, 63.2%, and 54.9% respectively. There was no significant difference in mean OS (P = 0.674) or 5-year OS (P = 0.965) between patients who received surgery alone, multimodality treatment with surgery and RT/CRT, or definitive RT/CRT. Mean ± SD 5-year OS was significantly higher with negative margins (62.7 ± 20.8%) compared with positive margins (22.7 ± 19.1%; P = 0.001). Mean ± SD local recurrence rate (LRR) was 32.0 ± 13.0%. LRRs were 41.8% for definitive RT/CRT, 39.3% for surgery and CRT, 33.6% for surgery alone, 24.7% for surgery and chemotherapy, and 20.1% for surgery and RT (P = 0.126). Conclusions: In the largest HNS study to date, negative margins were associated with an improvement in OS. Multimodality treatment did not confer an OS benefit. Definitive RT/CRT may be associated with a higher LRR. Randomized trials are needed to establish the optimal treatment approach for HNS.
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Affiliation(s)
- Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Cindy Lin
- Western University, London, ON, Canada
| | - Gabriel Boldt
- Department of Oncology, London Regional Cancer Program, London, ON, Canada
| | | | - Nancy Read
- London Health Sciences Centre, London, ON, Canada
| | | | - Jinka Sathya
- London Health Sciences Centre, London, ON, Canada
| | - Fung Kevin
- University of Western Ontario, London, ON, Canada
| | - Danielle MacNeil
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Adrian Mendez
- London Health Sciences Centre, Western University, London, ON, Canada
| | - John Yoo
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Anthony C. Nichols
- Western University and London Health Sciences Centre, London, ON, Canada
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Zayed S, Lin C, Boldt G, Lang P, Read N, Venkatesan V, Sathya J, Kevin F, MacNeil D, Mendez A, Yoo J, Warner A, Nichols AC, Palma DA. Survival outcomes in primary angiosarcoma of the head and neck: A systematic review and meta-analysis. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e18039] [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
e18039 Background: Angiosarcoma of the head and neck (ASHN) is a rare entity and confers substantial morbidity and mortality. Yet, the optimal management of ASHN remains unclear. This study aimed to describe the epidemiology of ASHN and to identify the most favorable treatment approach. Methods: We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the PubMed (Medline), EMBASE, and Cochrane Library databases, queried from 1990 until present. Articles in the English language reporting on survival outcomes of adult primary ASHN treated with curative-intent, were included. All estimates were weighted based on sample size. Analysis of variance (ANOVA) and two-sample t-tests were used as appropriate. This study was registered with PROSPERO, CRD42021220970. Results: A total of 3652 studies were identified, with 14 articles reporting on 2265 ASHN patients, meeting inclusion criteria. Mean ± SD age was 70.6 ± 7.7 years with 1621 (66.6%) men and 812 (33.4%) women. ASHN involved the scalp (n = 176, 57.9%) and the face (n = 128, 42.1%). 249 patients had early stage I-II disease (39.6%) whereas 379 had late stage III-IV disease (60.4%). Most (n = 529, 45.6%) received surgery and radiotherapy (RT), 305 (26.3%) received surgery alone, 210 (18.1%) received definitive RT/chemoradiotherapy (CRT), 75 (6.5%) received surgery and CRT, and 33 (2.8%) received surgery and chemotherapy. Negative margins were achieved in 471 (55.9%) whereas 371 (44.1%) had positive margins. Mean ± SD follow-up was 41.7 ± 15.4 months. Weighted mean, 1-, 5-, and 10-year overall survival (OS) were 26.9 months, 67.3%, 30.6%, and 20.8% respectively. Mean and 5-year disease-specific survival (DSS) were 72.9 months and 50.3% respectively. Mean ± SD local recurrence rate (LRR) was 32.1 ± 11.7%. Median RT dose delivered was 60 Gy (interquartile range: 60-70). Patients who received surgery had a significantly higher mean OS (34.9 vs. 18.7 months, P = 0.04) and 5-year OS (30.1 vs. 14.2%, P = 0.01) compared with those who did not receive surgery. There was no significant difference in mean OS for receiving adjuvant chemotherapy (P = 0.99) or RT (P = 0.51). Conclusions: In the largest ASHN study to date, definitive surgical resection was associated with an improvement in OS. Multimodality treatment did not confer an OS benefit. Randomized trials are needed to establish the optimal treatment approach for ASHN.
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Affiliation(s)
- Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Cindy Lin
- Western University, London, ON, Canada
| | - Gabriel Boldt
- Department of Oncology, London Regional Cancer Program, London, ON, Canada
| | | | - Nancy Read
- London Health Sciences Centre, London, ON, Canada
| | | | - Jinka Sathya
- London Health Sciences Centre, London, ON, Canada
| | - Fung Kevin
- University of Western Ontario, London, ON, Canada
| | - Danielle MacNeil
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Adrian Mendez
- London Health Sciences Centre, Western University, London, ON, Canada
| | - John Yoo
- London Health Sciences Centre, Western University, London, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre, London, ON, Canada
| | - Anthony C. Nichols
- Western University and London Health Sciences Centre, London, ON, Canada
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Zayed S, Lang P, Mendez LC, Read N, Sathya J, Venkatesan V, Moulin DE, Warner A, Palma DA. Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial. BMC Palliat Care 2021; 20:45. [PMID: 33740977 PMCID: PMC7980584 DOI: 10.1186/s12904-021-00735-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/26/2021] [Indexed: 03/17/2023] Open
Abstract
Background Radiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy alone (RT) or chemoradiotherapy (CRT), often reducing treatment compliance. However, no standard currently exists for the treatment of RIM, and high dose opioid therapy, with its associated side effects and increased risk for chronic opioid use, remains the cornerstone of HNC pain management. The goal of this randomized clinical trial is to compare multimodal analgesia using analgesic medications with different mechanisms of action, to the institutional standard of opioid analgesia alone, in order to ascertain the optimal analgesic regimen for the management of RIM pain in HNC patients. Methods In this open-label, single-institution, non-inferiority, randomized clinical trial, sixty-two patients with mucosal head and neck malignancies treated with curative-intent radiation will be randomized in a 1:1 ratio, stratified by RT or CRT, between Arm 1: opioid analgesia alone as per the institutional standard, or Arm 2: multimodal analgesia using Pregabalin, Acetaminophen, and Naproxen, in addition to opioids, if required. The primary endpoint is the average 11-Numeric Rating Scale (11-NRS) score for pain during the last week of radiation treatment. Secondary endpoints include: average weekly opioid use, duration of opioid requirement, average daily 11-NRS score for pain, average weekly opioids dispensed, quality of life, hospitalizations for analgesic medication-induced complications, time to feeding tube insertion, weight loss, toxicity, treatment interruptions, and death within 3 months of completing RT treatment. Patients are eligible once analgesia is required for moderate 4/10 pain. Discussion This study will assess the efficacy and safety of multimodal analgesia and its impact on opioid requirements, clinical outcomes, and quality of life, as a potential new standard treatment for RIM pain in HNC patients undergoing definitive RT or CRT. Trial registration ClinicalTrials.gov Identifier: NCT04221165. Date of registration: January 9, 2020. Appendix 2 reports the World Health Organization trial registration dataset. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00735-0.
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Affiliation(s)
- Sondos Zayed
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Lucas C Mendez
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Nancy Read
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Jinka Sathya
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Varagur Venkatesan
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Dwight E Moulin
- Departments of Clinical Neurological Sciences and Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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Kim HAJ, Zeng PYF, Shaikh MH, Mundi N, Ghasemi F, Di Gravio E, Khan H, MacNeil D, Khan MI, Patel K, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Boutros PC, Nichols AC. All HPV-negative head and neck cancers are not the same: Analysis of the TCGA dataset reveals that anatomical sites have distinct mutation, transcriptome, hypoxia, and tumor microenvironment profiles. Oral Oncol 2021; 116:105260. [PMID: 33725617 DOI: 10.1016/j.oraloncology.2021.105260] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Head and neck squamous cell carcinoma (HNSCC) affects various anatomical sites, which often dictates whether the cancer is managed with primary surgery or radiation. This study aimed to assess differences in single nucleotide variation (SNV), copy number, mRNA abundance, methylation, and tumor microenvironment (TME) between HPV-negative oral cavity (OC), oropharyngeal (OPC), hypopharyngeal (HPC), and laryngeal (LC) cancers within The Cancer Genome Atlas (TCGA). METHODS We downloaded the clinical information and molecular data for the TCGA HNSCC cohort from the data portal and published literature. The TME was estimated using mRNA abundance data. We conducted our analyses within the Bioconductor statistical framework in the R environment. CNA and mRNA abundance results were correlated and grouped with SNV results for downstream pathway analysis. RESULTS LC had a higher mutational burden than OC and OPC (p <10-4). LC tumors were enriched in CSMD3, NSD1, DCHS2 and ANK2 SNVs, while OC tumors were enriched in CASP8 SNVs (FDR < 0.1). LCs were enriched for neuronal and glycosylation pathways, while OCs were enriched for extracellular matrix pathways. B cells and endothelial cells were more abundant in LC while monocytes were more abundant in OC (FDR < 0.1). OPC was the most hypoxic, followed by OC then LC (FDR < 0.05). OC had greater methylation of Hox genes than LC. Subsite analysis revealed that oral tongue cancers had fewer CASP8 and FBN2 mutations and higher dendritic cell abundance than other oral cavity cancers. CONCLUSIONS We identified significant genomic, transcriptional, and microenvironmental differences between HPV-negative HNSCC. Further study is warranted to determine if these findings portend differential response to specific treatment modalities.
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Affiliation(s)
- Hugh Andrew Jinwook Kim
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Peter Y F Zeng
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Mushfiq Hassan Shaikh
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Neil Mundi
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Farhad Ghasemi
- Department of General Surgery, University of Western Ontario, London, Ontario, Canada
| | - Eric Di Gravio
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Halema Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Mohammed Imran Khan
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Krupal Patel
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, FL, USA
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Joe S Mymryk
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada; Department of Microbiology & Immunology, University of Western Ontario, London, Ontario, Canada
| | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Paul C Boutros
- Department of Human Genetics, University of California, Los Angeles, CA, USA; Department of Urology, University of California, Los Angeles, CA, USA; Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA, USA; Institute for Precision Health, University of California, Los Angeles, CA, USA; Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA, USA
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada; Department of Oncology, University of Western Ontario, London, Ontario, Canada.
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Sorgini A, Kim HAJ, Zeng PYF, Shaikh MH, Mundi N, Ghasemi F, Di Gravio E, Khan H, MacNeil D, Khan MI, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Patel KB, Boutros PC, Nichols AC. Analysis of the TCGA Dataset Reveals that Subsites of Laryngeal Squamous Cell Carcinoma are Molecularly Distinct. Cancers (Basel) 2020; 13:cancers13010105. [PMID: 33396315 PMCID: PMC7794818 DOI: 10.3390/cancers13010105] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/16/2020] [Accepted: 12/26/2020] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Squamous cell carcinomas from different parts of the larynx have distinct presentations and prognoses, but the molecular basis for this discrepancy has yet to be characterized. We aimed to determine whether different types of mutations at the DNA, mRNA, and protein levels exist to explain the differential prognoses observed. We found that cancers of the supraglottis had higher overall and smoking-associated genome mutations. Further, supraglottic cancers had a significantly poorer prognosis when other clinical variables and mutational status were controlled for. Different protein pathways were enriched in each subsite: muscle-related in the glottis and neural in the supraglottis. Specific cancer-related proteins were also differentially abundant between the supraglottis and glottis. Our findings may partially explain therapeutic response differences, but further study is required for validation. Abstract Laryngeal squamous cell carcinoma (LSCC) from different subsites have distinct presentations and prognosis. In this study, we carried out a multiomic comparison of LSCC subsites. The Cancer Genome Atlas (TCGA) LSCC cohort was analyzed in the R statistical environment for differences between supraglottic and glottic cancers in single nucleotide variations (SNVs), copy number alterations (CNAs), mRNA abundance, protein abundance, pathway overrepresentation, tumor microenvironment (TME), hypoxia status, and patient outcome. Supraglottic cancers had significantly higher overall and smoking-associated SNV mutational load. Pathway analysis revealed upregulation of muscle related pathways in glottic cancer and neural pathways in supraglottic cancer. Proteins involved in cancer relevant signaling pathways including PI3K/Akt/mTOR, the cell cycle, and PDL1 were differentially abundant between subsites. Glottic and supraglottic tumors have different molecular profiles, which may partially account for differences in presentation and response to therapy.
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Affiliation(s)
- Alana Sorgini
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Hugh Andrew Jinwook Kim
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Peter Y. F. Zeng
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Mushfiq Hassan Shaikh
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Neil Mundi
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Farhad Ghasemi
- Department of General Surgery, University of Western Ontario, London, ON N6A 5C5, Canada;
| | - Eric Di Gravio
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Halema Khan
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Danielle MacNeil
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Mohammed Imran Khan
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
| | - Adrian Mendez
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - John Yoo
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Kevin Fung
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Pencilla Lang
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - David A. Palma
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Joe S. Mymryk
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
- Department of Microbiology & Immunology, University of Western Ontario, London, ON N6A 5C1, Canada
| | - John W. Barrett
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
| | - Krupal B. Patel
- Department of Otolaryngology, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Paul C. Boutros
- Department of Human Genetics, University of California, Los Angeles, CA 90095, USA;
- Department of Urology, University of California, Los Angeles, CA 90095, USA
- Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, University of California, Los Angeles, CA 90095, USA
- Institute for Precision Health, University of California, Los Angeles, CA 90095, USA
- Jonsson Comprehensive Cancer Centre, University of California, Los Angeles, CA 90095, USA
| | - Anthony C. Nichols
- Department of Otolaryngology, Head and Neck Surgery, University of Western Ontario, London, ON N6A 5W9, Canada; (A.S.); (H.A.J.K.); (P.Y.F.Z.); (M.H.S.); (N.M.); (E.D.G.); (H.K.); (D.M.); (M.I.K.); (A.M.); (J.Y.); (K.F.); (D.A.P.); (J.S.M.); (J.W.B.)
- Department of Oncology, University of Western Ontario, London, ON N6A 5W9, Canada;
- Correspondence: ; Tel.: +519-685-8804
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Kim HA, Zeng PY, Sorgini A, Shaikh MH, Mundi N, Khan H, MacNeil D, Khan MI, Patel K, Mendez A, Yoo J, Fung K, Lang P, Palma DA, Mymryk JS, Barrett JW, Boutros PC, Nichols AC. Abstract PR11: Multi-omic disparities in head and neck squamous cell carcinomas in patients of different racio-ethnic backgrounds. Cancer Epidemiol Biomarkers Prev 2020. [DOI: 10.1158/1538-7755.disp20-pr11] [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: 11/16/2022] Open
Abstract
Abstract
Background: Numerous studies have demonstrated poorer outcomes by race/ethnicity in head and neck squamous cell carcinoma (HNSCC). Although some studies have identified differences in socioeconomic status and access to care as important factors affecting outcomes, differences in the genomic and extracellular composition of tumors from patients of different races/ethnicities have yet to be explored. Methods: We downloaded the clinical information, single nucleotide variation (SNV), copy number aberration (CNA), mRNA sequencing, and reverse phase protein assay (RPPA) data from The Cancer Genome Atlas (TCGA) and The Cancer Proteome Altas HNSCC cohorts. Survival data and hypoxia scores were downloaded from published studies. We stratified the cohort into combined racio-ethnic groups (REG) as follows: White/Non-Hispanic (White), Hispanic/Latino (Hispanic), Black/African American (Black), Asian, American Indian/Non-Hispanic (Indigenous American). Cases positive for human papillomavirus (HPV) occurred almost exclusively among White patients (68/71) and thus they were excluded. Results: The HPV-negative cohort contained 354 White, 43 Black, 22 Hispanic and 11 Asian and 1 Indigenous American patient. Black patients had poorer overall and progression-free survival than White patients on univariate and multivariate analysis, respectively (p<0.05). There were no significant SNV differences between any REGs after false discovery rate (FDR) correction. However, there was a large number of CNAs with higher frequency in Black patients compared to White patients (2294 shallow deletions, 96 gains, FDR<0.1). In particular, loss of the 3p chromosome arm was markedly more frequent in tumors from Black patients (p<0.01), but was not associated with poorer prognosis. From the RPPA data we found 31 cancer-associated proteins and phosphoproteins differentially expressed between Black and White patients (FDR<0.1). These included proteins in the PI3K/Akt/mTOR pathway in White patients, and N-cadherin and Hsp70 in Black patients. Deconvolution of the mRNA sequencing counts revealed differences in lymphocyte infiltration of the tumor microenvironment between Black, Hispanic, and White patients (FDR<0.1). Black patients also had more hypoxic tumors than White patients (FDR<0.1). Conclusions: In summary, we have identified important biological differences between tumors of different REGs that may partially account for differences in survival and inform targeted treatment decisions towards equitable outcomes.
Citation Format: Hugh A.J. Kim, Peter Y.F. Zeng, Alana Sorgini, Mushfiq H. Shaikh, Neil Mundi, Halema Khan, Danielle MacNeil, Mohammed I. Khan, Krupal Patel, Adrian Mendez, John Yoo, Kevin Fung, Pencilla Lang, David A. Palma, Joe S. Mymryk, John W. Barrett, Paul C. Boutros, Anthony C. Nichols. Multi-omic disparities in head and neck squamous cell carcinomas in patients of different racio-ethnic backgrounds [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR11.
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Affiliation(s)
| | | | | | | | - Neil Mundi
- 1Western University, London, ON, Canada,
| | | | | | | | | | | | - John Yoo
- 1Western University, London, ON, Canada,
| | - Kevin Fung
- 1Western University, London, ON, Canada,
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Weißleder A, Kulla M, Annecke T, Beese A, Lang P, Beinkofer D, Lefering R, Trentzsch H, Jost C, Treffer D. [Acute treatment of pregnant women after severe trauma-a retrospective multicenter analysis]. Unfallchirurg 2020; 123:944-953. [PMID: 33180155 DOI: 10.1007/s00113-020-00915-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND For the medical team, the management of pregnant trauma patients is a particular challenge. The aim of this study is to compile this data and to determine differences between pregnant and not pregnant trauma patients. MATERIALS AND METHODS We carried out a retrospective data analysis from the TraumaRegister DGU® with a comparison of 102 pregnant and 3135 not pregnant women of child-bearing age (16-45 years) from 2016-2018 who were treated in a trauma center. All patients were delivered to the resuscitation room and received intensive care treatment. RESULTS In Germany, Austria and Switzerland 3.2% of all trauma patients (102 women) were pregnant. Women with an average age of 29 years suffered most often trauma as a result of a road traffic accident. Major trauma (Injury Severity Score [ISS] ≥16 points) was seen in 24.5% of the pregnant women and 37.4% of the nonpregnant women. A computer tomography (whole body computer tomography) was carried out in 32.7% of all pregnant women but in 79.8% of the nonpregnant women. As a result of the trauma, 2.9% of the pregnant and 3.5% of the not pregnant women died. The standardised mortality rate (SMR) was 0.42 in pregnant women and 0.63 in nonpregnant women. CONCLUSION For the first time there is data regarding incidence, trauma mechanism, prehospital and in-hospital care as well as intensive care of pregnant trauma patients in Germany, Austria and Switzerland. Further research regarding foetal outcome and trauma-related injuries in pregnant women is needed to develop an adjusted management for these patients ready to implement in trauma centres. Gynaecologists and obstetricians should be implemented in the trauma room team when needed.
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Affiliation(s)
- A Weißleder
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland.
- Klinik XX Gynäkologie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland.
| | - M Kulla
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - T Annecke
- Universität zu Köln, Medizinische Fakultät und Uniklinik, Klinik für Anästhesiologie und Operative Intensivmedizin, Kerpener Straße 62, 50937, Köln, Deutschland
- Klinik für Anästhesiologie und operative Intensivmedizin, Klinikum der Universität Witten/Herdecke - Krankenhaus Köln-Merheim, Köln, Deutschland
| | - A Beese
- Praxis für Frauenheilkunde & Geburtshilfe Jena, Jena, Deutschland
| | - P Lang
- Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke am Campus Köln-Merheim, Köln-Merheim, Deutschland
| | - D Beinkofer
- Klinik XX Gynäkologie, Bundeswehrkrankenhaus Westerstede, Westerstede, Deutschland
| | - R Lefering
- Klinik für Unfallchirurgie und Orthopädie, Septische und Rekonstruktive Chirurgie, Sporttraumatologie, Bundeswehrkrankenhaus Ulm, Ulm, Deutschland
- Institut für Forschung in der Operativen Medizin, Universität Witten/Herdecke am Campus Köln-Merheim, Köln-Merheim, Deutschland
| | - H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Schillerstraße 53, 80336, München, Deutschland
| | - C Jost
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
| | - D Treffer
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Bundeswehrkrankenhaus Ulm, Oberer Eselsberg 40, 89081, Ulm, Deutschland
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Price KAR, Nichols AC, Shen CJ, Rammal A, Lang P, Palma DA, Rosenberg AJ, Chera BS, Agrawal N. Novel Strategies to Effectively De-escalate Curative-Intent Therapy for Patients With HPV-Associated Oropharyngeal Cancer: Current and Future Directions. Am Soc Clin Oncol Educ Book 2020; 40:1-13. [PMID: 32213088 DOI: 10.1200/edbk_280687] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The treatment of patients with HPV-associated oropharyngeal cancer (HPV-OPC) is rapidly evolving and challenging the standard of care of definitive radiotherapy with concurrent cisplatin. There are numerous promising de-escalation strategies under investigation, including deintensified definitive chemoradiotherapy, transoral surgery followed by de-escalated adjuvant therapy, and induction chemotherapy followed by de-escalated locoregional therapy. Definitive radiotherapy alone or with cetuximab is not recommended for curative-intent treatment of patients with locally advanced HPV-OPC. The results of ongoing phase III studies are awaited to help answer key questions and address ongoing controversies to transform the treatment of patients with HPV-OPC. Strategies for de-escalation under investigation include the incorporation of immunotherapy and the use of novel biomarkers for patient selection for de-escalation.
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Affiliation(s)
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Almoaidbellah Rammal
- Department of Otolaryngology-Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
| | - Pencilla Lang
- Division of Radiation Oncology, Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Ari J Rosenberg
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Bhisham S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Nishant Agrawal
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Chicago, Chicago, IL
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Di Gravio EJ, Lang P, Kim HAJ, Chinnery T, Mundi N, MacNeil SD, Mendez A, Yoo J, Fung K, Mymryk JS, Barrett JW, Read N, Venkatesan V, Kuruvilla S, Mendez LC, Winquist E, Mitchell S, Mattonen SA, Nichols AC, Palma DA. Modern treatment outcomes for early T-stage oropharyngeal cancer treated with intensity-modulated radiation therapy at a tertiary care institution. Radiat Oncol 2020; 15:261. [PMID: 33168055 PMCID: PMC7654053 DOI: 10.1186/s13014-020-01705-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/30/2020] [Indexed: 01/19/2023] Open
Abstract
Background Transoral surgery (TOS), particularly transoral robotic surgery (TORS) has become the preferred modality in the United States for the treatment of early stage oropharyngeal cancer, largely due to assumptions of fewer toxicities and improved quality of life compared to primary radiotherapy (RT). However, these assumptions are based on retrospective analysis, a subset of which utilize primary RT groups not limited to T1-2 stage tumors for which transoral robotic surgery is FDA approved. Thus, there is potential for underestimating survival and overestimating toxicity, including treatment related mortality, in primary RT. Methods Consecutive cases of early T-stage (T1–T2) oropharyngeal cancer presenting to the London Health Sciences Centre between 2014 and 2018 treated with RT or chemoradiation (CRT) were reviewed. Patient demographics, treatment details, survival outcomes and toxicity were collected. Toxicities were retrospectively graded using the Common Terminology Criteria for Adverse Events criteria. Results A total of 198 patients were identified, of which 82% were male and 73% were HPV-positive. Sixty-eight percent of patients experienced a grade 2 toxicity, 48% a grade 3 and 4% a grade 4. The most frequent toxicities were dysphagia, neutropenia and ototoxicity. The rates of gastrostomy tube dependence at 1 and 2 years were 2.5% and 1% respectively. There were no grade 5 (fatal) toxicities. HPV-positive patients experienced improved 5-year overall survival (86% vs 64%, p = 0.0026). Conclusions Primary RT or CRT provides outstanding survival for early T-stage disease, with low rates of severe toxicity and feeding tube dependence. This study provides a reference for comparison for patients treated with primary transoral surgery.
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Affiliation(s)
- Eric J Di Gravio
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Pencilla Lang
- Department of Oncology, Western University, London, ON, Canada
| | - Hugh Andrew Jinwook Kim
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Tricia Chinnery
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Neil Mundi
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Joe S Mymryk
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Western University, London, ON, Canada
| | - John W Barrett
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Nancy Read
- Department of Oncology, Western University, London, ON, Canada
| | | | - Sara Kuruvilla
- Department of Oncology, Western University, London, ON, Canada
| | - Lucas C Mendez
- Department of Oncology, Western University, London, ON, Canada
| | - Eric Winquist
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada
| | - Sylvia Mitchell
- Department of Oncology, Western University, London, ON, Canada
| | - Sarah A Mattonen
- Department of Oncology, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada.,Department of Oncology, Western University, London, ON, Canada.,Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, London Health Science Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - David A Palma
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada. .,Department of Oncology, Western University, London, ON, Canada. .,Department of Otolaryngology - Head and Neck Surgery, Victoria Hospital, London Health Science Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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Lang P, Zayed S, Warner A, Boldt G, Mendez L, Venkatesan V, Sathya J, Read N, Palma D. 53: Utility of Post-Treatment Pet in Hpv Associated Oropharyngeal Cancer: A Systematic Review and Meta-Analysis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)30945-2] [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: 11/26/2022]
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D'Souza D, Velker VM, Mendez L, Lang P, Sugimoto A. Managing a Locally Advanced Cervix Cancer Patient With COVID-19: Lessons Learned. Cureus 2020; 12:e10138. [PMID: 33005550 PMCID: PMC7524020 DOI: 10.7759/cureus.10138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Lang P, Contreras J, Kalman N, Paterson C, Bahig H, Billfalk-Kelly A, Brennan S, Rock K, Read N, Venkatesan V, Sathya J, Mendez LC, MacNeil SD, Nichols AC, Fung K, Mendez A, Winquist E, Kuruvilla S, Stewart P, Warner A, Mitchell S, Theurer JA, Palma DA. Preservation of swallowing in resected oral cavity squamous cell carcinoma: examining radiation volume effects (PRESERVE): study protocol for a randomized phase II trial. Radiat Oncol 2020; 15:196. [PMID: 32795322 PMCID: PMC7427897 DOI: 10.1186/s13014-020-01636-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with resected oral cavity squamous cell carcinoma (OCSCC) are often treated with adjuvant radiation (RT) ± concomitant chemotherapy based on pathological findings. Standard RT volumes include all surgically dissected areas, including the tumour bed and dissected neck. RT has significant acute and long-term toxicities including odynophagia, dysphagia, dermatitis and fibrosis. The goal of this study is to assess the rate of regional failure with omission of radiation to the surgically dissected pathologically node negative (pN0) hemi-neck(s) compared to historical control, and to compare oncologic outcomes, toxicity, and quality of life (QoL) profiles between standard RT volumes and omission of RT to the pN0 neck. METHODS This is a multicentre phase II study randomizing 90 patients with T1-4 N0-2 OCSCC with at least one pN0 hemi-neck in a 1:2 ratio between standard RT volumes and omission of RT to the pN0 hemi-neck(s). Patients will be stratified based on overall nodal status (nodal involvement vs. no nodal involvement) and use of concurrent chemotherapy. The primary endpoint is regional failure in the pN0 hemi-neck(s); we hypothesize that a 2-year regional recurrence of 20% or less will be achieved. Secondary endpoints include overall and progression-free survival, local recurrence, rate of salvage therapy, toxicity and QoL. DISCUSSION This study will provide an assessment of omission of RT to the dissected pN0 hemi-neck(s) on oncologic outcomes, QoL and toxicity. Results will inform the design of future definitive phase III trials. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT03997643 . Date of registration: June 25, 2019, Current version: 2.0 on July 11 2020.
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Affiliation(s)
- Pencilla Lang
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada.
| | - Jessika Contreras
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Noah Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | | | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Sinead Brennan
- Saint Luke's Radiation Oncology Network, Dublin, Ireland
| | - Kathy Rock
- Department of Radiation Oncology, Cork University Hospital, Cork, Ireland
| | - Nancy Read
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Varagur Venkatesan
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Jinka Sathya
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Lucas C Mendez
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario, Canada
| | - Eric Winquist
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - Sara Kuruvilla
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - Paul Stewart
- Department of Medical Oncology, Western University, London, Ontario, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Sylvia Mitchell
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
| | - Julie A Theurer
- School of Communication Sciences and Disorders, Western University, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, London Health Sciences Centre, 800 Commissioners Rd. E, London, ON, N6A 5W9, Canada
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Chinnery T, Arifin A, Tay KY, Leung A, Nichols AC, Palma DA, Mattonen SA, Lang P. Utilizing Artificial Intelligence for Head and Neck Cancer Outcomes Prediction From Imaging. Can Assoc Radiol J 2020; 72:73-85. [PMID: 32735452 DOI: 10.1177/0846537120942134] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Artificial intelligence (AI)-based models have become a growing area of interest in predictive medicine and have the potential to aid physician decision-making to improve patient outcomes. Imaging and radiomics play an increasingly important role in these models. This review summarizes recent developments in the field of radiomics for AI in head and neck cancer. Prediction models for oncologic outcomes, treatment toxicity, and pathological findings have all been created. Exploratory studies are promising; however, validation studies that demonstrate consistency, reproducibility, and prognostic impact remain uncommon. Prospective clinical trials with standardized procedures are required for clinical translation.
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Affiliation(s)
- Tricia Chinnery
- Department of Medical Biophysics, 6221Western University, London, Ontario, Canada
| | - Andrew Arifin
- Department of Oncology, 6221Western University, London, Ontario, Canada
| | - Keng Yeow Tay
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - Andrew Leung
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - Anthony C Nichols
- Department of Otolaryngology-Head and Neck Surgery, 6221Western University, London, Ontario, Canada
| | - David A Palma
- Department of Oncology, 6221Western University, London, Ontario, Canada
| | - Sarah A Mattonen
- Department of Medical Biophysics, 6221Western University, London, Ontario, Canada.,Department of Oncology, 6221Western University, London, Ontario, Canada
| | - Pencilla Lang
- Department of Oncology, 6221Western University, London, Ontario, Canada
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Christie JR, Lang P, Zelko LM, Palma DA, Abdelrazek M, Mattonen SA. Artificial Intelligence in Lung Cancer: Bridging the Gap Between Computational Power and Clinical Decision-Making. Can Assoc Radiol J 2020; 72:86-97. [PMID: 32735493 DOI: 10.1177/0846537120941434] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Lung cancer remains the most common cause of cancer death worldwide. Recent advances in lung cancer screening, radiotherapy, surgical techniques, and systemic therapy have led to increasing complexity in diagnosis, treatment decision-making, and assessment of recurrence. Artificial intelligence (AI)-based prediction models are being developed to address these issues and may have a future role in screening, diagnosis, treatment selection, and decision-making around salvage therapy. Imaging plays an essential role in all components of lung cancer management and has the potential to play a key role in AI applications. Artificial intelligence has demonstrated value in prognostic biomarker discovery in lung cancer diagnosis, treatment, and response assessment, putting it at the forefront of the next phase of personalized medicine. However, although exploratory studies demonstrate potential utility, there is a need for rigorous validation and standardization before AI can be utilized in clinical decision-making. In this review, we will provide a summary of the current literature implementing AI for outcome prediction in lung cancer. We will describe the anticipated impact of AI on the management of patients with lung cancer and discuss the challenges of clinical implementation of these techniques.
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Affiliation(s)
- Jaryd R Christie
- Department of Medical Biophysics, 6221Western University, London, Ontario, Canada
| | - Pencilla Lang
- Division of Radiation Oncology, 6221Western University, London, Ontario, Canada
| | - Lauren M Zelko
- Department of Medical Biophysics, 6221Western University, London, Ontario, Canada
| | - David A Palma
- Division of Radiation Oncology, 6221Western University, London, Ontario, Canada
| | - Mohamed Abdelrazek
- Department of Medical Imaging, 6221Western University, London, Ontario, Canada
| | - Sarah A Mattonen
- Department of Medical Biophysics, 6221Western University, London, Ontario, Canada.,Department of Oncology, 6221Western University, London, Ontario, Canada
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Steinfeldt T, Kessler P, Vicent O, Schwemmer U, Döffert J, Lang P, Mathioudakis D, Hüttemann E, Armbruster W, Sujatta S, Lange M, Weber S, Reisig F, Hillmann R, Volk T, Wiesmann T. [Peripheral truncal blocks-Overview and assessment]. Anaesthesist 2020; 69:860-877. [PMID: 32620990 DOI: 10.1007/s00101-020-00809-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
By implementation of sonography for regional anesthesia, truncal blocks became more relevant in the daily practice of anesthesia and pain therapy. Due to visualized needle guidance ultrasound supports more safety and helps to avoid complications during needle placement. Additionally, complex punctures are possible that were associated with higher risk using landmarks alone. Next to the blocking of specific nerve structures, interfascial and compartment blocks have also become established, whereby the visualization of individual nerves and plexus structures is not of relevance. The present review article describes published and clinically established puncture techniques with respect to the indications and procedures. The clinical value is reported according to the scientific evidence and the analgesic profile. Moreover, the authors explain potential risks, complications and dosing of local anesthetic agents.
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Affiliation(s)
- T Steinfeldt
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Diakoneo DIAK Klinikum, Diakoniestr. 10, 74523, Schwäbisch Hall, Deutschland.
- Klinik für Anästhesie und Intensivtherapie, Philipps-Universität Marburg, Baldingerstr., 35033, Marburg, Deutschland.
| | - P Kessler
- Abteilung für Anästhesiologie, Intensiv- und Schmerzmedizin, Orthopädische Universitätsklinik Friedrichsheim, Marienburgstraße 2, 60528, Frankfurt am Main, Deutschland
| | - O Vicent
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Karl-Gustav Carus, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - U Schwemmer
- Klinik für Anästhesiologie und Intensivmedizin, Kliniken des Landkreises Neumarkt i.d.OPf., Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Deutschland
| | - J Döffert
- , Leipzigerstraße 18, 76356, Weingarten, Deutschland
| | - P Lang
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Burger Str. 80, 96049, Bamberg, Deutschland
| | - D Mathioudakis
- Centre Hospitalier Bienne, Chante-Merle 84, Case postale, 2501, Bienne, Schweiz
| | - E Hüttemann
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum Worms gGmbH, Gabriel-von-Seidl-Straße 81, 67550, Worms, Deutschland
| | - W Armbruster
- Klinik für Anästhesiologie, Intensivmedizin, Schmerztherapie, Evangelisches Krankenhaus Unna, Holbeinstraße 10, 59423, Unna., Deutschland
| | - S Sujatta
- Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Bayreuth GmbH, Preuschwitzer Straße 101, 95445, Bayreuth, Deutschland
| | - M Lange
- Abteilung Anästhesie und Intensivtherapie, Waldkrankenhaus "Rudolf Elle" GmbH, Klosterlausnitzer Straße 81, 07607, Eisenberg, Deutschland
| | - S Weber
- Klinik für Anästhesie, Intensivmedizin und Schmerztherapie, Heilig Geist Krankenhaus Köln, Graseggerstr. 105, 50737, Köln, Deutschland
| | - F Reisig
- Standort Burgdorf, Schweiz. Abteilung für Anästhesiologie, Spital Emmental, Oberburgstraße 54, 3400, Burgdorf, Schweiz
| | - R Hillmann
- , Goethestr. 35, 73614, Schorndorf, Deutschland
| | - T Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Gebäude 57, 66421, Homburg, Deutschland
| | - T Wiesmann
- Klinik für Anästhesie und Intensivtherapie, UKGM Gießen-Marburg, Standort Marburg, Baldingerstr., 35033, Marburg, Deutschland
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Hütter C, Lanner M, Aigmüller T, Simon K, Hofmann P, Kratky M, Engelmann G, Mutz-Eckhart C, Blatt-Gunegger M, Klammer S, Berger G, Bermann C, Resetarits K, Huber A, Lang P, Lessiak V, Tamussino K. Implementierung der prophylaktischen bilateralen Salpingektomie (PBS) bei der minimal-invasiven Hysterektomie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- C Hütter
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
| | - M Lanner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
| | | | - K Simon
- LKH Hochsteiermark, Standort Leoben
| | - P Hofmann
- LKH Weststeiermark, Standort Deutschlandsberg
| | - M Kratky
- LKH Weststeiermark, Standort Deutschlandsberg
| | - G Engelmann
- LKH Murtal, Standort Judenburg
- LKH Rottenmann
| | | | | | | | | | | | | | | | - P Lang
- Krankenhaus der Barmherzigen Brüder Graz
| | - V Lessiak
- Krankenhaus der Barmherzigen Brüder Graz
| | - K Tamussino
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
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Abstract
The oligometastatic and oligoprogressive disease states have been recently recognized as common clinical scenarios in the management of non-small cell lung cancer (NSCLC). As a result, there has been increasing interest in treating these patients with locally ablative therapies including surgery, conventionally fractionated radiotherapy, stereotactic ablative radiotherapy, and radiofrequency ablation. This article provides an overview of oligometastatic and oligoprogressive disease in the setting of NSCLC and reviews the evidence supporting ablative treatment. Phase II randomized controlled trials and retrospective series suggest that ablative treatment of oligometastases may substantially improve progression-free survival and overall survival, and additional large randomized studies testing this hypothesis in a definitive context are ongoing. However, several challenges remain, including quantifying the possible benefits of ablative therapies for oligoprogressive disease and developing prognostic and predictive models to assist in clinical decision making.
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Affiliation(s)
- Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
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Tomasch G, Lemmerer M, Oswald S, Schauer C, Schütz AM, Bliem B, Lang P, Rosanelli G, Ronaghi F, Tschmelitsch J, Tamussino K. Prophylaktische Salpingektomie im Rahmen der laparoskopischen Cholezystektomie (SaLCHE): Geht das? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- G Tomasch
- Univ.-Klinik für Frauenheilkunde und Geburtshilfe, MedUni Graz
| | - M Lemmerer
- Abteilung für Chirurgie, KH der Barmherzigen Brüder (BHB) Graz
- Univ.-Klinik für Chirurgie, MedUni Graz
| | - S Oswald
- Abteilung für Chirurgie, KH der Elisabethinen Graz
| | - C Schauer
- Abteilung für Gynäkologie, KH der BHB Graz
| | - A M Schütz
- Univ.-Klinik für Frauenheilkunde und Geburtshilfe, MedUni Graz
| | - B Bliem
- Univ.-Klinik für Frauenheilkunde und Geburtshilfe, MedUni Graz
| | - P Lang
- Abteilung für Gynäkologie, KH der BHB Graz
| | - G Rosanelli
- Abteilung für Chirurgie, KH der Elisabethinen Graz
| | - F Ronaghi
- Abteilung für Gynäkologie und Geburtshilfe, KH der BHB St.Veit/Glan
| | | | - K Tamussino
- Univ.-Klinik für Frauenheilkunde und Geburtshilfe, MedUni Graz
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42
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Hütter C, Lanner M, Aigmüller T, Simon K, Hofmann P, Kratky M, Engelmann G, Mutz-Eckhart C, Blatt-Gunegger M, Klammer S, Berger G, Bermann C, Resetarits K, Huber A, Lang P, Lessiak V, Tamussino K. Implementierung der prophylaktischen bilateralen Salpingektomie (PBS) bei der minimal-invasiven Hysterektomie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- C Hütter
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
| | - M Lanner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
| | | | - K Simon
- LKH Hochsteiermark, Standort Leoben
| | - P Hofmann
- LKH Weststeiermark, Standort Deutschlandsberg
| | - M Kratky
- LKH Weststeiermark, Standort Deutschlandsberg
| | | | | | | | | | | | | | | | | | - P Lang
- Krankenhaus der Barmherzigen Brüder Graz
| | - V Lessiak
- Krankenhaus der Barmherzigen Brüder Graz
| | - K Tamussino
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Med. Universität Graz
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Rinner H, Trost J, Schilcher D, Schauer C, Lang P. Nutzen einer endozervikalen Kürettage unmittelbar nach einer Konisation. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0039-3403397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- H Rinner
- Abteilung für Gynäkologie, Krankenhaus Barmherzige Brüder Graz
| | - J Trost
- Abteilung für Gynäkologie, Krankenhaus Barmherzige Brüder Graz
| | - D Schilcher
- Abteilung für Gynäkologie, Krankenhaus Barmherzige Brüder Graz
| | - C Schauer
- Abteilung für Gynäkologie, Krankenhaus Barmherzige Brüder Graz
| | - P Lang
- Abteilung für Gynäkologie, Krankenhaus Barmherzige Brüder Graz
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44
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Varatheeswaran R, Hassan U, Pillen S, Lang P, Yuen K, Meyer B, Kalisch R, Bergmann T. P12 Connectivity-informed concurrent TMS-fMRI for indirect stimulation of the ventromedial prefrontal cortex. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.123] [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: 10/24/2022]
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45
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Nichols AC, Lang P, Prisman E, Berthelet E, Tran E, Hamilton S, Wu J, Fung K, de Almeida JR, Bayley A, Goldstein DP, Eskander A, Husain Z, Bahig H, Christopoulous A, Hier M, Sultanem K, Richardson K, Mlynarek A, Krishnan S, Le H, Yoo J, MacNeil SD, Mendez A, Winquist E, Read N, Venkatesan V, Kuruvilla S, Warner A, Mitchell S, Corsten M, Rajaraman M, Johnson-Obaseki S, Eapen L, Odell M, Chandarana S, Banerjee R, Dort J, Matthews TW, Hart R, Kerr P, Dowthwaite S, Gupta M, Zhang H, Wright J, Parker C, Wehrli B, Kwan K, Theurer J, Palma DA. Treatment de-escalation for HPV-associated oropharyngeal squamous cell carcinoma with radiotherapy vs. trans-oral surgery (ORATOR2): study protocol for a randomized phase II trial. BMC Cancer 2020; 20:125. [PMID: 32059705 PMCID: PMC7023689 DOI: 10.1186/s12885-020-6607-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/06/2020] [Indexed: 11/28/2022] Open
Abstract
Background Patients with human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma (OPC) have substantially better treatment response and overall survival (OS) than patients with HPV-negative disease. Treatment options for HPV+ OPC can involve either a primary radiotherapy (RT) approach (± concomitant chemotherapy) or a primary surgical approach (± adjuvant radiation) with transoral surgery (TOS). These two treatment paradigms have different spectrums of toxicity. The goals of this study are to assess the OS of two de-escalation approaches (primary radiotherapy and primary TOS) compared to historical control, and to compare survival, toxicity and quality of life (QOL) profiles between the two approaches. Methods This is a multicenter phase II study randomizing one hundred and forty patients with T1–2 N0–2 HPV+ OPC in a 1:1 ratio between de-escalated primary radiotherapy (60 Gy) ± concomitant chemotherapy and TOS ± de-escalated adjuvant radiotherapy (50–60 Gy based on risk factors). Patients will be stratified based on smoking status (< 10 vs. ≥ 10 pack-years). The primary endpoint is OS of each arm compared to historical control; we hypothesize that a 2-year OS of 85% or greater will be achieved. Secondary endpoints include progression free survival, QOL and toxicity. Discussion This study will provide an assessment of two de-escalation approaches to the treatment of HPV+ OPC on oncologic outcomes, QOL and toxicity. Results will inform the design of future definitive phase III trials. Trial Registration Clinicaltrials.gov identifier: NCT03210103. Date of registration: July 6, 2017, Current version: 1.3 on March 15, 2019.
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Affiliation(s)
- Anthony C Nichols
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Pencilla Lang
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Eitan Prisman
- Division of Otolaryngology - Head and Neck Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Eric Berthelet
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Eric Tran
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Sarah Hamilton
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Jonn Wu
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Kevin Fung
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Andrew Bayley
- Department of Radiation Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head and Neck Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Antoine Eskander
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Houda Bahig
- Department of Radiation Oncology, CHUM, Université de Montréal, Montreal, QC, Canada
| | - Apostolos Christopoulous
- Department of Otorhinolaryngology - Head and Neck Surgery, CHUM, Université de Montréal, Montreal, QC, Canada
| | - Michael Hier
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Khalil Sultanem
- Department of Radiation Oncology, McGill University, Montreal, QC, Canada
| | - Keith Richardson
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Alex Mlynarek
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, QC, Canada
| | - Suren Krishnan
- Department of Otolaryngology - Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Hien Le
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - John Yoo
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - S Danielle MacNeil
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Adrian Mendez
- Department of Otolaryngology - Head and Neck Surgery, Western University, London, ON, Canada
| | - Eric Winquist
- Department of Medical Oncology, Western University, London, ON, Canada
| | - Nancy Read
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Varagur Venkatesan
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Sara Kuruvilla
- Department of Medical Oncology, Western University, London, ON, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Sylvia Mitchell
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada
| | - Martin Corsten
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | - Murali Rajaraman
- Division of Otolaryngology - Head and Neck Surgery, Dalhousie University, Halifax, NS, Canada
| | | | - Libni Eapen
- Department of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada
| | - Michael Odell
- Department of Otolaryngology - Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada
| | - Shamir Chandarana
- Section of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
| | - Robyn Banerjee
- Department of Radiation Oncology, University of Calgary, Calgary, AB, Canada
| | - Joseph Dort
- Section of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
| | - T Wayne Matthews
- Section of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
| | - Robert Hart
- Section of Otolaryngology - Head and Neck Surgery, University of Calgary, Calgary, AB, Canada
| | - Paul Kerr
- Department of Otolaryngology, University of Manitoba, Winnipeg, MB, Canada
| | - Samuel Dowthwaite
- Department of Otolaryngology - Head and Neck Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael Gupta
- Division of Otolaryngology - Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Han Zhang
- Division of Otolaryngology - Head and Neck Surgery, McMaster University, Hamilton, ON, Canada
| | - Jim Wright
- Department of Radiation Oncology, McMaster University, Hamilton, ON, Canada
| | - Christina Parker
- Department of Audiology, London Health Sciences Centre, London, ON, Canada
| | - Bret Wehrli
- Department of Pathology, Western University, London, ON, Canada
| | - Keith Kwan
- Department of Pathology, Western University, London, ON, Canada
| | - Julie Theurer
- School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, Western University, 800 Commissioners Rd. E, London, Ontario, N6A 5W9, Canada.
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Mack I, Erlanger TE, Lang P, Sinniger P, Perisa D, Heininger U. Dose-dependent effectiveness of acellular pertussis vaccine in infants: A population-based case-control study. Vaccine 2019; 38:1444-1449. [PMID: 31813648 DOI: 10.1016/j.vaccine.2019.11.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pertussis is a vaccine-preventable disease which is most severe in young infants. More than two decades after the introduction of acelluar pertussis vaccines (aPV) in national immunization programs in many countries worldwide, a resurgence of pertussis has been recognized. Suboptimal effectiveness of aPV has been blamed as one major reason but only few studies have evaluated dose-dependent vaccine effectiveness (VE) provided by aPV in current practice. METHODS We performed a population-based retrospective case-control study by comparing pertussis immunization data of children 2.5 months to 2 years of age hospitalized for pertussis and residing in Switzerland with immunization data of a random control sample of children aged 2 years and residing in Switzerland. VE was defined as the percentage of hospitalizations avoided by number of aPV doses. It was calculated as 1-infection rate ratio (IRR)*100. IRR was calculated by dividing infection rates of vaccinated children and infection rates of unvaccinated children. To get dose specific VE,infection rates were stratified by number doses received. RESULTS VE against hospitalization due to pertussis increased significantly with each consecutive aPV dose in a "3 + 1" primary course in infants: 42.1% (95% CI: 11.3-62.6), 83.9% (70.2-92.1), 98.2% (96.1-99.3), and 100% (97.9-100) after the 1st, 2nd, 3rd, and 4th dose, respectively. CONCLUSION Acellular pertussis vaccines continue to demonstrate protection against hospitalization due to pertussis in infants and young children. Therefore, together with advancing immunization of pregnant women and household contacts, better control of severe pertussis in young infants can be achieved by timely initiation of immunization.
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Affiliation(s)
- I Mack
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology Unit, Basel, Switzerland; University of Basel, Faculty of Medicine, Basel, Switzerland.
| | - T E Erlanger
- University Hospital Basel and University of Basel, Department of Clinical Research, Clinical Trial Unit, Basel, Switzerland
| | - P Lang
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Department of Public Health, Zurich, Switzerland
| | - P Sinniger
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Department of Public Health, Zurich, Switzerland
| | - D Perisa
- Swiss Federal Office of Public Health, Division of Infectious Diseases, Bern, Switzerland
| | - U Heininger
- University of Basel Children's Hospital, Paediatric Infectious Diseases and Vaccinology Unit, Basel, Switzerland; University of Basel, Faculty of Medicine, Basel, Switzerland
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Frikha M, Auperin A, Tao Y, Elloumi F, Toumi N, Blanchard P, Lang P, Sun S, Racadot S, Thariat J, Alfonsi M, Tuchais C, Cornely A, Moussa A, Guigay J, Daoud J, Bourhis J. A randomized trial of induction docetaxel-cisplatin-5FU followed by concomitant cisplatin-RT versus concomitant cisplatin-RT in nasopharyngeal carcinoma (GORTEC 2006-02). Ann Oncol 2019; 29:731-736. [PMID: 29236943 DOI: 10.1093/annonc/mdx770] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Concomitant chemotherapy (CT)-radiotherapy (RT) is a standard of care in locally advanced nasopharyngeal carcinoma (NPC) and a role for induction CT is not established. Methods Patients with locally advanced NPC, WHO type 2 or 3, were randomized to induction TPF plus concomitant cisplatin-RT or concomitant cisplatin-RT alone. The TPF regimen consisted of three cycles of Docetaxel 75 mg/m2 day 1; cisplatin 75 mg/m2 day 1; 5FU 750 mg/m2/day days 1-5. RT consisted of 70 Gy in 7 weeks plus concomitant cisplatin 40 mg/m2 weekly. Results A total of 83 patients were included in the study. Demographics and tumour characteristics were well balanced between both arms. Most of the patients (95%) in the TPF arm received three cycles of induction CT. The rate of grade 3-4 toxicity and the compliance (NCI-CTCAE v3) during cisplatin-RT were not different between both arms. With a median follow-up of 43.1 months, the 3-year PFS rate was 73.9% in the TPF arm versus 57.2% in the reference arm [hazard ratio (HR) = 0.44; 95% confidence interval (CI): 0.20-0.97, P = 0.042]. Similarly the 3 years overall survival rate was 86.3% in the TPF arm versus 68.9% in the reference arm (HR = 0.40; 95% CI: 0.15-1.04, P = 0.05). Conclusion In conclusion, several important aspects can be emphasized: the compliance to induction TPF was good and TPF did not compromise the tolerance of the concomitant RT-cisplatin phase. The improved PFS and overall survival rates needs to be confirmed by further trials.
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Affiliation(s)
- M Frikha
- Medical Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - A Auperin
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - Y Tao
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - F Elloumi
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - N Toumi
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia
| | - P Blanchard
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - P Lang
- Radiation Oncology Department, Pitié Salpetrière, Paris, France
| | - S Sun
- Radiation Oncology Department, Centre Hospitalier Montbeliard, Montbeliard, France
| | - S Racadot
- Radiation Oncology Department, Centre L. Bérard, Lyon, France
| | - J Thariat
- Department of Oncology, Centre A. Lacassagne, Nice, France
| | - M Alfonsi
- Radiation Oncology Department, Clinique St Catherine, Avignon, France
| | - C Tuchais
- Radiation Oncology Department, Centre C. Papin, Angers, France
| | - A Cornely
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - A Moussa
- Department of Statistics, Gustave-Roussy, Villejuif, France
| | - J Guigay
- Department of Oncology, Centre A. Lacassagne, Nice, France
| | - J Daoud
- Radiation Oncology Department, Sfax University Hospital, Sfax, Tunisia.
| | - J Bourhis
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France; Radiation Oncology Department, CHUV, Lausanne, Switzerland.
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Chung H, Lang P, Kayvanrad M, Thompson R, Chu W, Gennatas E, Valdes G, Cheung P. EP-1453 Machine learning prediction of early distant progression after SBRT for colorectal cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31873-0] [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: 11/27/2022]
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Yuen H, Stachowicz A, Lang P, Levy D, Whiteside J. 87: Factors associated with emergency department utilization after benign gynecologic surgery. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.117] [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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Tamussino K, Tomasch G, Oswald S, Lemmerer M, Uranitsch S, Schütz AM, Schauer C, Berger A, Lang P, Rosanelli G, Uranüs S. Prophylaktische Salpingektomie bei der laparaskopischen Cholezystektomie (SaLCHE): Geht das? Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- K Tamussino
- UFK Graz, Abteilung Gynäkologie, Graz, Österreich
| | - G Tomasch
- UFK Graz, Abteilung Gynäkologie, Graz, Österreich
| | - S Oswald
- KH der Elisabethinen Graz, Abteilung Chirurgie, Graz, Österreich
| | - M Lemmerer
- KH der Barmherzigen Brüder Graz, Abteilung Chirurgie, Graz, Österreich
| | - S Uranitsch
- KH der Barmherzigen Brüder Graz, Abteilung Chirurgie, Graz, Österreich
| | - AM Schütz
- UFK Graz, Abteilung Gynäkologie, Graz, Österreich
| | - C Schauer
- KH der Barmherzigen Brüder Graz, Abteilung Gynäkologie, Graz, Österreich
| | - A Berger
- KH der Barmherzigen Brüder Graz, Abteilung Chirurgie, Graz, Österreich
| | - P Lang
- KH der Barmherzigen Brüder Graz, Abteilung Gynäkologie, Graz, Österreich
| | - G Rosanelli
- KH der Elisabethinen Graz, Abteilung Chirurgie, Graz, Österreich
| | - S Uranüs
- Univ.-Klinik für Chirurgie, Abteilung Viszeralchirurgie, Graz, Österreich
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