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Tzikas A, Lavdas E, Kehagias D, Amdur R, Mendenhall W, Sheets N, Green R, Chera B, Mavroidis P. NTCP modelling of xerostomia after radiotherapy for oropharyngeal cancer using the PRO-CTCAE and CTCAE scoring systems at different time-points post-RT. Phys Med 2023; 116:103169. [PMID: 37989042 DOI: 10.1016/j.ejmp.2023.103169] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 09/30/2023] [Accepted: 11/05/2023] [Indexed: 11/23/2023] Open
Abstract
PURPOSE This study aims at determining the parameter values of three normal tissue complication probability (NTCP) models for the contralateral parotid gland, contralateral submandibular gland (SMG) and contralateral salivary glands regarding the endpoint of xerostomia 6-24 months after radiotherapy for oropharynx cancer. METHODS The treatment and outcome data of 231 patients with favorable risk, HPV-associated oropharyngeal squamous cell carcinoma are analyzed. 60 Gy intensity modulated radiotherapy was delivered to all the patients. The presence and severity of xerostomia was recorded (pre- and post- radiotherapy) by the PRO-CTCAE and the CTCAE scoring systems. In both scoring systems, patients with a change in symptom severity (from baseline) of ≥ 2 were considered responders. RESULTS Xerostomia was observed in 61.3 %, 39.2 %, 28.6 % and 27.0 % of the patients based on the PRO-CTCAE scoring system at 6-, 12-, 18- and 24-months post-RT, respectively. The AUCs of the contralateral salivary glands ranged between 0.58-0.64 in the LKB model with the gEUD ranging between 20.3 Gy and 24.7 Gy. CONCLUSIONS Based on the PRO-CTCAE scores, mean dose < 22 Gy, V50 < 10 % for the contralateral salivary glands and mean dose < 18 Gy, V45 < 10 % for the contralateral parotid were found to significantly reduce by a factor of 2-3 the risk for radiation induced xerostomia that is observed at 6-24 months post-RT, respectively. Also, gEUD < 22 Gy to the contralateral salivary glands and < 18 Gy to the contralateral parotid was found to significantly reduce the risk for radiation induced xerostomia that is observed at 6-24 months post-RT by 2.0-2.3 times.
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Affiliation(s)
- Athanasios Tzikas
- University of West Attica, Department of Biomedical Sciences, Athens, Greece
| | - Eleftherios Lavdas
- University of West Attica, Department of Biomedical Sciences, Athens, Greece
| | - Dimitrios Kehagias
- University of West Attica, Department of Biomedical Sciences, Athens, Greece
| | - Robert Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, FL, United States
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, FL, United States
| | - Nathan Sheets
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC, United States
| | - Rebecca Green
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC, United States
| | - Bhishamjit Chera
- Department of Radiation Oncology, MUSC Hollings Cancer Center, Charleston, SC, United States
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, NC, United States.
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Hanubal KS, Galochkina Z, Lee JH, List MA, Massini TC, Conrad D, Hughley B, Danan D, DeJesus R, Hitchcock K, Nichols S, Mendenhall W, Dziegielewski PT. Tumor volume as a predictor of survival in advanced laryngeal cancer treated with total laryngectomy. Head Neck 2023; 45:1376-1388. [PMID: 37009789 DOI: 10.1002/hed.27351] [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: 08/26/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Recent literature shows that tumor volume (TV) in T3 laryngeal squamous cell carcinoma (LSCC) is associated with response to radiation therapy. The aim of this study was to evaluate the effect of TV on survival outcomes in patients undergoing total laryngectomy (TL). METHODS One hundred and seventeen patients with LSCC undergoing TL between 2013 and 2020 at the University of Florida were included. TV was measured using a previously validated method on preoperative-CT scans. Multivariable CoxPH models for overall survival (OS) and disease-specific survival (DSS), metastasis-free survival (MFS), and recurrence-free survival (RFS) were developed with TV. RESULTS Mean age was 61.5 years and 81.2% were male. Higher TV was associated with decreased OS, MFS, DSS, and RFS with adjusted hazard ratios 1.02 (95%CI: 1.01, 1.03), 1.01, (95%CI: 1.00, 1.03), 1.03 (95%CI: 1.01, 1.06), and 1.02 (95%CI: 1.00, 1.03) respectively. TV >7.1 cc had worse prognoses. CONCLUSIONS TV appears associated with decreased survival in LSCC treated with TL.
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Affiliation(s)
- Krishna S Hanubal
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Zhanna Galochkina
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Ji-Hyun Lee
- Division of Quantitative Sciences, University of Florida Health Cancer Center, Gainesville, Florida, USA
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Marna A List
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Tara C Massini
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - Dustin Conrad
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Brian Hughley
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Deepa Danan
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Reordan DeJesus
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - Kathryn Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
- University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Spencer Nichols
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
- University of Florida Health Cancer Center, Gainesville, Florida, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
- University of Florida Health Cancer Center, Gainesville, Florida, USA
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Shama M, Al-Qurayshi Z, Dahl M, Amdur RJ, Bates J, Mendenhall W, Hitchcock K, Festa BM, Ghanem T, Dziegielewski PT. Human Papillomavirus-Negative Oropharyngeal Cancer Survival Outcomes Based on Primary Treatment: National Cancer Database Analysis. Otolaryngol Head Neck Surg 2021; 167:100-108. [PMID: 34546828 DOI: 10.1177/01945998211047169] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare survival outcomes between primary surgery and primary radiation therapy (RT) in patients with human papillomavirus (HPV)-negative oropharyngeal squamous cell carcinoma (OPSCC). STUDY DESIGN A retrospective observational cohort study. SETTING National Cancer Database. METHODS A National Cancer Database review was conducted of 2635 patients with HPV-negative OPSCC who underwent surgery or RT ± chemotherapy between 2010 and 2014. Univariate analysis was performed on all variables and entered into a multivariate model. The main outcome was overall survival (OS). RESULTS A total of 2635 patients with HPV-negative OPSCC were organized into 4 groups based on cancer staging. In group 1 (T1-2 N0-1; n = 774), up-front surgery had significantly better 5-year OS (76.2%) than RT (56.8%; adjusted hazard ratio [aHR], 1.76; P = .009; 95% CI, 1.15-2.69) and chemoradiation therapy (CRT; 69.5%; aHR, 1.56; P = .019; 95% CI, 1.08-2.26). In group 2 (T3-4 N0-1; n = 327), no significant difference existed between surgery and CRT (5-year OS, 51.3% vs 52.4%; aHR, 0.96; P = .88; 95% CI, 0.54-1.69). In group 3a (T1-2 N2-3; n = 807), surgery with adjuvant treatment showed significantly better 5-year OS than CRT (78.6% vs 68.8%; aHR, 1.51; P = .027; 95% CI, 1.05-2.18). In group 3b (T3-4 N2-3; n = 737), surgery with adjuvant treatment was not statistically associated with better 5-year OS as compared with CRT (61.0% vs 43.7%; aHR, 1.53; P = .06; 95% CI, 0.98-2.39). CONCLUSION Primary surgery may provide improved survival outcomes in many cases of HPV-negative OPSCCs. These data should be used in weighing treatment options and may serve as a basis to better delineate treatment algorithms for HPV-negative disease.
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Affiliation(s)
- Mohamed Shama
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.,Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Zaid Al-Qurayshi
- Department of Otolaryngology, University of Iowa, Iowa City, Iowa, USA
| | - Mohammad Dahl
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.,University of Mosul, Mosul, Iraq
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - James Bates
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Kathryn Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
| | - Bianca M Festa
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA
| | - Tamer Ghanem
- Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, Gainesville, Florida, USA.,UF Health Cancer Center, University of Florida, Gainesville, Florida, USA
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Djabali EJ, Rotter J, Chheda NN, Amdur RJ, Hitchcock K, Mendenhall W, Dziegielewski PT. Woody hardness classification impact on salvage laryngectomy functional outcomes. Am J Otolaryngol 2021; 42:102877. [PMID: 33485049 DOI: 10.1016/j.amjoto.2020.102877] [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: 11/16/2020] [Accepted: 12/25/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Post-radiation therapy salvage surgeries are challenging for surgeons due to tissue fibrosis. The woody hardness classification is valuable in differentiating the degree of neck stiffness, but its clinical utility has not been evaluated. We applied it to patients undergoing salvage laryngectomy to study the impact of woody hardness on postoperative outcomes. MATERIALS AND METHODS A retrospective observational study was performed on patients undergoing salvage laryngectomy between 2014 and 2019. Patients were assigned into the A (extremely woody hard), B (moderately woody hard), or C (mildly woody hard) woody hardness class. The primary outcome was pharyngoesophageal stricture development. Secondary outcomes included time to pharyngoesophageal stricture, pharyngocutaneous fistula development, time to pharyngocutaneous fistula, development of post-operative complications, and tracheoesophageal puncture complications. RESULTS Fifty-one patients were included in the study: Class A 1 patient, Class B 30 patients, and Class C 20 patients. The single Class A patient was grouped with the Class B patients. The development of a pharyngoesophageal stricture shows consistent negative association with woody hardness despite most analyses not reaching statistical significance. These associations are robust to a number of confounding variables in multivariate logistic and time to event analyses. Furthermore, the time to event analysis controlling for squamous cell carcinoma diagnosis led to a statistically significant association between woody hardness (i.e., A/B higher risk) and time to stricture (HR=5, p=0.02). CONCLUSIONS This study suggests that this classification may be useful in predicting pharyngoesophageal stricture formation in salvage laryngectomy patients and could be used to implement stricture preventive measures.
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Affiliation(s)
- Emma J Djabali
- College of Medicine, University of Florida, 1600 SW Archer Road, Gainesville, FL, USA.
| | - Jason Rotter
- Mathematica, Inc., 1100 First St. NE, #1200, Washington, DC, USA
| | - Neil N Chheda
- Department of Otolaryngology, University of Florida, PO Box 100264 1345, Center Dr., M2-228 MSB, Gainesville, FL, USA
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - Kathryn Hitchcock
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
| | - Peter T Dziegielewski
- Department of Otolaryngology, University of Florida, PO Box 100264 1345, Center Dr., M2-228 MSB, Gainesville, FL, USA; UF Health Cancer Center, University of Florida, 2033 Mowry Rd., Suite, 145, Gainesville, FL, USA
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Civantos FJ, Vermorken JB, Shah JP, Rinaldo A, Suárez C, Kowalski LP, Rodrigo JP, Olsen K, Strojan P, Mäkitie AA, Takes RP, de Bree R, Corry J, Paleri V, Shaha AR, Hartl DM, Mendenhall W, Piazza C, Hinni M, Robbins KT, Tong NW, Sanabria A, Coca-Pelaz A, Langendijk JA, Hernandez-Prera J, Ferlito A. Metastatic Squamous Cell Carcinoma to the Cervical Lymph Nodes From an Unknown Primary Cancer: Management in the HPV Era. Front Oncol 2020; 10:593164. [PMID: 33244460 PMCID: PMC7685177 DOI: 10.3389/fonc.2020.593164] [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: 08/09/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background Patients with metastases in the lymph nodes of the neck and no obvious primary tumor, neck cancer with unknown primary (NCUP), represent a management challenge. A majority of patients have metastatic squamous cell carcinoma (SCC), although other histologies do occur. Methods We comprehensively reviewed the literature, compared available guidelines, and conferred with an international team of experts. Results Positron emission tomography-computed tomography (PET-CT) and fine needle aspiration (FNA) under ultrasound guidance increase accuracy of diagnosis. Immunohistochemistry (IHC), determination of human papilloma virus (HPV) status, by p16 staining or by in situ hybridization (ISH), and next-generation gene sequencing can guide us regarding probable primary sites and tumor biology. Narrow Band Imaging (NBI) has been introduced for the early detection of subtle mucosal lesions. Direct laryngoscopy (DL) and tonsillectomy have long been procedures used in the search for a primary site. More recently, TransOral Robotic Surgery (TORS) or Transoral LASER Microsurgery (TLM) have been introduced for lingual tonsillectomy. Conclusions New technologies have been developed which can better detect, diagnose, and treat occult primary tumors. Decisions regarding therapy are based on the primary tumor site (if discovered) and N stage. Options include neck dissection with or without postoperative adjuvant therapy, primary irradiation, or combined chemotherapy with irradiation. The preferred treatment of patients whose primary remains unidentified is controversial.
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Affiliation(s)
- Francisco J Civantos
- Department of Otolaryngology, Sylvester Cancer Center, University of Miami, Miami, FL, United States
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium
| | - Jatin P Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | | | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paolo, Brazil.,Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Kerry Olsen
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, MN, United States
| | - Primoz Strojan
- Department of Radiation Oncology Institute of Oncology, University of Ljubljana, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and HUS Helsinki University Hospital, Helsinki, Finland
| | - Robert P Takes
- Department of Otolaryngology/Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - June Corry
- Department of Medicine Division Radiation Oncology, St. Vincent's Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ashok R Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Dana M Hartl
- Division of Surgical Oncology, Gustave Roussy Cancer Center and Paris-Sud University, Paris, France
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, United States
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michael Hinni
- Department of Otolaryngology, Mayo Clinic, Phoenix, AZ, United States
| | - K Thomas Robbins
- Southern Illinois University School of Medicine, Department of Otolaryngology, Springfield, IL, United States
| | - Ng Wai Tong
- Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, Hong Kong
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Hospital Universitario San Vicente Fundacion. CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Universidad de Antioquia, Medellín, Colombia
| | - Andres Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Alfio Ferlito
- International Head and Neck Scientific Group, Padua, Italy
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Chera BS, Kumar S, Shen C, Amdur R, Dagan R, Green R, Goldman E, Weiss J, Grilley-Olson J, Patel S, Zanation A, Hackman T, Blumberg J, Patel S, Thorp B, Weissler M, Yarbrough W, Sheets N, Mendenhall W, Tan XM, Gupta GP. Plasma Circulating Tumor HPV DNA for the Surveillance of Cancer Recurrence in HPV-Associated Oropharyngeal Cancer. J Clin Oncol 2020; 38:1050-1058. [PMID: 32017652 PMCID: PMC7106982 DOI: 10.1200/jco.19.02444] [Citation(s) in RCA: 196] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Plasma circulating tumor human papillomavirus DNA (ctHPVDNA) is a sensitive and specific biomarker of human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). We investigated whether longitudinal monitoring of ctHPVDNA during post-treatment surveillance could accurately detect clinical disease recurrence. METHODS AND MATERIALS A prospective biomarker clinical trial was conducted among patients with nonmetastatic HPV-associated (p16-positive) OPSCC. All patients were treated with curative-intent chemoradiotherapy (CRT). Patients underwent a 3-month post-CRT positron emission tomography/computed tomography scan and were thereafter clinically evaluated every 2-4 months (years 1-2), then every 6 months (years 3-5). Chest imaging was performed every 6 months. Blood specimens were collected every 6-9 months for analysis of plasma ctHPVDNA using a multianalyte digital polymerase chain reaction assay. The primary endpoint was to estimate the negative predictive value (NPV) and positive predictive value (PPV) of ctHPVDNA surveillance. RESULTS One hundred fifteen patients were enrolled, and 1,006 blood samples were analyzed. After a median follow-up time of 23 months (range, 6.1-54.7 months), 15 patients (13%) developed disease recurrence. Eighty-seven patients had undetectable ctHPVDNA at all post-treatment time points, and none developed recurrence (NPV, 100%; 95% CI, 96% to 100%). Twenty-eight patients developed a positive ctHPVDNA during post-treatment surveillance, 15 of whom were diagnosed with biopsy-proven recurrence. Sixteen patients had 2 consecutively positive ctHPVDNA blood tests, 15 of whom developed biopsy-proven recurrence. Two consecutively positive ctHPVDNA blood tests had a PPV of 94% (95% CI, 70% to 99%). Median lead time between ctHPVDNA positivity and biopsy-proven recurrence was 3.9 months (range, 0.37-12.9 months). CONCLUSION Detection of ctHPVDNA in two consecutive plasma samples during post-treatment surveillance has high PPV and NPV for identifying disease recurrence in patients with HPV-associated oropharyngeal cancer and may facilitate earlier initiation of salvage therapy.
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Affiliation(s)
- Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
| | - Sunil Kumar
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
| | - Colette Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
| | - Robert Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, FL
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, FL
| | - Rebecca Green
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily Goldman
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC.,Department of Medicine, Division of Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Juneko Grilley-Olson
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC.,Department of Medicine, Division of Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Shetal Patel
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC.,Department of Medicine, Division of Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Adam Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Trevor Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jeff Blumberg
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Samip Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Brian Thorp
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Mark Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Wendell Yarbrough
- Department of Medicine, Division of Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, NC.,Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - William Mendenhall
- Department of Medicine, Division of Hematology Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Xianming M Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
| | - Gaorav P Gupta
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC
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Holtzman A, Rotondo R, Rutenberg M, Indelicato D, Rao D, Louis D, Morris C, Mendenhall W. RARE-40. OUTCOMES AFTER PROTON THERAPY FOR SKULL-BASE CHORDOMA: A PROSPECTIVE STUDY. Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz175.963] [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: 11/13/2022] Open
Abstract
Abstract
We evaluated treatment outcomes following definitive or adjuvant high-dose, image-guided proton therapy in 91 patients with skull-base chordoma enrolled on a prospective outcomes tracking protocol and treated between February 2007 and February 2018. The median age was 53 years (range, 22–78 years). Patients received passively scattered 3-dimensional conformal proton therapy to a median dose of 73.8 GyRBE (range, 69.6–75.6 GyRBE). Two patients received a component of intensity-modulated radiotherapy. Seventy percent (n=64) were men and 30% (n=27) were woman. Eighty-two percent (n=75) of patients had macroscopic disease at the time of radiotherapy; 18% (n=16) had undergone a macroscopic gross total resection. Overall survival, cause-specific survival, local control, and RT-related grade 3 toxicity-free survival were calculated. Proton therapy-related toxicities were scored using CTCAE v4.0. With a median follow-up of 3.7 years (range, 0.2–10 years), 26 patients experienced disease recurrence, including 26 local, 0 regional, and 1 distant recurrence. The median time to local progression was 2.2 years (range, 0.4–7.0 years). At the time of last follow-up, 66 patients were alive (56 with no evidence of disease progression) and 25 were deceased (18 with disease progression). There were no acute grade 3 toxicities related to the radiation therapy. The 4-year actuarial rates of overall survival, cause-specific survival, local control, and radiation therapy-related grade 3 toxicity-free survival were 83%, 87%, 76% and 83%, respectively. Definitive or adjuvant high-dose passively scattered 3-dimensional conformal proton therapy for skull-base chordoma provides acceptable local control, comparing favorably to historic photon data, with no acute grade ≥3 radiation-related toxicity and an acceptable rate of grade ≥3 late toxicity. Further follow-up of this cohort is necessary to better characterize long-term disease control and late toxicities.
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Affiliation(s)
- Adam Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ronny Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Michael Rutenberg
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Daniel Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Dinesh Rao
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Debbie Louis
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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Chera BS, Amdur RJ, Green R, Shen C, Gupta G, Tan X, Knowles M, Fried D, Hayes N, Weiss J, Grilley-Olson J, Patel S, Zanation A, Hackman T, Zevallos J, Blumberg J, Patel S, Kasibhatla M, Sheets N, Weissler M, Yarbrough W, Mendenhall W. Phase II Trial of De-Intensified Chemoradiotherapy for Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. J Clin Oncol 2019; 37:2661-2669. [PMID: 31411949 PMCID: PMC7010421 DOI: 10.1200/jco.19.01007] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report the results of a phase II clinical trial of de-intensified chemoradiotherapy for patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma. MATERIALS AND METHODS Major inclusion criteria were (1) having American Joint Committee on Cancer (AJCC) 7th edition T0-T3, N0-N2c, M0 (AJCC 8th edition T0-T3, N0-N2, M0), (2) being p16 positive, and (3) reporting minimal or remote smoking history. Treatment was limited to 60 Gy intensity-modulated radiotherapy with concurrent intravenous cisplatin 30 mg/m2 once per week. Patients with T0-T2 N0-1 (AJCC 7th edition) did not receive chemotherapy. All patients had a 10- to 12-week post-treatment positron emission tomography/computed tomography to assess for neck dissection. The primary end point was 2-year progression-free survival. Secondary end points included 2-year local-regional control, distant metastasis-free survival and overall survival, and patient-reported outcomes (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire and the patient-reported outcomes version of the Common Terminology Criteria for Adverse Events). RESULTS One hundred fourteen patients were enrolled (median follow-up of 31.8 months), with 81% having a minimum follow-up of 2 years. Eighty percent of patients had 10 or fewer tobacco pack-years. Two-year local-regional control, distant metastasis-free survival, progression-free survival, and overall survival were as follows: 95%, 91%, 86%, and 95%, respectively. Mean pre- and 2-year post-treatment European Organisation for Research and Treatment of Cancer quality of life scores were as follows: global, 79/84 (lower worse); swallowing, 8/9 (higher worse); and dry mouth, 14/45 (higher worse). Mean pre- and 2-year post-treatment patient-reported outcomes version of the Common Terminology Criteria for Adverse Events scores (0 to 4 scale, higher worse) were as follows: swallowing, 0.5/0.7, and dry mouth, 0.4/1.3. Thirty-four percent of patients required a feeding tube (median, 10.5 weeks; none permanent). There were no grade 3 or higher late adverse events. CONCLUSION Clinical outcomes with a de-intensified chemoradiotherapy regimen of 60 Gy intensity-modulated radiotherapy with concurrent low-dose cisplatin are favorable in patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma. Neither neoadjuvant chemotherapy nor routine surgery is needed to obtain favorable results with de-escalation.
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Affiliation(s)
- Bhishamjit S. Chera
- University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Hospitals, Chapel Hill, NC
| | | | - Rebecca Green
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Colette Shen
- University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Hospitals, Chapel Hill, NC
| | - Gaorav Gupta
- University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Hospitals, Chapel Hill, NC
| | - Xianming Tan
- University of North Carolina Hospitals, Chapel Hill, NC
| | - Mary Knowles
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - David Fried
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Neil Hayes
- University of Tennessee Health Science Center, Memphis, TN
| | - Jared Weiss
- University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Hospitals, Chapel Hill, NC
| | - Juneko Grilley-Olson
- University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Hospitals, Chapel Hill, NC
| | - Shetal Patel
- University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Hospitals, Chapel Hill, NC
| | - Adam Zanation
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Trevor Hackman
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Jose Zevallos
- Washington University School of Medicine, St Louis, MO
| | - Jeffrey Blumberg
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Samip Patel
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Mark Weissler
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Wendell Yarbrough
- University of North Carolina School of Medicine, Chapel Hill, NC
- University of North Carolina Hospitals, Chapel Hill, NC
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9
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Chera BS, Kumar S, Beaty BT, Marron D, Jefferys S, Green R, Goldman EC, Amdur R, Sheets N, Dagan R, Hayes DN, Weiss J, Grilley-Olson JE, Zanation A, Hackman T, Blumberg JM, Patel S, Weissler M, Tan XM, Parker JS, Mendenhall W, Gupta GP. Rapid Clearance Profile of Plasma Circulating Tumor HPV Type 16 DNA during Chemoradiotherapy Correlates with Disease Control in HPV-Associated Oropharyngeal Cancer. Clin Cancer Res 2019; 25:4682-4690. [PMID: 31088830 DOI: 10.1158/1078-0432.ccr-19-0211] [Citation(s) in RCA: 182] [Impact Index Per Article: 36.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/22/2019] [Accepted: 05/08/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE To identify a profile of circulating tumor human papilloma virus (HPV) DNA (ctHPVDNA) clearance kinetics that is associated with disease control after chemoradiotherapy (CRT) for HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). EXPERIMENTAL DESIGN A multi-institutional prospective biomarker trial was conducted in 103 patients with (i) p16-positive OPSCC, (ii) M0 disease, and (iii) receipt of definitive CRT. Blood specimens were collected at baseline, weekly during CRT, and at follow-up visits. Optimized multianalyte digital PCR assays were used to quantify ctHPVDNA (types 16/18/31/33/35) in plasma. A control cohort of 55 healthy volunteers and 60 patients with non-HPV-associated malignancy was also analyzed. RESULTS Baseline plasma ctHPVDNA had high specificity (97%) and high sensitivity (89%) for detecting newly diagnosed HPV-associated OPSCC. Pretreatment ctHPV16DNA copy number correlated with disease burden, tumor HPV copy number, and HPV integration status. We define a ctHPV16DNA favorable clearance profile as having high baseline copy number (>200 copies/mL) and >95% clearance of ctHPV16DNA by day 28 of CRT. Nineteen of 67 evaluable patients had a ctHPV16DNA favorable clearance profile, and none had persistent or recurrent regional disease after CRT. In contrast, patients with adverse clinical risk factors (T4 or >10 pack years) and an unfavorable ctHPV16DNA clearance profile had a 35% actuarial rate of persistent or recurrent regional disease after CRT (P = 0.0049). CONCLUSIONS A rapid clearance profile of ctHPVDNA may predict likelihood of disease control in patients with HPV-associated OPSCC patients treated with definitive CRT and may be useful in selecting patients for deintensified therapy.
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Affiliation(s)
- Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. .,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Sunil Kumar
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Brian T Beaty
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - David Marron
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Bioinformatics Core, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Stuart Jefferys
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Bioinformatics Core, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Rebecca Green
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Emily C Goldman
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Robert Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida
| | - Nathan Sheets
- Department of Radiation Oncology, UNC Rex Hospitals, Raleigh, North Carolina
| | - Roi Dagan
- University of Florida Health Proton Therapy Institute, Jacksonville, Florida
| | - D Neil Hayes
- West Cancer Center, University of Tennessee, Memphis, Tennessee
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,Division of Hematology Oncology, Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina
| | - Juneko E Grilley-Olson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,Division of Hematology Oncology, Department of Medicine, University of North Carolina, School of Medicine, Chapel Hill, North Carolina
| | - Adam Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Trevor Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jeffrey M Blumberg
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Samip Patel
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Mark Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Xianming M Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Joel S Parker
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.,Lineberger Bioinformatics Core, University of North Carolina Hospitals, Chapel Hill, North Carolina.,Department of Genetics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida
| | - Gaorav P Gupta
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. .,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Su Z, Li Z, Henderson R, Hoppe B, Nichols RC, Bryant C, Mendenhall W, Mendenhall N. PTV margin analysis for prostate patients treated with initial pelvic nodal IMRT and prostate proton boost. ACTA ACUST UNITED AC 2019; 64:04NT04. [DOI: 10.1088/1361-6560/aafd75] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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11
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Silver N, Dourado J, Hitchcock K, Fullerton A, Fredenburg K, Dziegielewski P, Danan D, Tighe P, Morris C, Amdur R, Mendenhall W, Fillingim RB. Chronic opioid use in patients undergoing treatment for oropharyngeal cancer. Laryngoscope 2019; 129:2087-2093. [DOI: 10.1002/lary.27791] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/06/2018] [Accepted: 12/14/2018] [Indexed: 01/28/2023]
Affiliation(s)
- Natalie Silver
- Department of Otolaryngology–Head and Neck Surgery Gainesville Florida U.S.A
| | | | | | - Amy Fullerton
- Department of Speech Language and Hearing Sciences Gainesville Florida U.S.A
| | | | - Peter Dziegielewski
- Department of Otolaryngology–Head and Neck Surgery Gainesville Florida U.S.A
| | - Deepa Danan
- Department of Otolaryngology–Head and Neck Surgery Gainesville Florida U.S.A
| | - Patrick Tighe
- Department of Anesthesiology Gainesville Florida U.S.A
| | - Chris Morris
- Department of Radiation Oncology Gainesville Florida U.S.A
| | - Robert Amdur
- Department of Radiation Oncology Gainesville Florida U.S.A
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12
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Chera B, Amdur R, Tan X, Hayes N, Weiss J, Grilley-Olson J, Zanation A, Hackman T, Zevallos J, Patel S, Sheets N, Weissler M, Mendenhall W. OC-0273: Phase II Trial of De-intensified Chemoradiotherapy for HPV-associated Oropharyngeal Cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30583-8] [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: 11/29/2022]
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13
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Holtzman A, Rotondo R, Rutenberg M, Indelicato D, Morris C, Mendenhall W. A Prospective Outcomes Study of Proton Therapy for Skull-Base Chondrosarcomas. Skull Base Surg 2018. [DOI: 10.1055/s-0038-1633589] [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]
Affiliation(s)
- Adam Holtzman
- University of Florida College of Medicine, Gainesville, Florida, United States
| | - Ronny Rotondo
- University of Florida College of Medicine, Gainesville, Florida, United States
| | - Michael Rutenberg
- University of Florida College of Medicine, Gainesville, Florida, United States
| | - Daniel Indelicato
- University of Florida College of Medicine, Gainesville, Florida, United States
| | - Christopher Morris
- University of Florida College of Medicine, Gainesville, Florida, United States
| | - William Mendenhall
- University of Florida College of Medicine, Gainesville, Florida, United States
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de Bree R, Senft A, Coca-Pelaz A, Kowalski L, Lopez F, Mendenhall W, Quer M, Rinaldo A, Shaha AR, Strojan P, Takes RP, Silver CE, Leemans CR, Ferlito A. Detection of Distant Metastases in Head and Neck Cancer: Changing Landscape. Adv Ther 2018; 35:161-172. [PMID: 29396680 DOI: 10.1007/s12325-018-0662-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [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: 12/15/2017] [Indexed: 12/18/2022]
Abstract
As head and neck squamous cell carcinoma (HNSCC) patients with distant metastases (DM) were generally treated only palliatively, the value of screening for DM was usually limited to attempts to avoid extensive locoregional treatment when DM were present pretreatment. Recently, the concept of treating oligometastases, e.g., by metastatectomy or stereotactic body radiotherapy, has been reintroduced for HNSCC and may cause a change in the treatment paradigm. Although whole body 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) combined with computed tomography (CT; WB-FDG-PET/CT) is still the mainstay diagnostic technique, there is a growing body of evidence supporting implementation of whole body magnetic resonance imaging (WB-MRI) as an important diagnostic technique for screening for DM. Also, FDG-PET/MRI may become a valuable technique for the detection of DM in HNSCC patients. Because the yield of examinations for detection of DM is too low to warrant routine screening of all HNSCC patients, only patients with high risk factors should be selected for intense screening for DM. Clinical and histopathological risk factors are mainly related to the extent of lymph node metastases. Risk for development of DM may also be assessed by molecular characterization of the primary tumor using genomic and proteomic technologies and radiomics. More research is needed to develop a new protocol for screening for DM after introduction of the concept of treating oligometastases in HNSCC.
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Affiliation(s)
- Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Asaf Senft
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Andrés Coca-Pelaz
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luiz Kowalski
- Department of Otorhinolaryngology-Head and Neck Surgery, Centro de Tratamento e Pesquisa Hospital do Cancer A.C. Camargo, São Paulo, Brazil
| | - Fernando Lopez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain
- Instituto Universitario de Oncología del Principado de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, University of Oviedo, Oviedo, Spain
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Miquel Quer
- Department of Otolaryngology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Ashok R Shaha
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carl E Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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15
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Mavroidis P, Price A, Fried D, Kostich M, Amdur R, Mendenhall W, Liu C, Das S, Marks LB, Chera B. Dose-volume toxicity modeling for de-intensified chemo-radiation therapy for HPV-positive oropharynx cancer. Radiother Oncol 2017; 124:240-247. [PMID: 28712533 DOI: 10.1016/j.radonc.2017.06.020] [Citation(s) in RCA: 14] [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: 12/28/2016] [Revised: 04/07/2017] [Accepted: 06/21/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE The aim is to determine the radiobiological parameters of four popular normal tissue complication probability (NTCP) models that describe the dose-response relations of salivary glands and pharyngeal constrictors to the severity of patient reported xerostomia and dysphagia, respectively 6 and 12months post chemo-radiotherapy, furthermore, to evaluate the goodness-of-fit of the NTCP models for different combinations of glands and constrictors. MATERIAL AND METHODS Forty-three patients were treated on a prospective multi-institutional phase II study (ClinicalTrials.gov, NCT01530997) assessing the efficacy of de-intensified chemoradiotherapy in patients with favorable risk, HPV-associated oropharyngeal squamous cell carcinoma. All patients received 60Gy intensity modulated radiotherapy with concurrent weekly intravenous cisplatinum. All patients reported severity of their xerostomia and dysphagia (pre- and post-treatment) using the patient reported outcome version of the CTCAE (PRO-CTCAE). A change in severity (from baseline) of ≥2 was considered clinically meaningful. The Lyman-Kutcher-Burman (LKB), Relative Seriality (RS), Logit, and Relative Seriality Logit (RSL) NTCP models were used to fit the patients' dose/volume data to changes in PRO-CTCAE severity of xerostomia and dysphagia (from baseline to 6 and 12months post-treatment). The correlation of the models with the patient outcomes was performed for different combinations of salivary glands and different sections of pharyngeal constrictors. The goodness-of-fit of the different models was assessed through the area under the receiver operating characteristic curve (AUC), maximum of the log-likelihood function, normal error distribution and Akaike information criterion (AIC). RESULTS The dose/volume metrics of the combined contralateral (parotid+submandibular) glands appear to correlate best with xerostomia, at both 6- and 12-months. Among the different sections of pharyngeal constrictors, the dose/volume metrics of the superior pharyngeal constrictors appear to correlate best with dysphagia at 6months. The AUC values ranged from 0.72 to 0.85 in the case of xerostomia and 0.73 to 0.74 in the case of dysphagia over the different models. The four NTCP models showed similar goodness-of-fit. The differences in AIC between the different models were less than 2 and ranged within 0.7 and 0.8 in the cases of xerostomia and dysphagia, respectively. The calculated parameters of the LKB model were D50=26.9Gy, m=0.63, n=1.0 for the combined contralateral glands at 12months and D50=62.0Gy, m=0.10, n=0.49 for the superior pharyngeal constrictors at 6months. CONCLUSIONS The values of the parameters of four NTCP models were determined for salivary glands and pharyngeal constrictors. All four models could fit the clinical data equally well. The NTCP predictions of the combined contralateral glands and superior pharyngeal constrictors showed the best correlation with the patient reported outcomes of xerostomia and dysphagia, respectively.
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Affiliation(s)
- Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, United States.
| | - Alex Price
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, United States
| | - David Fried
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, United States
| | - Mark Kostich
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, United States
| | - Robert Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, United States; Shands Cancer Center, University of Florida Hospitals, Gainesville, United States
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, United States; Shands Cancer Center, University of Florida Hospitals, Gainesville, United States
| | - Chihray Liu
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, United States
| | - Shiva Das
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, United States
| | - Lawrence B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, United States
| | - Bhishamjit Chera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, United States; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, United States
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16
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Falchook AD, Green R, Knowles ME, Amdur RJ, Mendenhall W, Hayes DN, Grilley-Olson JE, Weiss J, Reeve BB, Mitchell SA, Basch EM, Chera BS. Comparison of Patient- and Practitioner-Reported Toxic Effects Associated With Chemoradiotherapy for Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2017; 142:517-23. [PMID: 27149571 DOI: 10.1001/jamaoto.2016.0656] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
IMPORTANCE Agreement between patient- and practitioner-reported toxic effects during chemoradiotherapy for head and neck cancer is unknown. OBJECTIVE To compare patient-reported symptom severity and practitioner-reported toxic effects among patients receiving chemoradiotherapy for head and neck cancer. DESIGN, SETTING, AND PARTICIPANTS Forty-four patients participating in a phase 2 trial of deintensified chemoradiotherapy for oropharyngeal carcinoma were included in the present study (conducted from February 8, 2012, to March 2, 2015). Most treatment (radiotherapy, 60 Gy, with concurrent weekly administration of cisplatin, 30 mg/m2) was administered at academic medical centers. Included patients had no prior head and neck cancers, were 18 years or older, and had a smoking history of 10 pack-years or less or more than 10 pack-years but 30 pack-years or less and abstinent for the past 5 years. Cancer status was untreated human papillomavirus or p16-positive squamous cell carcinoma of the oropharynx or unknown head and neck primary site; and cancer staging was category T0 to T3, category N0 to N2c, M0, and Eastern Cooperative Oncology Group performance status 0 to 1. Baseline, weekly, and posttreatment toxic effects were assessed by physicians or nurse practitioners using National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Patient-reported symptom severity was measured using the Patient-Reported Outcomes version of the CTCAE (PRO-CTCAE). Descriptive statistics were used to characterize raw agreement between CTCAE grades and PRO-CTCAE severity ratings. INTERVENTIONS Baseline, weekly, and posttreatment toxic effects assessed using CTCAE, version 4.0, and PRO-CTCAE. MAIN OUTCOMES AND MEASURES Raw agreement indices between patient-reported toxic effects, including symptom frequency, severity, and interference with daily activities (score range, 0 [none] to 4 [very severe]), and practitioner-measured toxic effects, including swallowing, oral pain, and hoarseness (score range, 1 [mild] to 5 [death]). RESULTS Of the 44 patients included in the analysis (39 men, 5 women; mean [SD] age, 61 [8.4] years), there were 327 analyzable pairs of CTCAE and PRO-CTCAE symptom surveys and no treatment delays due to toxic effects. Patient-reported and practitioner-reported symptom severity agreement was high at baseline when most symptoms were absent but declined throughout treatment as toxic effects increased. Most disagreement was due to lower severity of toxic effects reported by practitioners (eg, from 45% agreement at baseline to 27% at the final week of treatment for pain). This was particularly noted for domains that are not easily evaluated by physical examination, such as anxiety and fatigue (eg, severity of fatigue decreased from 43% at baseline to 12% in the final week of treatment). CONCLUSIONS AND RELEVANCE Practitioner-reported toxic effects are lower than patient self-reports during head and neck chemoradiotherapy. The inclusion of patient-reported symptomatic toxic effects provides information that can potentially enhance clinical management and improve data quality in clinical trials.
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Affiliation(s)
- Aaron D Falchook
- Department of Radiation Oncology, University of North Carolina, Chapel Hill
| | - Rebecca Green
- Department of Radiation Oncology, University of North Carolina, Chapel Hill
| | - Mary E Knowles
- Department of Radiation Oncology, University of North Carolina, Chapel Hill
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville3Shands Cancer Center, University of Florida Hospitals, Gainesville
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville3Shands Cancer Center, University of Florida Hospitals, Gainesville
| | - David N Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill5Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Juneko E Grilley-Olson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill5Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill5Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Bryce B Reeve
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Sandra A Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Ethan M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill5Division of Hematology/Oncology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina, Chapel Hill4Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill
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17
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Chera BS, Amdur RJ, Mendenhall W, Zevallos J, Hayes DN. Beware of deintensification of radiation therapy in patients with p16-positive oropharynx cancer and rheumatological diseases. Pract Radiat Oncol 2017; 7:e261-e262. [PMID: 28242189 DOI: 10.1016/j.prro.2016.12.004] [Citation(s) in RCA: 5] [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] [Received: 10/19/2016] [Revised: 12/02/2016] [Accepted: 12/15/2016] [Indexed: 11/26/2022]
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Chera BS, Fried D, Price A, Amdur RJ, Mendenhall W, Lu C, Das S, Sheets N, Marks L, Mavroidis P. Dosimetric Predictors of Patient-Reported Xerostomia and Dysphagia With Deintensified Chemoradiation Therapy for HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2017; 98:1022-1027. [PMID: 28721884 DOI: 10.1016/j.ijrobp.2017.03.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/15/2017] [Accepted: 03/21/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVE(S) To estimate the association between different dose-volume metrics of the salivary glands and pharyngeal constrictors with patient reported severity of xerostomia/dysphagia in the setting of deintensified chemoradiation therapy (CRT). METHODS AND MATERIALS Forty-five patients were treated on a phase 2 study assessing the efficacy of deintensified CRT for favorable-risk, HPV-associated oropharyngeal squamous cell carcinoma. Patients received 60 Gy intensity modulated radiation therapy with concurrent weekly cisplatin (30 mg/m2), and reported the severity of their xerostomia/dysphagia (before and after treatment) using the patient-reported outcome version of the Common Terminology Criteria for Adverse Events (CTCAE) (PRO-CTCAE). Individual patient dosimetric data of the contralateral parotid and submandibular glands and pharyngeal constrictors were correlated with changes in PRO-CTCAE severity. A change in severity (from baseline) of ≥2 was considered clinically meaningful. Associations between dose-volume metrics and patient outcomes were assessed with receiver operating characteristic (ROC) curve and logistic regression model. RESULTS Six months after CRT, patients reporting <2 change in xerostomia severity (n=14) had an average Dmean = 22 ± 9 Gy to the sum of the contralateral glands (parotid + submandibular) compared with the patients reporting ≥2 change (n=21), who had an average Dmean = 34 ± 8 Gy. V15 to V55 for the combined contralateral glands showed the strongest association with xerostomia (area under the curve [AUC] = 0.83-0.86). Based on the regression analysis, a 20% risk of toxicity was associated with V15 = 48%, V25 = 30%, and Dmean=21 Gy. Six months after CRT, patients reporting <2 change in dysphagia severity (n=26) had an average V55 = 76 ± 13 (%) to the superior pharyngeal constrictor compared with the patients reporting ≥2 change in severity (n=9), who had average V55 = 89 ± 13 (%). V55to V60 had the strongest association with dysphagia (AUC = 0.70-0.75). Based on the regression analysis, a 20% risk of toxicity was associated with V55 = 78%, V60 = 40%. The findings at 12 months were similar. CONCLUSIONS After deintensified CRT, the rate of patient-reported xerostomia/dysphagia appears to be associated with the V15 of the combined contralateral salivary glands and V55 to V60 of the superior pharyngeal constrictors.
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Affiliation(s)
- Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina.
| | - David Fried
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Alex Price
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida; Shands Cancer Center, University of Florida Hospitals, Gainesville, Florida
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida; Shands Cancer Center, University of Florida Hospitals, Gainesville, Florida
| | - Chiray Lu
- Department of Radiation Oncology, University of Florida Hospitals, Gainesville, Florida
| | - Shiva Das
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Nathan Sheets
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Lawrence Marks
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Mavroidis P, Price A, Kostich M, Amdur R, Mendenhall W, Sheets N, Green R, Das S, Marks L, Chera B. SU-D-204-05: Fitting Four NTCP Models to Treatment Outcome Data of Salivary Glands Recorded Six Months After Radiation Therapy for Head and Neck Tumors. Med Phys 2016. [DOI: 10.1118/1.4955610] [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: 11/07/2022] Open
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Mavroidis P, Price A, Kostich M, Amdur R, Mendenhall W, Sheets N, Green R, Das S, Marks L, Chera B. SU-F-T-104: Determining the NTCP Parameters of Pharyngeal Constrictors and Proximal Esophagus for Radiation Induced Swallowing Problems Recorded Six Months After Radiation Therapy for Head and Neck Tumors. Med Phys 2016. [DOI: 10.1118/1.4956240] [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: 11/07/2022] Open
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Chera B, Price A, Kostich M, Amdur R, Mendenhall W, Sheets N, Green R, Marks L, Das S, Mavroidis P. SU-D-204-04: Correlations Between Dosimetric Indices and Follow-Up Data for Salivary Glands Six Months After Radiation Therapy for Head and Neck Cancer. Med Phys 2016. [DOI: 10.1118/1.4955609] [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: 11/07/2022] Open
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Chera B, Price A, Kostich M, Amdur R, Mendenhall W, Sheets N, Green R, Marks L, Das S, Mavroidis P. SU-F-T-107: Correlations Between Dosimetric Indices of Pharyngeal Constrictors and Proximal Esophagus with Associated Patient-Reported Outcomes Six Months After Radiation Therapy for Head and Neck Cancer. Med Phys 2016. [DOI: 10.1118/1.4956243] [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: 11/07/2022] Open
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Chera B, Amdur R, Tepper J, Qaqish B, Green R, Hayes N, Weiss J, Grilley-Olson J, Zanation A, Hackman T, Funkhouser W, Sheets N, Weissler M, Mendenhall W. OC-0453: Phase II trial of de-intensified chemoradiotherapy for HPV-associated oropharyngeal cancer. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31702-9] [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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Chera BS, Amdur RJ, Tepper J, Qaqish B, Green R, Aumer SL, Hayes N, Weiss J, Grilley-Olson J, Zanation A, Hackman T, Funkhouser W, Sheets N, Weissler M, Mendenhall W. Phase 2 Trial of De-intensified Chemoradiation Therapy for Favorable-Risk Human Papillomavirus-Associated Oropharyngeal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2015; 93:976-85. [PMID: 26581135 DOI: 10.1016/j.ijrobp.2015.08.033] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 07/14/2015] [Accepted: 08/17/2015] [Indexed: 01/08/2023]
Abstract
PURPOSE To perform a prospective, multi-institutional, phase 2 study of a substantial decrease in concurrent chemoradiation therapy (CRT) intensity as primary treatment for favorable-risk, human papillomavirus-associated oropharyngeal squamous cell carcinoma. METHODS AND MATERIALS The major inclusion criteria were: (1) T0 to T3, N0 to N2c, M0; (2) human papillomavirus or p16 positive; and (3) minimal/remote smoking history. Treatment was limited to 60 Gy intensity modulated radiation therapy with concurrent weekly intravenous cisplatinum (30 mg/m(2)). The primary study endpoint was pathologic complete response (pCR) rate based on required biopsy of the primary site and dissection of pretreatment positive lymph node regions, regardless of radiographic response. Power computations were performed for the null hypothesis that the pCR rate is 87% and n=40, resulting in a type 1 error of 14.2%. Secondary endpoint measures included physician-reported toxicity (Common Toxicity Terminology for Adverse Events, CTCAE), patient-reported symptoms (PRO-CTCAE), and modified barium swallow studies. RESULTS The study population was 43 patients. The pCR rate was 86% (37 of 43). The incidence of CTCAE grade 3/4 toxicity and PRO-CTCAE severe/very severe symptoms was as follows: mucositis 34%/45%, general pain 5%/48%, nausea 18%/52%, vomiting 5%/34%, dysphagia 39%/55%, and xerostomia 2%/75%. Grade 3/4 hematologic toxicities were 11%. Thirty-nine percent of patients required a feeding tube for a median of 15 weeks (range, 5-22 weeks). There were no significant differences in modified barium swallow studies before and after CRT. CONCLUSIONS The pCR rate with decreased intensity of therapy with 60 Gy of IMRT and weekly low-dose cisplatinum is very high in favorable-risk oropharyngeal squamous cell carcinoma, with evidence of decreased toxicity compared with standard therapies. ClinicalTrials.gov ID: NCT01530997.
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Affiliation(s)
- Bhishamjit S Chera
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Robert J Amdur
- Department of Radiation Oncology, University of Florida School of Medicine, Gainesville, Florida; Shands Cancer Center, University of Florida School of Medicine, Gainesville, Florida
| | - Joel Tepper
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Bahjat Qaqish
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Rebecca Green
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Shannon L Aumer
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Neil Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Hematology Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jared Weiss
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Hematology Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Juneko Grilley-Olson
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Division of Hematology Oncology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Adam Zanation
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Trevor Hackman
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - William Funkhouser
- Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Mark Weissler
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida School of Medicine, Gainesville, Florida; Shands Cancer Center, University of Florida School of Medicine, Gainesville, Florida
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Zeitlin R, Su Z, Flampouri S, Li Z, Morris C, Bryant C, Henderson R, Hoppe B, Mendenhall W, Nichols R, Mendenhall N. The Dosimetric Impact of Small Smearing and PTV Margin Reductions on DVH Values for OAR in Image Guided Therapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1418] [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: 11/16/2022]
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Huh S, Lee S, Dagan R, Malyapa R, Mendenhall N, Mendenhall W, Ho M, Hough D, Yam M, Li Z. SU-E-J-70: Feasibility Study of Dynamic Arc and IMRT Treatment Plans Utilizing Vero Treatment Unit and IPlan Planning Computer for SRS/FSRT Brain Cancer Patients. Med Phys 2014. [DOI: 10.1118/1.4888122] [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: 11/07/2022] Open
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Bhandare N, Mendenhall W, Morris CG, Antonelli PJ. Vestibular Apparatus Dysfunction after External Beam Radiation Therapy for Head and Neck Cancers. Otolaryngol Head Neck Surg 2013. [DOI: 10.1177/0194599813496044a295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: Radiation therapy (RT) for head and neck cancers (HNC) may be associated with vestibular dysfunction (VD). The goal of this study is to examine the post-RT incidence of VD in HNC patients receiving RT +/- chemotherapy (chemo) and its association with patient and treatment related factors. Methods: Pre and post-RT records of 376 HNC patients were retrospectively assessed for the presence of possible VD. Dose received by vestibular apparatus was estimated using the CT-based treatment plan for the patient. Uni- and multivariate analyses evaluated the association between various variables and incidence of VD. Results: Subjective vertigo or dizziness was reported in 53(14.5%) patients over a median time of 16 months (range 0 to 36 months). Abnormal elecronystagmography was observed in 41 of 49 (83.6%) tested patients: 24 (48.9%) bithermal caloric stimulation, 8 (16.3%) sinusoidal tracking, and 5 (10.2%) with both. Doses received by vestibular apparatus varied between 45 to 80 Gy. Vestibular RT dose was significantly associated with VD ( P < 0.05), but age (>60), gender, fractionation were not. Use of chemo was marginally associated with VD ( P = 0.056). Conclusions: Radiation dose to the vestibular apparatus appears to be the primary determinant of VD in HNC patients treated with RT. Further prospective investigation is needed to better understand the effects of RT and chemo-RT on vestibular apparatus.
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Kil WJ, Nichols RC, Hoppe BS, Morris CG, Marcus RB, Mendenhall W, Mendenhall NP, Li Z, Costa JA, Williams CR, Henderson RH. Hypofractionated passively scattered proton radiotherapy for low- and intermediate-risk prostate cancer is not associated with post-treatment testosterone suppression. Acta Oncol 2013; 52:492-7. [PMID: 23477360 PMCID: PMC3613975 DOI: 10.3109/0284186x.2013.767983] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background. To investigate post-treatment changes in serum testosterone in low- and intermediate-risk prostate cancer patients treated with hypofractionated passively scattered proton radiotherapy. Material and methods. Between April 2008 and October 2011, 228 patients with low- and intermediate-risk prostate cancer were enrolled into an institutional review board-approved prospective protocol. Patients received doses ranging from 70 Cobalt Gray Equivalent (CGE) to 72.5 CGE at 2.5 CGE per fraction using passively scattered protons. Three patients were excluded for receiving androgen deprivation therapy (n = 2) or testosterone supplementation (n = 1) before radiation. Of the remaining 226 patients, pretreatment serum testosterone levels were available for 217. Of these patients, post-treatment serum testosterone levels were available for 207 in the final week of treatment, 165 at the six-month follow-up, and 116 at the 12-month follow-up. The post-treatment testosterone levels were compared with the pretreatment levels using Wilcoxon's signed-rank test for matched pairs. Results. The median pretreatment serum testosterone level was 367.7 ng/dl (12.8 nmol/l). The median changes in post-treatment testosterone value were as follows: +3.0 ng/dl (+0.1 nmol/l) at treatment completion; +6.0 ng/dl (+0.2 nmol/l) at six months after treatment; and +5.0 ng/dl (0.2 nmol/l) at 12 months after treatment. None of these changes were statistically significant. Conclusion. Patients with low- and intermediate-risk prostate cancer treated with hypofractionated passively scattered proton radiotherapy do not experience testosterone suppression. Our findings are consistent with physical measurements demonstrating that proton radiotherapy is associated with less scatter radiation exposure to tissues beyond the beam paths compared with intensity-modulated photon radiotherapy.
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Affiliation(s)
- Whoon Jong Kil
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Romaine C. Nichols
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Bradford S. Hoppe
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Robert B. Marcus
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - William Mendenhall
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Nancy P. Mendenhall
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Joseph A. Costa
- Division of Urology, University of Florida Shands Hospital,
Jacksonville, Florida, USA
| | | | - Randal H. Henderson
- Department of Radiation Oncology, University of Florida,
Gainesville, Florida, USA
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
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Su Z, Zhao T, Li Z, Hoppe B, Henderson R, Mendenhall W, Nichols RC, Marcus R, Mendenhall N. Reduction of prostate intrafraction motion using gas-release rectal balloons. Med Phys 2012; 39:5869-73. [DOI: 10.1118/1.4749932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nichols R, George T, Zaiden R, Hochwald S, Awad Z, Ho M, Li Z, Mendenhall N, Mendenhall W, Hoppe B. EP-1089 PROTON THERAPY FOR PANCREATIC AND AMPULLARY CANCER IS ASSOCIATED WITH A LOW INCIDENCE OF GASTROINTESTINAL TOXICITY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71422-6] [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: 11/16/2022]
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Malyapa R, Mendenhall W, Yeung D, McKenzie C, Li Z, Morris C, Mendenhall N, Okunieff P. Proton Therapy of Cancers of the Nasal Cavity and Paranasal Sinuses—the UFPTI Experience. Skull Base Surg 2012. [DOI: 10.1055/s-0032-1312082] [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: 10/28/2022]
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Su Z, Zhao T, Li Z, Hoppe B, Henderson R, Mendenhall W, Nichols C, Marcus R, Mendenhall N. Reduction of Prostate Intrafraction Motion using Gas-release Rectal Balloons. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1208] [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: 11/28/2022]
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Wang Z, Zhang Z, Kirwan J, Mendenhall W. 8568 POSTER Protection of Oral Mucosa in Patients With Oral Tongue Squamous Cell Carcinoma Treated Postoperatively With Intensity Modulated Radiotherapy. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72210-9] [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: 11/24/2022]
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Malyapa R, Mendenhall W, McKenzie C, Yeung D, Li Z, Mendenhall N, Okunieff P. Proton Therapy of Esthesioneuroblastoma: The UFPTI Experience. Skull Base 2011. [DOI: 10.1055/s-2011-1274314] [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: 10/18/2022]
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Mendenhall W, Chera B, Morris C, Amdur R. Radiotherapy Treatment Outcomes for T1–T2N0 Squamous Cell Carcinoma of the Glottic Larynx. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.964] [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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Malyapa R, Mendenhall W, Li Z, Yeung D, Mendenhall N. Proton Therapy of Paranasal Sinus Tumors: An Update of the UFPTI Experience. Skull Base 2009. [DOI: 10.1055/s-2009-1242286] [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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Bhandare N, Song W, Moiseenko V, Mendenhall W. TU-C-BRB-02: Dose-Response Analysis of Radiation-Induced Sensory Neural Hearing Loss. Med Phys 2009. [DOI: 10.1118/1.3182327] [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: 11/07/2022] Open
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Malyapa R, Mendenhall W, Yeung D, Li Z, McKenzie C, Lanza D, Mendenhall N. Proton Therapy of Paranasal Sinus Tumors: The UFPTI Experience. Skull Base 2008. [DOI: 10.1055/s-2008-1093269] [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: 10/21/2022]
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Keole S, Zhao G, Hsi W, Morris C, Vargas C, Mendenhall W, Henderson R, Mendenhall N. The Impact of Penumbra on Proton Dosimetry for Prostate Cancer: A Proton-IMRT Comparison of the High-dose Isodose Region. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.122] [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: 10/21/2022]
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Brizel DM, Murphy BA, Rosenthal DI, Pandya KJ, Glück S, Brizel HE, Meredith RF, Berger D, Chen MG, Mendenhall W. Phase II study of palifermin and concurrent chemoradiation in head and neck squamous cell carcinoma. J Clin Oncol 2008; 26:2489-96. [PMID: 18487568 DOI: 10.1200/jco.2007.13.7349] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [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] Open
Abstract
PURPOSE Acute mucositis is a dose-limiting toxicity of concurrent chemoradiotherapy regimens for locally advanced head and neck cancer. Palifermin (a recombinant human keratinocyte growth factor; DeltaN23-KGF) stimulates the proliferation and differentiation of mucosal epithelium to reduce mucositis in patients receiving intensive therapy for hematologic cancers. This study assessed the efficacy and safety of palifermin in patients receiving concurrent chemoradiotherapy for advanced head and neck squamous cell carcinoma. PATIENTS AND METHODS In a phase II trial, standard radiotherapy was delivered in daily 2-Gy fractions to 70 Gy, or hyperfractionated radiotherapy was delivered in 1.25-Gy fractions twice daily to 72 Gy, over 7 weeks. Chemotherapy included cisplatin 20 mg/m(2) for 4 days and continuous-infusion fluorouracil 1,000 mg/m(2)/d for 4 days on weeks 1 and 5 of irradiation. Patients were randomly assigned 2:1 to palifermin 60 microg/kg or placebo once weekly for 10 doses. A follow-up trial evaluated long-term survival. RESULTS Sixty-seven patients received palifermin and 32 received placebo. The median duration of grade >or= 2 mucositis was 6.5 and 8.1 weeks in the palifermin and placebo groups, respectively (P = .157). Palifermin appeared to reduce mucositis, dysphagia, and xerostomia during hyperfractionated radiotherapy (n = 40) but not standard radiation therapy (n = 59). Adverse events were similar between treatment groups. Palifermin did not alter tumor response or survival. CONCLUSION Ten once-weekly doses of palifermin at 60 microg/kg were well tolerated. Most patients completed treatment, but palifermin did not reduce the morbidity of concurrent chemotherapy and radiotherapy. Future studies should evaluate higher palifermin doses with longer and more standardized assessment of acute mucositis.
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Affiliation(s)
- David M Brizel
- Department of Radiation Oncology, Duke University, Durham, NC, USA.
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Amdur RJ, Liu C, Li J, Mendenhall W, Hinerman R. Matching Intensity-Modulated Radiation Therapy to an Anterior Low Neck Field. Int J Radiat Oncol Biol Phys 2007; 69:S46-8. [PMID: 17848293 DOI: 10.1016/j.ijrobp.2007.04.091] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2007] [Accepted: 04/24/2007] [Indexed: 11/19/2022]
Abstract
When using intensity-modulated radiation therapy (IMRT) to treat head and neck cancer with the primary site above the level of the larynx, there are two basic options for the low neck lymphatics: to treat the entire neck with IMRT, or to match the IMRT plan to a conventional anterior "low neck" field. In view of the potential advantages of using a conventional low neck field, it is important to look for ways to minimize or manage the problems of matching IMRT to a conventional radiotherapy field. Treating the low neck with a single anterior field and the standard larynx block decreases the dose to the larynx and often results in a superior IMRT plan at the primary site. The purpose of this article is to review the most applicable studies and to discuss our experience with implementing a technique that involves moving the position of the superior border of the low neck field several times during a single treatment fraction.
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Affiliation(s)
- Robert J Amdur
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL 32160, USA.
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Schoenfeld G, Amdur R, Morris C, Hinerman R, Mendenhall W. Pattern of Failure and Toxicity of Intensity-Modulated Radiation Therapy for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2007. [DOI: 10.1016/j.ijrobp.2007.06.014] [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: 10/22/2022]
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Chvetsov A, Siemann D, Mendenhall W, Palta J. SU-FF-T-330: Optimal Dose Fractionation Schedules Computed with Different Tumor Reoxygenation Rates. Med Phys 2007. [DOI: 10.1118/1.2760993] [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: 11/07/2022] Open
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Galloway T, Morris C, Mancuso A, Amdur R, Mendenhall W. Impact of Radiographic Findings on Prognosis for Skin Carcinoma with Clinical Perineural Invasion. Int J Radiat Oncol Biol Phys 2005. [DOI: 10.1016/j.ijrobp.2005.07.604] [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: 11/30/2022]
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Parulekar W, de Marsh RW, Wong R, Mendenhall W, Davey P, Zlotecki R, Berry S, Rout WR, Bjarnason GA. Phase I study of 5-fluorouracil and leucovorin by continuous infusion chronotherapy and pelvic radiotherapy in patients with locally advanced or recurrent rectal cancer. Int J Radiat Oncol Biol Phys 2004; 58:1487-95. [PMID: 15050328 DOI: 10.1016/j.ijrobp.2003.09.073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2003] [Revised: 09/09/2003] [Accepted: 09/12/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine the maximal tolerated dose of chronomodulated 5-fluorouracil (5-FU) and leucovorin (LV) given concurrently with radiotherapy in patients with rectal cancer. METHODS AND MATERIALS Forty-five patients with T3, T4 or recurrent rectal cancer received concurrent radiotherapy to a minimal dose of 4500 cGy. Chemotherapy was administered by a programmable pump in chronomodulated fashion, with 62.5% of the total dose given within 7 hours around 9:30 pm. The starting doses were LV at 5 mg/m2/d and 5-FU at 150 mg/m2/d. LV was escalated in 5-mg/m2 increments to 20 mg/m2/d; 5-FU was then escalated in 25 mg/m2 increments to the maximal tolerated dose. RESULTS Diarrhea and stomatitis were dose limiting, with Grade 3 or worse toxicity occurring in 16% and 5% of patients, respectively. Thirty-seven patients (84%) received their scheduled dose of radiotherapy (range, 4500-6000 cGy). Thirty-two patients had clinical T3 disease; all were treated with definitive surgery; 23 (71%) underwent sphincter-sparing surgery with complete resection in 28 (87%). Ten patients (31%) had no evidence of tumor in the pathologic specimen. CONCLUSION Preoperative chemoradiotherapy in rectal cancer using chronomodulated 5-FU and LV is feasible. The recommended Phase II dose is 5-FU 200 mg/m2 and LV 20 mg/m2 daily for 5 weeks.
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Affiliation(s)
- Wendy Parulekar
- Department of Medical Oncology, Kingston Regional Cancer Center, Kingston, ON, Canada
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Deschler DG, Miller FR, Snyderman CH, Koch WM, Lavertu P, Mendenhall W, Riggs CE. Miniseminar: Diagnosis and Treatment of the Unknown Primary. Otolaryngol Head Neck Surg 2003. [DOI: 10.1016/s0194-59980300855-6] [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: 01/11/2023]
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Brizel D, Le Q, Rosenthal D, Meredith R, Brizel H, Heard R, Yao B, Eng T, Sailer S, Chen Y, Murphy B, Mendenhall W. Phase 2 study of recombinant human keratinocyte growth factor (rHuKGF) in head & neck cancer treated with standard (SRT) or hyperfractionated irradiation (HRT) & concurrent chemotherapy (CT). Int J Radiat Oncol Biol Phys 2002. [DOI: 10.1016/s0360-3016(02)03551-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mancuso AA, Mukherji SK, Schmalfuss I, Mendenhall W, Parsons J, Pameijer F, Hermans R, Kubilis P. Preradiotherapy computed tomography as a predictor of local control in supraglottic carcinoma. J Clin Oncol 1999; 17:631-7. [PMID: 10080608 DOI: 10.1200/jco.1999.17.2.631] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine the utility of pretreatment computed tomography (CT) for predicting primary site control in patients with supraglottic squamous cell carcinoma (SCC) treated with definitive radiotherapy (RT). MATERIALS AND METHODS Pretreatment CT studies in 63 patients were reviewed. Minimum length of follow-up was 2 years. Local recurrence and treatment complications resulting in permanent loss of laryngeal function were documented. Tumor volume was calculated using a computer digitizer, and pre-epiglottic space (PES) spread was estimated. The data were analyzed using a combination of Fisher's exact test, logistic regression modeling, and multivariate analyses. Five-year local control rates were calculated using the product-limit method. RESULTS Local control rates were inversely and roughly linearly related to tumor volume, although there seemed to be a threshold volume at which primary site prognosis diminished. Local control was 89% in tumors less than 6 cm3 and 52% when volumes were > or =6 cm3 (P = .0012). The likelihood of maintaining laryngeal function also varied with tumor volume: 89% for tumors less than 6 cm3 and 40% for tumors > or =6 cm3 (P = .00004). Pre-epiglottic space involvement by tumor of > or =25% was associated with a reduced chance of saving the larynx (P = .0076). Multivariate analyses revealed that only tumor volume independently altered these end points. CONCLUSION Pretreatment CT measurements of tumor volume permits stratification of patients with supraglottic SCC treated with RT alone (which allows preservation of laryngeal function) into groups in which local control is more likely and less likely. Pre-epiglottic space spread is not a contraindication to using RT as the primary treatment for supraglottic SCC.
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Affiliation(s)
- A A Mancuso
- Department of Radiology, University of Florida College of Medicine, Gainesville 32610-0374, USA.
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