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Khoo A, Boyer M, Jafri Z, Makeham T, Pham T, Khachigian LM, Floros P, Dowling E, Fedder K, Shonka D, Garneau J, O'Meara CH. Human Papilloma Virus Positive Oropharyngeal Squamous Cell Carcinoma and the Immune System: Pathogenesis, Immunotherapy and Future Perspectives. Int J Mol Sci 2024; 25:2798. [PMID: 38474047 DOI: 10.3390/ijms25052798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC), a subset of head and neck squamous cell carcinoma (HNSCC), involves the palatine tonsils, soft palate, base of tongue, and uvula, with the ability to spread to adjacent subsites. Personalized treatment strategies for Human Papillomavirus-associated squamous cell carcinoma of the oropharynx (HPV+OPSCC) are yet to be established. In this article, we summarise our current understanding of the pathogenesis of HPV+OPSCC, the intrinsic role of the immune system, current ICI clinical trials, and the potential role of small molecule immunotherapy in HPV+OPSCC.
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Affiliation(s)
- A Khoo
- Department of Otolaryngology, Head & Neck Surgery, Canberra Health Services, Canberra, ACT 2601, Australia
| | - M Boyer
- Chris O'Brien Lifehouse, Camperdown, NSW 2050, Australia
| | - Z Jafri
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - T Makeham
- Department of Otolaryngology, Head & Neck Surgery, Canberra Health Services, Canberra, ACT 2601, Australia
- ANU School of Medicine & Psychology, Australian National University, Canberra, ACT 0200, Australia
| | - T Pham
- Department of Otolaryngology, Head & Neck Surgery, Canberra Health Services, Canberra, ACT 2601, Australia
- ANU School of Medicine & Psychology, Australian National University, Canberra, ACT 0200, Australia
| | - L M Khachigian
- Vascular Biology and Translational Research, Department of Pathology, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - P Floros
- St Vincent's Hospital, 390 Victoria Street, Sydney, NSW 2010, Australia
| | - E Dowling
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - K Fedder
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - D Shonka
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - J Garneau
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
| | - C H O'Meara
- Department of Otolaryngology, Head & Neck Surgery, Canberra Health Services, Canberra, ACT 2601, Australia
- ANU School of Medicine & Psychology, Australian National University, Canberra, ACT 0200, Australia
- Department of Otolaryngology, Head & Neck Surgery, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
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Blyth K, Stainlay H, McCabe P. Speech and swallowing intervention following oral cancer treatment: A survey of speech-language pathologists in Australia and New Zealand. Int J Speech Lang Pathol 2023:1-11. [PMID: 37705219 DOI: 10.1080/17549507.2023.2240043] [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] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
PURPOSE Treatment for oral cancer has debilitating effects on speech and swallowing, however, little is known about current speech-language pathology practice. METHOD An online survey of speech-language pathologists (SLPs) was disseminated via emails to speech pathology departments, social media platforms, and professional online forums. Survey questions captured demographics, service delivery, type and timing of speech and swallowing interventions, and influences and barriers to practice. RESULT Forty-three SLPs working in Australia (n = 41) and New Zealand (n = 2) completed the survey. SLPs recommended speech and swallowing compensatory strategies significantly more frequently than active intervention. Swallowing outcomes measures were either instrumental (n = 31, 94%) or performance ratings (n = 25, 76%), whereas speech was measured informally with judgements of intelligibility (n = 30, 91%). SLPs used a range of supports for their decision making, particularly expert opinion (n = 81, 38.2%). They reported time and staffing limitations (n = 55, 55%) and a lack of relevant evidence (n = 35, 35%) as the largest barriers to evidence-based service delivery. CONCLUSION There is variability amongst SLPs in Australia and New Zealand regarding rehabilitation of speech and swallowing for people with oral cancer. This study highlights the need for evidence-based guidelines outlining best practice for screening processes, active rehabilitation protocols, and valid outcome measures with this population.
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Affiliation(s)
- Katrina Blyth
- Speech Pathology, The University of Sydney Faculty of Medicine and Health, Sydney, Australia
| | - Hannah Stainlay
- Caringbah Community Health Centre, South Eastern Sydney Local Health District, Caringbah, Australia
| | - Patricia McCabe
- Speech Pathology, The University of Sydney Faculty of Medicine and Health, Sydney, Australia
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Gao G, Miyasato D, Barner LA, Serafin R, Bishop KW, Xie W, Glaser AK, Rosenthal EL, True LD, Liu JT. Comprehensive Surface Histology of Fresh Resection Margins With Rapid Open-Top Light-Sheet (OTLS) Microscopy. IEEE Trans Biomed Eng 2023; 70:2160-2171. [PMID: 37021859 PMCID: PMC10324671 DOI: 10.1109/tbme.2023.3237267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE For tumor resections, margin status typically correlates with patient survival but positive margin rates are generally high (up to 45% for head and neck cancer). Frozen section analysis (FSA) is often used to intraoperatively assess the margins of excised tissue, but suffers from severe under-sampling of the actual margin surface, inferior image quality, slow turnaround, and tissue destructiveness. METHODS Here, we have developed an imaging workflow to generate en face histologic images of freshly excised surgical margin surfaces based on open-top light-sheet (OTLS) microscopy. Key innovations include (1) the ability to generate false-colored H&E-mimicking images of tissue surfaces stained for < 1 min with a single fluorophore, (2) rapid OTLS surface imaging at a rate of 15 min/cm2 followed by real-time post-processing of datasets within RAM at a rate of 5 min/cm2, and (3) rapid digital surface extraction to account for topological irregularities at the tissue surface. RESULTS In addition to the performance metrics listed above, we show that the image quality generated by our rapid surface-histology method approaches that of gold-standard archival histology. CONCLUSION OTLS microscopy has the feasibility to provide intraoperative guidance of surgical oncology procedures. SIGNIFICANCE The reported methods can potentially improve tumor-resection procedures, thereby improving patient outcomes and quality of life.
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Affiliation(s)
- Gan Gao
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Dominie Miyasato
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Lindsey A. Barner
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Robert Serafin
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Kevin W. Bishop
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Weisi Xie
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Adam K. Glaser
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Allen Institute for Neural Dynamics, Seattle, WA, USA
| | - Eben L. Rosenthal
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lawrence D. True
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Jonathan T.C. Liu
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
- Department of Bioengineering, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
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Dar MA, Chauhan R, Murti K, Trivedi V, Dhingra S. Development and Validation of Subjective Financial Distress Questionnaire (SFDQ): A Patient Reported Outcome Measure for Assessment of Financial Toxicity Among Radiation Oncology Patients. Front Oncol 2022; 11:819313. [PMID: 35186720 PMCID: PMC8847677 DOI: 10.3389/fonc.2021.819313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 11/21/2021] [Accepted: 12/29/2021] [Indexed: 11/24/2022] Open
Abstract
Background Financial toxicity is a consequence of subjective financial distress experienced by cancer patients as a result of treatment expenditures. Financial toxicity has been associated with poor quality of life, early mortality, and non-adherence. It is evident from the literature that the currently available instruments for the assessment of financial toxicity do not measure coping and support seeking domains. The aim of this study was to develop an instrument for the assessment of financial toxicity among radiation oncology patients that captures and integrates all the relevant domains of subjective financial distress. Materials and Methods The study was conducted among Head & Neck cancer (HNC) patients (age ≥18 years) who have completed the radiotherapy either as stand-alone or part of a multimodal treatment. Literature review, expert opinion, and patient interviews were used for scale item generation. The validity and underlying factor structure were evaluated by Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). The reliability and internal consistency of the final scale was assessed using Cronbach’s alpha coefficient. Results A total of 17 items were identified for scale development. The preliminary 17-item instrument was administered to 142 HNC patients. Among 142 participants, 85.9% were male and 98.6% were from rural areas. EFA was performed on 17 items and three items were removed (factor loadings <0.5). The remaining 14 items loaded onto three factors (eigenvalue >1) explaining 62.0% of the total variance. The Chi-square goodness of fit test in CFA and the values of other model fit indices, namely, RMSEA = 0.045, SRMR = 0.014, GFI = 0.92, CFI = 0.98, and TLI=0.97 indicate a good model fit suggesting the three-factor model adequately fits the data. The Cronbach’s α for the final 14-item scale was 0.87 indicating excellent reliability and the Cronbach’s α coefficient of all the individual 14 items was ≥0.85 (range 0.85–0.88). Conclusion The SFDQ showed excellent validity and reliability. SFDQ captures and integrates all the relevant domains of financial toxicity. However, the provisional SFDQ instrument warrants further larger sample studies for validation and psychometric evaluation in different primary cancer subsites and treatment modalities from multiple cancer centers to improve the generalizability of this instrument.
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Affiliation(s)
- Mukhtar Ahmad Dar
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
| | - Richa Chauhan
- Department of Radiotherapy, Mahavir Cancer Sansthan and Research Centre (MCSRC), Phulwarisharif, India
| | - Krishna Murti
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
| | - Vinita Trivedi
- Department of Radiotherapy, Mahavir Cancer Sansthan and Research Centre (MCSRC), Phulwarisharif, India
| | - Sameer Dhingra
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Hajipur, India
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Caputo MP, Rodriguez CS, Padhya TA, Mifsud MJ. Medical Cannabis as Adjunctive Therapy for Head and Neck Cancer Patients. Cureus 2021; 13:e18396. [PMID: 34729274 PMCID: PMC8555939 DOI: 10.7759/cureus.18396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/29/2021] [Indexed: 12/15/2022] Open
Abstract
The goal of this systematic review was to define a consensus within the current literature regarding the impact/effect of cannabis or cannabinoids on the treatment of patients with head and neck cancer. We conducted a review of PubMed, Embase, and Web of Science databases, using a comprehensive search strategy, focusing on articles relating to head & neck cancer and cannabis/cannabinoids without a time limit for publication. Two, independent reviewers screened articles based on title/abstract and included the ones selected by both. We then conducted a full-text review and excluded all articles which did not meet inclusion criteria. A single reviewer then assessed studies for methodological quality and extracted relevant data using a premade data collection tool. We identified five studies that met inclusion criteria. Studies were of varying quality and the majority investigated recreational cannabis use with only one study reporting dosing across participants. Lack of standardized cannabis exposure presents a wide array of potential confounding variables across the remaining studies. Meta-analysis was not attempted due to variability in reported outcomes. It is impossible to draw any conclusions regarding the benefit or adverse effects of current medical cannabis products in this patient population. The literature regarding the effect of cannabis/cannabinoids on head & neck cancer patients is limited. However, the current lack of evidence does not definitively disprove the efficacy of cannabis. High-quality studies are necessary for physicians to provide advice to patients who are either using or interested in cannabis as an adjunctive treatment.
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Affiliation(s)
- Mathew P Caputo
- Otolaryngology - Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | | | - Tapan A Padhya
- Otolaryngology - Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
| | - Matthew J Mifsud
- Otolaryngology - Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, USA
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Pandit PN, Patil RA, Palwe VS, Tambade SH, Wagh SY, Gavit MK, Nagarkar RV. Patterns of blood pressure changes in patients with head and neck cancer receiving radiotherapy or chemo-radiotherapy at a tertiary cancer centre. Head Neck 2020; 43:1280-1288. [PMID: 33372394 DOI: 10.1002/hed.26590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/05/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To evaluate patterns of blood pressure (BP) changes in patients with head and neck cancer (HNC) receiving radiation (RT)/chemo-radiation (CRT) METHODS: This study included data collection, compilation, and analysis of 451 consecutive HNC patients who underwent RT/CRT. RESULTS Out of 451 patients, 376 (82%) were male and 75 (18%) were female with a median age of 52 years. Patients receiving 3DCRT experienced greater fall in BP, including for SBP and MAP, compared to those receiving IMRT-IGRT. Female patients experienced greater fall in diastolic BP as compared to male patients (p: 0.03). At the end of treatment, we observed a significant association between a fall in systolic BP (decrease by 10% of baseline) and weight loss of more than 10% of baseline weight (p: 0.03). CONCLUSION Fall in BP during RT/CRT is significantly affected by treatment technique and sex and is strongly associated with significant weight loss.
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Affiliation(s)
- Prakash N Pandit
- Department of Radiation Oncology, HCG Manavata Cancer Centre, Nashik, India
| | | | - Vijay S Palwe
- Department of Radiation Oncology, HCG Manavata Cancer Centre, Nashik, India
| | - Suwarna H Tambade
- Department of Internal Medicine, HCG Manavata Cancer Centre, Nashik, India
| | - Sameer Y Wagh
- Department of Internal Medicine, HCG Manavata Cancer Centre, Nashik, India
| | - Majula K Gavit
- Department of Nursing, HCG Manavata Cancer Centre, Nashik, India
| | - Raj V Nagarkar
- Department of Surgical Oncology, HCG Manavata Cancer Centre, Nashik, India
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Abstract
INTRODUCTION It is well known that malignant cells can be implanted at distant donor sites due to iatrogenic surgical contamination. Only a small number of reports, however, have been published describing this. CASE PRESENTATION We present a case of oral cavity Squamous Cell Carcinoma (SCC) reconstructed with a radial forearm free flap in which SCC developed in the subcutaneous tissues beneath the donor incision site 6 months after surgery. MANAGEMENT The implanted tumor was excised and the field was subsequently treated with radiation. The patient remains disease-free on follow-up. DISCUSSION We present the second report of tumor implanted in a free flap donor site. Additionally, we discuss the risks of tumor implantation, review the literature, and make recommendations to avoid this complication.
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Affiliation(s)
- Priscilla Pichardo
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Nicholas Purdy
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, PA, USA
| | - Thorsen Haugen
- Department of Otolaryngology-Head & Neck Surgery, Geisinger Medical Center, Danville, PA, USA
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Wang L, Yang L, Han S, Zhu J, Li Y, Wang Z, Fan YH, Lin E, Zhang R, Sahoo N, Li Y, Zhang X, Wang X, Li T, Zhu XR, Zhu H, Heymach JV, Myers JN, Frank SJ. Patterns of protein expression in human head and neck cancer cell lines differ after proton vs photon radiotherapy. Head Neck 2020; 42:289-301. [PMID: 31710172 DOI: 10.1002/hed.26005] [Citation(s) in RCA: 8] [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: 05/28/2019] [Revised: 09/26/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Proton radiotherapy (PRT) may be a less toxic alternative to photon radiotherapy (XRT) for patients with head and neck squamous cell carcinoma (HNSCC). However, the molecular responses of HNSCC cells to PRT vs XRT are unclear. METHODS Proteomics analyses of protein expression profiles by reverse-phase protein arrays were done for two human papillomavirus [HPV]-negative and two HPV+ cell lines. Expression patterns of 175 proteins involved in several signaling pathways were tested. RESULTS Compared with PRT, XRT tended to induce lower expression of DNA damage repair-and cell cycle arrest-related proteins and higher expression of cell survival- and proliferation-related proteins. CONCLUSIONS Under these experimental conditions, PRT and XRT induced different protein expression and activation profiles. Further preclinical verification is needed, as are studies of tumor pathway mutations as biomarkers for choice of treatment or as radiosensitization targets to improve the response of HNSCC to PRT or XRT.
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Affiliation(s)
- Li Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Liuqing Yang
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Shichao Han
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jinming Zhu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yuting Li
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zeming Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - You-Hong Fan
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eric Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ruiping Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Narayan Sahoo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yupeng Li
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiaodong Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiaochun Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tengfei Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Xiaorong R Zhu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hongtu Zhu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John V Heymach
- Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey N Myers
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chauvin J, Judee F, Merbahi N, Vicendo P. Effects of Plasma Activated Medium on Head and Neck FaDu Cancerous Cells: Comparison of 3D and 2D Response. Anticancer Agents Med Chem 2019; 18:776-783. [PMID: 28762317 DOI: 10.2174/1871520617666170801111055] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/02/2017] [Accepted: 07/22/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this work is to investigate the inhibitory effect of Plasma Activated Medium (PAM) on Head and Neck cancerous cells (FaDu). The response of FaDu cells in monolayer cultures and Multi Cellular Tumor Spheroids (MCTS) after treatment with different PAMs will be compared. BACKGROUND Head and Neck squamous cell carcinoma is a widespread cancer that responds poorly to anticancer treatments such as chemotherapy and radiotherapy. Nowadays there is a growing interest in cold plasmas and their applications in cancer therapy. METHODS A homemade helium plasma jet is used to produce PAM. The effects of PAM and hydrogen peroxide H2O2 on FaDu 2D cells cultures and MCTS were characterized by evaluating the cell viability with PrestoBlue test and by measuring the size of MCTS. RESULTS One treatment with PAM induce cell detachment from MCTS since the first day in a PAM exposure dependent manner. This is due to the presence of H2O2 in PAM. However, a rapid spheroids regrowth is observed attributed to a resistance of FaDu cells to H2O2. After multiple treatments of MCTS with PAM we obtained an inhibition of cell growth. MCTS are brought out when comparing PAM effect on 2D versus MCTS. Inversely, PAM induces cell death in the case of 2D cell culture. CONCLUSION PAM may be considered as a potentially efficient agent in the therapy of head and neck cancer. We also point out that MCTS is a more valuable model than 2D cell culture for the evaluation of the anti-cancer activity of PAM.
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Affiliation(s)
- Julie Chauvin
- Universite de Toulouse-LAPLACE, UMR 5213, UPS, Toulouse, France.,Universite de Toulouse-IMRCP, UMR 5263, CNRS, Toulouse, France
| | - Florian Judee
- Universite de Toulouse-LAPLACE, UMR 5213, UPS, Toulouse, France
| | - Nofel Merbahi
- Universite de Toulouse-LAPLACE, UMR 5213, UPS, Toulouse, France
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Chen L, Zhou Z, Sher D, Zhang Q, Shah J, Pham NL, Jiang S, Wang J. Combining many-objective radiomics and 3D convolutional neural network through evidential reasoning to predict lymph node metastasis in head and neck cancer. Phys Med Biol 2019; 64:075011. [PMID: 30780137 PMCID: PMC7178778 DOI: 10.1088/1361-6560/ab083a] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Lymph node metastasis (LNM) is a significant prognostic factor in patients with head and neck cancer, and the ability to predict it accurately is essential to optimizing treatment. Positron emission tomography (PET) and computed tomography (CT) imaging are routinely used to identify LNM. Although large or highly active lymph nodes (LNs) have a high probability of being positive, identifying small or less reactive LNs is challenging. The accuracy of LNM identification strongly depends on the physician's experience, so an automatic prediction model for LNM based on CT and PET images is warranted to assist LMN identification across care providers and facilities. Radiomics and deep learning are the two promising imaging-based strategies for node malignancy prediction. Radiomics models are built based on handcrafted features, while deep learning learns the features automatically. To build a more reliable model, we proposed a hybrid predictive model that takes advantages of both radiomics and deep learning based strategies. We designed a new many-objective radiomics (MaO-radiomics) model and a 3D convolutional neural network (3D-CNN) that fully utilizes spatial contextual information, and we fused their outputs through an evidential reasoning (ER) approach. We evaluated the performance of the hybrid method for classifying normal, suspicious and involved LNs. The hybrid method achieves an accuracy (ACC) of 0.88 while XmasNet and Radiomics methods achieve 0.81 and 0.75, respectively. The hybrid method provides a more accurate way for predicting LNM using PET and CT.
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Affiliation(s)
- Liyuan Chen
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Zhiguo Zhou
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - David Sher
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Qiongwen Zhang
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Department of Head and Neck Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jennifer Shah
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Nhat-Long Pham
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Steve Jiang
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Jing Wang
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
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Chen L, Zhou Z, Sher D, Zhang Q, Shah J, Pham NL, Jiang S, Wang J. Predicting Lymph Node Metastasis in Head and Neck Cancer by Combining Many-objective Radiomics and 3-dimensioal Convolutional Neural Network through Evidential Reasoning. Annu Int Conf IEEE Eng Med Biol Soc 2018; 2018:1-4. [PMID: 30440295 PMCID: PMC7103090 DOI: 10.1109/embc.2018.8513070] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Lymph node metastasis (LNM) is a significant prognostic factor in patients with head and neck cancer, and the ability to predict it accurately is essential for treatment optimization. PET and CT imaging are routinely used for LNM identification. However, uncertainties of LNM always exist especially for small size or reactive nodes. Radiomics and deep learning are the two preferred imaging-based strategies for node malignancy prediction. Radiomics models are built based on handcrafted features, and deep learning can learn the features automatically. We proposed a hybrid predictive model that combines many-objective radiomics (MO-radiomics) and 3-dimensional convolutional neural network (3D-CNN) through evidential reasoning (ER) approach. To build a more reliable model, we proposed a new many-objective radiomics model. Meanwhile, we designed a 3D-CNN that fully utilizes spatial contextual information. Finally, the outputs were fused through the ER approach. To study the predictability of the two modalities, three models were built for PET, CT, and PET& CT. The results showed that the model performed best when the two modalities were combined. Moreover, we showed that the quantitative results obtained from the hybrid model were better than those obtained from MO-radiomics and 3D-CNN.
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Affiliation(s)
- Liyuan Chen
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Zhiguo Zhou
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - David Sher
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Qiongwen Zhang
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Department of Head and Neck Cancer, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jennifer Shah
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Nhat-Long Pham
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Steve Jiang
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Jing Wang
- Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
- Medical Artificial Intelligence and Automation (MAIA) Lab, the University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
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12
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Li X, Zhang YY, Shi YH, Zhou LH, Zhen X. Evaluation of deformable image registration for contour propagation between CT and cone-beam CT images in adaptive head and neck radiotherapy. Technol Health Care 2017; 24 Suppl 2:S747-55. [PMID: 27259084 DOI: 10.3233/thc-161204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 11/15/2022]
Abstract
Deformable image registration (DIR) is a critical technic in adaptive radiotherapy (ART) to propagate contours between planning computerized tomography (CT) images and treatment CT/Cone-beam CT (CBCT) image to account for organ deformation for treatment re-planning. To validate the ability and accuracy of DIR algorithms in organ at risk (OAR) contours mapping, seven intensity-based DIR strategies are tested on the planning CT and weekly CBCT images from six Head & Neck cancer patients who underwent a 6 ∼ 7 weeks intensity-modulated radiation therapy (IMRT). Three similarity metrics, i.e. the Dice similarity coefficient (DSC), the percentage error (PE) and the Hausdorff distance (HD), are employed to measure the agreement between the propagated contours and the physician delineated ground truths. It is found that the performance of all the evaluated DIR algorithms declines as the treatment proceeds. No statistically significant performance difference is observed between different DIR algorithms (p> 0.05), except for the double force demons (DFD) which yields the worst result in terms of DSC and PE. For the metric HD, all the DIR algorithms behaved unsatisfactorily with no statistically significant performance difference (p= 0.273). These findings suggested that special care should be taken when utilizing the intensity-based DIR algorithms involved in this study to deform OAR contours between CT and CBCT, especially for those organs with low contrast.
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Affiliation(s)
- X Li
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Y Y Zhang
- Department of Radiotherapy Oncology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - Y H Shi
- Department of Radiotherapy Oncology, the First Hospital of Jilin University, Changchun, Jilin, China
| | - L H Zhou
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - X Zhen
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
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13
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Warram JM, de Boer E, Moore LS, Schmalbach CE, Withrow KP, Carroll WR, Richman JS, Morlandt AB, Brandwein-Gensler M, Rosenthal EL. A ratiometric threshold for determining presence of cancer during fluorescence-guided surgery. J Surg Oncol 2015; 112:2-8. [PMID: 26074273 DOI: 10.1002/jso.23946] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 02/09/2015] [Accepted: 05/20/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND OBJECTIVE Fluorescence-guided imaging to assist in identification of malignant margins has the potential to dramatically improve oncologic surgery. However, a standardized method for quantitative assessment of disease-specific fluorescence has not been investigated. Introduced here is a ratiometric threshold derived from mean fluorescent tissue intensity that can be used to semi-quantitatively delineate tumor from normal tissue. METHODS Open-field and a closed-field imaging devices were used to quantify fluorescence in punch biopsy tissues sampled from primary tumors collected during a phase 1 trial evaluating the safety of cetuximab-IRDye800 in patients (n = 11) undergoing surgical intervention for head and neck cancer. Fluorescence ratios were calculated using mean fluorescence intensity (MFI) from punch biopsy normalized by MFI of patient-matched tissues. Ratios were compared to pathological assessment and a ratiometric threshold was established to predict presence of cancer. RESULTS During open-field imaging using an intraoperative device, the threshold for muscle normalized tumor fluorescence was found to be 2.7, which produced a sensitivity of 90.5% and specificity of 78.6% for delineating disease tissue. The skin-normalized threshold generated greater sensitivity (92.9%) and specificity (81.0%). CONCLUSION Successful implementation of a semi-quantitative threshold can provide a scientific methodology for delineating disease from normal tissue during fluorescence-guided resection of cancer.
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Affiliation(s)
- Jason M Warram
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Esther de Boer
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lindsay S Moore
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Cecelia E Schmalbach
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kirk P Withrow
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - William R Carroll
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Joshua S Richman
- Division of General Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Anthony B Morlandt
- Department of Oral & Maxillofacial Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Margaret Brandwein-Gensler
- Division of Anatomic Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Eben L Rosenthal
- Division of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama
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14
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Arbyn M, de Sanjosé S, Saraiya M, Sideri M, Palefsky J, Lacey C, Gillison M, Bruni L, Ronco G, Wentzensen N, Brotherton J, Qiao YL, Denny L, Bornstein J, Abramowitz L, Giuliano A, Tommasino M, Monsonego J. EUROGIN 2011 roadmap on prevention and treatment of HPV-related disease. Int J Cancer 2012; 131:1969-82. [PMID: 22623137 PMCID: PMC3429628 DOI: 10.1002/ijc.27650] [Citation(s) in RCA: 177] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/21/2012] [Accepted: 04/24/2012] [Indexed: 02/06/2023]
Abstract
The EUROGIN 2011 roadmap reviews the current burden of human papillomavirus (HPV)-related morbidity, as well as the evidence and potential practice recommendations regarding primary and secondary prevention and treatment of cancers and other disease associated with HPV infection. HPV infection causes ~600,000 cases of cancer of the cervix, vulva, vagina, anus and oropharynx annually, as well as benign diseases such as genital warts and recurrent respiratory papillomatosis. Whereas the incidence of cervical cancer has been decreasing over recent decades, the incidence of anal and oropharyngeal carcinoma, for which there are no effective screening programs, has been rising over the last couple of decades. Randomized trials have demonstrated improved efficacy of HPV-based compared to cytology-based cervical cancer screening. Defining the best algorithms to triage HPV-positive women, age ranges and screening intervals are priorities for pooled analyses and further research, whereas feasibility questions can be addressed through screening programs. HPV vaccination will reduce the burden of cervical precancer and probably also of invasive cervical and other HPV-related disease in women. Recent trials demonstrated that prophylactic vaccination also protects against anogenital HPV infection, anogenital intraepithelial lesions and warts associated with vaccine types, in males; and anal HPV infection and anal intraepithelial neoplasia in MSM. HPV-related oropharyngeal cancer could be treated less aggressively because of better survival compared to cancers of the oropharynx unrelated to HPV. Key findings in the field of cervical cancer prevention should now be translated in cost-effective strategies, following an organized approach integrating primary and secondary prevention, according to scientific evidence but adapted to the local situation with particular attention to regions with the highest burden of disease.
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Affiliation(s)
- Marc Arbyn
- Unit of Cancer Epidemiology, Scientific Institute of Public Health, Brussels, Belgium.
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15
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Dedhia RC, Grandis JR, Fontes PA, Johnson JT, Weissfeld J. Screening for head and neck cancer in liver transplant candidates: a review of 11 years of experience at the University of Pittsburgh. Laryngoscope 2012; 122:539-42. [PMID: 22183711 PMCID: PMC3391608 DOI: 10.1002/lary.22406] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 08/24/2011] [Indexed: 12/12/2022]
Abstract
OBJECTIVES/HYPOTHESIS At our institution, any liver transplant candidate with a recent history of smoking combined with daily use of alcohol prior to a 6-month sobriety period warrants formal evaluation by otolaryngology. Given the significant resource consumption and lack of evidence in support of this strategy, we sought to determine the effectiveness of these guidelines in detecting head and neck cancer. STUDY DESIGN Retrospective review of clinical database and patient billing records. METHODS Under an institutional review board-approved protocol, a search was performed for patients seen at our institution's otolaryngology office from 1999 to 2010. This patient list was cross-matched with the patients evaluated for transplant at the University of Pittsburgh Starzl Transplantation Institute during the same timeframe. A search for the diagnosis of head and neck squamous cell carcinoma of the head and neck (HNC) among these patients was carried out through both a National Cancer Institute-affiliated clinical research registry and ICD-9 codes from billing records. Otolaryngology attending physicians were also asked to recall detection of HNC upon screening of this patient population. RESULTS Of 581 patient evaluations performed by the otolaryngologist for HNC screening prior to liver transplantation from 1999 to 2009, one (0.17% of evaluations) case of HNC was detected. CONCLUSIONS Given the consumption of resources required for this screening strategy and the limited yield, it appears that current screening guidelines are ineffective and need to be reconsidered.
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Affiliation(s)
- Raj C. Dedhia
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | | | - Paulo A. Fontes
- Department of Transplant Surgery, University of Pittsburgh School of Medicine
| | - Jonas T. Johnson
- Department of Otolaryngology, University of Pittsburgh School of Medicine
| | - Joel Weissfeld
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health
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