Treatment Stratification in First-Line Recurrent or Metastatic Head and Neck Cancer, on Behalf of the EORTC Young Investigator Head and Neck Cancer Group

Multiple factors differentially influence treatment decisions in the first line treatment of recurrent/metastatic HNSCC. The EORTC Young investigator group launched a survey among treating physicians to explore the main influencing factors for treatment stratification. The questionnaire was posted as a web-survey link from May to August 2020. Next to defining the factors that mostly influence therapeutic decision the survey was complemented by a clinical case discussion of five patient cases. A total of 118 responses from 19 countries were collected. The key factors identified to guide treatment decision were performance status, PD-L1 Expression, time from last systemic treatment above or below 6 months, and disease burden.Prospective evaluation of patient characteristics and additional potential predictive biomarkers for novel treatment options remains an important question to stratify personalized treatment for RM HNSCC

Defining oligometastatic disease from a radiation oncology perspective : an ESTRO-ASTRO consensus document

Background: Recognizing the rapidly increasing interest and evidence in using metastasis-directed radiotherapy (MDRT) for oligometastatic disease (OMD), ESTRO and ASTRO convened a committee to establish consensus regarding definitions of OMD and define gaps in current evidence. Methods: A systematic literature review focused on curative intent MDRT was performed in Medline, Embase and Cochrane. Subsequent consensus opinion, using a Delphi process, highlighted the current state of evidence and the limitations in the available literature. Results: Available evidence regarding the use of MDRT for OMD mostly derives from retrospective, single-centre series, with significant heterogeneity in patient inclusion criteria, definition of OMD, and outcomes reported. Consensus was reached that OMD is largely independent of primary tumour, metastatic location and the presence or length of a disease-free interval, supporting both synchronous and metachronous OMD. In the absence of clinical data supporting a maximum number of metastases and organs to define OMD, and of validated molecular biomarkers, consensus supported the ability to deliver safe and clinically meaningful radiotherapy with curative intent to all metastatic sites as a minimum requirement for defining OMD in the context of radiotherapy. Systemic therapy induced OMD was identified as a distinct state of OMD. High-resolution imaging to assess and confirm OMD is crucial, including brain imaging when indicated. Minimum common endpoints such as progression-free and overall survival, local control, toxicity and quality-of-life should be reported; uncommon endpoints as deferral of systemic therapy and cost were endorsed. Conclusion: While significant heterogeneity exists in the current OMD definitions in the literature, consensus was reached on multiple key questions. Based on available data, OMD can to date be defined as 1–5 metastatic lesions, a controlled primary tumor being optional, but where all metastatic sites must be safely treatable. Consistent definitions and reporting are warranted and encouraged in ongoing trials and reports generating further evidence to optimize patient benefits

Efektifitas Penggunaan Model Pembelajaran Probing-prompting terhadap Konsentrasi Belajar Peserta Didik SMAN 14 Gowa pada Mata Pelajaran Fisika

Hasil penelitian menunjukkan adanya peningkatan konsentarsi belajar pada peserta didik yang diajar menggunakan model pembelajaran probing-prompting, diperoleh hasil pada penggunaan model pembelajaran probing-prompting sebesar 0,863 (sig > 0,05). Dan adanya peningkatan konsentarsi belajar pada peserta didik yang diajar menggunakan model pembelajaran konvensional yang diterapkan pada peserta didik kelas XI IPA 1, diperoleh hasil pada model pembelajaran konvensional 0,548 (sig > 0,05). Walaupun perbedaanya hanya selisih sedikit pada satu kelas yang dilakukan secara bergantian selama dua pekan. Hasil ini diperoleh dari hasil pengisian kuesioner dan perhitungan menggunakan aplikasi SPSS versi 20 for windows. Hal ini dapat menunjukkan bahwa model pembelajaran probing-prompting efektif untuk diterapkan dalam proses pembelajaran dibandingan dengan model pembelajaran Konvensional dalam hal konsentrasi belajar

Professional development through mentoring: Final evaluation of the pilot mentoring programme of the European society of radiotherapy and oncology

: The European SocieTy for Radiotherapy and Oncology (ESTRO) organized a one-year pilot mentoring programme. At evaluation after one year, both mentors and mentees scored the programme with a median score of 9 on a scale of 10. All of the mentors indicated that they wanted to participate again as mentors

Study protocol for a randomized controlled trial : prophylactic swallowing exercises in head-and-neck cancer patients treated with (chemo)radiotherapy (PRESTO trial)

Background: Dysphagia is a common and serious complication after (chemo)radiotherapy (CRT) for head-and-neck cancer (HNC) patients. Prophylactic swallowing exercises (PSE) can have a significantly positive effect on post-treatment swallowing function. However, low adherence rates are a key issue in undermining this positive effect. This current randomized trial will investigate the effect of adherence-improving measures on patients' swallowing function, adherence and quality of life (QOL). Methods: This ongoing trial will explore the difference in adherence and swallowing-related outcome variables during and after PSE in HNC patients performing the same therapy schedule, receiving different delivery methods. One hundred and fifty patients treated in various hospitals will be divided into three groups. Group 1 performs PSE at home, group 2 practices at home with continuous counseling through an app and group 3 receives face-to-face therapy by a speech and language pathologist. The exercises consist of tongue-strengthening exercises and chin-tuck against resistance with effortful swallow. The Iowa Oral Performance Instrument and the Swallowing Exercise Aid are used for practicing. Patients are evaluated before, during and after treatment by means of strength measurements, swallowing and QOL questionnaires. Discussion: Since low adherence rates undermine the positive impact of PSE on post-treatment swallowing function, there is need to develop an efficient PSE protocol maximizing adherence rates

Optimalisatie van radiotherapie voor hoofd- en halskanker: De behandeling van de hals en het gebruik van predictieve modellen voor toxiciteit.

status: publishe

HPV-positive head and neck tumours, a distinct clinical entity

Abstract. HPV-positive head and neck tumours, a distinct clinical entity. A worldwide rise in the incidence of oropharyngeal squamous cell cancer has been recorded over the past decade. This rise has been attributed to an increase in oncogenic human papilloma virus (HPV) infections. The biology of HPV-positive oropharyngeal cancer is distinct; it includes p53 degradation, retinoblastoma pathway inactivation, and p16 upregulation. The best method for detecting HPV in tumour material is controversial; both in-situ hybridisation and PCR are commonly used. However, p16 can serve as a potential surrogate marker, and therefore, p16 immunohistochemistry is widely used in clinical practice. Compared to HPV-negative cancers, HPV-positive oropharyngeal cancer appears to be more responsive to chemotherapy and radiotherapy. Thus, p16 can serve as a prognostic marker for enhanced overall survival and disease-free survival. In this review, we aimed to highlight the current understanding of the epidemiology, biology, detection, and management of HPV-related oropharyngeal head and neck squamous cell carcinoma.status: publishe

The role of stem cells in the prevention and treatment of radiation-induced xerostomia in patients with head and neck cancer

Xerostomia is an important complication following radiotherapy (RT) for head and neck cancer. Current treatment approaches are insufficient and can only temporarily relieve symptoms. New insights into the physiopathology of radiation-induced xerostomia might help us in this regard. This review discusses the current knowledge of salivary gland stem cells in radiation-induced xerostomia and their value in the prevention and treatment of this complication. Salivary gland stem cell transplantation, bone marrow-derived cell mobilization, molecular regulation of parotid stem cells, stem cell sparing RT, and adaptive RT are promising techniques that are discussed in this study.status: publishe

Rol van het humaan papillomavirus in hoofd- en halscarcinomen

Hoofd- en halscarcinomen vormen een heterogene groep van maligne tumoren die ontstaan uit de mucosale aflijning van de bovenste aerodigestieve tractus. Meer dan 90% van deze tumoren zijn plaveiselcelcarcinomen. Ze zijn wereldwijd de zesde meest voorkomende maligne tumoren. In België werden 2.628 nieuwe diagnosen gesteld in 2011. Tot voor kort werden als oorzakelijke factoren voornamelijk alcoholmisbruik en/of roken naar voren geschoven. Sinds enkele jaren zijn er echter ook meer en meer aanwijzingen voor een virale etiologie, met name het humaan papillomavirus (HPV). Het aantal HPV-geïnduceerde carcinomen lijkt de laatste jaren te stijgen. Deze maligne tumoren situeren zich hoofdzakelijk ter hoogte van de orofarynx en meer specifiek de tongbasis of de tonsillen. Naast deze specifieke lokalisatie onderscheiden deze maligne tumoren zich van de klassieke hoofd- en halscarcinomen door specifieke biologische en klinische eigenschappen. HPV-gerelateerde carcinomen blijken bovendien een significant betere prognose te hebben in vergelijking met de klassieke hoofd- en halscarcinomen. Studies zullen nog moeten uitwijzen of dit een verandering van de bestaande behandelingsparadigma’s noodzakelijk maaktstatus: accepte