A nationwide study on cancer recurrences, second primary tumours, distant metastases and survival after treatment for primary head and neck cancer in the Netherlands

Introduction: There is no consensus on the optimal duration of post-treatment follow-up after head and neck cancer (HNC). To generate site-specific input for follow-up guidelines, this study describes the incidence and timing of manifestations of disease during five years of follow-up. Methods: All patients diagnosed with HNC in the Netherlands in 2015 were selected from the Netherlands Cancer Registry. The follow-up events local recurrence (LR), regional recurrence (RR), second primary tumour (SPT), distant metastasis (DM) and death were studied per follow-up-year. The cumulative incidence of these events was calculated using competing risk analyses, with LR, RR and SPT of the head and neck (SPHNC) as events and SPT outside the head-neck (SPOHN), DM and death as competing events. Analyses were performed for oral cavity-, oropharynx-, larynx- and hypopharynx squamous cell carcinoma (SCC), and all HNC patients. Results: The 1-, 1.5-, and 2-year cumulative incidence of an event (LR, RR, SPHNC) were 10% (95%CI 8–13), 12% (95%CI 10–15), and 13% (95%CI 10–16) for oral cavity SCC; 6% (95%CI 4–9), 10% (95%CI 7–14), and 11% (95%CI 8–15) for oropharynx SCC; 7% (95%CI 5–10), 11% (95%CI 9–15), and 13% (95%CI 10–16) for larynx SCC and 11% (95%CI 6–19), 19% (95%CI 12–27), and 19% (95%CI 12–27) for hypopharynx SCC. Conclusions: One year of follow-up for oral cavity SCC, and 1.5 years for oropharynx-, larynx-, and hypopharynx SCC suffices for the goal of detecting disease manifestations after treatment. More research into other aspects of follow-up care should be performed to determine the optimal follow-up regimen.</p

Reconstruction of the mandible with a poly(D,L-lactide) scaffold, autogenous corticocancellous bone graft, and autogenous platelet-rich plasma: an animal experiment.

Contains fulltext : 39358.pdf (publisher's version ) (Open Access)An animal study is presented, evaluating a method of mandibular reconstruction using a poly(D,Llactide) (PDLLA) scaffold. Six goats underwent a continuity resection of the mandibular angle. The defect was bridged with a preshaped PDLLA scaffold, filled with an autogenous particulate bone graft from the anterior iliac crest, and fixed with two preshaped titanium plates. To accelerate bone healing, autogenous platelet-rich plasma was mixed with the particulate bone graft. All goats had an uneventful healing. The osteosynthesis system withstood immediate loading for a period of 6 weeks until sacrifice. The particulate bone grafts within the PDLLA scaffold, which appeared to be narrowed, showed considerable resorption and replacement by fibrous tissue. In all goats, however, callus formation along the reconstructed segment was seen, providing bony continuity and maintaining the original contour of the reconstructed segment. Thus, the technique used may provide an alternative for reconstruction with revascularized composite flaps with less associated donor site morbidity

Differences in the association of time to treatment initiation and survival according to various head and neck cancer sites in a nationwide cohort

Objectives: To assess whether there are differences in the effects of time to treatment interval (TTI) on patient survival for head and neck cancer (HNC) sites in order to provide evidence that can support decision-making regarding prioritizing treatment. Materials and methods: Patients in the Netherlands with a first primary HNC without distant metastasis between 2010 and 2014 were included for analysis (N = 10,486). TTI was defined as the time from pathologic diagnosis to the start of initial treatment. Overall survival (OS), cox regression analyses and cubic spline hazard models were calculated and visualized. Results: Overall, the hazard of dying was higher (HR = 1.003; 95 % CI 1.001–1.005) with each additional day until treatment initiation. The pattern, as visualized in cubic spline graphs, differed by site the hazard increased more steeply with increasing TTI for oral cavity cancer. For oropharyngeal and laryngeal cancer, a slight increase commenced after a longer TTI than for oral cavity cancer, while there was hardly an increase in hazard with increasing TTI for hypopharyngeal cancer. Conclusion: The relationship between longer TTI and decreased survival was confirmed, but slight variations in the pattern of the hazard of dying by TTI by tumour site were observed. These findings could support decisions on prioritizing treatment. However, other aspects such as extent of treatment and quality of life should be investigated further so this can also be included.</p

Number of life-years lost at the time of diagnosis and several years post-diagnosis in patients with solid malignancies: a population-based study in the Netherlands, 1989–2019Research in context

Summary: Background: Loss of life expectancy (LOLE) may provide more intuitive information on the impact of cancer than relative survival over a fixed time horizon (e.g., 5-year relative survival). We aimed to assess the evolution of the LOLE using a nationwide, population-based cohort including patients diagnosed with one of 17 most frequent solid malignancies. Methods: From the Netherlands Cancer Registry, we selected adult patients diagnosed with one of the 17 most frequent solid malignancies in the Netherlands during 1989–2019, with survival follow-up until 2022. We used flexible parametric survival models to estimate the LOLE at diagnosis and the LOLE after surviving several years post-diagnosis (conditional LOLE; CLOLE) by cancer type, calendar year, age, sex, and disease stage. Findings: For all cancers combined, the LOLE consistently decreased from 1989 to 2019. This decrease was most pronounced for males with prostate cancer (e.g., from 6.9 [95% confidence interval [CI], 6.7–7.1] to 2.7 [95% CI, 2.5–3.0] for 65-year-olds) and females with breast cancer (e.g., from 6.6 [95% CI, 6.4–6.7] to 1.9 [95% CI, 1.8–2.0] for 65-year-olds). The LOLE among patients with cancers of the head and neck or the central nervous system remained constant over time. Overall, the CLOLE showed that the life years lost among patients with cancer decreased with each additional year survived post-diagnosis. For example, the LOLE at diagnosis for 65-year-old females diagnosed with breast cancer in 2019 was 1.9 [95% CI, 1.8–2.0] compared with 1.7 [95% CI, 1.6–1.8], 1.0 [95% CI, 0.9–1.1], and 0.5 [95% CI, 0.5–0.6] when surviving one, five, and ten years post-diagnosis, respectively. Estimates for other combinations of patient and tumour characteristics are available in a publicly available web-based application. Interpretation: Our findings suggested that the evolution of LOLE substantially varies across cancer type, age, and disease stage. LOLE estimates help patients better understand the impact of their specific cancer diagnosis on their life expectancy. Funding: None

Time patterns of recurrence and second primary tumors in a large cohort of patients treated for oral cavity cancer

Introduction: Routine follow-up after curative treatment of patients with oral squamous cell carcinoma (OSCC) is common practice considering the high risk of second primaries and recurrences (ie second events). Current guidelines advocate a follow-up period of at least 5 years. The recommendations are not evidence-based and benefits are unclear. This is even more so for follow-up after a second event. To facilitate the development of an evidence- and personalized follow-up program for OSCC, we investigated the course of time until the second and subsequent events and studied the risk factors related to these events. Materials and methods: We retrospectively studied 594 OSCC patients treated with curative intent at the Head and Neck Cancer Unit of the Radboud University Medical Centre from 2000 to 2012. Risk of recurrence was calculated addressing death from intercurrent diseases as competing event. Results: The 1-, 5- and 10-year cumulative risks of a second event were 17% (95% CI:14%;20%), 30% (95% CI:26%;33%), and 37% (95% CI:32%;41%). Almost all locoregional recurrences occurred in the first 2 years after treatment. The incidence of second primary tumors was relatively stable over the years. The time pattern of presentation of third events was similar. Discussion: Our findings support a follow-up time of 2 years after curative treatment for OSCC. Based on the risk of recurrence there is no indication for a different follow-up protocol after first and second events. After 2 years, follow-up should be tailored to the individual needs of patients for supportive care, and monitoring of late side-effects of treatment

A community-based oral health promotion model for HIV patients in Nairobi, East District in Kenya: a study protocol

<em>Background</em>: General HIV-related orofacial lesions, most commonly oropharyngeal candidiasis, have a typical clinical appearance and can be recognised by members of the community. Although affected patients often experience pain leading to compromised eating and swallowing, barriers such as social stigma and lack of knowledge regarding available services may prevent them from seeking early care. Educating the community about these lesions through community health workers (CHWs) who are democratically elected community members may encourage individuals affected to seek early oral health-care in the health facilities. A health facility (HF) is a health centre mainly run by clinical officers (CO),<em> i.e. </em>personnel with a 3-year medical training, and nurses. This study aims to evaluate the effect of a CHW training programme on: i) their knowledge and recognition of HIV-related oral-facial lesions at a community level; and ii) referral of affected patients from the community to the HFs. <em>Design and Methods</em>: All 800 CHWs in 2 administrative divisions of Nairobi East District (test group n=400; control group n=400) will be selected. The test group will receive training. CHWs in both groups will be assessed at 4 time points: −3, 0, +3 and +6 months with reference to the training on: i) their knowledge of HIV-related orofacial lesions (using a written questionnaire); and ii) their performance in referring affected patients to the HFs (using clinical data). <em>Expected Impact</em>: Early recognition of HIV-related orofacial lesions at a community level will prompt community members to seek early oral care, leading to early HIV testing and counselling regarding failure of antiretroviral therapy, while treatment outcomes are still favourable

Tongue function and its influence on masticatory performance in patients treated for oral cancer : a five-year prospective study

Purpose: The purpose of this study was to observe the impact of oral oncological treatment, including the recovery of several tongue functions (force, mobility, and sensory functions), and to determine the influence of these functions on masticatory performance. Materials and methods: Masticatory performance and tongue force, mobility, and sensory functions were determined in 123 patients with oral cavity cancer. The assessments were performed 4 weeks before treatment and 4 to 6 weeks, 6 months, 1 year, and 5 years after treatment. Generalized estimation equations and mixed model analyses were performed, correcting for previously identified factors in the same population. Results: A significant deterioration in tongue mobility and sensory function was observed in patients with mandible and tongue and/or floor-of-mouth tumors. Better tongue force and sensory function (thermal and tactile) positively influenced masticatory performance, and this effect was stronger where fewer occlusal units were present. The effect of both the tongue force and maximum bite force was weaker in dentate patients in comparison with patients with full dentures. A web-based application was developed to enable readers to explore our results and provide insight into the coherence between the found factors in the mixed model. Conclusions: Tongue function deteriorates after oral oncological treatment, without statistically significant recovery. Adequate bite and tongue forces are especially important for patients with a poor prosthetic state. Patients with sensory tongue function deficits especially benefit from the presence of more occluding pairs

Masticatory function and related factors after oral oncological treatment: A 5‐year prospective study

Background: Chewing ability is often compromised in patients with oral cancer. The aim of this study was to identify which factors affect masticatory performance in these patients. Methods: Patients with primary oral cancer were assessed for up to 5 years after primary treatment. Healthy controls were assessed once. A mixed-model analysis was performed, with masticatory performance as outcome measure. Results: A total of 123 patients were included in the study. Factors positively associated with masticatory performance were number of occlusal units (OU), having functional dentures, and maximum mouth opening (MMO). The impact of tumor location and maximum bite force (MBF) differed per assessment moment. Masticatory performance declined for up to 1 year but recovered at 5 years after treatment. Conclusion: Masticatory performance in patients treated for oral cancer is affected by MBF, MMO, number of OU, and dental status. These should be the focus of posttreatment therapy