65 research outputs found
Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced squamous cell carcinoma of the head and neck: a single-institution experience
Prospective subjective evaluation of swallowing function and dietary pattern in head and neck cancers treated with concomitant chemo-radiation
Aim : Prospective subjective evaluation of swallowing function and
dietary pattern in locally advanced head and neck cancer patients
treated with concomitant chemo-radiotherapy (CRT). Materials and
Methods : Prospective evaluation of swallowing function with
performance status scale for head and neck cancer patients (PSSHN) at
pre-CRT, CRT completion and at subsequent follow-ups in adult with
loco-regionally advanced head and neck squamous cell carcinoma (HNSCC)
patients. Results : In 47 patients (40 male, seven females; mean age
53; 72% smoker 53%, oropharyngeal cancer), the mean total PSSHN score
at pre-CRT was 258.5 and decreased to 225.2 and 219.2 at two and six
months respectively. Understandability of speech, normalcy in diet and
eating in public at pre-CRT and six months were 91.5 and 84.4; 80.4 and
63.1; 87.3 and 76.6 respectively. In univariate analysis, pre-CRT PSSHN
scores were significantly lesser in patients with severe pre-CRT
dysphagia (P = 0.001), hypopharyngeal cancer (P = 0.244) and advanced
T-stage (T3/4) disease (P = 0.144). At CRT completion, there was
significant reduction of PSSHN scores in patients with severe pre-CRT
dysphagia (P = 0.008), post-CRT weight loss (>10%) and disease
progression (P = 0.039). At two months and six months, 17 (57%) and 11
(73.5%) patients respectively showed change in dietary habit. Mean
increase in meal time was 13% and 21% at two and six-month follow-up.
Conclusions : HNSCC patients show deterioration in swallowing function
after CRT with normalcy of diet in maximum and eating in public least
affected. Pre-CRT severity of dysphagia, weight loss> 10% and
disease progression have significant correlation with higher swallowing
function deterioration after CRT
Nimotuzumab-cisplatin-radiation versus cisplatin-radiation in HPV negative oropharyngeal cancer
BACKGROUND: Addition of nimotuzumab to weekly cisplatin and radiation improves outcomes in head and neck cancer. HPV negative oropharyngeal cancer has unsatisfactory treatment outcomes and is a candidate for escalation of treatment. We wanted to determine whether the addition of nimotuzumab to cisplatin-radiation could improve outcomes in these poor-risk tumors.METHODS: This was a subgroup analysis of a phase 3 randomized study. In this study, locally advanced head and neck cancer patients undergoing definitive chemoradiation were randomly allocated to weekly cisplatin (30 mg/m2 IV)- radiation (66â70 Gy) {CRT arm} or nimotuzumab (200 mg weekly) -weekly cisplatin (30 mg/m2)-radiation (66â70 Gy) {NCRT arm}. The data of HPV negative oropharyngeal cancer was extracted from the database of this study for the analysis. HPV testing was done with p16 immunohistochemistry (IHC) staining and reported according to the CAP criteria. The outcomes assessed were progression-free survival (PFS), disease-free survival (DFS), locoregional control, and overall survival (OS). Interaction test was performed between the study arms and HPV status prior to doing any HPV specific analysis for each of the studied outcomes. Kaplan Meier estimates for 2 year OS with 95% CI was calculated. The hazard ratio was obtained using COX regression analysis.RESULTS: We had 187 HPV negative oropharyngeal cancers, 91 in the CRT arm and 96 in NCRT arm. The interaction test was significant for PFS (p = 0.000), locoregional control (p = 0.007) and overall survival (p = 0.002) but not for DFS (p = 0.072). The 2- year PFS was 31.5% (95%CI 21.5â42) in CRT arm versus 57.2% (95%CI 45.8â67.1) in NCRT arm (HR -0.54; 95%CI 0.36â0.79, p = 0.002). The 2-year LRC was 41.4% (95%CI 29.8â52.6) in the CRT arm versus in 60.4% (95%CI 48.7â70.2) in the NCRT arm (HR -0.61; 95%CI 0.4â0.94, p = 0.024). The addition of nimotuzumab also lead to an improvement in 2-year OS from 39.0% (95%CI 28.4â49.6) to 57.6% (95%CI 46.3â67.4) (HR-0.63, 95%CI 0.43â0.92, p = 0.018).CONCLUSIONS:Â The addition of nimotuzumab to weekly cisplatin-radiation improves outcomes inclusive of OS in HPV negative oropharyngeal cancers.<br/
Nimotuzumab-cisplatin-radiation versus cisplatin-radiation in HPV negative oropharyngeal cancer
BACKGROUND: Addition of nimotuzumab to weekly cisplatin and radiation improves outcomes in head and neck cancer. HPV negative oropharyngeal cancer has unsatisfactory treatment outcomes and is a candidate for escalation of treatment. We wanted to determine whether the addition of nimotuzumab to cisplatin-radiation could improve outcomes in these poor-risk tumors.METHODS: This was a subgroup analysis of a phase 3 randomized study. In this study, locally advanced head and neck cancer patients undergoing definitive chemoradiation were randomly allocated to weekly cisplatin (30 mg/m2 IV)- radiation (66â70 Gy) {CRT arm} or nimotuzumab (200 mg weekly) -weekly cisplatin (30 mg/m2)-radiation (66â70 Gy) {NCRT arm}. The data of HPV negative oropharyngeal cancer was extracted from the database of this study for the analysis. HPV testing was done with p16 immunohistochemistry (IHC) staining and reported according to the CAP criteria. The outcomes assessed were progression-free survival (PFS), disease-free survival (DFS), locoregional control, and overall survival (OS). Interaction test was performed between the study arms and HPV status prior to doing any HPV specific analysis for each of the studied outcomes. Kaplan Meier estimates for 2 year OS with 95% CI was calculated. The hazard ratio was obtained using COX regression analysis.RESULTS: We had 187 HPV negative oropharyngeal cancers, 91 in the CRT arm and 96 in NCRT arm. The interaction test was significant for PFS (p = 0.000), locoregional control (p = 0.007) and overall survival (p = 0.002) but not for DFS (p = 0.072). The 2- year PFS was 31.5% (95%CI 21.5â42) in CRT arm versus 57.2% (95%CI 45.8â67.1) in NCRT arm (HR -0.54; 95%CI 0.36â0.79, p = 0.002). The 2-year LRC was 41.4% (95%CI 29.8â52.6) in the CRT arm versus in 60.4% (95%CI 48.7â70.2) in the NCRT arm (HR -0.61; 95%CI 0.4â0.94, p = 0.024). The addition of nimotuzumab also lead to an improvement in 2-year OS from 39.0% (95%CI 28.4â49.6) to 57.6% (95%CI 46.3â67.4) (HR-0.63, 95%CI 0.43â0.92, p = 0.018).CONCLUSIONS:Â The addition of nimotuzumab to weekly cisplatin-radiation improves outcomes inclusive of OS in HPV negative oropharyngeal cancers.<br/
Delineation of the primary tumour Clinical Target Volumes (CTV-P) in laryngeal, hypopharyngeal, oropharyngeal and oral cavity squamous cell carcinoma : AIRO, CACA, DAHANCA, EORTC, GEORCC, GORTEC, HKNPCSG, HNCIG, IAG-KHT, LPRHHT, NCIC CTG, NCRI, NRG Oncology, PHNS, SBRT, SOMERA, SRO, SSHNO, TROG consensus guidelines
Purpose: Few studies have reported large inter-observer variations in target volume selection and delineation in patients treated with radiotherapy for head and neck squamous cell carcinoma. Consensus guidelines have been published for the neck nodes (see Gregoire et al., 2003, 2014), but such recommendations are lacking for primary tumour delineation. For the latter, two main schools of thoughts are prevailing, one based on geometric expansion of the Gross Tumour Volume (GTV) as promoted by DAHANCA, and the other one based on anatomical expansion of the GTV using compartmentalization of head and neck anatomy. Method: For each anatomic location within the larynx, hypopharynx, oropharynx and oral cavity, and for each T-stage, the DAHANCA proposal has been comprehensively reviewed and edited to include anatomic knowledge into the geometric Clinical Target Volume (CTV) delineation concept. A first proposal was put forward by the leading authors of this publication (VG and CG) and discussed with opinion leaders in head and neck radiation oncology from Europe, Asia, Australia/New Zealand, North America and South America to reach a worldwide consensus. Results: This consensus proposes two CTVs for the primary tumour, the so called CTV-P1 and CVT-P2, corresponding to a high and lower tumour burden, and which should be associated with a high and a lower dose prescription, respectively. Conclusion: Implementation of these guidelines in the daily practice of radiation oncology should contribute to reduce treatment variations from clinicians to clinicians, facilitate the conduct of multi institutional clinical trials, and contribute to improved care of patients with head and neck carcinoma. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe
Prospective longitudinal assessment of parotid gland function using dynamic quantitative pertechnate scintigraphy and estimation of doseâresponse relationship of parotid-sparing radiotherapy in head-neck cancers
Commentary on 8th Edition of tumor node metastasis for staging of cancers of the oral cavity
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