Head and neck cancer

Salvage surgery for recurrent oropharyngeal cancer after chemoradiotherapy.

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Abstract

Background

The current study aimed to assess the role of salvage surgery for failure cases of oropharyngeal cancer (OPC) undergoing initial chemoradiotherapy (CRT).

Methods

The data for 523 patients with previously untreated OPC were gathered from 12 institutions belonging to the Head and Neck Cancer Study Group in Japan Clinical Oncology Group (JCOG).

Results

Of the 170 patients who received CRT, 35 patients (21 %) had local recurrence or residual disease. Only 11 patients underwent further salvage surgery, and 24 patients received nonsurgical treatment. There were statistically significant differences between the two groups in terms of patient age and the presence of a simultaneous regional recurrence. The 5-year overall survival rates for the patients who underwent salvage surgery were 49.1 %, whereas those for the patients who received nonsurgical treatment were 16.3 %.

Conclusion

The initial treatment method for OPC should be decided carefully and the limitations of salvage surgery should be fully considered.

Source: International Journal of Clinical Oncology

Evaluation of Human Papillomavirus Antibodies and Risk of Subsequent Head and Neck Cancer..

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Abstract

PURPOSEHuman papillomavirus type 16 (HPV16) infection is causing an increasing number of oropharyngeal cancers in the United States and Europe. The aim of our study was to investigate whether HPV antibodies are associated with head and neck cancer risk when measured in prediagnostic sera. METHODSWe identified 638 participants with incident head and neck cancers (patients; 180 oral cancers, 135 oropharynx cancers, and 247 hypopharynx/larynx cancers) and 300 patients with esophageal cancers as well as 1,599 comparable controls from within the European Prospective Investigation Into Cancer and Nutrition cohort. Prediagnostic plasma samples from patients (collected, on average, 6 years before diagnosis) and control participants were analyzed for antibodies against multiple proteins of HPV16 as well as HPV6, HPV11, HPV18, HPV31, HPV33, HPV45, and HPV52. Odds ratios (ORs) of cancer and 95% CIs were calculated, adjusting for potential confounders. All-cause mortality was evaluated among patients using Cox proportional hazards regression.ResultsHPV16 E6 seropositivity was present in prediagnostic samples for 34.8% of patients with oropharyngeal cancer and 0.6% of controls (OR, 274; 95% CI, 110 to 681) but was not associated with other cancer sites. The increased risk of oropharyngeal cancer among HPV16 E6 seropositive participants was independent of time between blood collection and diagnosis and was observed more than 10 years before diagnosis. The all-cause mortality ratio among patients with oropharyngeal cancer was 0.30 (95% CI, 0.13 to 0.67), for patients who were HPV16 E6 seropositive compared with seronegative. CONCLUSIONHPV16 E6 seropositivity was present more than 10 years before diagnosis of oropharyngeal cancers.

Source: Pubmed

HPV virus ‘linked to third of throat cancer cases’.

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One third of people diagnosed with throat cancer are infected with a form of the HPV virus, a study suggests.

HPV (human papillomavirus) is the major cause of cervical cancer, and the virus is known to spread through genital or oral contact.

Actor Michael Douglas is reported to have spoken about the link after his own diagnosis with throat cancer.

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Experts said this study in the Journal of Clinical Oncology, which quantifies the link, showed “striking” results.

There are more than 100 types of HPV. Most people will be infected with HPV at some point, but in most the immune system will offer protection.

There are two HPV strains which are most likely to cause cancer – HPV-16 and HPV-18.

HPV-16 is thought to be responsible for around 60% of cervical cancers, 80% of cancers in the anus and 60% of oral cancers.

Around 1,500 people are diagnosed with throat cancers each year in the UK, with around 470 people dying from the disease.

Survival benefit

This study looked at HPV’s link with cancer of the back of the throat – oropharyngeal cancer.

It looked at blood test results collected from people who took part in a huge prospective study into lifestyle and cancer, who were all healthy at the start.

Everyone gives a blood sample when they join the study, and in this case the researchers were able to check for the presence of antibodies to one of HPV’s key proteins – E6.

 “Start Quote

Condoms won’t stop infections completely.””

E6 knocks out part of cells’ protection system, which should prevent cancer developing.

Having the antibodies means HPV has already overcome that defence and caused cancerous changes in cells.

The researchers compared blood test results – some more than 10 years old – for 135 people who went on to develop throat cancer and for 1,599 cancer-free people.

The University of Oxford team found 35% of those with throat cancer had the antibodies, compared with fewer than 1% of those who were cancer-free.

However, these patients were more likely to survive throat cancer than people whose disease had other causes, such as alcohol or tobacco use.

The study found 84% of people with the antibodies were still alive five years after diagnosis, compared with 58% of those without.

Broader effect?

Dr Ruth Travis, a Cancer Research UK scientist at Oxford who worked on the study, said: “These striking results provide some evidence that HPV-16 infection may be a significant cause of oropharyngeal cancer.”

Sara Hiom, Cancer Research UK’s director of health information, said: “HPV is an extremely common virus.

“Practising safer sex may reduce the risk of getting or passing on HPV, but condoms won’t stop infections completely.”

She added: “If the HPV vaccine can also protect against oral HPV infections and cancers, then it could have a broader potential protective effect, but we don’t have enough research yet to tell us. ”

Source: BBC

Transoral Robotic Surgery for Oropharyngeal CancerLong-term Quality of Life and Functional Outcomes.

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ABSTRACT

Importance  Because treatment for oropharyngeal squamous cell carcinoma (OPSCC), especially in patients of older age, is associated with decreased patient quality of life (QOL) after surgery, demonstration of a less QOL-impairing treatment technique would improve patient satisfaction substantially.

Objective  To determine swallowing, speech, and QOL outcomes following transoral robotic surgery (TORS) for OPSCC.

Design, Patients, and Setting  This prospective cohort study of 81 patients with previously untreated OPSCC was conducted at a tertiary care academic comprehensive cancer center.

Interventions  Primary surgical resection via TORS and neck dissection as indicated.

Main Outcomes and Measures  Patients were asked to complete the Head and Neck Cancer Inventory (HNCI) preoperatively and at 3 weeks as well as 3, 6, and 12 months postoperatively. Swallowing ability was assessed by independence from a gastrostomy tube (G-tube). Clinicopathologic and follow-up data were also collected.

Results  Mean follow-up time was 22.7 months. The HNCI response rates at 3 weeks and 3, 6, and 12 months were 79%, 60%, 63%, and 67% respectively. There were overall declines in speech, eating, aesthetic, social, and overall QOL domains in the early postoperative periods. However, at 1 year post TORS, scores for aesthetic, social, and overall QOL remained high. Radiation therapy was negatively correlated with multiple QOL domains (P < .05 for all comparisons), while age older than 55 years correlated with lower speech and aesthetic scores (P < .05 for both). Human papillomavirus status did not correlate with any QOL domain. G-tube rates at 6 and 12 months were 24% and 9%, respectively. Greater extent of TORS (>1 oropharyngeal site resected) and age older than 55 years predicted the need for a G-tube at any point after TORS (P < .05 for both).

Conclusions and Relevance  Patients with OPSCC treated with TORS maintain a high QOL at 1 year after surgery. Adjuvant treatment and older age tend to decrease QOL. Patients meeting these criteria should be counseled appropriately.

Source: JAMA

 

Evaluation of Human Papillomavirus Antibodies and Risk of Subsequent Head and Neck Cancer.

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Abstract

Purpose Human papillomavirus type 16 (HPV16) infection is causing an increasing number of oropharyngeal cancers in the United States and Europe. The aim of our study was to investigate whether HPV antibodies are associated with head and neck cancer risk when measured in prediagnostic sera.

Methods We identified 638 participants with incident head and neck cancers (patients; 180 oral cancers, 135 oropharynx cancers, and 247 hypopharynx/larynx cancers) and 300 patients with esophageal cancers as well as 1,599 comparable controls from within the European Prospective Investigation Into Cancer and Nutrition cohort. Prediagnostic plasma samples from patients (collected, on average, 6 years before diagnosis) and control participants were analyzed for antibodies against multiple proteins of HPV16 as well as HPV6, HPV11, HPV18, HPV31, HPV33, HPV45, and HPV52. Odds ratios (ORs) of cancer and 95% CIs were calculated, adjusting for potential confounders. All-cause mortality was evaluated among patients using Cox proportional hazards regression.

Results HPV16 E6 seropositivity was present in prediagnostic samples for 34.8% of patients with oropharyngeal cancer and 0.6% of controls (OR, 274; 95% CI, 110 to 681) but was not associated with other cancer sites. The increased risk of oropharyngeal cancer among HPV16 E6 seropositive participants was independent of time between blood collection and diagnosis and was observed more than 10 years before diagnosis. The all-cause mortality ratio among patients with oropharyngeal cancer was 0.30 (95% CI, 0.13 to 0.67), for patients who were HPV16 E6 seropositive compared with seronegative.

Conclusion HPV16 E6 seropositivity was present more than 10 years before diagnosis of oropharyngeal cancers.

Source: JCO

 

Induction chemotherapy followed by concurrent chemoradiotherapy (sequential chemoradiotherapy) versus concurrent chemoradiotherapy alone in locally advanced head and neck cancer (PARADIGM): a randomised phase 3 trial.

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The relative efficacy of the addition of induction chemotherapy to chemoradiotherapy compared with chemoradiotherapy alone for patients with head and neck cancer is unclear. The PARADIGM study is a multicentre open-label phase 3 study comparing the use of docetaxel, cisplatin, and fluorouracil (TPF) induction chemotherapy followed by concurrent chemoradiotherapy with cisplatin-based concurrent chemoradiotherapy alone in patients with locally advanced head and neck cancer.
METHODS: Adult patients with previously untreated, non-metastatic, newly diagnosed head and neck cancer were eligible. Patients were eligible if their tumour was either unresectable or of low surgical curability on the basis of advanced tumour stage (3 or 4) or regional-node stage (2 or 3, except T1N2), or if they were a candidate for organ preservation. Patients were randomly assigned (in a 1:1 ratio) to receive either induction chemotherapy with three cycles of TPF followed by concurrent chemoradiotherapy with either docetaxel or carboplatin or concurrent chemoradiotherapy alone with two cycles of bolus cisplatin. A computer-generated randomisation schedule using minimisation was prepared and the treatment assignment was done centrally at one of the study sites. Patients, study staff, and investigators were not masked to group assignment. Stratification factors were WHO performance status, primary disease site, and stage. The primary endpoint was overall survival. Analysis was by intention to treat. Patient accrual was terminated in December, 2008, because of slow enrolment. The trial is registered with ClinicalTrials.gov, number NCT00095875.
FINDINGS: Between Aug 24, 2004, and Dec 29, 2008, we enrolled 145 patients across 16 sites. After a median follow-up of 49 months (IQR 39-63), 41 patients had died-20 in the induction chemotherapy followed by chemoradiotherapy group and 21 in the chemoradiotherapy alone group. 3-year overall survival was 73% (95% CI 60-82) in the induction therapy followed by chemoradiotherapy group and 78% (66-86) in the chemoradiotherapy alone group (hazard ratio 1.09, 95% CI 0.59-2.03; p=0.77). More patients had febrile neutropenia in the induction chemotherapy followed by chemoradiotherapy group (16 patients) than in the chemoradiotherapy alone group (one patient).
INTERPRETATION: Although survival results were good in both groups there was no difference noted between those patients treated with induction chemotherapy followed by chemoradiotherapy and those who received chemoradiotherapy alone. We cannot rule out the possibility of a difference in survival going undetected due to early termination of the trial. Clinicians should still use their best judgment, based on the available data, in the decision of how to best treat patients. The addition of induction chemotherapy remains an appropriate approach for advanced disease with high risk for local or distant failure.

Source: Lancet oncology

IMRT role confirmed in head and neck cancer.

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How have recent studies added to our understanding of the appropriate use of intensity modulated radiotherapy in head and neck cancer?

Important data concerning the use of intensity modulated radiotherapy (IMRT) in patients with head and neck cancer were recently published, confirming the potential of the technique to effectively treat tumors while minimizing adverse events.

The French Oncology and Radiotherapy Group for Head and Neck Cancer (known as GORTEC) set up the prospective GORTEC 2004-03 study in response to a request from the French National Authority for Health. The authority had stated in 2003 that IMRT appeared to be of major benefit in the irradiation of head and neck cancer, and called for it to be evaluated further in prospective trials.

IMRT enables specialists to spare sensitive structures (such as the parotid gland, irradiation of which can lead to xerostomia and a reduced quality of life) without compromising on the coverage of tumor target volumes.

In the prospective GORTEC 2004-03 study, specialists at 8 centers in France evaluated IMRT in a total of 208 patients. The tumor sites were the orophyarynx (56% of patients), nasopharynx (18%), oral cavity (12%), pharyngo-larynx (12%), and cervical lymph node from an unknown primary (2%). Of these, 29% were stage I-II tumors, and 71% were stage III-IV tumors.

Overall, almost half of the patients had surgery then postoperative IMRT, while just over a third of patients received concurrent chemotherapy.

Analysis of 2-year follow-up data showed that the locoregional progression-free survival rate was 86%, the metastatic progression-free survival rate was 92.7%, the recurrence-free survival rate 80%, and the overall 2-year survival rate was 86.7%.

At 18 months, xerostomia of grade 2 or above was seen in 16.1% of patients. The researchers found that a mean IMRT dose to the spared parotid below 28 Gy was associated with a significantly lower incidence of xerostomia (8.5% with grade 2 or above, compared to 24% in patients who received 28 Gy or more).

The researchers calculated that the rate of xerostomia (grade 2 or above) increased by about 3% per Gy of the mean parotid dose up to 28 Gy, then increased by 7% per Gy above 33 Gy.

In their paper describing the study findings, published in the journal Radiotherapy and Oncology, the researchers concluded that IMRT for head and neck cancer “seems to reduce late toxicities without jeopardising local control and overall survival”.

They added that “the results of the GORTEC 2004-03 prospective cohort study confirm the benefit of IMRT in the treatment of head and neck cancers”.1

References:
1. Toledano I, et al. Radiother Oncol. 2012;103:57-62.

 

Source: www. getinsidehealth.com