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Sample records for advanced head-and-neck cancer

  1. Head and neck cancer

    International Nuclear Information System (INIS)

    Vogl, S.E.

    1988-01-01

    This book contains 10 chapters. Some of the titles are: Combined Surgical Resection and Irradiation for Head and Neck Cancers; Analysis of Radiation Therapy Oncology Group Head and Neck Database: Identification of Prognostic Factors and the Re-evaluation of American Joint Committee Stages; Combined Modality Approach to Head and Neck Cancer; Induction Combination Chemotherapy of Regionally Advanced Head and Neck Cancer; and Outcome after Complete Remission to Induction Chemotherapy in Head and Neck Cancer

  2. Postoperative radiation for advanced head and neck cancers

    International Nuclear Information System (INIS)

    Ang, K. Kian; Garden, Adam S.

    1995-01-01

    Purpose: To discuss both general and specific indications for radiation following surgery for patients with cancers of the head and neck. Patients with advanced cancers of the head and neck are often not suitable candidates for treatment with definitive radiation, and are treated with surgery. Frequently these patients fail by recurring in either the primary sites or in the necks. Adjuvant radiation is therefore often a critical component in the management of these patients. While radiation can be done either prior to or after surgery, most centers prefer the postoperative setting. This refresher course will review general concepts of postoperative irradiation for the patient with head and neck cancer and apply these concepts to specific situations. The course will begin with a broad review of the indications for postoperative irradiation as not all patients undergoing surgery for cancers of the head and neck require additional treatment. We will also review the concept of using postoperative radiation to allow for more conservative surgery with preservation of function. The second portion of the course will focus on general techniques of postoperative irradiation. We will review concepts of patient setup and treatment portal design and describe how specific techniques are practiced at MDACC. Controversial topics, including field matching, total dose and fractionation, and the timing of postoperative radiation will be discussed. The final section of the course will review the results of postoperative irradiation as applied to the head and neck in general as well as to specific subsites. In addition to results for the common scenarios of squamous cell carcinomas of the oral cavity, pharynx and larynx, we will review results of postoperative irradiation for skin cancers of the head and neck, paranasal sinuses, and salivary glands

  3. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu; Yea, Ji Woon

    2010-01-01

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  4. Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Eun; Eun; Kim, Jae Chul; Park, In Kyu [Kyungpook National Yonsei University School of Medicine, Daegu (Korea, Republic of); Yea, Ji Woon [Dongguk University Gyeongju Hospital, Gyeongju (Korea, Republic of)

    2010-11-15

    The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patients especially with the risk factor of neck node dissection.

  5. Hyperfractionation radiation therapy in advanced head and neck cancer

    International Nuclear Information System (INIS)

    Kim, Jin Hee; Ye, Ji Won

    2003-01-01

    The effects of hyperfractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department at Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7 ; 1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 76.8 Gy). Fallow-up periods ranged between 3 and 136 months, with the median of 52 months. The overall survival rates at 3 and 5 years in all patients were 66.7% and 52.4%. The disease-free survival rates at 3 and 5 years (3YDFS, 5YDFS) in all patients Were 66.7% and 47.6%. The 3YDFS and 5YDFS in stage III patients were 81.8% and 63.6%, and those in stage IV patients were 53.8% and 32.3%. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25%) died due to distant metastasis and 12.5% died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteoradionecrosis of the mandible 58 months after treatment. Although this study was

  6. Head and Neck Cancer Treatment

    Science.gov (United States)

    ... Professions Site Index A-Z Head and Neck Cancer Treatment Head and neck cancer overview What are my ... and neck cancer. For updated information on new cancer treatments that are available, you should discuss these issues ...

  7. Head and Neck Cancer

    International Nuclear Information System (INIS)

    Tomita, Toshiki; Imanishi, Yorihisa

    2008-01-01

    The limitation of concurrent chemo-radiotherapy (CCRT) in head and neck cancer (HNC) as the primary treatment is described based on recent findings. Limits in the application/indication involve factors of age, performance status (PS) and renal function. The first is that, as deaths in >71 years old patients are derived from other causes (41%) than HNC, CCRT is only useful for younger population; the second, patients with PS 0-1 or Karnofsky performance score >60-70 can be indicated; and third, contraindicated are those with creatinine clearance (CCr) <60 mL/min as the key drug cisplatin in CCRT has a high renal toxicity. It should be recognized that completion rates of chemotherapy and RT are as low as 66-85% and 84-92%, respectively, in CCRT. CCRT has such limiting adverse events as mucitis, dry mouth, dysohagia, weight loss, neutropenia, sepsis, etc., which are most important in CCRT application. CCRT is recommended for the primary cancers of larynx and hypopharynx because they are significantly better conserved than middle pharyngeal, oral and upper jaw cancers. Evidence of CCRT is poor for cancers in paranasal sinuses. Planned neck dissection (PND) is for the cervical metastatic lymph nodes and conducted 6-12 weeks after CCRT regardless to its outcome. In fluorodeoxyglucose-positron emission tomography (FDG-PET) negative cases, PND can be omitted. Necessity of PND is possibly inversely proportional to CCRT intensity performed. For control of remote metastasis, CCRT has obvious limits and inductive chemotherapy before it is currently considered. Salvage surgery post CCRT does not always yield a relief because of complication. Patients with advanced laryngeal cancer can be selected either to surgery or CCRT depending on results of the inductive chemotherapy. To predict the sensitivity to CCRT, some biomarkers like HPV, EGFR and VEGF have been suggested to be useful by retrospective studies. Understanding the limitation is as important as knowing the usefulness in

  8. Advances in Radiotherapy for Head and Neck Cancer

    NARCIS (Netherlands)

    Gregoire, Vincent; Langendijk, Johannes A.; Nuyts, Sandra

    2015-01-01

    Over the last few decades, significant improvements have been made in the radiotherapy (RT) treatment of head and neck malignancies. The progressive introduction of intensity-modulated RT and the use of multimodality imaging for target volume and organs at risk delineation, together with the use of

  9. Palliative radiotherapy in locally advanced head and neck cancer-A prospective trial

    Directory of Open Access Journals (Sweden)

    Ghoshal Sushmita

    2004-01-01

    Full Text Available AIM: To evaluate the role of palliative radiotherapy for symptom control in patients with locally advanced head and neck cancer. MATERIALS AND METHODS: 25 patients with stage 3 and stage 4 head and neck cancer were treated with a short course of palliative radiotherapy (30 Gray (Gy in 10 fractions over 2 weeks. Baseline symptoms were assessed using a 11 point numerical scale for pain, dysphagia, cough, insomnia and dyspnoea. The primary end point was relief of symptoms in the fourth week after radiotherapy. Percentage symptom relief was quantified by the patient using a rupee scale. RESULTS: All 22 patients with pain and 90% of patients with dysphagia, dyspnoea and disturbed sleep had greater than 50% relief in symptoms after radiotherapy. Cough was relieved in sixty percent of cases. CONCLUSION: A short course of radiation can be an effective method of symptom palliation in head and neck cancers.

  10. Cetuximab in locally advanced head-and-neck cancer: defining the population

    Science.gov (United States)

    Ho, C.

    2010-01-01

    Encouraging data for targeted therapy in head-and-neck squamous cell carcinoma are opening new options for treatment. Phase III trials of cetuximab, an antibody directed against the epidermal growth factor receptor (egfr) have demonstrated benefit in the locally advanced and metastatic settings. Recognizing the importance of emerging therapies, Cancer Care Ontario published guideline recommendations for egfr-targeted therapy in stage iii and iv head-and-neck cancer. The present paper takes a further look at the population for whom an offer of cetuximab therapy may be appropriate. PMID:20697514

  11. Post-operative radiation therapy for advanced head and neck cancers

    International Nuclear Information System (INIS)

    Ang, Kian K.; Garden, Adam S.

    1996-01-01

    Purpose: To discuss both general and specific indications for radiation following surgery for patients with cancers of the head and neck. Patients with advanced cancers of the head and neck are often not suitable candidates for treatment with definitive radiation, and are treated with surgery. Frequently these patients fail by recurring in either the primary sites or in the necks. Adjuvant radiation is therefore often a critical component in the management of these patients. While radiation can be done either prior to or after surgery, most centers prefer the postoperative setting. This refresher course will review general concepts of postoperative irradiation for the patient with head and neck cancer and apply these concepts to specific situations. The course will begin with a broad review of the indications for postoperative irradiation as not all patients undergoing surgery for cancers of the head and neck require additional treatment. We will also review the concept of using postoperative radiation to allow for more conservative surgery with preservation of function. The second portion of the course will focus on general techniques of postoperative irradiation. We will review concepts of patient setup and treatment portal design and describe how specific techniques are practiced at MDACC. Controversial topics, including field matching, total dose and fractionation, and the timing of postoperative radiation will be discussed. The final section of the course will review the results of postoperative irradiation as applied to the head and neck in general as well as to specific subsites. In addition to results for the common scenarios of squamous cell carcinomas of the oral cavity, pharynx and larynx, we will review results of postoperative irradiation for skin cancers of the head and neck, paranasal sinuses, and salivary glands

  12. Case Report: Down-staging locally advanced head and neck cancer ...

    African Journals Online (AJOL)

    Case Report: Down-staging locally advanced head and neck cancer in an HIV infected patient in a limited resource setting. L Masamba, D Nkosi, D Kumiponjera. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals ...

  13. Two Cases of Pneumatosis Intestinalis during Cetuximab Therapy for Advanced Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    James A. Miller

    2015-01-01

    Full Text Available Pneumatosis intestinalis is a rare but known potential complication of treatment with cetuximab. Here we present two cases of pneumatosis intestinalis occurring in patients who were receiving cetuximab as treatment for advanced head and neck cancer. In both cases, cetuximab was discontinued after discovery of the pneumatosis intestinalis.

  14. The effect of radiotherapy on NKT cells in patients with advanced head and neck cancer.

    Science.gov (United States)

    Kobayashi, Kouichi; Tanaka, Yuriko; Horiguchi, Shigetoshi; Yamamoto, Shouji; Toshinori, Nakayama; Sugimoto, Akira; Okamoto, Yoshitaka

    2010-10-01

    Cancer immunotherapy with NKT cells is a potential new treatment strategy for advanced head and neck cancer. NKT cell therapy is promising due to its unique anti-tumor activity and higher degree of safety compared to current therapies. Radiotherapy is indispensable as a standard treatment for advanced head and neck cancer. To elucidate the possibility of using NKT cells as an adjuvant immunotherapy with radiotherapy, we examined the effect of radiotherapy on NKT cells in patients with head and neck cancer. The number, IFN-gamma production and proliferation capacity of NKT cells were analyzed before and after 50 Gy radiation therapy in 12 patients with stage IV head and neck squamous cell carcinoma. The cytotoxic activity of NKT cells was examined in vitro. The number of NKT cells in the blood varied widely between patients. After radiation therapy, the population of CD3 T cells decreased significantly, while the NKT cell population remained stable. The number of NKT cells was the same after radiation therapy as before. IFN-gamma production from NKT cells collected just after radiotherapy was impaired after stimulation with exogenous ligand, but the proliferative responses of these NKT cells was enhanced in comparison to those collected before radiation therapy. Furthermore, the proliferated NKT cells displayed a significant level of anti-tumor activity. NKT cells are relatively resistant to radiation and might therefore be suitable for adjuvant immunotherapy to eradicate remnant cancer cells in patients who have undergone radiation therapy.

  15. Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer.

    Science.gov (United States)

    Goguen, Laura A; Posner, Marshall R; Norris, Charles M; Tishler, Roy B; Wirth, Lori J; Annino, Donald J; Gagne, Adele; Sullivan, Christopher A; Sammartino, Daniel E; Haddad, Robert I

    2006-06-01

    Assess impact of sequential chemoradiation therapy (SCRT) for advanced head and neck cancer (HNCA) on swallowing, nutrition, and quality of life. Prospective cohort study of 59 patients undergoing SCRT for advanced head and neck cancer. Follow-up median was 47.5 months. Regional Cancer Center. Median time to gastrostomy tube removal was 21 weeks. Eighteen of 23 patients who underwent modified barium swallow demonstrated aspiration; none developed pneumonia. Six of 7 with pharyngoesophageal stricture underwent successful dilatation. Functional Assessment of Cancer Therapy-Head and Neck Scale questionnaires at median 6 months after treatment revealed "somewhat" satisfaction with swallowing. At the time of analysis, 97% have the gastronomy tube removed and take soft/regular diet. Early after treatment dysphagia adversely affected weight, modified barium swallow results, and quality of life. Diligent swallow therapy, and dilation as needed, allowed nearly all patients to have their gastronomy tubes removed and return to a soft/regular diet. Dysphagia is significant after SCRT but generally slowly recovers 6 to 12 months after SCRT. C-4.

  16. Recent advances in head and neck cancer reconstruction

    Directory of Open Access Journals (Sweden)

    Prabha Yadav

    2014-01-01

    Full Text Available Treatment of cancer is race against time! Following radical excision, breathing, speech, mastication and swallowing are hampered. Face is invariably involved. Beside functional normalcy, excellent cosmetic restoration is necessary for patient′s life quality. Primary wound healing, quick resumption of adequate oral intake, prompt initiation of chemo-radiotherapy has direct bearing on cure. Primary reconstruction with pedicle or free flap is the choice of treatment in most protocols. Composite defects are requiring bone, muscle and skin restrict choice of donor site and may have shortfalls in aesthetic and functional requirements. To improve further newer, and newer modalities are being developed and used to give best aesthetic and functions. Navigation, use of three-dimensional imaging, stereo lithic model and custom made implant for reconstruction are recommended as they promise improvement in aesthetics. Robotic surgeries allow access for resection of tumours and reconstruction with free flap in deep oropharynx obviating need of doing mandibulotomy. Researchers in stem cell and tissue engineering are looking forward to regenerating tissues and avoid the need of autologous tissue flaps. Desired tissue combination across counter may be available in the future. Excellent immunosuppressant drugs have made it possible to reconstruct composite facial anatomical units with allotransplant in a single surgery, along sensory and motor recovery! Mythological heterogenic head transplant like clone Ganesha, will be a reality in the near future!!

  17. Multidisciplinary Service Utilization Pattern by Advanced Head and Neck Cancer Patients: A Single Institution Study

    Directory of Open Access Journals (Sweden)

    Jacqueline C. Junn

    2012-01-01

    Full Text Available Purpose. To analyze the patterns and associations of adjunctive service visits by head and neck cancer patients receiving primary, concurrent chemoradiation therapy. Methods. Retrospective chart review of patients receiving adjunctive support during a uniform chemoradiation regimen for stages III-IV head and neck squamous cell carcinoma. Univariate and multivariate models for each outcome were obtained from simple and multivariate linear regression analyses. Results. Fifty-two consecutive patients were assessed. Female gender, single marital status, and nonprivate insurance were factors associated with an increased number of social work visits. In a multivariate analysis, female gender and marital status were related to increased social work services. Female gender and stage IV disease were significant for increased nursing visits. In a multivariate analysis for nursing visits, living greater than 20 miles between home and hospital was a negative predictive factor. Conclusion. Treatment of advanced stage head and neck cancer with concurrent chemoradiation warrants a multidisciplinary approach. Female gender, single marital status, and stage IV disease were correlated with increased utilization of social work and nursing services. Distance over 20 miles from the center was a negative factor. This information may help guide the treatment team to allocate resources for the comprehensive care of patients.

  18. Usefulness of cimetidine and superselective intra-arterial chemotherapy for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Yokoyama, Junkichi; Ito, Shin; Ohba, Shinichi; Haruyama, Takuo; Fujimaki, Mitsuhisa; Ikeda, Katsuhisa; Hanaguri, Makoto

    2011-01-01

    Since 1995, we have conducted intra-arterial chemotherapy for advanced head and neck cancer to improve prognosis and to preserve significant organs. Novel approaches have increased the organ preservation rate in spite of frequent distant metastasis. Cimetidine, a kind of H2-blocker, inhibits the development of E-selectin on vascular endothelial cells, and contributes to a decrease in distant metastasis and improvement in prognosis for digestive cancer. To evaluate the decrease in distant metastasis and its relation to the administration of Cimetidine when used concurrently with intra-arterial chemotherapy for advanced head and neck cancer. 153 patients treated by intra-arterial chemotherapy for stage IV head and neck cancer from May 2000 to December 2008 were divided into two groups: the Cimetidine group (114 patients) and the non-Cimetidine group (39 patients). Analysis of distant metastasis between the two groups was performed retrospectively. Intra-arterial chemotherapy was administered at 150 mg/m 2 of cisplatin (CDDP) four times per week. In the Cimetidine group, 800 mg of Cimetidine was administered for a period of more than one year prior to treatment. Fluorodeoxyglucose positron emission tomography (FDG-PET) was performed 2 months after the treatment. Pulmonary CT was performed every 6 months, and chest X-ray examination was conducted every three months. The median period of observation was 45 months for the Cimetidine group and 64 months for the non-Cimetidine group (p<0.05). Distant metastasis was detected in 10 out of the 39 cases in the non-Cimetidine group and in 6 out of the 114 cases in the Cimetidine group (p<0.05). Metastatic organs consisted of: 8 cases in lungs, 5 cases in bones, 2 cases in brain, and 1 case in retroperitoneum. The mean time of distant metastasis after treatment was 6.9 months (2-20). Combined intra-arterial chemotherapy and Cimetidine is useful for the treatment of advanced head and neck cancer due to increased loco

  19. Head and Neck Cancer

    Science.gov (United States)

    ... paranasal sinus cancer. The nasal cavity is the space just behind the nose where air passes on ... want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. ...

  20. Case Report: Down-staging locally advanced head and neck cancer ...

    African Journals Online (AJOL)

    big meta-analysis of chemotherapy in head and neck cancer. (MACH-NC) involving over ... and neck cancer of squamous cell histology, HIV infected who was down-staged ... of the submitted specimen confirmed ulcerated oral mucosa with an ...

  1. Induction chemotherapy followed by simultaneous hyperfractionated radiochemotherapy in advanced head and neck cancer. A pilot study

    International Nuclear Information System (INIS)

    Jereczek-Fossa, B.; Medical Univ. Gdansk; De Braud, F.; Gasparetto, M.; De Pas, T.; Tradati, N.; Leonardi, M.C.; Marsiglia, H.R.; Orecchia, R.; Milan Univ.

    1998-01-01

    Purpose: To evaluate the feasibility of induction chemotherapy followed by concomitant chemotherapy and hyperfractionated irradiation in locally advanced, inoperable head and neck cancer. Methods: A pilot study was undertaken comprising 3 cycles of cisplatinum (100 mg/m 2 , day 1) and 5-fluorouracil (1000 mg/m 2 in continuous intravenous infusion over the first 120 h) followed by bifractionated radiotherapy applied to tumor/involved lymph nodes up to the dose of 74.4 Gy given in 2 fractions of 1.2 Gy daily for 5 days a week combined with concomitant weekly cisplatinum infusion (50 mg/m 2 ). Results: Six patients were enrolled in the study. All of them completed the protocol therapy. Severe mucositis and myelotoxicity were the most common acute side effects observed in all and in 5 of the patients, respectively. Acute toxicity required interruption of concomitant chemotherapy in 5 cases and in 2 interruption of radiotherapy was necessary. Opioid analgesic parenteral therapy was administered in 4 patients. Three of them had to be hospitalized. One patient experienced cerebral stroke 1 day after the completion of therapy and died 7 days later. Due to high acute toxicity, patient accrual was terminated after 6 patients. At the mean follow-up of 17 months, 4 patients are alive, 3 of them are free of disease and in 1 local progression has been diagnosed. Conclusions: High acute toxicity of induction cisplatinum and 5-fluorouracil followed by concomitant cisplatinum and hyperfractionated irradiation calls for less toxic treatment schedules in locally advanced inoperable head and neck cancer. (orig.) [de

  2. Postoperative radiation therapy following laser surgery in locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Pradier, O.; Schmidberger, H.; Christiansen, H.; Florez, R.; Hess, C.F.; Jackel, M.C.; Steiner, W.

    2002-01-01

    The results achieved with trans oral micro-surgery in advanced head and neck carcinoma with adjuvant radiotherapy are comparable to those with radical surgery. The haemoglobin level has an important role in the loco regional control and on survival. Split course radiation therapy regimen has not a place in the adjuvant situation. (author)

  3. Determinants of Patient-Centered Financial Stress in Patients With Locally Advanced Head and Neck Cancer.

    Science.gov (United States)

    de Souza, Jonas A; Kung, Sunny; O'Connor, Jeremy; Yap, Bonnie J

    2017-04-01

    To prospectively estimate patient-centered financial stress and its relationship with health care utilization in patients with head and neck cancer. This was a survey-based, longitudinal, prospective study of treatment-naïve patients with stage III, IVa, or IVb locally advanced head and neck cancer at a single-institution tertiary care hospital from May 2013 to November 2014. With 121 patients approached, 73 (60%) agreed to participate. Self-reported data were collected on demographics, income, wealth, cost-coping strategies, out-of-pocket costs, supportive medication compliance, and perceived social isolation. Health care utilization was measured by hospital admissions and outpatient appointments on a 6-month timeline. Logistic regression models were constructed to identify factors associated with use of cost-coping strategies. Covariates included all demographics, measures of income, wealth, out-of-pocket costs, indirect costs, and perceived social isolation. Fifty-one patients (69%) relied on at least one coping strategy. On multivariable analysis, Medicaid patients were more likely than privately insured patients to use cost-coping strategies (odds ratio, 42.3; P = .0042). Decreased wealth ( P = .002) and higher total out-of-pocket costs ( P = .003) were independently associated with using cost-coping strategies. Patients with high perceived social isolation were also more likely to use cost-coping strategies (odds ratio, 11.5; P = .01). Patients with high perceived social isolation were more likely to report nonadherence to supportive medications (21.4 v 5.45 days over 6 months; P = .0278) and missed appointments (seven v three; P = .0077). A majority of patients used at least one cost-coping strategy during their treatment, highlighting the financial stress that patients experience. Perceived social isolation is an important social determinant of increased medication nonadherence, missed appointments, and use of cost-coping strategies. Interventions should

  4. Treatment results of preoperative radiotherapy for advanced head and neck cancers

    International Nuclear Information System (INIS)

    Shikama, Naoto; Oguchi, Masahiko; Kurita, Hiroshi; Katsuno, Satoshi

    2000-01-01

    One hundred and nine patients with advanced head and neck cancers (oral cavity: 50, oropharynx: 11, hypopharynx: 18, larynx: 30) received preoperative radiotherapy from 1987 through 1997 in our institute. The median age was 66 years (20-83). Almost all patients had advanced disease (stage II: 17, III: 34, IV: 58). The median dose of preoperative radiotherapy was 40 Gy (20-50). Seventy patients received chemotherapy. The median follow-up time was 30 months. The 5-year overall and disease-free survival rates of all patients were 66% and 56%, respectively. The 5-year locoregional and distant failure rates were 36% and 10%, respectively. The locoregional failure rate of oral cavity cancer (54%) was worse than those of other sites (13-28%) (p=0.0015). The locoregional failure rates of oral cavity cancers according to clinical stage were 59% (II), 57% (III) and 48% (IV), respectively. Incidentally those of other sites were 0% (II), 16% (III) and 30% (IV), respectively. Thirty-eight patients had major complication after surgery. The locoregional failure rates of preoperative radiotherapy following surgery for oral cavity cancers of all stages and other sites of stage IV were high. Preoperative radiotherapy should be stopped and postoperative radiotherapy for these patients should be considered. (author)

  5. Head and Neck Cancers in Developing Countries

    Directory of Open Access Journals (Sweden)

    Poonam Joshi

    2014-04-01

    Full Text Available Head and neck cancers are the most common cancers in developing countries, especially in Southeast Asia. Head and neck cancers are more common in males compared to females. This is mainly attributed to tobacco, areca nut, alcohol, etc. Oral cancers are most common amongst all head and neck squamous cell cancers (HNSCC. HNSCC in the developing world differ from those in the Western world in terms of age, site of disease, etiology, and molecular biology. Poverty, illiteracy, advanced stage at presentation, lack of access to health care, and poor treatment infrastructure pose a major challenge in management of these cancers. The annual GDP (gross domestic product spent on health care is very low in developing countries compared to the developed countries. Cancer treatment leads to a significant financial burden on the cancer patients and their families. Several health programs have been implemented to curb this rising burden of disease. The main aims of these health programs are to increase awareness among people regarding tobacco and to improve access to health care facilities, early diagnosis, treatment, and palliative care.

  6. Boron neutron capture therapy outcomes for advanced or recurrent head and neck cancer

    International Nuclear Information System (INIS)

    Suzuki, Minoru; Kato, Ituro; Aihara, Teruhito

    2014-01-01

    We retrospectively review outcomes of applying boron neutron capture therapy (BNCT) to unresectable advanced or recurrent head and neck cancers. Patients who were treated with BNCT for either local recurrent or newly diagnosed unresectable head or neck cancers between December 2001 and September 2007 were included. Clinicopathological characteristics and clinical outcomes were retrieved from hospital records. Either a combination of borocaptate sodium and boronophenylalanine (BPA) or BPA alone were used as boron compounds. In all the treatment cases, the dose constraint was set to deliver a dose <10–12 Gy-eq to the skin or oral mucosa. There was a patient cohort of 62, with a median follow-up of 18.7 months (range, 0.7–40.8). A total of 87 BNCT procedures were performed. The overall response rate was 58% within 6 months after BNCT. The median survival time was 10.1 months from the time of BNCT. The 1- and 2-year overall survival (OS) rates were 43.1% and 24.2%, respectively. The major acute Grade 3 or 4 toxicities were hyperamylasemia (38.6%), fatigue (6.5%), mucositis/stomatitis (9.7%) and pain (9.7%), all of which were manageable. Three patients died of treatment-related toxicity. Three patients experienced carotid artery hemorrhage, two of whom had coexistent infection of the carotid artery. This study confirmed the feasibility of our dose-estimation method and that controlled trials are warranted. (author)

  7. Concurrent Cisplatin and Radiation Versus Cetuximab and Radiation for Locally Advanced Head-and-Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Koutcher, Lawrence, E-mail: Koutchel@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Sherman, Eric; Fury, Matthew [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wolden, Suzanne [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zhang Zhigang; Mo Qianxing [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Stewart, Laschelle; Schupak, Karen; Gelblum, Daphna [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Wong, Richard; Kraus, Dennis; Shah, Jatin [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Zelefsky, Michael [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pfister, David [Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Lee, Nancy [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2011-11-15

    Purpose: To compare concurrent cisplatin (CDDP) and radiation (RT) with cetuximab (C225) and RT for locally advanced head-and-neck cancer (LAHNC). Methods and Materials: This study retrospectively compared 174 consecutive, newly diagnosed LAHNC patients definitively treated from March 1, 2006, to April 1, 2008, with single-agent CDDP/RT (n = 125) or C225/RT (n = 49). We excluded patients who received additional concurrent, induction, or adjuvant systemic therapy; weekly cisplatin; prior head-and-neck radiotherapy; or primary surgical resection. Outcomes were analyzed by the Kaplan-Meier method, Cox model, and competing-risks analysis tools. Results: The C225/RT patients were older and had decreased creatinine clearance. At a median follow-up of 22.5 months for living patients, the 2-year locoregional failure rate was 5.7% for CDDP/RT and 39.9% for C225/RT (p < 0.0001). The 2-year failure-free survival (FFS) and overall survival (OS) rates were 87.4% vs. 44.5% (p < 0.0001) and 92.8% vs. 66.6% (p = 0.0003), respectively, in favor of CDDP/RT. When the Cox proportional hazards model was used for multivariate analysis, treatment with CDDP/RT predicted for improved locoregional control (p < 0.0001), FFS (p < 0.0001), and OS (p = 0.01). Late Grade 3 or 4 toxicity or feeding tube dependence 9 months after completion of RT was observed in 21% of patients in the CDDP/RT cohort and 24% in the C225/RT cohort (p = 0.66). Conclusions: In this study of LAHNC patients, CDDP/RT achieved better locoregional control, FFS, and OS than C225/RT. Although the results were upheld on multivariate analysis, they must be interpreted cautiously because of the retrospective nature of the study and significant differences in patient selection. There was no statistically significant difference in late Grade 3 or 4 effects or feeding tube dependence.

  8. Patterns of Care for Elderly Patients With Locally Advanced Head and Neck Cancer.

    Science.gov (United States)

    Juarez, Jesus E; Choi, Jehee; St John, Maie; Abemayor, Elliot; TenNapel, Mindi; Chen, Allen M

    2017-07-15

    To compare patterns of care for elderly patients aged ≥70 years with locally advanced head and neck cancer versus those of younger patients treated for the same disease. The medical records of 421 consecutive patients over the age of 50 years treated at a single institution between April 2011 and June 2016 for stage III/IV squamous cell carcinoma of the head and neck were reviewed. The primary treatment approach was compared using a t test statistic among 3 age cohorts: 50 to 59 years (118 patients); 60 to 69 years (152 patients); and 70 years and older (151 patients). Logistical regression was used to determine variables that influenced the likelihood of receiving surgery versus nonsurgical treatment, as well as radiation alone versus chemoradiation. There was no difference in sex, T stage, N stage, Karnofsky performance status, or the number of chronic comorbid conditions among the 3 age cohorts (P>.05 for all). A greater proportion of elderly patients aged ≥70 years were treated by radiation alone compared with those aged 50 to 59 and 60 to 69 years (44% vs 16% and 24%, P=.01). Increasing age was associated with a greater likelihood of receiving primary nonsurgical versus surgical treatment (odds ratio 1.023, 95% confidence interval 1.004-1.042) and radiation alone compared with chemoradiation (odds ratio 1.054; 95% confidence interval 1.034-1.075). Ten chemotherapy regimens were used concurrently with radiation for patients aged ≥70 years, including carboplatin/paclitaxel (19%), carboplatin/cetuximab (19%), cisplatin (17%), and cetuximab (17%). Despite similar performance status and comorbidity burden compared with their younger counterparts, patients aged ≥70 years were more commonly treated with less-aggressive strategies, including radiation alone. The variability of concurrent chemotherapy regimens used further suggests that the standard of care remains to be defined for this population. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Preliminary results in advanced head and neck cancer with radiotherapy by multiple fractions a day

    International Nuclear Information System (INIS)

    Gonzalez, D.G.; Breur, K.; Schueren, E. v.d.

    1980-01-01

    Nine patients with advanced head and neck cancer were treated by irradiation consisting of three fractions a day of 180 rad administered with intervals of 4 h. The total dose was 4860-5400 rad in an overall time of 11-12 days. The acute mucosal reactions produced by this multifractionated schedule were similar to those observed with conventional fractionation. The acute skin reactions were minimal. The period of acute reactions were shorter than is generally observed with conventional fractionation. In six patients with a follow-up time of six months or longer no late reactions were detected with the exception of one patient requiring permanent tracheostomy because of laryngeal oedema. In the whole group of patients loco-regional control of the disease was achieved. Six patients had maintained the full response for six months or longer. The results so far obtained with this multiple fractions a day schedule are encouraging. More patients have to be entered in this study in order to draw definitive conclusions. (author)

  10. Simultaneous radiochemotherapy versus concomitant boost radiation for advanced inoperable head and neck cancer

    International Nuclear Information System (INIS)

    Schaefer, U.; Schueller, P.; Micke, O.; Willich, N.

    2000-01-01

    In this prospective, non-randomized study we compare the results of simultaneous radiochemotherapy (RCT) with those of concomitant boost treatment (CBT) in advanced head and neck cancer. From January 1993 to March 1999, 77 patients were treated with cisplatin, 5-FU, and 70.2 Gy (accelerated split-course); from January 1995 to March 1999, a further 33 patients received CBT to a total dose of 72 Gy. Toxicities were prospectively recorded according to RTOG/EORTC criteria. Acute and subacute reactions did not differ significantly. Severe late effects (III/IV) remained anecdotal (one fistula). Therapy-associated mortalities were 3%(RCT) vs. 0% (CBT), most tumors responding well to therapy (CR + PR: RCT: 72%, CBT: 63%). The 2-year probabilities for freedom from locoregional progression amounted to 42% (RCT) and 31% (CBT); p > 0.05. Tumor-specific 2-year survival amounted to 40% (RCT) and 34% (CBT); p > 0.05. Both of the treatment concepts yield high remission rates with moderate toxicities. Nevertheless, median time to recurrence is still fairly short. We could not find any differences for local control and survival. For patients who are not able to complete the full three courses of radiochemotherapy, the concomitant boost schedule presents a good alternative

  11. Drugs Approved for Head and Neck Cancer

    Science.gov (United States)

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for head and neck cancer. The list includes generic names and brand names. The drug names link to NCI’s Cancer Drug Information summaries.

  12. A randomized study of accelerated fractionation radiotherapy with and without mitomycin C in the treatment of locally advanced head and neck cancer

    DEFF Research Database (Denmark)

    Ezzat, M.; Shouman, T.; Zaza, K.

    2005-01-01

    Objectives: This single-institution study evaluates the feasibility of accelerated fractionation radiotherapy (AF) with and without mitomycin C (MMC) in the treatment of locally advanced head and neck cancer. Patients and Methods: Between May 1998 and October 2001, sixty patients with locally...... advanced stage III and IV of head and neck cancer were randomized into three treatment arms: (1) conventional fractionation radiotherapy (CF) (5 fractions per week); (2) accelerated fractionation radiotherapy (AF) (6 fractions per week); and (3) AF plus Mitomycin C (MMC). Results: The 2-year overall....... Key Words: Head and Neck cancer , Radiotherapy , Altered fractionation , Mitomycin C....

  13. Roles of chemoradio therapy for stage III or IV advanced head and neck cancers

    International Nuclear Information System (INIS)

    Tachikawa, Takuya; Iwai, Hiroshi; Tsuji, Hiroyuki; Minamino, Masayuki; Yamamoto, Takashi; Yukawa, Hisaya; Inoue, Toshiya; Yamashita, Toshio

    2002-01-01

    The effectiveness of chemoradio therapy (CRT), which was performed on 31 patients with advanced head and neck cancers of stage III or IV at Kansai Medical University between September 1999 and December 2000, was examined. The CRT consisted of continuous infusion of 5FU (500 mg/m 2 ) for 120 hours, prior to drip infusion of CDDP (50 mg/m 2 ) for 2 hours and conventional radiotherapy (2 Gy/day, 5 days/w). The 31 patients with these cancers were divided into two groups; a non-operative group (16 patients) and an operative group (15 patients). The patients in the non-operative group (16 patients) and an operative group (15 patients). The patients in the non-operative group underwent CRT (60-70 Gy of total radiation dose and two courses of chemotherapy) without surgery. The patients in the operative group received surgical treatment followed by CRT (40 Gy of total radiation dose and one course of chemotherapy). The results of CRT indicated 87.1% of the response rate (RR), and 29.0% of the complete response rate (CR) in the group. The CR rate was lower than in other reports. However, the combination of CRT and the subsequent operation indicated a disease-free survival rate of 61.3% and reduction of the recurrence rate to 17.4%. Eight of 9 patients of CR after CRT without surgery revealed NED. On the other hand, the results indicated that all 10 patients of PR after CRT showed tumor residue, 9 of 10 patients of PR showed NED after additional surgery. Therefore, it is likely that the patients of CR do not need the additional surgery, however, the patients of PR are strongly recommended the surgery to improve the local control rate as well as survival rate. Although adverse reactions of CRT on patients included mucositis, leucopenia, thrombopenia and dermatitis, the symptoms ranged within grade 3. (author)

  14. Long-term results of accelerated radiation treatment for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Lamb, D.S.; Morum, P.E.; Denham, J.W.; Gray, A.J.

    1998-01-01

    Background and purpose: This report presents long-term follow-up data from a prospective but unrandomized trial of a continuous 3.5-week course of accelerated radiation treatment (ART) used as primary treatment for patients with loco-regionally advanced head and neck cancer. Materials and methods: Ninety-three patients in three centres in New Zealand and Australia were treated with ART (59.40 Gy in 33 fractions over 24-25 days). Their disease originated from three anatomical regions (oral cavity, 35 patients; pharynx, 31 patients; larynx, 27 patients). Seventy-nine of these patients had stage III or IV cancers. Results: Follow-up ranged from 68 to 203 months (median 139 months). Loco-regional (LR) failure occurred in 52 patients leading to a 10-year actuarial expectation of LR control of 38%. The actuarial expectation of LR control at 10 years was highly dependent on stage and for stage III, IVA and IVB patients it was 57±8.1%, 32±1.7% and 7±0.5%, respectively. Multivariate analysis could not confirm an independent impact of primary site or histological differentiation on LR failure. Two patients died of acute toxicity of treatment and six patients developed grade 3/4 late complications affecting soft tissues only, yielding an actuarial expectation of complications of this severity at 5 years of 9%. No cases of osteoradionecrosis or myelitis were observed. Conclusion: This ART, which has proved easy to use at a number of large and small centres, has produced encouraging long-term LR control at a cost of limited soft tissue morbidity. (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  15. Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Caudell, Jimmy J.; Schaner, Philip E.; Meredith, Ruby F.; Locher, Julie L.; Nabell, Lisle M.; Carroll, William R.; Magnuson, J. Scott; Spencer, Sharon A.; Bonner, James A.

    2009-01-01

    Purpose: The use of altered fractionation radiotherapy (RT) regimens, as well as concomitant chemotherapy and RT, to intensify therapy for locally advanced head-and-neck cancer can lead to increased rates of long-term dysphagia. Methods and Materials: We identified 122 patients who had undergone definitive RT for locally advanced head-and-neck cancer, after excluding those who had been treated for a second or recurrent head-and-neck primary, had Stage I-II disease, developed locoregional recurrence, had <12 months of follow-up, or had undergone postoperative RT. The patient, tumor, and treatment factors were correlated with a composite of 3 objective endpoints as a surrogate for severe long-term dysphagia: percutaneous endoscopic gastrostomy tube dependence at the last follow-up visit; aspiration on a modified barium swallow study or a clinical diagnosis of aspiration pneumonia; or the presence of a pharyngoesophageal stricture. Results: A composite dysphagia outcome occurred in 38.5% of patients. On univariate analysis, the primary site (p = 0.01), use of concurrent chemotherapy (p = 0.01), RT schedule (p = 0.02), and increasing age (p = 0.04) were significantly associated with development of composite long-term dysphagia. The use of concurrent chemotherapy (p = 0.01), primary site (p = 0.02), and increasing age (p = 0.02) remained significant on multivariate analysis. Conclusion: The addition of concurrent chemotherapy to RT for locally advanced head-and-neck cancer resulted in increased long-term dysphagia. Early intervention using swallowing exercises, avoidance of nothing-by-mouth periods, and the use of intensity-modulated RT to reduce the dose to the uninvolved swallowing structures should be explored further in populations at greater risk of long-term dysphagia

  16. Unusual Cancers of the Head and Neck

    Science.gov (United States)

    ... more information). Unusual Cancers of the Head and Neck Nasopharyngeal Cancer See the PDQ summary on Childhood ... of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ ...

  17. Fast-neutron therapy in advanced head and neck cancer: a collaborative international randomized trial

    Energy Technology Data Exchange (ETDEWEB)

    Maor, Moshe H; Errington, R Douglas; Caplan, Richard J; Griffin, Thomas W; Laramore, George E; Parker, Robert G; Burnison, Michele; Stetz, Joann; Zink, Sandra; Davis, Lawrence W; Peters, Lester J

    1995-06-15

    Purpose: To compare the efficacy of fast-neutron radiotherapy with that of conventionally fractionated photon therapy in the management of patients with locally advanced squamous cell carcinoma of the head and neck. Methods and Materials: Patients with Stage III or IV disease were randomized to receive either 20.4 Gy/12 fractions/4 weeks of neutrons or 70 Gy/35 fractions/7 weeks of photons (control). Between April 1986 and March 1991, 178 patients were entered, 169 of whom were eligible for analysis. The treatment arms were balanced for age, stage, and performance status, but not for primary site of origin. Results: Complete response occurred in 70 and 52% with neutrons and photons, respectively (p = 0.006). Local regional failure at 3 years for all patients was 63% for neutrons and 68% for photons. Actuarial overall survival curves were virtually identical in both study arms, falling to 27% at 3 years. Acute toxicity was similar in the two arms, but late grade 3-5 toxicity was 40% with neutrons compared to 18% with photons (p = 0.008). Conclusion: Although the initial response rate was higher with neutrons, permanent local control and survival were not improved, and the incidence of late normal tissue toxicity was increased. As a result, fast-neutron therapy for advanced squamous cell carcinoma of the head and neck can only be recommended for patients in whom the logistic benefit of treatment in 12 sessions over 4 weeks outweighs the increased risk of late toxicity.

  18. Fast-neutron therapy in advanced head and neck cancer: a collaborative international randomized trial

    International Nuclear Information System (INIS)

    Maor, Moshe H.; Errington, R. Douglas; Caplan, Richard J.; Griffin, Thomas W.; Laramore, George E.; Parker, Robert G.; Burnison, Michele; Stetz, Joann; Zink, Sandra; Davis, Lawrence W.; Peters, Lester J.

    1995-01-01

    Purpose: To compare the efficacy of fast-neutron radiotherapy with that of conventionally fractionated photon therapy in the management of patients with locally advanced squamous cell carcinoma of the head and neck. Methods and Materials: Patients with Stage III or IV disease were randomized to receive either 20.4 Gy/12 fractions/4 weeks of neutrons or 70 Gy/35 fractions/7 weeks of photons (control). Between April 1986 and March 1991, 178 patients were entered, 169 of whom were eligible for analysis. The treatment arms were balanced for age, stage, and performance status, but not for primary site of origin. Results: Complete response occurred in 70 and 52% with neutrons and photons, respectively (p = 0.006). Local regional failure at 3 years for all patients was 63% for neutrons and 68% for photons. Actuarial overall survival curves were virtually identical in both study arms, falling to 27% at 3 years. Acute toxicity was similar in the two arms, but late grade 3-5 toxicity was 40% with neutrons compared to 18% with photons (p = 0.008). Conclusion: Although the initial response rate was higher with neutrons, permanent local control and survival were not improved, and the incidence of late normal tissue toxicity was increased. As a result, fast-neutron therapy for advanced squamous cell carcinoma of the head and neck can only be recommended for patients in whom the logistic benefit of treatment in 12 sessions over 4 weeks outweighs the increased risk of late toxicity

  19. Split Course Hyperfractionated Accelerated Radio-Chemotherapy (SCHARC) for patients with advanced head and neck cancer: Influence of protocol deviations and hemoglobin on overall survival, a retrospective analysis

    OpenAIRE

    Stadler, Peter; Putnik, Kurt; Kreimeyer, Thore; Sprague, Lisa D; Koelbl, Oliver; Schäfer, Christof

    2006-01-01

    Abstract Background The advantage of hyperfractionated accelerated radiation therapy for advanced head and neck cancer has been reported. Furthermore, randomized trials and meta-analyses have confirmed the survival benefit of additional chemotherapy to radiotherapy. We retrospectively analyzed the efficiency and toxicity of the Regensburg standard therapy protocol "SCHARC" and the overall survival of our patients. Methods From 1997 to 2004, 64 patients suffering from advanced head and neck ca...

  20. Role of Met Axis in Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Yiru, E-mail: xuyiru@umich.edu; Fisher, Gary J., E-mail: xuyiru@umich.edu [Department of Dermatology, University of Michigan, Ann Arbor, MI 48109 (United States)

    2013-11-26

    Head and neck cancer is the sixth most common type of cancer worldwide. Despite advances in aggressive multidisciplinary treatments, the 5-year survival rate for this dreadful disease is only 50%, mostly due to high rate of recurrence and early involvement of regional lymph nodes and subsequent metastasis. Understanding the molecular mechanisms responsible for invasion and metastasis is one of the most pressing goals in the field of head and neck cancer. Met, also known as hepatocyte growth factor receptor (HGFR), is a member of the receptor protein tyrosine kinase (RPTK) family. There is compelling evidence that Met axis is dysregulated and plays important roles in tumorigenesis, progression, metastasis, angiogenesis, and drug resistance in head and neck cancer. We describe in this review current understanding of Met axis in head and neck cancer biology and development of therapeutic inhibitors targeting Met axis.

  1. Utility of FMISO PET in advanced head and neck cancer treated with chemoradiation incorporating a hypoxia-targeting chemotherapy agent

    Energy Technology Data Exchange (ETDEWEB)

    Hicks, Rodney J. [Peter MacCallum Cancer Centre, Centre for Molecular Imaging, Melbourne (Australia); University of Melbourne, Department of Medicine, St Vincent' s Medical School, Melbourne (Australia); Rischin, Danny [University of Melbourne, Department of Medicine, St Vincent' s Medical School, Melbourne (Australia); Peter MacCallum Cancer Centre, Division of Haematology and Medical Oncology, Melbourne (Australia); Fisher, Richard [Peter MacCallum Cancer Centre, Centre for Biostatistics and Clinical Trials, Melbourne (Australia); Binns, David [Peter MacCallum Cancer Centre, Centre for Molecular Imaging, Melbourne (Australia); Scott, Andrew M. [Austin Hospital, Centre for PET, and Ludwig Institute for Cancer Research, Melbourne (Australia); Peters, Lester J. [Peter MacCallum Cancer Centre, Division of Radiation Oncology, Melbourne (Australia)

    2005-12-01

    The purpose of the study was to evaluate [{sup 18}F]fluoromisonidazole (FMISO) PET in advanced head and neck cancer during hypoxia-targeting therapy. Fifteen of 16 patients in a phase I trial of chemoradiation plus tirapazamine (specific cytotoxin for hypoxic cells) in advanced (T3/4 and/or N2/3) head and neck cancer underwent serial [{sup 18}F]fluorodeoxyglucose (FDG) and FMISO PET. We have previously reported excellent early clinical outcome of these patients and now review FMISO PET results in the context of longer follow-up of this patient cohort. Based on blinded qualitative scoring by two readers, FMISO PET was positive in 13/15 patients at baseline: 12/15 of primary sites and 8/13 neck nodes were scored as positive. All sites of corresponding FDG and FMISO abnormality at baseline showed marked qualitative reduction of uptake within 4 weeks of commencing therapy, consistent with effective hypoxia-targeted therapy. With a median follow-up of 6.9 years, there have been only four locoregional failures, while three other patients have died of metachronous lung cancer. The 5-year overall survival was 50% (95% CI 27-73%), the 5-year failure-free survival was 44% (95% CI 22-68%) and the 5-year freedom from locoregional failure was 68% (95% CI 38-88%). The high prevalence of hypoxia demonstrated on FMISO PET imaging is consistent with the advanced disease stage of these patients and would be expected to predict an adverse prognosis. Evidence of the early resolution of FMISO abnormality during treatment, associated with excellent locoregional control in this patient cohort, supports further investigation of hypoxia-targeting agents in advanced head and neck cancer. (orig.)

  2. Utility of FMISO PET in advanced head and neck cancer treated with chemoradiation incorporating a hypoxia-targeting chemotherapy agent

    International Nuclear Information System (INIS)

    Hicks, Rodney J.; Rischin, Danny; Fisher, Richard; Binns, David; Scott, Andrew M.; Peters, Lester J.

    2005-01-01

    The purpose of the study was to evaluate [ 18 F]fluoromisonidazole (FMISO) PET in advanced head and neck cancer during hypoxia-targeting therapy. Fifteen of 16 patients in a phase I trial of chemoradiation plus tirapazamine (specific cytotoxin for hypoxic cells) in advanced (T3/4 and/or N2/3) head and neck cancer underwent serial [ 18 F]fluorodeoxyglucose (FDG) and FMISO PET. We have previously reported excellent early clinical outcome of these patients and now review FMISO PET results in the context of longer follow-up of this patient cohort. Based on blinded qualitative scoring by two readers, FMISO PET was positive in 13/15 patients at baseline: 12/15 of primary sites and 8/13 neck nodes were scored as positive. All sites of corresponding FDG and FMISO abnormality at baseline showed marked qualitative reduction of uptake within 4 weeks of commencing therapy, consistent with effective hypoxia-targeted therapy. With a median follow-up of 6.9 years, there have been only four locoregional failures, while three other patients have died of metachronous lung cancer. The 5-year overall survival was 50% (95% CI 27-73%), the 5-year failure-free survival was 44% (95% CI 22-68%) and the 5-year freedom from locoregional failure was 68% (95% CI 38-88%). The high prevalence of hypoxia demonstrated on FMISO PET imaging is consistent with the advanced disease stage of these patients and would be expected to predict an adverse prognosis. Evidence of the early resolution of FMISO abnormality during treatment, associated with excellent locoregional control in this patient cohort, supports further investigation of hypoxia-targeting agents in advanced head and neck cancer. (orig.)

  3. Pocket Proteins Suppress Head and Neck Cancer

    Science.gov (United States)

    Shin, Myeong-Kyun; Pitot, Henry C.; Lambert, Paul F.

    2012-01-01

    Head and neck squamous cell carcinomas (HNSCC) is a common cancer in humans long known to be caused by tobacco and alcohol use, but now an increasing percentage of HNSCC is recognized to be caused by the same human papillomaviruses (HPVs) that cause cervical and other anogenital cancers. HPV-positive HNSCCs differ remarkably from HPV-negative HNSCCs in their clinical response and molecular properties. From studies in mice, we know that E7 is the dominant HPV oncoprotein in head and neck cancer. E7 is best known for its ability to inactivate pRb, the product of the retinoblastoma tumor susceptibility gene. However loss of pRb function does not fully account for E7’s potency in causing head and neck cancer. In this study, we characterized the cancer susceptibility of mice deficient in the expression of pRb and either of two related “pocket” proteins, p107 and p130, that are also inactivated by E7. pRb/p107 deficient mice developed head and neck cancer as frequently as do HPV16 E7 transgenic mice. The head and neck epithelia of the pRb/p107 deficient mice also displayed the same acute phenotypes and biomarker readouts as observed in the epithelia of E7 transgenic mice. Mice deficient for pRb and p130 in their head and neck epithelia showed intermediate acute and tumor phenotypes. We conclude that pRb and p107 act together to efficiently suppress head and neck cancer, and are therefore highly relevant targets of HPV16 E7 in its contribution to HPV-positive HNSCC. PMID:22237625

  4. Sequential radiotherapy and chemotherapy using CDDP and 5-FU for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Takamura, Akio; Arimoto, Takuro; Mizoe, Jun-etsu; Tomita, Masayoshi; Kitahara, Toshihiro; Irie, Goro; Matsuoka, Yoshisuke.

    1991-01-01

    From April 1989 to January 1990, nine patients with locally advanced stage IV squamous cell carcinoma of the head and neck underwent combined chemotherapy and radiotherapy (RT). Chemotherapy consisted of two cycles of CDDP (100 mg/m 2 , day 1) + 5-FU (1 g/m 2 , days 1-5, continuous infusion) every five weeks. RT was interdigitated with chemotherapy after the second course of chemotherapy. Each course was initiated two or three days after interrupting chemotherapy. RT was delivered at 65 or 70 Gy for 8 weeks. Of the 7 patients completing the treatment, 29% responded totally, and 43% responded partially. Seven patients died: two due to acute treatment-related toxicity; four due to locoregional progression; and one due to an unrelated cause. Two patients are still alive (10 and 12 months); one is free of tumor, the other has a metastatic bone tumor. Though sequential use of CT might be considered effective for some patients, acute toxicity was moderate to severe and patients with poor performance (≤70%), elderly (≥70 yr) and renal dysfunction (creatinine clearance<80 ml/min) patients must be considered as high risk for treatment by our combined regimen. (author)

  5. Treatment results of the neck by concurrent chemoradiotherapy for advanced head and neck cancer

    International Nuclear Information System (INIS)

    Tokumaru, Yutaka; Fujii, Masato; Habu, Noboru; Yajima, Yoko; Yorozu, Atsunori

    2009-01-01

    Concurrent chemoradiotherapy (CCRT) is one of the recent emerging modalities for advanced squamous cell carcinoma of the head and neck (HNSCC). However some of the patients treated by CCRT have residual or recurrent cervical lymph nodes. In these cases, neck dissection is considered to be useful in the point of locolegional control and disease free survival. This study aims to analyze neck control rate by CCRT and usefulness of the neck dissection after CCRT for HNSCC. The medical records of 69 consecutive patients (stage III: 4%, stage IV: 96%) treated with CCRT for SCCHN (hypopharynx: 40, oropharynx: 25, larynx: 4) from 2003 through 2007 were reviewed. Clinical complete response (CR) rates of N1, N2a, N2b, N2c and N3 were 75%, 100%, 71%, 74% and 43% respectively. Among the patients with complete neck response, only 2 patients (5%) had an isolated neck recurrence. Eleven patients underwent surgical neck procedures including 7 planned neck dissections and 4 salvage neck dissections. All the 11 patients with neck dissections had good regional control except 1 case. There were a few minor complications such as wound infection and laryngeal edema. Patients who have a complete clinical regional response to CCRT have a low probability of an isolated recurrence in the neck. Planned and salvage neck dissections can be safely performed and considered to be useful in the point of regional control after intensive CCRT. (author)

  6. The Danish Head and Neck Cancer database

    DEFF Research Database (Denmark)

    Overgaard, Jens; Jovanovic, Aleksandar; Godballe, Christian

    2016-01-01

    of continuous clinical trials and subsequent implementation in national guidelines. The database has furthermore been used to describe the effect of reduced waiting time, changed epidemiology, and influence of comorbidity and socioeconomic parameters. CONCLUSION: Half a century of registration of head and neck......AIM OF THE DATABASE: The Danish Head and Neck Cancer database is a nationwide clinical quality database that contains prospective data collected since the early 1960s. The overall aim of this study was to describe the outcome of the national strategy for multidisciplinary treatment of head and neck......) of cancer in the nasal sinuses, salivary glands, or thyroid gland (corresponding to the International Classification of Diseases, tenth revision, classifications C.01-C.11, C.30-C.32, C.73, and C.80). MAIN VARIABLES: The main variables used in the study were symptoms and the duration of the symptoms...

  7. Risk factors for competing noncancer mortality after definitive treatment for advanced-stage head and neck cancer.

    Science.gov (United States)

    Kim, Yong Han; Roh, Jong-Lyel; Kim, Sung-Bae; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

    2018-05-27

    Patients with head and neck cancer (HNC) can die of index tumor progression and second tumor or noncancer causes. Here, we investigated the risk factors for competing noncancer mortality (NCM) in a prospective cohort of patients with advanced-stage HNC. A prospective observational study was conducted with 604 patients who underwent definitive treatment for advanced-stage HNC between 2010 and 2015. Main outcomes were NCM and cancer mortality (CM) defined as death from noncancer causes and HNC or second cancers, respectively. Cumulative incidence and cause-specific hazard functions were used to analyze the risk factors of NCM and CM. Age, smoking, Charlson comorbidity index (CCI), performance status, body mass index, rural residence, education and hemoglobin level at diagnosis, and chemotherapy were significantly associated with NCM (all Padvanced-stage HNC. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  8. Chemotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Pfister, David G.

    1997-01-01

    Purpose/Objective: The role of chemotherapy in the management of squamous cell carcinoma of the upper aerodigestive tract is undergoing rapid evolution. Historically, the use of chemotherapy was limited to patients with incurable disease who had exhausted all surgical and radiation therapy options. The results of recent randomized trials, however, suggest an increasing role for chemotherapy as part of primary management in patients with unresectable disease; advanced larynx or hypopharynx cancer with the intent of larynx preservation, or advanced nasopharynx cancer. This refresher course will provide a comprehensive overview of the current indications for chemotherapy in the management of these malignancies, and will highlight areas of controversy and future directions of investigation. More specifically, the following areas will be emphasized. 1. The identification of drugs commonly used in the management of head and neck cancer, their customary dosing and side effects. 2. The impact of induction and/or adjuvant chemotherapy combined with surgery and radiation therapy as defined by randomized trials, including a discussion of the Head and Neck Contracts program and the Intergroup adjuvant trial. 3. The development of larynx/function preservation treatment programs, including a review of the Veterans Administration and EORTC larynx preservation studies. 4. The evolving role of chemotherapy as part of innovative combined modality programs, especially in patients with unresectable disease. The rationale and utility of sequential versus concomitant/alternating chemotherapy-radiation strategies, and relevant randomized clinical trials comparing the different strategies will be discussed. 5. The appropriate application of chemotherapy in the palliative setting, including a discussion of the relative merits of single-agent versus combination chemotherapy

  9. Head and neck cancer: metronomic chemotherapy

    International Nuclear Information System (INIS)

    De Felice, Francesca; Musio, Daniela; Tombolini, Vincenzo

    2015-01-01

    In the era of personalized medicine, head and neck squamous cell carcinoma (HNSCC) represents a critical oncologic topic. Conventional chemotherapy regimens consist of drugs administration in cycles near or at the maximum tolerated dose (MDT), followed by a long drug-free period to permit the patient to recover from acute toxicities. Despite this strategy is successful in controlling the cancer process at the beginning, a significant number of HNSCC patients tend to recurred or progress, especially those patients with locally advanced or metastatic disease. The repertoire of drugs directed against tumor cells has greatly increased and metronomic chemotherapy (MC) could be an effective treatment option. It is the purpose of this article to review the concept of MC and describe its potential use in HNSCC. We provide an update of ongoing progress and current challenges related to this issue

  10. Long-term outcome and patterns of failure in patients with advanced head and neck cancer

    International Nuclear Information System (INIS)

    Hauswald, Henrik; Simon, Christian; Hecht, Simone; Debus, Juergen; Lindel, Katja

    2011-01-01

    To access the long-time outcome and patterns of failure in patients with advanced head and neck squamous cell carcinoma (HNSCC). Between 1992 and 2005 127 patients (median age 55 years, UICC stage III n = 6, stage IV n = 121) with primarily inoperable, advanced HNSCC were treated with definite platinum-based radiochemotherapy (median dose 66.4 Gy). Analysed end-points were overall survival (OS), disease-free survival (DFS), loco-regional progression-free survival (LPFS), development of distant metastases (DM), prognostic factors and causes of death. The mean follow-up time was 34 months (range, 3-156 months), the 3-, 5- and 10-year OS rates were 39%, 28% and 14%, respectively. The median OS was 23 months. Forty-seven patients achieved a complete remission and 78 patients a partial remission. The median LPFS was 17 months, the 3-, 5- and 10-year LPFS rates were 41%, 33% and 30%, respectively. The LPFS was dependent on the nodal stage (p = 0.029). The median DFS was 11 months (range, 2-156 months), the 3-, 5- and 10-year DFS rates were 30%, 24% and 22%, respectively. Prognostic factors in univariate analyses were alcohol abuse (n = 102, p = 0.015), complete remission (n = 47, p < 0.001), local recurrence (n = 71, p < 0.001), development of DM (n = 45, p < 0.001; median OS 16 months) and borderline significance in nodal stage N2 versus N3 (p = 0.06). Median OS was 26 months with lung metastases (n = 17). Nodal stage was a predictive factor for the development of DM (p = 0.025). Cause of death was most commonly tumor progression. In stage IV HNSCC long-term survival is rare and DM is a significant predictor for mortality. If patients developed DM, lung metastases had the most favourable prognosis, so intensified palliative treatment might be justified in DM limited to the lungs

  11. Influence of low-dose daily cisplatin on the distant metastasis-free survival of patients with locally advanced nonmetastatic head and neck cancer treated with radiation therapy

    International Nuclear Information System (INIS)

    Jeremic, Branislav; Milicic, Biljana

    2008-01-01

    We investigated the impact of low dose daily cisplatin on distant metastasis-free survival (DMFS) in locally advanced head and neck cancer treated with hyperfractionated radiotherapy (77 Gy in 70 fractions in 35 treatment days). In locally controlled tumors cisplatin led to better DMFS (p = 0.0272); Cisplatin may have acted independently of micrometastasis in locally advanced H and N cancer

  12. Usability of advanced pneumatic compression to treat cancer-related head and neck lymphedema: A feasibility study.

    Science.gov (United States)

    Mayrovitz, Harvey N; Ryan, Shelly; Hartman, James M

    2018-01-01

    This functional usability study assessed ease of use, fit, comfort, and potential clinical benefits of advanced pneumatic compression treatment of cancer-related head and neck lymphedema. Patient-reported comfort and other treatment aspects were evaluated and multiple face and neck measurements were obtained on 44 patients with head and neck lymphedema before and after 1 treatment session to assess usability and treatment-related lymphedema changes. A majority of the patients (82%) reported the treatment was comfortable; most patients (61%) reported feeling better after treatment, and 93% reported that they would be likely to use this therapy at home. One treatment produced overall small but highly statistically significant reductions in composite metrics (mean ± SD) of the face (82.5 ± 4.3 cm vs 80.9 ± 4.1 cm; P < .001) and neck (120.4 ± 12.2 cm vs 119.2 ± 12.1 cm; P < .001) with no adverse events. Results found the treatment to be safe, easy to use, and well tolerated while demonstrating edema reduction after a single initial treatment. © 2017 The Authors Head & Neck Published by Wiley Periodicals, Inc.

  13. Cetuximab And The Head And Neck Squamous Cell Cancer.

    Science.gov (United States)

    Concu, Riccardo; Cordeiro, Maria Natalia Dias Soeiro

    2018-01-12

    The head and neck squamous cell cancer (HNSCC) is the most common type of head and neck cancer (more than 90%), and all over the world more than a half million people have been developing this cancer in the last years. This type of cancer is usually marked by a poor prognosis with a really significant morbidity and mortality. Cetuximab received early favor as an exciting and promising new therapy with relatively mild side effect, and due to this received authorization in the 2004 from the European Medicines Agency (EMA) and in the 2006 from the Food and Drug Association (FDA) for the treatment of patients with squamous cell cancer of the head and neck in combination with radiation therapy for locally advanced disease. In this work we will review the application and the efficacy of the Cetuximab in the treatment of the HNSCC. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  14. Skin Cancer of the Head and Neck

    OpenAIRE

    Ouyang, Yun-Hsuan

    2010-01-01

    The majority of skin cancers of the head and neck are nonmelanoma skin cancers (NMSC). Basal cell carcinoma and squamous cell carcinoma are the most frequent types of NMSC. Malignant melanoma is an aggressive neoplasm of skin, and the ideal adjuvant therapy has not yet been found, although various options for treatment of skin cancer are available to the patient and physician, allowing high cure rate and excellent functional and cosmetic outcomes. Sunscreen protection and early evaluation of ...

  15. Preliminary results using twice-a-day fractionation in the radiotherapeutic management of advanced cancers of the head and neck

    International Nuclear Information System (INIS)

    Jampolis, S.; Pipard, G.; Horiot, J.C.; Bolla, M.; Le Dorze, C.

    1977-01-01

    Twenty-four cases of advanced T4 cancers of the head and neck were treated using a twice-a-day treatment fractionation delivering a 1,200 rad weekly tumor dose and 7,000 rad total tumor dose in 5 1 / 2 to 6 weeks. Acute normal mucosal reactions and skin reactions were plotted weekly and corresponded to reactions observed when delivering 1,000 rad per week in five treatment sessions. Chronic problems have been limited to severe neck fibrosis appearing in three of five patients who underwent a planned neck dissection 6 weeks after the completion of radiotherapy. Local control was observed in 14 of 23 patients (61%) and regional control in 22 of 23 patients

  16. A phase II study using vinorelbine and continuous 5-fluorouracil in patients with advanced head and neck cancer

    DEFF Research Database (Denmark)

    Larsen, Susanne; Serup-Hansen, Eva; Andersen, Lisbeth J

    2007-01-01

    Seventy patients with advanced head and neck cancer were treated with vinorelbine and continuous 5-FU administered in a central venous catheter. Over all response was 36% with 9% complete responses. The most common grade 3 and 4 toxicities were stomatitis (13), infection (5), pain related...... to vinorelbine infusion (4), skin toxicity (3). Thirty one patients had grade 3 or 4 leukopenia. Treatment was complicated by venous thrombosis in the central venous catheter in one case. A majority of patients experienced dose reduction of one or both drugs or treatment delays due to toxicity. Median time...... to progression was 4.7 months and overall median survival 6.6 months. We conclude that the regimen is feasible and tolerated with moderate toxicity. Response rates and time to progression are comparable to other studies with multi agent treatment...

  17. Concurrent platinum-based chemotherapy and hyperfractionated radiotherapy with late intensification in advanced head and neck cancer

    International Nuclear Information System (INIS)

    Glicksman, Arvin S.; Wanebo, Harold J.; Slotman, Gus; Liu Li; Landmann, Christine; Clark, Jeffrey; Zhu, Timothy C.; Lohri, Andreas; Probst, Rudolf

    1997-01-01

    months), disease-specific survival is 63%. The actuarial survival for all patients is 51%. Patients with pathological CR after initial treatment have disease specific survival of 73% at 4 years vs. 48% of patients with partial response (PR) only. Conclusion: This study, developed on the basis of radiobiological and cell kinetic precepts, produced results that compare favorably with other reports of management of patients with advanced head and neck cancer. In comparison with our previous study, these results are comparable, not impressively better. The associated morbidity was somewhat worse

  18. Lhermitte's Sign Developing after IMRT for Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Dong C. Lim

    2010-01-01

    Full Text Available Background. Lhermitte's sign (LS is a benign form of myelopathy with neck flexion producing an unpleasant electric-shock sensation radiating down the extremities. Although rare, it can occur after head and neck radiotherapy. Results. We report a case of Lhermitte's developing after curative intensity-modulated radiotherapy (IMRT for a patient with locoregionally advanced oropharyngeal cancer. IMRT delivers a conformal dose of radiation in head and neck cancer resulting in a gradient of radiation dose throughout the spinal cord. Using IMRT, more dose is delivered to the anterior spinal cord than the posterior cord. Conclusions. Lhermitte's sign can develop after IMRT for head and neck cancer. We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.

  19. Randomized phase III trial of concurrent chemoradiotherapy vs accelerated hyperfractionation radiotherapy in locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Chitapanarux, Imjai; Kamnerdsupaphon, Pimkhuan; Pukanhapan, Nantaka; Tharavichitkul, Ekkasit; Vongtama, Roy

    2013-01-01

    The aim of this study was to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) vs accelerated hyperfractionation with concomitant boost (CCB) as a primary treatment for patients with Stage III-IV squamous cell carcinoma of head and neck (SCCHN). A total of 85 non-metastatic advanced SCCHN patients were accrued from January 2003 to December 2007. Of these, 48 and 37 patients received CCRT and CCB, respectively. The patients were randomized to receive either three cycles of carboplatin and 5-fluorouracil plus conventional radiotherapy (CCRT, 66 Gy in 6.5 weeks) or hybrid accelerated radiotherapy (CCB, 70 Gy in 6 weeks). The primary endpoint was determined by locoregional control rate. The secondary endpoints were overall survival and toxicity. With a median follow-up of 43 months (range, 3-102), the 5-year locoregional control rate was 69.6% in the CCRT arm vs 55.0% in the CCB arm (P = 0.184). The 5-year overall survival rate was marginally significantly different (P = 0.05): 76.1% in the CCRT arm vs 63.5% in the CCB arm. Radiotherapy treatment interruptions of more than three days were 60.4% and 40.5% in the CCRT arm and CCB arm, respectively. The median total treatment time was 55.5 days in the CCRT arm and 49 days in the CCB arm. The rate of Grade 3 - 4 acute mucositis was significantly higher in the CCB arm (67.6% vs 41.7%, P = 0.01), but no high grade hematologic toxicities were found in the CCB arm (27.2% vs 0%). CCRT has shown a trend of improving outcome over CCB irradiation in locoregionally advanced head and neck cancer. (author)

  20. Low skeletal muscle mass is a predictive factor for chemotherapy dose-limiting toxicity in patients with locally advanced head and neck cancer

    NARCIS (Netherlands)

    Wendrich, Anne W; Swartz, Justin E; Bril, Sandra I; Wegner, Inge; de Graeff, Alexander; Smid, Ernst J; de Bree, Remco; Pothen, Ajit J

    OBJECTIVES: Low skeletal muscle mass (SMM) or sarcopenia is emerging as an adverse prognostic factor for chemotherapy dose-limiting toxicity (CLDT) and survival in cancer patients. Our aim was to determine the impact of low SMM on CDLT in patients with locally advanced head and neck squamous cell

  1. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises

    NARCIS (Netherlands)

    Kraaijenga, Sophie A. C.; van der Molen, Lisette; Jacobi, Irene; Hamming-Vrieze, Olga; Hilgers, Frans J. M.; van den Brekel, Michiel W. M.

    2015-01-01

    Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in

  2. A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

    NARCIS (Netherlands)

    Retel, Valesca; Retèl, Valesca P.; van der Molen, Lisette; Hilgers, Frans J.M.; Rasch, Coen R.N.; l'Ortye, Annemiek A.A.M.H.J.; Steuten, Lotte Maria Gertruda; van Harten, Willem H.

    2011-01-01

    In recent years, concomitant chemo-radiotherapy (CCRT) has become an indispensable organ preserving treatment modality for advanced head and neck cancer, improving local control and overall survival in several anatomical sites [1]. Unfortunately, CCRT can have a detrimental effect on many functions

  3. A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

    NARCIS (Netherlands)

    Retèl, Valesca P.; van der Molen, Lisette; Hilgers, Frans J.M.; Rasch, Coen R.N.; l'Ortye, Annemiek A.A.M.H.J.; Steuten, Lotte M.G.; van Harten, Wim H.

    2011-01-01

    Background: Concomitant chemo-radiotherapy (CCRT) has become an indispensable organ, but not always function preserving treatment modality for advanced head and neck cancer. To prevent/limit the functional side effects of CCRT, special exercise programs are increasingly explored. This study presents

  4. Cancer of the head and neck

    International Nuclear Information System (INIS)

    Leignel, D.; Toledano, A.; Calais, G.; Gardner, M.; Valinta, D.; Halimi, P.; Alberini, J.L.; Plantet, M.M.; Banal, A.; Hans, S.; Floiras, J.L.; Labib, A.; Djemaa, A.; Naoun, L.; Bali, M.; Melais, K.; George, L.; Cazalet, M.; Gross, E.; Padovani, L.; Cowen, D.; Pignon, T.; Bannour, N.; Guedouar, R.; Bouaouina, N.; Mege, A.; Lapeyre, M.; Graff, P.; Marchesi, V.; Aletti, P.; Marchal, C.; Peiffert, D.; Serre, A.; Ailleres, N.; Lemanski, C.; Hay, M.H.; Llacer Moscardo, C.; Allaw, A.; Azria, D.; Dubois, J.B.; Fenoglietto, P.; Maalej, M.; Nasr, C.; Chaari, N.; Hentati, D.; Kochbati, L.; Besbes, M.; Benjelloun, H.; Benchakroun, N.; Houjami, M.; Jouhadi, H.; Tawfiq, N.; Acharki, A.; Sahraoui, S.; Benider, A.; Racadot, S.; Mercier, M.; Dessard-Diana, B.; Bensadoun, R.J.; Martin, M.; Malaurie, E.; Favrel, V.; Housset, M.; Journel, C.; Calais, G.; Huet, J.; Pillet, G.; Hennequin, C.; Haddad, E.; Diana, C.; Blaska-Jaulerry, B.; Henry-Amar, M.; Gehanno, P.; Baillet, F.; Mazeron, J.J.; Chaouache, C.K.; Tebra Mrad, T.M.S.; Bannour, B.N.S.; Bouaouina, B.N.; Favrel, V.; Khodri, M.; Chapet, O.; Nguyen, D.; Ardiet, J.; Romestaing, P.; Thillays, F.; Bardet, E.; Rolland, F.; Maingan, P.; Campion, L.; Mahe, M.A.

    2005-01-01

    Thirteen articles are presented in relation with head and neck cancer. Chemoradiotherapy, medical examinations using nuclear techniques such PET scanning, fractionated radiotherapy after a chemotherapy, analysis of dose volume for patients treated by irradiation with a combined chemotherapy, dosimetry, conformal radiotherapy with intensity modulation, dosimetry in brachytherapy, association of radiotherapy and chemotherapy in the treatment of nose pharynx carcinomas, recurrence, are the different subjects treated in this part. (N.C.)

  5. Superselective intra-arterial chemoradiotherapy for advanced head and neck cancers. Evaluation of preservation of organ function

    International Nuclear Information System (INIS)

    Akisada, Takeshi; Harada, Tamotsu; Imai, Shigeki; Gyoten, Masayuki; Hiraoka, Takashi

    2008-01-01

    The objective of this study was to evaluate preservation of organ function in the treatment of superselective intra-arterial chemoradiotherapy for advanced head and neck cancers. Among 96 patients receiving concomitant radiation and intra-arterial docetaxel, systemic cisplatin and 5-fluorouracil (FU) chemotherapy, we identified laryngeal preservation rate, studied tracheostomy cases and gastrostomy cases, and evaluated videofluoroscopic examination and videoendoscopy. Laryngeal preservation rate of hypopharyngeal cancer is very high at 96.2%, and that of laryngeal cancer is high at 71.4%. Videofluoroscopic examination revealed improved swallowing function in 2 of 12, no change in 3, slightly worse in 5, and worse in 2 patients. Following treatment, the incidence of aspiration increased to 4 patients. Videoendoscopy revealed residual vallecula in a few cases. Only 7 patients (7.3%) required a tracheostomy and 4 patients (4.2%) required a gastrostomy. Most of the patients are able to swallow after chemoradiation. Our new chemoradiation protocol is as good as other treatment modalities for maintaining organ preservation and function. (author)

  6. Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer

    International Nuclear Information System (INIS)

    Ang, K. Kian; Trotti, Andy; Brown, Barry W.; Garden, Adam S.; Foote, Robert L.; Morrison, William H.; Geara, Fady B.; Klotch, Douglas W.; Goepfert, Helmuth; Peters, Lester J.

    2001-01-01

    , PORT in patients with advanced head-and-neck squamous cell cancer in a prospective, multi-institutional setting. It also revealed the impact of the overall treatment time in the combination of surgery and PORT on the outcome in high-risk patients and showed that PORT acceleration without a reduction in dose by a concomitant boost regimen did not increase the late complication rate. These findings emphasize the importance of coordinated interdisciplinary care in the delivery of combined surgery and RT

  7. The potential for tumor suppressor gene therapy in head and neck cancer.

    Science.gov (United States)

    Birkeland, Andrew C; Ludwig, Megan L; Spector, Matthew E; Brenner, J Chad

    2016-01-01

    Head and neck squamous cell carcinoma remains a highly morbid and fatal disease. Importantly, genomic sequencing of head and neck cancers has identified frequent mutations in tumor suppressor genes. While targeted therapeutics increasingly are being investigated in head and neck cancer, the majority of these agents are against overactive/overexpressed oncogenes. Therapy to restore lost tumor suppressor gene function remains a key and under-addressed niche in trials for head and neck cancer. Recent advances in gene editing have captured the interest of both the scientific community and the public. As our technology for gene editing and gene expression modulation improves, addressing lost tumor suppressor gene function in head and neck cancers is becoming a reality. This review will summarize new techniques, challenges to implementation, future directions, and ethical ramifications of gene therapy in head and neck cancer.

  8. Modified Weekly Cisplatin-Based Chemotherapy Is Acceptable in Postoperative Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Cancer

    Science.gov (United States)

    Lu, Hsueh-Ju; Yang, Chao-Chun; Wang, Ling-Wei; Chu, Pen-Yuan; Tai, Shyh-Kuan; Chen, Ming-Huang; Yang, Muh-Hwa; Chang, Peter Mu-Hsin

    2015-01-01

    Background. Triweekly cisplatin-based postoperative concurrent chemoradiotherapy (CCRT) has high intolerance and toxicities in locally advanced head and neck cancer (LAHNC). We evaluated the effect of a modified weekly cisplatin-based chemotherapy in postoperative CCRT. Methods. A total of 117 patients with LAHNC were enrolled between December 2007 and December 2012. Survival, compliance/adverse events, and independent prognostic factors were analyzed. Results. Median follow-up time was 30.0 (3.1–73.0) months. Most patients completed the entire course of postoperative CCRT (radiotherapy ≥ 60 Gy, 94.9%; ≥6 times weekly chemotherapy, 75.2%). Only 17.1% patients required hospital admission. The most common adverse effect was grade 3/4 mucositis (28.2%). No patient died due to protocol-related adverse effects. Multivariate analysis revealed the following independent prognostic factors: oropharyngeal cancer, extracapsular spread, and total radiation dose. Two-year progression-free survival and overall survival rates were 70.9% and 79.5%, respectively. Conclusion. Modified weekly cisplatin-based chemotherapy is an acceptable regimen in postoperative CCRT for LAHNC. PMID:25793192

  9. Modified Weekly Cisplatin-Based Chemotherapy Is Acceptable in Postoperative Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Hsueh-Ju Lu

    2015-01-01

    Full Text Available Background. Triweekly cisplatin-based postoperative concurrent chemoradiotherapy (CCRT has high intolerance and toxicities in locally advanced head and neck cancer (LAHNC. We evaluated the effect of a modified weekly cisplatin-based chemotherapy in postoperative CCRT. Methods. A total of 117 patients with LAHNC were enrolled between December 2007 and December 2012. Survival, compliance/adverse events, and independent prognostic factors were analyzed. Results. Median follow-up time was 30.0 (3.1–73.0 months. Most patients completed the entire course of postoperative CCRT (radiotherapy ≥ 60 Gy, 94.9%; ≥6 times weekly chemotherapy, 75.2%. Only 17.1% patients required hospital admission. The most common adverse effect was grade 3/4 mucositis (28.2%. No patient died due to protocol-related adverse effects. Multivariate analysis revealed the following independent prognostic factors: oropharyngeal cancer, extracapsular spread, and total radiation dose. Two-year progression-free survival and overall survival rates were 70.9% and 79.5%, respectively. Conclusion. Modified weekly cisplatin-based chemotherapy is an acceptable regimen in postoperative CCRT for LAHNC.

  10. Preoperative hyperfractionated accelerated radiotherapy and radical surgery in advanced head and neck cancer: A prospective phase II study

    International Nuclear Information System (INIS)

    Lindholm, Paula; Valavaara, Ritva; Aitasalo, Kalle; Kulmala, Jarmo; Laine, Juhani; Elomaa, Liisa; Sillanmaeki, Lauri; Minn, Heikki; Grenman, Reidar

    2006-01-01

    Background and purpose: To evaluate whether preoperative hyperfractionated accelerated radiotherapy (RT) combined with major radical surgery is feasible and successful in the treatment of advanced primary head and neck cancer. Patients and methods: Ninety four patients with histologically confirmed head and neck squamous cell cancer (HNSCC) in the oral cavity (41/96; 43%), supraglottis (14/96; 15%), glottis (5/96; 5%), oropharynx (16/96; 17%), nasal cavity/paranasal sinuses (8/96; 8%), nasopharynx (3/96; 3%), hypopharynx (7/96; 7%) and two (2%) with unknown primary tumour and large cervical lymph nodes entered into the study. 21/96 patients (22%) had stage II, 17/96 (18%) stage III and 58/96 patients (60%) stage IV disease. The patients received preoperative hyperfractionated RT 1.6 Gy twice a day, 5 days a week to a median tumour dose of 63 Gy with a planned break for 11 days (median) after the median dose of 37 Gy. Then, after a median of 27 days the patients underwent major radical surgery of the primary tumour and metastatic lymph nodes including reconstructions with pedicled or microvascular free flaps when indicated as a part of the scheduled therapy. 12/96 patients had only ipsilateral or bilateral neck dissections. Results: After a median follow-up time of 37.2 mos 77/96 (80.2%) patients had complete locoregional control. All but 2 patients had complete histological remission after surgery. 40/96 pts were alive without disease, two of them after salvage surgery. 32/96 patients had relapsed; 15 had locoregional and 13 distant relapses, 4 patients relapsed both locoregionally and distantly. Fifty patients have died; 29 with locoregional and/or distant relapse, eight patients died of second malignancy, and 19 had intercurrent diseases. Disease-specific and overall survival at 3 years was 67.7 and 51%, respectively. Acute grade three mucosal reactions were common, but transient and tolerable. Late grade 3-4 adverse effects were few. Conclusions: Preoperative

  11. Palliative radiotherapy in head and neck cancers: Evidence based review

    Directory of Open Access Journals (Sweden)

    Talapatra Kaustav

    2006-01-01

    Full Text Available Squamous cell carcinoma of head and neck (SCCHN is one of the commonest cancers seen in India, constituting up to 25% of their overall cancer burden. Advanced SCCHN is a bad disease with a poor prognosis and patients usually die of uncontrolled loco-regional disease. Curative intent management of loco-regionally advanced SCCHN has become more evidence-based with active clinical research in the form of large prospective randomized controlled trials and meta-analyses. However, little has been written about palliative radiotherapy (PRT in head and neck cancers. It is widely recognized that PRT provides effective palliation and improved quality-of-life in advanced incurable malignancies. It is in this context that this study proposes to review the existing literature on palliative radiotherapy in advanced incurable SCCHN to help formulate consensus guidelines and recommendations.

  12. Cisplatin-Based Chemotherapy versus Cetuximab in Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Ming-Hung Hu

    2014-01-01

    Full Text Available Background and Purpose. This study aimed to analyze survival, clinical responses, compliance, and adverse effects in locally advanced head and neck cancer (LAHNC patients treated with split-dose cisplatin-based concurrent chemoradiation therapy (SD-CCRT or cetuximab with concurrent radiation therapy (BioRT. Materials and Methods. We retrospectively evaluated 170 LAHNC patients diagnosed between January 1, 2009, and July 31, 2012: 116 received CCRT and 54 received BioRT. Results. Complete response rates were similar in the SD-CCRT and BioRT groups (63.8% versus 59.3%; P=0.807, and locoregional relapse rates were 18.1% and 13.0%, respectively (P=0.400. The 3-year relapse-free survival rate was 65.8% in the SD-CCRT group and 65.5% in the BioRT group, respectively (P=0.647. The 3-year overall survival rate was 78.5% in the SD-CCRT group and 70.9% in the BioRT group, respectively (P=0.879. Hematologic side effects were significantly more frequent in the SD-CCRT than in the BioRT group. Mucositis frequency was similar. Conclusions. Primary SD-CCRT and BioRT both showed good clinical response and survival. Hematologic toxicities were more frequent, but tolerable, in the SD-CCRT group. Both groups showed good compliance.

  13. Cisplatin-Based Chemotherapy versus Cetuximab in Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Cancer Treatment

    Science.gov (United States)

    Hu, Ming-Hung; Wang, Ling-Wei; Lu, Hsueh-Ju; Chu, Pen-Yuan; Tai, Shyh-Kuan; Lee, Tsung-Lun; Chen, Ming-Huang; Yang, Muh-Hwa; Chang, Peter Mu-Hsin

    2014-01-01

    Background and Purpose. This study aimed to analyze survival, clinical responses, compliance, and adverse effects in locally advanced head and neck cancer (LAHNC) patients treated with split-dose cisplatin-based concurrent chemoradiation therapy (SD-CCRT) or cetuximab with concurrent radiation therapy (BioRT). Materials and Methods. We retrospectively evaluated 170 LAHNC patients diagnosed between January 1, 2009, and July 31, 2012: 116 received CCRT and 54 received BioRT. Results. Complete response rates were similar in the SD-CCRT and BioRT groups (63.8% versus 59.3%; P = 0.807), and locoregional relapse rates were 18.1% and 13.0%, respectively (P = 0.400). The 3-year relapse-free survival rate was 65.8% in the SD-CCRT group and 65.5% in the BioRT group, respectively (P = 0.647). The 3-year overall survival rate was 78.5% in the SD-CCRT group and 70.9% in the BioRT group, respectively (P = 0.879). Hematologic side effects were significantly more frequent in the SD-CCRT than in the BioRT group. Mucositis frequency was similar. Conclusions. Primary SD-CCRT and BioRT both showed good clinical response and survival. Hematologic toxicities were more frequent, but tolerable, in the SD-CCRT group. Both groups showed good compliance. PMID:25110705

  14. Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views

    Directory of Open Access Journals (Sweden)

    Rasch Coen RN

    2009-11-01

    Full Text Available Abstract Background Aim of this study is to thoroughly assess pretreatment organ function in advanced head and neck cancer through various clinical outcome measures and patients' views. Methods A comprehensive, multidimensional assessment was used, that included quality of life, swallowing, mouth opening, and weight changes. Fifty-five patients with stage III-IV disease were entered in this study prior to organ preserving (chemoradiation treatment. Results All patients showed pretreatment abnormalities or problems, identified by one or more of the outcome measures. Most frequent problems concerned swallowing, pain, and weight loss. Interestingly, clinical outcome measures and patients' perception did no always concur. E.g. videofluoroscopy identified aspiration and laryngeal penetration in 18% of the patients, whereas only 7 patients (13% perceived this as problematic; only 2 out of 7 patients with objective trismus actually perceived trismus. Conclusion The assessment identified several problems already pre-treatment, in this patient population. A thorough assessment of both clinical measures and patients' views appears to be necessary to gain insight in all (perceived pre-existing functional and quality of life problems.

  15. Advanced and rapidly progressing head and neck cancer: good palliation following intralesional bleomycin.

    LENUS (Irish Health Repository)

    Quintyne, Keith Ian

    2011-09-01

    The authors herein report the case of a 61-year-old man undergoing adjuvant therapy for locally advanced laryngeal cancer, who developed parastomal recurrence in his radiation field around his tracheotomy site, while he was undergoing radiation therapy, and compromised the secure placement of his tracheotomy tube and maintenance of his upper airway. MRI restaging and biopsy confirmed recurrence and progressive disease in his mediastinum. He underwent local therapy with intralesional bleomycin with good palliation, and ability to maintain the patency of his upper airway.

  16. Photodynamic therapy in head and neck cancer

    Directory of Open Access Journals (Sweden)

    Kamil H Nelke

    2014-02-01

    Full Text Available Photodynamic therapy (PDT is a special type of treatment involving the use of a photosensitizer or a photosensitizing agent along with a special type of light, which, combined together, induces production of a form of oxygen that is used to kill surrounding cells in different areas of the human body. Specification of the head and neck region requires different approaches due to the surrounding of vital structures. PDT can also be used to treat cells invaded with infections such as fungi, bacteria and viruses. The light beam placed in tumor sites activates locally applied drugs and kills the cancer cells. Many studies are taking place in order to invent better photosensitizers, working on a larger scale and to treat deeply placed and larger tumors. It seems that PDT could be used as an alternative surgical treatment in some tumor types; however, all clinicians should be aware that the surgical approach is still the treatment of choice. PDT is a very accurate and effective therapy, especially in early stages of head and neck squamous cell carcinomas (HNSCC, and can greatly affect surgical outcomes in cancerous patients. We present a detailed review about photosensitizers, their use, and therapeutic advantages and disadvantages.

  17. Treatment of Pediatric Head and Neck Cancer - Health Professional Version

    Science.gov (United States)

    Find information about prognosis, staging, and treatment for the following head and neck cancer sites in children: esthesioneuroblastoma, larynx and papillomatosis, nasopharynx, oral cavity, and salivary gland.

  18. Symptom burden and quality of life in advanced head and neck cancer patients: AIIMS study of 100 patients

    Directory of Open Access Journals (Sweden)

    Ajeet Kumar Gandhi

    2014-01-01

    Full Text Available Aim: Head and neck cancers (HNCa are the most common cancers among males in India and 70-80% present in advanced stage. The study aims to assess symptom burden and quality of life (QOL in advanced incurable HNCa patients at presentation. Materials and Methods: One hundred patients were asked to fill EORTC QLQ-C15-PAL questionnaire, which consisted of Global QOL, physical functioning (PF, emotional functioning (EF, fatigue (FA, nausea-vomiting (NV, pain (PA, dyspnea (DY, sleep (SL, appetite (AP, and constipation (CO. Additional questions pertaining to swallowing (SW, hoarseness (HO, cough (CG, weight loss (WL, using pain killers (PK, taste (TA, bleeding (BL, hearing (HE, pain in neck lump (PALMP, opening mouth (OM, and oral secretions (OS were asked based on a modified EORTC-HN35 questionnaire. Scoring was according to EORTC scoring manual. Mean, median and range were calculated for each item for the entire cohort. Results: The female:male ratio was 17:83.42% of them were ≥60 years of age. Sixty-six patients had T4, 25 had T3, 36 had N2, and 33 had N3 disease. Median QOL was 50 (range 0-83.33 and PF was 77.78 (0-100. Median score for EF and FA was 50. Median score for PA, PK, and SL was 66.67 while that for AP was 33.33. Median value for SW, HO, WL, BL, PALMP, OM, and OS was 33.33 (100-0 while TA, CG, NV, DY, and HE had a median score of 0.00. Conclusion: Advanced HNCa has a significant burden of symptoms. These results would help in giving patients better symptom directed therapies and improve their QOL.

  19. Radiochemotherapy With Cetuximab, Cisplatin, and Amifostine for Locally Advanced Head and Neck Cancer: A Feasibility Study

    International Nuclear Information System (INIS)

    Koukourakis, Michael I.; Tsoutsou, Pelagia G.; Karpouzis, Antonios; Tsiarkatsi, Maria; Karapantzos, Ilias; Daniilidis, Vassilios; Kouskoukis, Constantinos

    2010-01-01

    Purpose: Radiotherapy (RT) combined with cisplatin or cetuximab is the standard of care for patients with locally advanced head/neck cancer (LA-HNC). The feasibility of radiochemotherapy with cisplatin and cetuximab, supported with amifostine, was herein investigated. Methods and Materials: Forty-three patients with LA-HNC were recruited. Conformal hypofractionated/accelerated RT with amifostine cytoprotection (2.7 Gy/fraction, 21 fractions in 4 weeks) was combined with cisplatin (30 mg/m 2 /week) and cetuximab (standard weekly regimen) therapy. The dose of amifostine was individualized according to tolerance. Results: A high daily amifostine dose (750-1,000 mg) was tolerated by 41.8% of patients, and a standard dose (500 mg) was tolerated by 34.9% of patients. A high amifostine dose was linked to reduced RT delays (p = 0.0003). Grade 3 to 4 (3-4) mucositis occurred in 7/43 (16.2%) patients, and fungal infections occurred in 18/43 (41.8%) patients. Radiation dermatitis was not aggravated. Interruption of cetuximab due to acneiform rash was necessary in 23.3% of patients, while amifostine-related fever and rash were not observed. Severe late radiation sequelae consisted of laryngeal edema (9% laryngeal cases) and cervical strictures (33% of hypopharyngeal cases). Good salivary function was preserved in 6/11 (54.5%) nasopharyngeal cancer patients. The complete response rate was 68.5%, reaching 77.2% in patients with minor radiotherapy delays. The 24-month local control and survival rates were 72.3% and 91%, respectively (median follow-up was 13 months.). Conclusions: In this feasibility study, weekly administration of cisplatin and cetuximab was safely combined with accelerated RT, supported with amifostine, at the cost of a high incidence of acneiform rash but a reduced incidence of amifostine-related fever/rash. A high daily dose of amifostine allows completion of therapy with minor delays.

  20. 50 Facts about Oral, Head and Neck Cancer

    Science.gov (United States)

    ... Marketplace Find an ENT Doctor Near You 50 Facts about Oral, Head and Neck Cancer 50 Facts about Oral, Head and Neck Cancer Patient Health ... cancer has increased in all races and both sexes. Thyroid cancers account for ... who work in environments with dust, glues, formaldehyde, mustard gas, ...

  1. Fractionation schedules for cancers of the head and neck

    International Nuclear Information System (INIS)

    Harari, Paul M.

    1995-01-01

    Purpose/Objective: This refresher course reviews current research activity and treatment results in the field of radiation therapy fractionation. The presentation emphasizes worldwide studies of altered fractionation, highlighting head and neck cancer as the primary teaching model. Basic radiobiological principles guiding the development of altered fractionation regimens, and advancing the understanding of fractionation effects on normal and tumor tissue are reviewed. A 'standard' prescription of 2 Gy x 35 fractions = 70 Gy may not provide the optimal balance between primary tumor control and late normal tissue effects for all patients with squamous cell carcinoma of the head and neck. The last decade has witnessed the treatment of thousands of head and neck cancer patients with curative radiotherapy using altered fractination schedules designed to improve overall treatment results. Although the number of different fractionation regimens currently being investigated continues to increase, the common guiding principles behind their design are relatively simple. Common fractionation terminology (i.e., accelerated hyperfractionation) will be reviewed, as well as a brief summary of radiobiological concepts pertaining to tumor potential doubling time, tumor proliferation kinetics, overall treatment time and fraction size-dependence of acute and late tissue effects. Several well known head and neck fractionation schedules from around the world (Manchester Christie Hospital-United Kingdom, Princess Margaret Hospital-Canada, Massachusetts General Hospital-USA, MD Anderson Hospital-USA, University of Florida-USA, Mount Vernon Hospital CHART-United Kingdom, RTOG and EORTC trials-USA and Europe) will be summarized with regard to design-rationale, treatment technique and results. The design of several current cooperative group trials investigating altered head and neck fractionation will be presented, as well as concepts prompting the pilot evaluation of several brand new

  2. Enteral Feeding During Chemoradiotherapy for Advanced Head-and-Neck Cancer: A Single-Institution Experience Using a Reactive Approach

    International Nuclear Information System (INIS)

    Clavel, Sebastien; Fortin, Bernard; Despres, Philippe; Donath, David; Soulieres, Denis; Khaouam, Nader; Charpentier, Danielle; Belair, Manon; Guertin, Louis; Nguyen-Tan, Phuc Felix

    2011-01-01

    Purpose: The optimal method for providing enteral nutrition to patients with head-and-neck cancer is unclear. The purpose of the present study was to evaluate the safety and efficacy of our reactive policy, which consists of the installation of a nasogastric (NG) feeding tube only when required by the patient's nutritional status. Methods and Materials: The records of all patients with Stage III and IV head-and-neck cancer treated with concomitant chemotherapy and radiotherapy between January 2003 and December 2006 were reviewed. The overall and disease-free survival rates were estimated using the Kaplan-Meier method and compared with the log-rank test. Results: The present study included 253 patients, and the median follow-up was 33 months. At 3 years, the estimated overall survival and disease-free survival rate was 82.8% and 77.8%, respectively, for the whole population. No survival difference was observed when the patients were compared according to the presence and absence of a NG tube or stratified by weight loss quartile. The mean weight loss during treatment for all patients was 10.4%. The proportion of patients requiring a NG tube was 49.8%, and the NG tube remained in place for a median duration of 40 days. No major complications were associated with NG tube installation. Only 3% of the patients were still dependent on enteral feeding at 6 months. Conclusion: These results suggest that the use of a reactive NG tube with an interdisciplinary team approach is a safe and effective method to manage malnutrition in patients treated with concomitant chemotherapy and radiotherapy for head-and-neck cancer.

  3. Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Nguyen, N.P.; Chi, A.; Vock, J.

    2012-01-01

    Purpose: In this work, the treatment tolerance of elderly patients (≥ 70 years) undergoing intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) and chemotherapy for locally advanced head and neck cancer was assessed. Patients and methods: A retrospective review of 112 patients undergoing concurrent chemoradiation for locally advanced head and neck cancer was performed. Treatment toxicity, protocol violations, long-term complications, and survival were compared between 85 younger patients (< 70 years) and 27 older patients (≥ 70 years). Results: Grade 3-4 treatment toxicity was observed in 88.2% and 88.8% for younger and older patients, respectively. Mean weight loss and treatment break were 5.9 and 3.9 kg (p = 0.03) and 7.3 and 7.8 days (p = 0.8) for younger and older patients, respectively. Seven patients (8.2%) did not complete treatment in the younger group compared to 1 patient (3.7%) in the older group (p = 0.6). No significant differences in protocol violations and survival were found between the two groups. Conclusion: Compared to younger patients, elderly patients with locally advanced head and neck cancer tolerated chemoradiation with IMRT and IGRT well, and should not be denied curative treatment based solely on age. (orig.)

  4. End-stage head and neck cancer coping mechanisms

    Directory of Open Access Journals (Sweden)

    Bogdan Popescu

    2017-10-01

    Full Text Available Coping mechanisms are patients’ means of adapting to stressful situations and involve psychological and physical changes in behavior. Patients adapt to head and neck cancer in a variety of ways. Head and neck cancers are extremely debilitating, especially in advanced stages of the disease or in end-of-life situations. While an oncology team needs to address the needs of all oncology patients, the advanced terminal patients require special attention. Most of these patients do not cope well with their situation and have a tendency to cease social interactions. Pain is the most frequentlyexperienced medical disability in patients having an end-stage illness experience, and thus an important medical endeavor is to afford dignity to the dying patient facingan incurable disease. In such cases, the medical community should never refuse therapy or to assist a dying patient.In some instances, the patient and family may derive benefit from their religious beliefs.

  5. Clinical Value of High Mobility Group Box 1 and the Receptor for Advanced Glycation End-products in Head and Neck Cancer: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Nguyen, Austin

    2016-04-01

    Full Text Available Introduction High mobility group box 1 is a versatile protein involved in gene transcription, extracellular signaling, and response to inflammation. Extracellularly, high mobility group box 1 binds to several receptors, notably the receptor for advanced glycation end-products. Expression of high mobility group box 1 and the receptor for advanced glycation end-products has been described in many cancers. Objectives To systematically review the available literature using PubMed and Web of Science to evaluate the clinical value of high mobility group box 1 and the receptor for advanced glycation end-products in head and neck squamous cell carcinomas. Data synthesis A total of eleven studies were included in this review. High mobility group box 1 overexpression is associated with poor prognosis and many clinical and pathological characteristics of head and neck squamous cell carcinomas patients. Additionally, the receptor for advanced glycation end-products demonstrates potential value as a clinical indicator of tumor angiogenesis and advanced staging. In diagnosis, high mobility group box 1 demonstrates low sensitivity. Conclusion High mobility group box 1 and the receptor for advanced glycation end-products are associated with clinical and pathological characteristics of head and neck squamous cell carcinomas. Further investigation of the prognostic and diagnostic value of these molecules is warranted.

  6. Is there room for combined modality treatments? Dosimetric comparison of boost strategies for advanced head and neck and prostate cancer

    International Nuclear Information System (INIS)

    Gora, Joanna; Hopfgartner, Johannes; Kuess, Peter; Paskeviciute, Brigita; Georg, Dietmar

    2013-01-01

    The purpose of the study was to determine the dosimetric difference between three emerging treatment modalities-volumetric-modulated arc therapy (VMAT), intensity-modulated proton beam therapy (IMPT) and intensity-modulated carbon ion beam therapy (IMIT)-for two tumour sites where selective boosting of the tumour is applied. For 10 patients with locally advanced head and neck (H and N) cancer and 10 with high-risk prostate cancer (PC) a VMAT plan was generated for PTV initial that included lymph node regions, delivering 50 Gy (IsoE) for H and N and 50.4 Gy (IsoE) for PC patients. Furthermore, separate boost plans (VMAT, IMPT and IMIT) were created to boost PTV boost up to 70 Gy (IsoE) and 78 Gy (IsoE) for H and N and PC cases, respectively. Doses to brainstem, myelon, larynx and parotid glands were assessed for H and N cases. Additionally, various organs at risk (OARs) (e.g. cochlea, middle ear, masticator space) were evaluated that are currently discussed with respect to quality of life after treatment. For PC cases, bladder, rectum and femoral heads were considered as OARs. For both tumour sites target goals were easily met. Looking at OAR sparing, generally VMAT + VMAT was worst. VMAT + IMIT had the potential to spare some structures in very close target vicinity (such as cochlea, middle ear, masticator space) significantly better than VMAT + IMPT. Mean doses for rectal and bladder wall were on average 4 Gy (IsoE) and 1.5 Gy (IsoE) higher, respectively, compared to photons plus particles scenarios. Similar results were found for parotid glands and larynx. Concerning target coverage, no significant differences were observed between the three treatment concepts. Clear dosimetric benefits were observed for particle beam therapy as boost modality. However, the clinical benefit of combined modality treatments remains to be demonstrated. (author)

  7. Irradiation with misonidazole and hyperbaric oxygen: final report on a randomized trial in advanced head and neck cancer

    International Nuclear Information System (INIS)

    Sealy, R.; Cridland, S.; Barry, L.; Norris, R.

    1986-01-01

    One hundred and thirty patients with locally advanced squamous carcinoma of the head and neck were treated in a prospective randomized trial to compare conventional irradiation (63.00 Gy in 30 fractions) with a combination sensitizer regimen of misonidazole and hyperbaric oxygen. The drug (2.0 gm/m2) was given with each of six fractions of 6.0 Gy in hyperbaric oxygen at 3 ATA. The results support a previous study and favor the combination at 1 year at better than the 10% level. This regimen could be useful for bulky primary or nodal disease

  8. Five versus ten fractions per week radiotherapy in locally advanced head and neck cancer

    Directory of Open Access Journals (Sweden)

    Ramanjis Viranna Tallari

    2017-01-01

    Conclusions: After induction chemotherapy, HFRT seems to be more efficacious than CFRT in locally advanced HNSCC, by increasing significantly the probability of progression-free survival and locoregional control.

  9. Differentiation of irradiation and cetuximab induced skin reactions in patients with locally advanced head and neck cancer undergoing radioimmunotherapy: the HICARE protocol (Head and neck cancer: ImmunoChemo and Radiotherapy with Erbitux) – a multicenter phase IV trial

    International Nuclear Information System (INIS)

    Habl, G; Potthoff, K; Haefner, MF; Abdollahi, A; Hassel, JC; Boller, E; Indorf, M; Debus, J

    2013-01-01

    In order to improve the clinical outcome of patients with locally advanced squamous cell carcinoma of the head and neck (LASCCHN) not being capable to receive platinum-based chemoradiation, radiotherapy can be intensified by addition of cetuximab, a monoclonal antibody that blocks the epidermal growth factor receptor (EGFR). The radioimmunotherapy with cetuximab is a feasible treatment option showing a favourable toxicity profile. The most frequent side effect of radiotherapy is radiation dermatitis, the most common side effect of treatment with cetuximab is acneiform rash. Incidence and severity of these frequent, often overlapping and sometimes limiting skin reactions, however, are not well explored. A clinical and molecular differentiation between radiogenic skin reactions and skin reactions caused by cetuximab which may correlate with outcome, have never been described before. The HICARE study is a national, multicenter, prospective phase IV study exploring the different types of skin reactions that occur in patients with LASCCHN undergoing radioimmun(chemo)therapy with the EGFR inhibitor cetuximab. 500 patients with LASCCHN will be enrolled in 40 participating sites in Germany. Primary endpoint is the rate of radiation dermatitis NCI CTCAE grade 3 and 4 (v. 4.02). Radioimmunotherapy will be applied according to SmPC, i.e. cetuximab will be administered as loading dose and then weekly during the radiotherapy. Irradiation will be applied as intensity-modulated radiation therapy (IMRT) or 3D-dimensional radiation therapy. The HICARE trial is expected to be one of the largest trials ever conducted in head and neck cancer patients. The goal of the HICARE trial is to differentiate skin reactions caused by radiation from those caused by the monoclonal antibody cetuximab, to evaluate the incidence and severity of these skin reactions and to correlate them with outcome parameters. Besides, the translational research program will help to identify and confirm novel

  10. Long-Term Outcomes and Toxicity of Concurrent Paclitaxel and Radiotherapy for Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Citrin, Deborah; Mansueti, John; Likhacheva, Anna; Sciuto, Linda; Albert, Paul S.; Rudy, Susan F.; Cooley-Zgela, Theresa; Cotrim, Ana; Solomon, Beth; Colevas, A. Dimitrios; Russo, Angelo; Morris, John C.; Herscher, Laurie; Smith, Sharon

    2009-01-01

    Purpose: To report the long-term outcomes and toxicity of a regimen of infusion paclitaxel delivered concurrently with radiotherapy in patients with locally advanced squamous cell carcinoma of the head and neck. Patients and Methods: Between 1995 and 1999, 35 patients with nonmetastatic, Stage III or IV squamous cell carcinoma of the head and neck were treated with three cycles of paclitaxel as a 120-h continuous infusion beginning on Days 1, 21, and 42, concurrent with radiotherapy. The initial 16 patients received 105 mg/m 2 /cycle, and the subsequent 19 patients received 120 mg/m 2 /cycle. External beam radiotherapy was delivered to a dose of 70.2-72 Gy at five fractions weekly. Patients were followed to evaluate the disease outcomes and late toxicity of this regimen. Results: The median follow-up for all patients was 56.5 months. The median survival was 56.5 months, and the median time to local recurrence was not reached. Of the 35 patients, 15 (43%) developed hypothyroidism. Of the 33 patients who underwent percutaneous endoscopic gastrostomy tube placement, 11 were percutaneous endoscopic gastrostomy tube dependent until death or their last follow-up visit. Also, 5 patients (14%) required a tracheostomy until death, and 3 (9%) developed a severe esophageal stricture. All evaluated long-term survivors exhibited salivary hypofunction. Fibrosis in the radiation field occurred in 24 patients (69%). Conclusion: The results of our study have shown that concurrent chemoradiotherapy with a 120-h infusion of paclitaxel provides long-term local control and survival in patients with squamous cell carcinoma of the head and neck. Xerostomia, hypothyroidism, esophageal and pharyngeal complications, and subcutaneous fibrosis were common long-term toxicities; however, the vast majority of toxicities were grade 1 or 2.

  11. Comparative study of four advanced 3d-conformal radiation therapy treatment planning techniques for head and neck cancer

    International Nuclear Information System (INIS)

    Herrassi, Mohamed Yassine; Bentayeb, Farida; Malisan, Maria Rosa

    2013-01-01

    For the head-and-neck cancer bilateral irradiation, intensity-modulated radiation therapy (IMRT) is the most reported technique as it enables both target dose coverage and organ-at-risk (OAR) sparing. However, during the last 20 years, three-dimensional conformal radiotherapy (3DCRT) techniques have been introduced, which are tailored to improve the classic shrinking field technique, as regards both planning target volume (PTV) dose conformality and sparing of OARs, such as parotid glands and spinal cord. In this study, we tested experimentally in a sample of 13 patients, four of these advanced 3DCRT techniques, all using photon beams only and a unique isocentre, namely Bellinzona, Forward-Planned Multisegments (FPMS), ConPas, and field-in-field (FIF) techniques. Statistical analysis of the main dosimetric parameters of PTV and OARs DVHs as well as of homogeneity and conformity indexes was carried out in order to compare the performance of each technique. The results show that the PTV dose coverage is adequate for all the techniques, with the FPMS techniques providing the highest value for D95%; on the other hand, the best sparing of parotid glands is achieved using the FIF and ConPas techniques, with a mean dose of 26 Gy to parotid glands for a PTV prescription dose of 54 Gy. After taking into account both PTV coverage and parotid sparing, the best global performance was achieved by the FIF technique with results comparable to that of IMRT plans. This technique can be proposed as a valid alternative when IMRT equipment is not available or patient is not suitable for IMRT treatment. (author)

  12. Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer.

    Science.gov (United States)

    Smith, A F; Hall, P S; Hulme, C T; Dunn, J A; McConkey, C C; Rahman, J K; McCabe, C; Mehanna, H

    2017-11-01

    A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. Bevacizumab, Fluorouracil, and Hydroxyurea Plus Radiation Therapy in Treating Patients With Advanced Head and Neck Cancer

    Science.gov (United States)

    2013-02-06

    Metastatic Squamous Neck Cancer With Occult Primary Squamous Cell Carcinoma; Recurrent Adenoid Cystic Carcinoma of the Oral Cavity; Recurrent Basal Cell Carcinoma of the Lip; Recurrent Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Recurrent Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Recurrent Lymphoepithelioma of the Nasopharynx; Recurrent Lymphoepithelioma of the Oropharynx; Recurrent Metastatic Squamous Neck Cancer With Occult Primary; Recurrent Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Recurrent Mucoepidermoid Carcinoma of the Oral Cavity; Recurrent Salivary Gland Cancer; Recurrent Squamous Cell Carcinoma of the Hypopharynx; Recurrent Squamous Cell Carcinoma of the Larynx; Recurrent Squamous Cell Carcinoma of the Lip and Oral Cavity; Recurrent Squamous Cell Carcinoma of the Nasopharynx; Recurrent Squamous Cell Carcinoma of the Oropharynx; Recurrent Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Recurrent Verrucous Carcinoma of the Larynx; Recurrent Verrucous Carcinoma of the Oral Cavity; Stage III Adenoid Cystic Carcinoma of the Oral Cavity; Stage III Basal Cell Carcinoma of the Lip; Stage III Esthesioneuroblastoma of the Paranasal Sinus and Nasal Cavity; Stage III Inverted Papilloma of the Paranasal Sinus and Nasal Cavity; Stage III Lymphoepithelioma of the Nasopharynx; Stage III Lymphoepithelioma of the Oropharynx; Stage III Midline Lethal Granuloma of the Paranasal Sinus and Nasal Cavity; Stage III Mucoepidermoid Carcinoma of the Oral Cavity; Stage III Salivary Gland Cancer; Stage III Squamous Cell Carcinoma of the Hypopharynx; Stage III Squamous Cell Carcinoma of the Larynx; Stage III Squamous Cell Carcinoma of the Lip and Oral Cavity; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Oropharynx; Stage III Squamous Cell Carcinoma of the Paranasal Sinus and Nasal Cavity; Stage III Verrucous Carcinoma of the Larynx; Stage III Verrucous

  14. Chemotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Pfister, David G.

    1995-01-01

    Purpose/Objective: The role of chemotherapy in the management of squamous cell carcinoma of the upper aerodigestive tract is undergoing rapid evolution. Historically, the use of chemotherapy was limited to patients with incurable disease who had exhausted all surgical and radiation therapy options. The results of recent randomized trials, however, suggest an increasing role for chemotherapy as part of primary management in patients seeking to avoid potentially morbid surgical procedures or with unresectable disease. This refresher course will provide a comprehensive overview of the current indications for chemotherapy in the management of these malignancies, and will highlight areas of controversy and future directions of investigation. More specifically, the following areas will be emphasized. 1. The identification of drugs commonly used in the management of head and neck cancer, their customary dosing and side effects. 2. The impact of induction and/or adjuvant chemotherapy combined with surgery and radiation therapy as defined by randomized trials, including a discussion of the Head and Neck Contracts program and the Intergroup adjuvant trial. 3. The development of larynx/function preservation treatment programs, including a review of the Memorial Hospital experience with larynx preservation and the Veterans Administration larynx preservation study. 4. The evolving role of chemotherapy as part of innovative combined modality programs, especially in patients with unresectable disease. The rationale and utility of sequential versus concomitant/alternating chemotherapy-radiation strategies, and relevant randomized clinical trials comparing the different strategies will be discussed. 5. The appropriate application of chemotherapy in the palliative setting, including a discussion of the relative merits of single-agent versus combination chemotherapy

  15. Brachytherapy in the treatment of head and neck cancer

    International Nuclear Information System (INIS)

    Yoo, Seong Yul

    1999-01-01

    Brachytherapy has been proved to be an effective method for the purpose of increasing radiation dose to the tumor and reducing the dose to the surrounding normal tissue. In head and neck cancer, the rationale of brachytherapy is as follows; Firstly, early small lesion is radiocurative and the major cause of failure is local recurrence. Secondly, it can diminish evidently the dose to the normal tissue especially masseteric muscle and salivary gland. Thirdly, the anatomy of head and neck is suitable to various technique of brachytherapy. On background of accumulated experience of LDR iridium brachytherapy of head and neck cancer for the last 15 years, the author reviewed the history of radioisotope therapy, the characteristics of radionuclides, and some important things in the method, clinical technique and treatment planning. The author analyzed the clinical result of 185 cases of head and neck cancer treated in the Korea Cancer Center Hospital. Finally the future prospect of brachytherapy of head and neck cancer is discussed

  16. The influence of quantitative tumor volume measurements on local control in advanced head and neck cancer using concomitant boost accelerated superfractionated irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Christopher R; Khandelwal, Shiv R; Schmidt-Ullrich, Rupert K; Ravalese, Joseph; Wazer, David E

    1995-06-15

    Purpose: Current methods to clinically define head and neck tumor bulk are qualitative and imprecise. Although the American Joint Committee on Cancer (AJCC) staging system is important for this purpose, limitations exist. This study will investigate the prognostic value of computed tomography (CT) derived tumor volume measurements in comparison to AJCC stage and other significant variables. Materials and Methods: Seventy-six patients with advanced head and neck squamous cell carcinoma were treated with concomitant boost accelerated superfractionated irradiation. Doses ranged from 68.4-73.8 Gy (median 70.2 Gy). Good quality pretherapy CT scans were available in 51 patients. Total tumor volume (TTV) estimates were derived from these scans using digital integration of primary tumor and metastatic lymphadenopathy. Actuarial and multivariate statistical techniques were applied to analyze local control. Results: Thirty-six-month local control was 63%. TTV ranged from 5-196 cm{sup 3} (median 35 cm{sup 3}) for all cases, 5-142 cm{sup 3} (median 17 cm{sup 3}) for those controlled, and 16-196 cm{sup 3} (median 47 cm{sup 3}) for local failures. There was a significant increase in failures above 35 cm{sup 3}. Univariate analysis found that TTV, T-stage, N-stage, and primary site were each significant prognostic variables. Local control for TTV {<=}35 cm{sup 3} was 92% at 36 months vs. 34% for TTV >35 cm{sup 3} (p = 0.0001). Multivariate analysis, however, found that TTV, primary site, and sex were important as independent variables; T and N stage were not independently significant unless TTV was removed from the model. Conclusions: This study demonstrates the prognostic significance of TTV in advanced carcinoma of the head and neck. This variable appears to be a more predictive than AJCC clinical stage. Quantitative tumor volume measurements may prove to be a useful parameter in future analyses of head and neck cancer.

  17. Pattern of head and neck cancers among patients attending ...

    African Journals Online (AJOL)

    Lack of baseline data in Tanzania concerning head and ... that there is a synergistic effect of alcohol consumption and tobacco use in causing head and neck cancers ... risk factors, while radiation around the head and neck is associated with ...

  18. 125I implants as an adjuvant to surgery and external beam radiotherapy in the management of locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Martinez, A.; Goffinet, D.R.; Fee, W.; Goode, R.; Cox, R.S.

    1983-01-01

    125 I seeds either individually placed or inserted into absorbable Vicryl suture carriers were utilized in conjunction with surgery and external beam radiotherapy in an attempt to increase local control rates in patients with advanced oropharyngeal and laryngopharyngeal cancers (T3-T4, N2-N3), massive cervical lymphadenopathy (N3) and an unknown primary site and locally recurrent head and neck cancers. Forty-eight patients were treated with 55 implants. The carotid artery was implanted in 15 patients, while seven patients had seeds inserted into the base of the skull region, and another three patients had implants near cranial nerves. Eighteen of the 48 patients were treated for cure. The actuarial survival at five years in this subgroup was 50%. The overall local control in the head and neck area was 58%. In this group no patients to date have had a local failure in the implanted volume. Seventeen patients with comparable stage of disease treated prior to 1974 with curative intent without 125 I implants were analyzed retrospectively for comparison with the implanted patients. The actuarial survival of these patients was 18% and the overall head and neck control was 21%. These differences are statistically significant at a P value of 0.01 and 0.007, respectively. Seventeen patients received implants for local recurrence. The local control in the head and neck area was 50%; however, the 2.5 year actuarial survival was only 17%. The complication rate was 11% (six of 55 implants). The improved survival, the high local control, and the minimal complication rates in this series makes the intraoperative implantation of 125 I seeds and effective adjunctive treatment to surgery and external beam irradiation

  19. Treatment of Childhood Head and Neck Cancer - Patient Version

    Science.gov (United States)

    Find diagnosis, staging, and treatment information for these head and neck cancers: hypopharynx, larynx, lip and oral cavity, neck cancer with occult primary, nasopharynx, oropharynx, paranasal sinus and nasal cavity, and salivary gland cancer.

  20. Treatment of Head and Neck Cancer in Adults - Patient Version

    Science.gov (United States)

    Find diagnosis, staging, and treatment information for these head and neck cancers: hypopharynx, larynx, lip and oral cavity, neck cancer with occult primary, nasopharynx, oropharynx, paranasal sinus and nasal cavity, and salivary gland cancer.

  1. Genome Study Yields Clues to Head and Neck Cancers

    Science.gov (United States)

    Researchers have surveyed the genetic changes in nearly 300 head and neck cancers, revealing some previously unknown alterations that may play a role in the disease, including in patients whose cancer is associated with the human papillomavirus (HPV).

  2. Preventive sparing of spinal cord and brain stem in the initial irradiation of locally advanced head and neck cancers.

    Science.gov (United States)

    Farace, Paolo; Piras, Sara; Porru, Sergio; Massazza, Federica; Fadda, Giuseppina; Solla, Ignazio; Piras, Denise; Deidda, Maria Assunta; Amichetti, Maurizio; Possanzini, Marco

    2014-01-06

    Since reirradiation in recurrent head and neck patients is limited by previous treatment, a marked reduction of maximum doses to spinal cord and brain stem was investigated in the initial irradiation of stage III/IV head and neck cancers. Eighteen patients were planned by simultaneous integrated boost, prescribing 69.3 Gy to PTV1 and 56.1 Gy to PTV2. Nine 6 MV coplanar photon beams at equispaced gantry angles were chosen for each patient. Step-and-shoot IMRT was calculated by direct machine parameter optimization, with the maximum number of segments limited to 80. In the standard plan, optimization considered organs at risk (OAR), dose conformity, maximum dose < 45 Gy to spinal cord and < 50 Gy to brain stem. In the sparing plans, a marked reduction to spinal cord and brain stem were investigated, with/without changes in dose conformity. In the sparing plans, the maximum doses to spinal cord and brain stem were reduced from the initial values (43.5 ± 2.2 Gy and 36.7 ± 14.0 Gy), without significant changes on the other OARs. A marked difference (-15.9 ± 1.9 Gy and -10.1 ± 5.7 Gy) was obtained at the expense of a small difference (-1.3% ± 0.9%) from initial PTV195% coverage (96.6% ± 0.9%). Similar difference (-15.7 ± 2.2 Gy and -10.2 ± 6.1 Gy) was obtained compromising dose conformity, but unaffecting PTV195% and with negligible decrease in PTV295% (-0.3% ± 0.3% from the initial 98.3% ± 0.8%). A marked spinal cord and brain stem preventive sparing was feasible at the expense of a decrease in dose conformity or slightly compromising target coverage. A sparing should be recommended in highly recurrent tumors, to make potential reirradiation safer.

  3. Assessment of an advanced monoenergetic reconstruction technique in dual-energy computed tomography of head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Albrecht, Moritz H.; Scholtz, Jan-Erik; Kraft, Johannes; Bauer, Ralf W.; Kaup, Moritz; Dewes, Patricia; Bucher, Andreas M.; Burck, Iris; Lehnert, Thomas; Kerl, J.M.; Vogl, Thomas J. [University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Wagenblast, Jens [University Hospital Frankfurt, Department of Otolaryngology, Head and Neck Surgery, Frankfurt am Main (Germany); Wichmann, Julian L. [University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt am Main (Germany); Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

    2015-08-15

    To define optimal keV settings for advanced monoenergetic (Mono+) dual-energy computed tomography (DECT) in patients with head and neck squamous cell carcinoma (SCC). DECT data of 44 patients (34 men, mean age 55.5 ± 16.0 years) with histopathologically confirmed SCC were reconstructed as 40, 55, 70 keV Mono + and M0.3 (30 % 80 kV) linearly blended series. Attenuation of tumour, sternocleidomastoid muscle, internal jugular vein, submandibular gland, and noise were measured. Three radiologists with >3 years of experience subjectively assessed image quality, lesion delineation, image sharpness, and noise. The highest lesion attenuation was shown for 40 keV series (248.1 ± 94.1 HU), followed by 55 keV (150.2 ± 55.5 HU; P = 0.001). Contrast-to-noise ratio (CNR) at 40 keV (19.09 ± 13.84) was significantly superior to all other reconstructions (55 keV, 10.25 ± 9.11; 70 keV, 7.68 ± 6.31; M0.3, 5.49 ± 3.28; all P < 0.005). Subjective image quality was highest for 55 keV images (4.53; κ = 0.38, P = 0.003), followed by 40 keV (4.14; κ = 0.43, P < 0.001) and 70 keV reconstructions (4.06; κ = 0.32, P = 0.005), all superior (P < 0.004) to linear blending M0.3 (3.81; κ = 0.280, P = 0.056). Mono + DECT at low keV levels significantly improves CNR and subjective image quality in patients with head and neck SCC, as tumour CNR peaks at 40 keV, and 55 keV images are preferred by observers. (orig.)

  4. A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

    International Nuclear Information System (INIS)

    Retèl, Valesca P; Molen, Lisette van der; Hilgers, Frans JM; Rasch, Coen RN; L'Ortye, Annemiek AAMHJ; Steuten, Lotte MG; Harten, Wim H van

    2011-01-01

    Concomitant chemo-radiotherapy (CCRT) has become an indispensable organ, but not always function preserving treatment modality for advanced head and neck cancer. To prevent/limit the functional side effects of CCRT, special exercise programs are increasingly explored. This study presents cost-effectiveness analyses of a preventive (swallowing) exercise program (PREP) compared to usual care (UC) from a health care perspective. A Markov decision model of PREP versus UC was developed for CCRT in advanced head and neck cancer. Main outcome variables were tube dependency at one-year and number of post-CCRT hospital admission days. Primary outcome was costs per quality adjusted life years (cost/QALY), with an incremental cost-effectiveness ratio (ICER) as outcome parameter. The Expected Value of Perfect Information (EVPI) was calculated to obtain the value of further research. PREP resulted in less tube dependency (3% and 25%, respectively), and in fewer hospital admission days than UC (3.2 and 4.5 days respectively). Total costs for UC amounted to €41,986 and for PREP to €42,271. Quality adjusted life years for UC amounted to 0.68 and for PREP to 0.77. Based on costs per QALY, PREP has a higher probability of being cost-effective as long as the willingness to pay threshold for 1 additional QALY is at least €3,200/QALY. At the prevailing threshold of €20,000/QALY the probability for PREP being cost-effective compared to UC was 83%. The EVPI demonstrated potential value in undertaking additional research to reduce the existing decision uncertainty. Based on current evidence, PREP for CCRT in advanced head and neck cancer has the higher probability of being cost-effective when compared to UC. Moreover, the majority of sensitivity analyses produced ICERs that are well below the prevailing willingness to pay threshold for an additional QALY (range from dominance till €45,906/QALY)

  5. Cancer stem cells in head and neck cancer

    Directory of Open Access Journals (Sweden)

    Trapasso S

    2012-11-01

    Full Text Available Eugenia Allegra, Serena TrapassoOtolaryngology – Head and Neck Surgery, University Magna Graecia of Catanzaro, Catanzaro, ItalyAbstract: Cancer stem cells (CSCs, also called "cells that start the tumor," represent in themselves one of the most topical and controversial issues in the field of cancer research. Tumor stem cells are able to self-propagate in vitro (self-renewal, giving rise both to other tumor stem cells and most advanced cells in the line of differentiation (asymmetric division. A final characteristic is tumorigenicity, a fundamental property, which outlines the tumor stem cell as the only cell able to initiate the formation of a tumor when implanted in immune-deficient mice. The hypothesis of a hierarchical organization of tumor cells dates back more than 40 years, but only in 1997, thanks to the work of John Dick and Dominique Bonnet, was there the formal proof of such an organization in acute myeloid leukemia. Following this, many other research groups were able to isolate CSCs, by appropriate selection markers, in various malignancies, such as breast, brain, colon, pancreas, and liver cancers and in melanoma. To date, however, it is not possible to isolate stem cells from all types of neoplasia, particularly in solid tumors. From a therapeutic point of view, the concept of tumor stem cells implies a complete revision of conventional antineoplastic treatment. Conventional cytotoxic agents are designed to target actively proliferating cells. In the majority of cases, this is not sufficient to eliminate the CSCs, which thanks to their reduced proliferative activity and/or the presence of proteins capable of extruding chemotherapeutics from the cell are not targeted. Therefore, the theory of cancer stem cells can pose new paradigms in terms of cancer treatment. Potential approaches, even in the very early experimental stages, relate to the selective inhibition of pathways connected with self-renewal, or more specifically based on

  6. PET-CT–Guided Surveillance of Head and Neck Cancers

    Science.gov (United States)

    Patients with advanced squamous cell carcinoma of the head and neck who underwent PET-CT–guided surveillance had fewer operations but similar overall survival rates to those of patients who underwent planned neck dissection.

  7. Radiation therapy for head and neck cancers

    International Nuclear Information System (INIS)

    Gillette, S.M.; Gillette, E.L.

    1995-01-01

    Radiation therapy may be indicated for larger invasive tumors of the head and neck that may be difficult to surgically excise or for which surgery would be significantly disfiguring. Previous studies of oral squamous cell carcinomas indicate that it should be possible to control approximately 80% of all but the most advanced local or locoregional tumors. Aggressive radiation therapy to total doses of 56 Gy or greater may be required. That can be done by using smaller doses per fraction and gradually reducing the size of the field so that the highest dose is given only to the tumor with a relatively tight margin. Malignant melanomas can be controlled locally apparently with a few large fractions. Metastatic disease limits survival; therefore, some type of systemic therapy seems to be needed to improve survival of those patients. Canine oral fibrosarcomas require a very high dose for a reasonable probability of control. It seems that a dose of 56 Gy given in 3.3 Gy fractions might provide local control of 50% of the tumors. It is likely that a combination of surgery and radiation would significantly improve the probability for control. Oral squamous cell carcinomas of cats must also be treated very aggressively to improve local control. Tumors of the nasal cavity are usually very large and invasive at the time of diagnosis. Radiation therapy has been shown to be effective in some instances. It is possible that with better definition of the tumor through computerized tomography imaging and improved treatment planning, control of these difficult to manage nasal tumors can be improved

  8. Prediction of clinical toxicity in locally advanced head and neck cancer patients by radio-induced apoptosis in peripheral blood lymphocytes (PBLs)

    International Nuclear Information System (INIS)

    Bordón, Elisa; Henríquez-Hernández, Luis Alberto; Lara, Pedro C; Ruíz, Ana; Pinar, Beatriz; Rodríguez-Gallego, Carlos; Lloret, Marta

    2010-01-01

    in locally advanced head and neck cancer patients. Anyhow, prospective studies with different cancer types and higher number of patients are needed to validate these results

  9. Tumor Hypoxia is Independent of Hemoglobin and Prognostic for Loco-regional Tumor Control after Primary Radiotherapy in Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    Nordsmark, Marianne; Overgaard, Jens

    2004-01-01

    There is evidence that tumor hypoxia adversely affects loco-regional tumor control and survival in head and neck cancer. The aim of the current study was to compare pretreatment tumor oxygenation measured by Eppendorf pO2 electrodes with known prognostic factors in advanced head and neck tumors after definitive radiotherapy, and to evaluate the prognostic significance of these parameters on loco-regional tumor control. Sixty-seven patients, median age 56 years (22-82), all with primary stage III-IV squamous cell carcinoma were available for survival analysis. Tumor oxygenation was described as the fraction of pO2 values=2.5 mmHg (HP2.5) and the median tumor pO2. By regression analysis HP2.5 was independent of known prognostic factors including stage, pretreatment hemoglobin (Hb) and the largest tumor diameter at the site of pO2 measurement. By Kaplan-Meier analysis loco-regional tumor control at 5 years was in favor of less hypoxic tumors using either HP2.5 or median tumor pO2 as descriptors and stratifying by the median values. Also, Hb was prognostic of loco-regional tumor control at 5 years using the median value as cut off. HP2.5 as continuous parameter was highly significant for loco-regional tumor control in a multivariate analysis. In conclusion both HP2.5 and total Hb were prognostic for loco-regional tumor control, but HP2.5 as continuous variable was independently the strongest prognostic indicator for loco-regional tumor control after definitive primary radiotherapy in advanced head and neck tumors

  10. Expression and clinical significance of connective tissue growth factor in advanced head and neck squamous cell cancer.

    Science.gov (United States)

    Kikuchi, Ryoko; Kikuchi, Yoshihiro; Tsuda, Hitoshi; Maekawa, Hitoshi; Kozaki, Ken-Ichi; Imoto, Issei; Tamai, Seiichi; Shiotani, Akihiro; Iwaya, Keiichi; Sakamoto, Masaru; Sekiya, Takao; Matsubara, Osamu

    2014-07-01

    Connective tissue growth factor (CTGF) has been reported to play critical roles in the tumorigenesis of several human malignancies. This study was performed to evaluate CTGF protein expression in head and neck squamous cell carcinoma (HNSCC). Surgical specimens from 76 primary HNSCC were obtained with written informed consents and the expression level of CTGF was immunohistochemically evaluated. The cytoplasmic immunoreactivity of CTGF in cancer cells was semiquantitatively classified into low and high expression. Among all 76 cases with or without neoadjuvant therapy, low CTGF showed significantly longer (P = 0.0282) overall survival (OS), but not disease-free survival (DFS) than high CTGF. Although low CTGF in patients with stage I, II and III did not result in any significant difference of the OS and DFS, stage IV HNSCC patients with low CTGF showed significantly longer OS (P = 0.032) and DFS (P = 0.0107) than those with high CTGF. These differences in stage IV cases were also confirmed using multivariate analyses. These results suggest that low CTGF in stage IV HNSCC is an independent prognostic factor, despite with or without neoadjuvant therapy.

  11. Radiation therapy and concurrent cisplatin administration in locally advanced head and neck cancer. A Hellenic co-operative oncology group study

    International Nuclear Information System (INIS)

    Fountzilas, G.; Skarlos, D.; Kosmidis, P.; Samantas, E.; Kalogera-Fountzila, A.; Papaspyrou, S.; Tzitzikas, J.; Sridhar, K.S.; Makrantonakis, P.; Pantelakos, P.; Nikolaou, A.; Bacoyiannis, H.; Sinodinou, M.; Banis, C.; Daniilidis, J.

    1994-01-01

    In an attempt to improve local control of locally advanced head and neck cancer, radiation therapy was combined with cisplatin. Forty-eight patients entered into this study. All patients were irradiated with a 60 Co unit and according to the protocol they should receive 70 Gy in the tumor area and 45 Gy in the rest of neck. Cisplatin was administered at a dose of 100 mg/m 2 on days 2, 22 and 42. Thirty-seven (80%) patients received the total radiation dose as initially planned. Thirty-four (72%) patients achieved complete and 5 (10%) partial response. Grade 3-4 toxicities included vomiting (14%) stomatitis (4%), diarrhea (2%), myelotoxicity (14%), hoarseness (4%), dysphagia (30%), weight loss (32%), nephrotoxicity (4%) and dermatitis (2%). After a median follow-up of 26 (range, 18-33) months, 16 patients have died. Among the 35 complete responders 6 later on relapsed. Median relapse-free survival has not yet been reached. Combined radiation therapy and cisplatin appears to be a highly active treatment in patients with advanced head and neck cancer as far as primary locoregional response is concerned. (orig.)

  12. Postoperative radiotherapy after laser surgery with or without chemotherapy in head and neck evolved cancers

    International Nuclear Information System (INIS)

    Ryll, L.; Pradier, O.; Nitsche, M.; Christiansen, H.; Hess, C.

    2007-01-01

    We compared concurrent combination chemoradiotherapy and adjuvant radiotherapy after laser surgery in patients with stage 3/4 non metastatic squamous cell head and neck cancer. Combination chemotherapy and concurrent irradiation after laser surgery was not superior to surgery and postoperative radiotherapy for resectable advanced squamous cell head and neck cancer. However, the collective is small, and the follow-up to short to conclude. (authors)

  13. Low skeletal muscle mass is a predictive factor for chemotherapy dose-limiting toxicity in patients with locally advanced head and neck cancer.

    Science.gov (United States)

    Wendrich, Anne W; Swartz, Justin E; Bril, Sandra I; Wegner, Inge; de Graeff, Alexander; Smid, Ernst J; de Bree, Remco; Pothen, Ajit J

    2017-08-01

    Low skeletal muscle mass (SMM) or sarcopenia is emerging as an adverse prognostic factor for chemotherapy dose-limiting toxicity (CLDT) and survival in cancer patients. Our aim was to determine the impact of low SMM on CDLT in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) treated with primary radiochemotherapy (RCT). Consecutive patients diagnosed with LA-HNSCC and treated with primary RCT between 2007 and 2011 in our center were included. Clinical variables were retrospectively retrieved and SMM was measured at the level of the third cervical vertebra using pre-treatment head and neck CT-scans. After determining a cut-off value for low SMM, multivariate analysis was performed to identify prognostic factors for CDLT. Of 112 patients included, 30.4% experienced CDLT. The optimal cut-off value for low SMM as a predictor of CDLT was ≤43.2cm 2 /m 2 . Using this cut-off, 54.5% patients had low SMM. Patients with low SMM experienced CDLT more frequently than patients with normal SMM (44.3% vs. 13.7%, pSMM, p=0.044). At multivariate analysis, low SMM was independently inversely associated with CDLT (OR 0.93, 95%CI: 0.88-0.98). Patients experiencing CDLT had a lower overall survival than patients who did not (mean 36.6vs. 54.2months, p=0.038). Low SMM is an independent risk factor for CDLT in LA-HNSCC patients treated with primary RCT. Pre-therapeutic estimation of SMM using routine CT-scans of the head and neck region may identify patients at risk of CDLT. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Cetuximab: its unique place in head and neck cancer treatment

    Directory of Open Access Journals (Sweden)

    Specenier P

    2013-04-01

    Full Text Available Pol Specenier, Jan B Vermorken Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium Abstract: Head and neck cancer is the sixth most common cancer worldwide. At present, globally about 650,000 new cases of squamous cell carcinoma of the head and neck (SCCHN are diagnosed each year. The epidermal growth factor receptor (EGFR is almost invariably expressed in SCCHN. Overexpression of the EGFR is a strong and independent unfavorable prognostic factor in SCCHN. Cetuximab is a chimeric monoclonal antibody, which binds with high affinity to the extracellular domain of the human EGFR, blocking ligand binding, resulting in inhibition of the receptor function. It also targets cytotoxic immune effector cells towards EGFR-expressing tumor cells (antibody dependent cell-mediated cytotoxicity. The addition of cetuximab to radiotherapy (RT improves locoregional control and survival when compared to RT alone. The addition of cetuximab to platinum-based chemoradiation (CRT is feasible but does not lead to an improved outcome. Cetuximab plus RT has never been compared prospectively to CRT, which therefore remains the standard treatment for patients with locoregionally advanced SCCHN for whom surgery is not considered the optimal treatment, provided they can tolerate CRT. The addition of cetuximab to platinum-based chemotherapy prolongs survival in patients with recurrent or metastatic SCCHN. The combination of a platinum-based regimen and cetuximab should be considered as the standard first line regimen for patients who can tolerate this treatment. Keywords: SCCHN, cetuximab, recurrent metastatic, locoregionally advanced, chemoradiation

  15. Impact of weight loss on survival after chemoradiation for locally advanced head and neck Cancer: secondary results of a randomized phase III trial (SAKK 10/94)

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Hayoz, Stefanie; Zimmermann, Frank; Bodis, Stephan; Kaul, David; Badakhshi, Harun; Bernier, Jacques; Studer, Gabriela; Plasswilm, Ludwig; Budach, Volker; Aebersold, Daniel M

    2015-01-01

    To analyze the impact of weight loss before and during chemoradiation on survival outcomes in patients with locally advanced head and neck cancer. From 07/1994-07/2000 a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to either hyperfractionated radiation therapy alone or the same radiation therapy combined with two cycles of concomitant cisplatin. The primary endpoint was time to any treatment failure (TTF); secondary endpoints were locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS) and overall survival (OS). Patient weight was measured 6 months before treatment, at treatment start and treatment end. The proportion of patients with >5% weight loss was 32% before, and 51% during treatment, and the proportion of patients with >10% weight loss was 12% before, and 17% during treatment. After a median follow-up of 9.5 years (range, 0.1 – 15.4 years) weight loss before treatment was associated with decreased TTF, LRRFS, DMFS, cancer specific survival and OS in a multivariable analysis. However, weight loss during treatment was not associated with survival outcomes. Weight loss before and during chemoradiation was commonly observed. Weight loss before but not during treatment was associated with worse survival

  16. Radical chemo-irradiation using intensity-modulated radiotherapy for locally advanced head and neck cancer in elderly patients: Experience from a tertiary care center in South India.

    Science.gov (United States)

    Chalissery, J R; Sudheeran, P C; Varghese, K M; Venkatesan, K

    2016-01-01

    To assess the feasibility, tolerance and response of radical chemo irradiation using Intensity modulated Radiotherapy [IMRT] in elderly patients [age >65] with locally advanced head and neck cancer. Patients aged 65 and above [range 65 to 84years] registered in oncology outpatient unit in our institution between December 2011 to 2014, with stage III and IV head and neck cancer were treated with radical dose of radiotherapy using IMRT and concurrent chemotherapy with cisplatin 40mg/sq.m weekly. Response evaluation and toxicity profile assessment was done 6 to 8 weeks after completion of treatment and 3 monthly thereafter with median follow up of 3 years. Total number of patients analysed were 47. 43(91.5%) patients tolerated 66-.70Gy of radiotherapy and 4 or more cycles of weekly chemotherapy with cisplatin. First follow up evaluation at 6 to 8 weeks showed 81% patients having complete loco regional response. Grade III skin reaction and mucositis was noticed in 24% and 47% respectively. No grade III neutropenia observed. Median follow up of 3 years showed a complete local control in 53% and overall survival of 60%. Radical chemo irradiation with IMRT in elderly patients is a feasible option. Long term local control and overall survival benefits needs to be followed up.

  17. Taxane-containing induction chemotherapy followed by definitive chemoradiotherapy. Outcome in patients with locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Broemme, J.O.; Schmuecking, M.; Leiser, D.; Geretschlaeger, A.; Ghadjar, P.; Aebersold, D.M. [Bern Univ. Hospital and Bern Univ. (Switzerland). Dept. of Radiation Oncology; Arnold, A.; Giger, R. [Bern Univ. (Switzerland). Head and Neck Surgery; Rauch, D. [Bern Univ. (Switzerland). Medical Oncology; Plasswilm, L. [Kantonsspital, St. Gallen (Switzerland). Radiation Oncology

    2013-08-15

    Background: Induction chemotherapy followed by definitive chemoradiotherapy is an intensified treatment approach for locally advanced squamous cell carcinoma of the head and neck (HNSCC) that might be associated with high rates of toxicity. Materials and methods: The data of 40 consecutive patients who underwent induction chemotherapy with docetaxel-containing regimens followed by intensity-modulated radiotherapy (IMRT) and concomitant systemic therapy for unresectable locally advanced HNSCC were retrospectively analyzed. Primary objectives were RT-related acute and late toxicity. Secondary objectives were response to induction chemotherapy, locoregional recurrence-free survival (LRRFS), overall survival (OS), and influencing factors for LRRFS and OS. Results: The median follow-up for surviving patients was 21 months (range, 2-53 months). Patients received a median of three cycles of induction chemotherapy followed by IMRT to 72 Gy. Three patients died during induction chemotherapy and one during chemoradiotherapy. Acute RT-related toxicity was of grade 3 and 4 in 72 and 3 % of patients, respectively, mainly dysphagia and dermatitis. Late RT-related toxicity was mainly xerostomia and bone/cartilage necrosis and was of grade 3 and 4 in 15 % of patients. One- and 2-year LRRFS and OS were 72 and 49 % and 77 and 71 %, respectively. Conclusion: Induction chemotherapy followed by chemoradiotherapy using IMRT was associated with a high rate of severe acute and late RT-related toxicities in this selected patient cohort. Four patients were lost because of fatal complications. Induction chemotherapy did not compromise the delivery of full-dose RT; however, the use of three cycles of concomitant cisplatin was impaired. (orig.)

  18. Prognostic value of hemoglobin concentrations in patients with advanced head and neck cancer treated with combined radio-chemotherapy and surgery

    International Nuclear Information System (INIS)

    Wagner, W.; Hermann, R.; Koch, O.; Hartlapp, J.; Krech, R.

    2000-01-01

    Purpose: Hemoglobin levels are currently the focus of interest as prognostic factors in patients with head and neck cancer. Most published clinical trials have confirmed hemoglobin to process a significant influence on survival in patients treated with radiotherapy. In our study we have investigated the prognostic value of hemoglobin in a combined modality schedule. Patients and Methods: Forty-three patients with advanced head and neck tumors were treated with combined radiochemotherapy. The therapy comprised 2 courses of induction chemotherapy with ifosfamide (1,500 mg/m 2 , day 1 to 5) and cisplatin (60 mg/m 2 , day 5) followed by hyperfractionated accelerated radiotherapy with a total dose of only 30 Gy. Surgery involved tumor resection and neck dissection. Results: The 1-year overall survival rate and the 2-year survival rate were 79% and 56%, respectively. The 1- and 2-year recurrence-free survival rates were 68% and 49%, respectively. Prognostic factors with an impact on survival were seen in tumor size (T3 vs T4, p=0.0088), response to radio-chemotherapy at the primary site (no vital tumor rest vs vital tumor rest, p=0.045), response to lymph node radio-chemotherapy (no vital tumor cells vs vital tumor cells, p=0.013) and level of hemoglobin after radio-chemotherapy (Hb≥11.5 g/dl vs [de

  19. A historical review of head and neck cancer in celebrities.

    Science.gov (United States)

    Folz, B J; Ferlito, A; Weir, N; Pratt, L W; Rinaldo, A; Werner, J A

    2007-06-01

    The illnesses of celebrity patients always receive more attention from the general public than those of ordinary patients. With regard to cancer, this fact has helped to spread information about the four major malignancies: breast cancer, prostatic cancer, lung cancer and colorectal cancer. Head and neck cancer, on the other hand, is still not well recognised by the lay public, although the risk factors are similar to those of lung cancer. It was the objective of this analysis to identify cases of celebrity patients, the description of which could help to increase awareness of head and neck cancer, its symptoms and risk factors. The Internet and medical literature databases were searched for celebrity patients who had suffered from head and neck cancer. The search revealed numerous famous head and neck cancer patients. However, only seven cases were documented well in the medical literature. Among the identified persons were one emperor, two United States presidents, a legendary composer, a world-renowned medical doctor, an outstanding athlete and an extraordinary entertainer. In spite of their exclusive position in society, these patients did not have a better prognosis compared with ordinary patients of their time. Only two of the group experienced long term survival and only one was cured. None of these influential figures used their influence to fund research or to promote knowledge about their respective diseases. The identified cases could help increase public awareness of head and neck cancer. Similar to activities in other oncologic fields, current celebrity head and neck cancer patients should be encouraged to discuss their diseases openly, which could have a positive effect on public health.

  20. Split Course Hyperfractionated Accelerated Radio-Chemotherapy (SCHARC for patients with advanced head and neck cancer: Influence of protocol deviations and hemoglobin on overall survival, a retrospective analysis

    Directory of Open Access Journals (Sweden)

    Sprague Lisa D

    2006-12-01

    Full Text Available Abstract Background The advantage of hyperfractionated accelerated radiation therapy for advanced head and neck cancer has been reported. Furthermore, randomized trials and meta-analyses have confirmed the survival benefit of additional chemotherapy to radiotherapy. We retrospectively analyzed the efficiency and toxicity of the Regensburg standard therapy protocol "SCHARC" and the overall survival of our patients. Methods From 1997 to 2004, 64 patients suffering from advanced head and neck cancer (88 % stage IV, 12 % stage III were assigned to receive the SCHARC protocol. Around half of the patients were diagnosed with oro-hypopharynx carcinoma (52 %, one third with tongue and floor of mouth tumors (29 % and one fifth (19 % suffered from H & N cancer at other sites. The schedule consisted of one therapy block with 30 Gy in 20 fractions over a two week period with concomitant chemotherapy (d 1–5: 20 mg/m2/d DDP + 750–1000 mg/m2/d 5FU (cont. infusion. This therapy block was repeated after a fortnight break up to a cumulative dose of 60 Gy and followed by a boost up to 70 Gy (69–70.5 Gy. All patients assigned to this scheme were included in the survival evaluation. Results Forty patients (63 % received both radiation and chemotherapy according to the protocol. The mean follow up was 2.3 years (829 d and the median follow up was 1.9 years (678 d, respectively. The analysis of survival revealed an estimated 3 year overall survival rate of 57 %. No patient died of complications, 52 patients (80 % had acute grade 2–3 mucositis, and 33 patients (58 % suffered from acute grade 3 skin toxicity. Leucopenia was no major problem (mean nadir 3.4 g/nl, no patient 10.5 g/dl and for patients who completed the protocol. Conclusion The SCHARC protocol was effective in patients diagnosed with advanced head and neck cancer. It led to long-term disease control and survival in about 50 % of the patients with significant but acceptable toxicity. Most patients

  1. Split Course Hyperfractionated Accelerated Radio-Chemotherapy (SCHARC) for patients with advanced head and neck cancer: Influence of protocol deviations and hemoglobin on overall survival, a retrospective analysis

    International Nuclear Information System (INIS)

    Stadler, Peter; Putnik, Kurt; Kreimeyer, Thore; Sprague, Lisa D; Koelbl, Oliver; Schäfer, Christof

    2006-01-01

    The advantage of hyperfractionated accelerated radiation therapy for advanced head and neck cancer has been reported. Furthermore, randomized trials and meta-analyses have confirmed the survival benefit of additional chemotherapy to radiotherapy. We retrospectively analyzed the efficiency and toxicity of the Regensburg standard therapy protocol 'SCHARC' and the overall survival of our patients. From 1997 to 2004, 64 patients suffering from advanced head and neck cancer (88 % stage IV, 12 % stage III) were assigned to receive the SCHARC protocol. Around half of the patients were diagnosed with oro-hypopharynx carcinoma (52 %), one third with tongue and floor of mouth tumors (29 %) and one fifth (19 %) suffered from H & N cancer at other sites. The schedule consisted of one therapy block with 30 Gy in 20 fractions over a two week period with concomitant chemotherapy (d 1–5: 20 mg/m 2 /d DDP + 750–1000 mg/m 2 /d 5FU (cont. infusion). This therapy block was repeated after a fortnight break up to a cumulative dose of 60 Gy and followed by a boost up to 70 Gy (69–70.5 Gy). All patients assigned to this scheme were included in the survival evaluation. Forty patients (63 %) received both radiation and chemotherapy according to the protocol. The mean follow up was 2.3 years (829 d) and the median follow up was 1.9 years (678 d), respectively. The analysis of survival revealed an estimated 3 year overall survival rate of 57 %. No patient died of complications, 52 patients (80 %) had acute grade 2–3 mucositis, and 33 patients (58 %) suffered from acute grade 3 skin toxicity. Leucopenia was no major problem (mean nadir 3.4 g/nl, no patient < 1.0 g/nl) and the mean hemoglobin value decreased from 13.2 to 10.5 g/dl. Univariate analysis of survival showed a better outcome for patients with a hemoglobin nadir >10.5 g/dl and for patients who completed the protocol. The SCHARC protocol was effective in patients diagnosed with advanced head and neck cancer. It led

  2. Split course hyperfractionated accelerated radio-chemotherapy (SCHARC) for patients with advanced head and neck cancer: influence of protocol deviations and hemoglobin on overall survival, a retrospective analysis.

    Science.gov (United States)

    Stadler, Peter; Putnik, Kurt; Kreimeyer, Thore; Sprague, Lisa D; Koelbl, Oliver; Schäfer, Christof

    2006-12-07

    The advantage of hyperfractionated accelerated radiation therapy for advanced head and neck cancer has been reported. Furthermore, randomized trials and meta-analyses have confirmed the survival benefit of additional chemotherapy to radiotherapy. We retrospectively analyzed the efficiency and toxicity of the Regensburg standard therapy protocol "SCHARC" and the overall survival of our patients. From 1997 to 2004, 64 patients suffering from advanced head and neck cancer (88 % stage IV, 12 % stage III) were assigned to receive the SCHARC protocol. Around half of the patients were diagnosed with oro-hypopharynx carcinoma (52 %), one third with tongue and floor of mouth tumors (29 %) and one fifth (19 %) suffered from H & N cancer at other sites. The schedule consisted of one therapy block with 30 Gy in 20 fractions over a two week period with concomitant chemotherapy (d 1-5: 20 mg/m2/d DDP + 750-1000 mg/m2/d 5FU (cont. infusion). This therapy block was repeated after a fortnight break up to a cumulative dose of 60 Gy and followed by a boost up to 70 Gy (69-70.5 Gy). All patients assigned to this scheme were included in the survival evaluation. Forty patients (63 %) received both radiation and chemotherapy according to the protocol. The mean follow up was 2.3 years (829 d) and the median follow up was 1.9 years (678 d), respectively. The analysis of survival revealed an estimated 3 year overall survival rate of 57 %. No patient died of complications, 52 patients (80 %) had acute grade 2-3 mucositis, and 33 patients (58 %) suffered from acute grade 3 skin toxicity. Leucopenia was no major problem (mean nadir 3.4 g/nl, no patient hemoglobin value decreased from 13.2 to 10.5 g/dl. Univariate analysis of survival showed a better outcome for patients with a hemoglobin nadir >10.5 g/dl and for patients who completed the protocol. The SCHARC protocol was effective in patients diagnosed with advanced head and neck cancer. It led to long-term disease control and survival in

  3. Autopsy findings in carotid arterial rupture following radiotherapy of head and neck advanced carcinoma

    International Nuclear Information System (INIS)

    Satake, Bunsuke; Matsuura, Shizumu; Sakaino, Kouji; Maehara, Yasunobu

    1989-01-01

    The influence of radiotherapy in advanced head and neck cancer was investigated by autopsy of head and neck patients who had had carotid artery rupture. Twenty-five cases of head and neck cancer revealed carotid artery rupture among the 255 head and neck cases autopsied from 1972 to 1985. The rate of carotid artery rupture in hypopharyngeal cancer was 8/32 (25%); in oral cancer 8/55 (14.5%), and in other cancers 9/165 (5.4%). In localization of ruptured arteries there were 9 cases of common carotid artery, 14 cases of external carotid artery, one case of internal carotid artery, and one unknown. These cases were irradiated using more than 70 Gy. The following reasons for carotid artery rupture were suspected: 1. There was a tumor with deep ulceration and necrosis near the vessel. 2. The wall of the artery had radiation angitis. 3. The artery wall was necrotic because of invasion by the tumor. 4. Thrombosis developed with ensuant rupture of the artery. Radiotherapy for advanced cancer of the head and neck is necessary to control pain and as palliative treatment, but to avoid rupture of the carotid artery, pain clinic techniques and chemotherapy as palliative treatment for this kinds of terminal condition should also be considered. (author)

  4. A cost-effectiveness analysis of a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

    Directory of Open Access Journals (Sweden)

    Retèl Valesca P

    2011-11-01

    Full Text Available Abstract Background Concomitant chemo-radiotherapy (CCRT has become an indispensable organ, but not always function preserving treatment modality for advanced head and neck cancer. To prevent/limit the functional side effects of CCRT, special exercise programs are increasingly explored. This study presents cost-effectiveness analyses of a preventive (swallowing exercise program (PREP compared to usual care (UC from a health care perspective. Methods A Markov decision model of PREP versus UC was developed for CCRT in advanced head and neck cancer. Main outcome variables were tube dependency at one-year and number of post-CCRT hospital admission days. Primary outcome was costs per quality adjusted life years (cost/QALY, with an incremental cost-effectiveness ratio (ICER as outcome parameter. The Expected Value of Perfect Information (EVPI was calculated to obtain the value of further research. Results PREP resulted in less tube dependency (3% and 25%, respectively, and in fewer hospital admission days than UC (3.2 and 4.5 days respectively. Total costs for UC amounted to €41,986 and for PREP to €42,271. Quality adjusted life years for UC amounted to 0.68 and for PREP to 0.77. Based on costs per QALY, PREP has a higher probability of being cost-effective as long as the willingness to pay threshold for 1 additional QALY is at least €3,200/QALY. At the prevailing threshold of €20,000/QALY the probability for PREP being cost-effective compared to UC was 83%. The EVPI demonstrated potential value in undertaking additional research to reduce the existing decision uncertainty. Conclusions Based on current evidence, PREP for CCRT in advanced head and neck cancer has the higher probability of being cost-effective when compared to UC. Moreover, the majority of sensitivity analyses produced ICERs that are well below the prevailing willingness to pay threshold for an additional QALY (range from dominance till €45,906/QALY.

  5. Cetuximab Concomitant with Second-Line Radiation Therapy in Patients with Locally Advanced Recurrent Squamous Cell Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Muge Akmansu

    2010-12-01

    Full Text Available We presented 9 recurrent head and neck carcinoma patients. Priorly all of them had received radiochemotherapy. We used cetuximab and irradiation concomitantly. Overall survival analysis of the patients was performed using the Kaplan-Meier method on SPSS version 15.0. Based on this calculation, mean follow-up duration is 12.8 months. Mean survival time is 19.8 months and annual mean survival rate is 59.3%.

  6. CYP39A1 polymorphism is associated with toxicity during intensive induction chemotherapy in patients with advanced head and neck cancer

    International Nuclear Information System (INIS)

    Melchardt, Thomas; Hufnagl, Clemens; Magnes, Teresa; Weiss, Lukas; Hutarew, Georg; Neureiter, Daniel; Schlattau, Alexander; Moser, Gerhard; Gaggl, Alexander; Tränkenschuh, Wolfgang; Greil, Richard; Egle, Alexander

    2015-01-01

    Induction chemotherapy incorporating docetaxel, cisplatin and 5- fluorouracil before radiotherapy may improve the outcome of patients with advanced head and neck cancer. Nevertheless, the addition of docetaxel increases hematological toxicity and infectious complications. Therefore, genetic markers predicting toxicity and efficacy of this treatment regimen may help to identify patients, who would have the most benefit from this intensive treatment. A cohort of 78 patients with advanced head and neck cancer treated with induction chemotherapy was assessed for clinical outcome and toxicity during treatment with curative intention. Genetic polymorphisms primary associated with treatment efficacy (ERCC2-rs13181, rs1799793, ERCC1-rs3212986, rs11615, XRCC1-rs25487) or with docetaxel caused toxicity (CYP39A1-rs7761731, SLCO1B3-rs11045585) were evaluated in all patients. The results of these analyses were correlated with the clinical outcome of the patients (loco regional control, progression free survival, overall survival) and treatment related toxicity during induction chemotherapy. Median progression free survival and overall survival was 20 and 31 months in an intention to treat analysis, respectively. Overall response rate to induction chemotherapy was high with 78.1 % of all patients. None of the polymorphisms tested was associated with the clinical outcome of the patients. Genotype A of the CYP39A1 rs7761731 polymorphism was associated with a higher incidence of leucopenia and infections or death during induction chemotherapy. Intensive induction chemotherapy results in a high response rate in the majority of patients. None of the polymorphisms tested was associated with the clinical outcome of the patients. The CYP39A1 polymorphism rs7761731 may help to identify patients at high risk for treatment related toxicity

  7. Primary Tumor Volume Is an Important Predictor of Clinical Outcomes Among Patients With Locally Advanced Squamous Cell Cancer of the Head and Neck Treated With Definitive Chemoradiotherapy

    International Nuclear Information System (INIS)

    Strongin, Anna; Yovino, Susannah; Taylor, Rodney; Wolf, Jeffrey; Cullen, Kevin; Zimrin, Ann; Strome, Scott; Regine, William; Suntharalingam, Mohan

    2012-01-01

    Purpose: The tumor volume has been established as a significant predictor of outcomes among patients with head-and-neck cancer undergoing radiotherapy alone. The present study attempted to add to the existing data on tumor volume as a prognostic factor among patients undergoing chemoradiotherapy. Methods and Materials: A total of 78 patients who had undergone definitive chemoradiotherapy for Stage III-IV squamous cell cancer of the hypopharynx, oropharynx, and larynx were identified. The primary tumor volumes were calculated from the treatment planning computed tomography scans, and these were correlated to the survival and tumor control data obtained from the retrospective analysis. Results: The interval to progression correlated with the primary tumor volume (p = .007). The critical cutoff point for the tumor volume was identified as 35 cm 3 , and patients with a tumor volume 3 had a significantly better prognosis than those with a tumor volume >35 cm 3 at 5 years (43% vs. 71%, p = .010). Longer survival was also correlated with smaller primary tumor volumes (p = .022). Similarly, patients with a primary tumor volume 3 had a better prognosis in terms of both progression-free survival (61% vs. 33%, p = .004) and overall survival (84% vs. 41%, p = 3 larger than tumors without locoregional failure (p = .028) and 27.1-cm 3 larger than tumors that recurred as distant metastases (p = .020). Conclusion: The results of our study have shown that the primary tumor volume is a significant prognostic factor in patients with advanced cancer of the head and neck undergoing definitive chemoradiotherapy and correlated with the treatment outcomes better than the T or N stage.

  8. The Danish Head and Neck Cancer fast-track program

    DEFF Research Database (Denmark)

    Roennegaard, Anders B.; Rosenberg, Tine; Bjørndal, Kristine

    2018-01-01

    -track clinical pathway solutions. Objectives: The objectives of this study were 1) to present the setup of the head and neck cancer (HNC) fast-track program at Odense University Hospital (OUH) as an example of the Danish model and 2) to present patient characteristics, diagnostic outcome, cancer detection rate...

  9. Prolonged radiation time and low nadir hemoglobin during postoperative concurrent chemoradiotherapy are both poor prognostic factors with synergistic effect on locally advanced head and neck cancer patients

    Directory of Open Access Journals (Sweden)

    Su NW

    2015-01-01

    Full Text Available Nai-Wen Su,1 Chung-Ji Liu,2 Yi-Shing Leu,3 Jehn-Chuan Lee,3 Yu-Jen Chen,4 Yi-Fang Chang1,51Division of Medical Oncology and Hematology, Department of Internal Medicine, 2Department of Oral and Maxillofacial Surgery, 3Department of Otorhinolaryngology, 4Department of Radiation Oncology, 5Good Clinical Research Center, Department of Medical Research, Mackay Memorial Hospital, Taipei, TaiwanBackground: Anemia, a common complication of head and neck cancer treatment, is regarded as a poor prognostic factor. We evaluated the impact of low hemoglobin (Hb levels, measured at different time points, on a consecutive cohort of patients with locally advanced squamous cell carcinoma of the head and neck (LA-SCCHN who underwent postoperative concurrent chemoradiotherapy (CCRT.Materials and methods: From 2002 to 2009, 140 patients were enrolled and reviewed retrospectively. Preoperative (pre-op Hb, pre-CCRT Hb, and nadir Hb during CCRT were measured and recorded. The three Hb parameters were analyzed against several well-established pathologic risk factors and radiation-associated variables. Prognostic impacts were investigated with multivariate analysis by Cox proportional hazards model.Results: On Cox regression analysis, significantly higher risk of death was associated with pre-op Hb %13 g/dL (hazard ratio [HR] =1.8; 95% confidence interval [CI], 1.1–3.1; P=0.023, nadir Hb %11 g/dL (HR =1.9; 95% CI, 1.1–3.3; P=0.020, radiation treatment time (RTT >7 weeks (HR =1.9; 95% CI, 1.1–3.3; P=0.022, and multiple positive lymph nodes (HR =2.1; 95% CI, 1.2–3.7; P=0.010, after adjusting for primary tumor site and pathologic lymphovascular invasion. Patients with poor prognosticators including low nadir Hb %11 g/dL and RTT >7 weeks had a higher risk of death (HR =4.0; 95% CI =1.6–10.2; P=0.004.Conclusion: In the treatment setting of LA-SCCHN patients who underwent postoperative CCRT, coexistance of lower nadir Hb during CCRT and prolonged RTT resulted in

  10. IMRT for head and neck cancer: reducing xerostomia and dysphagia

    International Nuclear Information System (INIS)

    Wang, XiaoShen; Eisbruch, Avraham

    2016-01-01

    Dysphagia and xerostomia are the main sequellae of chemoradiotherapy for head and neck cancer, and the main factors in reducing long-term patient quality of life. IMRT uses advanced technology to focus the high radiation doses on the targets and avoid irradiation of non-involved tissues. The decisions about sparing organs and tissues whose damage causes xerostomia and dysphagia depends on the evidence for dose–response relationships for the organs causing these sequellae. This paper discusses the evidence for the contribution of radiotherapy to xerostomia via damage of the major salivary glands (parotid and submandibular) and minor salivary glands within the oral cavity, and the contribution of radiotherapy-related effect on important swallowing structures causing dysphagia. Recommendations for dose limits to these organs, based on measurements of xerostomia and dysphagia following radiotherapy, are provided here

  11. Supportive care for head and neck cancer patients receiving radiotherapy

    International Nuclear Information System (INIS)

    Zenda, Sadamoto

    2015-01-01

    Recently (chemo-)radiotherapy has been widely used in head and neck cancer with definite evidence. As long survivor has increased, social problems associated with late toxicity have become more. Late toxicities induced by radiotherapy for head and neck lesion are often severe. Xerostomia is one of the severe late toxicities conventionally and dysphagia after chemoradiotherapy is a new topic. Some industrial development (ex. Intensity Modulated Radiotherapy: IMRT) play a great role in toxicity management. Multidisciplinary approach (cooperation between not only physicians but also nurses and dentists) is necessary to control toxicities. The research of supportive care will be needed same as definitive treatment in the future. (author)

  12. Intensity-modulated radiotherapy vs. parotid-sparing 3D conformal radiotherapy. Effect on outcome and toxicity in locally advanced head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lambrecht, M.; Nevens, D.; Nuyts, S. [University Hospitals Leuven (Belgium). Dept. of Radiation Oncology

    2013-03-15

    Background and purpose: Intensity-modulated radiotherapy (IMRT) has rapidly become standard of care in the management of locally advanced head and neck squamous cell carcinoma (HNSCC). In this study, our aim was to retrospectively investigate the effect of the introducing IMRT on outcome and treatment-related toxicity compared to parotid-sparing 3D conformal radiotherapy (3DCRT). Material and methods: A total of 245 patients with stage III and IV HNSCC treated with primary radiotherapy between January 2003 and December 2010 were included in this analysis: 135 patients were treated with 3DCRT, 110 patients with IMRT. Groups were compared for acute and late toxicity, locoregional control (LRC), and overall survival (OS). Oncologic outcomes were estimated using Kaplan-Meier analysis and compared using a log-rank test. Acute toxicity was analyzed according to the Common Terminology Criteria for Adverse Events v3.0 and late toxicity was scored using the RTOG/EORTC late toxicity scoring system. Results: Median follow-up was 35 months in the IMRT group and 68 months in the 3DCRT group. No significant differences were found in 3-year LRC and OS rates between the IMRT group and 3DCRT group. Significantly less acute mucositis {>=} grade 3 was observed in the IMRT group (32% vs. 44%, p = 0.03). There was significantly less late xerostomia {>=} grade 2 in the IMRT group than in the 3DCRT group (23% vs. 68%, p < 0.001). After 24 months, there was less dysphagia {>=} grade 2 in the IMRT group although differences failed to reach statistical significance. Conclusion: The introduction of IMRT in the radiotherapeutic management of locally advanced head and neck cancer significantly improved late toxicity without compromising tumor control compared to a parotid-sparing 3D conformal radiotherapy technique. (orig.)

  13. Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70-75 Gy in 5 weeks for advanced head and neck cancer. A phase I dose escalation study

    Energy Technology Data Exchange (ETDEWEB)

    Cvek, J.; Skacelikova, E.; Otahal, B.; Halamka, M.; Feltl, D. [University Hospital Ostrava (Czech Republic). Dept. of Oncology; Kubes, J. [University Hospital Bulovka, Prague (Czech Republic). Dept. of Radiation Oncology; Kominek, P. [University Hospital Ostrava (Czech Republic). Dept. of Otolaryngology

    2012-08-15

    Background and purpose: The present study was performed to evaluate the feasibility of a new, 5-week regimen of 70-75 Gy hyperfractionated accelerated radiotherapy with concomitant integrated boost (HARTCIB) for locally advanced, inoperable head and neck cancer. Methods and materials: A total of 39 patients with very advanced, stage IV nonmetastatic head and neck squamous cell carcinoma (median gross tumor volume 72 ml) were included in this phase I dose escalation study. A total of 50 fractions intensity-modulated radiotherapy (IMRT) were administered twice daily over 5 weeks. Prescribed total dose/dose per fraction for planning target volume (PTV{sub tumor}) were 70 Gy in 1.4 Gy fractions, 72.5 Gy in 1.45 Gy fractions, and 75 Gy in 1.5 Gy fractions for 10, 13, and 16 patients, respectively. Uninvolved lymphatic nodes (PTV{sub uninvolved}) were irradiated with 55 Gy in 1.1 Gy fractions using the concomitant integrated boost. Results: Acute toxicity was evaluated according to the RTOG/EORTC scale; the incidence of grade 3 mucositis was 51% in the oral cavity/pharynx and 0% in skin and the recovery time was {<=} 9 weeks for all patients. Late toxicity was evaluated in patients in complete remission according to the RTOG/EORTC scale. No grade 3/4 late toxicity was observed. The 1-year locoregional progression-free survival was 50% and overall survival was 55%. Conclusion: HARTCIB (75 Gy in 5 weeks) is feasible for patients deemed unsuitable for chemoradiation. Acute toxicity was lower than predicted from radiobiological models; duration of dysphagia and confluent mucositis were particularly short. Better conformity of radiotherapy allows the use of more intensive altered fractionation schedules compared with older studies. These results suggest that further dose escalation might be possible when highly conformal techniques (e.g., stereotactic radiotherapy) are used.

  14. Public knowledge of head and neck cancer.

    LENUS (Irish Health Repository)

    O'Connor, T E

    2010-04-01

    Studies show 60% of patients with newly diagnosed Head & Neck Squamous Cell Cancer in Ireland, present with advanced disease. A poor level of knowledge and awareness among the public of Head & Neck Cancer, is an important consideration in the often delayed presentation for medical attention in many of these cases. Our study surveyed 200 members of the public to assess their knowledge and awareness of Head & Neck Cancer. One hundred and forty (70%) of respondents had never encountered the term "Head & Neck Cancer". One hundred and forty six (73%) failed to identify excessive alcohol consumption as a risk factor. Less than 100 (50%) would have concern about persisting hoarseness or a prolonged oral ulcer. An urgent need exists to raise awareness of Head & Neck Cancer among the public in Ireland.

  15. A cost-effectiveness analysis of using TheraBite in a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

    NARCIS (Netherlands)

    Retèl, Valesca P.; van der Molen, Lisette; Steuten, Lotte M. G.; van den Brekel, Michiel W.; Hilgers, Frans J. M.

    2016-01-01

    Previous studies have shown that a "Preventive Exercise Program" (PREP) is cost-effective compared to the standard exercise program provided in "Usual Care" (UC) in patients with advanced head and neck cancer. The current paper specifically estimates the cost-effectiveness of the TheraBite jaw

  16. A cost-effectiveness analysis of using TheraBite in a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

    NARCIS (Netherlands)

    Retèl, V.P.; van der Molen, L.; Steuten, L.M.G.; van den Brekel, M.W.; Hilgers, F.J.M.

    2015-01-01

    Previous studies have shown that a "Preventive Exercise Program" (PREP) is cost-effective compared to the standard exercise program provided in "Usual Care" (UC) in patients with advanced head and neck cancer. The current paper specifically estimates the cost-effectiveness of the TheraBite jaw

  17. A cost-effectiveness analysis of using TheraBite in a preventive exercise program for patients with advanced head and neck cancer treated with concomitant chemo-radiotherapy

    NARCIS (Netherlands)

    Retè, Valesca P.; van der Molen, Lisette; Steuten, Lotte M.G.; van den Brekel, Michiel W.; Hilgers, Frans J.M.

    2016-01-01

    Previous studies have shown that a “Preventive Exercise Program” (PREP) is cost-effective compared to the standard exercise program provided in “Usual Care” (UC) in patients with advanced head and neck cancer. The current paper specifically estimates the cost-effectiveness of the TheraBite jaw

  18. Morbidity And Quality Of Life Among Head And Neck Cancer ...

    African Journals Online (AJOL)

    Objectives: To determine the relative frequency of acute radiation morbidity and their perceived effect on quality of life among head and neck cancer patients treated with radical radiotherapy. Design: A cross-sectional study. Setting: Kenyatta National Hospital, Nairobi. Subjects: Thirty eight patients comprising 28 males and ...

  19. Preradiation dental decisions in patients with head and neck cancer

    NARCIS (Netherlands)

    Bruins, H.H. (Hubert Herman)

    2001-01-01

    This thesis presents a series of studies that investigated preradiation dental decision making in patients with head and neck cancer. In Chapter 1, it is ascertained that in view of the risk for oral sequelae resulting from high-dose radiotherapy, special attention to preradiation dental planning

  20. [Psychological care of patients with head and neck cancer].

    Science.gov (United States)

    Moya, Mélanie

    2015-09-01

    Treatments for head and neck cancers are generally complex and debilitating. Surgery, often mutilating, profoundly affects the relationship between oneself and others and causes verbal communication, breathing and swallowing difficulties. The functional and aesthetic sequelae are a constant reminder to the patient of the disease and make them conscious of their appearance. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. 10th International Symposium on Head And Neck Skin Cancer

    NARCIS (Netherlands)

    van den Brekel, Michiel W. M.; Balm, Alfons J. M.; Lohuis, Peter J. F. M.; van der Veen, J. P. Wietse

    2011-01-01

    Since 1993, ten multidisciplinary symposia were organized at The Netherlands Cancer Institute on the diagnosis and treatment of malignancies of the head and neck. The symposia are meant to provide up-to-date teaching for physicians by world-renowned speakers. The previous symposia dealt with

  2. Immunotherapy for head and neck cancer patients: shifting the balance

    NARCIS (Netherlands)

    Turksma, A.W.; Braakhuis, B.J.M.; Bloemena, E.; Meijer, C.J.L.M.; Leemans, C.R.; Hooijberg, E.

    2013-01-01

    Head and neck squamous cell carcinoma is the sixth most common cancer in the western world. Over the last few decades little improvement has been made to increase the relatively low 5-year survival rate. This calls for novel and improved therapies. Here, we describe opportunities in immunotherapy

  3. Morbidity of the neck after head and neck cancer therapy

    NARCIS (Netherlands)

    van Wilgen, C.P.; Dijkstra, P.U.; van der Laan, B.F.; Plukker, J.T.; Roodenburg, J.L.

    Background. Studies on morbidity of the neck after head and neck cancer therapy are scarcely described. Methods. Patients who underwent surgery, including neck dissection, with and without radiation therapy at least 1 year before the study were asked to participate. We assessed neck pain, loss of

  4. A review of scientific papers about head and neck cancers

    Energy Technology Data Exchange (ETDEWEB)

    Paoli, Severo de; Fonseca, Adenilson de Souza da; Paoli, Flavia de; Geller, Mauro [Centro Universitario Serra dos Orgaos, Teresopolis, RJ (Brazil)]. E-mail: severodepaoli@gmail.com; Presta, Giuseppe Antonio [Universidade Federal do Estado do Rio de Janeiro (UNIRIO), RJ (Brazil); Santos-Filho, Sebastiao David; Bernardo-Filho, Mario [Universidade do Estado do Rio de Janeiro (UERJ), RJ (Brazil). Inst. de Biologia Roberto Alcantara Gomes. Dept. de Biofisica e Biometria

    2008-12-15

    Head and neck cancer is one of the 10 most frequent cancers worldwide, with an estimated 500000 new cases diagnosed annually. Treatment of head and neck cancers require a multidisciplinary approach due their complexity and the functional and esthetic alterations that cancer can cause. The interest of the scientific community in a specific subject can be evaluated by analyzing of the number and the quality of published papers on the topic. The information obtained from PubMed (www.ncbi.nlm.nih.gov/sites/entrez) has been used as a tool in various publications to aid the evaluation of the scientific interest in specific research areas The aim of this work is to evaluate, using PubMed, the scientific interest in studies of head and neck cancer treatments such as radiotherapy, chemotherapy and surgery. The searches were performed on PubMed for publications from the period of 1949 to 2008 using the search terms 'head and neck cancer' and 'surgery' or 'radiotherapy' or 'chemotherapy'. The number of publications per year was determined in each search. The percentage of publications was also calculated for each subject in each year. An interest factor in a subject (IFS) was also determined. The number of publications was higher for surgery than chemotherapy or radiotherapy. The calculated 1964 IFS for surgery was 14.79, 12.74 for radiotherapy, and 19.58 for chemotherapy. The 1995 IFS for surgery was 1.99, 2.09 for radiotherapy, and 2.08 for chemotherapy. The relation obtained for 1995 was maintained in the subsequent years. There are more publications related to surgical treatment for head and neck cancer when compared with radiotherapy and chemotherapy. Moreover, in the recent years there has an increased interest in treatments utilizing chemotherapy, or this associated to radiotherapy. (author)

  5. A review of scientific papers about head and neck cancers

    International Nuclear Information System (INIS)

    Paoli, Severo de; Fonseca, Adenilson de Souza da; Paoli, Flavia de; Geller, Mauro; Presta, Giuseppe Antonio; Santos-Filho, Sebastiao David; Bernardo-Filho, Mario

    2008-01-01

    Head and neck cancer is one of the 10 most frequent cancers worldwide, with an estimated 500000 new cases diagnosed annually. Treatment of head and neck cancers require a multidisciplinary approach due their complexity and the functional and esthetic alterations that cancer can cause. The interest of the scientific community in a specific subject can be evaluated by analyzing of the number and the quality of published papers on the topic. The information obtained from PubMed (www.ncbi.nlm.nih.gov/sites/entrez) has been used as a tool in various publications to aid the evaluation of the scientific interest in specific research areas The aim of this work is to evaluate, using PubMed, the scientific interest in studies of head and neck cancer treatments such as radiotherapy, chemotherapy and surgery. The searches were performed on PubMed for publications from the period of 1949 to 2008 using the search terms 'head and neck cancer' and 'surgery' or 'radiotherapy' or 'chemotherapy'. The number of publications per year was determined in each search. The percentage of publications was also calculated for each subject in each year. An interest factor in a subject (IFS) was also determined. The number of publications was higher for surgery than chemotherapy or radiotherapy. The calculated 1964 IFS for surgery was 14.79, 12.74 for radiotherapy, and 19.58 for chemotherapy. The 1995 IFS for surgery was 1.99, 2.09 for radiotherapy, and 2.08 for chemotherapy. The relation obtained for 1995 was maintained in the subsequent years. There are more publications related to surgical treatment for head and neck cancer when compared with radiotherapy and chemotherapy. Moreover, in the recent years there has an increased interest in treatments utilizing chemotherapy, or this associated to radiotherapy. (author)

  6. A phase I study of dose-escalated chemoradiation with accelerated intensity modulated radiotherapy in locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Guerrero Urbano, Teresa; Clark, Catharine H.; Hansen, Vibeke N.; Adams, Elizabeth J.; A'Hern, Roger; Miles, Elizabeth A.; McNair, Helen; Bidmead, Margaret; Warrington, Alan P.; Dearnaley, David P.; Harrington, Kevin J.; Nutting, Christopher M.

    2007-01-01

    Background and purpose: Intensity modulated radiotherapy (IMRT) allows the delivery of higher and more homogeneous radiation dose to head and neck tumours. This study aims to determine the safety of dose-escalated chemo-IMRT for larynx preservation in locally advanced head and neck cancer. Methods: Patients with T2-4, N1-3, M0 squamous cell carcinoma of the larynx or hypopharynx were treated with a simultaneous-boost IMRT. Two radiation dose levels (DL) were tested: In DL 1, 63 Gy/28F was delivered to primary tumour and involved nodes and 51.8 Gy/28F to elective nodes. In DL 2, the doses were 67.2 Gy/28F and 56 Gy/28F, respectively, representing a 9% dose escalation for the primary. All patients received 2 cycles of neoadjuvant cisplatin and 5-fluorouracil, and concomitant cisplatin. Acute (NCICTCv.2.0) and late toxicity (RTOG and modified LENTSOM) were collected. Results: Thirty patients were entered, 15 in each dose level. All patients completed the treatment schedule. In DL 1, the incidences of acute G3 toxicities were 27% (pain), 20% (radiation dermatitis), 0% (xerostomia) and 67% required gastrostomy tubes. For DL 2 the corresponding incidences were 40%, 20%, 7%, and 87%. G3 dysphagia and pain persisted longer in DL 2. With regard to mucositis, a prolonged healing time for DL 2 was found, with prevalence of G2 of 58% in week 10. No acute grade 4 toxicity was observed. At 6 months, 1 patient in DL 2 had G3 late toxicity (dysphagia). No dose limiting toxicity was found. Complete response rates were 80% in DL 1, and 87% in DL 2. Conclusion: Moderately accelerated chemo-IMRT is safe and feasible with good compliance and acceptable acute toxicity. Dose escalation was possible without a significant difference in acute toxicity. Longer follow-up is required to determine the incidence of late radiation toxicities, and tumour control rates

  7. A value framework in head and neck cancer care.

    Science.gov (United States)

    de Souza, Jonas A; Seiwert, Tanguy Y

    2014-01-01

    The care of head and neck squamous cell carcinoma has greatly evolved over the past 30 years. From single modality to a multidisciplinary care, there has also been a concurrent increase in treatment intensity, resulting, at many times, in more zealous regimens that patients must endure. In this article, we apply Porter's value model as a framework to balance survival, toxicities, cost, and trade-offs from a patient's perspective in head and neck cancer. This model defines value as the health outcome per dollar achieved. Domains and outcomes that are important to patients, including not only survival or short-term quality of life, but also functional outcomes, recovery, sustainability of recovery, and the lasting consequences of therapy are included in this framework. Other outcomes that are seldom measured in head and neck cancer, such as work disability and financial toxicities, are also included and further discussed. Within this value model and based on evidence, we further discuss de-escalation of care, intensity-modulated radiation therapy, newer surgical methods, and enhancements in the process of care as potential approaches to add value for patients. Finally, we argue that knowing the patient's preferences is essential in the value discussion, as the attribute that will ultimately provide the most value to the individual patient with head and neck cancer.

  8. Head and neck cancer in South Asia: Macroeconomic consequences and the role of the head and neck surgeon.

    Science.gov (United States)

    Alkire, Blake C; Bergmark, Regan W; Chambers, Kyle; Lin, Derrick T; Deschler, Daniel G; Cheney, Mack L; Meara, John G

    2016-08-01

    Head and neck cancer constitutes a substantial portion of the burden of disease in South Asia, and there is an undersupply of surgical capacity in this region. The purpose of this study was to estimate the economic welfare losses due to head and neck cancer in India, Pakistan, and Bangladesh in 2010. We used publicly available estimates of head and neck cancer morbidity and mortality along with a concept termed the value of a statistical life to estimate economic welfare losses in the aforementioned countries in 2010. Economic losses because of head and neck cancer in India, Pakistan, and Bangladesh totaled $16.9 billion (2010 US dollars [USD]), equivalent to 0.26% of the region's economic output. Bangladesh, the poorest country, experienced the greatest proportional losses. The economic consequences of head and neck cancer in South Asia are significant, and building surgical capacity is essential to begin to address this burden. © 2016 Wiley Periodicals, Inc. Head Neck 38:1242-1247, 2016. © 2016 Wiley Periodicals, Inc.

  9. [Managment of head and neck cancers during pregnancy].

    Science.gov (United States)

    Kiciński, Krzysztof; Skorek, Andrzej; Stankiewicz, Czesław

    2011-01-01

    The coincidence of malignant disease during pregnancy is uncommon. The incidence of cancer in pregnancy has increased, due to the tendency to postpone childbirth to an older age. Cancer complicates approximately 0.1% of all pregnancies. Managing head and neck cancers during pregnancy requires additional pregnancy-related understanding of the aetiological effect of pregnancy on cancer, knowledge of the direct and indirect effects of cancer on pregnancy, and the effect of diagnostic and treatment modalities on pregnancy. The timing of treatment is an important determinant on foetal wellbeing. A multidisciplinary approach should be adopted to enable parents and clinicians to make the best clinical decision. Clinicians must be cognizant with the ethical dilemmas of treatment. In head and neck cancers, pregnancy has no effect on maternal prognosis when compared to non-pregnant patients matched by age, cancer stage and treatment. Copyright © 2011 Polish Otolaryngology Society. Published by Elsevier Urban & Partner (Poland). All rights reserved.

  10. Improving Therapeutic Ratio in Head and Neck Cancer with Adjuvant and Cisplatin-Based Treatments

    Directory of Open Access Journals (Sweden)

    Loredana G. Marcu

    2013-01-01

    Full Text Available Advanced head and neck cancers are difficult to manage despite the large treatment arsenal currently available. The multidisciplinary effort to increase disease-free survival and diminish normal tissue toxicity was rewarded with better locoregional control and sometimes fewer side effects. Nevertheless, locoregional recurrence is still one of the main reasons for treatment failure. Today, the standard of care in head and neck cancer management is represented by altered fractionation radiotherapy combined with platinum-based chemotherapy. Targeted therapies as well as chronotherapy were trialled with more or less success. The aim of the current work is to review the available techniques, which could contribute towards a higher therapeutic ratio in the treatment of advanced head and neck cancer patients.

  11. Sequential response patterns to chemotherapy and radiotherapy in head and neck cancer

    International Nuclear Information System (INIS)

    Hong, W.K.; O'Donoghue, G.M.; Sheetz, S.

    1985-01-01

    Surgery and/or radiotherapy have been the standard therapies for locally advanced squamous cell carcinoma of the head and neck region. Despite major improvement in these therapeutic techniques, the control rate in cases of advanced cancer remains poor. More recently, induction chemotherapy as initial treatment has been used in previously untreated squamous cell carcinoma of the head and neck. For the last 6 years at the Boston Veterans Administration (V.A.) Medical Center, initial induction chemotherapy followed by surgery and/or radiotherapy has been employed in the treatment of advanced head and neck cancer. The use of chemotherapy and radiotherapy has allowed the authors to monitor and correlate sequential response patterns produced by each modality of treatment. The authors have observed that responders to chemotherapy can be predicted to have further response to subsequent radiotherapy

  12. Prevalence and clinical significance of cancer cachexia based on time from treatment in advanced-stage head and neck squamous cell carcinoma.

    Science.gov (United States)

    Kwon, Minsu; Kim, Rock Bum; Roh, Jong-Lyel; Lee, Sang-Wook; Kim, Sung-Bae; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

    2017-04-01

    The purpose of this study was to identify the prevalence of cancer cachexia and its prognostic impact in patients with advanced head and neck squamous cell carcinoma (HNSCC). The prevalence of cancer cachexia was analyzed according to the follow-up periods during the first year after curative initial treatment. Recurrences, noncancer health events (NCHEs), and cause-specific survival outcomes were also analyzed according to the incidence of cancer cachexia during follow-up. Cancer cachexia was identified in 22 (6.1%), 148 (41%), 66 (18.4%), and 65 (18.7%) of 361 enrolled patients at pretreatment, immediately after treatment, 6-months after treatment, and 12-months after treatment, respectively. Sustained or newly developed cachexia at 6 and 12 months showed a significant association with recurrence and NCHE occurrence (p cachexia had a higher probability of cancer-specific death, noncancerous death, and overall death (p Cachexia prevalence at 6 and 12 months after treatment for HNSCC indicates a higher chance of recurrence, NCHE, and death. © 2016 Wiley Periodicals, Inc. Head Neck 39: 716-723, 2017. © 2016 Wiley Periodicals, Inc.

  13. Head and Neck Cancer: Symptoms and Signs

    Science.gov (United States)

    ... to Content ASCO.org Conquer Cancer Foundation ASCO Journals Donate eNews Signup f Cancer.net on Facebook t Cancer.net on Twitter q Cancer.net on YouTube g Cancer.net on Google Menu Home Types of Cancer Navigating Cancer Care Coping With Cancer Research and Advocacy Survivorship Blog About ...

  14. Cryotherapy and radiotherapy combination in extensive and recurrent types of head and neck skin cancer treatment

    International Nuclear Information System (INIS)

    Pustynskij, I.N.; Paches, A.I.; Tkachev, S.I.; Tabolinovskaya, T.D.; Alieva, S.B.; Yagubov, A.S.; Slanina, S.V.; Bazhutova, G.A.

    2007-01-01

    The method of infiltrative skin cancer treatment based on different variants of radiotherapy and cryotherapy combination is described. During the period of 1988-2006 the Department of head and neck neoplasms of N. N. Blohin Russian Cancer Research Center provided radiation and cryogenic treatment of 94 patients with locally advanced head and neck epidermoid and basal cell cancer. For this purpose before every radiotherapy session the tumor was exposed to cryo cooling till freezing temperature (-5 degrees C). The total involution of tumors was observed at 91 patients. Residual tumors were removed surgically. The follow-up showed good functional and aesthetic results, retention of local tissues.

  15. High response rates following paclitaxel/5-FU and simultaneous radiotherapy in advanced head and neck carcinoma

    International Nuclear Information System (INIS)

    Schroeder, M.; Westerhausen, M.; Makoski, H.B.; Sesterhenn, K.; Schroeder, R.

    1997-01-01

    The main stay of treatment for head and neck cancer patients with advanced disease has been chemotherapy with Cisplatin/5-FU and simultaneous applied radiotherapy. With this multimodality treatment including radical surgery after two cycles of neoadjuvant chemotherapy and 40 Gy radiotherapy we reported 60% complete remission after 5 years for patients with stage III/IV of head and neck cancer. Paclitaxel, a new plant product, has demonstrated significant antineoplastic activity in head and neck tumors (ECOG-Study: 40% RR). Therefore we performed a trial with Taxol/5-FU and simultaneous radiation in a neoadjuvant and postoperative adjuvant setting of stage III/IV squamous cell carcinoma of the head and neck with pre-existent contraindication against Cisplatin. Patients and Methods: 30 patients with a primarily inoperable stage III/IV of SCC of the head and neck were enrolled to receive day 1 and 29 Taxol 175 mg/m 2 as a 3-hour-infusion, followed by 120-hour-cvi of 1000 mg/m 2 /d 5-FU. Locally irradiation was given ad 40 Gy (2 Gy/d/day 1-26). Radical surgery followed about day 56. Postoperatively patients received again 2 cycles of Taxol/5-FU and simultaneous irradiation with 30 Gy. Results: So far 30 patients were treated and all patients reached a CR after complete treatment, ongoing for 23/30 patients for 6 till 34 months: 4 patients developed a second neoplasia, and 3 patients gloved a local relapse. The principal toxicity was moderate (neutropenia, peripheral neuropathy, arthralgia/myalgia) and sensible with supportive care (e.g. PEG). Conclusions: The results suggest that the treatment of SCC of the head and neck with Taxol/5-FU and simultaneous radiation and radical surgery is a highly effective schedule and comparable with the treatment with Cisplatin/5-FU. (orig.) [de

  16. The Anatomical Biological Value on Pretreatment (18)F-fluorodeoxyglucose Positron Emission Tomography Computed Tomography Predicts Response and Survival in Locally Advanced Head and Neck Cancer.

    Science.gov (United States)

    Ashamalla, Hani; Mattes, Malcolm; Guirguis, Adel; Zaidi, Arifa; Mokhtar, Bahaa; Tejwani, Ajay

    2014-05-01

    (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has become increasingly relevant in the staging of head and neck cancers, but its prognostic value is controversial. The objective of this study was to evaluate different PET/CT parameters for their ability to predict response to therapy and survival in patients treated for head and neck cancer. A total of 28 consecutive patients with a variety of newly diagnosed head and neck cancers underwent PET/CT scanning at our institution before initiating definitive radiation therapy. All underwent a posttreatment PET/CT to gauge tumor response. Pretreatment PET/CT parameters calculated include the standardized uptake value (SUV) and the anatomical biological value (ABV), which is the product of SUV and greatest tumor diameter. Maximum and mean values were studied for both SUV and ABV, and correlated with response rate and survival. The mean pretreatment tumor ABVmax decreased from 35.5 to 7.9 (P = 0.0001). Of the parameters tested, only pretreatment ABVmax was significantly different among those patients with a complete response (CR) and incomplete response (22.8 vs. 65, respectively, P = 0.021). This difference was maximized at a cut-off ABVmax of 30 and those patients with ABVmax < 30 were significantly more likely to have a CR compared to those with ABVmax of ≥ 30 (93.8% vs. 50%, respectively, P = 0.023). The 5-year overall survival was 80% compared to 36%, respectively, (P = 0.028). Multivariate analysis confirmed that ABVmax was an independent prognostic factor. Our data supports the use of PET/CT, and specifically ABVmax, as a prognostic factor in head and neck cancer. Patients who have an ABVmax ≥ 30 were more likely to have a poor outcome with chemoradiation alone, and a more aggressive trimodality approach may be indicated in these patients.

  17. Moving Toward Bioadjuvant Approaches to Head and Neck Cancer Prevention

    International Nuclear Information System (INIS)

    Saba, Nabil F.; Hammond, Anthea; Shin, Dong M.; Khuri, Fadlo R.

    2007-01-01

    Head and neck squamous cell carcinoma affects >45,000 Americans annually. Patients who are successfully treated for their primary tumor are at high risk of developing a second primary tumor, making effective preventive strategies highly desirable for this disease. Although a landmark study in 1990 suggested some benefit of high-dose retinoids in head and neck cancer prevention, subsequent trials using more tolerable doses have shown limited clinical success. Newer preventive strategies have included bioadjuvant therapy combining retinoids with interferon and α-tocopherol, combinations of molecularly targeted agents, and oncolytic viruses. Furthermore, considerable evidence has supported a cancer protective role for several nutrients, including green tea and curcumin analogs. Natural compounds such as these with favorable long-term safety profiles might be particularly suited to the cancer prevention setting, in which patients will usually tolerate only moderate risk and toxicity

  18. Genome Stability Pathways in Head and Neck Cancers

    Directory of Open Access Journals (Sweden)

    Glenn Jenkins

    2013-01-01

    Full Text Available Genomic instability underlies the transformation of host cells toward malignancy, promotes development of invasion and metastasis and shapes the response of established cancer to treatment. In this review, we discuss recent advances in our understanding of genomic stability in squamous cell carcinoma of the head and neck (HNSCC, with an emphasis on DNA repair pathways. HNSCC is characterized by distinct profiles in genome stability between similarly staged cancers that are reflected in risk, treatment response and outcomes. Defective DNA repair generates chromosomal derangement that can cause subsequent alterations in gene expression, and is a hallmark of progression toward carcinoma. Variable functionality of an increasing spectrum of repair gene polymorphisms is associated with increased cancer risk, while aetiological factors such as human papillomavirus, tobacco and alcohol induce significantly different behaviour in induced malignancy, underpinned by differences in genomic stability. Targeted inhibition of signalling receptors has proven to be a clinically-validated therapy, and protein expression of other DNA repair and signalling molecules associated with cancer behaviour could potentially provide a more refined clinical model for prognosis and treatment prediction. Development and expansion of current genomic stability models is furthering our understanding of HNSCC pathophysiology and uncovering new, promising treatment strategies.

  19. Genome Stability Pathways in Head and Neck Cancers

    Science.gov (United States)

    O'Byrne, Kenneth J.; Panizza, Benedict; Richard, Derek J.

    2013-01-01

    Genomic instability underlies the transformation of host cells toward malignancy, promotes development of invasion and metastasis and shapes the response of established cancer to treatment. In this review, we discuss recent advances in our understanding of genomic stability in squamous cell carcinoma of the head and neck (HNSCC), with an emphasis on DNA repair pathways. HNSCC is characterized by distinct profiles in genome stability between similarly staged cancers that are reflected in risk, treatment response and outcomes. Defective DNA repair generates chromosomal derangement that can cause subsequent alterations in gene expression, and is a hallmark of progression toward carcinoma. Variable functionality of an increasing spectrum of repair gene polymorphisms is associated with increased cancer risk, while aetiological factors such as human papillomavirus, tobacco and alcohol induce significantly different behaviour in induced malignancy, underpinned by differences in genomic stability. Targeted inhibition of signalling receptors has proven to be a clinically-validated therapy, and protein expression of other DNA repair and signalling molecules associated with cancer behaviour could potentially provide a more refined clinical model for prognosis and treatment prediction. Development and expansion of current genomic stability models is furthering our understanding of HNSCC pathophysiology and uncovering new, promising treatment strategies. PMID:24364026

  20. Chemotherapy and radiotherapy for elderly head and neck cancer patients

    International Nuclear Information System (INIS)

    Fujii, Masato

    2012-01-01

    Among head and neck cancers, cases affecting elderly people are increasing. Radical treatment is sometimes difficult in advanced cases of elderly patients. With progressive cancer, because radical surgery is often difficult, radiotherapy is chosen and may be used together with chemotherapy when overall status is good. However, according to the meta-analysis of Pignon et al., the chemoradiotherapy for elderly patients 71 years old or older, the hazard ratio becomes approximately 0.95, and there is little chemotherapy combined effect. In terms of 5-year survival rate, chemotherapy combined effect is -0.7%. Chemotherapy effect in elderly patients is not clear in past clinical trials. We examined 50 cases 75 years or older treated mainly by radiotherapy at Tokyo Medical Center between February, 2003 and August, 2011. In all, 21 of the 50 patients died, including four who died due to other cancers, while pneumonia accounted for five other deaths. These results suggested that various complications are often present and multiple primary cancers often occur in elderly people. With chemotherapy for elderly people, the effect of radiotherapy treatment and quality of life of the patients should be considered fully based on characteristics of elderly people, and a treatment plan devised accordingly. It is also necessary to undertake care after treatment. (author)

  1. Concomitant Cisplatin and Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: 10-Year Follow-Up of a Randomized Phase III Trial (SAKK 10/94)

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Simcock, Mathew; Studer, Gabriela; Allal, Abdelkarim S.; Ozsahin, Mahmut; Bernier, Jacques; Töpfer, Michael; Zimmermann, Frank; Betz, Michael; Glanzmann, Christoph; Aebersold, Daniel M.

    2012-01-01

    Purpose: To compare the long-term outcome of treatment with concomitant cisplatin and hyperfractionated radiotherapy versus treatment with hyperfractionated radiotherapy alone in patients with locally advanced head and neck cancer. Methods and Materials: From July 1994 to July 2000, a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to receive either hyperfractionated radiotherapy alone (median total dose, 74.4 Gy; 1.2 Gy twice daily; 5 days per week) or the same radiotherapy combined with two cycles of cisplatin (20 mg/m 2 for 5 consecutive days during weeks 1 and 5). The primary endpoint was the time to any treatment failure; secondary endpoints were locoregional failure, metastatic failure, overall survival, and late toxicity assessed according to Radiation Therapy Oncology Group criteria. Results: Median follow-up was 9.5 years (range, 0.1–15.4 years). Median time to any treatment failure was not significantly different between treatment arms (hazard ratio [HR], 1.2 [95% confidence interval {CI}, 0.9–1.7; p = 0.17]). Rates of locoregional failure-free survival (HR, 1.5 [95% CI, 1.1–2.1; p = 0.02]), distant metastasis-free survival (HR, 1.6 [95% CI, 1.1–2.5; p = 0.02]), and cancer-specific survival (HR, 1.6 [95% CI, 1.0–2.5; p = 0.03]) were significantly improved in the combined-treatment arm, with no difference in major late toxicity between treatment arms. However, overall survival was not significantly different (HR, 1.3 [95% CI, 0.9–1.8; p = 0.11]). Conclusions: After long-term follow-up, combined-treatment with cisplatin and hyperfractionated radiotherapy maintained improved rates of locoregional control, distant metastasis-free survival, and cancer-specific survival compared to that of hyperfractionated radiotherapy alone, with no difference in major late toxicity.

  2. Analysis of carotid artery deformation in different head and neck positions for maxillofacial catheter navigation in advanced oral cancer treatment

    Directory of Open Access Journals (Sweden)

    Ohya Takashi

    2012-09-01

    Full Text Available Abstract Background To improve the accuracy of catheter navigation, it is important to develop a method to predict shifts of carotid artery (CA bifurcations caused by intraoperative deformation. An important factor affecting the accuracy of electromagnetic maxillofacial catheter navigation systems is CA deformations. We aimed to assess CA deformation in different head and neck positions. Methods Using two sets of computed tomography angiography (CTA images of six patients, displacements of the skull (maxillofacial segments, C1–C4 cervical vertebrae, mandible (mandibular segment, and CA along with its branches were analyzed. Segmented rigid bones around CA were considered the main causes of CA deformation. After superimposition of maxillofacial segments, C1–C4 and mandible segments were superimposed separately for displacement measurements. Five bifurcation points (vA–vE were assessed after extracting the CA centerline. A new standardized coordinate system, regardless of patient-specific scanning positions, was employed. It was created using the principal axes of inertia of the maxillofacial bone segments of patients. Position and orientation parameters were transferred to this coordinate system. CA deformation in different head and neck positions was assessed. Results Absolute shifts in the center of gravity in the bone models for different segments were C1, 1.02 ± 0.9; C2, 2.18 ± 1.81; C3, 4.25 ± 3.85; C4, 5.90 ± 5.14; and mandible, 1.75 ± 2.76 mm. Shifts of CA bifurcations were vA, 5.52 ± 4.12; vB, 4.02 ± 3.27; vC, 4.39 ± 2.42; vD, 4.48 ± 1.88; and vE, 2.47 ± 1.32. Displacements, position changes, and orientation changes of C1–C4 segments as well as the displacements of all CA bifurcation points were similar in individual patients. Conclusions CA deformation was objectively proven as an important factor contributing to errors in maxillofacial navigation. Our study results suggest that

  3. Hypofractionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment - 'Hypo Trial'

    International Nuclear Information System (INIS)

    Porceddu, Sandro V.; Rosser, Brenda; Burmeister, Bryan H.; Jones, Mark; Hickey, Brigid; Baumann, Kacy; Gogna, Kumar; Pullar, Andrew; Poulsen, Michael; Holt, Tanya

    2007-01-01

    Background and purpose: The primary purpose of the trial was to assess rate of tumour response to a hypofractionated course of radiotherapy in patients with incurable squamous cell carcinoma of the head and neck (HNSCC). Secondary objectives included radiation toxicity, symptom control, quality of life (QoL) and progression-free and overall survival. Patients and methods: Patients were planned to receive 30 Gy in 5 fractions at 2/week, at least 3 days apart, with an additional boost of 6 Gy for small volume disease (≤3 cm) in suitable patients. Thirty-seven patients were enrolled between August 2004 and March 2006. Median age was 68 (43-87) years, 81% were male and the predominant primary site was oropharynx (32%). The majority (73%) presented with Stage III-IV disease. Results: Thirty-five patients received radiotherapy, 1 died prior to treatment and one refused treatment. Of the 35 patients receiving radiotherapy, 31 (88%) received ≥30 Gy. Of the 35 patients who received treatment the overall objective response was 80%. Grade 3 mucositis and dysphagia were experienced in 9/35 (26%) and 4/35 (11%), respectively. QoL and symptom control were assessable in 21 patients. Thirteen (62%) reported an overall improvement in QoL and 14 (67%) experienced an improvement in pain. The median time to progression and death was 3.9 and 6.1 months, respectively. Conclusion: The 'Hypo Trial' regimen provided effective palliative treatment in HNSCC unsuitable for curative treatment. Compliance was excellent and resulted in high response rates, symptom control and improvement in QoL with acceptable toxicity. However, progression free and overall survival was short

  4. Hearing loss due to concurrent daily low-dose cisplatin chemoradiation for locally advanced head and neck cancer

    International Nuclear Information System (INIS)

    Zuur, Charlotte L.; Simis, Yvonne J.W.; Verkaik, Roxanna S.; Schornagel, Jan H.; Balm, Alfons J.M.; Dreschler, Wouter A.; Rasch, Coen R.N.

    2008-01-01

    Background and purpose: Cisplatin-based chemo-irradiation (CRT) is increasingly used for head and neck squamous cell carcinoma (HNSCC). We aimed to assess hearing deterioration due to low-dose cisplatin chemoradiation and to compare the observed hearing loss with hearing loss in our previously described high-dose cisplatin CRT cohort. Materials and methods: A prospective analysis of hearing thresholds at low and (ultra)-high frequencies obtained before and after treatment in 60 patients. Patients received low-dose cisplatin (6 mg/m 2 , daily infusions, 20-25 days) with concomitant accelerated radiotherapy (70 Gy). Results: Audiometry up to 16 kHz was performed before therapy and 31 days (median) post-treatment. The total incidence of ototoxicity in CTCAEv3.0 was 31% in audiograms up to 8 kHz, and 5% of ears tested qualified for HAs due to treatment. The mean hearing loss at speech frequencies was 2.6 dB (SD 5.7) and 2.3 dB (SD 9.2) at PTA 1-2-4 kHz air-conduction and bone-conduction, respectively. The mean hearing loss at ultra-high frequencies (PTA AC 8-10-12.5 kHz) was 9.0 dB (SD 8.1). Low-dose cisplatin CRT caused less acute hearing loss (CTCAE 31%), compared to high-dose cisplatin CRT (CTCAE 78%). Conclusions: Low-dose cisplatin chemo-irradiation for HNSCC is a relatively safe treatment protocol with respect to ototoxicity

  5. Metabolic microscopy of head and neck cancer organoids

    Science.gov (United States)

    Shah, Amy T.; Skala, Melissa C.

    2016-03-01

    Studies for head and neck cancer have primarily relied on cell lines or in vivo animal studies. However, a technique that combines the benefits of high-throughput in vitro studies with a complex, physiologically relevant microenvironment would be advantageous for understanding drug effects. Organoids provide a unique platform that fulfills these goals. Organoids are generated from excised and digested tumor tissue and are grown in culture. Fluorescence microscopy provides high-resolution images on a similar spatial scale as organoids. In particular, autofluorescence imaging of the metabolic cofactors NAD(P)H and FAD can provide insight into response to anti-cancer treatment. The optical redox ratio reflects relative amounts of NAD(P)H and FAD, and the fluorescence lifetime reflects enzyme activity of NAD(P)H and FAD. This study optimizes and characterizes the generation and culture of organoids grown from head and neck cancer tissue. Additionally, organoids were treated for 24 hours with a standard chemotherapy, and metabolic response in the organoids was measured using optical metabolic imaging. Ultimately, combining head and neck cancer organoids with optical metabolic imaging could be applied to test drug sensitivity for drug development studies as well as treatment planning for cancer patients.

  6. The role of EGFR-targeting strategies in the treatment of head and neck cancer

    Directory of Open Access Journals (Sweden)

    Dequanter D

    2012-07-01

    Full Text Available Didier Dequanter, Mohammad Shahla, Pascal Paulus, Philippe H LothaireDepartment of Surgery, CHU Charleroi (Hopital Andre Vésale, Montigny le Tilleul, BelgiumAbstract: With its targeted mechanism of action and synergistic activity with current treatment modalities, cetuximab is a potentially valuable treatment option for patients with recurrent and/or metastatic squamous cell cancer of the head and neck who have progressed on cisplatin-based chemotherapy. The use of cetuximab in combination with radiotherapy as definitive treatment for locoregionally advanced squamous cell cancer of the head and neck is generally restricted to patients unfit to receive cisplatin-based chemoradiation, which is still considered the standard of care. The effect of this epidermal growth factor receptor antagonist occurs without any change in the pattern and the severity of toxicity usually associated with head and neck radiation.Keywords: cetuximab, SCCHN, radiotherapy

  7. Taste dysfunction in irradiated patients with head and neck cancer

    International Nuclear Information System (INIS)

    Zheng, Wen-Kai; Yamamoto, Tomoya; Komiyama, Sohtaro

    2002-01-01

    Taste disorders caused by radiation therapy for head and neck cancer are common. This prospective study of 40 patients with head and neck cancer assessed changes in taste sensations during radiation therapy. The relationship between the time course and the degree of taste disorder was studied. The taste recognition threshold and supra-threshold taste intensity performance for the four basic tastes were measured using the whole-mouth taste method before, during, and after radiation therapy. Bitter taste was affected most. An increase in threshold for sweet taste depended upon whether the tip of tongue was included within the radiation field. The slope of the taste intensity performance did not change during or after radiotherapy. The pattern of salivary dysfunction was different from that of taste dysfunction. The main cause of taste disorders during radiation support the hypothesis that taste dysfunction is due to damage to the taste buds in the radiation field. (author)

  8. Taste dysfunction in irradiated patients with head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Wen-Kai; Yamamoto, Tomoya; Komiyama, Sohtaro [Kyushu Univ., Fukuoka (Japan). Faculty of Medicine; Inokuchi, Akira [Saga Medical School (Japan)

    2002-04-01

    Taste disorders caused by radiation therapy for head and neck cancer are common. This prospective study of 40 patients with head and neck cancer assessed changes in taste sensations during radiation therapy. The relationship between the time course and the degree of taste disorder was studied. The taste recognition threshold and supra-threshold taste intensity performance for the four basic tastes were measured using the whole-mouth taste method before, during, and after radiation therapy. Bitter taste was affected most. An increase in threshold for sweet taste depended upon whether the tip of tongue was included within the radiation field. The slope of the taste intensity performance did not change during or after radiotherapy. The pattern of salivary dysfunction was different from that of taste dysfunction. The main cause of taste disorders during radiation support the hypothesis that taste dysfunction is due to damage to the taste buds in the radiation field. (author)

  9. Epidemiology and Molecular Biology of Head and Neck Cancer.

    Science.gov (United States)

    Jou, Adriana; Hess, Jochen

    2017-01-01

    Head and neck cancer is a common and aggressive malignancy with a high morbidity and mortality profile. Although the large majority of cases resemble head and neck squamous cell carcinoma (HNSCC), the current classification based on anatomic site and tumor stage fails to capture the high level of biologic heterogeneity, and appropriate clinical management remains a major challenge. Hence, a better understanding of the molecular biology of HNSCC is urgently needed to support biomarker development and personalized care for patients. This review focuses on recent findings based on integrative genomics analysis and multi-scale modeling approaches and how they are beginning to provide more sophisticated clues as to the biological and clinical diversity of HNSCC. © 2017 S. Karger GmbH, Freiburg.

  10. Early Prediction of Outcome in Advanced Head-and-Neck Cancer Based on Tumor Blood Volume Alterations During Therapy: A Prospective Study

    International Nuclear Information System (INIS)

    Cao Yue; Popovtzer, Aron; Li, Diana; Chepeha, Douglas B.; Moyer, Jeffrey S.; Prince, Mark E.; Worden, Francis; Teknos, Theodoros; Bradford, Carol; Mukherji, Suresh K.; Eisbruch, Avraham

    2008-01-01

    Purpose: To assess whether alterations in tumor blood volume (BV) and blood flow (BF) during the early course of chemo-radiotherapy (chemo-RT) for head-and-neck cancer (HNC) predict treatment outcome. Methods and Materials: Fourteen patients receiving concomitant chemo-RT for nonresectable, locally advanced HNC underwent dynamic contrast-enhanced (DCE) MRI scans before therapy and 2 weeks after initiation of chemo-RT. The BV and BF were quantified from DCE MRI. Preradiotherapy BV and BF, as well as their changes during RT, were evaluated separately in the primary gross tumor volume (GTV) and nodal GTV for association with outcomes. Results: At a median follow-up of 10 months (range, 5-27 months), 9 patients had local-regional controlled disease. One patient had regional failure, 3 had local failures, and 1 had local-regional failure. Reduction in tumor volume after 2 weeks of chemo-RT did not predict for local control. In contrast, the BV in the primary GTV after 2 weeks of chemo-RT was increased significantly in the local control patients compared with the local failure patients (p < 0.03). Conclusions: Our data suggest that an increase in available primary tumor blood for oxygen extraction during the early course of RT is associated with local control, thus yielding a predictor with potential to modify treatment. These findings require validation in larger studies

  11. Phase I and II trial of five-day infused 5-fluorouracil and radiation in advanced cancer of the head and neck

    International Nuclear Information System (INIS)

    Byfield, J.E.; Sharp, T.R.; Frankel, S.S.; Tang, S.G.; Callipari, F.B.

    1984-01-01

    Eighteen patients with advanced epithelial cancers of the head and neck region were studied for their tolerance and response to combined cycles of 120-hour infused 5-fluorouracil (5-FU) and external-beam radiation therapy. 5-FU infusions were given under conditions where radiosensitization would be expected at the higher infusion doses. Coincident radiation treatments were given as four sequential daily fractions of 250 rad each administered during days 1 through 4 of each five-day infusion cycle. The patients were rested for at least nine days after each cycle or longer until toxicity was resolved. The regimen was then repeated in each patient for a total of five treatment cycles. Thereafter therapy was consolidated, usually by boost radiation without drug. In sequential patient subsets the infusion load was progressively escalated in a phase I format. The complete response rate for stage IV patients was 75% with survival benefit compared to prior results. 5-FU dose-dependent combined modality loco-regional toxicity was demonstrated without significant enhancement of systemic toxicity of any form; 5-FU dose-dependent enhanced responsiveness and survival benefit is also suggested. Further scheduling and response studies of 5-FU under radiosensitizing conditions appear warranted

  12. Feasibility and efficacy of accelerated weekly concomitant boost postoperative radiation therapy combined with concomitant chemotherapy in patients with locally advanced head and neck cancer.

    Science.gov (United States)

    Pehlivan, Berrin; Luthi, Francois; Matzinger, Oscar; Betz, Michael; Dragusanu, Daniela; Bulling, Shelley; Bron, Luc; Pasche, Philippe; Seelentag, Walter; Mirimanoff, René O; Zouhair, Abderrahim; Ozsahin, Mahmut

    2009-05-01

    The aim of this study was to assess feasibility and efficacy of weekly concomitant boost accelerated postoperative radiation therapy (PORT) with concomitant chemotherapy (CT) in patients with locally advanced head and neck cancer (LAHNC). Conformal or intensity-modulated 66-Gy RT was performed in 5.5 weeks in 40 patients. Cisplatin was given at days 1, 22, and 43. Median follow-up was 36 months. Grade 3 mucositis, dysphagia, and erythema was observed in ten (25%), nine (23%), and six (13%) patients, respectively. Grade 3 or more anemia was observed in two (6%) patients, and leukopenia in five (13%) patients. No grade 3 or 4 thrombocytopenia was observed. Grade 3 nephrotoxicity was observed in one patient (3%). No treatment-related mortality was observed. Grade 2 or more xerostomia and edema were observed in ten (25%) and one (3%) patient, respectively. Locoregional relapse occurred in eight patients, and seven patients developed distant metastases. Median time to locoregional relapse was 6 months. Three-year overall, disease-free survival, and locoregional control rates were 63%, 62%, and 81%, respectively. Multivariate analysis revealed that the only prognostic factor was nodal status. Reducing overall treatment time using accelerated PORT/CT by weekly concomitant boost (six fractions per week) combined with concomitant cisplatin CT is easily feasible with acceptable morbidity.

  13. Pulmonary complication associated with head and neck cancer surgery

    International Nuclear Information System (INIS)

    Manzoor, T.; Ahmed, Z.; Sheikh, N.A.; Khan, M.M.

    2007-01-01

    To evaluate the frequency of short-term pulmonary complications in the patients undergoing various head and neck cancer surgeries in our setup and to assess possible risk factors responsible for these complications. Seventy patients of age group 20 to 80 years, regardless of gender, treated surgically for head and neck cancers were enrolled. Main outcome measures included development of pulmonary complications following 15 days of oncological surgery. The complications studied were pneumothorax, bronchopneumonia, atelectasis, pulmonary embolism and cardiopulmonary arrest. A total of 24.28% patients suffered from postoperative pulmonary complications; 17.14% developed bronchopneumonia, 5.71% pulmonary embolism, and 1.42% went into cardiopulmonary arrest, none developed pneumothorax or pulmonary atelectasis. A significant correlation of postoperative bronchopneumonia was seen with heavy smoking and assisted ventilation. Pulmonary embolism was associated with extended assisted ventilation and prolonged surgery. Cardiopulmonary arrest was associated with comorbidity and assisted ventilation after surgery. The frequency of bronchopneumonia supersedes all of the postoperative pulmonary complications in head and neck oncological surgery. Patients at risk of developing postoperative complications are heavy smokers, diabetics, those undergoing prolonged surgery, tracheostomy, and extended assisted ventilation. (author)

  14. Treatment of late sequelae after radiotherapy for head and neck cancer

    NARCIS (Netherlands)

    Strojan, Primož; Hutcheson, Katherine A; Eisbruch, Avraham; Beitler, Jonathan J; Langendijk, Johannes A; Lee, Anne W M; Corry, June; Mendenhall, William M; Smee, Robert; Rinaldo, Alessandra; Ferlito, Alfio

    Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many

  15. Molecular Imaging and Precision Medicine in Head and Neck Cancer.

    Science.gov (United States)

    Mena, Esther; Thippsandra, Shwetha; Yanamadala, Anusha; Redy, Siddaling; Pattanayak, Puskar; Subramaniam, Rathan M

    2017-01-01

    The concept of using tumor genomic profiling information has revolutionized personalized cancer treatment. Head and neck (HN) cancer management is being influenced by recent discoveries of activating mutations in epidermal growth factor receptor and related targeted therapies with tyrosine kinase inhibitors, targeted therapies for Kristen Rat Sarcoma, and MET proto-oncogenes. Molecular imaging using PET plays an important role in assessing the biologic behavior of HN cancer with the goal of delivering individualized cancer treatment. This review summarizes recent genomic discoveries in HN cancer and their implications for functional PET imaging in assessing response to targeted therapies, and drug resistance mechanisms. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Usefulness of CT-angiography for superselective intra-arterial chemotherapy for advanced head and neck cancers

    Energy Technology Data Exchange (ETDEWEB)

    Yokoyama, Junkichi [Iwaki Kyoritu General Hospital, Fukushima (Japan)

    2002-11-01

    Eighteen N3 cases, fourteen skullbase invasion cases and twenty-six cases of paranasal sinus cancer with orbital invasion were treated by superselective intra-arterial chemotherapy using cisplatin (CDDP) and sodium thiosulfate to preserve the organs and to improve poor prognosis. In these patients, 100-150 mg/m{sup 2} of CDDP was administered weekly to each feeding artery of the tumor superselectively at 5 mg/m. CT-arteriography (CTA) was used to diagnosis all feeding arteries of advanced cancers before infusing CDDP. Twenty-three of 26 cases with orbital invasion were treated with preservation of the eyeball. In three cases with extirpation of the eyeball CTA was not used in the treatment, and CDDP was infused into only the maxillary artery excluding the transverse facial artery. In skullbase invasion cases, the number of complete responses (CR) was 8/14, and that of partial responses (PR) was 6/14. Feeding arteries originating from the external carotid artery were found in 10 of all 14 cases by CTA, and four cases in which blood supply was from both carotid arteries were all anterior skullbase invasion cases. Ten cases with superselective intra-arterial chemotherapy originating from only the external carotid artery were significantly better responders than four cases originating from both carotid arteries. In N3 cases, feeding arteries were found in more than three arteries by CTA and the overall survival rate was 55%, calculated by the Kaplan-Meier method. CTA is a very efficient method for diagnosing all feeding arteries of advanced cancers in the superselective intra-arterial chemotherapy. (author)

  17. Usefulness of CT-angiography for superselective intra-arterial chemotherapy for advanced head and neck cancers

    International Nuclear Information System (INIS)

    Yokoyama, Junkichi

    2002-01-01

    Eighteen N3 cases, fourteen skullbase invasion cases and twenty-six cases of paranasal sinus cancer with orbital invasion were treated by superselective intra-arterial chemotherapy using cisplatin (CDDP) and sodium thiosulfate to preserve the organs and to improve poor prognosis. In these patients, 100-150 mg/m 2 of CDDP was administered weekly to each feeding artery of the tumor superselectively at 5 mg/m. CT-arteriography (CTA) was used to diagnosis all feeding arteries of advanced cancers before infusing CDDP. Twenty-three of 26 cases with orbital invasion were treated with preservation of the eyeball. In three cases with extirpation of the eyeball CTA was not used in the treatment, and CDDP was infused into only the maxillary artery excluding the transverse facial artery. In skullbase invasion cases, the number of complete responses (CR) was 8/14, and that of partial responses (PR) was 6/14. Feeding arteries originating from the external carotid artery were found in 10 of all 14 cases by CTA, and four cases in which blood supply was from both carotid arteries were all anterior skullbase invasion cases. Ten cases with superselective intra-arterial chemotherapy originating from only the external carotid artery were significantly better responders than four cases originating from both carotid arteries. In N3 cases, feeding arteries were found in more than three arteries by CTA and the overall survival rate was 55%, calculated by the Kaplan-Meier method. CTA is a very efficient method for diagnosing all feeding arteries of advanced cancers in the superselective intra-arterial chemotherapy. (author)

  18. Radiochemotherapy of head and neck cancers

    International Nuclear Information System (INIS)

    Mishina, Hitoshi; Okuyama, Shinichi; Yuasa, Ryo; Saijo, Shigeru; Kaneko, Yutaka

    1985-01-01

    Twenty-four cases of squamous cell carcinomas of the larynx and maxillary sinus were irradiated with or without cisplatin during a period from April 1973 through March 1984. Both bleomycin in oil and tegafur were adminstrered irrespective of cisplatin. Therapeutic effectiveness was critically evaluated by means of serial biopsy and/or surgery. Radiotherapy alone could not bring about negative conversion of the biopsies, but ultimate negative conversion was observed in 18 out of the 24 cases when chemotherapeutics were appropriately combined. The five positives underwent surgery. In the cases of maxillary cancer, mixed infections appeared to interfere with the curative effectiveness of the radiochemotherapy. A resulting dosage reduction of 15Gy was observed in radiotherapy for negative conversion and one of 10mg for bleomycin as a result of incorporation of cisplatin. (author)

  19. Human papilloma virus infection in head and neck cancer.

    Science.gov (United States)

    Tribius, Silke; Hoffmann, Markus

    2013-03-01

    The causal link between cervical cancer and human papilloma virus (HPV) is well known. It is now becoming clear that some types of squamous-cell carcinoma of the head and neck, particularly oropharyngeal carcinoma (OPC), are also linked to HPV infection. The development of vaccines against certain HPV genotypes has changed the management strategy for HPV-associated diseases of the uterine cervix. An analogous approach is now being considered for the prevention of HPV-associated diseases of the head and neck. We review pertinent articles retrieved by a selective search of the literature for phase II and III trials providing evidence about a possible effect of HPV status on the survival rates of patients with OPC. Seven trials fulfilled our search criteria: four phase III trials with retrospective HPV analysis and three phase II trials with retrospective and prospective HPV analysis. Patients with HPV-positive OPC survive significantly longer than those with HPV-negative OPC. Tobacco smoking has been identified as a negative prognostic factor in patients with either HPV-negative or HPV-positive disease. The established treatment strategy for OPC in patients with and without the traditional risk factors (tobacco and alcohol consumption) is now being reconsidered in the light of what we have learned about the role of HPV infection. Ongoing and projected clinical trials with risk-factor stratification may soon lead to changes in treatment. Further study is needed to answer the question whether HPV infection in the head and neck region is carcinogenic.

  20. Current and future state of chemoradiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Fuwa, Nobukazu

    2002-01-01

    Radiation therapy was the conventional treatment for locally advanced, nonresectable head and neck cancer. However, therapeutic results were poor with this treatment modality, and chemoradiotherapy has been used in an effort to improve therapeutic results. Improved local-regional control and disease-free or overall survival have been shown in several randomized trials using a concurrent or alternative approach. Induction chemotherapy (neoadjuvant chemotherapy), however, has not been shown to improve local-regional control or survival. Induction chemotherapy followed by definitive radiotherapy may be useful in the selection of patients who are likely to benefit from non-surgical organ preservation treatment schemes. Further clinical trials are needed to clarify the most suitable combination of chemotherapy and radiation. Intraarterial chemotherapy combined with radiation therapy for head and neck cancer has been attempted for many years. However, the indications, clinical significance, and selection of suitable anti-cancer drugs remain unclarified. The modern superselective intraarterial approach should be re-evaluated. Many head and neck cancers have been found to overexpress the receptor to epidermal growth factor (EGFR). Antibodies such as IMC-C225 that specifically target EGF receptors with radiotherapy and/or chemotherapy may prove to be valuable contributors to the treatment of advanced head and neck cancer. (author)

  1. Targeted therapies and radiation for the treatment of head and neck cancer

    International Nuclear Information System (INIS)

    Kim, Gwi Eon

    2004-01-01

    The purpose of this review is to provide an update on novel radiation treatments for head and neck cancer. Despite the remarkable advances in chemotherapy and radiotherapy techniques, the management of advanced head and neck cancer remains challenging. Epidermal growth factor receptor (EGFR) is an appealing target for novel therapies in head and neck cancer because not only EGFR activation stimulates many important signaling pathways associated with cancer development and progression, and importantly, resistance to radiation. Furthermore, EGFR overexpression is known to be portended for a worse outcome in patients with advanced head and neck cancer. Two categories of compounds designed to abrogate EGFR signaling, such as monoclonal antibodies (Cetuximab) and tyrosine kinase inhibitors (ZD1839 and OSI-774) have been assessed and have been most extensively studied in preclinical models and clinical trials. Additional TKIs in clinical trials include a reversible agent, Cl-1033, which blocks activation of all erbB receptors. Encouraging preclinical data for head and neck cancers resulted in rapid translation into the clinic. Results from initial clinical trials show rather surprisingly that only minority of patients benefited from EGFR inhibition as monotherapy or in combination with chemotherapy. In this review, we begin with a brief summary of erbB-mediated signal transduction. Subsequently, we present data on prognostic-predictive value of erbB receptor expression in HNC followed by preclinical and clinical data on the role of EGFR antagonists alone or in combination with radiation in the treatment of HNC. Finally, we discuss the emerging thoughts on resistance to EGFR blockade and efforts in the development of multiple-targeted therapy for combination with chemotherapy or radiation. Current challenges for investigators are to determine (1) who will benefit from targeted agents and which agents are most appropriate to combine with radiation and/or chemotherapy, (2

  2. Countermeasure against postoperative fistulas of head and neck cancer

    International Nuclear Information System (INIS)

    Hori, Yasutaka; Nishikawa, Kunio; Utida, Hiroshi; Fujisawa, Takurou; Eguchi, Motoharu

    2004-01-01

    It is very difficult to treat postoperative fistulas of head and neck cancer by irradiation and other preoperative therapy. We reviewed 179 patients with oral cancer, mesopharyngeal and hypopharyngeal cancer underwent reconstruction between 1994 and 2003. Our analysis reveals that the incidence of fistula is 18.4% and exposure dose is predisposing factor for fistula formation. We observed many fistulas in posterior of oral floor and pedicle flap more than free flap. There are 14 patients of surgical repair, we detected pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) in them. (author)

  3. Feasibility Study of Moderately Accelerated Intensity-Modulated Radiotherapy Plus Concurrent Weekly Cisplatin After Induction Chemotherapy in Locally Advanced Head-and Neck Cancer

    International Nuclear Information System (INIS)

    Morganti, Alessio G.; Mignogna, Samantha; Deodato, Francesco; Massaccesi, Mariangela; Cilla, Savino; Calista, Franco; Serafini, Giovanni; Digesu, Cinzia; Macchia, Gabriella; Picardi, Vincenzo; Caravatta, Luciana; Di Lullo, Liberato; Giglio, Gianfranco; Sallustio, Giuseppina; Piermattei, Angelo

    2011-01-01

    Purpose: To evaluate the feasibility and efficacy of moderately accelerated intensity-modulated radiation therapy (IMRT) along with weekly cisplatin, after induction chemotherapy, in patients with locally advanced unresectable head and neck cancer (HNC). Methods and Materials: Patients with Stage III or IV locally advanced HNC, without progressive disease after three courses of induction chemotherapy, received concurrent chemo-IMRT (weekly cisplatin 30 mg/m 2 plus simultaneous integrated boost IMRT). A total of 67.5 Gy in 30 fractions were delivered to primary tumor and involved nodes, 60 Gy in 30 fractions to high-risk nodal areas, and 55.5 Gy in 30 fractions to low-risk nodal areas. Results: In all, 36 patients (median age, 56 years) with International Union Against Cancer (UICC) Stage III (n = 5) and IV (n = 31) were included. Of the 36 patients, 17 had received CF (cisplatin and 5-fluorouracil (CF) and 19 had received docetaxel cisplatin and 5-fluorouracil (DCF). During concurrent chemoradiation, 11 of 36 patients (30.5%) experienced Grade III mucositis (CF, 47%; DCF, 15%; p < 0.04). Grade III pharyngeal-esophageal toxicity was observed in 5 of 19 patients (26.3%; CF, 0.0%; DCF, 26.3%; p = 0.02). Two patients died of complications (5.5%). After chemoradiation, the complete response rate was 63.8%. Two-year local control was 88.7%. Two-year progression free survival and overall survival were 74.5% and 60.9%, respectively. Conclusions: In our experience, a moderately accelerated chemo-IMRT was feasible after induction chemotherapy. However, a noteworthy early death rate of 5.5% was observed. Intensive supportive care strategies should be defined to better manage radiation-induced toxic effects. Longer follow-up is required to determine the incidence of late radiation toxicities and tumor control rates.

  4. Delayed damage after radiation therapy for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Yoshiyuki [Osaka Dental Univ., Hirakata (Japan)

    2000-03-01

    I investigated radiation damage, including osteoradionecrosis, arising from tooth extraction in fields that had received radiation therapy for head and neck cancer, and evaluated the effectiveness of pilocarpine for xerostomia. Between January 1990 and April 1996, I examined 30 patients for bone changes after tooth extraction in fields irradiated at the Department of Oral Radiology, Osaka Dental University Hospital. Nineteen of the patients had been treated for nasopharyngeal cancer and 11 for oropharyngeal cancer. Between January and April 1996, 4 additional patients were given pilocarpine hydrochloride (3-mg, 6-mg and 9-mg of KSS-694 orally three times a day) for 12 weeks and evaluated every 4 weeks as a base line. One had been treated for nasopharyngeal carcinoma, two for cancer of the cheek and one for an unknown carcinoma. Eighteen of the patients (11 with nasopharyngeal carcinoma and 7 with oropharyngeal carcinoma) had extractions. Use of preoperative and postoperative radiographs indicated that damage to the bone following tooth extraction after radiation exposure was related to whether antibiotics were administered the day before the extraction, whether forceps or elevators were used, and whether the tooth was in the field of radiation. Xerostomia improved in all 4 of the patients who received 6-mg or 9-mg of pilocarpine. It improved saliva production and relieved the symptoms of xerostomia after radiation therapy for head and neck cancer, although there were minor side effects such as fever. This information can be used to improve the oral environment of patients who have received radiation therapy for head and neck cancer, and to better understand their oral environment. (author)

  5. Delayed damage after radiation therapy for head and neck cancer

    International Nuclear Information System (INIS)

    Matsumoto, Yoshiyuki

    2000-01-01

    I investigated radiation damage, including osteoradionecrosis, arising from tooth extraction in fields that had received radiation therapy for head and neck cancer, and evaluated the effectiveness of pilocarpine for xerostomia. Between January 1990 and April 1996, I examined 30 patients for bone changes after tooth extraction in fields irradiated at the Department of Oral Radiology, Osaka Dental University Hospital. Nineteen of the patients had been treated for nasopharyngeal cancer and 11 for oropharyngeal cancer. Between January and April 1996, 4 additional patients were given pilocarpine hydrochloride (3-mg, 6-mg and 9-mg of KSS-694 orally three times a day) for 12 weeks and evaluated every 4 weeks as a base line. One had been treated for nasopharyngeal carcinoma, two for cancer of the cheek and one for an unknown carcinoma. Eighteen of the patients (11 with nasopharyngeal carcinoma and 7 with oropharyngeal carcinoma) had extractions. Use of preoperative and postoperative radiographs indicated that damage to the bone following tooth extraction after radiation exposure was related to whether antibiotics were administered the day before the extraction, whether forceps or elevators were used, and whether the tooth was in the field of radiation. Xerostomia improved in all 4 of the patients who received 6-mg or 9-mg of pilocarpine. It improved saliva production and relieved the symptoms of xerostomia after radiation therapy for head and neck cancer, although there were minor side effects such as fever. This information can be used to improve the oral environment of patients who have received radiation therapy for head and neck cancer, and to better understand their oral environment. (author)

  6. Molecular genetic study of head and neck cancer

    International Nuclear Information System (INIS)

    Lee, Yong Sik; Shim, Youn Sang; Lee, Je Ho

    1993-01-01

    We analyzed 15 cases of head and neck cancer (13 out of 15 were squqmous cell cancer.) by Southern blotting to identify the possible tumor suppressor gene. Firstly we searched the chromosome 17p with pYNZ22, pMCT35.1 and p144D6. 5 out of 7 informative cases showed loss of heterozygosity implying the loss of tumor suppressor gene near those loci. Afterwards analysis of these 5 cases is needed to identify the presence of tumor suppressor genes and the oncogenetic mechanism. (Author)

  7. The role of human papillomavirus in head and neck cancer

    DEFF Research Database (Denmark)

    Lajer, Christel Braemer; Buchwald, Christian von

    2010-01-01

    Over the last 20 years, there has been increasing awareness of a subset of squamous cell carcinomas of the head and neck (HNSCC), i.e. HPV-positive HNSCC. These cancers seem to differ somewhat from HPV-negative HNSCC. Patients with HPV-positive HNSCC tend to be younger and have a lower intake of ......-negative HNSCC, and this seems to be related to the immune system. Whether the new vaccines for HPV will protect not only against cervical cancer but also against HPV-positive HNSCC remains unknown....

  8. Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer. Results of a prospective study

    International Nuclear Information System (INIS)

    Tribius, Silke; Raguse, Marieclaire; Voigt, Christian; Petersen, Cordula; Kruell, Andreas; Muenscher, Adrian; Groebe, Alexander; Bergelt, Corinna; Singer, Susanne

    2015-01-01

    Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes. A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6-8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT. Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05). QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery. (orig.) [de

  9. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises.

    Science.gov (United States)

    Kraaijenga, Sophie A C; van der Molen, Lisette; Jacobi, Irene; Hamming-Vrieze, Olga; Hilgers, Frans J M; van den Brekel, Michiel W M

    2015-11-01

    Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

  10. Phase I Trial Using Induction Ciplatin, Docetaxel, 5-FU and Erlotinib Followed by Cisplatin, Bevacizumab and Erlotinib With Concurrent Radiotherapy for Advanced Head and Neck Cancer.

    Science.gov (United States)

    Ahn, Peter H; Machtay, Mitchell; Anne, Pramila R; Cognetti, David; Keane, William M; Wuthrick, Evan; Dicker, Adam P; Axelrod, Rita S

    2018-05-01

    Bevacizumab (avastin) and erlotinib (tarceva) had shown early clinical activity against head and neck cancer (HNC). We initiated a phase I trial of induction cisplatin, docetaxel, 5-fluorouracil and erlotinib (TPF-E) followed by cisplatin, bevacizumab and erlotinib (PA-E) with radiotherapy (XRT) for advanced HNC. The goal was to determine maximum tolerated erlotinib dose. Eligible patients had stage IVA or higher HNC with good performance status, hematologic, and renal reserve. Two cycles of induction TPF-E were administered. XRT was administered with concurrent weekly cisplatin and bevacizumab every 2 weeks. Initial erlotinib dose was 50 mg daily from start of induction chemotherapy until radiotherapy completion. Erlotinib dose escalations to 100 and 150 mg were planned. Thirteen patients with previously untreated locoregional disease (11 patients) or oligometastatic (2 patients) HNC were enrolled. Totally, 11 of 13 patients completed XRT as planned. Four of 8 patients in cohort 1 (erlotinib 50 mg), 3 of 4 patients in cohort 2 (100 mg), and 0 of 1 patients in cohort 3 (150 mg) completed the regimen. Two patients had significant gastrointestinal complications (bleeding and perforation), and 1 had dose-limiting diarrhea. Maximum tolerated dose was reached at 50 mg erlotinib. At median 23.4 months follow-up, 5 patients (38%) have no evidence of disease, and 2 (15%) have stable but measurable disease. Erlotinib in combination with induction TPF followed by erlotinib, cisplatin, and bevacizumab with XRT is active but toxic. Gastrointestinal toxicities partly caused high rates of study withdrawal. All doses studied in this protocol caused unexpected toxicities and we do not recommend advancement to phase II.

  11. A randomized phase III trial comparing concomitant chemoradiotherapy versus radiotherapy alone in advanced head and neck cancers - mature results: Yoodhvir Singh Nagar, Lucknow Cancer Institute, India

    International Nuclear Information System (INIS)

    Singh, S.; Kumar, S.; Datta, N.R.

    2003-01-01

    To evaluate contribution of concomitant chemoradiotherapy (CTRT) over and above radiotherapy alone (RT) in previously untreated stage III/IV, squamous cell carcinoma of the head and neck (SCCH and N). Patients with cancers of oral cavity (OC), oropharynx (OP), supraglottis (SG) and hypopharynx (HP) were randomized into RT arm or CTRT arm. Radiotherapy was identical in both arms (70Gy/35 fractions/7 weeks). In CTRT arm concomitant cisplatin (35mg/m 2 ) was given weekly for seven cycles. Surgery was reserved for salvage purposes when required. From May 1996 to December 1998, 155 patients (RT=78, CTRT=77) were enrolled and 139 patients (RT1,CTRT=68) were assessable. Over 90% patients in both arms completed planned treatment. The complete response rate was 51% in RT arm and 71% in CTRT arm (p=0.017). The median disease free survival (DFS) and overall survival (OS) in RT arm and CTRT arm were 3 months vs. 11 months (p=0.0009) and 9 months vs. 26 months (p=0.01) respectively. The 5-year DFS and OS in the two arms were 10% vs. 27% (p=0.000) and 16% vs. 29% (p=0.01) respectively. Acute grade III toxicity was comparable in both the arms (12% vs. 16%, p=0.74). Late grade I/II toxicity was higher in CTRT arm (70% vs. 51%, p=0.09). Serious late toxicities were not seen in both arms. On univariate analysis the favorable factors for immediate response were protocol (CTRT better), primary site (SG and OP better than OC and HP), T-stage (T1-T2 better), Nodes (N0 better than N+), Stage (III > IV), KPS (>80) and lesser overall treatment time (OTT). Multivariate analysis retained protocol, T stage, N stage and OTT as factors independently affecting the immediate response. Addition of concomitant weekly cisplatin (35mg/m 2 ) to radiotherapy improves the likelihood of local control, DFS and OS with acceptable acute and late toxicities and can be recommended as a standard form of treatment in advanced SCCH and N

  12. The radiotherapy effect on the quality of life of patients with head and neck cancer

    International Nuclear Information System (INIS)

    Sawada, Namie Okino; Dias, Adriana Marques; Zago, Marcia Maria Fontao

    2006-01-01

    In cases of head and neck cancer, surgical advances in combination with radiotherapy (RT) have brought an increase in patients' probability of cure. RT is widely used and aims to destroy cancer cells in order to reduce or eliminate a malignant tumor. However, RT also causes major changes in patients' quality of life during and after treatment. The current study aims to evaluate the side effects of RT in patients with head and neck cancer and its influence on quality of life. The study population included head and neck cancer patients submitted to RT at the University of Sao Paulo Hospital in Ribeirao Preto, Brazil. Data were collected with the FACT H and N instrument and McMaster University's Questionnaire for head and neck RT and submitted to quantitative statistical analysis using SPSS (Statistical Package for the Social Sciences). The main side effects of RT that affected physical quality of life were related to salivation and nutritional problems, while the predominant emotional problems were depression and anxiety. (author)

  13. Predictors of Pain among Head and Neck Cancer Patients

    Science.gov (United States)

    Shuman, Andrew G.; Terrell, Jeffrey E.; Light, Emily; Wolf, Gregory T.; Bradford, Carol R.; Chepeha, Douglas; Jiang, Yunyun; McLean, Scott; Ghanem, Tamer A.; Duffy, Sonia A.

    2014-01-01

    Objective Pain is a strong contributor to cancer patients’ quality of life. The objective of this study was to determine predictors of pain 1 year after the diagnosis of head and neck cancer. Design Prospective, multi-site cohort study. Setting Three academically-affiliated medical centers. Patients Previously untreated patients with carcinoma of the upper aerodigestive tract (n=374). Main Outcome Measures Participants were surveyed pre-treatment and 1 year thereafter. Multivariate analyses were conducted to determine predictors of the SF-36 bodily pain score 1 year after diagnosis. Results The mean SF-36 bodily pain score at 1 year was 65, compared to 61 at diagnosis (p=.004), compared to 75 among population norms (lower scores indicate worse pain). Variables independently associated with pain included pre-treatment pain score (p<0.001), less education (p=0.02), neck dissection (p=0.001), feeding tube (p=0.05), xerostomia (p<0.001), depressive symptoms (p<0.001), taking more pain medication (p<0.001), less physical activity (p=.02), and poor sleep quality (p=0.006). Current smoking and problem drinking were marginally significant (p=0.07 and 0.08, respectively). Conclusions Aggressive pain management may be indicated for head and neck cancer patients who undergo neck dissections, complain of xerostomia, require feeding tubes, and have medical comorbidities. Treatment of modifiable risk factors such as depression, poor sleep quality, tobacco and alcohol abuse may also reduce pain and improve quality of life among head and neck cancer patients. PMID:23165353

  14. TU-AB-BRA-10: Prognostic Value of Intra-Radiation Treatment FDG-PET and CT Imaging Features in Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Song, J; Pollom, E; Durkee, B; Aggarwal, S; Bui, T; Le, Q; Loo, B; Hara, W [Stanford University, Palo Alto, CA (United States); Cui, Y [Hokkaido University, Global Institute for Collaborative Research and Educat, Sapporo, Hokkaido (Japan); Li, R [Stanford University, Palo Alto, CA (United States); Hokkaido University, Global Institute for Collaborative Research and Educat, Sapporo, Hokkaido (Japan)

    2015-06-15

    Purpose: To predict response to radiation treatment using computational FDG-PET and CT images in locally advanced head and neck cancer (HNC). Methods: 68 patients with State III-IVB HNC treated with chemoradiation were included in this retrospective study. For each patient, we analyzed primary tumor and lymph nodes on PET and CT scans acquired both prior to and during radiation treatment, which led to 8 combinations of image datasets. From each image set, we extracted high-throughput, radiomic features of the following types: statistical, morphological, textural, histogram, and wavelet, resulting in a total of 437 features. We then performed unsupervised redundancy removal and stability test on these features. To avoid over-fitting, we trained a logistic regression model with simultaneous feature selection based on least absolute shrinkage and selection operator (LASSO). To objectively evaluate the prediction ability, we performed 5-fold cross validation (CV) with 50 random repeats of stratified bootstrapping. Feature selection and model training was solely conducted on the training set and independently validated on the holdout test set. Receiver operating characteristic (ROC) curve of the pooled Result and the area under the ROC curve (AUC) was calculated as figure of merit. Results: For predicting local-regional recurrence, our model built on pre-treatment PET of lymph nodes achieved the best performance (AUC=0.762) on 5-fold CV, which compared favorably with node volume and SUVmax (AUC=0.704 and 0.449, p<0.001). Wavelet coefficients turned out to be the most predictive features. Prediction of distant recurrence showed a similar trend, in which pre-treatment PET features of lymph nodes had the highest AUC of 0.705. Conclusion: The radiomics approach identified novel imaging features that are predictive to radiation treatment response. If prospectively validated in larger cohorts, they could aid in risk-adaptive treatment of HNC.

  15. Occupational Therapy for the Head and Neck Cancer Patient.

    Science.gov (United States)

    Park, Priscilla; Hashmi, Mahjabeen

    2018-01-01

    Occupational therapy is a health profession concerned with promoting health and well-being through occupation. A diagnosis of head and neck cancer (HNC) often invokes fear and anxiety because of the potential negative impact of the diagnosis and/or treatment on lifestyle and well-being. Occupational therapists perform a unique and important role in addressing quality of life concerns for HNC patients through applied expertise in lifestyle management, facilitating the use of positive coping strategies and daily routine management. Occupational therapy concurrently assists HNC patients to effectively manage the debilitating stress and anxiety associated with HNC diagnosis, treatment, and recovery while facilitating a return to prior or adapted daily routines.

  16. Prophylactic Swallowing Exercises in Head and Neck Cancer Radiotherapy

    DEFF Research Database (Denmark)

    Mortensen, H R; Jensen, Kenneth; Aksglæde, K

    2015-01-01

    Many head and neck cancer (HNC) survivors experience reduced quality of life due to radiotherapy (RT)-related dysphagia. The aim of this prospective randomized trial was to evaluate the impact of prophylactic swallowing exercises on swallowing-related outcomes in HNC patients treated with curative...... of the dysphagia outcomes during and after treatment. Adherence to exercises was poor and dropouts due to especially fatigue were very frequent in both groups. Systematic swallowing exercises had no impact on swallowing outcomes within the first year after RT. Despite repeated supervised sessions, adherence...

  17. Surgical Management of Perineural Spread of Head and Neck Cancers.

    Science.gov (United States)

    Solares, C Arturo; Mason, Eric; Panizza, Benedict J

    2016-04-01

    The surgical management of perineural spread of head and neck cancers has become an integral part in the contemporary treatment of this pathology. We now understand that tumour spreads within the epineurium and in a continuous fashion. We also can rely on the accuracy of magnetic resonance neurography in detecting and defining the extent of disease. With modern skull base techniques and a greater understanding of the anatomy in this region, specific operations can be designed to help eradicate disease. We review the current approaches and techniques used that enable us to better obtain tumour free margins and hence improve survival.

  18. Exercise program design considerations for head and neck cancer survivors.

    Science.gov (United States)

    Midgley, Adrian W; Lowe, Derek; Levy, Andrew R; Mepani, Vishal; Rogers, Simon N

    2018-01-01

    The present study aimed to establish exercise preferences, barriers, and perceived benefits among head and neck cancer survivors, as well as their level of interest in participating in an exercise program. Patients treated for primary squamous cell carcinoma of the head and neck between 2010 and 2014 were identified from the hospital database and sent a postal questionnaire pack to establish exercise preferences, barriers, perceived benefits, current physical activity levels, and quality of life. A postal reminder was sent to non-responders 4 weeks later. The survey comprised 1021 eligible patients of which 437 (43%) responded [74% male, median (interquartile range) age, 66 (60-73) years]. Of the respondents, 30% said 'Yes' they would be interested in participating in an exercise program and 34% said 'Maybe'. The most common exercise preferences were a frequency of three times per week, moderate-intensity, and 15-29 min per bout. The most popular exercise types were walking (68%), flexibility exercises (35%), water activites/swimming (33%), cycling (31%), and weight machines (19%). Home (55%), outdoors (46%) and health club/gym (33%) were the most common preferred choices for where to regularly exercise. Percieved exercise benefits relating to improved physical attributes were commonly cited, whereas potential social and work-related benefits were less well-acknowledged. The most commonly cited exercise barriers were dry mouth or throat (40%), fatigue (37%), shortness of breath (30%), muscle weakness (28%) difficulty swallowing (25%), and shoulder weakness and pain (24%). The present findings inform the design of exercise programs for head and neck cancer survivors.

  19. Hypothyroidism after radiotherapy for head and neck cancer patients

    International Nuclear Information System (INIS)

    Ozawa, Hiroyuki; Saito, Hideyuki; Inagaki, Kouji; Mizutari, Kunio

    2004-01-01

    We report two cases of hypothyroidism with clinical symptoms that occurred after radiotherapy for cancer of the head and neck. The first patient underwent total laryngectomy without thyroidectomy for laryngeal cancer and partial gastrectomy for gastric cancer. Radiation of the neck was carried out postoperatively. Two years later, he developed chest pain and pericardial effusion was detected, leading to a diagnosis of myxedema due to hypothyroidism. The second patient received radiotherapy alone for laryngeal carcinoma. Two months later, a low serum sodium concentration and anemia were detected, both of which proved difficult to correct. The cause of these changes was found subsequently to be hypothyroidism. From the experience of these 2 cases, we measured thyroid function in 37 patients who had received neck radiation for head and neck cancers at our hospital over the past 10 years. In 13 of the 37 patients (35%), hypothyroidism was observed. The prevalence of hypothyroidism was higher in the 13 patients treated with both radiation and surgery, with 6 (46%) showing this condition, compared with 7 of the 24 patients (29%) who received radiation alone. The risk factor responsible for hypothyroidism was not evident from statistical analysis of these cases. We consider that thyroid function should be evaluated periodically in patients who have received neck radiotherapy, as it is often difficult to diagnose hypothyroidism from clinical symptoms. (author)

  20. Results of high dose radiation and surgery in the treatment of advanced cancer of the head and neck

    International Nuclear Information System (INIS)

    Carifi, V.G.; Ohanion, M.L.; David, A.B.; Greenlaw, R.; Rush, B.F. Jr.

    1974-01-01

    One hundred nineteen patients with stage III or IV cancer of the oral cavity or laryngopharynx were treated with combined radiation therapy and surgery at the University of Kentucky and the New Jersey Medical School since 1962. In the University of Kentucky series, the three year postoperative survival figures in patients with stage III or IV lesions were 43 percent for lesions of the laryngopharynx and 39 percent for lesions of the oral cavity. Of great interest are the survival figures for patients with stage IV lesions: 50 percent for those with lesions of the laryngopharynx and 11 percent for those with lesions of the oral cavity. Although the New Jersey Medical School series is still young, the results (by actuarial projection) approached those of the University of Kentucky series and will be interesting to follow. (U.S.)

  1. PET/MRI in head and neck cancer: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Platzek, Ivan; Laniado, Michael [Dresden University Hospital, Department of Radiology, Dresden (Germany); Beuthien-Baumann, Bettina [Dresden University Hospital, Department of Nuclear Medicine, Dresden (Germany); Schneider, Matthias [Dresden University Hospital, Oral and Maxillofacial Surgery, Dresden (Germany); Gudziol, Volker [Dresden University Hospital, Department of Otolaryngology, Dresden (Germany); Langner, Jens; Schramm, Georg; Hoff, Joerg van den [Institute of Bioinorganic and Radiopharmaceutical Chemistry, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Kotzerke, Joerg [Dresden University Hospital, Nuclear Medicine, Dresden (Germany)

    2013-01-15

    To evaluate the feasibility of PET/MRI (positron emission tomography/magnetic resonance imaging) with FDG ({sup 18}F-fluorodeoxyglucose) for initial staging of head and neck cancer. The study group comprised 20 patients (16 men, 4 women) aged between 52 and 81 years (median 64 years) with histologically proven squamous cell carcinoma of the head and neck region. The patients underwent a PET scan on a conventional scanner and a subsequent PET/MRI examination on a whole-body hybrid system. FDG was administered intravenously prior to the conventional PET scan (267-395 MBq FDG, 348 MBq on average). The maximum standardized uptake values (SUV{sub max}) of the tumour and of both cerebellar hemispheres were determined for both PET datasets. The numbers of lymph nodes with increased FDG uptake were compared between the two PET datasets. No MRI-induced artefacts where observed in the PET images. The tumour was detected by PET/MRI in 17 of the 20 patients, by PET in 16 and by MRI in 14. The PET/MRI examination yielded significantly higher SUV{sub max} than the conventional PET scanner for both the tumour (p < 0.0001) and the cerebellum (p = 0.0009). The number of lymph nodes with increased FDG uptake detected using the PET dataset from the PET/MRI system was significantly higher the number detected by the stand-alone PET system (64 vs. 39, p = 0.001). The current study demonstrated that PET/MRI of the whole head and neck region is feasible with a whole-body PET/MRI system without impairment of PET or MR image quality. (orig.)

  2. Clinical problems of multiple primary cancers including head and neck cancers. From the viewpoint of radiotherapy

    International Nuclear Information System (INIS)

    Nishio, Masamichi; Myojin, Miyako; Nishiyama, Noriaki; Taguchi, Hiroshi; Takagi, Masaru; Tanaka, Katsuhiko

    2003-01-01

    A total of 2144 head and neck cancers were treated by radiotherapy at the National Sapporo Hospital between 1974 and 2001. Of these, 313 (14.6%) were found to have other primary cancers besides head and neck cancer, in which double cancers were 79% and triple or more cancers were 21%. Frequency according to primary site of the first head and neck cancer was oral cavity: 107/603 (17.7%), epipharynx cancer: 7/117 (6.0%), oropharyngeal cancer: 63/257 (24.5%), hypopharyngeal cancer: 65/200 (32.5%), laryngeal cancer: 114/558 (20.4%), and nose/paranasal sinus: 4.9% respectively. Esophageal cancer, head and neck cancer, lung cancer and gastric cancer were very frequent as other primary sites combined with the head and neck. The first onset region was the head and neck in 233 out of 313 cases with multiple primary cancers. The five-year survival rate from the onset of head and neck cancers is 52%, 10-year: 30%, and 5-year cause-specific survival rate 82%, and 10-year: 78%, respectively. The treatment possibilities in multiple primary cancers tend to be limited because the treatment areas are sometimes overlapped. New approaches to the treatment of multiple primary cancers should be considered in the future. (author)

  3. Serum prognostic biomarkers in head and neck cancer patients.

    Science.gov (United States)

    Lin, Ho-Sheng; Siddiq, Fauzia; Talwar, Harvinder S; Chen, Wei; Voichita, Calin; Draghici, Sorin; Jeyapalan, Gerald; Chatterjee, Madhumita; Fribley, Andrew; Yoo, George H; Sethi, Seema; Kim, Harold; Sukari, Ammar; Folbe, Adam J; Tainsky, Michael A

    2014-08-01

    A reliable estimate of survival is important as it may impact treatment choice. The objective of this study is to identify serum autoantibody biomarkers that can be used to improve prognostication for patients affected with head and neck squamous cell carcinoma (HNSCC). Prospective cohort study. A panel of 130 serum biomarkers, previously selected for cancer detection using microarray-based serological profiling and specialized bioinformatics, were evaluated for their potential as prognostic biomarkers in a cohort of 119 HNSCC patients followed for up to 12.7 years. A biomarker was considered positive if its reactivity to the particular patient's serum was greater than one standard deviation above the mean reactivity to sera from the other 118 patients, using a leave-one-out cross-validation model. Survival curves were estimated according to the Kaplan-Meier method, and statistically significant differences in survival were examined using the log rank test. Independent prognostic biomarkers were identified following analysis using multivariate Cox proportional hazards models. Poor overall survival was associated with African Americans (hazard ratio [HR] for death = 2.61; 95% confidence interval [CI]: 1.58-4.33; P = .000), advanced stage (HR = 2.79; 95% CI: 1.40-5.57; P = .004), and recurrent disease (HR = 6.66; 95% CI: 2.54-17.44; P = .000). On multivariable Cox analysis adjusted for covariates (race and stage), six of the 130 markers evaluated were found to be independent prognosticators of overall survival. The results shown here are promising and demonstrate the potential use of serum biomarkers for prognostication in HNSCC patients. Further clinical trials to include larger samples of patients across multiple centers may be warranted. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  4. Concurrent hyperfractionated accelerated radiotherapy with 5-FU and once weekly cisplatin in locally advanced head and neck cancer. The 10-year results of a prospective phase II trial

    Energy Technology Data Exchange (ETDEWEB)

    Budach, V.; Boehmer, D.; Badakhshi, H.; Jahn, U.; Stromberger, C. [Campus Virchow Klinikum, Charite Universitaetsmedizin Berlin, Department for Radiooncology, Clinic for Radiooncology, Berlin (Germany); Becker, E.T. [Charite Universitaetsmedizin, Department of Otorhinolaryngology, Berlin (Germany); Wernecke, K.D. [Sostana Statistics GmbH, Charite Universitaetsmedizin Berlin, Berlin (Germany)

    2014-03-15

    In this study, the acute toxicity and long-term outcome of a hyperfractionated accelerated chemoradiation regimen with cisplatin/5-fluorouracil (5-FU) in patients with locally advanced squamous cell carcinomas of head and neck were evaluated. From 2000-2002, 38 patients with stage III (5.3 %) and stage IV (94.7 %) head and neck cancer were enrolled in a phase II study. Patients received hyperfractionated-accelerated radiotherapy with 72 Gy in 15 fractions of 2 Gy followed by 1.4 Gy twice daily with concurrent, continuous infusion 5-FU of 600 mg/m{sup 2} on days 1-5 and 6 cycles of weekly cisplatin (30 mg/m{sup 2}). Acute toxicities (CTCAEv2.0), locoregional control (LRC), metastases-free (MFS), and overall survival (OS) were analyzed and exploratively compared with the ARO 95-06 trial. Median follow-up was 11.4 years (95 % CI 8.6-14.2) and mean dose 71.6 Gy. Of the patients, 82 % had 6 (n = 15) or 5 (n = 16) cycles of cisplatin, 5 and 2 patients received 4 and 3 cycles, respectively. Grade 3 anemia, leukopenia, and thrombocytopenia were observed in 15.8, 15.8, and 2.6 %, respectively. Grade 3 mucositis in 50 %, grade 3 and 4 dysphagia in 55 and 13 %. The 2-, 5-, and 10-year LRC was 65, 53.6, and 48.2 %, the MFS was 77.5, 66.7, and 57.2 % and the OS 59.6, 29.2, and 15 %, respectively. Chemoradiation with 5-FU and cisplatin seems feasible and superior in terms of LRC and OS to the ARO 95-06C-HART arm at 2 years. However, this did not persist at the 5- and 10-year follow-ups. (orig.) [German] Untersuchung der Akuttoxizitaet und des Langzeitueberlebens einer hyperfraktioniert-akzelerierten simultanen Radiochemotherapie mit Cisplatin/5-Fluorouracil (5-FU) bei Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren. Von 2000 bis 2002 wurden 38 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region im Stadium III (5,3 %) und IV (94,7 %) eingeschlossen. Es erfolgte eine simultane hyperfraktionierte akzelerierte Radiochemotherapie mit 72 Gy in 15 Fraktionen a 2 Gy

  5. Nutrition management for head and neck cancer patients improves clinical outcome and survival.

    Science.gov (United States)

    Müller-Richter, Urs; Betz, C; Hartmann, S; Brands, R C

    2017-12-01

    Up to 80% of patients with head and neck cancers are malnourished because of their lifestyle and the risk factors associated with this disease. Unfortunately, nutrition management systems are not implemented in most head and neck cancer clinics. Even worse, many head and neck surgeons as well as hospital management authorities disregard the importance of nutrition management in head and neck cancer patients. In addition, the often extensive resection and reconstruction required for tumors in the upper aerodigestive tract pose special challenges for swallowing and sufficient food intake, placing special demands on nutrition management. This article presents the basics of perioperative metabolism and nutrition management of head and neck cancer patients and makes recommendations for clinical practice. Implementing a nutrition management system in head and neck cancer clinics will improve the clinical outcome and the survival of the patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Radiotherapy and bleomycin-containing chemotherapy in the treatment of advanced head and neck cancer: report of six patients and review of the literature

    International Nuclear Information System (INIS)

    Forastiere, A.A.; Uikram, B.; Spiro, R.H.; Wittes, R.E.

    1981-01-01

    In an effort to improve the complete remission rate achievable with bleomycin and cisplatin, administered prior to radiotherapy in previously untreated patients with unresectable epidermoid carcinoma of the head and neck, we initiated a pilot study employing simultaneous chemotherapy and radiotherapy. Six patients were treated with bleomycin (B) 15 mg i.m. t.i.w. 30-60 minutes prior to radiotherapy (RT) treatment with conventional fractionation, 180-200 rad/fx, 5 fx/week. During interruptions in B + RT for healing of mucocutaneous reactions, patients received cisplatin 40 mg/mg m 2 once weekly. Toxicity included severe mucositis within the radiation port in all patients, three episodes of infection, and significant myelosuppression in one patient. Transient mild serum creatinine elevation occurred in four patients. Three patients did not complete treatment because of severity of toxicity. Response was: primary--4/6CR, 1/6 PR; regional nodes--1/5 CR, 4/5 PR. Review of the literature of concurrent bleomycin and radiotherapy trials in head and neck cancer indicates that other investigators have encountered severe toxicity using bleomycin dose and radiation fractionation schedules similar to ours. Toxicity may be reduced when lower doses of concurrent bleomycin and/or alternative radiation fractionation schedules are employed. Although results of uncontrolled trials suggest a possible therapeutic advantage to treatment with the combination compared to radiotherapy alone, this has not clearly been established in the four randomized trials reviewed

  7. Quad shot - hypofractionated radiotherapy for palliation in advanced squamous cell carcinoma of head and neck

    International Nuclear Information System (INIS)

    Maqsood, T.; Ali, U.; Arif, S.

    2017-01-01

    The objective of this study was to determine the efficacy of quad-shot radiation therapy for palliation in locally advanced and metastatic inoperable squamous cell carcinomas of head and neck. Study Design: A quasi-experimental study. Place and Duration of Study: Oncology department, Combined Military Hospital Rawalpindi, from Sep 2012 to Sep 2013. Material and Methods: Thirty five patients were included with histologically confirmed advanced inoperable squamous cell carcinoma in head and neck region, performance status 2 or 3 and survival =3 months. Patients were treated with radiation therapy 14 Gy in four fractions, megavoltage beam, twice daily fractions (at least 6 hours apart), for 2 consecutive days. Symptoms due to cancer (pain and dysphagia) were assessed as per common toxicity criteria adverse event version 4.0 on day 0 before treatment and day 21 after start of treatment. Results: Grades of pain and dysphagia showed significant improvement after treatment with a p-value <0.001. A total of 91.4% patients showed an improvement in grade of pain (32 out of 35 patients) and 45.7% of patients showed improvement in grade of dysphagia (16 out of 35 patients). There was a statistically significant decrease in grades of pain and dysphagia after treatment. Conclusion: The short duration of hypofractionated radiotherapy with Quad Shot was effective with respect to symptom palliation in locally advanced and metastatic inoperable head and neck cancers.

  8. Scoring irradiation mucositis in head and neck cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Spijkervet, F.K.L.; Panders, A.K. (Departments of Oral and Maxillofacial Surgery, University Hospital Groningen (Netherlands)); Saene, H.K.F. van (Medical Microbiology, University of Liverpool (UK)); Vermey, A. (Department of Surgery Oncology Division, University Hospital Groningen (Netherlands)); Mehta, D.M. (Department of Radiotherapy, University Hospital Groningen (Netherlands))

    1989-01-01

    Irradiation mucositis is defined as an inflammatory-like process of the oropharyngeal mucosa following therapeutic irradiation of patients who have head and neck cancer. Clinically, it is a serious side effect because severe mucositis can cause generalized problems (weight loss, nasogastic tube feedings) and interferes with the well-being of the patient seriously. Grading mucositis is important for the evaluation of preventive and therapeutic measures. The object of this study was to develop a scoring method based on local mucositis signs only. Four clinical local signs of mucositis were used in this score: white discoloration, erythema, pseudomembranes and ulceration. Mucositis of the oral cavity was calcualted during conventional irradiation protocol for 8 distinguishable areas using the 4 signs and their extent. A prospective evaluation of this method in 15 irradiated head and neck cancer patients displayed an S-curve reflecting a symptomless first irradiation week, followed by a rapid and steady increase of white discoloration, erythema and pseudomembranes during the second and third week. Oral candidiasis, generalized symptoms such as weight loss and the highest mucositis scores were seen after 3 weeks irradiation. The novel mucositis scoring method may be of value in studying the effect of hygiene programs, topical application of disinfectans or antibiotics on oral mucositis. (author).

  9. Clinicopathological correlates of pediatric head and neck cancer

    Directory of Open Access Journals (Sweden)

    Sengupta Subhabrata

    2009-01-01

    Full Text Available Background : The spectrum of head and neck tumors in children continues to be the cause of diverse, diagnostically challenging issues. Aims : To demonstrate and compare the unique clinicopathological features in our study population and their correlations with the final histopathological diagnosis. Methods : Fifty-three children with head and neck cancer were examined thoroughly at the Otorhinolaryngology department in a tertiary care teaching hospital followed by histopathological studies. Results : Lymphomas were the most common malignant lesions seen followed by rhabdomyosarcomas, nasopharyngeal carcinomas, and others like thyroid carcinomas and eosinophilic granulomas. In the neck, the commonest cause of primary malignant disease was lymphoma; however, the most frequent lesion was reactive lymphadenitis. In the sinonasal region, the commonest malignancy was rhabdomyosarcoma, which often had extension to the orbit and the face. Recurrent epistaxis was found universally in the malignant cases of this region. In the facial region, disfiguring swelling with proptosis was mainly caused by rhabdomyosarcoma. The only case of tonsillar malignancy was due to non-Hodgkin lymphoma. The duration of disease was less than 1 year. Conclusion : The most common manifestation of the malignant lesions in the pediatric age group was with a history of an enlarging, painless neck swelling. Still, an insignificant lump in the neck or recurrent bleeding from nose may be the manifestation of an underlying cancer.

  10. Scoring irradiation mucositis in head and neck cancer patients

    International Nuclear Information System (INIS)

    Spijkervet, F.K.L.; Panders, A.K.; Saene, H.K.F. van; Vermey, A.; Mehta, D.M.

    1989-01-01

    Irradiation mucositis is defined as an inflammatory-like process of the oropharyngeal mucosa following therapeutic irradiation of patients who have head and neck cancer. Clinically, it is a serious side effect because severe mucositis can cause generalized problems (weight loss, nasogastic tube feedings) and interferes with the well-being of the patient seriously. Grading mucositis is important for the evaluation of preventive and therapeutic measures. The object of this study was to develop a scoring method based on local mucositis signs only. Four clinical local signs of mucositis were used in this score: white discoloration, erythema, pseudomembranes and ulceration. Mucositis of the oral cavity was calcualted during conventional irradiation protocol for 8 distinguishable areas using the 4 signs and their extent. A prospective evaluation of this method in 15 irradiated head and neck cancer patients displayed an S-curve reflecting a symptomless first irradiation week, followed by a rapid and steady increase of white discoloration, erythema and pseudomembranes during the second and third week. Oral candidiasis, generalized symptoms such as weight loss and the highest mucositis scores were seen after 3 weeks irradiation. The novel mucositis scoring method may be of value in studying the effect of hygiene programs, topical application of disinfectans or antibiotics on oral mucositis. (author)

  11. Curative and organ-preserving treatment with intra-arterial carboplatin induction followed by surgery and/or radiotherapy for advanced head and neck cancer: single-center five-year results

    Directory of Open Access Journals (Sweden)

    Tinelli Carmine

    2007-04-01

    Full Text Available Abstract Background This study evaluated the feasibility, toxicity, response rate and survival of neoadjuvant superselective intra-arterial infusion of high dose carboplatin in advanced head and neck cancer. Methods Forty-six patients with primary head and neck squamous cell carcinoma received 3 cycles of intra-arterial carboplatin (300 to 350 mg/m2 per cycle every 2 weeks, followed by radiotherapy or surgery plus radiotherapy. Results No complications or severe toxicity occurred. Sixteen patients (35% were complete responders, 20 (43% partial responders while 10 (22% did not respond to treatment. After completion of the multimodality treatment, 38/46 patients (83% were complete responders. After a 5-year follow-up period, 18/46 patients (39% are alive and disease-free, 3 (6,5% have died of a second primary tumor and 25 (54,5% have died of the disease. Conclusion Intra-arterial carboplatin induction chemotherapy is a safe, well-tolerated technique that discriminates between responders and non-responders and so may have prognostic significance in planning further integrated treatments aimed to organ preservation for advanced head and neck carcinomas.

  12. Stereotactic Body Radiotherapy for Head and Neck Tumors

    Science.gov (United States)

    2016-04-18

    Squamous Cell Carcinoma of the Head and Neck; Nasopharyngeal Carcinoma; Salivary Gland Cancer; Head and Neck Sarcoma; Paraganglioma of Head and Neck; Chordoma of Head and Neck; Chondrosarcoma of Head and Neck; Angiofibroma of Head and Neck

  13. Modern principles of reconstructive surgery for advanced head and neck tumors

    Science.gov (United States)

    Kulbakin, D. E.; Choinzonov, E. L.; Mukhamedov, M. R.; Garbukov, E. U.; Shtin, V. I.; Havkin, N. M.; Vasilev, R. V.

    2017-09-01

    Background: Surgery remains the mainstay of treatment for head and neck cancer. Reconstruction after cancer surgery can help to restore both the appearance and function of the affected areas. Materials and methods: From 2008 to 2016, a total of 120 reconstructive surgeries were performed at the Department of Head and Neck Tumors of Tomsk Cancer Research Institute. The majority of patients had locally advanced cancer (T3 stage in 49 patients and T4 stage in 41 patients). The localizations of the defects requiring reconstruction were as follows: oral cavity—26 cases; tongue—24 cases; skin (including defects of lower lip)—12 cases; maxilla—14 cases; larynx and hypopharynx—12 cases; lips—6 cases, cheek—11 cases, and mandibulla—5 cases. Various free flaps (83%) and pedicle flaps (17%) were used for the reconstruction of the large defects following extirpation of head and neck malignant tumors. In 15 cases (13%), the implants from titanium and titanium nickelide (TiNi) were used to restore the supporting and skeletal functions of the reconstructed region. We used 3D model of the patient's skull for a more precise planning of the reconstruction of maxillofacial bone defects. Results: Good functional results were achieved in most cases. Full flap necrosis was observed in 12 cases (10%). Fibular flap necroses were noted in 8 cases (7%). Conclusions: Single-stage reconstructions of the lost structures after tumor resection significantly improve survival of head and neck cancer patients without causing significant functional and aesthetic damage, as well as contribute to quick rehabilitation of these patients and improvement of their social status. To reduce postoperative complications after reconstructive surgery, it is necessary to carefully select the appropriate reconstructive implant materials.

  14. Knowledge and screening of head and neck cancer among American Indians in South Dakota.

    Science.gov (United States)

    Dwojak, Sunshine; Deschler, Daniel; Sargent, Michele; Emerick, Kevin; Guadagnolo, B Ashleigh; Petereit, Daniel

    2015-06-01

    We established the level of awareness of risk factors and early symptoms of head and neck cancer among American Indians in South Dakota and determined whether head and neck cancer screening detected clinical findings in this population. We used the European About Face survey. We added questions about human papillomavirus, a risk factor for head and neck cancer, and demographics. Surveys were administered at 2 public events in 2011. Participants could partake in a head and neck cancer screening at the time of survey administration. Of the 205 American Indians who completed the survey, 114 participated in the screening. Mean head and neck cancer knowledge scores were 26 out of 44. Level of education was the only factor that predicted higher head and neck cancer knowledge (b = 0.90; P = .01). Nine (8%) people had positive head and neck cancer screening examination results. All abnormal clinical findings were in current or past smokers (P = .06). There are gaps in American Indian knowledge of head and neck cancer risk factors and symptoms. Community-based head and neck cancer screening in this population is feasible and may be a way to identify early abnormal clinical findings in smokers.

  15. The role of oral hygiene in head and neck cancer: results from International Head and Neck Cancer Epidemiology (INHANCE) consortium.

    Science.gov (United States)

    Hashim, D; Sartori, S; Brennan, P; Curado, M P; Wünsch-Filho, V; Divaris, K; Olshan, A F; Zevallos, J P; Winn, D M; Franceschi, S; Castellsagué, X; Lissowska, J; Rudnai, P; Matsuo, K; Morgenstern, H; Chen, C; Vaughan, T L; Hofmann, J N; D'Souza, G; Haddad, R I; Wu, H; Lee, Y-C; Hashibe, M; Vecchia, C La; Boffetta, P

    2016-08-01

    Poor oral hygiene has been proposed to contribute to head and neck cancer (HNC) risk, although causality and independency of some indicators are uncertain. This study investigates the relationship of five oral hygiene indicators with incident HNCs. In a pooled analysis of 8925 HNC cases and 12 527 controls from 13 studies participating in the International Head and Neck Cancer Epidemiology Consortium, comparable data on good oral hygiene indicators were harmonized. These included: no denture wear, no gum disease (or bleeding), oral hygiene indicator and cumulative score on HNC risk, adjusting for tobacco smoking and alcohol consumption. Inverse associations with any HNC, in the hypothesized direction, were observed for cancer sites, especially for tooth brushing and dentist visits. The population attributable fraction for ≤ 2 out of 5 good oral hygiene indicators was 8.9% (95% CI 3.3%, 14%) for oral cavity cancer. Good oral hygiene, as characterized by few missing teeth, annual dentist visits, and daily tooth brushing, may modestly reduce the risk of HNC. © The Author 2016. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  16. Advances in otolaryngology-Head and neck surgery. Volume 1

    International Nuclear Information System (INIS)

    Myers, E.N.; Bluestone, C.D.

    1987-01-01

    This book consists of 14 sections. The section titles are: The impact of AIDS on otolaryngology--head and neck surgery; The management of sleep apneas and snoring; Antimicrobial agents for infections in the ear, nose, and throat--head and neck; Nasal allergy: Medical and surgical treatment; Uses of computerized tomography and magnetic resonance imaging in temporal bone imaging; Surgical management of otitis media with effusion; middle ear reconstruction: Current status; Cochlear implants: an overview; Diagnosis and management of acute facial paralysis; The use of the laser in head and neck surgery; The management and prevention of subglottic stenosis in infants and children; Management of the mass in the thyroid; Suction-assisted lipectomy of the head and neck area; and Ambulatory surgery

  17. Advances in otolaryngology-Head and neck surgery. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    Myers, E.N. (Univ. of Pittsburgh School of Medicine, Pittsburgh, PA (US)); Bluestone, C.D. (Univ. of Pittsburgh, Pittsburgh, PA (US))

    1987-01-01

    This book consists of 14 sections. The section titles are: The impact of AIDS on otolaryngology--head and neck surgery; The management of sleep apneas and snoring; Antimicrobial agents for infections in the ear, nose, and throat--head and neck; Nasal allergy: Medical and surgical treatment; Uses of computerized tomography and magnetic resonance imaging in temporal bone imaging; Surgical management of otitis media with effusion; middle ear reconstruction: Current status; Cochlear implants: an overview; Diagnosis and management of acute facial paralysis; The use of the laser in head and neck surgery; The management and prevention of subglottic stenosis in infants and children; Management of the mass in the thyroid; Suction-assisted lipectomy of the head and neck area; and Ambulatory surgery.

  18. Weekly Gemcitabine and Cisplatin in Combination With Radiotherapy in Patients With Locally Advanced Head-and-Neck Cancer: Phase I Study

    Energy Technology Data Exchange (ETDEWEB)

    Arruda Viani, Gustavo, E-mail: gusviani@gmail.com [Radiation Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Afonso, Sergio Luis [Clinical Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Cardoso Tavares, Vivian [Head and Neck Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil); Bernardes Godoi da Silva, Lucas; Stefano, Eduardo Jose [Radiation Oncology Department, Faculty of Medicine of Marilia, Sao Paulo (Brazil)

    2011-11-15

    Purpose: To define the maximum tolerated dose by describing the dose-limiting toxicity (DLT) of weekly gemcitabine and cisplatin in patients with locally advanced head-and-neck (LAHN) cancer concomitant to irradiation. Methods and Materials: Patients with LAHN cancer were enrolled in a prospective, dose-escalation Phase I study. Toxicity was graded according to the Common Toxicity Criteria score. Maximum tolerated dose was defined when DLT developed in 2 of 6 patients. The starting dose of cisplatin was 20 mg/m{sup 2} and that of gemcitabine was 10 mg/m{sup 2} in 3 patients, with a subsequent dose escalation of 10 mg/m{sup 2} of cisplatin only for 3 new patients. In the next levels, only a dose escalation of gemcitabine with 10 mg/m{sup 2} for each new cohort was used (Level 1, 10 mg/m{sup 2} of gemcitabine and 20 mg/m{sup 2} of cisplatin; Level 2, 10 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin; and Level 3, 20 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin). Radiation therapy was administered by use of a conformal technique over a period of 6 to 7 weeks in 2.0-Gy daily fractions for 5 consecutive days per week to a total dose of 70 Gy. Results: From 2008 to 2009, 12 patients completing 3 dose levels were included in the study. At Dose Level 3, 1 of 3 patients had DLT with Grade 3 mucositis. Of the next 3 required patients, 2 showed DLT with Grade 3 dermatitis. At a follow-up of 3 months, 10 of 12 evaluable patients (83.3%) obtained a complete response and 1 patient (8.3%) obtained a partial response. Among the complete responders, at a median follow-up of 10 months (range, 6-14 months), 9 patients are alive and disease free. Conclusion: Gemcitabine at low doses combined with cisplatin is a potent radiosensitizer effective in patients with LAHN cancer. The recommended Phase II dose is 10 mg/m{sup 2} of gemcitabine and 30 mg/m{sup 2} of cisplatin with an acceptable tolerability profile.

  19. Transoral robotic surgery in head and neck cancer.

    Science.gov (United States)

    Hans, S; Delas, B; Gorphe, P; Ménard, M; Brasnu, D

    2012-02-01

    Robots have invaded industry and, more recently, the field of medicine. Following the development of various prototypes, Intuitive Surgical® has developed the Da Vinci surgical robot. This robot, designed for abdominal surgery, has been widely used in urology since 2000. The many advantages of this transoral robotic surgery (TORS) are described in this article. Its disadvantages are essentially its high cost and the absence of tactile feedback. The first feasibility studies in head and neck cancer, conducted in animals, dummies and cadavers, were performed in 2005, followed by the first publications in patients in 2006. The first series including more than 20 patients treated by TORS demonstrated the feasibility for the following sites: oropharynx, supraglottic larynx and hypopharynx. However, these studies did not validate the oncological results of the TORS technique. TORS decreases the number of tracheotomies, and allows more rapid swallowing rehabilitation and a shorter length of hospital stay. Technical improvements are expected. Smaller, more ergonomic, new generation robots, therefore more adapted to the head and neck, will probably be available in the future. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  20. Human Papillomavirus Genome Integration and Head and Neck Cancer.

    Science.gov (United States)

    Pinatti, L M; Walline, H M; Carey, T E

    2018-06-01

    We conducted a critical review of human papillomavirus (HPV) integration into the host genome in oral/oropharyngeal cancer, reviewed the literature for HPV-induced cancers, and obtained current data for HPV-related oral and oropharyngeal cancers. In addition, we performed studies to identify HPV integration sites and the relationship of integration to viral-host fusion transcripts and whether integration is required for HPV-associated oncogenesis. Viral integration of HPV into the host genome is not required for the viral life cycle and might not be necessary for cellular transformation, yet HPV integration is frequently reported in cervical and head and neck cancer specimens. Studies of large numbers of early cervical lesions revealed frequent viral integration into gene-poor regions of the host genome with comparatively rare integration into cellular genes, suggesting that integration is a stochastic event and that site of integration may be largely a function of chance. However, more recent studies of head and neck squamous cell carcinomas (HNSCCs) suggest that integration may represent an additional oncogenic mechanism through direct effects on cancer-related gene expression and generation of hybrid viral-host fusion transcripts. In HNSCC cell lines as well as primary tumors, integration into cancer-related genes leading to gene disruption has been reported. The studies have shown that integration-induced altered gene expression may be associated with tumor recurrence. Evidence from several studies indicates that viral integration into genic regions is accompanied by local amplification, increased expression in some cases, interruption of gene expression, and likely additional oncogenic effects. Similarly, reported examples of viral integration near microRNAs suggest that altered expression of these regulatory molecules may also contribute to oncogenesis. Future work is indicated to identify the mechanisms of these events on cancer cell behavior.

  1. The role of human papillomavirus in head and neck cancer

    DEFF Research Database (Denmark)

    Lajer, Christel Braemer; Buchwald, Christian von

    2010-01-01

    Over the last 20 years, there has been increasing awareness of a subset of squamous cell carcinomas of the head and neck (HNSCC), i.e. HPV-positive HNSCC. These cancers seem to differ somewhat from HPV-negative HNSCC. Patients with HPV-positive HNSCC tend to be younger and have a lower intake...... of tobacco and alcohol. Distinct molecular profiles separate them from HPV-negative cancers and show similarities with HPV-positive cervical SCC. There is evidence that HPV-positive HNSCC is a sexually transmitted disease. Patients with HPV-positive HNSCC are often diagnosed at a late stage with large cystic......-negative HNSCC, and this seems to be related to the immune system. Whether the new vaccines for HPV will protect not only against cervical cancer but also against HPV-positive HNSCC remains unknown....

  2. Concurrent weekly docetaxel and concomitant boost radiation therapy in the treatment of locally advanced squamous cell cancer of the head and neck

    International Nuclear Information System (INIS)

    Tishler, Roy B.; Posner, Marshall R.; Norris, Charles M.; Mahadevan, Anand; Sullivan, Christopher; Goguen, Laura; Wirth, Lori J.; Costello, Rosemary; Case, MaryAnn; Stowell, Sara; Sammartino, Dan; Busse, Paul M.; Haddad, Robert I.

    2006-01-01

    Purpose: In a Phase I/II trial, we investigated concurrent weekly docetaxel and concomitant boost radiation in patients with locally advanced squamous cell cancer of the head and neck (SCCHN) after induction chemotherapy. Patients and Methods: Patients presented with American Joint Committee on Cancer Stage III/IV and were treated initially with induction chemotherapy using cisplatinum/5-fluorouracil (PF), carboplatinum-5-FU, or docetaxel-PF. Patients then received docetaxel four times weekly with concomitant boost (CB) radiation (1.8 Gy once-daily X20, 1.8/1.5 Gy twice a day). Fifteen patients each received 20 mg/M 2 and 25 mg/M 2 . Results: Thirty-one patients were enrolled and 30 were evaluable for response and toxicity. Median follow-up was 42 months (range, 27-63 months). Primary sites were: oropharynx 19, oral cavity 2, larynx/hypopharynx 5, and unknown primary 4. Eighty-seven percent of patients had N2/N3 disease; 60% had T3/T4 disease. Twenty percent of patients had a complete response (CR) to induction chemotherapy. After chemoradiotherapy, 21 of 30 patients had a CR, 2 had progressive disease, and 7 had partial response (PR). Nineteen of 26 patients presenting with neck disease had neck dissections, and 7 of 19 were positive. Ninety-three percent of all patients were rendered disease-free after all planned therapy. Treatment failed in 8 patients, and 7 have died of disease. An additional patient died with no evidence of disease. Twenty-one patients (70%) are currently alive with no evidence of disease. No acute dose-limiting toxicity was observed at either dose level. Conclusions: This intensive treatment regimen of concurrent docetaxel/concomitant boost radiation and surgery after induction chemotherapy in poor prognosis patients yields good local regional control and survival. Docetaxel/CB chemoradiotherapy represents an aggressive alternative regimen to platinum-based chemoradiotherapy or surgery in patients who have a poor response to induction

  3. Locoregionally Advanced Head and Neck Cancer Treated With Primary Radiotherapy: A Comparison of the Addition of Cetuximab or Chemotherapy and the Impact of Protocol Treatment

    International Nuclear Information System (INIS)

    Caudell, Jimmy J.; Sawrie, Stephen M.; Spencer, Sharon A.; Desmond, Renee A.; Carroll, William R.; Peters, Glenn E.; Nabell, Lisle M.; Meredith, Ruby F.; Bonner, James A.

    2008-01-01

    Purpose: The addition of platinum-based chemotherapy (ChRT) or cetuximab (ExRT) to concurrent radiotherapy (RT) has resulted in improved survival in Phase III studies for locoregionally advanced head and neck cancer (LAHNC). However the optimal treatment regimen has not been defined. A retrospective study was performed to compare outcomes in patients who were treated definitively with ExRT or ChRT. Methods: Cetuximab with concurrent RT was used to treat 29 patients with LAHNC, all of whom had tumors of the oral cavity, oropharynx, or larynx. All patients were T2 to T4 and overall American Joint Committee on Cancer Stage III to IVB, with a Karnofsky Performance Status (KPS) score of 60 or greater. ChRT was used to treat 103 patients with similar characteristics. Patients were evaluated for locoregional control (LRC), distant metastasis-free survival (DMFS), disease-specific survival (DSS), and overall survival (OS). Median follow-up for patients alive at last contact was 83 months for those treated with ExRT and 53 months for those treated with ChRT. Cox proportional hazard models were used to assess independent prognostic factors. Results: The LRC, DMFS, and DSS were not significantly different, with 3-year rates of 70.7%, 92.4%, and 78.6% for ExRT and 74.7%, 86.6%, and 76.5% for ChRT, respectively. The OS was significantly different between the two groups (p = 0.02), with 3-year rates of 75.9% for ExRT and 61.3% for ChRT. OS was not significant when patients who were on protocol treatments of ExRT or ChRT were compared. Also, OS was not significant when multivariate analysis was used to control for potential confounding factors. Conclusion: In our single-institution retrospective review of patients treated with ExRT or ChRT, no significant differences were found in LRC, DMFS, DSS, or OS

  4. Prospective, longitudinal, multi-modal functional imaging for radical chemo-IMRT treatment of locally advanced head and neck cancer: the INSIGHT study

    International Nuclear Information System (INIS)

    Welsh, Liam; Panek, Rafal; McQuaid, Dualta; Dunlop, Alex; Schmidt, Maria; Riddell, Angela; Koh, Dow-Mu; Doran, Simon; Murray, Iain; Du, Yong; Chua, Sue; Hansen, Vibeke; Wong, Kee H.; Dean, Jamie; Gulliford, Sarah; Bhide, Shreerang; Leach, Martin O.; Nutting, Christopher; Harrington, Kevin; Newbold, Kate

    2015-01-01

    Radical chemo-radiotherapy (CRT) is an effective organ-sparing treatment option for patients with locally advanced head and neck cancer (LAHNC). Despite advances in treatment for LAHNC, a significant minority of these patients continue to fail to achieve complete response with standard CRT. By constructing a multi-modality functional imaging (FI) predictive biomarker for CRT outcome for patients with LAHNC we hope to be able to reliably identify those patients at high risk of failing standard CRT. Such a biomarker would in future enable CRT to be tailored to the specific biological characteristics of each patients’ tumour, potentially leading to improved treatment outcomes. The INSIGHT study is a single-centre, prospective, longitudinal multi-modality imaging study using functional MRI and FDG-PET/CT for patients with LAHNC squamous cell carcinomas receiving radical CRT. Two cohorts of patients are being recruited: one treated with, and another treated without, induction chemotherapy. All patients receive radical intensity modulated radiotherapy with concurrent chemotherapy. Patients undergo functional imaging before, during and 3 months after completion of radiotherapy, as well as at the time of relapse, should that occur within the first two years after treatment. Serum samples are collected from patients at the same time points as the FI scans for analysis of a panel of serum markers of tumour hypoxia. The primary aim of the INSIGHT study is to acquire a prospective multi-parametric longitudinal data set comprising functional MRI, FDG PET/CT, and serum biomarker data from patients with LAHNC undergoing primary radical CRT. This data set will be used to construct a predictive imaging biomarker for outcome after CRT for LAHNC. This predictive imaging biomarker will be used in future studies of functional imaging based treatment stratification for patients with LAHNC. Additional objectives are: defining the reproducibility of FI parameters; determining robust

  5. Community Awareness - A Key to the Early Detection of Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Ajay Manickam

    2016-04-01

    Full Text Available INTRODUCTION Mortality and morbidity associated with head and neck cancers have decreased to a great extent in many developed countries of the world due to early diagnosis and treatment with advances in surgical techniques and better availability of radiotherapist and oncologists. But the situation in developing countries like India is quite different. AIMS AND OBJECTIVES This study was conducted amongst the patients attending the Otolaryngology department of a teaching hospital in Kolkata to find the incidence of various types and sites of head and neck cancer, to assess time delay from the date of onset of symptom to the final disease confirmation in relation to patients’ demographic profile, to assess time delay in histopathological diagnosis after reaching a tertiary care setup and also to correlate tobacco consumption and alcohol intake as risk factors for head and neck cancer and to note the reasons for late presentation, as described by the patient. MATERIALS AND METHODS The descriptive study was conducted at a tertiary level teaching hospital, in the Department of Otorhinolaryngology for a period from August 2013 to August 2015 with a study population of 133.  OBSERVATIONS  An average time lag from the onset of symptom to final diagnosis as malignancy was found to be 6 months to one year in nearly 72% of cases. Most of the patients were uneducated males of more than 50 years of age, hailing from rural areas. Cancer larynx was found to be the commonest of all head and neck cancers (31.6%. More than 65% of the patients were addicted to tobacco chewing or smoking or consumption of alcohol.  DISCUSSION  Poverty, lack of education, poor communication, lack of health care infrastructure in rural areas, community awareness about various risk factors, lack of effective health policy to achieve early diagnosis of head neck cancer were common factors related to delay in diagnosis.  CONCLUSION  Tobacco use and alcohol intake are the

  6. Overexpression of EMMPRIN isoform 2 is associated with head and neck cancer metastasis.

    Directory of Open Access Journals (Sweden)

    Zhiquan Huang

    Full Text Available Extracellular matrix metalloproteinase inducer (EMMPRIN, a plasma membrane protein of the immunoglobulin (Ig superfamily, has been reported to promote cancer cell invasion and metastasis in several human malignancies. However, the roles of the different EMMPRIN isoforms and their associated mechanisms in head and neck cancer progression remain unknown. Using quantitative real-time PCR, we found that EMMPRIN isoform 2 (EMMPRIN-2 was the only isoform that was overexpressed in both head and neck cancer tissues and cell lines and that it was associated with head and neck cancer metastasis. To determine the effects of EMMPRIN-2 on head and neck cancer progression, we transfected head and neck cancer cells with an EMMPRIN-2 expression vector and EMMPRIN-2 siRNA to exogenously modulate EMMPRIN-2 expression and examined the functional importance of EMMPRIN-2 in head and neck cancer invasion and metastasis. We found that EMMPRIN-2 promoted head and neck cancer cell invasion, migration, and adhesion in vitro and increased lung metastasis in vivo. Mechanistic studies revealed that EMMPRIN-2 overexpression promoted the secretion of extracellular signaling molecules, including matrix metalloproteinases-2(MMP-2, urokinase-type plasminogen activator(uPA and Cathepsin B, in head and neck cancer cells. While MMP-2 and uPA have been demonstrated to be important mediators of EMMPRIN signaling, the role of Cathepsin B in EMMPRIN-mediated molecular cascades and tumorigenesis has not been established. We found that EMMPRIN-2 overexpression and Cathepsin B down-regulation significantly inhibited the invasion, migration and adhesion of Tca8133 cells, suggesting that Cathepsin B is required for EMMPRIN-2 enhanced cell migration and invasion in head and neck cancer. The results of our study demonstrate the important role of EMMPRIN-2 in head and neck cancer progression for the first time and reveal that increased extracellular secretion of Cathepsin B may be a novel

  7. Overexpression of EMMPRIN isoform 2 is associated with head and neck cancer metastasis.

    Science.gov (United States)

    Huang, Zhiquan; Tan, Ning; Guo, Weijie; Wang, Lili; Li, Haigang; Zhang, Tianyu; Liu, Xiaojia; Xu, Qin; Li, Jinsong; Guo, Zhongmin

    2014-01-01

    Extracellular matrix metalloproteinase inducer (EMMPRIN), a plasma membrane protein of the immunoglobulin (Ig) superfamily, has been reported to promote cancer cell invasion and metastasis in several human malignancies. However, the roles of the different EMMPRIN isoforms and their associated mechanisms in head and neck cancer progression remain unknown. Using quantitative real-time PCR, we found that EMMPRIN isoform 2 (EMMPRIN-2) was the only isoform that was overexpressed in both head and neck cancer tissues and cell lines and that it was associated with head and neck cancer metastasis. To determine the effects of EMMPRIN-2 on head and neck cancer progression, we transfected head and neck cancer cells with an EMMPRIN-2 expression vector and EMMPRIN-2 siRNA to exogenously modulate EMMPRIN-2 expression and examined the functional importance of EMMPRIN-2 in head and neck cancer invasion and metastasis. We found that EMMPRIN-2 promoted head and neck cancer cell invasion, migration, and adhesion in vitro and increased lung metastasis in vivo. Mechanistic studies revealed that EMMPRIN-2 overexpression promoted the secretion of extracellular signaling molecules, including matrix metalloproteinases-2(MMP-2), urokinase-type plasminogen activator(uPA) and Cathepsin B, in head and neck cancer cells. While MMP-2 and uPA have been demonstrated to be important mediators of EMMPRIN signaling, the role of Cathepsin B in EMMPRIN-mediated molecular cascades and tumorigenesis has not been established. We found that EMMPRIN-2 overexpression and Cathepsin B down-regulation significantly inhibited the invasion, migration and adhesion of Tca8133 cells, suggesting that Cathepsin B is required for EMMPRIN-2 enhanced cell migration and invasion in head and neck cancer. The results of our study demonstrate the important role of EMMPRIN-2 in head and neck cancer progression for the first time and reveal that increased extracellular secretion of Cathepsin B may be a novel mechanism

  8. Oxygenation measurements in head and neck cancers during hyperbaric oxygenation

    International Nuclear Information System (INIS)

    Becker, A.; Kuhnt, T.; Dunst, J.; Liedtke, H.; Krivokuca, A.; Bloching, M.

    2002-01-01

    Background: Tumor hypoxia has proven prognostic impact in head and neck cancers and is associated with poor response to radiotherapy. Hyperbaric oxygenation (HBO) offers an approach to overcome hypoxia. We have performed pO 2 measurements in selected patients with head and neck cancers under HBO to determine in how far changes in the oxygenation occur and whether a possible improvement of oxygenation parameters is maintained after HBO. Patients and Methods: Seven patients (five male, two female, age 51-63 years) with squamous cell cancers of the head and neck were investigated (six primaries, one local recurrence). The median pO 2 prior to HBO was determined with the Eppendorf histograph. Sites of measurement were enlarged cervical lymph nodes (n = 5), the primary tumor (n = 1) and local recurrence (n = 1). Patients then underwent HBO (100% O 2 at 240 kPa for 30 minutes) and the continuous changes in the oxygenation during HBO were determined with a Licox probe. Patients had HBO for 30 minutes (n = 6) to 40 minutes (n = 1). HBO was continued because the pO 2 had not reached a steady state after 30 minutes. After decompression, patients ventilated pure oxygen under normobaric conditions and the course of the pO 2 was further measured over about 15 minutes. Results: Prior to HBO, the median tumor pO 2 in the Eppendorf histography was 8.6 ± 5.4 mm Hg (range 3-19 mm Hg) and the pO 2 measured with the Licox probe was 17.3 ± 25.5 mm Hg (range 0-73 mm Hg). The pO 2 increased significantly during HBO to 550 ± 333 mm Hg (range 85-984 mm Hg, p = 0.018). All patients showed a marked increase irrespective of the oxygenation prior to HBO. The maximum pO 2 in the tumor was reached after 10-33 minutes (mean 17 minutes). After leaving the hyperbaric chamber, the pO 2 was 282 ± 196 mm Hg. All patients maintained an elevated pO 2 for further 5-25 minutes (138 ± 128 mm Hg, range 42-334 mm Hg, p = 0.028 vs the pO 2 prior to HBO). Conclusions: Hyperbaric oxygenation resulted in a

  9. Panendoscopy as a screening procedure for simultaneous primary tumors in head and neck cancer

    NARCIS (Netherlands)

    Dhooge, IJ; DeVos, M; Albers, FWJ; VanCauwenberge, PB

    Head and neck cancer is often associated with second primary neoplasms. These cancers most commonly involve other regions of the head and neck, esophagus, and lung. The majority of cases are also squamous cell carcinomas. In view of this rather frequent occurrence of multiple primary cancers and how

  10. Final Results of a Randomized Phase 2 Trial Investigating the Addition of Cetuximab to Induction Chemotherapy and Accelerated or Hyperfractionated Chemoradiation for Locoregionally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Seiwert, Tanguy Y., E-mail: tseiwert@medicine.bsd.uchicago.edu [Departments of Medicine, University of Chicago, Chicago, Illinois (United States); Melotek, James M. [Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois (United States); Blair, Elizabeth A. [Department of Otolaryngology, University of Chicago, Chicago, Illinois (United States); Stenson, Kerstin M. [Department of Otolaryngology, Rush University, Chicago, Illinois (United States); Salama, Joseph K. [Department of Radiation Oncology, Duke University, Durham, North Carolina (United States); Witt, Mary Ellyn [Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois (United States); Brisson, Ryan J.; Chawla, Apoorva; Dekker, Allison [Departments of Medicine, University of Chicago, Chicago, Illinois (United States); Lingen, Mark W. [Department of Pathology, University of Chicago, Chicago, Illinois (United States); Kocherginsky, Masha [Department of Public Health Sciences, University of Chicago, Chicago, Illinois (United States); Villaflor, Victoria M. [Departments of Medicine, University of Chicago, Chicago, Illinois (United States); Cohen, Ezra E.W. [Moores Cancer Center, University of California, San Diego, San Diego, California (United States); Haraf, Daniel J. [Department of Radiation and Cellular Oncology, University of Chicago, Chicago, Illinois (United States); Vokes, Everett E. [Departments of Medicine, University of Chicago, Chicago, Illinois (United States)

    2016-09-01

    Purpose: The role of cetuximab in the treatment of locoregionally advanced head and neck squamous cell cancer (LA-HNSCC) remains poorly defined. In this phase 2 randomized study, we investigated the addition of cetuximab to both induction chemotherapy (IC) and hyperfractionated or accelerated chemoradiation. Methods and Materials: Patients with LA-HNSCC were randomized to receive 2 cycles of weekly IC (cetuximab, paclitaxel, carboplatin) and either Cetux-FHX (concurrent cetuximab, 5-fluorouracil, hydroxyurea, and 1.5 Gy twice-daily radiation therapy every other week to 75 Gy) or Cetux-PX (cetuximab, cisplatin, and accelerated radiation therapy with delayed concomitant boost to 72 Gy in 42 fractions). The primary endpoint was progression-free survival (PFS), with superiority compared with historical control achieved if either arm had 2-year PFS ≥70%. Results: 110 patients were randomly assigned to either Cetux-FHX (n=57) or Cetux-PX (n=53). The overall response rate to IC was 91%. Severe toxicity on IC was limited to rash (23% grade ≥3) and myelosuppression (38% grade ≥3 neutropenia). The 2-year rates of PFS for both Cetux-FHX (82.5%) and Cetux-PX (84.9%) were significantly higher than for historical control (P<.001). The 2-year overall survival (OS) was 91.2% for Cetux-FHX and 94.3% for Cetux-PX. With a median follow-up time of 72 months, there were no significant differences in PFS (P=.35) or OS (P=.15) between the treatment arms. The late outcomes for the entire cohort included 5-year PFS, OS, locoregional failure, and distant metastasis rates of 74.1%, 80.3%, 15.7%, and 7.4%, respectively. The 5-year PFS and OS were 84.4% and 91.3%, respectively, among human papillomavirus (HPV)-positive patients and 65.9% and 72.5%, respectively, among HPV-negative patients. Conclusions: The addition of cetuximab to IC and chemoradiation was tolerable and produced long-term control of LA-HNSCC, particularly among poor-prognosis HPV-negative patients. Further

  11. Final Results of a Randomized Phase 2 Trial Investigating the Addition of Cetuximab to Induction Chemotherapy and Accelerated or Hyperfractionated Chemoradiation for Locoregionally Advanced Head and Neck Cancer

    International Nuclear Information System (INIS)

    Seiwert, Tanguy Y.; Melotek, James M.; Blair, Elizabeth A.; Stenson, Kerstin M.; Salama, Joseph K.; Witt, Mary Ellyn; Brisson, Ryan J.; Chawla, Apoorva; Dekker, Allison; Lingen, Mark W.; Kocherginsky, Masha; Villaflor, Victoria M.; Cohen, Ezra E.W.; Haraf, Daniel J.; Vokes, Everett E.

    2016-01-01

    Purpose: The role of cetuximab in the treatment of locoregionally advanced head and neck squamous cell cancer (LA-HNSCC) remains poorly defined. In this phase 2 randomized study, we investigated the addition of cetuximab to both induction chemotherapy (IC) and hyperfractionated or accelerated chemoradiation. Methods and Materials: Patients with LA-HNSCC were randomized to receive 2 cycles of weekly IC (cetuximab, paclitaxel, carboplatin) and either Cetux-FHX (concurrent cetuximab, 5-fluorouracil, hydroxyurea, and 1.5 Gy twice-daily radiation therapy every other week to 75 Gy) or Cetux-PX (cetuximab, cisplatin, and accelerated radiation therapy with delayed concomitant boost to 72 Gy in 42 fractions). The primary endpoint was progression-free survival (PFS), with superiority compared with historical control achieved if either arm had 2-year PFS ≥70%. Results: 110 patients were randomly assigned to either Cetux-FHX (n=57) or Cetux-PX (n=53). The overall response rate to IC was 91%. Severe toxicity on IC was limited to rash (23% grade ≥3) and myelosuppression (38% grade ≥3 neutropenia). The 2-year rates of PFS for both Cetux-FHX (82.5%) and Cetux-PX (84.9%) were significantly higher than for historical control (P<.001). The 2-year overall survival (OS) was 91.2% for Cetux-FHX and 94.3% for Cetux-PX. With a median follow-up time of 72 months, there were no significant differences in PFS (P=.35) or OS (P=.15) between the treatment arms. The late outcomes for the entire cohort included 5-year PFS, OS, locoregional failure, and distant metastasis rates of 74.1%, 80.3%, 15.7%, and 7.4%, respectively. The 5-year PFS and OS were 84.4% and 91.3%, respectively, among human papillomavirus (HPV)-positive patients and 65.9% and 72.5%, respectively, among HPV-negative patients. Conclusions: The addition of cetuximab to IC and chemoradiation was tolerable and produced long-term control of LA-HNSCC, particularly among poor-prognosis HPV-negative patients. Further

  12. Precision Medicine in Head and Neck Cancer: Myth or Reality?

    Science.gov (United States)

    Malone, Eoghan; Siu, Lillian L

    2018-01-01

    Standard treatment in head and neck squamous cell carcinoma (HNSCC) is limited currently with decisions being made primarily based on tumor location, histology, and stage. The role of the human papillomavirus in risk stratification is actively under clinical trial evaluations. The molecular complexity and intratumoral heterogeneity of the disease are not actively integrated into management decisions of HNSCC, despite a growing body of knowledge in these areas. The advent of the genomic era has delivered vast amounts of information regarding different cancer subtypes and is providing new therapeutic targets, which can potentially be elucidated using next-generation sequencing and other modern technologies. The task ahead is to expand beyond the existent armamentarium by exploiting beyond the genome and perform integrative analysis using innovative systems biology methods, with the goal to deliver effective precision medicine-based theragnostic options in HNSCC.

  13. PET imaging biomarkers in head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Differding, Sarah; Gregoire, Vincent [Universite Catholique de Louvain, St-Luc University Hospital, Department of Radiation Oncology, and Center for Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Experimentale et Clinique (IREC), Brussels (Belgium); Hanin, Francois-Xavier [Universite Catholique de Louvain, St-Luc University Hospital, Department of Nuclear Medicine, and Center for Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Experimentale et Clinique (IREC), Brussels (Belgium)

    2015-04-01

    In locally advanced head and neck squamous cell carcinoma (HNSCC), the role of imaging becomes more and more critical in the management process. In this framework, molecular imaging techniques such as PET allow noninvasive assessment of a range of tumour biomarkers such as metabolism, hypoxia and proliferation, which can serve different purposes. First, in a pretreatment setting they can influence therapy selection strategies and target delineation for radiation therapy. Second, their predictive and/or prognostic value could help enhance the therapeutic ratio in the management of HNSCC. Third, treatment modification can be performed through the generation of a molecular-based heterogeneous dose distribution with dose escalation to the most resistant parts of the tumour, a concept known as dose painting. Fourth, they are increasingly becoming a tool for monitoring response to therapy. In this review, PET imaging biomarkers used in the routine management of HNSCC or under investigation are discussed. (orig.)

  14. Head and neck cancers. Generalities and potential positron emission tomography with 18Flurodesoxyglucose indications

    International Nuclear Information System (INIS)

    Carpentier, Ph.; Gauthier, H.; Lefebvre, J.L.

    2003-01-01

    Head and neck cancers occur in patients after a long history of tobacco consumption and alcohol abuse. They are diagnosed most often at advanced stages, carry both a local and nodal aggressiveness with a notable risk of distant metastases. They are frequently associated to synchronous or metachronous cancers of the same origin (head and neck, esophagus, lung). They often require combined and heavy therapies. The post-therapeutic follow up may be difficult. If morphologic imaging is mandatory for an appropriate decision making, there is an emerging role for PET at various times of the patients' care (initial work up, treatment planning and follow-up) despite possible physiologic uptake in this area. PET may be of interest for diagnosis, metastatic lymph node from an unknown primary, assessment of response to treatment and follow up as well as radiotherapy targeting. (author)

  15. Nurse-led psychosocial interventions in follow-up care for head and neck cancer patients

    NARCIS (Netherlands)

    de Goeij, IC

    2017-01-01

    Introduction: Head and neck cancer and its treatment frequently results in long-term physical problems, such as dry mouth, difficulty eating, impaired speech and/or altered shoulder function. In part because of these persisting problems, head and neck cancer patients are prone to deteriorated

  16. Immunohistochemical detection of osteopontin in advanced head-and-neck cancer: Prognostic role and correlation with oxygen electrode measurements, hypoxia-inducible-factor-1α-related markers, and hemoglobin levels

    International Nuclear Information System (INIS)

    Bache, Matthias; Reddemann, Rolf; Said, Harun M.; Holzhausen, Hans-Juergen; Taubert, Helge; Becker, Axel; Kuhnt, Thomas; Haensgen, Gabriele; Dunst, Juergen; Vordermark, Dirk

    2006-01-01

    Purpose: The tumor-associated glycoprotein osteopontin (OPN) is discussed as a plasma marker of tumor hypoxia. However, the association of immunohistochemical OPN expression in tumor sections with tumor oxygenation parameters (HF5, median pO 2 ), the hypoxia-related markers hypoxia-inducible factor-1α (HIF-1α) and carbonic anhydrase IX (CAIX), or hemoglobin and systemic vascular endothelial growth factor (VEGF) levels has not been investigated. Methods and Materials: Tumor tissue sections of 34 patients with advanced head-and-neck cancer treated with radiotherapy were assessed by immunochemistry for the expression of OPN, HIF-1α, and CA IX. Relationship of OPN expression with tumor oxygenation parameters (HF5, median pO 2 ), HIF-1α and CA IX expression, hemoglobin and serum VEGF level, and clinical parameters was studied. Results: Bivariate analysis showed a significant correlation of positive OPN staining with low hemoglobin level (p = 0.02), high HIF-1α expression (p = 0.02), and high serum vascular endothelial growth factor level (p = 0.02) for advanced head-and-neck cancer. Furthermore, considering the 31 Stage IV patients, the median pO 2 correlated significantly with the OPN expression (p = 0.02). OPN expression alone had only a small impact on prognosis. However, in a univariate Cox proportional hazard regression model, the expression of either OPN or HIF-1α or CA IX was associated with a 4.1-fold increased risk of death (p = 0.02) compared with negativity of all three markers. Conclusion: Osteopontin expression detected immunohistochemically is associated with oxygenation parameters in advanced head-and-neck cancer. When the results of OPN, HIF-1α, and CA IX immunohistochemistry are combined into a hypoxic profile, a strong and statistically significant impact on overall survival is found

  17. [Assessment of psychological status of inpatients with head and neck cancer before surgery].

    Science.gov (United States)

    Li, L; Wang, B Q; Gao, T H; Tian, J

    2018-01-07

    Objective: To investigate the prevalence and psychosocial characteristics in inpatients with head and neck cancer before surgery. Method: From September 2015 to December 2016, 237 consecutive inpatients with head and neck cancer who had been scheduled for surgery were prospectively enrolled in Department of Head and Neck Surgery of Shanxi Provincial Tumor Hospital. Mental health symptoms were systematically investigated using three psychological instruments: symptom checklist-90 (SCL-90), Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS). SPSS 17.0 software was used to analyze the data. And he results of SCL-90, SAS and SDS were compared with the Chinese norm. For all statistical analyses, a P value psychological status in inpatients with head and neck cancer before surgery. Identifying these patients using proper screening instrument is of great important clinical implications for the early detection, management, and reduction of the distress associated with head and neck cancer.

  18. Residual deficits in quality of life one year after intensity-modulated radiotherapy for patients with locally advanced head and neck cancer. Results of a prospective study

    Energy Technology Data Exchange (ETDEWEB)

    Tribius, Silke; Raguse, Marieclaire; Voigt, Christian; Petersen, Cordula; Kruell, Andreas [University Medical Center Hamburg-Eppendorf, Department of Radiation Oncology, Hamburg (Germany); Muenscher, Adrian [University Medical Center Hamburg-Eppendorf, Department of Otorhinolaryngology and Head and Neck Surgery, Hamburg (Germany); Groebe, Alexander [University Medical Center Hamburg-Eppendorf, Department of Maxillofacial Surgery, Hamburg (Germany); Bergelt, Corinna [University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg (Germany); Singer, Susanne [University Medical Center Mainz, Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz (Germany)

    2015-03-08

    Patients with locally advanced head and neck cancer (LAHNC) undergo life-changing treatments that can seriously affect quality of life (QoL). This prospective study examined the key QoL domains during the first year after intensity-modulated radiotherapy (IMRT) and identified predictors of these changes in order to improve patient outcomes. A consecutive series of patients with LAHNC completed the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core module (QLQ-C30) and the HNC-specific QLQ-HN35 before (t0) and at the end (t1) of definitive or adjuvant IMRT, then at 6-8 weeks (t2), 6 months (t3), and 1 year (t4) after IMRT. Patients (n = 111) completing questionnaires at all five time points were included (baseline response rate: 99 %; dropout rate between t0 and t4: 5 %). QoL deteriorated in all domains during IMRT and improved slowly during the first year thereafter. Many domains recovered to baseline values after 1 year but problems with smelling and tasting, dry mouth, and sticky saliva remained issues at this time. Increases in problems with sticky saliva were greater after 1 year in patients with definitive versus adjuvant IMRT (F = 3.5, P = 0.05). QoL in patients with LAHNC receiving IMRT takes approximately 1 year to return to baseline; some domains remain compromised after 1 year. Although IMRT aims to maintain function and QoL, patients experience long-term dry mouth and sticky saliva, particularly following definitive IMRT. Patients should be counseled at the start of therapy to reduce disappointment with the pace of recovery. (orig.) [German] Die Therapie von Patienten mit lokal fortgeschrittenen Kopf-Hals-Tumoren (LFKHT) geht mit einschneidenden Veraenderungen einher und beeinflusst die Lebensqualitaet (LQ) erheblich. Diese prospektive Studie untersucht die LQ waehrend des ersten Jahres nach intensitaetsmodulierter Strahlentherapie (IMRT) und hat Praediktoren dieser Veraenderungen herausgearbeitet, um

  19. Enhanced CAR T cell therapy: A novel approach for head and neck cancers.

    Science.gov (United States)

    Wang, Songlin; Zhu, Zhao

    2018-05-05

    Head and neck cancer that presents in locally advanced stages often results in a bad prognosis with an increased recurrence rate even after curative resections. Radiation therapy is then applied, with multiple side effects, as adjuvant regional therapy. Because of the high rate of recurrence and mortality, new therapies are needed for patients suffering from head and neck malignant tumors.CAR (chimeric antigen receptor) T cell therapy, which was first devised about 25 years ago, causes the killing or apoptosis of target tumor cells through inducing the secretion of cytokines and granzymes by T cells (Cheadle et al., 2014). CARs are comprised of three canonical domains for antigen recognition, T cell activation, and co-stimulation, and are synthetic receptors that reprogram immune cells for therapeutic treatment of multiple tumors (Sadelain, 2017). This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. Palliation of inoperable head and neck cancer: combined intra-arterial infusion chemotherapy and irradiation

    International Nuclear Information System (INIS)

    Armstrong, A.L.; Meeker, W.R.

    1978-01-01

    Palliation of unresectable head and neck cancer remains a difficult problem. Because of excellent results reported by others with infusion of vinblastine, methotrexate, and 5-fluorouracil into the external carotid artery followed by irradiation before curative surgery, we applied this technic to 22 patients with advanced head and neck cancer. Fifteen patients from this group who had chemotherapy infusion followed by radiation therapy are compared with 21 patients who received radiation therapy alone. Both groups were similar in distribution of primary site, histology, and TNM stage. Of 15 patients, 14 (93%) had partial or complete tumor regression after both arterial chemotherapy infusion and irradiation, while 14 of 17 patients (82%) receiving primary irradiation had partial or complete response. Drug toxicity and complications related to infusion occurred in all patients. Most patients in both groups had short survivals (mean of 14.1 months in infusion chemotherapy and radiation vs 9.1 months in primary irradiation). One patient remains alive in the infusion group and two in the control group; however, all have recurrent disease. Results indicate a slight increase in survival time with the addition of infusion chemotherapy to irradiation in palliative treatment of head and neck cancer

  1. Delayed airway stenosis after radiotherapy for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yuta, Atsushi; Tatematsu, Masanori; Ishinaga, Hajime; Harada, Teruhiko; Majima, Yuichi [Mie Univ., Tsu (Japan). School of Medicine

    2002-03-01

    Seven cases of delayed airway stenosis after radiotherapy for early staged head and neck cancers during 1989 and 1999 were evaluated (aged 54-77 yrs, 6 male and a female). The cases included five glottic laryngeal cancers (T1a, T1b, and three T2), a subglottic laryngeal cancer, and an unknown origin, but strongly suspected laryngeal cancer, with neck metastasis. Radio injury was found from 3 months to 47 months after radiotherapy. {sup 60}Co for radiotherapy was used in all seven cases, although {sup 60}Co radionuclide was changed to Liniac in 1997. The total dose was 60 Gy for 3 cases, and 70 Gy for 4 cases. Tracheostomy was performed in 3 cases due to bilateral vocal cord impairment. Background, treatment, and response to radiotherapy were compared to those of 90 patients of a control group with early staged laryngeal cancer who did not fail radiation injury during the same period. As a result, radionuclide ({sup 60}Co), total dose, cervical surgery, antiinflammatory drugs, laryngeal edema during radiotherapy were risk factors. The intensity and the period of mucositis by radiotherapy was important for indicating delayed airway stenosis. (author)

  2. Delayed airway stenosis after radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Yuta, Atsushi; Tatematsu, Masanori; Ishinaga, Hajime; Harada, Teruhiko; Majima, Yuichi

    2002-01-01

    Seven cases of delayed airway stenosis after radiotherapy for early staged head and neck cancers during 1989 and 1999 were evaluated (aged 54-77 yrs, 6 male and a female). The cases included five glottic laryngeal cancers (T1a, T1b, and three T2), a subglottic laryngeal cancer, and an unknown origin, but strongly suspected laryngeal cancer, with neck metastasis. Radio injury was found from 3 months to 47 months after radiotherapy. 60 Co for radiotherapy was used in all seven cases, although 60 Co radionuclide was changed to Liniac in 1997. The total dose was 60 Gy for 3 cases, and 70 Gy for 4 cases. Tracheostomy was performed in 3 cases due to bilateral vocal cord impairment. Background, treatment, and response to radiotherapy were compared to those of 90 patients of a control group with early staged laryngeal cancer who did not fail radiation injury during the same period. As a result, radionuclide ( 60 Co), total dose, cervical surgery, antiinflammatory drugs, laryngeal edema during radiotherapy were risk factors. The intensity and the period of mucositis by radiotherapy was important for indicating delayed airway stenosis. (author)

  3. Radiation-induced cancers of the head and neck, (3)

    International Nuclear Information System (INIS)

    Umatani, Katsunori; Satoh, Takeo; Yoshino, Kunitoshi; Takagi, Tadashi; Fujii, Takashi; Hatta, Chihiro; Maetani, Chikahide; Lu, Bo

    1989-01-01

    This paper discusses twenty patients with radiation-induced cancers of the head and neck treated in the Department of Otorhinolaryngology, the Center for Adult Diseases, Osaka, from January 1979 to December 1985. The most common site of radiation-induced cancers was the hypopharynx and cervical esophagus (70%). We found synchronous double cancers in 2 out of the 20 patients (10%). One patient had hypopharyngeal cancer and thyroid cancer, and the other had oropharyngeal cancer and thyroid cancer. All of the laryngeal cancers were in the supraglottic area. Cancer of the hypopharynx and cervical esophagus occurred more frequently in females (1:3.7 males-females ratio). Half of the patients (10/20) had received irradiation for tuberculous cervical adenitis and 8 patients had been irradiated for malignant tumors. The averaged latent period in the patients who had irradiated for benign conditions was 37.4 years, and that for malignant diseases was 16.0 years. Therefore the latent period of the former was 2.3 times as long as that of the latter. The incidence of radiation-induced cancers in all the patients who had the cancer of the hypopharynx and cervical esophagus was 9% and that of the laryngeal cancer was 0.7%. The incidence of radiation-induced cancers in the hypopharynx and cervical esophagus remarkably differed from that in the larynx. However, it was suggested that the larynx was as resistant to radiation induction as the hypopharynx. Six of the 20 patients (30%) had radiation-induced thyroid tumors. Among them, the incidence of cancers was 33%. (author)

  4. Chemoradiation for Advanced Head and Neck Cancer: Potential for Improving Results to Match Those of Current Treatment Modalities for Early-Stage Tumors-Long-Term Results of Hyperfractionated Chemoradiation With Carbogen Breathing and Anemia Correction With Erythropoietin

    International Nuclear Information System (INIS)

    Villar, Alfonso; Martinez, Jose Carlos; Serdio, Jose Luis de

    2008-01-01

    Purpose: To attempt to improve results of chemoradiation for head and neck cancer. Methods and Materials: From March 1996 to April 2007, 98 patients with head and neck cancer (15 Stage III and 83 Stage IV) were treated with a twice-daily hyperfractionated schedule. Eleven patients presented with N0, 11 with N1, 13 with N2A, 17 with N2B, 24 with N2C, and 22 with N3. Each fraction of treatment consisted of 5 mg/m 2 of carboplatin plus 115 cGy with carbogen breathing. Treatment was given 5 days per week up to total doses of 350 mg/m 2 of carboplatin plus 8050 cGy in 7 weeks. Anemia was corrected with erythropoietin. Results: Ninety-six patients tolerated the treatment as scheduled. All patients tolerated the planned radiation dose. Local toxicity remained at the level expected with irradiation alone. Chemotherapy toxicity was moderate. Ninety-seven complete responses were achieved. After 11 years of follow-up (median, 81 months), actuarial locoregional control, cause-specific survival, overall survival, and nodal control rates at 5 and 10 years were, respectively, 83% and 83%, 68% and 68%, 57% and 55%, and 100% and 100%. Median follow-up of disease-free survivors was 80 months. No significant differences in survival were observed between the different subsites or between the pretreatment node status groups (N0 vs. N+, N0 vs. N1, N0 vs. N2A, N0 vs. N2B, N0 vs. N2C, and N0 vs. N3). Conclusions: Improving results of chemoradiation for advanced head and neck cancer up to the level obtained with current treatments for early-stage tumors is a potentially reachable goal

  5. Bridging Gaps in Multidisciplinary Head and Neck Cancer Care: Nursing Coordination and Case Management

    International Nuclear Information System (INIS)

    Wiederholt, Peggy A.; Connor, Nadine P.; Hartig, Gregory K.; Harari, Paul M.

    2007-01-01

    Patients with advanced head and neck cancer face not only a life-threatening malignancy, but also a remarkably complex treatment regimen that can affect their cosmetic appearance and ability to speak, breathe, and swallow. These patients benefit from the coordinated interaction of a multidisciplinary team of specialists and a comprehensive plan of care to address their physical and psychosocial concerns, manage treatment-related toxicities, and prevent or limit long-term morbidities affecting health-related quality of life. Although little has been published on patient-provider communication with a multidisciplinary team, evidence has suggested that gaps often occur in communication between patients and providers, as well as between specialists. These communication gaps can hinder the multidisciplinary group from working toward common patient-centered goals in a coordinated 'interdisciplinary' manner. We discuss the role of a head-and-neck oncology nurse coordinator at a single institution in bridging gaps across the continuum of care, promoting an interdisciplinary team approach, and enhancing the overall quality of patient-centered head-and-neck cancer care

  6. Treatment of late sequelae after radiotherapy for head and neck cancer.

    Science.gov (United States)

    Strojan, Primož; Hutcheson, Katherine A; Eisbruch, Avraham; Beitler, Jonathan J; Langendijk, Johannes A; Lee, Anne W M; Corry, June; Mendenhall, William M; Smee, Robert; Rinaldo, Alessandra; Ferlito, Alfio

    2017-09-01

    Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Treatment of Head and Neck Cancer in Adults - Health Professional Version

    Science.gov (United States)

    Find information about prognosis, staging, and treatment for adult head and neck cancer sites: hypopharynx, larynx, lip and oral cavity, neck cancer with occult primary, nasopharynx, oropharynx, paranasal sinus and nasal cavity, and salivary gland cancer.

  8. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy--results of a multicentric randomized German trial in advanced head-and-neck cancer.

    Science.gov (United States)

    Staar, S; Rudat, V; Stuetzer, H; Dietz, A; Volling, P; Schroeder, M; Flentje, M; Eckel, H E; Mueller, R P

    2001-08-01

    To demonstrate the efficacy of radiochemotherapy (RCT) as the first choice of treatment for advanced unresectable head-and-neck cancer. To prove an expected benefit of simultaneously given chemotherapy, a two-arm randomized study with hyperfractionated accelerated radiochemotherapy (HF-ACC-RCT) vs. hyperfractionated accelerated radiotherapy (HF-ACC-RT) was initiated. The primary endpoint was 1-year survival with local control (SLC). Patients with Stage III and IV (UICC) unresectable oro- and hypopharyngeal carcinomas were randomized for HF-ACC-RCT with 2 cycles of 5-FU (600 mg/m(2)/day)/carboplatinum (70 mg/m(2)) on days 1--5 and 29--33 (arm A) or HF-ACC-RT alone (arm B). In both arms, there was a second randomization for testing the effect of prophylactically given G-CSF (263 microg, days 15--19) on mucosal toxicity. Total RT dose in both arms was 69.9 Gy in 38 days, with a concomitant boost regimen (weeks 1--3: 1.8 Gy/day, weeks 4 and 5: b.i.d. RT with 1.8 Gy/1.5 Gy). Between July 1995 and May 1999, 263 patients were randomized (median age 56 years; 96% Stage IV tumors, 4% Stage III tumors). This analysis is based on 240 patients: 113 patients with RCT and 127 patients with RT, qualified for protocol and starting treatment. There were 178 oropharyngeal and 62 hypopharyngeal carcinomas. Treatment was tolerable in both arms, with a higher mucosal toxicity after RCT. Restaging showed comparable nonsignificant different CR + PR rates of 92.4% after RCT and 87.9% after RT (p = 0.29). After a median observed time of 22.3 months, l- and 2-year local-regional control (LRC) rates were 69% and 51% after RCT and 58% and 45% after RT (p = 0.14). There was a significantly better 1-year SLC after RCT (58%) compared with RT (44%, p = 0.05). Patients with oropharyngeal carcinomas showed significantly better SLC after RCT (60%) vs. RT (40%, p = 0.01); the smaller group of hypopharyngeal carcinomas had no statistical benefit of RCT (p = 0.84). For both tumor locations

  9. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy--results of a multicentric randomized German trial in advanced head-and-neck cancer

    International Nuclear Information System (INIS)

    Staar, Susanne; Rudat, Volker; Stuetzer, Hartmut; Dietz, Andreas; Volling, Peter; Schroeder, Michael; Flentje, Michael; Eckel, Hans Edmund; Mueller, Rolf-Peter

    2001-01-01

    Purpose: To demonstrate the efficacy of radiochemotherapy (RCT) as the first choice of treatment for advanced unresectable head-and-neck cancer. To prove an expected benefit of simultaneously given chemotherapy, a two-arm randomized study with hyperfractionated accelerated radiochemotherapy (HF-ACC-RCT) vs. hyperfractionated accelerated radiotherapy (HF-ACC-RT) was initiated. The primary endpoint was 1-year survival with local control (SLC). Methods and Materials: Patients with Stage III and IV (UICC) unresectable oro- and hypopharyngeal carcinomas were randomized for HF-ACC-RCT with 2 cycles of 5-FU (600 mg/m 2 /day)/carboplatinum (70 mg/m 2 ) on days 1-5 and 29-33 (arm A) or HF-ACC-RT alone (arm B). In both arms, there was a second randomization for testing the effect of prophylactically given G-CSF (263 μg, days 15-19) on mucosal toxicity. Total RT dose in both arms was 69.9 Gy in 38 days, with a concomitant boost regimen (weeks 1-3: 1.8 Gy/day, weeks 4 and 5: b.i.d. RT with 1.8 Gy/1.5 Gy). Between July 1995 and May 1999, 263 patients were randomized (median age 56 years; 96% Stage IV tumors, 4% Stage III tumors). Results: This analysis is based on 240 patients: 113 patients with RCT and 127 patients with RT, qualified for protocol and starting treatment. There were 178 oropharyngeal and 62 hypopharyngeal carcinomas. Treatment was tolerable in both arms, with a higher mucosal toxicity after RCT. Restaging showed comparable nonsignificant different CR + PR rates of 92.4% after RCT and 87.9% after RT (p=0.29). After a median observed time of 22.3 months, l- and 2-year local-regional control (LRC) rates were 69% and 51% after RCT and 58% and 45% after RT (p=0.14). There was a significantly better 1-year SLC after RCT (58%) compared with RT (44%, p=0.05). Patients with oropharyngeal carcinomas showed significantly better SLC after RCT (60%) vs. RT (40%, p=0.01); the smaller group of hypopharyngeal carcinomas had no statistical benefit of RCT (p=0.84). For both

  10. Characterization of the vascular bed of head-and neck advanced tumors by radioactive emboli

    International Nuclear Information System (INIS)

    Serson, D.

    1982-01-01

    A radioisotopic method, using labeled particles for the determination of regions irrigated by an artery is established. Patients with advanced head and neck cancer were studied, whose treatment was carried out with antiblastics by intra-arterial via. To check the vascular territory early reached by intra-arterial chemotherapy we used albumin macro-particles labeled with iodine 131. The method resulted harmless and of great importance for localization of the tumor bed. It was also observed that the method may be used for localization of the chemotherapic infusion in other sectors of the body or for the anatomic determination of the arterial vascularization. (Author) [pt

  11. Human Papilloma Virus in Head and Neck Squamous Cell Cancer

    Science.gov (United States)

    Asvadi Kermani, I; Seifi, SH; Dolatkhah, R; Sakhinia, E; Dastgiri, S; Ebrahimi, A; Lotfy, A; Esmaeili, HA; G, Mohammadi; M, Naderpour; SH, Hajalipour; Haggi A, Asghari; M, Nadri

    2012-01-01

    Background Epidemiologic and molecular evidences have established a strong link between high risk types of Human Papilloma Virus and a subgroup of Head and Neck Squamous Cell Carcinomas (HNSCC). We evaluated the frequency of HPV positivity in HNSCC and its relationship to demographic and some risk factor variables in an open case- control study. Methods Fourteen recently diagnosed patients with squamous cell cancer of oropharynx, hypopharynx and larynx aged 18-50 years were examined from 2008-2010 in Tabriz, Iran. HPV DNA was extracted from paraffin-embedded blocks of each patient's sample for PCR evaluation. Saliva samples of 94 control cancer-free subjects were collected for DNA analysis. Multivariable logistic regression method was used to calculate odds ratio for case-control comparisons. Results High risk HPV was detected in 6(42.8%) patients, and 6(5.3%) control subjects which was statistically significant (p<0.0001). HPV-18 was the most frequent type both in the cases and controls. HPV-16 DNA was detected in two patients of the case group, but it was not detected in any of the controls. The relation between demographic and risk factor variables was not statistically significant. Conclusion HPV infection has a significant impact on HNSCC. Despite HPV-16 stronger impact, HPV-18 is more likely to cause malignant degeneration in such cancers amongst some communities. It is vital to introduce and conduct immunization schedules in health care systems to protect communities to some extent. PMID:25780535

  12. Cetuximab in the treatment of head and neck cancer: preliminary results outside clinical trials

    Science.gov (United States)

    Dequanter, Didier; Shahla, Mohammad; Paulus, Pascal; Lothaire, Phillippe

    2010-01-01

    Introduction: The purpose of this study was to evaluate the clinical efficacy in our daily practice, outside clinical trials, of cetuximab plus radiotherapy in a majority of treatment-naive patients with locoregionally advanced head and neck squamous cell carcinomas. Methods: A retrospective study was performed to evaluate outcomes in patients who were treated definitively with cetuximab and radiotherapy (ExRT). Patients with stage III or IV, nonmetastatic, measurable squamous cell carcinoma of the head and neck (SCCHN) were eligible. Results: There were 18 males and two females. The median age was 61 years (range from 49 to 87 years old). Concurrent radiotherapy and cetuximab was used, in first line, in 17 patients with locally advanced disease; two patients with recurrent SCCHN, who were intolerant of Cisplatin-based regimens, were treated with radiotherapy combined with weekly cetuximab; and 1 patient received cetuximab and radiotherapy postoperatively. The median time of response was 10 months (range from 2 to 24 months). A partial response was observed in 11 cases; a complete response in nine cases. The occurrence of grade 2–3 skin toxicity was observed in 11 cases. Skin toxicity was clearly correlated with a better response and the duration of the response to the treatment. The use of cetuximab in combination with radiotherapy does not increase the side effects of radiotherapy. At the end of the follow-up, 17 patients died. Conclusion: Cetuximab, with its highly targeted mechanism of action and synergistic activity with current treatment modalities, is a valuable treatment option in head and neck patients. The effect of the epidermal growth factor receptor antagonist occurs without any change in the pattern and the severity of toxicity usually associated with head and neck radiation. Cetuximab seems not to provide the most benefit for patients with oropharyngeal cancers but will in patients with T4 tumors. However, the median duration of local control was

  13. Cetuximab in the treatment of head and neck cancer: preliminary results outside clinical trials

    International Nuclear Information System (INIS)

    Dequanter, Didier; Shahla, Mohammad; Paulus, Pascal; Lothaire, Phillippe

    2010-01-01

    The purpose of this study was to evaluate the clinical efficacy in our daily practice, outside clinical trials, of cetuximab plus radiotherapy in a majority of treatment-naive patients with locoregionally advanced head and neck squamous cell carcinomas. A retrospective study was performed to evaluate outcomes in patients who were treated definitively with cetuximab and radiotherapy (ExRT). Patients with stage III or IV, nonmetastatic, measurable squamous cell carcinoma of the head and neck (SCCHN) were eligible. There were 18 males and two females. The median age was 61 years (range from 49 to 87 years old). Concurrent radiotherapy and cetuximab was used, in first line, in 17 patients with locally advanced disease; two patients with recurrent SCCHN, who were intolerant of Cisplatin-based regimens, were treated with radiotherapy combined with weekly cetuximab; and 1 patient received cetuximab and radiotherapy postoperatively. The median time of response was 10 months (range from 2 to 24 months). A partial response was observed in 11 cases; a complete response in nine cases. The occurrence of grade 2–3 skin toxicity was observed in 11 cases. Skin toxicity was clearly correlated with a better response and the duration of the response to the treatment. The use of cetuximab in combination with radiotherapy does not increase the side effects of radiotherapy. At the end of the follow-up, 17 patients died. Cetuximab, with its highly targeted mechanism of action and synergistic activity with current treatment modalities, is a valuable treatment option in head and neck patients. The effect of the epidermal growth factor receptor antagonist occurs without any change in the pattern and the severity of toxicity usually associated with head and neck radiation. Cetuximab seems not to provide the most benefit for patients with oropharyngeal cancers but will in patients with T4 tumors. However, the median duration of local control was less as described in the clinical trials

  14. Intensity-modulated radiotherapy using simultaneous-integrated boost for definitive treatment of locally advanced mucosal head and neck cancer: outcomes from a single-institution series

    International Nuclear Information System (INIS)

    Johnston, Meredith; Guo, Linxin; Hanna, Catherine; Back, Michael; Guminski, Alex; Lee, Adrian; Eade, Thomas; Veivers, David; Wignall, Andrew

    2013-01-01

    The study aims to report outcomes for patients treated using intensity-modulated radiotherapy (IMRT) with simultaneous-integrated boost and weekly cisplatin for American Joint Committee on Cancer stage III/IV mucosal head and neck squamous cell carcinomas (HNSCCs). Records for 67 patients treated definitively with IMRT for HNSCC were reviewed. By including only those treated with weekly cisplatin, 45 patients were eligible for analysis. Treatment outcomes, effect of patient, tumour and treatment characteristics on disease recurrence were analysed. All patients completed IMRT to 7000cGy in 35 fractions, with concurrent weekly cisplatin 40mg/m 2 (median 6 cycles). Median follow-up was 28 months for living patients. Two-year loco-regional recurrence-free, metastasis-free and overall survival were 85.4, 81.0 and 87.4%, respectively. Local recurrence occurred in three patients, and distant recurrence in eight patients. Our results show efficacy of IMRT and weekly cisplatin in the treatment of stage III/IV HNSCC at our institution with respect to loco-regional control.

  15. Hyperfractionated chemoradiation with carbogen breathing, with or without erythropoietin: A stepwise developed treatment schedule for advanced head-and-neck cancer

    International Nuclear Information System (INIS)

    Martinez, Jose Carlos; Villar, Alfonso; Cabezon, Maria Auxiliadora; Serdio, Jose Luis de; Fuentes, Claudio; Espineira, Manuel; Perez, Maria Dolores; Gil, Jose; Artazkoz, Juan Jose; Borque, Carlos; Suner, Marcos; Saavedra, Juan Antonio

    2001-01-01

    Purpose: To investigate the influence of carbogen breathing on chemoradiation and the effects of erythropoietin on transfusions. Methods and Materials: From March 1996 to April 2000, 42 (4 Stage III and 38 Stage IV) patients with head and neck cancer were treated with a twice-a-day hyperfractionated schedule. Each fraction consisted of 5 mg/m 2 of carboplatin plus 115 cGy with carbogen breathing. Treatment was given 5 days per week up to total doses of 350 mg/m 2 of carboplatin plus 8050 cGy in 7 weeks. Anemia was treated either by transfusion or by erythropoietin. Results: Forty-one patients tolerated the treatment as scheduled. All patients tolerated the planned radiation dose. Five transfusions were given in the first group, but no transfusion was needed in the erythropoietin group. Local toxicities remained at the level expected with irradiation alone. Chemotherapy toxicity was moderate. Forty-two complete responses were achieved. At two years actuarial local control, cause-specific survival and overall survival are respectively 85%, 69%, and 68%. At four years estimated probabilities of local control, cause-specific survival and overall survival are also 85%, 69%, and 68%. Conclusions: These results compare favorably with those of most reported studies. The addition of carbogen breathing appears to improve the results of chemoradiation alone. Erythropoietin therapy avoided transfusions

  16. Nutritional consequences of the radiotherapy of head and neck cancer

    International Nuclear Information System (INIS)

    Chencharick, J.D.; Mossman, K.L.

    1983-01-01

    Nutrition-related complications of radiotherapy were evaluated in 74 head and neck cancer patients. Subjective changes of mouth dryness, taste, dysphagia, appetite, and food preferences were determined by questionnaire before and at weekly intervals during curative radiotherapy. Changes in body weight during therapy were also recorded. In addition, 24-hour dietary histories were taken from eight patients at the beginning and end of treatment. Results of the study indicate that patients were subjectively aware of nutritional problems prior to therapy and that therapy exacerbated these problems. As many as 25% of the patients experienced oral complications such as taste loss and/or dry mouth prior to initiation of radiotherapy. By the end of radiotherapy, over 80% of the patients were aware of oral and nutritional problems. Patients had an average weight loss of 5 kg prior to therapy; this loss of weight did not change during therapy. Diet histories of eight patients indicate significant caloric deficiencies early and late in radiotherapy. The oral and nutritional problems experienced by patients, even prior to therapy, support the idea that nutritional evaluation and maintenance are important not only during therapy, but prior to radiotherapy as well. Nutritional evaluation should be made a routine, integral part of therapy for every cancer patient

  17. Feasibility of primary tumor culture models and preclinical prediction assays for head and neck cancer : A narrative review

    NARCIS (Netherlands)

    Dohmen, Amy J C; Swartz, Justin E.; Van Den Brekel, Michiel W M; Willems, Stefan M.; Spijker, René; Neefjes, Jacques; Zuur, Charlotte L.

    2015-01-01

    Primary human tumor culture models allow for individualized drug sensitivity testing and are therefore a promising technique to achieve personalized treatment for cancer patients. This would especially be of interest for patients with advanced stage head and neck cancer. They are extensively treated

  18. Clinical Applications of FDG PET and PET/CT in Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Akram Al-Ibraheem

    2009-01-01

    Full Text Available 18F-FDG PET plays an increasing role in diagnosis and management planning of head and neck cancer. Hybrid PET/CT has promoted the field of molecular imaging in head and neck cancer. This modality is particular relevant in the head and neck region, given the complex anatomy and variable physiologic FDG uptake patterns. The vast majority of 18F-FDG PET and PET/CT applications in head and neck cancer related to head and neck squamous cell carcinoma. Clinical applications of 18F-FDG PET and PET/CT in head and neck cancer include diagnosis of distant metastases, identification of synchronous 2nd primaries, detection of carcinoma of unknown primary and detection of residual or recurrent disease. Emerging applications are precise delineation of the tumor volume for radiation treatment planning, monitoring treatment, and providing prognostic information. The clinical role of 18F-FDG PET/CT in N0 disease is limited which is in line with findings of other imaging modalities. MRI is usually used for T staging with an intense discussion concerning the preferable imaging modality for regional lymph node staging as PET/CT, MRI, and multi-slice spiral CT are all improving rapidly. Is this review, we summarize recent literature on 18F-FDG PET and PET/CT imaging of head and neck cancer.

  19. Multidisciplinary management of head and neck cancer: First expert consensus using Delphi methodology from the Spanish Society for Head and Neck Cancer (part 1).

    Science.gov (United States)

    Mañós, M; Giralt, J; Rueda, A; Cabrera, J; Martinez-Trufero, J; Marruecos, J; Lopez-Pousa, A; Rodrigo, J P; Castelo, B; Martínez-Galán, J; Arias, F; Chaves, M; Herranz, J J; Arrazubi, V; Baste, N; Castro, A; Mesía, R

    2017-07-01

    Head and neck cancer is one of the most frequent malignances worldwide. Despite the site-specific multimodality therapy, up to half of the patients will develop recurrence. Treatment selection based on a multidisciplinary tumor board represents the cornerstone of head and neck cancer, as it is essential for achieving the best results, not only in terms of outcome, but also in terms of organ-function preservation and quality of life. Evidence-based international and national clinical practice guidelines for head and neck cancer not always provide answers in terms of decision-making that specialists must deal with in their daily practice. This is the first Expert Consensus on the Multidisciplinary Approach for Head and Neck Squamous Cell Carcinoma (HNSCC) elaborated by the Spanish Society for Head and Neck Cancer and based on a Delphi methodology. It offers several specific recommendations based on the available evidence and the expertise of our specialists to facilitate decision-making of all health-care specialists involved. Copyright © 2017. Published by Elsevier Ltd.

  20. Thyroid dysfunction following radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Turner, S.L.; Tiver, K.W.; Boyages, S.C.

    1995-01-01

    Purpose: To determine the frequency of hypothyroidism (both subclinical and clinical) following external beam radiotherapy to the whole of the thyroid gland in the treatment of squamous cell cancers of the head and neck. Methods and Materials: One hundred and four patients who had completed radiotherapy 30 days to 5 years earlier (84 patients) or who were scheduled for radiotherapy (20 patients) had a single measurement of serum-free thyroxine and thyroid stimulating hormone levels between August 1991 and May 1992. Results: None of the 20 patients assessed prior to treatment showed thyroid dysfunction. Twenty of 84 (23.8%) previously treated patients had subclinical (9.5%) or clinical (14.3%) hypothyroidism. By 5 years, up to 40% of patients may become hypothyroid. Thyroid underactivity was significantly more common in patients having both laryngectomy (including hemi-thyroidectomy) and radiotherapy compared to radiotherapy alone (p < 0.001). Hypothyroidism had not been suspected clinically in any patient tested. Conclusion: In view of the frequency and potential morbidity of this complication, thyroid function testing should become a routine part of posttreatment follow-up for these patients

  1. The future of personalised radiotherapy for head and neck cancer.

    Science.gov (United States)

    Caudell, Jimmy J; Torres-Roca, Javier F; Gillies, Robert J; Enderling, Heiko; Kim, Sungjune; Rishi, Anupam; Moros, Eduardo G; Harrison, Louis B

    2017-05-01

    Radiotherapy has long been the mainstay of treatment for patients with head and neck cancer and has traditionally involved a stage-dependent strategy whereby all patients with the same TNM stage receive the same therapy. We believe there is a substantial opportunity to improve radiotherapy delivery beyond just technological and anatomical precision. In this Series paper, we explore several new ideas that could improve understanding of the phenotypic and genotypic differences that exist between patients and their tumours. We discuss how exploiting these differences and taking advantage of precision medicine tools-such as genomics, radiomics, and mathematical modelling-could open new doors to personalised radiotherapy adaptation and treatment. We propose a new treatment shift that moves away from an era of empirical dosing and fractionation to an era focused on the development of evidence to guide personalisation and biological adaptation of radiotherapy. We believe these approaches offer the potential to improve outcomes and reduce toxicity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Immunotherapy of Head and Neck Cancer: Current and Future Considerations

    Directory of Open Access Journals (Sweden)

    Alexander D. Rapidis

    2009-01-01

    Full Text Available Patients with head and neck squamous cell carcinoma (HNSCC are at considerable risk for death, with 5-year relative survival rates of approximately 60%. The profound multifaceted deficiencies in cell-mediated immunity that persist in most patients after treatment may be related to the high rates of treatment failure and second primary malignancies. Radiotherapy and chemoradiotherapy commonly have severe acute and long-term side effects on immune responses. The development of immunotherapies reflects growing awareness that certain immune system deficiencies specific to HNSCC and some other cancers may contribute to the poor long-term outcomes. Systemic cell-mediated immunotherapy is intended to activate the entire immune system and mount a systemic and/or locoregional antitumor response. The delivery of cytokines, either by single cytokines, for example, interleukin-2, interleukin-12, interferon-, interferon-, or by a biologic mix of multiple cytokines, such as IRX-2, may result in tumor rejection and durable immune responses. Targeted immunotherapy makes use of monoclonal antibodies or vaccines. All immunotherapies for HNSCC except cetuximab remain investigational, but a number of agents whose efficacy and tolerability are promising have entered phase 2 or phase 3 development.

  3. Allergies and risk of head and neck cancer.

    Science.gov (United States)

    Michaud, Dominique S; Langevin, Scott M; Eliot, Melissa; Nelson, Heather H; McClean, Michael D; Christensen, Brock C; Marsit, Carmen J; Kelsey, Karl T

    2012-08-01

    Individuals with allergies have a heightened Th2 (T helper 2) immunity, which may provide advantages in controlling tumor growth. Inverse associations have been reported among individuals with allergies and risk of brain and pancreatic cancers. We examined the relationship between allergies and risk of head and neck squamous cell carcinoma (HNSCC) in a population-based case-control study with 1,014 cases and 1,193 frequency-matched controls. Logistic regression models were used to estimate odds ratios (OR) and 95 % confidence intervals (95 % CI) controlling for age, sex, race, smoking history, alcohol consumption, and education. In addition, in a subset of the population, models were adjusted for HPV16 status. Individuals with allergies had a 19 % lower risk of HNSCC (OR = 0.81, 95 % CI = 0.67-0.98). Associations with allergies were stronger for laryngeal (OR = 0.66, 95 % CI = 0.45-0.97) and oropharyngeal (OR = 0.73, 95 % CI = 0.57-0.92) cancers, while no association was observed for oral cavity cancers (OR = 0.98, 95 % CI = 0.76-1.26). History of asthma was not associated with overall HNSCC, but the association was statistically significant for oropharyngeal cancer (OR = 0.67, 95 % CI = 0.44-0.99). HPV16 status did not confound or modify the associations with allergies. Elevated Th2 immunity in individuals with history of allergies and asthma may reduce the risk of HNSCC. Additional research into related mechanisms may provide new insights into how to treat HNSCC. These findings may provide new insight into biological pathways that could lead to a better understanding of the etiology of this disease.

  4. Phase III randomized trial of induction chemotherapy in patients with N2 or N3 locally advanced head and neck cancer.

    Science.gov (United States)

    Cohen, Ezra E W; Karrison, Theodore G; Kocherginsky, Masha; Mueller, Jeffrey; Egan, Robyn; Huang, Chao H; Brockstein, Bruce E; Agulnik, Mark B; Mittal, Bharat B; Yunus, Furhan; Samant, Sandeep; Raez, Luis E; Mehra, Ranee; Kumar, Priya; Ondrey, Frank; Marchand, Patrice; Braegas, Bettina; Seiwert, Tanguy Y; Villaflor, Victoria M; Haraf, Daniel J; Vokes, Everett E

    2014-09-01

    Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease. Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m(2) on day 1, cisplatin 75 mg/m(2) on day 1, and fluorouracil 750 mg/m(2) on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS). A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival. IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN. © 2014 by American Society of Clinical Oncology.

  5. Molecular and Clinical Responses in a Pilot Study of Gefitinib With Paclitaxel and Radiation in Locally Advanced Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Van Waes, Carter; Allen, Clint T.; Citrin, Deborah; Gius, David; Colevas, A. Dimetrios; Harold, Nancy A.; Rudy, Susan; Nottingham, Liesl; Muir, Christine; Chen, Zhong; Singh, Anurag K.; Dancey, Janet; Morris, John C.

    2010-01-01

    Purpose: Epidermal growth factor receptor (EGFR) overexpression in head-and-neck squamous cell carcinoma (HNSCC) stimulates tumor cell proliferation, inhibits apoptosis, and increases chemotherapy and radiation resistance. We examined the toxicity, safety and the effects on EGFR signaling in tumor biopsy samples from patients with locally advanced HNSCC treated with the EGFR signaling inhibitor gefitinib (GEF) combined with weekly intravenous paclitaxel (PAC) and radiation therapy (RT). Methods and Materials: This was a pilot Phase I dose-escalation study. Eligibility included Stage III to IVB HNSCC, age ≥18 years, no prior RT or chemotherapy, adequate organ function, and informed consent. Endpoints included determination of maximum tolerated dose (MTD) and analysis of treatment effect on EGFR signaling, tumor cell proliferation, and apoptosis in biopsy samples. Results: Ten patients were treated. The MTD of this combination was GEF 250 mg/d with PAC 36 mg/m 2 intravenously weekly x 6 with concurrent RT. Grade 3/4 toxicities included prolonged (>8 weeks) stomatitis (7 patients), infection (2 patients), and interstitial pneumonitis (1 patient). There were five complete responses (CR) and two partial responses (PR). Of 7 patients undergoing serial biopsies, only 1 patient demonstrated a reduction in phosphorylated EGFR, decreased downstream signaling, and reduced cellular proliferation after initiating GEF. Conclusions: Inhibition of EGFR by GEF was observed in only one of seven tumors studied. The addition of GEF to PAC and RT did not appear to improve the response of locally advanced HNSCC compared with our prior experience with PAC and RT alone. This treatment appeared to delay recovery from stomatitis.

  6. Increase in tumor control and normal tissue complication probabilities in advanced head-and-neck cancer for dose-escalated intensity-modulated photon and proton therapy

    Directory of Open Access Journals (Sweden)

    Annika eJakobi

    2015-11-01

    Full Text Available Introduction:Presently used radio-chemotherapy regimens result in moderate local control rates for patients with advanced head and neck squamous cell carcinoma (HNSCC. Dose escalation (DE may be an option to improve patient outcome, but may also increase the risk of toxicities in healthy tissue. The presented treatment planning study evaluated the feasibility of two DE levels for advanced HNSCC patients, planned with either intensity-modulated photon therapy (IMXT or proton therapy (IMPT.Materials and Methods:For 45 HNSCC patients, IMXT and IMPT treatment plans were created including DE via a simultaneous integrated boost (SIB in the high-risk volume, while maintaining standard fractionation with 2 Gy per fraction in the remaining target volume. Two DE levels for the SIB were compared: 2.3 Gy and 2.6 Gy. Treatment plan evaluation included assessment of tumor control probabilities (TCP and normal tissue complication probabilities (NTCP.Results:An increase of approximately 10% in TCP was estimated between the DE levels. A pronounced high-dose rim surrounding the SIB volume was identified in IMXT treatment. Compared to IMPT, this extra dose slightly increased the TCP values and to a larger extent the NTCP values. For both modalities, the higher DE level led only to a small increase in NTCP values (mean differences < 2% in all models, except for the risk of aspiration, which increased on average by 8% and 6% with IMXT and IMPT, respectively, but showed a considerable patient dependence. Conclusions:Both DE levels appear applicable to patients with IMXT and IMPT since all calculated NTCP values, except for one, increased only little for the higher DE level. The estimated TCP increase is of relevant magnitude. The higher DE schedule needs to be investigated carefully in the setting of a prospective clinical trial, especially regarding toxicities caused by high local doses that lack a sound dose response description, e.g., ulcers.

  7. Phase III Randomized Trial of Induction Chemotherapy in Patients With N2 or N3 Locally Advanced Head and Neck Cancer

    Science.gov (United States)

    Cohen, Ezra E.W.; Karrison, Theodore G.; Kocherginsky, Masha; Mueller, Jeffrey; Egan, Robyn; Huang, Chao H.; Brockstein, Bruce E.; Agulnik, Mark B.; Mittal, Bharat B.; Yunus, Furhan; Samant, Sandeep; Raez, Luis E.; Mehra, Ranee; Kumar, Priya; Ondrey, Frank; Marchand, Patrice; Braegas, Bettina; Seiwert, Tanguy Y.; Villaflor, Victoria M.; Haraf, Daniel J.; Vokes, Everett E.

    2014-01-01

    Purpose Induction chemotherapy (IC) before radiotherapy lowers distant failure (DF) rates in locally advanced squamous cell carcinoma of the head and neck (SCCHN). The goal of this phase III trial was to determine whether IC before chemoradiotherapy (CRT) further improves survival compared with CRT alone in patients with N2 or N3 disease. Patients and Methods Treatment-naive patients with nonmetastatic N2 or N3 SCCHN were randomly assigned to CRT alone (CRT arm; docetaxel, fluorouracil, and hydroxyurea plus radiotherapy 0.15 Gy twice per day every other week) versus two 21-day cycles of IC (docetaxel 75 mg/m2 on day 1, cisplatin 75 mg/m2 on day 1, and fluorouracil 750 mg/m2 on days 1 to 5) followed by the same CRT regimen (IC + CRT arm). The primary end point was overall survival (OS). Secondary end points included DF-free survival, failure pattern, and recurrence-free survival (RFS). Results A total of 285 patients were randomly assigned. The most common grade 3 to 4 toxicities during IC were febrile neutropenia (11%) and mucositis (9%); during CRT (both arms combined), they were mucositis (49%), dermatitis (21%), and leukopenia (18%). Serious adverse events were more common in the IC arm (47% v 28%; P = .002). With a minimum follow-up of 30 months, there were no statistically significant differences in OS (hazard ratio, 0.91; 95% CI, 0.59 to 1.41), RFS, or DF-free survival. Conclusion IC did not translate into improved OS compared with CRT alone. However, the study was underpowered because it did not meet the planned accrual target, and OS was higher than predicted in both arms. IC cannot be recommended routinely in patients with N2 or N3 locally advanced SCCHN. PMID:25049329

  8. Relationship between ABO blood groups and head and neck cancer among Greek patients.

    Science.gov (United States)

    Kakava, Kassiani; Karelas, Ioannis; Koutrafouris, Ioannis; Damianidis, Savvas; Stampouloglou, Paulos; Papadakis, Georgios; Xenos, Antonios; Krania, Foteini; Sarof, Paulos; Tasopoulos, Georgios; Petridis, Nikolaos

    2016-01-01

    We examined the association of ABO blood groups with the different types of head and neck cancers. 195 diagnosed cases and 801 controls were selected from a Greek tertiary cancer center. Information regarding type of head and neck cancer and ABO blood group was collected and registered. The O blood group was found to be most prevalent followed by A, B and AB among the controls, whereas blood group A followed by O, B and AB was most prevalent among cancer patients. The difference among the distribution between the cases and controls was statistically significant in blood group A (pblood group A had 1.52-fold higher risk of developing head and neck cancer compared to people of other blood groups. Blood group A was found to be a potential risk factor for the development of head and neck cancers.

  9. Second cancers following radiotherapy for early stage head and neck cancer

    International Nuclear Information System (INIS)

    Shibuya, Hitoshi; Yoshimura, Ryo-ichi; Oota, Sayako; Watanabe, Hiroshi; Miura, Masahiko

    2005-01-01

    Different site specificity of second primary cancer following treatment for early stage squamous cell carcinoma of the head and neck was found in the analysis of post-treatment long-term follow up cases. The highest risk of second primary cancer was observed in the oro-hypo-pharynx cancer groups, and the lowest risks were observed in the epi-pharynx cancer and maxillary sinus cancer groups. Squamous cell carcinoma in the irradiated head and neck region with long latency periods could be included in the radiation induced cancer from comparison with post-irradiation cases for malignant lymphoma, benign diseases as well as breast cancers. (author)

  10. Oncogenic impact of human papilloma virus in head and neck cancer.

    LENUS (Irish Health Repository)

    Heffernan, C B

    2012-02-01

    There is considerable debate within the literature about the significance of human papilloma virus in head and neck squamous cell carcinoma, and its potential influence on the prevention, diagnosis, grading, treatment and prognosis of these cancers. Cigarette smoking and alcohol consumption have traditionally been cited as the main risk factors for head and neck cancers. However, human papilloma virus, normally associated with cervical and other genital carcinomas, has emerged as a possible key aetiological factor in head and neck squamous cell carcinoma, especially oropharyngeal cancers. These cancers pose a significant financial burden on health resources and are increasing in incidence. The recent introduction of vaccines targeted against human papilloma virus types 16 and 18, to prevent cervical cancer, has highlighted the need for ongoing research into the importance of human papilloma virus in head and neck squamous cell carcinoma.

  11. Post-treatment PET/CT and p16 status for predicting treatment outcomes in locally advanced head and neck cancer after definitive radiation

    Energy Technology Data Exchange (ETDEWEB)

    Awan, Musaddiq J.; Machtay, Mitchell; Yao, Min [Case Western Reserve University and University Hospitals, Department of Radiation Oncology, Cleveland, OH (United States); Lavertu, Pierre; Zender, Chad; Rezaee, Rod; Fowler, Nicole [University Hospitals, Department of Otolaryngology and Head and Neck Surgery, Cleveland, OH (United States); Karapetyan, Lilit; Gibson, Michael [University Hospitals, Department of Medical Oncology, Cleveland, OH (United States); Wasman, Jay [University Hospitals, Department of Pathology, Cleveland, OH (United States); Faulhaber, Peter [University Hospitals, Department of Nuclear Medicine and Radiology, Cleveland, OH (United States)

    2017-06-15

    To retrospectively review post-treatment (post-tx) FDG-PET/CT scans in patients with advanced head and neck squamous cell carcinoma (HNSCC) and known p16 status, treated with definitive (chemo)radiation (RT). A total of 108 eligible patients had N2A or greater HNSCC treated with chemoRT from August 1, 2008, to February 28, 2015, with post-tx PET/CT within 6 months after RT. Kaplan-Meier curves, log-rank statistics, and Cox proportional hazards regression were used for statistical analysis. Median follow-up was 2.38 years. Sixty-eight (63.0%) patients had p16+ and 40 (37.0%) had p16- status. Two-year overall survival and recurrence-free survival were 93.4% and 77.8%, respectively. The negative predictive value (NPV) of PET/CT for local recurrence (LR) was 100%. The NPV for regional recurrence (RR) was 96.5% for all patients, 100% for p16+ patients, and 88.5% for p16- patients. The positive predictive value (PPV) of PET/CT for recurrence was 77.3% for all patients, 50.0% for p16+, and 78.6% for p16-. The PPV for LR was 72.7% for all patients, 50.0% for p16+ patients, and 72.7% for p16- patients. The PPV for RR was 50.0% for all patients, 33% for p16+, and 66.6% for p16-. Post-tx PET/CT and p16 status were independent predictors of recurrence-free survival (p < 0.01). Post-tx PET/CT predicts treatment outcomes in both p16 + and p16- patients, and does so independently of p16 status. P16- patients with negative PET have a 10% risk of nodal recurrence, and closer follow-up in these patients is warranted. (orig.)

  12. Quantitative assessment of Zirconium-89 labeled cetuximab using PET/CT imaging in patients with advanced head and neck cancer: a theragnostic approach.

    Science.gov (United States)

    Even, Aniek J G; Hamming-Vrieze, Olga; van Elmpt, Wouter; Winnepenninckx, Véronique J L; Heukelom, Jolien; Tesselaar, Margot E T; Vogel, Wouter V; Hoeben, Ann; Zegers, Catharina M L; Vugts, Daniëlle J; van Dongen, Guus A M S; Bartelink, Harry; Mottaghy, Felix M; Hoebers, Frank; Lambin, Philippe

    2017-01-17

    Biomarkers predicting treatment response to the monoclonal antibody cetuximab in locally advanced head and neck squamous cell carcinomas (LAHNSCC) are lacking. We hypothesize that tumor accessibility is an important factor in treatment success of the EGFR targeting drug. We quantified uptake of cetuximab labeled with Zirconium-89 (89Zr) using PET/CT imaging.Seventeen patients with stage III-IV LAHNSCC received a loading dose unlabeled cetuximab, followed by 10 mg 54.5±9.6 MBq 89Zr-cetuximab. PET/CT images were acquired either 3 and 6 or 4 and 7 days post-injection. 89Zr-cetuximab uptake was quantified using standardized uptake value (SUV) and tumor-to-background ratio (TBR), and correlated to EGFR immunohistochemistry. TBR was compared between scan days to determine optimal timing.Uptake of 89Zr-cetuximab varied between patients (day 6-7: SUVpeak range 2.5-6.2). TBR increased significantly (49±28%, p < 0.01) between first (1.1±0.3) and second scan (1.7±0.6). Between groups with a low and high EGFR expression a significant difference in SUVmean (2.1 versus 3.0) and SUVpeak (3.2 versus 4.7) was found, however, not in TBR. Data is available at www.cancerdata.org (DOI: 10.17195/candat.2016.11.1).In conclusion, 89Zr-cetuximab PET imaging shows large inter-patient variety in LAHNSCC and provides additional information over FDG-PET and EGFR expression. Validation of the predictive value is recommended with scans acquired 6-7 days post-injection.

  13. High-grade acute organ toxicity as positive prognostic factor in primary radio(chemo)therapy for locally advanced, inoperable head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Wolff, Hendrik Andreas; Bosch, Jan; Hennies, Steffen; Hess, Clemens F.; Christiansen, Hans [Dept. of Radiotherapy and Radiooncology, Univ. Medicine Goettingen (Germany); Jung, Klaus [Dept. of Medical Statistics, Univ. Medicine Goettingen (Germany); Overbeck, Tobias [Dept. of Haematology and Oncology, Univ. Medicine Goettingen (Germany); Matthias, Christoph; Roedel, Ralph M. [Dept. of Otorhinolaryngology, Univ. Medicine Goettingen (Germany)

    2010-05-15

    Purpose: to test for a possible correlation between high-grade acute organ toxicity during primary radio(chemo)therapy and treatment outcome in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Patients and methods: from 05/1994 to 01/2009, 216 HNSCC patients were treated with radio(chemo)therapy in primary approach. They received normofractionated (2 Gy/fraction) irradiation including associated nodal drainage sites to a cumulative dose of 70 Gy. 151 patients received additional concomitant chemotherapy (111 patients 5-fluorouracil/mitomycin C, 40 patients cisplatin-based). Toxicity during treatment was monitored weekly according to the Common Toxicity Criteria (CTC), and any toxicity grade CTC {>=} 3 of mucositis, dysphagia or skin reaction was assessed as high-grade acute organ toxicity for later analysis. Results: a statistically significant coherency between high-grade acute organ toxicity and overall survival as well as locoregional control was found: patients with CTC {>=} 3 acute organ toxicity had a 5-year overall survival rate of 4% compared to 8% in patients without (p < 0.01). Thereby, multivariate analyses revealed that the correlation was independent of other possible prognostic factors or factors that may influence treatment toxicity, especially concomitant chemotherapy and radiotherapy technique or treatment-planning procedure. Conclusion: these data indicate that normal tissue and tumor tissue may behave similarly with respect to treatment response, as high-grade acute organ toxicity during radio(chemo)therapy showed to be an independent prognostic marker in the own patient population. However, the authors are aware of the fact that a multivariate analysis in a retrospective study generally has statistical limitations. Therefore, their hypothesis should be further analyzed on biomolecular and clinical levels and other tumor entities in prospective trials. (orig.)

  14. Salvage Re-Irradiation for Recurrent Head and Neck Cancer

    International Nuclear Information System (INIS)

    Lee, Nancy; Chan, Kelvin; Bekelman, Justin E.; Zhung, Joanne; Mechalakos, James; Narayana, Ashwatha; Wolden, Suzanne; Venkatraman, Ennapadam S.; Pfister, David; Kraus, Dennis; Shah, Jatin; Zelefsky, Michael J.

    2007-01-01

    Purpose: To present a retrospective review of treatment outcomes for recurrent head and neck (HN) cancer patients treated with re-irradiation (re-RT) at a single medical center. Methods and Materials: From July 1996-September 2005, 105 patients with recurrent HN cancer underwent re-RT at our institution. Sites included were: the neck (n = 21), nasopharynx (n 21), paranasal sinus (n = 18), oropharynx (n = 16), oral cavity (n = 9), larynx (n = 10), parotid (n = 6), and hypopharynx (n = 4). The median prior RT dose was 62 Gy. Seventy-five patients received chemotherapy with their re-RT (platinum-based in the majority of cases). The median re-RT dose was 59.4 Gy. In 74 (70%), re-RT utilized intensity-modulated radiation therapy (IMRT). Results: With a median follow-up of 35 months, 18 patients were alive with no evidence of disease. The 2-year loco-regional progression-free survival (LRPFS) and overall survival rates were 42% and 37%, respectively. Patients who underwent IMRT, compared to those who did not, had a better 2-year LRPF (52% vs. 20%, p < 0.001). On multivariate analysis, non-nasopharynx and non-IMRT were associated with an increased risk of loco-regional (LR) failure. Patients with LR progression-free disease had better 2-year overall survival vs. those with LR failure (56% vs. 21%, p < 0.001). Acute and late Grade 3-4 toxicities were reported in 23% and 15% of patients. Severe Grade 3-4 late complications were observed in 12 patients, with a median time to development of 6 months after re-RT. Conclusions: Based on our data, achieving LR control is crucial for improved overall survival in this patient population. The use of IMRT predicted better LR tumor control. Future aggressive efforts in maximizing tumor control in the recurrent setting, including dose escalation with IMRT and improved chemotherapy, are warranted

  15. Amifostine - a radioprotector in locally advanced head and neck tumors

    International Nuclear Information System (INIS)

    Schoenekaes, K.G.; Wagner, W.; Prott, F.J.

    1999-01-01

    Purpose: There are some preliminary informations about the beneficial use of amifostine in avoiding side effects in patients with head and neck tumors who underwent radiotherapy. Patients and method: Amifostine was given as daily intravenous application (500 mg) 10 to 15 minutes prior to radiotherapy in 20 patients. The results were compared with another collective of patients which was similar. Results: According to the WHO score mucositis became manifest in 10 patients (Grade I) and 4 patients (Grade II) in the amifostine group vs 9 patients (Grade II), 6 patients (Grade III) and 1 patient (Grade IV) in the control group. Xerostomia has been seen in 15 patients (Grade I) and 5 patients (Grade II) after administration of amifostine. Without the drug 2 patients suffered from xerostomia (Grade I), 8 patients (Grade II) and 8 patients (Grade III), respectively. Administering amifostine had been feasible and non problematic. Only a small rate of toxic side effects like nausea (11%) or emesis (4%) was documented. Conclusions: Amifostine is an effective radioprotector decreasing acute and late side effects in patients with head and neck tumors. (orig.) [de

  16. Causes of death in long-term survivors of head and neck cancer.

    Science.gov (United States)

    Baxi, Shrujal S; Pinheiro, Laura C; Patil, Sujata M; Pfister, David G; Oeffinger, Kevin C; Elkin, Elena B

    2014-05-15

    Survivors of head and neck squamous cell carcinoma (HNSCC) face excess mortality from multiple causes. We used the population-based Surveillance, Epidemiology, and End Results (SEER) cancer registry data to evaluate the causes of death in patients with nonmetastatic HNSCC diagnosed between 1992 and 2005 who survived at least 3 years from diagnosis (long-term survivors). We used competing-risks proportional hazards regression to estimate probabilities of death from causes: HNSCC, second primary malignancy (SPM) excluding HNSCC, cardiovascular disease, and other causes. We identified 35,958 three-year survivors of HNSCC with a median age at diagnosis of 60 years (range = 18-100 years) and a median follow-up of 7.7 years (range = 3-18 years). There were 13,120 deaths during the study period. Death from any cause at 5 and 10 years was 15.4% (95% confidence interval [CI] = 15.0%-15.8%) and 41.0% (95% CI = 40.4%-41.6%), respectively. There were 3852 HNSCC deaths including both primary and subsequent head and neck tumors. The risk of death from HNSCC was greater in patients with nasopharynx or hypopharynx cancer and in patients with locally advanced disease. SPM was the leading cause of non-HNSCC death, and the most common sites of SPM death were lung (53%), esophagus (10%), and colorectal (5%) cancer. Many long-term HNSCC survivors die from cancers other than HNSCC and from noncancer causes. Routine follow-up care for HNSCC survivors should expand beyond surveillance for recurrent and new head and neck cancers. © 2014 American Cancer Society.

  17. Periodontal disease, atherosclerosis, adverse pregnancy outcomes, and head-and-neck cancer

    NARCIS (Netherlands)

    Han, Y.W.; Houcken, W.; Loos, B.G.; Schenkein, H.A.; Tezal, M.

    2014-01-01

    Interrelationships between periodontal infection and systemic conditions such as cardiovascular disease, adverse pregnancy outcomes, and head-and-neck cancer have become increasingly appreciated in recent years. Periodontitis is associated with cardiovascular disease (CVD) and, experimentally, with

  18. Implant-prosthetic rehabilitation after radiation treatment in head and neck cancer patients: a case-series report of outcome

    Directory of Open Access Journals (Sweden)

    Cotic Jasna

    2016-02-01

    Full Text Available Slovenia has a high burden of head and neck cancer. Patients are mostly treated with surgery followed by radiation therapy. Advanced surgical and prosthodontic techniques have expanded the rehabilitation options. The aim of the study was to review the outcome of implant-prosthetic treatment after radiation therapy.

  19. Hyperfractionated stereotactic reirradiation for recurrent head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cvek, Jakub; Knybel, Lukas; Skacelikova, Eva; Otahal, Bretislav; Molenda, Lukas; Feltl, David [University Hospital Ostrava, Department of Oncology, Ostrava (Czech Republic); Stransky, Jiri; Res, Oldrich [University Hospital Ostrava, Department of Maxilofacial Surgery, Ostrava (Czech Republic); Matousek, Petr; Zelenik, Karol [University Hospital Ostrava, Department of Otolaryngology, Ostrava (Czech Republic)

    2016-01-15

    The goal of this work was to evaluate the efficacy and toxicity of hyperfractionated stereotactic reirradiation (re-RT) as a treatment for inoperable, recurrent, or second primary head and neck squamous cell cancer (HNSCC) that is not suitable for systemic treatment. Forty patients with recurrent or second primary HNSCC were included in this study. The patients had a median gross tumor volume of 76 ml (range 14-193 ml) and a previous radiotherapy dose greater than 60 Gy. Treatment was designed to cover 95 % of the planning target volume (PTV, defined as gross tumor volume [GTV] + 3 mm to account for microscopic spreading, with no additional set-up margin) with the prescribed dose (48 Gy in 16 fractions b.i.d.). Treatment was administered twice daily with a minimum 6 h gap. Uninvolved lymph nodes were not irradiated. Treatment was completed as planned for all patients (with median duration of 11 days, range 9-14 days). Acute toxicity was evaluated using the RTOG/EORTC scale. A 37 % incidence of grade 3 mucositis was observed, with recovery time of ≤ 4 weeks for all of these patients. Acute skin toxicity was never observed to be higher than grade 2. Late toxicity was also evaluated according to the RTOG/EORTC scale. Mandible radionecrosis was seen in 4 cases (10 %); however, neither carotid blowout syndrome nor other grade 4 late toxicity occurred. One-year overall survival (OS) and local progression-free survival (L-PFS) were found to be 33 and 44 %, respectively. Performance status and GTV proved to be significant prognostic factors regarding local control and survival. Hyperfractionated stereotactic re-RT is a reasonable treatment option for patients with recurrent/second primary HNSCC who were previously exposed to high-dose irradiation and who are not candidates for systemic treatment or hypofractionation. (orig.) [German] Ziel der Studie war es, die Effektivitaet und Toxizitaet der hyperfraktionierten akzelerierten stereotaktischen Wiederbestrahlung (re

  20. Accuracy of self-reported tobacco assessments in a head and neck cancer treatment population

    International Nuclear Information System (INIS)

    Warren, Graham W.; Arnold, Susanne M.; Valentino, Joseph P.; Gal, Thomas J.; Hyland, Andrew J.; Singh, Anurag K.; Rangnekar, Vivek M.; Cummings, K. Michael; Marshall, James R.; Kudrimoti, Mahesh R.

    2012-01-01

    Prospective analysis was performed of self-reported and biochemically confirmed tobacco use in 50 head and neck cancer patients during treatment. With 93.5% compliance to complete weekly self-report and biochemical confirmatory tests, 29.4% of smokers required biochemical assessment for identification. Accuracy increased by 14.9% with weekly vs. baseline self-reported assessments. Data confirm that head and neck cancer patients misrepresent true tobacco use during treatment.

  1. Magnetic resonance imaging guided reirradiation of recurrent and second primary head and neck cancer

    OpenAIRE

    Chen, Allen M.; Cao, Minsong; Hsu, Sophia; Lamb, James; Mikaeilian, Argin; Yang, Yingli; Agazaryan, Nzhde; Low, Daniel A.; Steinberg, Michael L.

    2017-01-01

    Purpose: To report a single-institutional experience using magnetic resonance imaging (MRI) guided radiation therapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and materials: Between October 2014 and August 2016, 13 consecutive patients with recurrent or new primary cancers of the head and neck that occurred in a previously irradiated field were prospectively enrolled in an institutional registry trial to investigate the feasibility and efficacy of ...

  2. Radiofrequency ablation of sphenopalatine ganglion for head and neck cancer pain management

    Directory of Open Access Journals (Sweden)

    Priti R Sanghavi

    2017-01-01

    Full Text Available Introduction: Pain in advanced head and neck cancer is intractable and many a times difficult to manage with pharmacological agents. Sphenopalatine ganglion (SPG block provides excellent pain relief in patients who are suffering from various types of orofacial pain. Role of radiofrequency ablation (RFA of SPG is described for orofacial cancer pain. Aim: The aim of the study was to observe efficacy and duration of pain relief by RFA of SPG in advanced head and neck cancer patients. Materials and Methods: Thirty-three patients suffering from advanced head and neck cancer were enrolled in this study between September 2013 and February 2016. All patients underwent RFA of SPG, under fluoroscopy guidance following a successful diagnostic block of SPG with local anesthetic. Pain was assessed before the procedure, immediately after the procedure, and during each follow-up visit. Follow-up visits were weekly for 4 weeks and then monthly till the end of life. Patients were continued on oral morphine, but the dose was reduced to one-third of total dose and was adjusted according to patients' requirement during each follow-up. Duration of analgesia, morphine requirements, and incidence of complications were noted. Results: There were 32 males and one female. Mean age of patients was 43.24 ± 13.52 (mean ± standard deviation [SD], ranging from 19 to 58 years. Three patients did not undergo RFA due to cheek hematoma formation during the procedure. Visual analog score was reduced from 8.43 ± 1.10 (preprocedure to 1.36 ± 1.61 (postprocedure (mean ± SD. Mean duration of analgesia was 17.55 ± 26.12 (mean ± SD weeks. Mean reduction in the dose of morphine was from 124.65 ± 46.78 to 40.00 ± 18.05 mg (mean ± SD immediately after the procedure. One patient was followed up for 30 months. Sixteen patients died within 3 months and had good pain relief. None of the patients had any serious complications. Conclusion: RFA of SPG is a good adjuvant method of pain

  3. TU-D-207B-03: Early Assessment of Response to Chemoradiotherapy Based On Textural Analysis of Pre and Mid-Treatment FDG-PET Image in Locally Advanced Head and Neck Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Y; Pollom, E; Loo, B; Le, Q; Hara, W; Li, R [Stanford University, Palo Alto, CA (United States)

    2016-06-15

    Purpose: To evaluate whether tumor textural features extracted from both pre- and mid-treatment FDG-PET images predict early response to chemoradiotherapy in locally advanced head and neck cancer, and investigate whether they provide complementary value to conventional volume-based measurements. Methods: Ninety-four patients with locally advanced head and neck cancers were retrospectively studied. All patients received definitive chemoradiotherapy and underwent FDG-PET planning scans both before and during treatment. Within the primary tumor we extracted 6 textural features based on gray-level co-occurrence matrices (GLCM): entropy, dissimilarity, contrast, correlation, energy, and homogeneity. These image features were evaluated for their predictive power of treatment response to chemoradiotherapy in terms of local recurrence free survival (LRFS) and progression free survival (PFS). Logrank test were used to assess the statistical significance of the stratification between low- and high-risk groups. P-values were adjusted for multiple comparisons by the false discovery rate (FDR) method. Results: All six textural features extracted from pre-treatment PET images significantly differentiated low- and high-risk patient groups for LRFS (P=0.011–0.038) and PFS (P=0.029–0.034). On the other hand, none of the textural features on mid-treatment PET images was statistically significant in stratifying LRFS (P=0.212–0.445) or PFS (P=0.168–0.299). An imaging signature that combines textural feature (GLCM homogeneity) and metabolic tumor volume showed an improved performance for predicting LRFS (hazard ratio: 22.8, P<0.0001) and PFS (hazard ratio: 13.9, P=0.0005) in leave-one-out cross validation. Intra-tumor heterogeneity measured by textural features was significantly lower in mid-treatment PET images than in pre-treatment PET images (T-test: P<1.4e-6). Conclusion: Tumor textural features on pretreatment FDG-PET images are predictive for response to chemoradiotherapy

  4. Boron Neutron Capture Therapy in the Treatment of Locally Recurred Head and Neck Cancer

    International Nuclear Information System (INIS)

    Kankaanranta, Leena; Seppaelae, Tiina; Koivunoro, Hanna; Saarilahti, Kauko; Atula, Timo; Collan, Juhani; Salli, Eero; Kortesniemi, Mika; Uusi-Simola, Jouni; Maekitie, Antti; Seppaenen, Marko; Minn, Heikki; Kotiluoto, Petri; Auterinen, Iiro; Savolainen, Sauli; Kouri, Mauri; Joensuu, Heikki

    2007-01-01

    Purpose: Head and neck carcinomas that recur locally after conventional irradiation pose a difficult therapeutic problem. We evaluated safety and efficacy of boron neutron capture therapy (BNCT) in the treatment of such cancers. Methods and Materials: Twelve patients with inoperable, recurred, locally advanced (rT3, rT4, or rN2) head and neck cancer were treated with BNCT in a prospective, single-center Phase I-II study. Prior treatments consisted of surgery and conventionally fractionated photon irradiation to a cumulative dose of 56-74 Gy administered with or without concomitant chemotherapy. Tumor responses were assessed using the RECIST (Response Evaluation Criteria in Solid Tumors) criteria and adverse effects using the National Cancer Institute common toxicity grading v3.0. Intravenously administered boronophenylalanine-fructose (BPA-F, 400 mg/kg) was used as the boron carrier. Each patient was scheduled to be treated twice with BNCT. Results: Ten patients received BNCT twice; 2 were treated once. Ten (83%) patients responded to BNCT, and 2 (17%) had tumor growth stabilization for 5.5 and 7.6 months. The median duration of response was 12.1 months; six responses were ongoing at the time of analysis or death (range, 4.9-19.2 months). Four (33%) patients were alive without recurrence with a median follow-up of 14.0 months (range, 12.8-19.2 months). The most common acute adverse effects were mucositis, fatigue, and local pain; 2 patients had a severe (Grade 3) late adverse effect (xerostomia, 1; dysphagia, 1). Conclusions: Boron neutron capture therapy is effective and safe in the treatment of inoperable, locally advanced head and neck carcinomas that recur at previously irradiated sites

  5. Identification of Patient Benefit From Proton Therapy for Advanced Head and Neck Cancer Patients Based on Individual and Subgroup Normal Tissue Complication Probability Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Jakobi, Annika, E-mail: Annika.Jakobi@OncoRay.de [OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Bandurska-Luque, Anna [OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden (Germany); Stützer, Kristin; Haase, Robert; Löck, Steffen [OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden (Germany); Wack, Linda-Jacqueline [Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen (Germany); Mönnich, David [Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen (Germany); German Cancer Research Center, Heidelberg (Germany); German Cancer Consortium, Tübingen (Germany); Thorwarth, Daniela [Section for Biomedical Physics, University Hospital for Radiation Oncology, Eberhard Karls Universät Tübingen (Germany); and others

    2015-08-01

    Purpose: The purpose of this study was to determine, by treatment plan comparison along with normal tissue complication probability (NTCP) modeling, whether a subpopulation of patients with head and neck squamous cell carcinoma (HNSCC) could be identified that would gain substantial benefit from proton therapy in terms of NTCP. Methods and Materials: For 45 HNSCC patients, intensity modulated radiation therapy (IMRT) was compared to intensity modulated proton therapy (IMPT). Physical dose distributions were evaluated as well as the resulting NTCP values, using modern models for acute mucositis, xerostomia, aspiration, dysphagia, laryngeal edema, and trismus. Patient subgroups were defined based on primary tumor location. Results: Generally, IMPT reduced the NTCP values while keeping similar target coverage for all patients. Subgroup analyses revealed a higher individual reduction of swallowing-related side effects by IMPT for patients with tumors in the upper head and neck area, whereas the risk reduction of acute mucositis was more pronounced in patients with tumors in the larynx region. More patients with tumors in the upper head and neck area had a reduction in NTCP of more than 10%. Conclusions: Subgrouping can help to identify patients who may benefit more than others from the use of IMPT and, thus, can be a useful tool for a preselection of patients in the clinic where there are limited PT resources. Because the individual benefit differs within a subgroup, the relative merits should additionally be evaluated by individual treatment plan comparisons.

  6. Identification of Patient Benefit From Proton Therapy for Advanced Head and Neck Cancer Patients Based on Individual and Subgroup Normal Tissue Complication Probability Analysis

    International Nuclear Information System (INIS)

    Jakobi, Annika; Bandurska-Luque, Anna; Stützer, Kristin; Haase, Robert; Löck, Steffen; Wack, Linda-Jacqueline; Mönnich, David; Thorwarth, Daniela

    2015-01-01

    Purpose: The purpose of this study was to determine, by treatment plan comparison along with normal tissue complication probability (NTCP) modeling, whether a subpopulation of patients with head and neck squamous cell carcinoma (HNSCC) could be identified that would gain substantial benefit from proton therapy in terms of NTCP. Methods and Materials: For 45 HNSCC patients, intensity modulated radiation therapy (IMRT) was compared to intensity modulated proton therapy (IMPT). Physical dose distributions were evaluated as well as the resulting NTCP values, using modern models for acute mucositis, xerostomia, aspiration, dysphagia, laryngeal edema, and trismus. Patient subgroups were defined based on primary tumor location. Results: Generally, IMPT reduced the NTCP values while keeping similar target coverage for all patients. Subgroup analyses revealed a higher individual reduction of swallowing-related side effects by IMPT for patients with tumors in the upper head and neck area, whereas the risk reduction of acute mucositis was more pronounced in patients with tumors in the larynx region. More patients with tumors in the upper head and neck area had a reduction in NTCP of more than 10%. Conclusions: Subgrouping can help to identify patients who may benefit more than others from the use of IMPT and, thus, can be a useful tool for a preselection of patients in the clinic where there are limited PT resources. Because the individual benefit differs within a subgroup, the relative merits should additionally be evaluated by individual treatment plan comparisons

  7. The current status of oncolytic viral therapy for head and neck cancer

    Directory of Open Access Journals (Sweden)

    Matthew O. Old

    2016-06-01

    Full Text Available Objective: Cancer affects the head and neck region frequently and leads to significant morbidity and mortality. Oncolytic viral therapy has the potential to make a big impact in cancers that affect the head and neck. We intend to review the current state of oncolytic viruses in the treatment of cancers that affect the head and neck region. Method: Data sources are from National clinical trials database, literature, and current research. Results: There are many past and active trials for oncolytic viruses that show promise for treating cancers of the head and neck. The first oncolytic virus was approved by the FDA October 2015 (T-VEC, Amgen for the treatment of melanoma. Active translational research continues for this and many other oncolytic viruses. Conclusion: The evolving field of oncolytic viruses is impacting the treatment of head and neck cancer and further trials and agents are moving forward in the coming years. Keywords: Head and neck squamous cell carcinoma, Oncolytic viruses, Clinical trials, Novel therapeutics

  8. In a bad place: Carers of patients with head and neck cancer experiences of travelling for cancer treatment.

    Science.gov (United States)

    Balfe, Myles; Keohane, Kieran; O' Brien, Katie; Gooberman-Hill, Rachael; Maguire, Rebecca; Hanly, Paul; O' Sullivan, Eleanor; Sharp, Linda

    2017-10-01

    To explore the effect that treatment-related commuting has on carers of patients with head and neck cancer. Semi-structured interviews, thematically analysed, with 31 carers. Treatment-related commuting had a considerable impact on carers of patients with head and neck cancer, both in practical terms (economic costs, disruption) and also in psychological terms. Many carers of patients with head and neck cancer described becoming distressed by their commute. Some carers from large urban cities appeared to have hidden commuting burdens. Some carers respond to commuting stress by 'zoning out' or becoming 'like zombies'. Treatment-related travel for head and neck cancer can have significant practical and psychological impacts. Health professionals should be aware of the impacts that commuting can have on head and neck caregivers. Health services may be able to take practical steps, such as providing subsidized parking, to address head and neck carergivers' difficulties. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Validating a benchmarking tool for audit of early outcomes after operations for head and neck cancer

    OpenAIRE

    Tighe, D.; Sassoon, I.; McGurk, M.

    2017-01-01

    INTRODUCTION In 2013 all UK surgical specialties, with the exception of head and neck surgery, published outcome data adjusted for case mix for indicator operations. This paper reports a pilot study to validate a previously published risk adjustment score on patients from separate UK cancer centres. METHODS A case note audit was performed of 1,075 patients undergoing 1,218 operations for head and neck squamous cell carcinoma under general anaesthesia in 4 surgical centres. A logistic regressi...

  10. Sentinel node biopsy in head and neck cancer

    DEFF Research Database (Denmark)

    Ross, Gary L; Soutar, David S; Gordon MacDonald, D

    2004-01-01

    BACKGROUND: The aim was to determine the reliability and reproducibility of sentinel node biopsy (SNB) as a staging tool in head and neck squamous cell carcinoma (HNSCC) for T1/2 clinically N0 patients by means of a standardized technique. METHODS: Between June 1998 and June 2002, 227 SNB procedu...... cavity/oropharynx in a standardized fashion by centers worldwide. For the majority of these tumors the SNB technique can be used alone as a staging tool....

  11. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    International Nuclear Information System (INIS)

    Rütten, Heidi; Pop, Lucas A.M.; Janssens, Geert O.R.J.; Takes, Robert P.; Knuijt, Simone; Rooijakkers, Antoinette F.; Berg, Manon van den; Merkx, Matthias A.; Herpen, Carla M.L. van; Kaanders, Johannes H.A.M.

    2011-01-01

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence–free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  12. Long-Term Outcome and Morbidity After Treatment With Accelerated Radiotherapy and Weekly Cisplatin for Locally Advanced Head-and-Neck Cancer: Results of a Multidisciplinary Late Morbidity Clinic

    Energy Technology Data Exchange (ETDEWEB)

    Ruetten, Heidi, E-mail: h.rutten@rther.umcn.nl [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Pop, Lucas A.M.; Janssens, Geert O.R.J. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Takes, Robert P. [Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Knuijt, Simone [Department of Rehabilitation/Speech Pathology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Rooijakkers, Antoinette F. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Berg, Manon van den [Department of Gastroenterology-Dietetics, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Merkx, Matthias A. [Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Herpen, Carla M.L. van [Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands); Kaanders, Johannes H.A.M. [Department of Radiation Oncology, Radboud University Nijmegen Medical Centre, Nijmegen (Netherlands)

    2011-11-15

    Purpose: To evaluate the long-term outcome and morbidity after intensified treatment for locally advanced head-and-neck cancer. Methods and Materials: Between May 2003 and December 2007, 77 patients with Stage III to IV head-and-neck cancer were treated with curative intent. Treatment consisted of accelerated radiotherapy to a dose of 68 Gy and concurrent cisplatin. Long-term survivors were invited to a multidisciplinary outpatient clinic for a comprehensive assessment of late morbidity with special emphasis on dysphagia, including radiological evaluation of swallowing function in all patients. Results: Compliance with the treatment protocol was high, with 87% of the patients receiving at least five cycles of cisplatin and all but 1 patient completing the radiotherapy as planned. The 5-year actuarial disease-free survival and overall survival rates were 40% and 47%, respectively. Locoregional recurrence-free survival at 5 years was 61%. The 5-year actuarial rates of overall late Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) Grade 3 and Grade 4 toxicity were 52% and 25% respectively. Radiologic evaluation after a median follow-up of 44 months demonstrated impaired swallowing in 57% of the patients, including 23% with silent aspiration. Subjective assessment using a systematic scoring system indicated normalcy of diet in only 15.6% of the patients. Conclusion: This regimen of accelerated radiotherapy with weekly cisplatin produced favorable tumor control rates and survival rates while compliance was high. However, comprehensive assessment by a multidisciplinary team of medical and paramedical specialists revealed significant long-term morbidity in the majority of the patients, with dysphagia being a major concern.

  13. Amifostine - a radioprotector in locally advanced head and neck tumors

    Energy Technology Data Exchange (ETDEWEB)

    Schoenekaes, K.G.; Wagner, W. [Paracelsus-Strahlenklinik, Osnabrueck (Germany); Prott, F.J. [Muenster Univ. (Germany). Inst. fuer Strahlenonkologie

    1999-11-01

    Purpose: There are some preliminary informations about the beneficial use of amifostine in avoiding side effects in patients with head and neck tumors who underwent radiotherapy. Patients and method: Amifostine was given as daily intravenous application (500 mg) 10 to 15 minutes prior to radiotherapy in 20 patients. The results were compared with another collective of patients which was similar. Results: According to the WHO score mucositis became manifest in 10 patients (Grade I) and 4 patients (Grade II) in the amifostine group vs 9 patients (Grade II), 6 patients (Grade III) and 1 patient (Grade IV) in the control group. Xerostomia has been seen in 15 patients (Grade I) and 5 patients (Grade II) after administration of amifostine. Without the drug 2 patients suffered from xerostomia (Grade I), 8 patients (Grade II) and 8 patients (Grade III), respectively. Administering amifostine had been feasible and non problematic. Only a small rate of toxic side effects like nausea (11%) or emesis (4%) was documented. Conclusions: Amifostine is an effective radioprotector decreasing acute and late side effects in patients with head and neck tumors. (orig.) [German] Zielsetzung: Bisher gibt es nur wenige Informationen ueber den Nutzen von Amifostin bezueglich der Verminderung oder Vermeidung von Nebenwirkungen einer Radiatio bei Patienten mit Tumoren im HNO-Trakt. Patienten und Methode: Amifostin wurde als intravenoese Kurzinfusion mit einer Dosis von 500 mg zehn bis 15 Minuten vor der Bestrahlung bei 20 Patienten appliziert. Die unter Radiatio aufgetretenen Nebenwirkungen wurden nach WHO bzw. nach dem Oral Assessment Guide nach Eilers ausgewertet und mit einem entsprechenden historischen Kollektiv der Klinik verglichen. Ergebnisse: In der Amifostin-Gruppe wurde bei zehn Patienten eine Mukositis Grad I und bei vier Patienten eine Mukositis Grad II nach WHO beobachtet. Grad-III- und Grad-IV-Nebenwirkungen traten nicht auf. In der Kontrollgruppe waren dagegen bei neun

  14. Human Papillomavirus Induced Transformation in Cervical and Head and Neck Cancers

    Energy Technology Data Exchange (ETDEWEB)

    Adams, Allie K. [Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 (United States); Wise-Draper, Trisha M. [Division of Hematology/Oncology, University of Cincinnati Medical Center, University of Cincinnati, Cincinnati, OH 45229 (United States); Wells, Susanne I., E-mail: Susanne.Wells@cchmc.org [Cancer and Blood Diseases Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229 (United States)

    2014-09-15

    Human papillomavirus (HPV) is one of the most widely publicized and researched pathogenic DNA viruses. For decades, HPV research has focused on transforming viral activities in cervical cancer. During the past 15 years, however, HPV has also emerged as a major etiological agent in cancers of the head and neck, in particular squamous cell carcinoma. Even with significant strides achieved towards the screening and treatment of cervical cancer, and preventive vaccines, cervical cancer remains the leading cause of cancer-associated deaths for women in developing countries. Furthermore, routine screens are not available for those at risk of head and neck cancer. The current expectation is that HPV vaccination will prevent not only cervical, but also head and neck cancers. In order to determine if previous cervical cancer models for HPV infection and transformation are directly applicable to head and neck cancer, clinical and molecular disease aspects must be carefully compared. In this review, we briefly discuss the cervical and head and neck cancer literature to highlight clinical and genomic commonalities. Differences in prognosis, staging and treatment, as well as comparisons of mutational profiles, viral integration patterns, and alterations in gene expression will be addressed.

  15. Human Papillomavirus Induced Transformation in Cervical and Head and Neck Cancers

    International Nuclear Information System (INIS)

    Adams, Allie K.; Wise-Draper, Trisha M.; Wells, Susanne I.

    2014-01-01

    Human papillomavirus (HPV) is one of the most widely publicized and researched pathogenic DNA viruses. For decades, HPV research has focused on transforming viral activities in cervical cancer. During the past 15 years, however, HPV has also emerged as a major etiological agent in cancers of the head and neck, in particular squamous cell carcinoma. Even with significant strides achieved towards the screening and treatment of cervical cancer, and preventive vaccines, cervical cancer remains the leading cause of cancer-associated deaths for women in developing countries. Furthermore, routine screens are not available for those at risk of head and neck cancer. The current expectation is that HPV vaccination will prevent not only cervical, but also head and neck cancers. In order to determine if previous cervical cancer models for HPV infection and transformation are directly applicable to head and neck cancer, clinical and molecular disease aspects must be carefully compared. In this review, we briefly discuss the cervical and head and neck cancer literature to highlight clinical and genomic commonalities. Differences in prognosis, staging and treatment, as well as comparisons of mutational profiles, viral integration patterns, and alterations in gene expression will be addressed

  16. Socioeconomic position and stage at diagnosis of head and neck cancer - a nationwide study from DAHANCA

    DEFF Research Database (Denmark)

    Olsen, Maja Halgren; Bøje, Charlotte Rotbøl; Kjær, Trille Kristina

    2015-01-01

    socioeconomic position and advanced stage HNSCC at diagnosis. MATERIAL AND METHODS: Men and women with HNSCC diagnosed between 1992 and 2008 were identified in the Danish Head and Neck Cancer Group (DAHANCA) database, which contains detailed information on all cases of HNSCC treated in Denmark. Individual...... information on the following four socioeconomic indicators: highest attained educational level, cohabitation status, disposable income and degree of urbanisation were obtained from Statistics Denmark. For the 9683 cases on which there was full information, we estimated odds ratios (ORs) for a diagnosis...... for hypopharynx cancer patients living in rural areas or provincial cities. Having one or more comorbid conditions was associated with an increased OR for advanced stage oral cancer but with a decreased OR for oropharynx cancer. CONCLUSION: In this nationwide population-based study, socioeconomic differences...

  17. Uroporphyrinogen decarboxylase is a radiosensitizing target for head and neck cancer.

    Science.gov (United States)

    Ito, Emma; Yue, Shijun; Moriyama, Eduardo H; Hui, Angela B; Kim, Inki; Shi, Wei; Alajez, Nehad M; Bhogal, Nirmal; Li, Guohua; Datti, Alessandro; Schimmer, Aaron D; Wilson, Brian C; Liu, Peter P; Durocher, Daniel; Neel, Benjamin G; O'Sullivan, Brian; Cummings, Bernard; Bristow, Rob; Wrana, Jeff; Liu, Fei-Fei

    2011-01-26

    Head and neck cancer (HNC) is the eighth most common malignancy worldwide, comprising a diverse group of cancers affecting the head and neck region. Despite advances in therapeutic options over the last few decades, treatment toxicities and overall clinical outcomes have remained disappointing, thereby underscoring a need to develop novel therapeutic approaches in HNC treatment. Uroporphyrinogen decarboxylase (UROD), a key regulator of heme biosynthesis, was identified from an RNA interference-based high-throughput screen as a tumor-selective radiosensitizing target for HNC. UROD knockdown plus radiation induced caspase-mediated apoptosis and cell cycle arrest in HNC cells in vitro and suppressed the in vivo tumor-forming capacity of HNC cells, as well as delayed the growth of established tumor xenografts in mice. This radiosensitization appeared to be mediated by alterations in iron homeostasis and increased production of reactive oxygen species, resulting in enhanced tumor oxidative stress. Moreover, UROD was significantly overexpressed in HNC patient biopsies. Lower preradiation UROD mRNA expression correlated with improved disease-free survival, suggesting that UROD could potentially be used to predict radiation response. UROD down-regulation also radiosensitized several different models of human cancer, as well as sensitized tumors to chemotherapeutic agents, including 5-fluorouracil, cisplatin, and paclitaxel. Thus, our study has revealed UROD as a potent tumor-selective sensitizer for both radiation and chemotherapy, with potential relevance to many human malignancies.

  18. Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures

    NARCIS (Netherlands)

    van der Molen, Lisette; Heemsbergen, Wilma D.; de Jong, Rianne; van Rossum, Maya A.; Smeele, Ludi E.; Rasch, Coen R. N.; Hilgers, Frans J. M.

    2013-01-01

    Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment (N=37). Calculation of dose-volume parameters

  19. Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures

    NARCIS (Netherlands)

    van der Molen, L.; Heemsbergen, W.D.; de Jong, R.; van Rossum, M.A.; Smeele, L.E.; Rasch, C.R.N.; Hilgers, F.J.M.

    2013-01-01

    Background and purpose: Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Material and methods: Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment

  20. Occurance of head and neck cancers at the Nairobi Cancer Registry ...

    African Journals Online (AJOL)

    Occurance of head and neck cancers at the Nairobi Cancer Registry in Kenya 2000-2002. AK Limo, A Rugutt-Korir, JO Gichana, EA Dimba, ML Chindia, GZ Mutuma. Abstract. No Abstract. African Journal of Oral Health Sciences Vol. 5 (1) 2007: pp. 2-4. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL ...

  1. Twice-a-day fractionated radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Kita, Midori

    1996-01-01

    To improve the local control rate in radiotherapy for hand and neck cancer, several prospected twice-a-day fractionated radiotherapy (TDRF) were conducted in Tokyo Women's Medical College. T2 glottic cancer was irradiated with 1.5 Gy/fraction, 2 fraction/day to a total dose of 72 Gy. Five cumulative local control rate was 88.2%. Locally advanced head and neck cancer was treated with TDFR and systemic chemotherapy. Response rate was 100%. Palliative radiotherapy with TDFR was done to relive from the pain and other symptoms for advanced and recurrent cases. Nine cases of 11 were relieved from the symptoms. These results was suggested the TDFR was useful to improve the local control rate. (author)

  2. Twice-a-day fractionated radiotherapy for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kita, Midori [Tokyo Metropolitan Hospital of Fuchu (Japan)

    1996-12-01

    To improve the local control rate in radiotherapy for hand and neck cancer, several prospected twice-a-day fractionated radiotherapy (TDRF) were conducted in Tokyo Women`s Medical College. T2 glottic cancer was irradiated with 1.5 Gy/fraction, 2 fraction/day to a total dose of 72 Gy. Five cumulative local control rate was 88.2%. Locally advanced head and neck cancer was treated with TDFR and systemic chemotherapy. Response rate was 100%. Palliative radiotherapy with TDFR was done to relive from the pain and other symptoms for advanced and recurrent cases. Nine cases of 11 were relieved from the symptoms. These results was suggested the TDFR was useful to improve the local control rate. (author)

  3. Palliative Radiation Therapy for Advanced Head and Neck Carcinomas: A Phase 2 Study

    Energy Technology Data Exchange (ETDEWEB)

    Fortin, Bernard, E-mail: bfortin.hmr@ssss.gouv.qc.ca [Radiation Oncology, Maisonneuve-Rosemont Hospital, Montreal, Quebec (Canada); Khaouam, Nader [Radiation Oncology, Maisonneuve-Rosemont Hospital, Montreal, Quebec (Canada); Filion, Edith; Nguyen-Tan, Phuc Felix [Radiation Oncology, Centre Hospitalier de l' Université de Montréal, Montreal, Quebec (Canada); Bujold, Alexis [Radiation Oncology, Maisonneuve-Rosemont Hospital, Montreal, Quebec (Canada); Lambert, Louise [Radiation Oncology, Centre Hospitalier de l' Université de Montréal, Montreal, Quebec (Canada)

    2016-06-01

    Purpose: Incurable head and neck cancer is hard to manage with usual palliative care. Radiation therapy (RT) in this setting is sometimes omitted because there is an apprehension that the side effects in the head and neck region might counterbalance the benefits. The objective of this phase 2 study was to evaluate whether highly conformal RT could improve the therapeutic ratio with this comprehensive Quality of Life (QOL) and toxicity evaluation. Methods and Materials: Patients from 2 academic centers, deemed unfit for radical treatment because of their poor medical condition or advanced cancer stage by an experienced tumor board, were offered 25 Gy in 5 daily intensity modulated RT fractions over 1 week to the symptomatic tumor volume. QOL was evaluated with the European Organization for Research and Treatment of Cancer QLQ-C15-PAL and QLQ-H&N35 questionnaires, and toxicities with the Common Terminology Criteria for Adverse Events version 4.0. Survival and time to tumor progression were calculated with the Kaplan-Meier method. Results: Thirty-two patients were recruited, of whom 66% had at least T4, N3, or M1 disease. The QOL questionnaires completion rate was 86%. Eighty-eight percent of patients received the planned dose. The median overall survival and progression-free survival times were, respectively, 6.5 and 3.2 months. No grade 4 or 5 toxicity was seen. Only 13% of patients had any grade 3 toxicities, and 17% of patients reported no toxicity at all. The QOL was equal or improved, and head and neck symptoms remained equal to or lower than the baseline values for most patients at up to 6 months. Eighty-five percent of patients would have chosen to receive this RT regimen again when asked. Conclusions: This palliative RT regimen was highly tolerable and effective in preserving or improving self-reported QOL in most patients for up to 6 months, which corresponds to this population's median overall survival. Given the minimal side effects

  4. Molecular biology and immunology of head and neck cancer.

    Science.gov (United States)

    Guo, Theresa; Califano, Joseph A

    2015-07-01

    In recent years, our knowledge and understanding of head and neck squamous cell carcinoma (HNSCC) has expanded dramatically. New high-throughput sequencing technologies have accelerated these discoveries since the first reports of whole-exome sequencing of HNSCC tumors in 2011. In addition, the discovery of human papillomavirus in relationship with oropharyngeal squamous cell carcinoma has shifted our molecular understanding of the disease. New investigation into the role of immune evasion in HNSCC has also led to potential novel therapies based on immune-specific systemic therapies. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Fatal carotid blowout syndrome after BNCT for head and neck cancers

    International Nuclear Information System (INIS)

    Aihara, T.; Hiratsuka, J.; Ishikawa, H.; Kumada, H.; Ohnishi, K.; Kamitani, N.; Suzuki, M.; Sakurai, H.; Harada, T.

    2015-01-01

    Boron neutron capture therapy (BNCT) is high linear energy transfer (LET) radiation and tumor-selective radiation that does not cause serious damage to the surrounding normal tissues. BNCT might be effective and safe in patients with inoperable, locally advanced head and neck cancers, even those that recur at previously irradiated sites. However, carotid blowout syndrome (CBS) is a lethal complication resulting from malignant invasion of the carotid artery (CA); thus, the risk of CBS should be carefully assessed in patients with risk factors for CBS after BNCT. Thirty-three patients in our institution who underwent BNCT were analyzed. Two patients developed CBS and experienced widespread skin invasion and recurrence close to the carotid artery after irradiation. Careful attention should be paid to the occurrence of CBS if the tumor is located adjacent to the carotid artery. The presence of skin invasion from recurrent lesions after irradiation is an ominous sign of CBS onset and lethal consequences. - Highlights: • This study is fatal carotid blowout syndrome after BNCT for head and neck cancers. • Thirty-three patients in our institution who underwent BNCT were analyzed. • Two patients (2/33) developed CBS. • The presence of skin invasion from recurrent lesions after irradiation is an ominous sign of CBS. • We must be aware of these signs to perform BNCT safely.

  6. 14-3-3 zeta is a molecular target in guggulsterone induced apoptosis in Head and Neck cancer cells

    International Nuclear Information System (INIS)

    Macha, Muzafar A; Matta, Ajay; Chauhan, SS; Siu, KW Michael; Ralhan, Ranju

    2010-01-01

    The five-year survival rates for head and neck squamous cell carcinoma (HNSCC) patients are less than 50%, and the prognosis has not improved, despite advancements in standard multi-modality therapies. Hence major emphasis is being laid on identification of novel molecular targets and development of multi-targeted therapies. 14-3-3 zeta, a multifunctional phospho-serine/phospho-threonine binding protein, is emerging as an effector of pro-survival signaling by binding to several proteins involved in apoptosis (Bad, FKHRL1 and ASK1) and may serve as an appropriate target for head and neck cancer therapy. Herein, we determined effect of guggulsterone (GS), a farnesoid X receptor antagonist, on 14-3-3 zeta associated molecular pathways for abrogation of apoptosis in head and neck cancer cells. Head and neck cancer cells were treated with guggulsterone (GS). Effect of GS-treatment was evaluated using cell viability (MTT) assay and apoptosis was verified by annexin V, DNA fragmentation and M30 CytoDeath antibody assay. Mechanism of GS-induced apoptosis was determined by western blotting and co-IP assays using specific antibodies. Using in vitro models of head and neck cancer, we showed 14-3-3 zeta as a key player regulating apoptosis in GS treated SCC4 cells. Treatment with GS releases BAD from the inhibitory action of 14-3-3 zeta in proliferating HNSCC cells by activating protein phosphatase 2A (PP2A). These events initiate the intrinsic mitochondrial pathway of apoptosis, as revealed by increased levels of cytochrome c in cytoplasmic extracts of GS-treated SCC4 cells. In addition, GS treatment significantly reduced the expression of anti-apoptotic proteins, Bcl-2, xIAP, Mcl1, survivin, cyclin D1 and c-myc, thus committing cells to apoptosis. These events were followed by activation of caspase 9, caspase 8 and caspase 3 leading to cleavage of its downstream target, poly-ADP-ribose phosphate (PARP). GS targets 14-3-3 zeta associated cellular pathways for reducing

  7. The Role of HPV in Head and Neck Cancer Stem Cell Formation and Tumorigenesis

    Directory of Open Access Journals (Sweden)

    Mark S. Swanson

    2016-02-01

    Full Text Available The cancer stem cell (CSC theory proposes that a minority of tumor cells are capable of self-replication and tumorigenesis. It is these minority of cells that are responsible for cancer metastasis and recurrence in head and neck squamous cell cancers (HNSCC. Human papilloma virus (HPV-related cancer of the oropharynx is becoming more prevalent, which makes understanding of the relationship between HPV and CSCs more important than ever. This relationship is critical because CSC behavior can be predicted based on cell surface markers, which makes them a suitable candidate for targeted therapy. New therapies are an exciting opportunity to advance past the stalled outcomes in HNSCC that have plagued patients and clinicians for several decades.

  8. Association Between Preoperative Nutritional Status and Postoperative Outcome in Head and Neck Cancer Patients.

    Science.gov (United States)

    Leung, John S L; Seto, Alfred; Li, George K H

    2017-04-01

    Head and neck cancer patients treated with surgery often experience significant postoperative morbidities. Administering preoperative nutritional intervention may improve surgical outcomes, but there is currently a paucity of data reviewing the association between preoperative nutritional status and postoperative outcome. It is therefore of importance to investigate this association among head and neck cancer patients. To assess the association between preoperative nutritional status and postoperative outcome in head and neck cancer patients treated with surgery, a retrospective study of 70 head and neck cancer patients who were surgically treated between 2013 and 2014 in a tertiary referral head and neck surgery center in Hong Kong was conducted. Clinical data regarding preoperative nutritional status and postoperative outcome were retrieved from a computer record system. Logistic and linear regressions were used to analyze the appropriate parameters. A higher preoperative albumin level was associated with lower rates of postoperative complications and better wound healing (P cancer patients, preoperative intervention strategies that boost albumin levels could be considered for improving surgical outcome.

  9. Assessment of nutritional status and quality of life in patients treated for head and neck cancer.

    Science.gov (United States)

    Prevost, V; Joubert, C; Heutte, N; Babin, E

    2014-04-01

    The purpose of this study was to identify tools for the assessment of nutritional status in head and neck cancer patients, to evaluate the impact of malnutrition on therapeutic management and quality of life and to propose a simple screening approach adapted to routine clinical practice. The authors conducted a review of the literature to identify tools for the assessment of nutritional status in head and neck cancer patients published in French and English. Articles were obtained from the PubMed database and from the references of these articles and selected journals, using the keywords: "nutritional assessment", and "head and neck" and "cancer". Anthropometric indices, laboratory parameters, dietary intake assessment, clinical scores and nutritional risk scores used in patients with head and neck cancers are presented. The relevance of these tools in clinical practice and in research is discussed, together with the links between nutritional status and quality of life. This article is designed to help teams involved in the management of patients with head and neck cancer to choose the most appropriate tools for assessment of nutritional status according to their resources and their objectives. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  10. Brachytherapy for head and neck cancer. Treatment results and future prospect

    International Nuclear Information System (INIS)

    Shibuya, Hitoshi; Yoshimura, Ro-ichi; Miura, Masahiko; Ayukawa, Fumio; Watanabe, Hiroshi

    2005-01-01

    Following the increasing desire of many patients to keep the form and function of speech and swallowing, interstitial brachytherapy has become the main treatment for head and neck cancer. In addition, aged and physically handicapped patients who are refused general anesthesia have come to be referred to our clinic to receive less invasive and curative treatment. In the field of brachytherapy for head and neck cancers, less complicated and more superior treatment results have been achieved following the introduction of spacers, computer dosimetry and so on. As a result of these efforts, treatment results have come to fulfill the desire of patients and their families. During the past 43 years from 1962 to 2005, we have treated over 2, 100 patients of head and neck cancer including 850 with stage I·II oral tongue carcinoma by brachytherapy and acquired a lot of important and precious data including the treatment results, multiple primary cancers as well as radiation-induced cancers. (author)

  11. Inactivation of the Tumor Suppressor Genes Causing the Hereditary Syndromes Predisposing to Head and Neck Cancer via Promoter Hypermethylation in Sporadic Head and Neck Cancers

    OpenAIRE

    Smith, Ian M.; Mithani, Suhail K.; Mydlarz, Wojciech K.; Chang, Steven S.; Califano, Joseph A.

    2010-01-01

    Fanconi anemia (FA) and dyskeratosis congenita (DC) are rare inherited syndromes that cause head and neck squamous cell cancer (HNSCC). Prior studies of inherited forms of cancer have been extremely important in elucidating tumor suppressor genes inactivated in sporadic tumors. Here, we studied whether sporadic tumors have epigenetic silencing of the genes causing the inherited forms of HNSCC. Using bisulfite sequencing, we investigated the incidence of promoter hypermethylation of the 17 Fan...

  12. Head and neck cancer in HIV patients and their parents: a Danish cohort study

    DEFF Research Database (Denmark)

    Engsig, Frederik N; Gerstoft, Jan; Kronborg, Gitte

    2011-01-01

    The mechanism for the increased risk of head and neck cancer (HNC) observed in HIV patients is controversial. We hypothesized that family-related risk factors increase the risk of HNC why we estimated the risk of this type of cancer in both HIV patients and their parents.......The mechanism for the increased risk of head and neck cancer (HNC) observed in HIV patients is controversial. We hypothesized that family-related risk factors increase the risk of HNC why we estimated the risk of this type of cancer in both HIV patients and their parents....

  13. Critical appraisal of a conformal head and neck cancer irradiation avoiding electron beams and field matching

    International Nuclear Information System (INIS)

    Fogliata, Antonella; Cozzi, Luca; Bieri, Sabine; Bernier, Jacques

    1999-01-01

    Purpose: In head and neck cancer patients, spinal chains are usually irradiated by a combination of photon and electron beams, requiring high precision in field matching. This study compares a conventional treatment approach where two lateral photon beams are combined to direct electron fields, to a conformal radiotherapy based on five photon fields, covering the whole neck. Methods and Materials: A comparative analysis of dose distributions and dose-volume histograms was carried out in patients with locally advanced head and neck tumors, for which planning target volumes (PTV) were outlined from the base of the skull down to the supraclavicular region. The prescribed dose to PTV (excluding booster irradiation) was 54 Gy, with spinal dose constraint not exceeding 75% of the total dose, whatever the technique. Results: For the new five-field technique, minimum and maximum point doses showed mean deviations, on five patients entered in the study, of 84% and 113% from the ICRU prescription point. In the conventional treatment, the corresponding figures were 73% and 112%, respectively. A positioning error analysis (isocenter displacement of 2 mm, in all directions) did not elicit any systematic difference in five-field treatment plans while hot spots were found with electron fields. Conclusions: The five-field technique appears routinely feasible and compares favorably with the conventional mixed photon- and electron-therapy approach, especially in regard to its better compliance with dose homogeneity requirements and a reduced risk in dose inhomogeneity related to field matching and patient positioning

  14. All-in-one theranostic nanoagent for head and neck cancer treatment

    Science.gov (United States)

    Dreifuss, Tamar; Davidi, Erez Shmuel; Motiei, Menachem; Barnoy, Eran; Bragilovski, Dimitri; Lubimov, Leon; Kindler, Marc Jose Jonathan; Popovtzer, Aron; Popovtzer, Rachela

    2018-02-01

    Despite the significant improvement in the treatment paradigm of head and neck cancer, owing to advanced radiation techniques in combination with chemotherapy, resistance of tumors remains a critical problem, leading to poor outcomes and negative prognosis. In addition, chemotherapeutic agents result in severe systemic toxicity due to nonselective damaging of normal cells. Recently, nanoparticle-based approaches have gained broad attention for improving both radiation therapy and chemotherapy. In this study, we present a dual effect nanoplatform, consists of gold nanoparticles coated with glucose and cisplatin (CG-GNPs), which simultaneously acts as a radiosensitizer and as a carrier which specifically deliver cisplatin to head and neck tumor. Our CG-GNPs showed significant penetration into tumor cells and similar cellular toxicity as cisplatin alone. Moreover, in combination with radiation treatment, CG-GNPs led to greater tumor reduction than that of free cisplatin with radiation. Furthermore, our CG-GNPs also demonstrated highly efficient imaging capabilities, as they act as ideal tumor-targeted CT contrast agent. Therefore, this single nano-formulation is a promising theranostic agent that has the potential to increase the antitumor effect and allow imaging guided therapy.

  15. Pre- and postirradiation care of the mouth in head and neck cancer patients

    International Nuclear Information System (INIS)

    Cohen, M.A.; Lownie, J.F.

    1982-01-01

    Radiotherapy plays an important role in the treatment of head and neck cancer. The effects of radiotherapy on the oral hard and soft tissues may range from a mild mucositis to severe caries and osteoradionecrosis. It is the responsibility of the dentist to treat and prevent the severe sequelae which may arise. This paper outlines the effects of radiotherapy on the oral structures and discusses the dental treatment of the patient during radiotherapy. Emphasis is placed on the prevention of complications. The head and neck cancer patient must be thoroughly examined by the dentist and treatment planning may then be divided into pre-irradiaton treatment, treatment during irradiation and post-irradiation treatment. The dentist thus forms an essential member of the team treating patients with head and neck cancer [af

  16. Value of PET/CT in the approach to head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Curioni, Otavio Alberto; Amar, Ali; Viana, Debora [Hospital Heliopolis, Sao Paulo, SP (Brazil). Service of Head and Neck Surgery and Otorhynolaryngology; Souza, Ricardo Pires de [Hospital Heliopolis, Sao Paulo, SP (Brazil). Service of Radiology; Rapoport, Abrao [Hospital Heliopolis, Sao Paulo, SP (Brazil); Dedivitis, Rogerio Aparecido [Universidade de Sao Paulo (HC-FMUSP), SP (Brazil). Hospital das Clinicas. Group of Larynx and Hypopharynx; Cernea, Claudio Roberto; Brandao, Lenine Garcia [Universidade de Sao Paulo (FMUSP), SP (Brazil). Fac. de Medicina. Dept. of Head and Neck Surgery

    2012-11-15

    Objective: To evaluate the role of PET/CT in the approach to patients with head and neck cancer. Materials and Methods: Retrospective study of medical records and PET/CT images of 63 patients with head and neck cancer. Results: Alterations were observed in 76% of the cases. Out of these cases, 7 (11%) were considered as false-positive, with SUV < 5.0. PET/CT demonstrated negative results in 15 cases (24%). Among the 14 cases where the method was utilized for staging, 3 (22%) had their stages changed. Conclusion: PET/CT has shown to be of potential value in the routine evaluation of patients with head and neck cancer, but further studies of a higher number of cases are required to define a protocol for utilization of the method. (author)

  17. Outcome after re-irradiation of head and neck cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Platteaux, Nele; Dirix, Piet; Vanstraelen, Bianca; Nuyts, Sandra [University Hospitals Leuven, Campus Gasthuisberg (Belgium). Dept. of Radiation Oncology

    2011-01-15

    Purpose: To retrospectively report the outcome of head and neck cancer patients following re-irradiation. Patients and Methods: A total of 51 patients with recurrent or second primary head and neck cancer received re-irradiation at Leuven University Hospital. Survival and locoregional control were calculated. Doses to organs at risk were retrieved from dose-volume histograms. Radiation-related toxicities were reported. Results: The 2-year actuarial overall survival rate was 30%. On univariate analysis, surgery before re-irradiation and high radiation dose were associated with superior survival. Grade 3 acute and grade 3 or more late toxicity occurred in respectively 29.4% and 35.3% of the patients. Conclusion: Re-irradiation in head and neck cancer patients is feasible with acceptable late toxicity, although the survival remains poor. (orig.)

  18. Human papilloma virus: a new risk factor in a subset of head and neck cancers.

    Science.gov (United States)

    Bisht, Manisha; Bist, Sampan Singh

    2011-01-01

    Head and neck cancer is the sixth most common malignancy worldwide. Tobacco smoking and alcohol consumption are two well known behavioral risk factors associated with head and neck cancer. Recently, evidence is mounting that infection with human papilloma virus, most commonly human papilloma virus-16 is responsible for a subset of head and neck squamous cell carcinoma especially tumors of tonsillar origin. The molecular pathway used by human papilloma virus to trigger malignant transformation of tissue is different from that of other well known risk factors, i.e. smoking and alcohol, associated with squamous cell carcinoma. Apparently, these subsets of patients with human papilloma virus positive tumor are more likely to have a better prognosis than human papilloma virus negative tumor. Considering this fact, the human papilloma virus infection should be determined in all oropharyngeal cancers since it can have a major impact on the decision making process of the treatment.

  19. 18F-deoxyglucose-PET in the detection of recurrence in head and neck cancer

    International Nuclear Information System (INIS)

    Chen Yingrui; Li Weixiong; Gu Meixin; Xie Songxi

    2002-01-01

    Objective: To evaluate 18 F-deoxyglucose-positron emission tomography (FDG-PET) in the detection of suspicious recurrence in head and neck cancers, as compared with CT/MRI imaging. Methods: Thirty-seven patients with clinically suspicious recurrences in head and neck cancers underwent FDG-PET, with 34 checked with CT/MRI imaging. The final diagnosis of recurrence were proved by pathology or clinical following-up. Results: FDG-PET detected recurrence successfully in 32 of 37 (86.5%) patients with 3 false positives and 2 false negatives. The FDG-PET sensitivity, specificity and accuracy in defining local recurrence were 91.7%, 76.9%, 86.5%, respectively; and those of CT/MRI were 68.2%, 75.0%, 61.8%, respectively. Conclusion: In comparison with CT/MRI, FDG-PET possesses a high accuracy in detecting recurrence in head and neck cancers

  20. Pre- and postirradiation care of the mouth in head and neck cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Cohen, M A; Lownie, J F [University of the Witwatersrand, Johannesburg (South Africa). Dept. of Surgery

    1982-08-01

    Radiotherapy plays an important role in the treatment of head and neck cancer. The effects of radiotherapy on the oral hard and soft tissues may range from a mild mucositis to severe caries and osteoradionecrosis. It is the responsibility of the dentist to treat and prevent the severe sequelae which may arise. This paper outlines the effects of radiotherapy on the oral structures and discusses the dental treatment of the patient during radiotherapy. Emphasis is placed on the prevention of complications. The head and neck cancer patient must be thoroughly examined by the dentist and treatment planning may then be divided into pre-irradiaton treatment, treatment during irradiation and post-irradiation treatment. The dentist thus forms an essential member of the team treating patients with head and neck cancer.

  1. Analysis of free flaps in head and neck cancer reconstruction

    International Nuclear Information System (INIS)

    Hirokawa, Eiko; Yokogawa, Hideki; Nakatsuka, Takashi; Tsuchiya, Sunao; Sato, Tomoya; Momosawa, Akira

    2011-01-01

    Approximately 107 patients have received free tissue transfer in head and neck reconstruction since our center opened in April, 2007 (until March, 2010). We examined the relationship between the postoperative complication rate and past history (high blood pressure, diabetes, cerebro-vascular disease, radiation exposure to the head cervix. chemotherapy career and head cervix operation career). The mean patient age was 62.2 years old (range 15 to 90), and there were 77 males (72.0%) and 30 females (28.0%). Among the patients who developed postoperative complications, total necroses occurred in 3 cases (2.8%). In addition to these cases of total necrosis, 8 patients needed a re-operation, 5 of whom received preoperative radiotherapy. Preoperative radiotherapy was related to the development of complications when we performed multiplex logistics analysis. (author)

  2. Role of radiotherapy fractionation in head and neck cancers (MARCH)

    DEFF Research Database (Denmark)

    Lacas, Benjamin; Bourhis, Jean; Overgaard, Jens

    2017-01-01

    BACKGROUND: The Meta-Analysis of Radiotherapy in squamous cell Carcinomas of Head and neck (MARCH) showed that altered fractionation radiotherapy is associated with improved overall and progression-free survival compared with conventional radiotherapy, with hyperfractionated radiotherapy showing...... the greatest benefit. This update aims to confirm and explain the superiority of hyperfractionated radiotherapy over other altered fractionation radiotherapy regimens and to assess the benefit of altered fractionation within the context of concomitant chemotherapy with the inclusion of new trials. METHODS......: For this updated meta-analysis, we searched bibliography databases, trials registries, and meeting proceedings for published or unpublished randomised trials done between Jan 1, 2009, and July 15, 2015, comparing primary or postoperative conventional fractionation radiotherapy versus altered fractionation...

  3. The treatment of cancer in the head and neck

    International Nuclear Information System (INIS)

    Sato, Yasuo; Nomura, Yasunari; Kobayashi, Takeo; Inouye, Kenbun; Kumazawa, Akiyoshi

    1979-01-01

    1,438 cases of head and neck tumors were seen in our clinic during the period from 1965 - 1978. Under our multidisciplinary treatment, average dosage of radiation for nasal-paranasal tumors was 200 rad, for oral-mesopharyngeal tumors 1,800 rad, for nasopharyngeal tumors 2,400 rad, for laryngeal tumors 3,400 rad and for hypopharyngeal tumors 4,400 rad. After reduction of tumor mass and topical cleaning procedure, 1) a dosage of radiation-number of patients curve shifted to lower left, 2) repeated surgeries for recurrences became less frequent, 3) extended surgeries were unnecessary and 4) social rehabilitation of patients was obtained much easier even in aged. Principles of our treatment were simple: short hospitalization and careful long term follow-up. Treatment plan should be decided according to clinical finding and course of illness in each cases. (author)

  4. Evaluation of chemoradiotherapy of low dose nedaplatin (NDP) for head and neck cancer

    International Nuclear Information System (INIS)

    Semba, Osamu; Nagahara, Masamitsu; Miyazaki, Nobuo; Adachi, Osamu; Fukuda, Kazuyasu; Watanabe, Yusuke

    2002-01-01

    There were 21 evaluable cases (22 lesions) who received concurrent chemotherapy with low dose Nedaplatin and radiotherapy, and the diagnosis was head and neck cancer at our institute during the 3 years and 3 months from March 1997 to June 2000. Approximately 77.3% had advanced cancer, and all cases involved squamous cell carcinoma (SCC) except for one case involving undifferentiated carcinoma of the maxillary sinus. The 21 lesions of SCC which could be assessed by TNM classification showed clinical or pathological CR at the primary lesions (T). In consideration of the metastatic lymph nodes (N), 11 for 14 lesions (78.6%) showed CR. From the results, it is believed that this treatment is an excellent therapy in functional preservation and QOL, though further observation and more cases are necessary. (author)

  5. The protective role of carotenoids and polyphenols in patients with head and neck cancer

    Directory of Open Access Journals (Sweden)

    Hui-Ping Chang

    2015-02-01

    Full Text Available Head and neck cancer is a critical global health problem and approximately 650,000 patients per year are diagnosed with this type of cancer. In addition, head and neck cancer exhibits a high recurrence rate, readily causing second primary cancers in other locations, often yielding a poor prognosis. Current medical and surgical treatment options result in considerable impairment of speaking and swallowing functions, with side effects such as nausea, vomiting, bone marrow suppression, and renal damage, thereby impairing patients' quality of life. Thus, developing a prevention and therapeutic intervention strategy for head and neck cancer is vital. Phytochemicals have been shown to have a unique ability to protect cells from damage and modulation of cell repair. The chemopreventive activities of phytochemicals have also been demonstrated to be associated with their antioxidant properties and the induction and stimulation of intercellular communication via gap junctions, which play a role in the regulation of cancer cell cycle, differentiation, apoptosis, and stagnate cancer cell growth. Phytochemicals can also regulate cancer cell signaling pathways, reduce the invasion and metastasis of cancer cells, and protect normal cells during treatment, thus reducing the damage caused by chemotherapy and radiotherapy. The most studied of the chemopreventive effects of phytochemicals are the carotenoids and phenolics. In this review, we investigated the multiple mechanisms of carotenoids and polyphenols (PPs for use in preventing head and neck cancer, reducing the side effects of chemotherapy and radiotherapy, improving patient survival rates, and reducing the occurrence rate of second primary cancers.

  6. Incidence and risk factors of refeeding syndrome in head and neck cancer patients

    DEFF Research Database (Denmark)

    Rasmussen, Stine Ostenfeldt; Kristensen, Marianne Boll; Wessel, Irene

    2016-01-01

    This study aimed to determine the incidence rates of refeeding phenomena (defined as a decline in p-phosphate) and refeeding syndrome (RFS; defined as development of clinical symptoms in addition to a decline in p-phosphate) in head and neck cancer patients, and to identify risk factors. Fifty......-four head and neck cancer patients referred for surgery were included. Forty-six potential risk factors were registered at the baseline, and p-phosphate was measured at Days 2, 4, and 7. Eleven patients (20%) developed RFS, and twenty-eight (52%) developed refeeding phenomena. At baseline, these patients...... presented a higher prevalence of head and neck pain, eating difficulties, higher p-phosphate levels, lower p-transferrin levels, and, in men, lower b-hemoglobin levels. Patients who developed symptoms had a decline in p-phosphate ≥0.22 mmol/l. At baseline, these patients had higher p-phosphate levels...

  7. Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Kuhnt, Thomas; Stang, Andreas; Wienke, Andreas; Vordermark, Dirk; Schweyen, Ramona; Hey, Jeremias

    2016-01-01

    To identify potential risk factors for the development of jaw osteoradionecrosis (ORN) after 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) among patients with newly diagnosed head and neck cancer. This study included 776 patients who underwent 3D-CRT or IMRT for head and neck cancer at the Department of Radiotherapy at the University Hospital Halle-Wittenberg between 2003 and 2013. Sex, dental status prior to radiotherapy, tumor site, bone surgery during tumor resection, concomitant chemotherapy, and the development of advanced ORN were documented for each patient. ORN was classified as grade 3, 4, or 5 according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer classification or grade 3 or 4 according to the late effects in normal tissues/subjective, objective, management, and analytic scale. The cumulative incidence of ORN was estimated. Cox regression analysis was used to identify prognostic risk factors for the development of ORN. Fifty-one patients developed advanced ORN (relative frequency 6.6 %, cumulative incidence 12.4 %). The highest risk was found in patients who had undergone primary bone surgery during tumor resection (hazard ratio [HR] = 5.87; 95 % confidence interval [CI]: 3.09–11.19) and in patients with tumors located in the oral cavity (HR = 4.69; 95 % CI: 1.33–16.52). Sex, dentition (dentulous vs. edentulous), and chemotherapy had no clinically relevant influence. In contrast to most previous studies, we noted a low cumulative incidence of advanced ORN. Patients with tumors located in the oral cavity and those who undergo bone surgery during tumor resection prior to RT may be considered a high-risk group for the development of ORN

  8. Effect of cepharanthin to prevent radiation induced xerostomia in head and neck cancer

    International Nuclear Information System (INIS)

    Imada, Hajime; Nomoto, Satoshi; Ohguri, Takayuki; Yahara, Katsuya; Kato, Fumio; Morioka, Tomoaki; Korogi Yukunori

    2004-01-01

    We retrospectively examined the effect of Cepharanthin to prevent radiation xerostomia in 37 cases of head and neck cancer. In the Cepharanthin group, the degree of xerostomia was milder than in the non-Cepharanthin group in spite of higher normal tissue complication probability (NTCP) and mean dose (MD) of parotid glands. In the non-Cepharanthin group, the degree of xerostomia was significantly correlated with NTCP and MD of parotid glands. MD of parotid glands and use of Cepharanthin were significantly related to more severe xerostomia by multivariate analysis with logistic regression. Cepharanthin may prevent radiation xerostomia after radiotherapy for head and neck cancer. (author)

  9. The role of Human papillomavirus in head and neck cancer and the impact on radiotherapy outcome

    International Nuclear Information System (INIS)

    Lassen, Pernille

    2010-01-01

    The profound influence of Human papillomavirus (HPV) on the epidemiological pattern and clinical course of head and neck cancer (HNSCC) has led to a change in the traditional understanding of this disease entity. Separate therapeutic strategies based on tumour HPV status are under consideration and in this light provision of knowledge concerning the influence of tumour HPV on the radiation response in HNSCC appears highly relevant. This review provides a summary of the current understanding of the role of HPV in head and neck cancer with specific focus on the viral impact on radiotherapy outcome of HNSCC.

  10. Head and Neck Cancers in North-East Iran: A 25 year Survey

    Directory of Open Access Journals (Sweden)

    Maryam Emadzadeh

    2017-05-01

    Full Text Available Introduction Cancers are among the worst noncommunicable diseases around the world. Head and neck cancers are ranked as the fifth most common cancers worldwide. As there are different distributions of risk factors around the world, the incidence of these cancers varies from one place to another. Materials and Methods: We conducted a descriptive analytic cross-sectional study, based on census-based records from the private oncology clinic in Mashhad, Iran. Data from 1,075 patients with head and neck cancers were analyzed from 1986 to 2010. We categorized the duration of study into five periods: 1986–1990, 1991–1995, 1996–2000, 2001–2005, and 2006–2010. Head and neck cancers refers to cancers originating from seven sites in the head and neck including the nasal cavity, oral cavity, pharynx, larynx, salivary glands, paranasal sinuses, and thyroid. Results: Data of 1,075 patients were analyzed. 66.2% were male. Mean ± standard deviation (SD age at the time of diagnosis was 55.37±15.55 years. The most frequent type of head and neck cancer was larynx cancer (36%, followed by pharynx (28.5%, oral (17.5%, thyroid (6.8%, sinus (6.4%, salivary gland (4.10%, and nasal cancer (0.70%. although larynx cancer was the most frequent cancer over the whole study duration, there was a significant (P=0.04 difference in the relative frequency of these cancers across the five time periods. There was a significant difference in mean age between cancer categories (P

  11. High prevalence of cachexia in newly diagnosed head and neck cancer patients: an exploratory study

    NARCIS (Netherlands)

    Jager-Wittenaar, Harriët; Dijkstra, Pieter; Dijkstra, Gerard; Bijzet, Johan; Langendijk, Johannes A.; van der Laan, Bernard; Roodenburg, Jan

    2017-01-01

    In patients with cancer, weight loss can be related to simple starvation, disturbed metabolism, or both. In patients with head and neck cancer (HNC), weight loss often is attributed to simple starvation because the obvious oral symptoms are known to hinder dietary intake. In this population,

  12. High prevalence of cachexia in newly diagnosed head and neck cancer patients : An exploratory study

    NARCIS (Netherlands)

    Jager-Wittenaar, Harriet; Dijkstra, Pieter U.; Dijkstra, Gerard; Bijzet, Johan; Langendijk, Johannes A.; van der Laan, Bernard F. A. M.; Roodenburg, Jan L. N.

    Objective: In patients with cancer, weight loss can be related to simple starvation, disturbedmetabolism, or both. In patients with head and neck cancer (HNC), weight loss often is attributed to simple starvation because the obvious oral symptoms are known to hinder dietary intake. In this

  13. Risk of head-and-neck cancer following a diagnosis of severe cervical intraepithelial neoplasia

    DEFF Research Database (Denmark)

    Svahn, Malene F; Munk, C; Jensen, S M

    2016-01-01

    OBJECTIVE: Women with a history of cervical intraepithelial neoplasia grade 3 including adenocarcinoma in situ (CIN3/AIS) may be more prone to develop cancers of the ano-genital region and head-and-neck cancers. The current literature is, however, limited. METHODS: We established a nationwide...

  14. Advice about Work-Related Issues to Peers and Employers from Head and Neck Cancer Survivors

    NARCIS (Netherlands)

    Dewa, Carolyn S.; Trojanowski, Lucy; Tamminga, Sietske J.; Ringash, Jolie; McQuestion, Maurene; Hoch, Jeffrey S.

    2016-01-01

    The purpose of this exploratory and descriptive study is to contribute to the sparse return-to-work literature on head and neck cancer (HNC) survivors. Interview participants were asked to reflect upon their work-related experience with cancer by answering two specific questions: (1) What advice

  15. Predictors of severe late radiotherapy-related toxicity after hyperfractionated radiotherapy with or without concomitant cisplatin in locally advanced head and neck cancer. Secondary retrospective analysis of a randomized phase III trial (SAKK 10/94)

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Simcock, Mathew; Zimmermann, Frank; Betz, Michael; Bodis, Stephan; Bernier, Jacques; Studer, Gabriela; Aebersold, Daniel M.

    2012-01-01

    Background and purpose: This secondary analysis was performed to identify predictive factors for severe late radiotherapy (RT)-related toxicity after treatment with hyperfractionated RT +/− concomitant cisplatin in locally advanced head and neck cancer. Materials and methods: Patients were retrospectively analyzed from the previously reported randomized phase III trial: SAKK 10/94. Severe late RT-related toxicity was defined as late RTOG ⩾ grade 3 toxicity starting 3 months after end of RT and/or potential treatment-related death within 3 years of randomization. Results: Two hundred and thirteen randomized patients were analyzed; 84 (39%) experienced severe late RT-related toxicity. With median follow-up of 9.7 years (range, 0.4–15.4 years), median time to severe late RT-related toxicity was 9.6 years. In the univariate Cox proportional hazards model the following variables were associated with severe late RT-related toxicity: advanced N-classification (p < 0.001); technically unresectable disease (p = 0.04); weight loss ratio (p = 0.003); supportive measures (p = 0.009) and severe acute dysphagia (p = 0.001). In the subsequent multivariate analysis all variables except use of supportive measures remained statistically significant. Conclusions: Chemotherapy did not appear to affect severe late RT-related toxicity, but advanced N-classification, technically unresectable disease, weight loss ratio, and severe acute dysphagia were independent predictive factors for severe late RT-related toxicity.

  16. Profiling Invasiveness in Head and Neck Cancer: Recent Contributions of Genomic and Transcriptomic Approaches

    International Nuclear Information System (INIS)

    Nisa, Lluís; Aebersold, Daniel Matthias; Giger, Roland; Caversaccio, Marco Domenico; Borner, Urs; Medová, Michaela; Zimmer, Yitzhak

    2015-01-01

    High-throughput molecular profiling approaches have emerged as precious research tools in the field of head and neck translational oncology. Such approaches have identified and/or confirmed the role of several genes or pathways in the acquisition/maintenance of an invasive phenotype and the execution of cellular programs related to cell invasion. Recently published new-generation sequencing studies in head and neck squamous cell carcinoma (HNSCC) have unveiled prominent roles in carcinogenesis and cell invasion of mutations involving NOTCH1 and PI3K-patwhay components. Gene-expression profiling studies combined with systems biology approaches have allowed identifying and gaining further mechanistic understanding into pathways commonly enriched in invasive HNSCC. These pathways include antigen-presenting and leucocyte adhesion molecules, as well as genes involved in cell-extracellular matrix interactions. Here we review the major insights into invasiveness in head and neck cancer provided by high-throughput molecular profiling approaches

  17. Profiling Invasiveness in Head and Neck Cancer: Recent Contributions of Genomic and Transcriptomic Approaches

    Directory of Open Access Journals (Sweden)

    Lluís Nisa

    2015-03-01

    Full Text Available High-throughput molecular profiling approaches have emerged as precious research tools in the field of head and neck translational oncology. Such approaches have identified and/or confirmed the role of several genes or pathways in the acquisition/maintenance of an invasive phenotype and the execution of cellular programs related to cell invasion. Recently published new-generation sequencing studies in head and neck squamous cell carcinoma (HNSCC have unveiled prominent roles in carcinogenesis and cell invasion of mutations involving NOTCH1 and PI3K-patwhay components. Gene-expression profiling studies combined with systems biology approaches have allowed identifying and gaining further mechanistic understanding into pathways commonly enriched in invasive HNSCC. These pathways include antigen-presenting and leucocyte adhesion molecules, as well as genes involved in cell-extracellular matrix interactions. Here we review the major insights into invasiveness in head and neck cancer provided by high-throughput molecular profiling approaches.

  18. Fractionation and delivery schedules in combined radiotherapy-cisplatin for head and neck cancer

    International Nuclear Information System (INIS)

    Marcu, L.; Van Doorn, T.; Royal Adelaide Hospital,; Olver, I.

    2000-01-01

    Full text: Since Rosenberg's initial discovery, cisplatin has become one of the most effective anticancer drugs, with particular significance in head and neck cancer. For advanced disease, where the tumour is unresectable, radiotherapy and chemotherapy, either singularly or combined, remain the possible therapeutic modalities. The majority of the trials using a combination of cisplatin and radiation obtained much better results than the single-agent trials. But the best schedule, dosage and timing between radiation and drug administration are still unknown. Many positive steps were however made to eliminate the cisplatin-produced side effects, as much as possible. The tendency in current trials is to fractionate the drug dose by daily administration and also to hyperfractionate the radiation. In this way the long-term benefits are improved and the toxicity is better tolerated

  19. Progress in treatment of head and neck cancer. Pt. 1. Chemotherapy

    International Nuclear Information System (INIS)

    Stupp, R.; Vokes, E.E.; Chicago Univ., IL

    1995-01-01

    Cancer of the head and neck is commonly diagnosed in an advanced stage with a poor prognosis. New active agents and combinations have recently been identified. By adding chemotherapy to a multimodality approach with surgery and radiation therapy the outcome may be altered. We reviewed the more recently published literature on induction and adjuvant chemotherapy. No survival advantage has been shown for adjuvant chemotherapy. Organ preservation can be achieved with induction chemotherapy followed by limited surgery and radiation in approximately two thirds of the patients with laryngeal carcinoma. Patients achieving a complete response after induction chemotherapy have a better prognosis. Chemotherpy has consistently shown to reduce the frequency of distant metastases. Chemotherapy is indicated only in recurrent or metastatic disease. Induction chemotherapy is limited to laryngeal carcinoma with organ preservation as intent. Local recurrences and intercurrent morbidity are the main reasons for treatment failures. (orig.) [de

  20. Characterization of HPV and host genome interactions in primary head and neck cancers

    Science.gov (United States)

    Parfenov, Michael; Pedamallu, Chandra Sekhar; Gehlenborg, Nils; Freeman, Samuel S.; Danilova, Ludmila; Bristow, Christopher A.; Lee, Semin; Hadjipanayis, Angela G.; Ivanova, Elena V.; Wilkerson, Matthew D.; Protopopov, Alexei; Yang, Lixing; Seth, Sahil; Song, Xingzhi; Tang, Jiabin; Ren, Xiaojia; Zhang, Jianhua; Pantazi, Angeliki; Santoso, Netty; Xu, Andrew W.; Mahadeshwar, Harshad; Wheeler, David A.; Haddad, Robert I.; Jung, Joonil; Ojesina, Akinyemi I.; Issaeva, Natalia; Yarbrough, Wendell G.; Hayes, D. Neil; Grandis, Jennifer R.; El-Naggar, Adel K.; Meyerson, Matthew; Park, Peter J.; Chin, Lynda; Seidman, J. G.; Hammerman, Peter S.; Kucherlapati, Raju; Ally, Adrian; Balasundaram, Miruna; Birol, Inanc; Bowlby, Reanne; Butterfield, Yaron S.N.; Carlsen, Rebecca; Cheng, Dean; Chu, Andy; Dhalla, Noreen; Guin, Ranabir; Holt, Robert A.; Jones, Steven J.M.; Lee, Darlene; Li, Haiyan I.; Marra, Marco A.; Mayo, Michael; Moore, Richard A.; Mungall, Andrew J.; Robertson, A. Gordon; Schein, Jacqueline E.; Sipahimalani, Payal; Tam, Angela; Thiessen, Nina; Wong, Tina; Protopopov, Alexei; Santoso, Netty; Lee, Semin; Parfenov, Michael; Zhang, Jianhua; Mahadeshwar, Harshad S.; Tang, Jiabin; Ren, Xiaojia; Seth, Sahil; Haseley, Psalm; Zeng, Dong; Yang, Lixing; Xu, Andrew W.; Song, Xingzhi; Pantazi, Angeliki; Bristow, Christopher; Hadjipanayis, Angela; Seidman, Jonathan; Chin, Lynda; Park, Peter J.; Kucherlapati, Raju; Akbani, Rehan; Casasent, Tod; Liu, Wenbin; Lu, Yiling; Mills, Gordon; Motter, Thomas; Weinstein, John; Diao, Lixia; Wang, Jing; Fan, You Hong; Liu, Jinze; Wang, Kai; Auman, J. Todd; Balu, Saianand; Bodenheimer, Tom; Buda, Elizabeth; Hayes, D. Neil; Hoadley, Katherine A.; Hoyle, Alan P.; Jefferys, Stuart R.; Jones, Corbin D.; Kimes, Patrick K.; Marron, J.S.; Meng, Shaowu; Mieczkowski, Piotr A.; Mose, Lisle E.; Parker, Joel S.; Perou, Charles M.; Prins, Jan F.; Roach, Jeffrey; Shi, Yan; Simons, Janae V.; Singh, Darshan; Soloway, Mathew G.; Tan, Donghui; Veluvolu, Umadevi; Walter, Vonn; Waring, Scot; Wilkerson, Matthew D.; Wu, Junyuan; Zhao, Ni; Cherniack, Andrew D.; Hammerman, Peter S.; Tward, Aaron D.; Pedamallu, Chandra Sekhar; Saksena, Gordon; Jung, Joonil; Ojesina, Akinyemi I.; Carter, Scott L.; Zack, Travis I.; Schumacher, Steven E.; Beroukhim, Rameen; Freeman, Samuel S.; Meyerson, Matthew; Cho, Juok; Chin, Lynda; Getz, Gad; Noble, Michael S.; DiCara, Daniel; Zhang, Hailei; Heiman, David I.; Gehlenborg, Nils; Voet, Doug; Lin, Pei; Frazer, Scott; Stojanov, Petar; Liu, Yingchun; Zou, Lihua; Kim, Jaegil; Lawrence, Michael S.; Sougnez, Carrie; Lichtenstein, Lee; Cibulskis, Kristian; Lander, Eric; Gabriel, Stacey B.; Muzny, Donna; Doddapaneni, HarshaVardhan; Kovar, Christie; Reid, Jeff; Morton, Donna; Han, Yi; Hale, Walker; Chao, Hsu; Chang, Kyle; Drummond, Jennifer A.; Gibbs, Richard A.; Kakkar, Nipun; Wheeler, David; Xi, Liu; Ciriello, Giovanni; Ladanyi, Marc; Lee, William; Ramirez, Ricardo; Sander, Chris; Shen, Ronglai; Sinha, Rileen; Weinhold, Nils; Taylor, Barry S.; Aksoy, B. Arman; Dresdner, Gideon; Gao, Jianjiong; Gross, Benjamin; Jacobsen, Anders; Reva, Boris; Schultz, Nikolaus; Sumer, S. Onur; Sun, Yichao; Chan, Timothy; Morris, Luc; Stuart, Joshua; Benz, Stephen; Ng, Sam; Benz, Christopher; Yau, Christina; Baylin, Stephen B.; Cope, Leslie; Danilova, Ludmila; Herman, James G.; Bootwalla, Moiz; Maglinte, Dennis T.; Laird, Peter W.; Triche, Timothy; Weisenberger, Daniel J.; Van Den Berg, David J.; Agrawal, Nishant; Bishop, Justin; Boutros, Paul C.; Bruce, Jeff P; Byers, Lauren Averett; Califano, Joseph; Carey, Thomas E.; Chen, Zhong; Cheng, Hui; Chiosea, Simion I.; Cohen, Ezra; Diergaarde, Brenda; Egloff, Ann Marie; El-Naggar, Adel K.; Ferris, Robert L.; Frederick, Mitchell J.; Grandis, Jennifer R.; Guo, Yan; Haddad, Robert I.; Hammerman, Peter S.; Harris, Thomas; Hayes, D. Neil; Hui, Angela BY; Lee, J. Jack; Lippman, Scott M.; Liu, Fei-Fei; McHugh, Jonathan B.; Myers, Jeff; Ng, Patrick Kwok Shing; Perez-Ordonez, Bayardo; Pickering, Curtis R.; Prystowsky, Michael; Romkes, Marjorie; Saleh, Anthony D.; Sartor, Maureen A.; Seethala, Raja; Seiwert, Tanguy Y.; Si, Han; Tward, Aaron D.; Van Waes, Carter; Waggott, Daryl M.; Wiznerowicz, Maciej; Yarbrough, Wendell; Zhang, Jiexin; Zuo, Zhixiang; Burnett, Ken; Crain, Daniel; Gardner, Johanna; Lau, Kevin; Mallery, David; Morris, Scott; Paulauskis, Joseph; Penny, Robert; Shelton, Candance; Shelton, Troy; Sherman, Mark; Yena, Peggy; Black, Aaron D.; Bowen, Jay; Frick, Jessica; Gastier-Foster, Julie M.; Harper, Hollie A.; Lichtenberg, Tara M.; Ramirez, Nilsa C.; Wise, Lisa; Zmuda, Erik; Baboud, Julien; Jensen, Mark A.; Kahn, Ari B.; Pihl, Todd D.; Pot, David A.; Srinivasan, Deepak; Walton, Jessica S.; Wan, Yunhu; Burton, Robert; Davidsen, Tanja; Demchok, John A.; Eley, Greg; Ferguson, Martin L.; Shaw, Kenna R. Mills; Ozenberger, Bradley A.; Sheth, Margi; Sofia, Heidi J.; Tarnuzzer, Roy; Wang, Zhining; Yang, Liming; Zenklusen, Jean Claude; Saller, Charles; Tarvin, Katherine; Chen, Chu; Bollag, Roni; Weinberger, Paul; Golusiński, Wojciech; Golusiński, Paweł; Ibbs, Matthiew; Korski, Konstanty; Mackiewicz, Andrzej; Suchorska, Wiktoria; Szybiak, Bartosz; Wiznerowicz, Maciej; Burnett, Ken; Curley, Erin; Gardner, Johanna; Mallery, David; Penny, Robert; Shelton, Troy; Yena, Peggy; Beard, Christina; Mitchell, Colleen; Sandusky, George; Agrawal, Nishant; Ahn, Julie; Bishop, Justin; Califano, Joseph; Khan, Zubair; Bruce, Jeff P; Hui, Angela BY; Irish, Jonathan; Liu, Fei-Fei; Perez-Ordonez, Bayardo; Waldron, John; Boutros, Paul C.; Waggott, Daryl M.; Myers, Jeff; Lippman, Scott M.; Egea, Sophie; Gomez-Fernandez, Carmen; Herbert, Lynn; Bradford, Carol R.; Carey, Thomas E.; Chepeha, Douglas B.; Haddad, Andrea S.; Jones, Tamara R.; Komarck, Christine M.; Malakh, Mayya; McHugh, Jonathan B.; Moyer, Jeffrey S.; Nguyen, Ariane; Peterson, Lisa A.; Prince, Mark E.; Rozek, Laura S.; Sartor, Maureen A.; Taylor, Evan G.; Walline, Heather M.; Wolf, Gregory T.; Boice, Lori; Chera, Bhishamjit S.; Funkhouser, William K.; Gulley, Margaret L.; Hackman, Trevor G.; Hayes, D. Neil; Hayward, Michele C.; Huang, Mei; Rathmell, W. Kimryn; Salazar, Ashley H.; Shockley, William W.; Shores, Carol G.; Thorne, Leigh; Weissler, Mark C.; Wrenn, Sylvia; Zanation, Adam M.; Chiosea, Simion I.; Diergaarde, Brenda; Egloff, Ann Marie; Ferris, Robert L.; Romkes, Marjorie; Seethala, Raja; Brown, Brandee T.; Guo, Yan; Pham, Michelle; Yarbrough, Wendell G.

    2014-01-01

    Previous studies have established that a subset of head and neck tumors contains human papillomavirus (HPV) sequences and that HPV-driven head and neck cancers display distinct biological and clinical features. HPV is known to drive cancer by the actions of the E6 and E7 oncoproteins, but the molecular architecture of HPV infection and its interaction with the host genome in head and neck cancers have not been comprehensively described. We profiled a cohort of 279 head and neck cancers with next generation RNA and DNA sequencing and show that 35 (12.5%) tumors displayed evidence of high-risk HPV types 16, 33, or 35. Twenty-five cases had integration of the viral genome into one or more locations in the human genome with statistical enrichment for genic regions. Integrations had a marked impact on the human genome and were associated with alterations in DNA copy number, mRNA transcript abundance and splicing, and both inter- and intrachromosomal rearrangements. Many of these events involved genes with documented roles in cancer. Cancers with integrated vs. nonintegrated HPV displayed different patterns of DNA methylation and both human and viral gene expressions. Together, these data provide insight into the mechanisms by which HPV interacts with the human genome beyond expression of viral oncoproteins and suggest that specific integration events are an integral component of viral oncogenesis. PMID:25313082

  1. Hypothyroidism following treatment for head and neck cancer

    International Nuclear Information System (INIS)

    Vrabec, D.P.; Heffron, T.J.

    1981-01-01

    One hundred ninety-six head and neck patients were studied to determine the effects of radiation therapy and surgery on thyroid function. Serum thyroid-stimulating hormone (TSH) levels were obtained as a screening test for primary hypothyroidism. Elevated TSH levels were found in 57 of the 196 patients (29.1%). The highest incidence of abnormal TSH values (66%) occurred in the group treated with combination radiation therapy and surgery, including partial thyroidectomy. TSH levels rose early in the posttreatment period with 60% of the abnormal values occurring within the first three posttreatment years. Posttreatment thyroid dysfunction was twice as common in women (48.6%) as in men (25.4%). When serum thyroxine levels by radioimmunoassay (T4RIA) were correlated with the elevated serum TSH levels, a similar pattern was seen with 65% of the patients in Group 3 having a decreased T4RIA level indicating overt hypothyroidism. Pretreatment levels of thyroid function including thyroid antibody studies should be established for all patients. Serial TSH levels should be done every three months during the first three posttreatment years and semiannually thereafter as long as the patient will return for follow-up care. All patients treated with combination radiation therapy and surgery who develop elevated TSH levels should be treated with thyroid replacement therapy. Patients receiving radiation therapy alone should receive replacement thyroid therapy if they develop a depressed T4RIA value or a pattern of gradually increasing TSH levels

  2. The role of physical activity and nutritional intake on nutritional status in patients with head and neck cancer

    NARCIS (Netherlands)

    Martine Sealy

    2015-01-01

    Malnutrition is a frequent problem in patients with head and neck cancer. Prevention or timely treatment of malnutrition is of great importance because deteriorated nutritional status can have a negative effect on clinical outcome in head and neck cancer patients. Malnutrition can be viewed as a

  3. Critical weight loss in head and neck cancer - prevalence and risk factors at diagnosis : an explorative study

    NARCIS (Netherlands)

    Jager-Wittenaar, H.; Dijkstra, P.U.; Vissink, A.; van der Laan, B.F.A.M.; van Oort, R.P.; Roodenburg, J.L.N.

    Goals of work Critical weight loss (>= 5% in 1 month or >= 10% in 6 months) is a common phenomenon in head and neck cancer patients. It is unknown which complaints are most strongly related to critical weight loss in head and neck cancer patients at the time of diagnosis. The aim of this explorative

  4. The role of physical activity and nutritional intake on nutritional status in patients with head and neck cancer

    NARCIS (Netherlands)

    Sealy, Martine

    Malnutrition is a frequent problem in patients with head and neck cancer. Prevention or timely treatment of malnutrition is of great importance because deteriorated nutritional status can have a negative effect on clinical outcome in head and neck cancer patients. Malnutrition is a multidimensional

  5. Liposomal treatment of xerostomia, odor, and taste abnormalities in patients with head and neck cancer.

    Science.gov (United States)

    Heiser, Clemens; Hofauer, Benedikt; Scherer, Elias; Schukraft, Johannes; Knopf, Andreas

    2016-04-01

    Smell and taste disorders, sicca symptoms, can be detected in patients with head and neck cancer. The purpose of this study was to assess the utility of local liposomal application in the treatment of patients with head and neck cancers. Ninety-eight patients with head and neck cancer were included in this study. The groups were defined as: group 1 = only surgery; group 2 = surgery + adjuvant radiochemotherapy; and group 3 = primarily radiochemotherapy. All patients had finished cancer treatment and received liposomal sprays for the nose and mouth for 2 months (LipoNasal, LipoSaliva; Optima Pharmaceutical GmbH, Germany) and suffered from taste and smell disorders. We performed tests with "Sniffin' Sticks," "Taste Strips," and a xerostomia questionnaire before and after treatment. After application of liposomes, patients demonstrated a statistically significant increase in smell and taste, and reduced xerostomia. Our results demonstrate that using nonpharmaceutical liposomal sprays improve smell, taste, and symptoms of xerostomia in patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1232-E1237, 2016. © 2015 Wiley Periodicals, Inc.

  6. Treatment, patient and tumor characteristics impact quality of life (QOL) in patients with locally advanced head and neck cancer: Report of the radiation therapy oncology group (RTOG) trial 90-03

    International Nuclear Information System (INIS)

    Fisher, J.; Scott, C.; Fu, K.; Trotti, A.; Spencer, S.; Garden, A.; Phillips, T.; Movsas, B.; Byhardt, R.; Ang, K.

    2001-01-01

    Purpose: To determine factors that effect QOL in patients with locally advanced squamous cell cancer of the head and neck randomized to standard fractionation radiotherapy (SFX), hyperfractionation (HFX), Accelerated Fractionation with Split (AFX-S) and Accelerated Fractionation with Concomitant Boost (AFX-C). Materials and Methods: RTOG 90-03 used the Head and Neck Performance Status Scale (HNPSS) and the Functional Assessment of Cancer Therapy (FACT-H and N), version 2 to assess QOL. The HNPSS has three components Normalcy of Diet, Eating in Public, and Understandability of Speech. The FACT-H and N has two components: a global QOL questionnaire (FACT-G) consisting of 4 domains; Physical Well Being (PWB), Social Well Being (SWB), Emotional Well Being (EWB), Functional Well Being (FWB), and an additional H and N specific questionnaire (AC). Between 3/92 and 8/97, 1113 pts. were randomized; 718 completed a pretreatment FACT-H and N. Pts. completed the HNPSS and FACT-H and N; pretreatment, 4 weeks post-RT, every 3 months for 1 year. Results: Prior to the start of radiotherapy (RT) 48% of pts had normal diets, 64% had normal public eating, and 77% had normal speech. Age ( 60), KPS, tumor site (oral cavity vs. other), T-stage (T3+T4 vs. T1+T2+TX), N-stage (N0 vs. other), Race (Non-White vs. White), and marital status (single vs. married), FACT-G, PWB, EWB, FWB, AC, use of oral nutrient supplements, feeding tube, and parenteral nutrition predicted for pretreatment diet, public eating, and speech. During the acute toxicity phase diet, eating, and speech were related to the intensity of RT (HFX or AFX-C), marital status (single), tumor site (oral cavity), use of oral nutrient supplements, and feeding tube. At one-year oral cavity tumors, AFX-C, oral nutrient supplements, feeding tube, and single patients had worse diet, eating, and speech. Conclusion: Pretreatment patient and tumor characteristics impact on QOL prior to the initiation of therapy. Intensification of

  7. Pretreatment Quality of Life Predicts for Locoregional Control in Head and Neck Cancer Patients: A Radiation Therapy Oncology Group Analysis

    International Nuclear Information System (INIS)

    Siddiqui, Farzan; Pajak, Thomas F.; Watkins-Bruner, Deborah; Konski, Andre A.; Coyne, James C.; Gwede, Clement K.; Garden, Adam S.; Spencer, Sharon A.; Jones, Christopher; Movsas, Benjamin

    2008-01-01

    Purpose: To analyze the prospectively collected health-related quality-of-life (HRQOL) data from patients enrolled in two Radiation Therapy Oncology Group randomized Phase III head and neck cancer trials (90-03 and 91-11) to assess their value as an independent prognostic factor for locoregional control (LRC) and/or overall survival (OS). Methods and Materials: HRQOL questionnaires, using a validated instrument, the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H and N), version 2, were completed by patients before the start of treatment. OS and LRC were the outcome measures analyzed using a multivariate Cox proportional hazard model. Results: Baseline FACT-H and N data were available for 1,093 patients and missing for 417 patients. No significant difference in outcome was found between the patients with and without baseline FACT-H and N data (p = 0.58). The median follow-up time was 27.2 months for all patients and 49 months for surviving patients. Multivariate analyses were performed for both OS and LRC. Beyond tumor and nodal stage, Karnofsky performance status, primary site, cigarette use, use of concurrent chemotherapy, and altered fractionation schedules, the FACT-H and N score was independently predictive of LRC (but not OS), with p = 0.0038. The functional well-being component of the FACT-H and N predicted most significantly for LRC (p = 0.0004). Conclusions: This study represents, to our knowledge, the largest analysis of HRQOL as a prognostic factor in locally advanced head and neck cancer patients. The results of this study have demonstrated the importance of baseline HRQOL as a significant and independent predictor of LRC in patients with locally advanced head and neck cancer

  8. A Novel External Carotid Arterial Sheath System for Intra-arterial Infusion Chemotherapy of Head and Neck Cancer.

    Science.gov (United States)

    Ii, Noriko; Fuwa, Nobukazu; Toyomasu, Yutaka; Takada, Akinori; Nomura, Miwako; Kawamura, Tomoko; Sakuma, Hajime; Nomoto, Yoshihito

    2017-07-01

    The purpose of this study was to describe a novel system for treating advanced head and neck cancer consisting of an external carotid arterial sheath (ECAS) and a microcatheter to inject drugs retrogradely into multiple feeding arteries through the superficial temporal artery (STA). Four consecutive patients with head and neck cancer that had more than one feeding artery were enrolled in this study. The ECAS was made of polyurethane and surface-coated with heparin resin to prevent thrombus formation, allowing it to remain in place for a prolonged period of time. The ECAS was inserted through the STA, and its tip was placed between the maxillary artery and facial artery. The tumor-feeding arteries were selected using a hooked-shaped microcatheter through the ECAS. A total of 13 target arteries were selected in the four patients. The microcatheter inserted via the ECAS was used to catheterize ten arteries (five lingual arteries and five facial arteries). The remaining three lingual arteries were directly selected by the catheter without ECAS. All of the target arteries were able to be catheterized superselectively. The technical success rate was 100%. Vascular occlusion, which might have been caused by the ECAS, was observed in one patient. No neurologic toxicities occurred. This ECAS system is a new approach for retrograde superselective intra-arterial chemotherapy that covers the entire tumor with anticancer drugs. It has the potential to increase the effectiveness of therapy for advanced head and neck cancer. Level 4, Case Series.

  9. Affiliation to the work market after curative treatment of head-and-neck cancer

    DEFF Research Database (Denmark)

    Kjær, Trille; Bøje, Charlotte Rotbøl; Olsen, Maja Halgren

    2013-01-01

    Survivors of squamous cell carcinoma of the head and neck (HNSCC) are more severely affected in regard to affiliation to the work market than other cancer survivors. Few studies have investigated associations between socioeconomic and disease-related factors and work market affiliation after...

  10. Molecular imaging of head and neck cancers. Perspectives of PET/MRI

    International Nuclear Information System (INIS)

    Stumpp, P.; Kahn, T.; Purz, S.; Sabri, O.

    2016-01-01

    The 18 F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG-PET/CT) procedure is a cornerstone in the diagnostics of head and neck cancers. Several years ago PET-magnetic resonance imaging (PET/MRI) also became available as an alternative hybrid multimodal imaging method. Does PET/MRI have advantages over PET/CT in the diagnostics of head and neck cancers ?The diagnostic accuracy of the standard imaging methods CT, MRI and PET/CT is depicted according to currently available meta-analyses and studies concerning the use of PET/MRI for these indications are summarized. In all studies published up to now PET/MRI did not show superiority regarding the diagnostic accuracy in head and neck cancers; however, there is some evidence that in the future PET/MRI can contribute to tumor characterization and possibly be used to predict tumor response to therapy with the use of multiparametric imaging. Currently, 18 F-FDG-PET/CT is not outperformed by PET/MRI in the diagnostics of head and neck cancers. The additive value of PET/MRI due to the use of multiparametric imaging needs to be investigated in future research. (orig.) [de

  11. A critical evaluation of lymph node ratio in head and neck cancer

    NARCIS (Netherlands)

    de Ridder, M.; Marres, C. C. M.; Smeele, L. E.; van den Brekel, M. W. M.; Hauptmann, M.; Balm, A. J. M.; van Velthuysen, M. L. F.

    2016-01-01

    In head and neck squamous cell carcinoma (HNSCC), the search for better prognostic factors beyond TNM-stage is ongoing. Lymph node ratio (LNR) (positive lymph nodes/total lymph nodes) is gaining interest in view of its potential prognostic significance. All HNSCC patients at the Netherlands Cancer

  12. GST genotypes in head and neck cancer patients and its clinical ...

    African Journals Online (AJOL)

    Polymorphisms of carcinogen-metabolizing enzymes, known to be involved in metabolism of carcinogens found in tobacco smoke, are relatively common in most populations. Cigarette and bidi smoking has been demonstrated to increase the risk of head and neck cancers in our study group. This study evaluated the risk of ...

  13. p53 oncogene mutations in head and neck cancer based on the ...

    African Journals Online (AJOL)

    Yomi

    2012-01-26

    Jan 26, 2012 ... In order to study the p53 mutations in head and neck cancer, we explored the relationship between the different positions of the bases and the amino acids' physical and chemical properties. In this paper, the Euclidean distance (d) was defined. Furthermore, by using improved variation coefficient method,.

  14. Resting energy expenditure in head and neck cancer patients before and during radiotherapy

    NARCIS (Netherlands)

    Langius, Jacqueline A. E.; Kruizenga, Hinke M.; Uitdehaag, Bernard M. J.; Langendijk, Johannes A.; Doornaert, Patricia; Leemans, C. Rene; Weijs, Peter J. M.

    Background & aims: Weight loss is a frequently observed problem in patients with head and neck cancer (HNC) during radiotherapy. It is still to be assessed whether hypermetabolism is contributing to this problem. The aim of this study was to investigate hypermetabolism before radiotherapy, and

  15. Magnetic resonance imaging guided reirradiation of recurrent and second primary head and neck cancer

    Directory of Open Access Journals (Sweden)

    Allen M. Chen, MD

    2017-04-01

    Conclusions: Our preliminary findings show that reirradiation with MRI guided radiation therapy results in effective disease control with relatively low morbidity for patients with recurrent and second primary cancers of the head and neck. The superior soft tissue resolution of the MRI scans that were used for planning and delivery has the potential to improve the therapeutic ratio.

  16. International Cancer of the Head and Neck, Genetics and Environment (InterCHANGE) Study

    Science.gov (United States)

    2013-10-29

    Evaluate the Association Between Certain Environmental Exposures (e.g. Cigarette Smoking, Alcohol Drinking, Betel Nut Chewing…) and Head and Neck Cancers; Assess the Effect of Genetic Factors, Including Both SNP and Copy Number Variation (CNV) Through Analysis of Both Main Effect and Gene-gene Interaction

  17. Work-related experiences of head and neck cancer survivors: an exploratory and descriptive qualitative study

    NARCIS (Netherlands)

    Dewa, Carolyn S.; Trojanowski, Lucy; Tamminga, Sietske J.; Ringash, Jolie; McQuestion, Maurene; Hoch, Jeffrey S.

    2017-01-01

    This exploratory and descriptive study contributes to the growing knowledge about the return-to-work (RTW) experience of head and neck cancer (HNC) survivors. Viewing RTW as a process, participants were asked to consider the work-related experience with HNC at different phases: (1) at

  18. Understanding behavioral mechanisms for physical activity in head and neck cancer patients: a qualitative study

    NARCIS (Netherlands)

    Sealy, Martine; Stuiver, M.M.; Midtgard, Julie; van der Schans, Cees; Roodenburg, Jan L N; Jager-Wittenaar, Harriët

    2017-01-01

    Rationale: Head and neck cancer (HNC) patients often have adverse changes in body composition. Loss of muscle mass and strength frequently occur, even when dietary intake is adequate. Nascent evidence suggests that a healthy lifestyle, including adequate physical activity (PA) and diet, may prevent

  19. Dysphagia training after head and neck cancer fails to follow legislation and national recommendations

    DEFF Research Database (Denmark)

    Fredslund, Sara Vinther; Høgdal, Nina; Christensen, Malene Bæk

    2015-01-01

    INTRODUCTION: Dysphagia is a known sequela after head and neck cancer (HNC) and causes malnutrition, aspiration pneumonia and a reduced quality of life. Due to improved survival rates, the number of patients with sequelae is increasing. Evidence on the ideal HNC-specific rehabilitation of dysphag...

  20. Radiation dose, driving performance, and cognitive function in patients with head and neck cancer

    International Nuclear Information System (INIS)

    Yuen, Hon K.; Sharma, Anand K.; Logan, William C.; Gillespie, M. Boyd; Day, Terry A.; Brooks, Johnell O.

    2008-01-01

    Seven head and neck cancer patients participated in a driving evaluation in a driving simulator. Radiation dose on the temporal lobes was moderately associated with time to complete a cognitive test and with driving performance. Results indicated that incidental irradiation may contribute to a decrease in cognition and in unsafe driving performance, which seems to be time-dependent

  1. Comparison of weekly administration of cisplatin versus three courses of cisplatin 100 mg/m2 for definitive radiochemotherapy of locally advanced head-and-neck cancers

    International Nuclear Information System (INIS)

    Rades, Dirk; Seidl, Daniel; Janssen, Stefan; Bajrovic, Amira; Karner, Katarina; Strojan, Primoz; Schild, Steven E

    2016-01-01

    To compare definitive radiochemotherapy with weekly administration of 30–40 mg/m 2 of cisplatin to 100 mg/m 2 of cisplatin on days 1, 22 and 43 for outcomes and toxicity in patients with squamous cell carcinoma of the head-and-neck. Seventy-five patients receiving radiochemotherapy with weekly cisplatin (30–40 mg/m 2 ) were compared to 58 patients receiving radiochemotherapy with 100 mg/m 2 cisplatin on days 1, 22 and 43. Radiochemotherapy regimen plus seven characteristics (age, gender, performance score, tumor site, T-/N-category, histologic grading) were evaluated for locoregional control (LRC), metastases-free survival (MFS) and overall survival (OS). Radiochemotherapy groups were compared for toxicity. On multivariate analysis, improved LRC was associated with cisplatin 100 mg/m 2 (hazard ratio [HR] 1.57; p = 0.008) and female gender (HR 4.37; p = 0.003). Radiochemotherapy regimen was not significantly associated with MFS on univariate analysis (p = 0.66). On multivariate analysis, better MFS was associated with ECOG performance score 0–1 (HR 5.63; p < 0.001) and histological grade 1–2 (HR 1.81; p = 0.002). On multivariate analysis, improved OS was associated with cisplatin 100 mg/m 2 (HR 1.33; p = 0.023), ECOG performance score 0–1 (HR 2.15; p = 0.029) and female gender (HR 1.98; p = 0.026). Cisplatin 100 mg/m 2 was associated with higher rates of grade ≥3 hematotoxicity (p = 0.004), grade ≥2 renal failure (p = 0.004) and pneumonia/sepsis (p = 0.033). Radiochemotherapy with 100 mg/m 2 of cisplatin every 3 weeks resulted in better LRC and OS than weekly doses of 30–40 mg/m 2 . Given the limitations of a retrospective study, 100 mg/m 2 of cisplatin appears preferable. Since this regimen was associated with considerable acute toxicity, patients require close monitoring

  2. Complementary medicine use in patients with head and neck cancer in Ireland.

    LENUS (Irish Health Repository)

    Amin, Mohamed

    2010-08-01

    The objectives of the study were: first, to determine the prevalence of traditional medicine (TM) and complementary and alternative medicine (CAM) use in head and neck cancer patients in Ireland; second, to educate ourselves on the plethora of CAM\\/TM options available to patients outside the dominion of conventional medicine. The study design consisted of a cross-sectional survey carried out in three head and neck cancer centres. Self-administered questionnaires were distributed to 110 head and neck cancer patients attending the three cancer centres and data were collected for statistical analysis. A total of 106 patients completed the questionnaire; 21.7% of the participants used CAM\\/TM since their diagnosis with head and neck cancer. CAM\\/TM usage was higher in female (34.3%) than in male patients (16.2%). CAM\\/TM use was more common in the 41-50-year age group, in patients with higher educational levels and those holding strong religious beliefs, and also in married than single patients. The most common types of CAM\\/TM used were spiritual and laying on of hands. The most common reasons reported for using CAM\\/TM were to counteract the ill effects of treatment and increase the body\\'s ability to fight cancer. Sources of information on CAM\\/TM were friends (65%), family (48%) and media (21%). This survey reveals a high prevalence of CAM\\/TM use in head and neck cancer patients, hence emphasising the need for otolaryngologists to educate themselves on the various therapies available to be able to provide informative advice. There is an urgent need for evidence-based investigation of various CAM\\/TM therapies currently offered to patients.

  3. Cancer of the head and neck; Cancers de la tete et du cou

    Energy Technology Data Exchange (ETDEWEB)

    Leignel, D.; Toledano, A.; Calais, G.; Gardner, M.; Valinta, D.; Halimi, P.; Alberini, J.L.; Plantet, M.M.; Banal, A.; Hans, S.; Floiras, J.L.; Labib, A.; Djemaa, A.; Naoun, L.; Bali, M.; Melais, K.; George, L.; Cazalet, M.; Gross, E.; Padovani, L.; Cowen, D.; Pignon, T.; Bannour, N.; Guedouar, R.; Bouaouina, N.; Mege, A.; Lapeyre, M.; Graff, P.; Marchesi, V.; Aletti, P.; Marchal, C.; Peiffert, D.; Serre, A.; Ailleres, N.; Lemanski, C.; Hay, M.H.; Llacer Moscardo, C.; Allaw, A.; Azria, D.; Dubois, J.B.; Fenoglietto, P.; Maalej, M.; Nasr, C.; Chaari, N.; Hentati, D.; Kochbati, L.; Besbes, M.; Benjelloun, H.; Benchakroun, N.; Houjami, M.; Jouhadi, H.; Tawfiq, N.; Acharki, A.; Sahraoui, S.; Benider, A.; Racadot, S.; Mercier, M.; Dessard-Diana, B.; Bensadoun, R.J.; Martin, M.; Malaurie, E.; Favrel, V.; Housset, M.; Journel, C.; Calais, G.; Huet, J.; Pillet, G.; Hennequin, C.; Haddad, E.; Diana, C.; Blaska-Jaulerry, B.; Henry-Amar, M.; Gehanno, P.; Baillet, F.; Mazeron, J.J.; Chaouache, C.K.; Tebra Mrad, T.M.S.; Bannour, B.N.S.; Bouaouina, B.N.; Favrel, V.; Khodri, M.; Chapet, O.; Nguyen, D.; Ardiet, J.; Romestaing, P.; Thillays, F.; Bardet, E.; Rolland, F.; Maingan, P.; Campion, L.; Mahe, M.A

    2005-11-15

    Thirteen articles are presented in relation with head and neck cancer. Chemoradiotherapy, medical examinations using nuclear techniques such PET scanning, fractionated radiotherapy after a chemotherapy, analysis of dose volume for patients treated by irradiation with a combined chemotherapy, dosimetry, conformal radiotherapy with intensity modulation, dosimetry in brachytherapy, association of radiotherapy and chemotherapy in the treatment of nose pharynx carcinomas, recurrence, are the different subjects treated in this part. (N.C.)

  4. Dental problems of the patients with head and neck cancer after radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Shimizutani, Kimishige; Koseki, Yonoshin [Osaka Dental Univ. (Japan); Inoue, Toshihiko [and others

    1996-03-01

    The purpose of this study is to demonstrate dental problems such as changes of saliva flow rates (ml/min), taste sensation and DMF-teeth (D: decay, M: missing, F: filling) after radiation therapy for the patients with head and neck cancer. Between January 1990 and April 1995, a total of 56 patients with head and neck cancer after radiation therapy was reviewed to demonstrate dental problems at the Department of Oral Radiology, Osaka Dental University Hospital. The results were as follows. In the case of 7 inpatients with head and neck cancer (nasopharynx: 3, mouth floor: 2, tongue: 2), non-stimulating saliva flow rates for 5 minutes was nearly equal to 0 ml at the level of 60 Gy/6 weeks to 80 Gy/8 weeks. In the scoring system of the taste sensation after radiation therapy for 23 patients with oral cancer (tongue: 18, mouth floor: 5), distribution of the patients with 3 points (3 points stand for patients feel good as well as pretreatment) was 91% for sweetness, 78% for sharpness, 96% for bitterness and 96% for acidity, respectively. Concerning DMF-teeth after radiation therapy for 26 patients with head and neck cancer (nasopharynx: 10, oropharynx: 8, tongue: 8), changes of DMF-Teeth of the group of nasopharynx and oropharynx was more higher than that of the group of tongue comparing to report on the survey of dental diseases in Japan, 1993 as control. We emphasize that these data are more effective to improve their oral environments and to up their recognition for oral cavity in the patients with head and neck cancer pre or post-irradiation. (author).

  5. Dental problems of the patients with head and neck cancer after radiation therapy

    International Nuclear Information System (INIS)

    Shimizutani, Kimishige; Koseki, Yonoshin; Inoue, Toshihiko

    1996-01-01

    The purpose of this study is to demonstrate dental problems such as changes of saliva flow rates (ml/min), taste sensation and DMF-teeth (D: decay, M: missing, F: filling) after radiation therapy for the patients with head and neck cancer. Between January 1990 and April 1995, a total of 56 patients with head and neck cancer after radiation therapy was reviewed to demonstrate dental problems at the Department of Oral Radiology, Osaka Dental University Hospital. The results were as follows. In the case of 7 inpatients with head and neck cancer (nasopharynx: 3, mouth floor: 2, tongue: 2), non-stimulating saliva flow rates for 5 minutes was nearly equal to 0 ml at the level of 60 Gy/6 weeks to 80 Gy/8 weeks. In the scoring system of the taste sensation after radiation therapy for 23 patients with oral cancer (tongue: 18, mouth floor: 5), distribution of the patients with 3 points (3 points stand for patients feel good as well as pretreatment) was 91% for sweetness, 78% for sharpness, 96% for bitterness and 96% for acidity, respectively. Concerning DMF-teeth after radiation therapy for 26 patients with head and neck cancer (nasopharynx: 10, oropharynx: 8, tongue: 8), changes of DMF-Teeth of the group of nasopharynx and oropharynx was more higher than that of the group of tongue comparing to report on the survey of dental diseases in Japan, 1993 as control. We emphasize that these data are more effective to improve their oral environments and to up their recognition for oral cavity in the patients with head and neck cancer pre or post-irradiation. (author)

  6. Use of complementary and alternative medicine in head and neck cancer patients.

    Science.gov (United States)

    Lim, C M; Ng, A; Loh, K S

    2010-05-01

    To determine the prevalence and profile of patients who use complementary and alternative medicine, within a cohort of head and neck cancer patients. Cross-sectional survey. Ninety-three consecutive head and neck cancer patients being followed up at the department of otolaryngology head and neck surgery were surveyed using an interviewer-administered questionnaire. The prevalence of complementary and alternative medicine use was 67.8 per cent. Patients who used complementary and alternative medicine were more likely to be female, better educated and younger, compared with non-users. A total of 82.5 per cent (52/63) perceived complementary and alternative medicine to be effective, even though they were aware of the lack of research and endorsement by their physician regarding such medicine. The use of complementary and alternative medicine by head and neck cancer patients is common, regardless of efficacy or cost. Clinicians should routinely ask patients about their use of complementary and alternative medicine, to facilitate communication and enable appropriate use of such medicine.

  7. Anticancer activity of drug conjugates in head and neck cancer cells.

    Science.gov (United States)

    Majumdar, Debatosh; Rahman, Mohammad Aminur; Chen, Zhuo Georgia; Shin, Dong M

    2016-06-01

    Sexually transmitted oral cancer/head and neck cancer is increasing rapidly. Human papilloma virus (HPV) is playing a role in the pathogenesis of a subset of squamous cell carcinoma of head and neck (SCCHN). Paclitaxel is a widely used anticancer drug for breast, ovarian, testicular, cervical, non-small cell lung, head and neck cancer. However, it is water insoluble and orally inactive. We report the synthesis of water soluble nanosize conjugates of paclitaxel, branched PEG, and EGFR-targeting peptide by employing native chemical ligation. We performed a native chemical ligation between the N-hydroxy succinimide (NHS) ester of paclitaxel succinate and cysteine at pH 6.5 to give the cysteine-conjugated paclitaxel derivative. The thiol functionality of cysteine was activated and subsequently conjugated to multiarm thiol-PEG to obtain the paclitaxel branched PEG conjugate. Finally, we conjugated an EGFR-targeting peptide to obtain conjugates of paclitaxel, branched PEG, and EGFR-targeting peptide. These conjugates show anticancer activity against squamous cell carcinoma of head and neck cells (SCCHN, Tu212).

  8. MMP9 but Not EGFR, MET, ERCC1, P16, and P-53 Is Associated with Response to Concomitant Radiotherapy, Cetuximab, and Weekly Cisplatin in Patients with Locally Advanced Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    George Fountzilas

    2009-01-01

    Full Text Available Concomitant administration of radiotherapy with cisplatin or radiotherapy with cetuximab appear to be the treatment of choice for patients with locally advanced head and neck cancer. In the present retrospective analysis, we investigated the predictive role of several biomarkers in an unselected cohort of patients treated with concomitant radiotherapy, weekly cisplatin, and cetuximab (CCRT. We identified 37 patients treated with this approach, of which 13 (35% achieved a complete response and 10 (27% achieved a partial response. Severe side effects were mainly leucopenia, dysphagia, rash, and anemia. Tumor EGFR, MET, ERCC1, and p-53 protein and/or gene expression were not associated with treatment response. In contrast, high MMP9 mRNA expression was found to be significantly associated with objective response. In conclusion, CCRT is feasible and active. MMP9 was the only biomarker tested that appears to be of predictive value in cetuximab treated patients. However, this is a hypothesis generating study and the results should not be viewed as definitive evidence until they are validated in a larger cohort.

  9. The Prevalence of Xerostomia Occurrence after Doing Radiation Therapy in Patients with Head and Neck Cancer

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    Barunawaty Yunus

    2017-04-01

    Full Text Available Xerostomia is one side effect of radiation therapy that most commonly affects head and neck. This situation is a symptom and not a disease which is generally associated with reduced saliva. For patients this situation is not pleasant and for dentist, this symptom is considered as a challenging case. This research intended to know the prevalence of xerostomia after radiation therapy in cancer patients with head and neck area. The subjects of this study were patients with head and neck area cancer who underwent radiotherapy treatment at Hasanuddin University teaching hospital, subjects were then taken saliva before and after given a total dose of 20 Gy and a total dose of 40 Gy. The analysis of the data processed by the computer program and the Wilcoxon test significance level is accepted when p<0.05. The mean bulk saliva before radiotherapy was higher than average rainfall saliva after radiotherapy total dose of 20 Gy and 40 Gy. Radiotherapy of the head and neck area total dose of 20 Gy and 40 Gy may affect rainfall saliva so that patients feel the symptoms of xerostomia.

  10. Sequential vs alternate chemo-radiotherapy in advanced head and neck tumors

    International Nuclear Information System (INIS)

    Corvo', R.; Merlano, M.; Grimaldi, A.; Rosso, R.; Vitale, V.; Scarpati, D.; Santelli, A.; Scasso, F.

    1988-01-01

    Between 1983 and 1986, a multicenter randomized study was conducted to compare a sequential program of induction chemotherapy (CT) followed by radiotherapy (RT), Arm A, with an alteration of cycles of CT with 3 courses of RT (20 Gy/10 fractions up to a total dose of 60 Gy), Arm B, in advanced head and neck cancer patients. The same CT (VBM: Vinblastine, Bleomycin, Methotrexate) was used on both arms; one hundred and sixteen patients (pts) entered the study, 55 in Arm A, 61 in Arm B. Fourty-five pts had stage III and 71 stage IV cancers. The two arms are fully comparable. Up to October 1987, 116 pts are evaluable for survival, while 112 are evaluable for toxicity and 105 for response. In 21 patients (10 in Arm A, 11 in B) the association CT-RT was followed by surgery. Response analysis shows 14 complete responses in Arm A and 30 in Arm B (p≤0.03). The madian disease-free survival and median overall survival are also statistically different, with an advantage for Arm B (33 vs 22 weeks, p≤0.0007, and 59 vs 38 weeks, p<0.03 respectively). The actual overall survival of complete responders at 50 months id 43% (B) and 21% (A). Toxicity (mainly stage III-IV mucositis) is superior in Arm B (30% vs 4%). This experience demonstrates the advantages of alternate over sequential CT-RT. A comparison of this cyclic assiciation with RT alone is in progress

  11. Relative Risk of Various Head and Neck Cancers among Different Blood Groups: An Analytical Study.

    Science.gov (United States)

    Singh, Khushboo; Kote, Sunder; Patthi, Basavaraj; Singla, Ashish; Singh, Shilpi; Kundu, Hansa; Jain, Swati

    2014-04-01

    Cancer is a unique disease characterized by abnormal growth of cells which have the ability to invade the adjacent tissues and sometimes even distant organs. The limited and contrasting evidence regarding the association of ABO blood groups with the different types of head and neck cancers in the Indian population warrants the need for the present study. To assess the relative risk of various Head & Neck cancers among different blood groups. Three hundred sixty two diagnosed cases of different type of head and neck cancers and 400 controls were selected from four hospitals of New Delhi, India. The information regarding the type of head and neck cancer was obtained from the case sheets of the patients regarding their socio demographic profile, dietary history using a structured performa. The information regarding type of cancer (cases only), ABO blood group was collected. Statistical Tests: The data was analysed using the SPSS 19 version. Chi square test and odd ratios were calculated. The level of significance was fixed at 5%. The O blood group was found to be most prevalent followed by B, A and AB among the cases as well as the controls. Oral cancer patients showed maximum number in blood group O followed by B, A and AB. Significant pattern of distribution was seen among the patients of esophageal cancer, laryngeal cancer and salivary gland cancer as well (p= 0.003, p=0.000 p=0.112 respectively. The present study reveals that there is an inherited element in the susceptibility or protection against different types of head and neck cancers. Blood group A was found to be a potential risk factor for the development of oral cancers, esophageal cancers and salivary gland cancers while blood group B was found to be a potential risk factor for laryngeal cancers.

  12. Relative Risk of Various Head and Neck Cancers among Different Blood Groups: An Analytical Study

    Science.gov (United States)

    Kote, Sunder; Patthi, Basavaraj; Singla, Ashish; Singh, Shilpi; Kundu, Hansa; Jain, Swati

    2014-01-01

    Background: Cancer is a unique disease characterized by abnormal growth of cells which have the ability to invade the adjacent tissues and sometimes even distant organs. The limited and contrasting evidence regarding the association of ABO blood groups with the different types of head and neck cancers in the Indian population warrants the need for the present study. Aim and Objective: To assess the relative risk of various Head & Neck cancers among different blood groups. Materials and Method: Three hundred sixty two diagnosed cases of different type of head and neck cancers and 400 controls were selected from four hospitals of New Delhi, India. The information regarding the type of head and neck cancer was obtained from the case sheets of the patients regarding their socio demographic profile, dietary history using a structured performa. The information regarding type of cancer (cases only), ABO blood group was collected. Statistical Tests: The data was analysed using the SPSS 19 version. Chi square test and odd ratios were calculated. The level of significance was fixed at 5%. Results: The O blood group was found to be most prevalent followed by B, A and AB among the cases as well as the controls. Oral cancer patients showed maximum number in blood group O followed by B, A and AB. Significant pattern of distribution was seen among the patients of esophageal cancer, laryngeal cancer and salivary gland cancer as well (p= 0.003, p=0.000 p=0.112 respectively. Conclusion: The present study reveals that there is an inherited element in the susceptibility or protection against different types of head and neck cancers. Blood group A was found to be a potential risk factor for the development of oral cancers, esophageal cancers and salivary gland cancers while blood group B was found to be a potential risk factor for laryngeal cancers. PMID:24959511

  13. Management of somatic pain induced by treatment of head and neck cancer: Postoperative pain. Guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL).

    Science.gov (United States)

    Espitalier, F; Testelin, S; Blanchard, D; Binczak, M; Bollet, M; Calmels, P; Couturaud, C; Dreyer, C; Navez, M; Perrichon, C; Morinière, S; Albert, S

    2014-09-01

    To present the guidelines of the French Oto-Rhino-Laryngology--Head and Neck Surgery Society (SFORL) concerning the management of somatic pain induced by the treatment of head and neck cancer, and in particular the management of early and late post-surgical pain. A multidisciplinary work group conducted a review of the scientific literature on the study topic. An editorial group subsequently read the resulting guidelines before validation. It is recommended to prevent onset of pain caused by malpositioning on the operating table, as well as pain related to postoperative care. During surgery, it is recommended to spare nerve and muscle structures as far as possible to limit painful sequelae. Management of early postoperative pain upon tumor resection and flap harvesting sites requires patient-controlled analgesia by morphine pump. Physical therapy is recommended after flap harvesting to minimize painful sequelae. Preventive and curative measures should be undertaken for appropriate management of post-surgical pain in the treatment of head and neck cancers. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  14. Feasibility of Primary Tumor Culture Models and Preclinical Prediction Assays for Head and Neck Cancer: A Narrative Review

    International Nuclear Information System (INIS)

    Dohmen, Amy J. C.; Swartz, Justin E.; Van Den Brekel, Michiel W. M.; Willems, Stefan M.; Spijker, René; Neefjes, Jacques; Zuur, Charlotte L.

    2015-01-01

    Primary human tumor culture models allow for individualized drug sensitivity testing and are therefore a promising technique to achieve personalized treatment for cancer patients. This would especially be of interest for patients with advanced stage head and neck cancer. They are extensively treated with surgery, usually in combination with high-dose cisplatin chemoradiation. However, adding cisplatin to radiotherapy is associated with an increase in severe acute toxicity, while conferring only a minor overall survival benefit. Hence, there is a strong need for a preclinical model to identify patients that will respond to the intended treatment regimen and to test novel drugs. One of such models is the technique of culturing primary human tumor tissue. This review discusses the feasibility and success rate of existing primary head and neck tumor culturing techniques and their corresponding chemo- and radiosensitivity assays. A comprehensive literature search was performed and success factors for culturing in vitro are debated, together with the actual value of these models as preclinical prediction assay for individual patients. With this review, we aim to fill a gap in the understanding of primary culture models from head and neck tumors, with potential importance for other tumor types as well

  15. Feasibility of Primary Tumor Culture Models and Preclinical Prediction Assays for Head and Neck Cancer: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Amy J. C. Dohmen

    2015-08-01

    Full Text Available Primary human tumor culture models allow for individualized drug sensitivity testing and are therefore a promising technique to achieve personalized treatment for cancer patients. This would especially be of interest for patients with advanced stage head and neck cancer. They are extensively treated with surgery, usually in combination with high-dose cisplatin chemoradiation. However, adding cisplatin to radiotherapy is associated with an increase in severe acute toxicity, while conferring only a minor overall survival benefit. Hence, there is a strong need for a preclinical model to identify patients that will respond to the intended treatment regimen and to test novel drugs. One of such models is the technique of culturing primary human tumor tissue. This review discusses the feasibility and success rate of existing primary head and neck tumor culturing techniques and their corresponding chemo- and radiosensitivity assays. A comprehensive literature search was performed and success factors for culturing in vitro are debated, together with the actual value of these models as preclinical prediction assay for individual patients. With this review, we aim to fill a gap in the understanding of primary culture models from head and neck tumors, with potential importance for other tumor types as well.

  16. Feasibility of Primary Tumor Culture Models and Preclinical Prediction Assays for Head and Neck Cancer: A Narrative Review

    Energy Technology Data Exchange (ETDEWEB)

    Dohmen, Amy J. C., E-mail: a.dohmen@nki.nl [Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands); Department of Cell Biology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands); Swartz, Justin E. [Department of Otorhinolaryngology-Head and Neck Surgery, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA (Netherlands); Van Den Brekel, Michiel W. M. [Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands); Willems, Stefan M. [Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA (Netherlands); Spijker, René [Medical library, Academic Medical Center, Amsterdam 1100 DE (Netherlands); Dutch Cochrane Centre, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3508 GA (Netherlands); Neefjes, Jacques [Department of Cell Biology, the Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands); Zuur, Charlotte L. [Department of Head and Neck Surgery and Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, Amsterdam 1066 CX (Netherlands)

    2015-08-28

    Primary human tumor culture models allow for individualized drug sensitivity testing and are therefore a promising technique to achieve personalized treatment for cancer patients. This would especially be of interest for patients with advanced stage head and neck cancer. They are extensively treated with surgery, usually in combination with high-dose cisplatin chemoradiation. However, adding cisplatin to radiotherapy is associated with an increase in severe acute toxicity, while conferring only a minor overall survival benefit. Hence, there is a strong need for a preclinical model to identify patients that will respond to the intended treatment regimen and to test novel drugs. One of such models is the technique of culturing primary human tumor tissue. This review discusses the feasibility and success rate of existing primary head and neck tumor culturing techniques and their corresponding chemo- and radiosensitivity assays. A comprehensive literature search was performed and success factors for culturing in vitro are debated, together with the actual value of these models as preclinical prediction assay for individual patients. With this review, we aim to fill a gap in the understanding of primary culture models from head and neck tumors, with potential importance for other tumor types as well.

  17. Role of infectious agents in the carcinogenesis of brain and head and neck cancers

    Directory of Open Access Journals (Sweden)

    Alibek Kenneth

    2013-02-01

    Full Text Available Abstract This review concentrates on tumours that are anatomically localised in head and neck regions. Brain cancers and head and neck cancers together account for more than 873,000 cases annually worldwide, with an increasing incidence each year. With poor survival rates at late stages, brain and head and neck cancers represent serious conditions. Carcinogenesis is a multi-step process and the role of infectious agents in this progression has not been fully identified. A major problem with such research is that the role of many infectious agents may be underestimated due to the lack of or inconsistency in experimental data obtained globally. In the case of brain cancer, no infection has been accepted as directly oncogenic, although a number of viruses and parasites are associated with the malignancy. Our analysis of the literature showed the presence of human cytomegalovirus (HCMV in distinct types of brain tumour, namely glioblastoma multiforme (GBM and medulloblastoma. In particular, there are reports of viral protein in up to 100% of GBM specimens. Several epidemiological studies reported associations of brain cancer and toxoplasmosis seropositivity. In head and neck cancers, there is a distinct correlation between Epstein-Barr virus (EBV and nasopharyngeal carcinoma (NPC. Considering that almost every undifferentiated NPC is EBV-positive, virus titer levels can be measured to screen high-risk populations. In addition there is an apparent association between human papilloma virus (HPV and head and neck squamous cell carcinoma (HNSCC; specifically, 26% of HNSCCs are positive for HPV. HPV type 16 was the most common type detected in HNSCCs (90% and its dominance is even greater than that reported in cervical carcinoma. Although there are many studies showing an association of infectious agents with cancer, with various levels of involvement and either a direct or indirect causative effect, there is a scarcity of articles covering the role of

  18. Head and neck cancer due to heavy metal exposure via tobacco smoking and professional exposure: A review

    International Nuclear Information System (INIS)

    Khlifi, Rim; Hamza-Chaffai, Amel

    2010-01-01

    Chronic exposures to heavy metals via tobacco smoking and professional exposure may increase the risk of head and neck cancer, although the epidemiologic evidence is limited by problems of low study power and inadequate adjustment for tobacco and professional exposure use. Numerous scientific reviews have examined the association of various heavy metals exposure with respiratory cancer as well as other cancer types, but few have been published on head and neck cancer. The purpose of this paper, therefore, is to review the head and neck tract cancer-related data on exposure to heavy metals via smoking and working exposure and to study the major mechanisms underlying some toxic metals carcinogenesis.

  19. Haemoglobin and creatinine values as prognostic factors for outcome of concurrent radiochemotherapy in locally advanced head and neck cancers. Secondary results of two European randomized phase III trials (ARO 95-06, SAKK 10/94)

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Stromberger, Carmen; Kaul, David; Wust, Peter; Budach, Volker; Poettgen, Christoph; Joos, Daniela; Hayoz, Stefanie; Baumann, Michael; Bodis, Stephan; Budach, Wilfried; Studer, Gabriela; Zimmermann, Frank; Plasswilm, Ludwig; Olze, Heidi; Bernier, Jacques; Aebersold, Daniel M.

    2016-01-01

    To determine the influence of baseline laboratory values on treatment outcome in patients with locally advanced head and neck cancer (HNSCC). Data of the randomized trials ARO 95 -06 (n = 384) and SAKK 10 /94 (n = 224) were pooled for a total sample size of 608 patients. Haemoglobin (Hb) and creatinine (Cr) were available at baseline and their association with locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS) was analyzed using univariable and multivariable Cox regression models. A total of 580 and 564 patients were available with baseline Hb and Cr values in the pooled analysis. Univariable analyses revealed that lower baseline Hb values were significantly associated with decreased LRRFS, DMFS, CSS and OS. This effect remained significant for OS when the treatment arms (radiotherapy [RT] alone vs. chemoradiation [CRT]) were analyzed separately. Higher baseline Cr was associated with improved OS in the pooled analysis. Interestingly, the prognostic value of baseline Cr appeared to be limited to the subgroup of 284 patients who were treated with CRT. In the multivariable Cox regression model lower baseline Hb remained associated with decreased OS both in the patients who received CRT (HR 0.79, 95 % CI 0.66-0.94, p = 0.009) and in those patients who underwent RT alone (HR 0.67, 95 % CI 0.58-0.78, p < 0.001). Increased baseline Cr remained significantly associated with improved OS in patients who underwent CRT (HR 0.79, 95 % CI 0.69-0.92, p = 0.002) but not in those patients who underwent RT alone. An association between lower baseline Hb and inferior treatment outcome was confirmed. Baseline Cr was introduced as a prognosticator of outcome after CRT for locally advanced HNSCC. (orig.) [de

  20. Paclitaxel, cisplatin, 5-fluorouracil and radiotherapy in the management of advanced squamous cell carcinoma of the head and neck. A phase II trial

    International Nuclear Information System (INIS)

    Merlano, Marco; Russi, Elvio G.; Numico, Gianmauro; Colantonio, Ida; Garrone, Ornella; Pelissero, Antonio; Granetto, Cristina; Gasco, Milena; Di Costanzo, Gianna; Heouaine, Abdelhamid; Vigna Taglianti, Riccardo; Cipolat, Marco

    2005-01-01

    Aim of the present study was to test, activity and toxicity of a rapidly alternating chemoradiation (paclitaxel based) in 31 patients with unresectable, locally advanced or recurrent after surgery, head and neck cancer. Three-year overall survival and progression-free survival were 61.4 and 73.7%, respectively. Main side effects remain a major problem

  1. Head and neck cancer burden and preventive measures in Central and South America.

    Science.gov (United States)

    Perdomo, Sandra; Martin Roa, Guillermo; Brennan, Paul; Forman, David; Sierra, Mónica S

    2016-09-01

    Central and South America comprise one of the areas characterized by high incidence rates for head and neck cancer. We describe the geographical and temporal trends in incidence and mortality of head and neck cancers in the Central and South American region in order to identify opportunities for intervention on the major identified risk factors: tobacco control, alcohol use and viral infections. We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. Age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years were estimated. Brazil had the highest incidence rates for oral and pharyngeal cancer in the region for both sexes, followed by Cuba, Uruguay and Argentina. Cuba had the highest incidence and mortality rates of laryngeal cancer in the region for males and females. Overall, males had rates about four times higher than those in females. Most countries in the region have implemented WHO recommendations for both tobacco and alcohol public policy control. Head and neck squamous-cell cancer (HNSCC) incidence and mortality rates in the Central and South America region vary considerably across countries, with Brazil, Cuba, French Guyana, Uruguay and Argentina experiencing the highest rates in the region. Males carry most of the HNSCC burden. Improvement and implementation of comprehensive tobacco and alcohol control policies as well as the monitoring of these factors are fundamental to prevention of head and neck cancers in the region. Copyright © 2015 International Agency for Research on Cancer. Published by Elsevier Ltd.. All rights reserved.

  2. Overexpression of EMMPRIN Isoform 2 Is Associated with Head and Neck Cancer Metastasis

    OpenAIRE

    Huang, Zhiquan; Tan, Ning; Guo, Weijie; Wang, Lili; Li, Haigang; Zhang, Tianyu; Liu, Xiaojia; Xu, Qin; Li, Jinsong; Guo, Zhongmin

    2014-01-01

    Extracellular matrix metalloproteinase inducer (EMMPRIN), a plasma membrane protein of the immunoglobulin (Ig) superfamily, has been reported to promote cancer cell invasion and metastasis in several human malignancies. However, the roles of the different EMMPRIN isoforms and their associated mechanisms in head and neck cancer progression remain unknown. Using quantitative real-time PCR, we found that EMMPRIN isoform 2 (EMMPRIN-2) was the only isoform that was overexpressed in both head and n...

  3. Retrospective study of 48 cases of post-operative radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Mnejja, W.; Yahiaoui, S.; Siala, W.; Daoud, J.; Ghorbel, A.; Frikha, M.

    2011-01-01

    The authors report a study which aimed at assessing therapeutic results after post-operative radiotherapy of 48 patients suffering from head and neck cancers. The analysis is made in terms of cancer control, survival without recurrence and global survival. The post-operative radiotherapy improves the disease control rate. Ganglionary attack and capsular failure are survival prognosis factors. The concomitant association of chemo-therapy and radiotherapy should improve therapeutic results. Short communication

  4. Head and neck cancer in South Asia: macroeconomic consequences and the role of surgery.

    Science.gov (United States)

    Alkire, Blake C; Bergmark, Regan W; Chambers, Kyle; Cheney, Mack L; Meara, John G

    2015-04-27

    Head and neck cancer, for which the diagnosis and treatment are often surgical, comprises a substantial proportion of the burden of disease in South Asia. Further, estimates of surgical volume suggest this region faces a critical shortage of surgical capacity. We aimed to estimate the total economic welfare losses due to the morbidity and mortality of head and neck cancer in India, Pakistan, and Bangladesh for 1 year (2010). We used publicly available estimates from the Institute for Health Metrics and Evaluation regarding the morbidity and mortality of head and neck cancer in India, Pakistan, and Bangladesh, along with an economic concept termed the value of a statistical life, to estimate total economic welfare losses due to head and neck cancer in the aforementioned countries in the year 2010. The counterfactual scenario is absence of disease. Sensitivity analyses were done with regard to how the value of a statistical life changes with income. In 2010, the most conservative estimate of economic welfare losses due to head and neck cancer in the three studied countries is US$16·9 billion (2010 USD, PPP), equivalent to 0·26% of their combined gross domestic product (GDP). The welfare losses experienced by the population younger than 70 years of age accounted for US$15·2 billion (90% of the total losses). When adjusted for the size of their respective economies, Bangladesh, the poorest of the three countries, incurred the greatest loss (US$930 million), equivalent to 0·29% of its GDP. India and Pakistan experienced welfare losses of US$14·1 billion and US$1·9 billion, respectively. These figures are equivalent to 0·26% of the GDP for both countries. Oropharyngeal and hypopharyngeal cancer made up the largest share of the total burden at 39% (US$6·6 billion), followed closely by oral cavity cancer at 34% (US$5·7 billion). The burden of non-communicable diseases, to which cancer contributes greatly, is growing at a rapid pace in South Asia. Head and neck

  5. Unilateral Cervical Polyneuropathies following Concurrent Bortezomib, Cetuximab, and Radiotherapy for Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Alhasan Elghouche

    2016-01-01

    Full Text Available We report a constellation of cervical polyneuropathies in a patient treated with concurrent bortezomib, cetuximab, and cisplatin alongside intensity modulated radiotherapy for carcinoma of the tonsil with neck metastasis. The described deficits include brachial plexopathy, cervical sensory neuropathy, and oculosympathetic, recurrent laryngeal, and phrenic nerve palsies within the ipsilateral radiation field. Radiation neuropathy involving the brachial plexus is typically associated with treatment of breast or lung cancer; however, increased awareness of this entity in the context of investigational agents with potential neuropathic effects in head and neck cancer has recently emerged. With this report, we highlight radiation neuropathy in the setting of investigational therapy for head and neck cancer, particularly since these sequelae may present years after therapy and entail significant and often irreversible morbidity.

  6. Comparison between Japanese and French interstitial brachytherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Nose, Takayuki; Koizumi, Masahiko; Nishiyama, Kinji; Inoue, Toshihiko

    2001-01-01

    Interstitial brachytherapy is the optimal radiotherapy modality for head and neck cancer because the highest dose conformity can be achieved, and implanted tubes can move synchronously with the tumor movement. Compared with radical surgery, interstitial brachytherapy can achieve equivalent local control with less morbidity and less functional deficit. In Japan, because of technical limitations, interstitial brachytherapy has been confined to treatment of small tongue cancers. To improve our head and neck cancer treatment, technical limitations should be eliminated and a wider indication for interstitial brachytherapy should be achieved. In France, interstitial brachytherapy has been technically more developed and widely indicated than in Japan. We analyzed the differences between Japanese (Osaka) and French (Lyon and Nancy) techniques, to improve our interstitial brachytherapy. Implant devices and techniques: French applicators (Longcip 1) are more flexible and more suitable for loop techniques of the soft palate, the base of the tongue, and the vallecula, than applicators available in Japan. Various implant techniques are established especially for the oropharynx in France. Mandibular protection: Lead blocks used in France can more effectively shield the mandible than our silicone spacers. We showed the dosimetric results in an experimental treatment setting. Dose specification: The five-mm dose specification method used in Japan can work only for easy cases, such as small oral tongue cancers and mouth floor cancers. For complicated implants, such as for the oropharynx, the CTV-based dose specification method used in France is essential for sufficient irradiation. Indications: The indication for head and neck interstitial brachytherapy in Japan is limited mostly to small oral tongue cancers. The indication in France is wider, including the oral cavity, the oropharynx, and postoperative cases. We can refine our head and neck cancer treatment if we combine French

  7. Stepwise Progress in Epidermal Growth Factor Receptor/Radiation Studies for Head and Neck Cancer

    International Nuclear Information System (INIS)

    Harari, Paul M.

    2007-01-01

    The U.S. Food and Drug Administration approval of four new epidermal growth factor receptor (EGFR) inhibitors for cancer therapy (cetuximab, panitumumab, gefitinib, and erlotinib) over the last 3 years is a remarkable milestone in oncology. Indeed, molecular inhibition of EGFR signaling represents one of the most promising current arenas for the development of molecular-targeted cancer therapies. Epidermal growth factor receptor inhibitors from both the monoclonal antibody and tyrosine kinase inhibitor class have demonstrated clinical activity in the treatment of a broad spectrum of common human malignancies. For the discipline of radiation oncology, the 2006 report of a phase III trial demonstrating a survival advantage for advanced head and neck cancer patients with the addition of weekly cetuximab during a 7-week course of radiation is particularly gratifying. Indeed, this is the first phase III trial to confirm a survival advantage with the addition of a molecular-targeted agent to radiation. Furthermore, this result seems to have been achieved with only a modest increment in overall treatment toxicity and with very high compliance to the prescribed treatment regimen. Nevertheless, much remains to be learned regarding the rational integration of EGFR inhibitors into cancer treatment regimens, as well as methods to optimize the selection of patients most likely to benefit from EGFR inhibitor strategies

  8. Oral and head and neck cancer. Special listing

    International Nuclear Information System (INIS)

    1981-09-01

    This Special Listing of Current Cancer Research Projects is a publication of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute. Each Listing contains descriptions of ongoing projects in one selected cancer research area. The research areas include: Human cancer etiology and epidemiology; Experimental carcinogenesis and pathology; Preclinical diagnosis and therapy; Clinical diagnosis and prognosis; Clinical therapy; Rehabilitation and psychological aspects of treatment; Training programs for dental professionals; Broad clinical programs

  9. The role of dentistry other than oral care in patients undergoing radiotherapy for head and neck cancer

    Directory of Open Access Journals (Sweden)

    Hidenobu Matsuzaki

    2017-05-01

    Full Text Available The usefulness of dental approaches, such as oral management, has gained recognition among patients treated for head and neck cancer. In particular, oral management plays a very important role before, during, and after treatment in patients undergoing radiotherapy, chemotherapy, or a combination of both. However, specialized dentistry knowledge and techniques that are useful for patients undergoing radiotherapy for head and neck cancer have yet to be reported. Therefore, in this review article, our aim is to introduce dental approaches in radiotherapy for patients with head and neck cancer that have been developed and are currently being used at our institute.

  10. Effect of Pretreatment Anemia on Treatment Outcome of Concurrent Radiochemotherapy in Patients With Head and Neck Cancer

    International Nuclear Information System (INIS)

    Fortin, Andre; Wang Changshu; Vigneault, Eric

    2008-01-01

    Purpose: To investigate the effect of anemia on outcome of treatment with radiochemotherapy in patients with head-and-neck cancer. Methods and Materials: The data of 196 patients with Stage II-IV head-and-neck cancer treated with concomitant cisplatin-based radiochemotherapy were retrospectively reviewed. Anemia was defined according to World Health Organization criteria as hemoglobin 140 g/L. Conclusions: Anemia was strongly associated with local control and survival in this cohort of patients with head-and-neck cancer receiving radiochemotherapy

  11. Motives that head and neck cancer patients have for contacting a specialist nurse - an empirical study.

    Science.gov (United States)

    Salander, Pär; Isaksson, Joakim; Granström, Brith; Laurell, Göran

    2016-11-01

    The purpose of this study is to systematically explore the motives for patients with head and neck cancer to contact a specialist nurse during two years postdiagnosis. Research focusing on the role of specialist nurses in cancer care almost exclusively concern cancers other than head and neck cancer. Qualitative, descriptive study based on the contacts between patients with head and neck cancer and a specialist nurse. Patients were invited to contact a specialist nurse by telephone. The specialist nurse took systematic field notes, that is, she registered who contacted her, the nature of the call and the outcome. Sixty patients were included. In descending order, the motives for contact were questions about practical and uncomplicated matters, consultations about medical troubles/worries, presenting a report of the patient's situation, requests for additional information about the treatment plan and requests for medical information. The pattern of the patients' motivations for calling was not related to medical or social factors, suggesting that the initiative to make contact is very much a question of the complexity of individual life circumstances. Very few referrals were sent from the specialist nurse to other professionals. The specialist nurse turned out to be more than just a coordinator of health-care resources. The findings bring up questions about the potential of the nurse's function as a coordinator, but also as a potential attachment figure, and questions about the nurse's relationships to other professionals. When implementing a specialist nurse function, it is important to decide whether the function should be inspired by a broader relational perspective. In addition to the indispensible competence and experience in the clinical field of head and neck cancer, training in counselling and acquaintance with object-relational psychology will then be desirable. © 2016 John Wiley & Sons Ltd.

  12. Emotions and coping of patients with head and neck cancers after diagnosis: A qualitative content analysis.

    Science.gov (United States)

    Jagannathan, A; Juvva, S

    2016-01-01

    Patients suffering with head and neck cancers are observed to have a relatively high risk of developing emotional disturbances after diagnosis and treatment. These emotional concerns can be best understood and explored through the method of content analysis or qualitative data. Though a number of qualitative studies have been conducted in the last few years in the field of psychosocial oncology, none have looked at the emotions experienced and the coping by head and neck cancer patients. Seventy-five new cases of postsurgery patients of head and neck cancers were qualitatively interviewed regarding the emotions experienced and coping strategies after diagnosis. Qualitative content analysis of the in-depth interviews brought out that patients experienced varied emotions on realizing that they were suffering from cancer, the cause of which could be mainly attributed to three themes: 1) knowledge of their illness; 2) duration of untreated illness; and 3) object of blame. They coped with their emotions by either: 1) inculcating a positive attitude and faith in the doctor/treatment, 2) ventilating their emotions with family and friends, or 3) indulging in activities to divert attention. The results brought out a conceptual framework, which showed that an in-depth understanding of the emotions - Their root cause, coping strategies, and spiritual and cultural orientations of the cancer survivor - Is essential to develop any effective intervention program in India.

  13. A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer

    International Nuclear Information System (INIS)

    Dische, Stanley; Saunders, Michele; Barrett, Ann; Harvey, Angela; Gibson, Della; Parmar, Mahesh

    1997-01-01

    Background and purpose: Continuous, hyperfractionated, accelerated radiotherapy (CHART) has shown promise of improved tumour control and reduced late morbidity in pilot studies and has now been tested in a multicentre randomised controlled clinical trial. Material and methods: Patients with squamous cell cancer in the main sites within the head and neck region with the general exception of early T1 N0 tumours were entered into the study by 11 centres. There was a 3:2 randomisation to either CHART, where a dose of 54 Gy was given in 36 fractions over 12 days, or to conventional therapy where 66 Gy was given in 33 fractions over 6.5 weeks. A total of 918 patients were included over a 5 year period from March 1990. Results: Acute Morbidity: Acute radiation mucositis was more severe with CHART, occurred earlier but settled sooner and was in nearly all cases healed by 8 weeks in both arms. Skin reactions were less severe and settled more quickly in the CHART treated patients. Tumour control and survival: Life table analyses of loco-regional control, primary tumour control, nodal control, disease-free interval, freedom from metastasis and survival showed no evidence of differences between the two arms. In exploratory subgroup analyses there was evidence of a greater response to CHART in younger patients (P = 0.041) and poorly differentiated tumours appeared to fare better with conventional radiotherapy (P = 0.030). In the larynx there was evidence of a trend towards increasing benefit with more advanced T stage (P = 0.002). Late treatment related morbidity: Osteoradionecrosis occurred in 0.4% of patients after CHART and 1.4% of patients after conventional radiotherapy. The incidence of chondritis or cartilage necrosis was similar in both arms. Life table analysis showed evidence of reduced severity in a number of late morbidities in favour of CHART. These were most striking for skin telangiectasia, superficial and deep ulceration of the mucosa and laryngeal oedema

  14. Split-course accelerated therapy in head and neck cancer: an analysis of toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Delaney, Geoffrey P; Fisher, Richard J; Smee, Robert I; Hook, Carolyn; Barton, Michael B

    1995-06-15

    Purpose: To retrospectively assess a protocol of split-course accelerated radiation therapy (SCAT) for selected head and neck cancers. Methods and Materials: SCAT consisted of 1.8 Gy per fraction administered twice daily with a minimum gap between fractions of 6 h. The treatment protocol prescribed an initial 16 fractions followed by a planned 5 to 12 day break, and then a further 20 to 22 fractions for a total dose ranging from 64.8 to 72 Gy delivered in 5 to 6 weeks. Results: Twenty-eight patients received SCAT for histologically confirmed head and neck cancer between January 1987 and August 1991. All patients were followed up until December 1, 1993. The mean potential follow-up time was 4.2 years (range: 2.9-6.2 years). All patients completed the treatment protocol. Thirteen tumors were laryngeal in origin, eight hypopharyngeal, four paranasal sinus, and three oropharyngeal. There were no Stage I, three Stage II, nine Stage III, and 12 Stage IV tumors. Four tumors were not staged (two paranasal sinus cancers and two surgical recurrences). Early and late toxicities were moderate to severe. Confluent mucositis was experienced by 27 of the 28 patients (96%). One patient required a prolonged midtreatment break of 24 days. Nine patients (32%) required narcotic analgesia for pain relief. Eleven patients (39%) required hospitalization for nasogastric feeding or pain control. The median length of hospital stay was 14 days (range 7-98 days). The actuarial rate of severe late toxicity at 3 years was 47% (standard error (SE) = 13%). A complete tumor response was achieved in 86% of patients. The actuarial local control rate at 3 years was 43% (SE = 11%) and the actuarial survival rate at 3 years was 25% (SE = 8%). Conclusion: Given the encouraging complete response rate and local control for such advanced tumors, SCAT for locoregionally advanced tumors merits further investigation. However, because of the significant late toxicity observed, the total dose, interfraction

  15. Split-course accelerated therapy in head and neck cancer: an analysis of toxicity

    International Nuclear Information System (INIS)

    Delaney, Geoffrey P.; Fisher, Richard J.; Smee, Robert I.; Hook, Carolyn; Barton, Michael B.

    1995-01-01

    Purpose: To retrospectively assess a protocol of split-course accelerated radiation therapy (SCAT) for selected head and neck cancers. Methods and Materials: SCAT consisted of 1.8 Gy per fraction administered twice daily with a minimum gap between fractions of 6 h. The treatment protocol prescribed an initial 16 fractions followed by a planned 5 to 12 day break, and then a further 20 to 22 fractions for a total dose ranging from 64.8 to 72 Gy delivered in 5 to 6 weeks. Results: Twenty-eight patients received SCAT for histologically confirmed head and neck cancer between January 1987 and August 1991. All patients were followed up until December 1, 1993. The mean potential follow-up time was 4.2 years (range: 2.9-6.2 years). All patients completed the treatment protocol. Thirteen tumors were laryngeal in origin, eight hypopharyngeal, four paranasal sinus, and three oropharyngeal. There were no Stage I, three Stage II, nine Stage III, and 12 Stage IV tumors. Four tumors were not staged (two paranasal sinus cancers and two surgical recurrences). Early and late toxicities were moderate to severe. Confluent mucositis was experienced by 27 of the 28 patients (96%). One patient required a prolonged midtreatment break of 24 days. Nine patients (32%) required narcotic analgesia for pain relief. Eleven patients (39%) required hospitalization for nasogastric feeding or pain control. The median length of hospital stay was 14 days (range 7-98 days). The actuarial rate of severe late toxicity at 3 years was 47% (standard error (SE) = 13%). A complete tumor response was achieved in 86% of patients. The actuarial local control rate at 3 years was 43% (SE = 11%) and the actuarial survival rate at 3 years was 25% (SE = 8%). Conclusion: Given the encouraging complete response rate and local control for such advanced tumors, SCAT for locoregionally advanced tumors merits further investigation. However, because of the significant late toxicity observed, the total dose, interfraction

  16. Reduction of xerostomia in head and neck cancer patients. A critical review of the literature

    International Nuclear Information System (INIS)

    Hanley, O.; Leech, M.

    2016-01-01

    Background: Radical radiotherapy given with or without concurrent chemotherapy is the main treatment modality in non-surgical patients for the management of squamous cell carcinoma in the head and neck. Xerostomia, which results from reduced salivary production is a debilitating side-effect of radiation therapy to these patients. Xerostomia may greatly impact on quality of life for head and neck cancer patients for up to 24 months post-radiation therapy. Such effects include difficulties in fundamental daily activities such as speech, mastication and swallowing. It is believed that modulated techniques provide better sparing to surrounding salivary glands. The aim of this critical review of the literature is to investigate what advantage intensity modulated radiotherapy (IMRT) can provide over 3 dimensional conformal radiation therapy (3DCRT) in reducing xerostomia in this subset of patients. Search methodology: An extensive literature search was undertaken to compare the incidence of grade 2 or worse xerostomia in HNSCC patients treated with IMRT or 3DCRT (±chemotherapy). Results: Studies reported a lower incidence of grade 2 or worse xerostomia with IMRT over patients treated with 3DCRT. The highest incidence of xerostomia was reported at 6 months following the completion of radiotherapy treatment. The incidence of xerostomia in patients declined with time, in both patients treated with IMRT and those of the 3DCRT cohort. The incidence of xerostomia was greater in the acute setting than in the late. Conclusion: An IMRT technique can consistently reduce grade 2 or worse xerostomia in head and neck cancer patients over conformal techniques. This will not compromise dose homogeneity or dose coverage. IMRT should remain the standard of care for head and neck patients. - Highlights: • IMRT technique can consistently reduce grade 2 or worse xerostomia in head and neck cancer patients over 3DCRT. • IMRT does not compromise the treatment's dose homogeneity or

  17. Daily amifostine given concomitantly to chemoradiation in head and neck cancer. A pilot study

    International Nuclear Information System (INIS)

    Trog, D.; Bank, P.; Wendt, T.G.; Koscielny, S.; Beleites, E.

    1999-01-01

    Background: In patients with loco-regionally advanced head and neck cancer conventionally fractionated radiotherapy alone results in poor loco-regional control and survival rates. Treatment intensification by simultaneous administration of cytotoxic drugs produces higher acute morbidity. Therefore chemical radioprotection of normal tissues may be of clinical benefit. Patients and Methods: In a pilot study patients with advanced nonresectable head neck cancer treated with conventionally fractionated radical radiotherapy (60 to 66 Gy total doses) and concomitantly given 5-fluorouracil as protracted venous infusion, 250 mg/sqm/24 h over the entire treatment period were given amifostine 300 mg absolutely before each fraction. Acute treatment related mobidity was scored according to CTC classification and loco-regional control and survival rates were estimated. Comparison was made with a historical control group of identical chemoradiation but without amifostine application. Results: Chemoradiation induced oral mucositis was delayed and showed significant lower degrees at all 10 Gy increments (p 0.05). No significant toxicity was recorded with respect to blood pressure, serum calcium, potassium, hematologic parameters, emesis, nausea or body weight loss. Progression free survival and overall survival probability at 2 years were not statistically different in both cohorts. Conclusion: Amifostine given before each fraction of radiotherapy over 6 weeks has no cumulative toxicity, was well tolerated and may reduce treatment induced oral mucositis. No tumor protective effect was observed. (orig.) [de

  18. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Nam P. [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care System, Radiation Oncology Service (140), 4500 S, Lancaster Road, Dallas, TX 72516 (United States)]. E-mail: NamPhong.Nguyen@med.va.gov; Moltz, Candace C. [Audiology and Speech Pathology Service (126), VA North Texas Health Care System, Dallas, TX 75216 (United States); Frank, Cheryl [Audiology and Speech Pathology Service (126), VA North Texas Health Care System, Dallas, TX 75216 (United States); Karlsson, Ulf [Department of Radiation Oncology, East Carolina University, Greenville, NC 27858 (United States); Nguyen, Phuc D. [Department of Radiation Oncology, University of Texas Southwestern Medical Center at Dallas, VA North Texas Health Care System, Radiation Oncology Service (140), 4500 S, Lancaster Road, Dallas, TX 72516 (United States); Vos, Paul [Department of Biostatistics, East Carolina University, Greenville, NC 27858 (United States); Smith, Herbert J. [Radiology Service, VA North Texas Health Care System, Dallas, TX 75216 (United States); Dutta, Suresh [Department of Radiation Oncology, University of Southern California, Los Angeles, CA 90033 (United States); Nguyen, Ly M. [Public Health School, University of Michigan, Ann Arbor, MI 48109 (United States); Lemanski, Claire [Department of Radiation Oncology, Val D' Aurelle, Montpellier (France); Chan, Wayne [Radiation Oncology Service, VAMC, Jackson, MS 39216 (United States); Sallah, Sabah [Division of Hematology/Oncology Research, Novo Nordisk, Athens (Greece)

    2006-09-15

    Objective: The purpose of the study is to evaluate dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer, and particularly the aspiration risk because of its potential life-threatening consequence. Materials and methods: We reviewed retrospectively the modified barium swallow (MBS) results in 110 patients who complained of dysphagia following chemoradiation (57) and postoperative radiation (53) of their head and neck cancer. Patients were selected if they were cancer free at the time of the swallowing study. Dysphagia severity was graded on a scale of 1-7. Patients were grouped according to the dysphagia severity: mild (grades 2-3), moderate (grades 4-5), and severe (grades 6-7). Results: Mean and median dysphagia grades were 4.84/5 and 4.12/4 for chemoradiation and postoperative radiation respectively. The mean difference between the two groups is statistically significant (p = 0.02). Mild dysphagia occurred in 13 patients (22%) of the chemoradiation group and 17 (32%) of the postoperative group. Corresponding number for the moderate group was 25 (43%) and 25 (48%), respectively. Severe dysphagia was significant in the chemoradiation group (34%) compared to the postoperative group (19%). However, the difference was not statistically significant (p = 0.29). There was a higher proportion of patients with large tumor (T3-T4) in the chemoradiation group who developed severe dysphagia. Conclusion: Dysphagia remained a significant morbidity of chemoradiation and postoperative radiation for head and neck cancer. Dysphagia may be more severe in the chemoradiation group because of the higher proportion of patients with large tumor, the high radiation dose, and a high number of oropharyngeal tumors. Aspiration occurred in both groups. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, as it may be silent.

  19. Dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer

    International Nuclear Information System (INIS)

    Nguyen, Nam P.; Moltz, Candace C.; Frank, Cheryl; Karlsson, Ulf; Nguyen, Phuc D.; Vos, Paul; Smith, Herbert J.; Dutta, Suresh; Nguyen, Ly M.; Lemanski, Claire; Chan, Wayne; Sallah, Sabah

    2006-01-01

    Objective: The purpose of the study is to evaluate dysphagia severity following chemoradiation and postoperative radiation for head and neck cancer, and particularly the aspiration risk because of its potential life-threatening consequence. Materials and methods: We reviewed retrospectively the modified barium swallow (MBS) results in 110 patients who complained of dysphagia following chemoradiation (57) and postoperative radiation (53) of their head and neck cancer. Patients were selected if they were cancer free at the time of the swallowing study. Dysphagia severity was graded on a scale of 1-7. Patients were grouped according to the dysphagia severity: mild (grades 2-3), moderate (grades 4-5), and severe (grades 6-7). Results: Mean and median dysphagia grades were 4.84/5 and 4.12/4 for chemoradiation and postoperative radiation respectively. The mean difference between the two groups is statistically significant (p = 0.02). Mild dysphagia occurred in 13 patients (22%) of the chemoradiation group and 17 (32%) of the postoperative group. Corresponding number for the moderate group was 25 (43%) and 25 (48%), respectively. Severe dysphagia was significant in the chemoradiation group (34%) compared to the postoperative group (19%). However, the difference was not statistically significant (p = 0.29). There was a higher proportion of patients with large tumor (T3-T4) in the chemoradiation group who developed severe dysphagia. Conclusion: Dysphagia remained a significant morbidity of chemoradiation and postoperative radiation for head and neck cancer. Dysphagia may be more severe in the chemoradiation group because of the higher proportion of patients with large tumor, the high radiation dose, and a high number of oropharyngeal tumors. Aspiration occurred in both groups. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, as it may be silent

  20. Aspiration rate following chemoradiation for head and neck cancer: An underreported occurrence

    International Nuclear Information System (INIS)

    Nguyen, Nam P.; Frank, Cheryl; Moltz, Candace C.; Vos, Paul; Smith, Herbert J.; Bhamidipati, Prabhakar V.; Karlsson, Ulf; Nguyen, Phuc D.; Alfieri, Alan; Nguyen, Ly M.; Lemanski, Claire; Chan, Wayne; Rose, Sue; Sallah, Sabah

    2006-01-01

    Background and purpose: We would like to assess the prevalence of aspiration before and following chemoradiation for head and neck cancer. Patients and methods: We reviewed retrospectively the Modified Barium Swallow (MBS) in 63 patients who underwent concurrent chemotherapy and radiation for head and neck cancer. MBS was performed prior to treatment to determine the need for immediate gastrostomy tube placement. MBS was repeated following treatment to assess the safety of oral feeding prior to removal of tube feeding. All patients were cancer free at the time of the swallowing study. No patient had surgery. Dysphagia severity was graded on a scale of 1-7. Tube feedings were continued if patients were diagnosed to have severe aspiration (grade 6-7) or continued weight loss. Patients with abnormal swallow (grade 3-7) received swallowing therapy following MBS. Results: Before treatment, there were 18 grade 1, 18 grade 2, 9 grade 3, 8 grade 4, 3 grade 5, 3 grade 6, and 4 grade 7. Following chemoradiation, at a median follow-up of 2 months (1-10 months), one patient had grade 1, eight patients had grade 2, nine patients had grade 3, eight patients had grade 4, 13 patients had grade 5, seven patients had grade 6, and 11 patients had grade 7. Six patients died from aspiration pneumonia (one before, three during, and two post-treatment), and did not have the second MBS. Overall, 37/63 (59%) patients developed aspiration, six of them (9%) fatal. If we excluded the 10 patients who had severe aspiration at diagnosis and the six patients who died from pneumonia, the prevalence of severe aspiration was 33% (21/63). Conclusions: Aspiration remained a significant morbidity following chemoradiation for head and neck cancer. Its prevalence is underreported in the literature because of its often silent nature. Diagnostic studies such as MBS should be part of future head and neck cancer prospective studies to assess the prevalence of aspiration, and for rehabilitation

  1. Psychosocial aspects of head and neck cancer--a review of the literature.

    Science.gov (United States)

    Pruyn, J F; de Jong, P C; Bosman, L J; van Poppel, J W; van Den Borne, H W; Ryckman, R M; de Meij, K

    1986-12-01

    This study is a systematic analysis of the literature on psychosocial aspects in head and neck cancer patients. Patients with head and neck cancer experience a variety of physical as well as psychosocial problems. Physical problems include swallowing or chewing, speech and physical appearance. Psychosocial problems include anxiety, depression, loss of self-esteem and uncertainty about the future. Because of these problems, isolation from friends typically occurs, re-employment is difficult, and there are social and sexual tensions within families. Information and support by professionals, partners and/or fellow patients are related to positive rehabilitation outcomes such as the acquisition of speech, increases in constructive social functioning and decreases in depression.

  2. Counseling Is Effective for Smoking Cessation in Head and Neck Cancer Patients

    DEFF Research Database (Denmark)

    Klemp, Ingrid; Wangsmo Steffenssen, Mia Charlotte; Bakholdt, Vivi T.

    2016-01-01

    PURPOSE: The purpose of this systematic review was to describe the efficacy of smoking cessation counseling and the resulting quit rate in patients with head and neck cancer. MATERIALS AND METHODS: A systematic literature search was conducted in the PubMed, Embase, and Cochrane databases. Predictor...... variables were smoking cessation counseling and smoking cessation interventions. The outcome was smoking cessation. Data collection and quality assessment were performed independently by 2 of the authors. Selected publications were assessed for potential risk of bias, and the level of evidence was evaluated...... in patients who received smoking cessation counseling compared with those who received usual care. CONCLUSIONS: This review shows that counseling supplemented with nicotine replacement therapy increases the possibility for smoking cessation in patients with head and neck cancer....

  3. Posttraumatic stress disorder symptoms in newly diagnosed patients with head and neck cancer and their partners.

    Science.gov (United States)

    Posluszny, Donna M; Dougall, Angela Liegey; Johnson, Jonas T; Argiris, Athanassios; Ferris, Robert L; Baum, Andrew; Bovbjerg, Dana H; Dew, Mary Amanda

    2015-09-01

    Head and neck cancer is a life-threatening illness requiring aversive treatments. Despite clear potential for posttraumatic stress disorder (PTSD) symptoms in both patients and their partners, research is scant. Newly diagnosed patients and partners (number of dyads = 42) completed questionnaires to assess symptoms of PTSD, anxiety, and depression, as well as demographic, medical, and attitudinal variables. Partners had higher average levels of PTSD symptoms than patients (p = .023). More partners (28.6%) met criteria for estimated PTSD caseness than did patients (11.9%). There were no significant differences in levels of other anxiety or depression symptoms. Perceived threat of disease appeared to be a stronger correlate of PTSD symptom levels than medical variables in patients and partners. A diagnosis of head and neck cancer elicits significant levels of PTSD symptoms in patients, and even higher levels among partners. Identified correlates of distress, including perceived threat of disease, are potential intervention targets. © 2014 Wiley Periodicals, Inc.

  4. Proton therapy for head and neck cancer: Rationale, potential indications, practical considerations, and current clinical evidence

    International Nuclear Information System (INIS)

    Mendenhall, Nancy P.; Malyapa, Robert S.; Su, Zhong; Yeung, Daniel; Mendenhall, William M.; Li, Zuofeng

    2011-01-01

    There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT. To date, few clinical data are available, but early clinical experiences in sinonasal tumors in particular suggest significant improvements in both disease control and radiation-related toxicity

  5. Proton therapy for head and neck cancer: Rationale, potential indications, practical considerations, and current clinical evidence

    Energy Technology Data Exchange (ETDEWEB)

    Mendenhall, Nancy P.; Malyapa, Robert S.; Su, Zhong; Yeung, Daniel; Mendenhall, William M.; Li, Zuofeng (Univ. of Florida Proton Therapy Inst., Jacksonville, Florida (United States)), e-mail: menden@shands.ufl.edu

    2011-08-15

    There is a strong rationale for potential benefits from proton therapy (PT) for selected cancers of the head and neck because of the opportunity to improve the therapeutic ratio by improving radiation dose distributions and because of the significant differences in radiation dose distribution achievable with x-ray-based radiation therapy (RT) and PT. Comparisons of dose distributions between x-ray-based and PT plans in selected cases show specific benefits in dose distribution likely to translate into improved clinical outcomes. However, the use of PT in head and neck cancers requires special considerations in the simulation and treatment planning process, and currently available PT technology may not permit realization of the maximum potential benefits of PT. To date, few clinical data are available, but early clinical experiences in sinonasal tumors in particular suggest significant improvements in both disease control and radiation-related toxicity

  6. Positron emission tomography-computed tomography protocol considerations for head and neck cancer imaging.

    Science.gov (United States)

    Escott, Edward J

    2008-08-01

    Positron emission tomographic-computed tomographic (PET-CT) imaging of patients with primary head and neck cancers has become an established approach for staging and restaging, as well as radiation therapy planning. The inherent co-registration of PET and CT images made possible by the integrated PET-CT scanner is particularly valuable in head and neck cancer imaging due to the complex and closely situated anatomy in this part of the body, the varied sources of physiologic and benign 2-deoxy-2-[F-18]fluoro-D-glucose (FDG) tracer uptake that occurs in the neck, and the varied and complex posttreatment appearance of the neck. Careful optimization of both the CT and the PET portion of the examination is essential to insure the most accurate and clinically valuable interpretation of these examinations.

  7. Oral mucositis in head and neck cancer: risk, biology, and management.

    Science.gov (United States)

    Sonis, Stephen T

    2013-01-01

    Of the toxicities associated with conventional forms of treatment for head and neck cancers, probably none has such a consistent legacy as oral mucositis.1 Despite the fact that mucosal injury was noted as far back as Marie Curie's first forays into therapeutic radiation, an effective intervention has yet to be developed. In addition to its historic link to radiation, new therapeutic strategies including induction chemotherapy often produce mucositis, and targeted therapies appear to alter mucositis risk and its severity and course.2 The symptomatic effect of oral mucositis is profound. Disabling oral and oropharyngeal pain prevents patients from eating normally, requires opiate analgesics, and in some cases results in alteration or discontinuation of anticancer therapy.3 Furthermore, the health and economic consequences of oral mucositis are far from trivial. The incremental cost of oral mucositis in patients with head and neck cancer exceeds $17,000 (USD).4.

  8. Oncologic safety of cervical nerve preservation in neck dissection for head and neck cancer.

    Science.gov (United States)

    Honda, Keigo; Asato, Ryo; Tsuji, Jun; Miyazaki, Masakazu; Kada, Shinpei; Tsujimura, Takashi; Kataoka, Michiko

    2017-09-01

    Although the functional merits of preserving cervical nerves in neck dissection for head and neck cancer have been reported, the oncologic safety has not yet been determined. Therefore, the purpose of this study was to evaluate the safety of cervical nerve preservation. A retrospective chart review was performed on patients with head and neck cancer who had been treated by neck dissection between 2009 and 2014 at Kyoto Medical Center. Management of cervical nerves and clinical results were analyzed. A total of 335 sides of neck dissection had been performed in 222 patients. Cervical nerves were preserved in 175 neck sides and resected in 160 sides. The 5-year overall survival (OS) rate calculated by the Kaplan-Meier method was 71%. The 5-year neck control rate was 95% in cervical nerve preserved sides and 89% in cervical nerve resected sides. Preserving cervical nerves in neck dissection is oncologically safe in selected cases. © 2017 Wiley Periodicals, Inc.

  9. Quality of Life in Swallowing Disorders after Nonsurgical Treatment for Head and Neck Cancer

    Directory of Open Access Journals (Sweden)

    Silveira, Marta Halina

    2014-12-01

    Full Text Available Introduction Radiotherapy or chemoradiotherapy can result in severe swallowing disorders with potential risk for aspiration and can negatively impact the patient's quality of life (QOL. Objective To assess swallowing-related QOL in patients who underwent radiotherapy/chemoradiotherapy for head and neck cancer. Methods We interviewed 110 patients (85 men and 25 women who had undergone exclusive radiotherapy (25.5% or concomitant chemoradiotherapy (74.5% from 6 to 12 months before the study. The Quality of Life in Swallowing Disorders (SWAL-QOL questionnaire was employed to evaluate dysphagia-related QOL. Results The QOL was reduced in all domains for all patients. The scores were worse among men. There was a relationship between oral cavity as the primary cancer site and the fatigue domain and also between advanced cancer stage and the impact of food selection, communication, and social function domains. Chemoradiotherapy association, the presence of nasogastric tube and tracheotomy, and the persistence of alcoholism and smoking had also a negative effect on the QOL. Conclusions According to the SWAL-QOL questionnaire, the dysphagia-related impact on QOL was observed 6 to 12 months after the treatment ended.

  10. Oral care for patients with head and neck cancer in Hokkaido University Hospital

    International Nuclear Information System (INIS)

    Hata, Hironobu; Yamazaki, Yutaka; Imamachi, Kenji

    2011-01-01

    We have been providing oral care for patients with head and neck cancer in Hokkaido University Hospital since 2007. In this paper, we report clinical statistics of the 254 head and neck cancer patients who received oral care. About 80 percent of these patients were treated with radiation therapy, so it is important to cope with adverse events related to such therapy. Oral care is helpful for cancer patients when it is started as soon as possible (at least 1 week before radiation therapy is started). The percentage of patients who could start oral care 4 days before radiation therapy gradually increased to about 60 percent by fiscal 2009. In fiscal 2010, the percentage decreased to its lowest level of 37.9 percent. To start oral care for all patients 7 days before irradiation, we are going to change our system and start oral care in the outpatient period. In their hometowns, oral care was continued for only 19 (27.0 percent) of the 74 patients who could not visit our hospital. An important task for our project is to establish a medical cooperation system for discharged patients treated for head and neck cancer. (author)

  11. Initial results of CyberKnife treatment for recurrent previously irradiated head and neck cancer

    International Nuclear Information System (INIS)

    Himei, Kengo; Katsui, Kuniaki; Yoshida, Atsushi

    2003-01-01

    The purpose of this study was to evaluate the efficacy of CyberKnife for recurrent previously irradiated head and neck cancer. Thirty-one patients with recurrent previously irradiated head and neck cancer were treated with a CyberKnife from July 1999 to March 2002 at Okayama Kyokuto Hospital were retrospectively studied. The accumulated dose was 28-80 Gy (median 60 Gy). The interval between CyberKnife treatment and previous radiotherapy was 0.4-429.5 months (median 16.3 months). Primary lesions were nasopharynx: 7, maxillary sinus: 6, tongue: 5, ethmoid sinus: 3, and others: 1. The pathology was squamous cell carcinoma: 25, adenoid cystic carcinoma: 4, and others: 2. Symptoms were pain: 8, and nasal bleeding: 2. The prescribed dose was 15.0-40.3 Gy (median 32.3 Gy) as for the marginal dose. The response rate (complete response (CR)+partial response (PR)) and local control rate (CR+PR+no change (NC)) was 74% and 94% respectively. Pain disappeared for 4 cases, relief was obtained for 4 cases and no change for 2 cases and nasal bleeding disappeared for 2 cases for an improvement of symptoms. An adverse effects were observed as mucositis in 5 cases and neck swelling in one case. Prognosis of recurrent previously irradiated head and neck cancer was estimated as poor. Our early experience shows that CyberKnife is expected to be feasible treatment for recurrent previously irradiated head and neck cancer, and for the reduction adverse effects and maintenance of useful quality of life (QOL) for patients. (author)

  12. [Validation of the German version of Eating Assessment Tool for head and neck cancer patients].

    Science.gov (United States)

    Zaretsky, Eugen; Steinbach-Hundt, Silke; Pluschinski, Petra; Grethel, Isabel

    2018-04-10

    The assessment of subjective swallowing complaints constitutes an important element in a multidimensional, modern management of head and neck cancer patients suffering from dysphagia. For this purpose, an internationally recognized and validated 10-item questionnaire EAT-10 is used that was developed and validated by Belafski et al. in 2008. The purpose of the present study is the translation of EAT-10 into the German language and its validation for head and neck cancer patients. After the translation of EAT-10 into German according to the guidelines for the translation of foreign measuring instruments, a validation of gEAT-10 was carried out on the basis of the sample of 210 head and neck cancer patients. The reliability was determined by means of the internal consistency (Cronbach's Alpha) and item-total correlations (Spearman). The construct validity was verified by the uni- and multivariate analyses of the distribution of gEAT-10 total scores depending on gender, age, BMI, tumor stage and localization as well as type of the oncological therapy. The internal consistency amounted to α = .94, the item-total correlations varied between ρ = .59 and ρ = .85. No significant associations between gEAT-10 total scores and gender as well as age were identified in univariate calculations. Such associations were found for BMI, tumor stage and localization as well as type of the oncological therapy. However, only the tumor stage yielded a significant result in a regression. The gEAT-10 was shown to be a reliable and construct valid questionnaire for the assessment of subjective swallowing complaints in patients with head and neck cancer. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Prevalence and risk factors of depressive disorder in caregivers of patients with head and neck cancer.

    Science.gov (United States)

    Lee, Yu; Lin, Pao-Yen; Chien, Chih-Yen; Fang, Fu-Min

    2015-02-01

    The purpose of this study is to examine the prevalence and risk factors of depressive disorder in caregivers of patients with head and neck cancer. Study subjects were recruited from a multidisciplinary outpatient clinic for head and neck cancer in a medical center from February to July 2012. Caregivers of patients with head and neck cancer were enrolled and assessed using the Structured Clinical Interview for the DSM-IV, Clinician Version, the Short Form 36 Health Survey, and the Family APGAR index. The main aim of the study was to examine the difference in demographic data and clinical characteristics between the caregivers with and without depressive disorders. In addition, a stepwise forward model of logistic regression was used to test the possible risk factors. One hundred and forty-three caregivers were included in the study. The most prevalent psychiatric disorder was depressive disorder (14.7%), followed by adjustment disorder (13.3%). Nearly one-third of the caregivers had a psychiatric diagnosis. By using logistic regression analysis, it was found that unemployment (odds ratio (OR) = 3.16; 95% CI, 1.04-9.68), lower social functioning (OR = 1.43; 95% CI, 1.18-1.72), and lower educational level (OR = 1.16; 95% CI, 1.01-1.34) were significant risk factors for the depressive disorder. The clinical implication of our results is the value of using the standardized structured interview for early diagnosis of depressive disorder in caregivers of head and neck cancer patients. Early screening and management of depression in these caregivers will raise their quality of life and capability to care patients. Copyright © 2014 John Wiley & Sons, Ltd.

  14. Relevance of brachytherapy in the era of IMRT/IGRT in head and neck cancers

    International Nuclear Information System (INIS)

    Ghoshal, Sushmita

    2016-01-01

    Cancers arising in the head and neck area are predominantly squamous cell carcinoma that are only moderately sensitive to radiation. They also have a propensity for local and lymphatic spread that require adequate safety margins while planning radiation. As a result, the volume of normal tissue irradiated increases with a risk of increased radiation induced toxicity. Various attempts have been made to improve the therapeutic ratio but one of the best ways of achieving this is by brachytherapy

  15. Primary head and neck cancers in north eastern Nigeria | Otoh ...

    African Journals Online (AJOL)

    Carcinomas (68.4%) were the most common cancers reported, mostly affecting the oral cavity (20.3%). Carcinomas were associated with farmers, kola nut chewers and tobacco users in this region, while kaposi sarcoma was the only cancer associated with HIV-positive patients. The overall mean duration of symptoms for ...

  16. Prospective subjective evaluation of swallowing function and dietary pattern in head and neck cancers treated with concomitant chemo-radiation

    Directory of Open Access Journals (Sweden)

    Agarwal Jaiprakash

    2010-01-01

    Full Text Available 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.

  17. Primary Radiation Therapy for Head-and-Neck Cancer in the Setting of Human Immunodeficiency Virus

    International Nuclear Information System (INIS)

    Klein, Emily A.; Guiou, Michael; Farwell, D. Gregory; Luu, Quang; Lau, Derick H.; Stuart, Kerri; Vaughan, Andrew; Vijayakumar, Srinivasan; Chen, Allen M.

    2011-01-01

    Purpose: To analyze outcomes after radiation therapy for head-and-neck cancer among a cohort of patients with human immunodeficiency virus (HIV). Methods and Materials: The medical records of 12 patients with serologic evidence of HIV who subsequently underwent radiation therapy to a median dose of 68 Gy (range, 64-72 Gy) for newly diagnosed squamous cell carcinoma of the head and neck were reviewed. Six patients (50%) received concurrent chemotherapy. Intensity-modulated radiotherapy was used in 6 cases (50%). All patients had a Karnofsky performance status of 80 or 90. Nine patients (75%) were receiving antiretroviral therapies at the time of treatment, and the median CD4 count was 460 (range, 266-800). Toxicity was graded according to the Radiation Therapy Oncology Group / European Organization for the Treatment of Cancer toxicity criteria. Results: The 3-year estimates of overall survival and local-regional control were 78% and 92%, respectively. Acute Grade 3+ toxicity occurred in 7 patients (58%), the most common being confluent mucositis (5 patients) and moist skin desquamation (4 patients). Two patients experienced greater than 10% weight loss, and none experienced more than 15% weight loss from baseline. Five patients (42%) experienced treatment breaks in excess of 10 cumulative days, although none required hospitalization. There were no treatment-related fatalities. Conclusions: Radiation therapy for head-and-neck cancer seems to be relatively well tolerated among appropriately selected patients with HIV. The observed rates of toxicity were comparable to historical controls without HIV.

  18. Treatment results of chemoradiotherapy with 5-FU/CDGP for head and neck cancer

    International Nuclear Information System (INIS)

    Himei, Kengo; Katayama, Norihisa; Takemoto, Mitsuhiro; Kuroda, Masahiro; Nomiya, Shigenobu; Onoda, Tomoo; Tominaga, Susumu; Kanazawa, Susumu

    2006-01-01

    We investigated the safety and efficacy of alternative and concurrent chemoradiotherapy with 5-fluorouracil (FU)/nedaplatin (CDGP) for head and neck cancer. From January 2003 to August 2005, 19 patients with head and neck squamous cell carcinoma were treated in our institution. Alternative chemoradiotherapy (ACRT) was performed for 8 cases of nasopharyngeal cancer. Concurrent chemoradiotherapy (CCRT) was performed for 11 cases of other head and neck cancer. Median total dose of radiotherapy was 63 Gy. ACRT consisted of 5-FU at a dose of 500 mg/m 2 on days 1-5 and 28-32 and CDGP at a dose of 60 mg/m 2 on days 6 and 33. CCRT consisted of 5-FU at a dose of 500 mg/m 2 on days 1-4 and 28-31 and CDGP at a dose of 60 mg/m 2 on days 5 and 32. Median follow-up period was 13 months. CR+PR was admitted in five cases (63%) with ACRT, and in 9 cases (82%) with CCRT. Non-hematological adverse effects of grade 3 were admitted in eight cases (100%) of ACRT, and in 9 cases (82%) of CCRT. Chemoradiotherapy attained good results and non-hematological adverse effects were able to be managed by preserved treatment. (author)

  19. Head and neck cancer information on the internet: type, accuracy and content.

    LENUS (Irish Health Repository)

    Ni Riordain, Richeal

    2009-08-01

    This study aimed to determine the type, accuracy and content of information available on the internet regarding head and neck cancer. The search engine Google was used to generate a list of the top 100 websites about head and neck cancer. The websites were evaluated using the DISCERN instrument and the JAMA benchmarks and whether the site displayed the Health on the Net seal was also recorded. The search yielded 1,650,000 sites on the Google website. Of the top 100 sites, a total of 33 sites were suitable for analysis due to duplicate links, non-functioning links and irrelevant website. 45% achieved all four JAMA benchmarks and 18% achieved only 1 benchmark. No website receiving the maximum mark on the overall score and four websites received the lowest overall score regarding the DISCERN instrument. The question with the poorest response score was \\'Does it describe how the treatment choices affect overall quality of life?\\' 39% of the websites displayed the Health on the Net (HON) seal. A wide variety of types of information are available on the internet regarding head and neck cancer with variable accuracy levels based on both Journal of the American Medical Association (JAMA) benchmarks and DISCERN. The onus lies with the practitioner to guide the patient regarding scientific reliability of information and to direct the patient in filtering the information sourced. The inclusion of quality of life related information is currently lacking and should be addressed to ensure a more comprehensive understanding for patients of treatment options.

  20. Modern molecular biomarkers of head and neck cancer. Part I. Epigenetic diagnostics and prognostics: Systematic review.

    Science.gov (United States)

    Juodzbalys, Gintaras; Kasradze, David; Cicciù, Marco; Sudeikis, Aurimas; Banys, Laurynas; Galindo-Moreno, Pablo; Guobis, Zygimantas

    2016-01-01

    Nearly half of the head and neck cancer cases are diagnosed in late stages. Traditional screening modalities have many disadvantages. The aim of the present article was to review the scientific literature about novel head and neck cancer diagnostics - epigenetic biomarkers. A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed database. Authors conducted the search of articles in English language published from 2004 to 2015. A total of thirty three relevant studies were included in the review. Fifteen of them concerned DNA methylation alterations, nine evaluation of abundancies in histone expressions and nine miRNA expression changes in HNC. Considerable number of epigenetic biomarkers have been identified in both tumor tissue and salivary samples. Genes with best diagnostic effectiveness rates and further studying prospects were: TIMP3, DCC, DAPK, CDH1, CCNA1, AIM1, MGMT, HIC1, PAX1, PAX5, ZIC4, p16, EDNRB, KIF1A, MINT31, CD44, RARβ , ECAD. Individual histone and miRNA alterations tend to be hnc specific. Prognostic values of separate biomarkers are ambiguous. No established standards for molecular assay of head and neck cancer was found in order to elude the paradoxical results and discrepancies in separate trials.

  1. Magnetic resonance imaging guided reirradiation of recurrent and second primary head and neck cancer.

    Science.gov (United States)

    Chen, Allen M; Cao, Minsong; Hsu, Sophia; Lamb, James; Mikaeilian, Argin; Yang, Yingli; Agazaryan, Nzhde; Low, Daniel A; Steinberg, Michael L

    2017-01-01

    To report a single-institutional experience using magnetic resonance imaging (MRI) guided radiation therapy for the reirradiation of recurrent and second cancers of the head and neck. Between October 2014 and August 2016, 13 consecutive patients with recurrent or new primary cancers of the head and neck that occurred in a previously irradiated field were prospectively enrolled in an institutional registry trial to investigate the feasibility and efficacy of MRI guided radiation therapy using a 0.35-T MRI scanner with a cobalt-60 radiation therapy source called the ViewRay system (ViewRay Inc., Cleveland, OH). Eligibility criteria included biopsy-proven evidence of recurrent or new primary squamous cell carcinoma of the head and neck, measurable disease, and previous radiation to >60 Gy. MRI guided reirradiation was delivered either using intensity modulated radiation therapy with conventional fractionation to a median dose of 66 Gy or stereotactic body radiation therapy (SBRT) using 7 to 8 Gy fractions on nonconsecutive days to a median dose of 40 Gy. Two patients (17%) received concurrent chemotherapy. The 1- and 2-year estimates of in-field control were 72% and 72%, respectively. A total of 227 daily MRI scans were obtained to guide reirradiation. The 2-year estimates of overall survival and progression-free survival were 53% and 59%, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis and/or conjunctivitis, and 1 case of aspiration pneumonia. Our preliminary findings show that reirradiation with MRI guided radiation therapy results in effective disease control with relatively low morbidity for patients with recurrent and second primary cancers of the head and neck. The superior soft tissue resolution of the MRI scans that were used for planning and delivery has the potential to improve the therapeutic ratio.

  2. Adjuvant radiotherapy after transoral laser microsurgery for advanced squamous carcinoma of the head and neck

    International Nuclear Information System (INIS)

    Pradier, Olivier; Christiansen, Hans; Schmidberger, Heinz; Martin, Alexios; Jaeckel, Martin C.; Steiner, Wolfgang; Ambrosch, Petra; Kahler, Elke; Hess, Clemens F.

    2005-01-01

    Purpose: To evaluate the efficacy of an adjuvant radiotherapy after transoral laser microsurgery for advanced squamous cell carcinoma of the head and neck and to show that a less invasive surgery with organ preservation in combination with radiotherapy is an alternative to a radical treatment. Patients and Methods: Between 1987 and 2000, 208 patients with advanced squamous cell carcinoma of the head and neck were treated with postoperative radiotherapy after surgical CO 2 laser resection. Primary sites included oral cavity, 38; oropharynx, 88; larynx, 36; hypopharynx, 46. Disease stages were as follows: Stage III, 40 patients; Stage IV, 168 patients. Before 1994, the treatment consisted of a split-course radiotherapy with carboplatinum (Treatment A). After 1994, the patients received a conventional radiotherapy (Treatment B). Results: Patients had 5-year locoregional control and disease-specific survival (DSS) rates of 68% and 48%, respectively. The 5-year DSS was 70% and 44% for Stages III and IV, respectively (p = 0.00127). Patients treated with a hemoglobin level greater or equal to 13.5 g/dL before radiotherapy had a 5-year DSS of 55% as compared with 39% for patients treated with a hemoglobin level greater than 13.5 g/dL (p = 0.0054). Conclusion: In this series of patients with advanced head-and-neck tumors, transoral laser surgery in combination with adjuvant radiotherapy resulted in locoregional control and DSS rates similar to those reported for radical surgery followed by radiotherapy. Treatment B has clearly been superior to Treatment A. A further improvement of our treatment regimen might be expected by the combination of adjuvant radiotherapy with concomitant platinum-based chemotherapy

  3. Postoperative radiotherapy after laser surgery with or without chemotherapy in head and neck evolved cancers; Radiotherapie postoperatoire apres chirurgie laser avec ou sans chimiotherapie dans les cancers evolues de la tete et du cou

    Energy Technology Data Exchange (ETDEWEB)

    Ryll, L.; Pradier, O. [Centre Hospitalier Universitaire Morvan, Dept. de Cancerologie, Brest (France); Nitsche, M.; Christiansen, H.; Hess, C. [Universitatsklinikum, Dept. de Cancerologie, Goettingen (Germany)

    2007-11-15

    We compared concurrent combination chemoradiotherapy and adjuvant radiotherapy after laser surgery in patients with stage 3/4 non metastatic squamous cell head and neck cancer. Combination chemotherapy and concurrent irradiation after laser surgery was not superior to surgery and postoperative radiotherapy for resectable advanced squamous cell head and neck cancer. However, the collective is small, and the follow-up to short to conclude. (authors)

  4. Dental and nutritional management of the head and neck cancer patient

    International Nuclear Information System (INIS)

    Lee, W. Robert; Sandow, Pamela L.; Moore, Giselle J.

    1997-01-01

    This course will examine the expected acute and late normal tissue toxicities associated with the delivery of high dose radiation therapy to the head and neck region. The purpose of this course will be to identify strategies to reduce radiotherapy-related toxicity without compromising adequate tumor treatment. A multidisciplinary approach will be emphasized and the following topics will be addressed: 1) Appropriate dental evaluation prior to the institution of treatment, oral care during radiation therapy and management of dental complications following completion of treatment. 2) Treatment techniques that accurately localize the target tissue, displace normal tissues from high dose volume and reduce the volume of normal tissue included in the radiation portals. 3) The investigative use of radioprotective agents. 4) The nutritional management of head and neck cancer patients including enteral and parenteral nutrition. 5) The use of medications to reduce the severity of acute symptomatology before, during and after radiation therapy

  5. The role of computed tomography in the radiotherapy of head and neck cancer

    International Nuclear Information System (INIS)

    Hokama, Yukio; Miura, Kentaro; Katsuyama, Naofumi; Nakano, Masao; Noda, Yutaka; Yamashiro, Masahiro

    1983-01-01

    The clinical usefullness of computed tomography (CT) was evaluated in 20 patients with carcinoma of the head and neck before, during and after radiotherapy. The role of CT in the radiotherapy of head and neck cancer was studied. In case of carcinoma of nasopharynx and maxillary antrum, bone destruction and tumor configuration in soft tissue were well delineated and usefull for clinical staging and radiotherapy planning. Neck lymph node involvement was also well detected, especially by using contrast enhancement. CT revealed also the structure of metastatic lesion to neck lymph node, for example central necrosis. Many authors have reported the usefullness of CT for radiotherapy planning. But we would emphasize the contribution in the observation of tumor regression by radiotherapy, and follow-up after the therapy. (author)

  6. Impact of HPV infection on the development of head and neck cancer

    Science.gov (United States)

    Betiol, J.; Villa, L.L.; Sichero, L.

    2013-01-01

    Human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) is considered to be a distinct clinical entity with better prognosis than the classical tobacco- and alcohol-associated tumors. The increasing incidence of this neoplasia during the last decades highlights the need to better understand the role of HPV in the development of these cancers. Although the proportion of HNSCC attributed to HPV varies considerably according to anatomical site, overall approximately 25% of all HNSCC are HPV-DNA positive, and HPV-16 is by far the most prevalent type. In this review we discuss the existing evidence for a causal association between HPV infection and HNSCC at diverse anatomical head and neck subsites. PMID:23532264

  7. In vivo dosimetry using thermoluminescent detector in cancer therapy of head and neck

    International Nuclear Information System (INIS)

    Viegas, Claudio C.B.; Batista, D.V.; Campos, A.M.; Lopes, R.T.

    2002-01-01

    The viability and implementation of a routine in vivo dosimetry, using thermoluminescent dosemeters (TLD), at the radiotherapy section of the National Institute of Cancer in Brazil, in the case of head and neck treatment is shown. In order to reach that aim, the characteristics of the response of the LiF:Mg;Ti (TLD-100) thermoluminescent detectors in powder form were determined. The performed of this detector for in vivo dosimetry was testes using an RANDO Alderson anthropomorphic phantom and, once their adequability proved for the kind of measurements proposed , it was used for dose assessment in the case of tumour treatments in the head and neck regions, for Cobalt-60 irradiations. (author)

  8. Dental and nutritional management of the head and neck cancer patient

    International Nuclear Information System (INIS)

    Lee, W. Robert; Sandow, Pamela L.; Moore, Giselle J.

    1996-01-01

    This course will examine the expected acute and late normal tissue toxicities associated with the delivery of high dose radiation therapy to the head and neck region. The purpose of this course will be to identify strategies to reduce radiotherapy-related toxicity without compromising adequate tumor treatment. A multidisciplinary approach will be emphasized and the following topics will be addressed: 1) Appropriate dental evaluation prior to the institution of treatment, oral care during radiation therapy and management of dental complications following completion of treatment. 2) Treatment techniques that accurately localize the target tissue, displace normal tissues from high dose volume and reduce the volume of normal tissue included in the radiation portals. 3) The investigative use of radioprotective agents. 4) The nutritional management of head and neck cancer patients including enteral and parenteral nutrition. 5) The use of medications to reduce the severity of acute symptomatology before, during and after radiation therapy

  9. Institutional clinical trial accrual volume and survival of patients with head and neck cancer.

    Science.gov (United States)

    Wuthrick, Evan J; Zhang, Qiang; Machtay, Mitchell; Rosenthal, David I; Nguyen-Tan, Phuc Felix; Fortin, André; Silverman, Craig L; Raben, Adam; Kim, Harold E; Horwitz, Eric M; Read, Nancy E; Harris, Jonathan; Wu, Qian; Le, Quynh-Thu; Gillison, Maura L

    2015-01-10

    National Comprehensive Cancer Network guidelines recommend patients with head and neck cancer (HNC) receive treatment at centers with expertise, but whether provider experience affects survival is unknown. The effect of institutional experience on overall survival (OS) in patients with stage III or IV HNC was investigated within a randomized trial of the Radiation Therapy Oncology Group (RTOG 0129), which compared cisplatin concurrent with standard versus accelerated fractionation radiotherapy. As a surrogate for experience, institutions were classified as historically low- (HLACs) or high-accruing centers (HHACs) based on accrual to 21 RTOG HNC trials (1997 to 2002). The effect of accrual volume on OS was estimated by Cox proportional hazards models. Median RTOG accrual (1997 to 2002) at HLACs was four versus 65 patients at HHACs. Analysis included 471 patients in RTOG 0129 (2002 to 2005) with known human papillomavirus and smoking status. Patients at HLACs versus HHACs had better performance status (0: 62% v 52%; P = .04) and lower T stage (T4: 26.5% v 35.3%; P = .002) but were otherwise similar. Radiotherapy protocol deviations were higher at HLACs versus HHACs (18% v 6%; P accounting for radiotherapy protocol deviations. Institutional experience substantially influences survival in locally advanced HNC. © 2014 by American Society of Clinical Oncology.

  10. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients

    International Nuclear Information System (INIS)

    Bonomi, Marcelo; Batt, Katharine

    2015-01-01

    Oral mucositis (OM) is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC) patients receiving radiotherapy (RT) with concurrent cisplatin experience severe OM with symptoms of extreme pain, mucosal ulceration and consequent limitations in swallowing and achieving adequate nutritional intake. This panoply of symptoms inevitably impacts a patients’ quality of life and their willingness to continue treatment. In spite of all the advances made in understanding the pathophysiology of OM, there is still no prophylactic therapy with proven efficacy. Strategies to limit the extent of OM and to manage its symptomatology include basic oral care, supportive medications, nutritional support and targeting aggressive treatments to high-risk patients. This review focuses on OM recognition, preventive measurements, and symptom-management strategies

  11. Supportive Management of Mucositis and Metabolic Derangements in Head and Neck Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Bonomi, Marcelo, E-mail: mbonomi@wakehealth.edu; Batt, Katharine [Section of Hematology and Medical Oncology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 (United States)

    2015-09-03

    Oral mucositis (OM) is among the most undesirable, painful, and expensive toxicities of cytotoxic cancer therapy, and is disheartening for patients and frustrating for caregivers. Accurate assessment of the incidence of OM has been elusive, but accumulating data suggests that reported OM frequency is significantly less than its actual occurrence. It has been suggested that over 90% of head and neck cancer (HNC) patients receiving radiotherapy (RT) with concurrent cisplatin experience severe OM with symptoms of extreme pain, mucosal ulceration and consequent limitations in swallowing and achieving adequate nutritional intake. This panoply of symptoms inevitably impacts a patients’ quality of life and their willingness to continue treatment. In spite of all the advances made in understanding the pathophysiology of OM, there is still no prophylactic therapy with proven efficacy. Strategies to limit the extent of OM and to manage its symptomatology include basic ora