Second Primary Non–Small-Cell Lung Cancer After Head and Neck Cancer: A Population-Based Study of Clinical and Pathologic Characteristics and Survival Outcomes in 3597 Patients

IntroductionRetrospective studies have shown an increased risk of second primary lung cancer in patients with a history of head and neck cancer (HNC). No population-based study has examined the overall survival (OS) outcomes of patients with second primary non–small-cell lung cancer (NSCLC) after HNC comparison with patients with first primary NSCLC.Patients and MethodsIndividuals with histologically confirmed NSCLC diagnosed after nonmetastatic squamous-cell carcinoma of the head and neck (HNC-NSCLC; n = 3597) were identified in Surveillance, Epidemiology, and End Results 18 registries (1988-2013). OS and baseline characteristics were compared in patients with first primary NSCLC (NSCLC-1; n = 365,551) in the same registries.ResultsSquamous NSCLC was more common in HNC-NSCLC (n = 745 [64.1%] localized, n = 833 [71.9%] regional, and n = 811 [63.5%] distant) than in the NSCLC-1 (n = 30,901 [38.3%] localized, n = 50,557 [48.2%] regional, and n = 53,720 [29.8%] distant; P < .001). The leading cause of death in HNC-NSCLC was NSCLC (n = 2183; 60.6%), and median OS after localized, regional, and distant NSCLC diagnosis was 2.50 years, 1.17 years, and 5 months, respectively. For NSCLC-1, median OS was 4.58 years, 1.58 years, and 6 months, respectively. These differences were significant (P < .001). In multivariable analysis, a history of HNC remained associated with worse OS for localized (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.29-1.51; P < .001), regional (HR, 1.26; 95% CI, 1.19-1.35; P < .001) and distant (HR, 1.11; 95% CI, 1.04-1.18; P < .01) stage NSCLC.ConclusionA history of HNC adversely affects OS in patients who subsequently develop NSCLC. This OS decrement might have implications for NSCLC surveillance and NSCLC therapy selection in this population.     

Is FDG –PET-CT A Valuable Tool in Prediction of Persistent Disease in Head and Neck Cancer

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancercases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated withdefinitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy.Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients.Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overallsensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection ofresidual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responderswhile it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment oftreatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis.Definitely more precise criteria are required for assessment of response, there being no clear cut uptake valueindicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appearas increased uptake in control FDG PET CT.     

Early Mortality after Radical Radiotherapy in Head and Neck Cancer – A Nationwide Analysis from the Danish Head and Neck Cancer Group (DAHANCA) Database

AimsCurative-intent radiotherapy (RT) or chemoradiation (CRT) of squamous cell carcinoma of the head and neck (HNSCC) produces high survival rates, but is associated with substantial toxicity. However, there are no commonly accepted quality metrics for early mortality in radiation oncology. To assess the applicability of early mortality as a clinical quality indicator, this study investigated the temporal distribution, risk factors and trends of 90- and 180-day overall and non-cancer mortality in a nationwide cohort of HNSCC patients treated with RT/CRT.Materials and methodsInformation on all HNSCC patients treated with curative-intent RT/CRT in Denmark between 2000 and 2017 was obtained from the national Danish Head and Neck Cancer Group clinical database. Deaths in patients with residual or recurrent disease after RT/CRT were classified as cancer-related. Possible risk factors were investigated using logistic regression analysis.ResultsData from 11 419 patients were extracted. In total, 90- and 180-day mortality risks were 3.1% and 7.1%, respectively. There was a uniform temporal distribution of 180-day mortality. In multivariable analysis, increasing age, stage, performance status, earlier treatment year and hypopharyngeal cancer were significantly associated with an increased risk (P < 0.05). Risk factor estimates were comparable for 90- versus 180-day mortality as well as for overall versus non-cancer mortality. Between 2000 and 2017 there was a significant decrease in 180-day mortality, which was driven by a reduction in cancer-related events.ConclusionThe distribution of 180-day overall and non-cancer mortality did not indicate a well-defined early high-risk period. Moreover, risk factor estimates were highly similar across risk periods and groups. Taken together, our findings question the applicability of early mortality as a standard metric for treatment-associated toxicity.     

Rights of Cancer Patient’s: a Pilot Study from Turkey

The chief aims of this study are to examine the levels of knowledge of cancer patients who have been receiving treatment in Turkey, related to the patient’s rights they have, and determine the personal factors that affect their level of knowledge. The research was conducted with 294 patients who have been receiving treatment in a university hospital in Ankara. Findings have manifested that although the patients had some level of knowledge about fundamental rights of the patients, they have never used a great deal of them and they had no knowledge of plenty of important patient’s rights. It is concluded that in order for cancer patients to participate in the treatment they receive, their level knowledge of patient’s rights should be enhanced and this should be provided by education.     

Vitamin B12 and Folate Status in Head and Neck Cancer

Deficiency of vitamin B12 and folate is associated with causation of certain precancerous conditions and cancer.The present study was carried out on 56 controls, 167 patients with oral precancerous conditions (OPC) and 214head and neck cancer patients, to evaluate the plasma vitamin B12 and folate levels to determine their associationwith tobacco habits and vegetarianism and several sociodemographic factors. The subjects were interviewed using ahealth habit and diet questionnaire at the time of blood collection. Simultaneous estimations of plasma vitamin B12and folate were done by Dual Count Radioassay. It was found that the habit of tobacco consumption, lower educationand low income were among the risk factors. A decrease in the plasma vitamin B12 and folate levels with respect totobacco habits, disease progression, and vegetarian diet was also observed. The individuals in the ower quartile forvitamin B12 and folate were at a higher risk of developing OPC, as compared to those in higher quartiles. Similarly,the patients with OPC in lower quartiles were found to be at a higher risk of developing cancer than their counterparts.There was a significant positive correlation between vitamin B12 and folate levels in the subjects consuming tobacco,and more so in patients with OPC (r=0.4330, p=0.000). Folate levels were significantly lower in patients with advancedas compared with early disease (ANOVA p=0.006 and Spearman’s Rho = -0.211 and p=0.01). The results suggest,potential significance of plasma vitamin B12 and folate levels in head and neck malignancies which needs to beconfirmed by further studies on a large population.     

Chemotherapy： Is it Warranted in Curable Head and Neck Cancer？

Since the last century, many physicians have been trying to utilize chemotherapy to replace conventional surgical treatment for cases of cancer of the oropharynx, larynx, and hypopharynx, which would otherwise be candidates for total laryngectomy. Some authors claim that the preservation rate of the larynx increases after treatment by chemotherapy, which even may take the place of routine surgical methods. However, when calculated in a more rigorous way following accepted statistical methods, what they claim is questionable. As a result, the routine application of chemotherapy in its present form is not advisable for curable squamous cell carcinoma of the head and neck region. Further research is required to justify its benefit.     

Imaging of Neck Nodes in Head and Neck Cancers – a Comprehensive Update

Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.     

The Indications and Clinical Curative Effects of Modified Neck Dissection in Head and Neck Cancers

OBJECTIVE Functional neck dissection was first described by Bocca and Pignataro in 1967. It has been used in clinical practice for years, but remains controversial among neck-surgery experts. This study was designed to evaluate indications and curative effects of functional-neck dissection (FND). METHODS One hundred and fifty-two cases which underwent FND were reviewed with an analysis of pathological specimens and follow-up datas. RESULTS The series of FND included 20 cases of tongue carcinoma, 23 cases of larynx carcinoma, 96 cases of thyroid papillary adenocarcinoma, 9 cases of follicular adenocarcinoma and 4 cases of medullary adenocarcinoma; the five-year recurrence rate for tongue carcinoma was 12.5%, 14.3%, 40.0% and for a larynx carcinoma was 20.0%, 16.7%, 50.0% in N0 stage, N1 stage, N2a stage, respectively. The 5-year recurrence rate of thyroid papillary adenocarcinoma was 6.5%, 7.1% in N1a, N1b, respectively. CONCLUSION Functional neck dissection is indicated in early and low malignant head and neck neoplasms and results in satisfactory curative effects.     

“Cancer Doesn't Mean Curtains”: Benefit Finding in Patients with Head and Neck Cancer in Remission

There is an increasing awareness that there are often aspects of the experience of cancer that patients view as positive or beneficial despite substantial physical and psychological impacts. Individuals with head and neck cancer (HNC) are unique with respect to the possible facial disfigurement and functional limitations following disease and treatment. This qualitative study aimed to explore whether patients with HNC experience positive consequences posttreatment, and to investigate the nature of any benefit finding. Emerging master themes included a change in life priorities, greater closeness to family and friends, a greater awareness of self, for example, an increase in self-confidence and empowerment, and a greater awareness of faith and spirituality. Despite the adverse affects often associated with HNC, patients report some degree of positive growth following treatment.     

Is Planned Neck Dissection Necessary for Head and Neck Cancer After Intensity-Modulated Radiotherapy?

PURPOSE: The objective of this study was to determine regional control of local regional advanced head and neck squamous cell carcinoma (HNSCC) treated with intensity-modulated radiotherapy (IMRT), along with the role and selection criteria for neck dissection after IMRT. METHODS AND MATERIALS: A total of 90 patients with stage N2A or greater HNSCC were treated with definitive IMRT from December 1999 to July 2005. Three clinical target volumes were defined and were treated to 70 to 74 Gy, 60 Gy, and 54 Gy, respectively. Neck dissection was performed for selected patients after IMRT. Selection criteria evolved during this period with emphasis on post-IMRT [(18)F] fluorodeoxyglucose positron emission tomography in recent years. RESULTS: Median follow-up for all patients was 29 months (range, 0.2-74 months). All living patients were followed at least 9 months after completing treatment. Thirteen patients underwent neck dissection after IMRT because of residual lymphadenopathy. Of these, 6 contained residual viable tumor. Three patients with persistent adenopathy did not undergo neck dissection: 2 refused and 1 had lung metastasis. Among the remaining 74 patients who were observed without neck dissection, there was only 1 case of regional failure. Among all 90 patients in this study, the 3-year local and regional control was 96.3% and 95.4%, respectively. CONCLUSIONS: Appropriately delivered IMRT has excellent dose coverage for cervical lymph nodes. A high radiation dose can be safely delivered to the abnormal lymph nodes. There is a high complete response rate. Routine planned neck dissection for patients with N2A and higher stage after IMRT is not necessary. Post-IMRT [(18)F] fluorodeoxyglucose positron emission tomography is a useful tool in selecting patients appropriate for neck dissection.     

Trans-Lycopene and β-Cryptoxanthin Intake and Stomach Cancer in Vietnamese Men: A Pilot Case-Control Study

Objective: To examine the association between dietary intake of Trans-Lycopene and β-Cryptoxanthin and stomach cancer in Vietnamese men. Methods: A case-control study including 80 male incident stomach cancer cases and 146 male controls was performed in a general hospital in Viet Nam. A validated semi-quantitative food frequency (SQFFQ) and demographic lifestyle questionnaire were designed, and venous blood samples were collected to determine H. pylori status by IgG ELISA. Nutrient intake was converted using the data of SQFFQ and the Nutritive Composition Table of Vietnamese Foods, updated in 2019. The respective associations between Trans-Lycopene and β-Cryptoxanthin intake and stomach cancer were examined using unconditional logistic regression analysis with adjustments for possible cofactors. Results: Both Trans-Lycopene and β-Cryptoxanthin intake and stomach cancer showed a significantly inverse association, tertile-3 versus tertile-1, (OR = 0.15, 95%CI: 0.06–0.35, p trend = 0.00) and (OR = 0.34, 95%CI: 0.14–0.79, p trend = 0.02, respectively). For Trans-Lycopene intake stratifying by H. pylori status remained the benefit effect against stomach cancer among H. pylori-negative participants (OR = 0.15, 95%CI: 0.03–0.69, p trend = 0.02) and H. pylori-positive participants (OR = 0.13, 95%CI: 0.04–0.42, p trend = 0.00). Conclusions: Both Trans-Lycopene and β-Cryptoxanthin intake showed a strong protective effect against stomach cancer. The findings suggest that these two types of fat-soluble micronutrients would be considered as an anti-cancer therapy for both primary and secondary prevention.     

How Much Radiation is the Chemotherapy Worth in Advanced Head and Neck Cancer?

PURPOSE: To estimate the radiotherapeutic dose equivalence of chemoradiotherapy in head and neck cancer. METHODS: The biologic equivalent dose (BED) of radiotherapy in nine trials of standard and five trials of modified fractionated radiotherapy with or without chemotherapy was calculated using the linear-quadratic formulation. Data from Radiation Therapy Oncology Group (RTOG) study 90-03 were used to calculate the relationship (S) between increase in locoregional control (LRC) and increase in BED with modified vs. standard fractionated radiotherapy. The increase in LRC with chemoradiotherapy vs. radiotherapy alone, the BED of the radiotherapy-alone arms, and the "S" value were used to calculate the BED contribution from chemotherapy and the total BED of chemoradiotherapy from each study. RESULTS: From RTOG 90-03, a 1% increase in BED yields a 1.1% increase in LRC. The mean BED of standard fractioned radiotherapy was 60.2 Gy(10) and 66 Gy(10) for modified fractionation. The mean BED of standard fractionated chemoradiotherapy was 71 Gy(10) (10.8 Gy(10) contributed by chemotherapy). The mean BED of modified fractionated chemoradiotherapy was 76 Gy(10) (10.4 Gy(10) contributed by chemotherapy). CONCLUSIONS: Chemotherapy increases BED by approximately 10 Gy(10) in standard and modified fractionated radiotherapy, equivalent to a dose escalation of 12 Gy in 2 Gy daily or 1.2 Gy twice daily. Such an escalation could not be safely achieved by increasing radiation dose alone.