头颈部腺样囊性癌放射治疗30例分析及文献复习

目的 :评价头颈部腺样囊性癌放射治疗的意义。方法 :回顾性分析 1971年 4月～ 1996年 4月收治的 30例头颈部腺样囊性癌的临床资料 ,生存情况并与文献比较。结果 :术后放疗 10年总生存率、10年无瘤生存率分别为 91 7%和 75 0 % ,首程放疗剂量 6 0～ 75Gy/ 6～ 7 5w ,5年内复发率 2 3%。结论 :术后放疗在本病治疗中占有很重要的地位 ,其可提高生存率 ,降低局部复发。     

头颈部肿瘤体积在放射治疗中的意义

肿瘤体积是影响放疗疗效的预后因素之一。综述了肿瘤体积的测量方法 ,在不同头颈部肿瘤放疗中对疗效的影响作用以及可能的机制 ,并提出将来临床工作中的解决方法。     

Role of PET/CT in Treatment Planning for Head and Neck Cancer Patients Undergoing Definitive Radiotherapy

Background: In this study, we aimed to investigate the benefits of 18F-deoxyglucose positron emissiontomography/computed tomography (FGD-PET/CT) imaging for staging and radiotherapy planning in patientswith head and neck cancer undergoing definitive radiotherapy. Materials and Methods: Thirty-seven headand neck cancer patients who had undergone definitive radiotherapy and PET/CT at the Uludag UniversityMedical Faculty Department of Radiation Oncology were investigated in order to determine the role of PET/CTin staging and radiotherapy planning. Results: The median age of this patient group of 32 males and 5 femaleswas 57 years (13-84years). The stage remained the same in 18 cases, decreased in 5 cases and increased in 14cases with PET/CT imaging. Total gross tumor volume (GTV) determined by CT (GTVCT-Total) was increasedin 32 cases (86.5%) when compared to total GTV determined by PET/CT (GTVPET/CT-Total). The GTV of theprimary tumor determined by PET/CT (GTVPET/CT) was larger in 3 cases and smaller in 34 cases comparedto that determined by CT (GTVCT). The GTV of lymph nodes determined by PET/CT (GTVLNPET/CT) waslarger in 20 cases (54%) and smaller in 12 cases (32.5%) when compared to GTV values determined by CT(GTVLNCT). No pathological lymph nodes were observed in the remaining five cases with both CT and PET/CT. Conclusions: We can conclude that PET/CT can significantly affect both pretreatment staging and assessedtarget tumor volume in patients with head and neck cancer. We therefore recommend examining such cases withPEC/CT before treatment.     

调强放疗对头颈部肿瘤患者甲状腺功能的影响

目的 探讨调强放疗对头颈部肿瘤患者甲状腺功能的影响.方法 40例头颈部恶性肿瘤(不包括甲状腺来源的恶性肿瘤),接受调强适形放射治疗,采用放射免疫法检测放疗前及放疗后3、6、12、18及24个月的T3、T4以及TSH水平.结果 40例头颈部非甲状腺癌的恶性肿瘤患者中,放疗后3、6、12、18及24个月T3、T4下降及TSH升高分别有1例(2.5％)、3例(7.5％)、5例(12.5％)、7例(17.5％)和10例(25％),其中2例(5％)伴有轻度的表情淡漠等临床症状,给予补充甲状腺素治疗后好转.结论 调强放射治疗可导致甲状腺功能不同程度的改变,且随着随访时间的延长,甲状腺功能损伤发生率呈增高趋势,应引起临床关注.     

Prognostic Value of Osteopontin in Patients Treated with Primary Radiotherapy for Head and Neck Cancer

Background: The prognostic value of tumor osteopontin (OPN) in patients with squamous-cell head and neckcancer (SCHNC) was investigated. Materials and Methods: OPN expression was assessed by immunohistochemicalmethods in 50 patients, who were treated with primary radiotherapy (RT) for locally advanced SCHNC. Theeffects of OPN on clinical parameters, local-regional control after RT and metastasis-free survival, was assessed.Results: The rate of OPN expression in tumor tissue was 76%. OPN positive cases had lower Hb levels (p=0.088).Mean time to local recurrence was 53.8 months (SE 3.9) in OPN-negative cases and 39.1 months (SE 4.7) inOPN-positive cases (p=0.047). OPN increased the risk of local recurrence 5.9 times (p=0.085). It had no effecton metastasis-free (p=0.116) or overall survival (p=0.123). OPN was positive in 12 of 19 cases that developedgrade 3-4 acute radiation dermatitis (p=0.096). Conclusions: OPN expression is associated with an increase inlocal recurrence in patients who were treated with primary RT for locally advanced SCHNC.     

Hypofractionated Accelerated Radiotherapy with Concurrent Carboplatin for Locally Advanced Squamous Cell Carcinoma of the Head and Neck

Aims

Hypofractionated accelerated radiotherapy with concurrent carboplatin utilises both advantages of altered fractionation and synchronous chemotherapy to maximise local control in locally advanced head and neck cancer. Such fractionation schedules are increasingly used in the intensity-modulated radiotherapy era and the aim of this study was to determine the outcome of hypofractionated accelerated radiotherapy with carboplatin.

Materials and methods

One hundred and fifty consecutive patients with squamous cell carcinoma of the larynx, oropharynx, oral cavity and hypopharynx (International Union Against Cancer [IUAC] stage II-IV) treated with 55 Gy in 20 fractions over 25 days with concurrent carboplatin were analysed. Outcome measures were 2 year overall survival, local control and disease-free survival.

Results

The median follow-up in surviving patients was 25 months. IUAC stages: II n = 15; III n = 42; IV n = 93. Two year overall survival for all patients was 74.9% (95% confidence interval 66.0-81.7%). Two year local control was 78.3% (95% confidence interval 69.6-84.8%). Two year disease-free survival was 67.2% (95% confidence interval 58.3-74.7%). There were 135 patients with stage III and IV disease. For these patients, the 2 year overall survival, local control and disease-free survival were 74.3% (95% confidence interval 64.7-81.6%), 79.1% (95% confidence interval 69.8-85.9%) and 67.6% (95% confidence interval 58.0-75.4%), respectively. Prolonged grade 3 and 4 mucositis seen at ≥4 weeks were present in 9 and 0.7%, respectively. Late feeding dysfunction (determined by dependence on a feeding tube at 1 year) was seen in 13% of the surviving patients at 1 year.

Conclusion

Hypofractionated accelerated radiotherapy with concurrent carboplatin achieves a high local control. This regimen should be considered for a radiotherapy dose-escalation study using intensity-modulated radiotherapy.     

Patterns of Failure after Intensity-modulated Radiotherapy in Head and Neck Squamous Cell Carcinoma using Compartmental Clinical Target Volume Delineation

AimsTo determine the pattern of disease recurrence in non-nasopharyngeal head and neck squamous cell carcinoma (HNSCC) patients treated with radical intensity-modulated radiotherapy (IMRT) with or without chemotherapy, and to correlate the sites of locoregional recurrence with radiotherapy target volumes.Materials and methodsIn total, 136 patients treated with radical IMRT with or without chemotherapy between 2008 and 2011 for non-nasopharyngeal HNSCC were retrospectively identified. A compartmental approach to clinical target volume (CTV) delineation was routinely utilised during this period and IMRT was delivered using a 5–7 angle step and shoot technique. Locoregional recurrences were reconstructed on the planning computed tomography scan by both deformable image coregistration and by visual assessment, and were analysed in relation to target volumes and dosimetry.ResultsThe median follow-up was 31 (range 3–53) months. Two year local control, regional control, disease-free survival, distant metastasis-free survival and overall survival were 86, 93, 78, 89 and 79%, respectively. One hundred and twenty of 136 (88%) patients achieved a complete response to treatment and 7/120 (6%) have subsequently had a locoregional recurrence. Analysis of these recurrences revealed five to be infield; one to be marginal to the high-dose CTV; one to be out-of-field. Overall the marginal/out-of-field recurrence rate was 2/136 (1.5%).ConclusionsIMRT utilising a compartmental approach to CTV delineation was associated with a low rate of marginal/out-of-field recurrence.     

Curative-Intent Radiotherapy for Squamous Cell Carcinoma of the Head and Neck in Sri Lanka: The Impact of Radiotherapy Technique on Survival

AimsWe conducted a retrospective analysis of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with curative-intent radiotherapy at the National Cancer Institute of Sri Lanka to determine the impact of the treatment technique on disease-free survival (DFS).Materials and methodsSCCHN patients treated with radical radiotherapy or adjuvant postoperative radiotherapy from 2016 to 2017 were included in the study. Data on the following variables were collected by reviewing clinical and radiotherapy treatment records: age, gender, tumour site, stage, time to delivery of radiotherapy, use of neoadjuvant chemotherapy, use of concurrent radiosensitising chemotherapy and treatment technique. DFS, defined as the time to death, tumour recurrence or loss to follow-up, was the primary end point and outcomes were compared between patients treated with intensity-modulated radiotherapy (IMRT) in linear accelerators and those treated with conventional radiotherapy in cobalt teletherapy units. Univariate and multivariate analyses were carried out on known prognostic variables.ResultsIn total, 408 patients were included in the study, with 138 (34%) being treated with IMRT in the linear accelerator. More than 75% of patients were of stage III or IV at diagnosis. The 2-year DFS of the whole cohort was 25% (95% confidence interval 21–30%). Patients treated with IMRT in the linear accelerator had a superior DFS in comparison with those treated with conventional radiotherapy in the cobalt teletherapy units (P < 0.001, hazard ratio 0.64, 95% confidence interval 0.5–0.82). Higher stage, cobalt treatment and use of neoadjuvant chemotherapy were adversely associated with DFS on multivariate analysis.ConclusionA large proportion of patients with SCCHN treated with curative-intent radiotherapy in Sri Lanka had locally advanced disease and DFS was superior in patients treated with IMRT in the linear accelerator.     

Glutathione S-transferase Polymorphisms in Head and Neck Squamous Cell Carcinoma Treated with Chemotherapy and/or Radiotherapy

Background/Aim: The Glutathione S-transferases (GSTs) are important carcinogen-metabolizing enzymes. Polymorphisms involved in these enzymes can modulate the development and treatment of head and neck cancer. To investigate the association of GSTs polymorphisms with head and neck cancer and risk factors, clinical-pathological features, and survival time of the patients treated with chemotherapy and/or radiotherapy. Methods: The GST gene polymorphisms were evaluated in 197 cases and 514 controls by PCR-RFLP-Polymerase Chain Reaction Restriction Fragment Length Polymorphism. Results: The GSTP-313 was associated with a decreased risk for HNSCC (p=0.050). The GSTP1 haplotype analysis revealed a higher frequency of the AC and AT haplotypes in the case group than in the control group (p=0.013 and p=0.019, respectively), and the opposite for G-C haplotype (p = 0.015). Yet, the different combinations between the genotypes were associated with an increased risk of cancer. The study showed no association between the polymorphisms and primary tumor site, clinical-pathological characteristics, treatment (chemotherapy and/or radiotherapy) and survival time of the patients. Conclusion: The GST polymorphisms combination showed an increased risk for carcinogenesis, and studies with larger casuistry can contribute to the clarification of the role in individual patient differences for the response to chemotherapy and/or radiotherapy and identify biomarkers of susceptibility.     

Clinical Character of Pediatric Head and Neck Rhabdomysarcomas: A 7-Year Retrospective Study

Objective: The rhabdomysarcoma (RMS) is most common soft tissue carcinoma in children, mostly foundin the head and neck with high degree of malignancy. The current study aimed to summarize clinical data andevaluate treatment outcome of cases in a single hospital. Methods: Forty-one (24 male, 17 female) children withnewly diagnosed RMS in Beijing Tong Ren Hospital were enrolled between November, 2004 and May, 2011. The.Students’ t and Chi tests were then performed on retrospectively reviewed clinical data, followed by survivalanalysis based on the Kaplan Meier method using SPSS 17.0 software. Results: Of all cases, 32 were treated bycommon chemotherapy, and 3 cases with stage III RMS received high-dose chemotherapy and auto-peripheralblood stem cell transplantation (APBSCT). Side-effects in the former were: I grade for 62.5% (20/32), II gradefor 28.1% (9/32), III grade account for 9.275% (3/32). Side-effects of 3 cases with APBSCT: 2 were I grade, 1 wasIII grade. The median follow-up time of 41 RMS cases was 41 months. Four cases were lost to follow-up, 7 casesrecurred, and 5 cases died of cerebral metastasis, witha total survival rate was 86.5% (32/37). CR rate was 67.6%(25/37), PR was 18.9% (7/37). Conclusion: Multidiscipline treatment including chemotherapy, radiotherapy,surgery and auto-PBSCT is highly recommended for pediatric patients with head and neck RMS.     

Extra-mandibular Osteoradionecrosis after the Treatment of Head and Neck Cancer

AimsOsteoradionecrosis (ORN) is a serious toxicity of head and neck radiotherapy. It predominantly affects the mandible. Extra-mandibular ORN is rare. The aim of this study was to report the incidence and outcomes of extra-mandibular ORNs from a large institutional database.Materials and methodsIn total, 2303 head and neck cancer patients were treated with radical or adjuvant radiotherapy. Of these, extra-mandibular ORN developed in 13 patients (0.5%).ResultsMaxillary ORNs (n = 8) were a consequence of the treatment of various primaries (oropharynx = 3, sinonasal = 2, maxilla = 2, parotid = 1). The median interval from the end of radiotherapy to the development of ORN was 7.5 months (range 3–42 months). The median radiotherapy dose in the centre of the ORN was 48.5 Gy (range 22–66.5 Gy). Four patients (50%) healed in 7, 14, 20 and 41 months.All temporal bone ORNs (n = 5) developed after treatment to the parotid gland (of a total of 115 patients who received radiotherapy for parotid gland malignancy). The median interval from the end of radiotherapy to the development of ORN was 41 months (range 20–68 months). The median total dose in the centre of the ORN was 63.5 Gy (range 60.2–65.3 Gy). ORN healed in only one patient after 32 months of treatment with repeated debridement and topical betamethasone cream.ConclusionExtra-mandibular ORN is a rare late toxicity and this current study provides useful information on its incidence and outcome. The risk of temporal bone ORN should be considered in the treatment of parotid malignancies and patients should be counselled. More research is required to determine the optimal management of extra-mandibular ORN, particularly on the role of the PENTOCLO regimen.     

Thyroid Dysfunction Following Therapeutic External Radiation to Head and Neck Cancer

Aim: The aim of the present study was to evaluate changes in thyroid function in patients with head andneck cancer treated with external beam radiotherapy (EBRT). Materials and Methods: This prospective studywas conducted on ninety patients with non-thyroid head and neck cancer who were referred to the departmentof radiotherapy. Thyroid function tests were conducted before, midway during and after EBRT, with followup at monthly intervals up to 6 months after the completion of therapy. Results: Serum T3 and T4 levels weredecreased at completion of EBRT and remained so after 6 months follow up. However, serum TSH levels didnot significantly vary. Conclusion: EBRT to the neck region for treatment of head and neck cancer induceshypothyroidism and therefore utmost care must be taken to exclude the thyroid from radiation beams withoutsparing the tumor as far as possible. The clinical protocol in such cases should include monitoring of T3, T4 andTSH levels during and after the EBRT.     

Evaluation of Quality of Life in Turkish Patients with Head and Neck Cancer

Background: In this study, our aim was to investigate the effect of factors, such as radiotherapy, the doseof radiotherapy, the region of radiotherapy, the age of the patient, performance, co-morbidity, the stage of thedisease and the therapy modalities on the quality of life of patients with head and neck cancer. Materials andMethods: Eighty-two patients who were treated by either chemoradiotherapy or radiotherapy, at the CumhuriyetUniversity Faculty of Medicine, Department of Radiation Oncology, between February 2007 and September 2010,for head and neck cancer were included. The quality of life European Organisation for Research and Treatmentof Cancer, Questionnaire module to be used in Quality of Life assessments in Head and Neck Cancer (EORTCQLQ-H&N35) questionnaire was conducted in all patients before starting the radiotherapy, in the middle, at theend, at 1 month and at 6 months after the treatment. Results: According to the questionnaires at the end and atthe 6th month after the radiotherapy, it was found that the age of the patient, co-morbidity, ECOG performancestate, localization, type of treatment, the stage of the disease, the dose and the region of radiotherapy affect someof the symptom scales for quality of life. Conclusions: Quality of life was affected negatively during and afterthe radiotherapy. However, in the 6th month after the therapy, a significant improvement was observed in mostsymptoms.     

Changes in Apparent Diffusion Coefficient (ADC) in Serial Weekly MRI during Radiotherapy in Patients with Head and Neck Cancer: Results from the PREDICT-HN Study

Background: The PREDICT-HN study aimed to systematically assess the kinetics of imaging MR biomarkers during head and neck radiotherapy. Methods: Patients with intact squamous cell carcinoma of the head and neck were enrolled. Pre-, during, and post-treatment MRI were obtained. Serial GTV and ADC measurements were recorded. The correlation between each feature and the GTV was calculated using Spearman’s correlation coefficient. The linear mixed model was used to evaluate the change in GTV over time. Results: A total of 41 patients completed the study. The majority (76%) had oropharyngeal cancer. A total of 36 patients had intact primary tumours that can be assessed on MRI, and 31 patients had nodal disease with 46 nodes assessed. Median primary GTV (GTVp) size was 14.1cc. The rate of GTVp shrinkage was highest between pre-treatment and week 4. Patients with T3-T4 tumours had a 3.8-fold decrease in GTVp compared to T1-T2 tumours. The ADC values correlated with residual GTVp. The median nodal volume (GTVn) was 12.4cc. No clinical features were found to correlate with GTVn reduction. The overall change in ADC for GTVn from pre-treatment was significant for 35th–95th percentiles in weeks 1–4 (p < 0.001). Conclusion: A discrepancy in the trajectory of ADC between primary and nodal sites suggested that they exhibit different treatment responses and should be analysed separately in future studies.     

A Predictive Model for Reactive Tube Feeding in Head and Neck Cancer Patients Undergoing Definitive (Chemo) Radiotherapy

AimsCareful management of a patient's nutritional status during and after treatment for head and neck squamous cell cancers (HNSCC) is crucial for optimal outcomes. The aim of this study was to develop a model for stratifying a patient's risk of requiring reactive enteral feeding through a nasogastric tube during radiotherapy for HNSCC, based on clinical and treatment-related factors.Materials and methodsA cohort of consecutive patients treated with definitive (chemo)radiotherapy for HNSCC between January 2016 and January 2018 was identified in the institutional electronic database for retrospective analysis. Patients requiring enteral feeding pretreatment were excluded. Clinical and treatment data were obtained from prospectively recorded electronic clinical notes and planning software.ResultsBaseline patient characteristics and tumour-related parameters were captured for 225 patients. Based on the results of the univariate analysis and using a stepwise backwards selection process, clinical and dosimetric variables were selected to optimise a clinically predictive multivariate model, fitted using logistic regression. The parameters found to affect the probability, P, of requiring a nasogastric feeding tube for >4 weeks in our clinical multivariate model were: tumour site, tumour stage (early T0/1/2 stage versus advanced T3/T4 stage), chemotherapy drug (none versus any drug) and mean dose to the contralateral parotid gland. A scoring model using the regression coefficients of the selected variables in the clinical multivariate model achieved an area under the curve (AUC) of 0.745 (95% confidence interval 0.678–0.812), indicating good discriminative performance. Internal validation of the model involved splitting the dataset 80:20 into training and test datasets 10 times and assessing differences in AUC of the model fitted to these.ConclusionsWe developed an easy-to-use prediction model based on both clinical and dosimetric parameters, which, once externally validated, can lead to more personalised treatment planning and inform clinical decision-making on the appropriateness of prophylactic versus reactive enteral feeding.     

Paclitaxel,Carboplatin, and Concomitant Radiotherapy for Resected Patients with High Risk Head and Neck Cancer

Abstract

Many resected patients with locally advanced head and neck cancer are found on pathological assessment to have high-risk features for recurrence. We thus performed a feasibility trial of post-operative radiotherapy with paclitaxel and carboplatin in high-risk carcinoma of the head and neck. All patients were planned for 6 cycles of weekly paclitaxel (40 mg/m²) and carboplatin (AUC=1) and concomitant radiotherapy, 60 Gy in 6 weeks. The most common side effect was grade 3 and 4 mucositis in 5/6 patients and g-tube placement in 4/6 patients. Five out of 6 patients remain alive without evidence of disease at a mean time of 19 months since completion of therapy. Our pilot study treated 6 postoperative patients. Since 4 of 6 enrolled patients were unable to complete the treatment as prescribed, we conclude that this regimen is not feasible. With an 83% grade 3 or 4 mucositis rate and 67% of patients enrolled requiring feeding tube placement, this regimen is not tolerable.     

A Systematic Review and Meta-Analysis on the Efficacy of Curcumin/Turmeric for the Prevention and Amelioration of Radiotherapy/Radiochemotherapy Induced Oral Mucositis in Head and Neck Cancer Patients

Background: Oral Mucositis(OM) is an acute debilitating dose limiting toxicity of Radiotherapy/Radiochemotherapy(RT/RCT) in management of Head and Neck Cancer (HNC). Curcumin/Turmeric may reduce OM in patients. Aim: Efficacy of Curcumin/Turmeric for preventing and ameliorating the onset and severity of RT/RCT induced OM was analysed in this review. Methods: A systematic literature search with meta-analysis were performed using Mesh terms in PubMed, Google scholar, Science Direct, Cochrane library and manual searching, articles published from 2010 to April 2021 were included. Clinical trials that studied the efficacy/effects of turmeric / curcumin in management of RT/RCT induced OM in HNC patients were included. Statistical Analysis were done to calculate the pooled Risk ratio at 95%confidence interval with significance at p