Intensity modulated proton therapy (IMPT) – The future of IMRT for head and neck cancer

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Amy C. Moreno, Steven J. Frank, Adam S. Garden, David I. Rosenthal, Clifton D. Fuller, Gary B. Gunn, Jay P Reddy, William H. Morrison, Tyler D. Williamson, Emma B. Holliday, Jack Phan, Pierre Blanchard

Abstract

Radiation therapy plays an integral role in the management of head and neck cancers (HNCs). While most HNC patients have historically been treated with photon-based radiation techniques such as intensity modulated radiation therapy (IMRT), there is a growing awareness of the potential clinical benefits of proton therapy over IMRT in the definitive, postoperative and reirradiation settings given the unique physical properties of protons. Intensity modulated proton therapy (IMPT), also known as "pencil beam proton therapy," is a sophisticated mode of proton therapy that is analogous to IMRT and an active area of investigation in cancer care. Multifield optimization IMPT allows for high quality plans that can target superficially located HNCs as well as large neck volumes while significantly reducing integral doses. Several dosimetric studies have demonstrated the superiority of IMPT over IMRT to improve dose sparing of nearby organs such as the larynx, salivary glands, and esophagus. Evidence of the clinical translation of these dosimetric advantages has been demonstrated with documented toxicity reductions (such as decreased feeding tube dependency) after IMPT for patients with HNCs. While there are relative challenges to IMPT planning that exist today such as particle range uncertainties and high sensitivity to anatomical changes, ongoing investigations in image-guidance techniques and robust optimization methods are promising. A systematic approach towards utilizing IMPT and additional prospective studies are necessary in order to more accurately estimate the clinical benefit of IMPT over IMRT and passive proton therapy on a case-by-case basis for patients with sub-site specific HNCs.

https://ift.tt/2DCrSFX

HPV related head and neck squamous cell carcinoma: New evidences for an emerging spontaneous animal model

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Gennaro Altamura, Giuseppe Borzacchiello

https://ift.tt/2Q9B4bF

Prognostic factors and selection criteria in the retreatment of head and neck cancers

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Michael E. May, Elizabeth D. Cash, Craig L. Silverman, Rebecca A. Redman, Cesar A. Perez, Liz D. Wilson, Paul A. Tennant, Jeffrey M. Bumpous, Neal E. Dunlap

Abstract

Objectives

To determine predictors of treatment selection, outcome, and survival, we examined a cohort of previously irradiated head and neck squamous cell carcinoma (HNSCC) patients.

Materials and methods

We retrospectively analyzed 100 patients at our institution who were treated for recurrent or second primary (RSP) HNSCC, focusing on subgroups receiving reirradiation (ReRT) alone and those undergoing surgical salvage (SS) with or without post-operative reirradiation therapy (POReRT). Logistic regression modeling was performed to identify factors predictive of retreatment modality. Cox regression modeling was used to determine prognostic factors for progression free survival (PFS) and overall survival (OS).

Results

ReRT alone was less likely in current smokers and neck recurrences, with reirradiation more likely in primary site recurrences. POReRT was significantly more likely in patients with positive surgical margins (PSM), neck dissection, or organ dysfunction. POReRT omission negatively impacted PFS when PSM (HR: 8.894, 95% CI: 1.742–45.403) and perineural invasion (PNI) (HR: 3.391, 95% CI: 1.140–10.089) were present. Tracheostomy was associated with worse OS, but ReRT alone and POReRT improved OS. PSM correlated with worse OS, regardless of whether POReRT was given (HR: 14.260, 95% CI: 2.064–98.547).

Conclusion

This analysis confirms known factors for predicting outcome and shows nonsmoking status and primary site recurrence as predictors for ReRT alone. POReRT for PSM and PNI improves PFS. Tracheostomy patients are more likely to have ReRT due to acute toxicity not limiting treatment and POReRT improves OS compared to surgery alone. The presence of PSM negatively impacts survival which cannot be overcome by POReRT.

https://ift.tt/2DFdUmL

Rapid, non-invasive fluorescence margin assessment: Optical specimen mapping in oral squamous cell carcinoma

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Stan van Keulen, Nynke S. van den Berg, Naoki Nishio, Andrew Birkeland, Quan Zhou, Guolan Lu, Han-Wei Wang, Lyle Middendorf, Tymour Forouzanfar, Brock A. Martin, A. Dimitrios Colevas, Eben L. Rosenthal

Abstract

Objective

Surgical resection remains the primary treatment for the majority of solid tumors. Despite efforts to obtain wide margins, close or positive surgical margins (<5 mm) are found in 15–30% of head and neck cancer patients. Obtaining negative margins requires immediate, intraoperative feedback of margin status. To this end, we propose optical specimen mapping of resected tumor specimens immediately after removal.

Materials and methods

A first-in-human pilot study was performed in patients (n = 8) after infusion of fluorescently labeled antibody, panitumumab-IRDye800 to allow surgical mapping of the tumor specimen. Patients underwent standard of care surgical resection for head and neck squamous cell carcinoma (HNSCC). Optical specimen mapping was performed on the primary tumor specimen and correlated with pathological findings after tissue processing.

Results

Optical mapping of the specimen had a 95% sensitivity and 89% specificity to detect cancer within 5 mm (n = 160) of the cut surface. To detect tumor within 2 mm of the specimen surface, the sensitivity of optical specimen mapping was 100%. The maximal observed penetration depth of panitumumab-IRDye800 through human tissue in our study was 6.3 mm.

Conclusion

Optical specimen mapping is a highly sensitive and specific method for evaluation of margins within <5 mm of the tumor mass in HNSCC specimens. This technology has potentially broad applications for ensuring adequate tumor resection and negative margins in head and neck cancers.

https://ift.tt/2Qfqf7M

Oral cancer prevention worldwide: Challenges and perspectives

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Jean-Philippe Foy, Chloé Bertolus, Pierre Saintigny

https://ift.tt/2DF7VOG

Functional imaging early during (chemo)radiotherapy for response prediction in head and neck squamous cell carcinoma; a systematic review

Publication date: January 2019

Source: Oral Oncology, Volume 88

Author(s): Roland M. Martens, Daniel P. Noij, Meedie Ali, Thomas Koopman, J. Tim Marcus, Marije R. Vergeer, Henrica de Vet, Marcus C. de Jong, C. René Leemans, Otto S. Hoekstra, Remco de Bree, Pim de Graaf, Ronald Boellaard, Jonas A. Castelijns

Abstract

This systematic review gives an extensive overview of the current state of functional imaging during (chemo)radiotherapy to predict locoregional control (LRC) and overall survival (OS) for head and neck squamous cell carcinoma. MEDLINE and EMBASE were searched for literature until April 2018 assessing the predictive performance of functional imaging (computed tomography perfusion (CTp), MRI and positron-emission tomography (PET)) within 4 weeks after (chemo)radiotherapy initiation. Fifty-two studies (CTp: n = 4, MRI: n = 19, PET: n = 26, MRI/PET: n = 3) were included involving 1623 patients. Prognostic information was extracted according the PRISMA protocol. Pooled estimation and subgroup analyses were performed for comparable parameters and outcome. However, the heterogeneity of included studies limited the possibility for comparison. Early tumoral changes from (chemo)radiotherapy can be captured by functional MRI and ¹⁸F-FDG-PET and could allow for personalized treatment adaptation. Lesions showed potentially prognostic intratreatment changes in perfusion, diffusion and metabolic activity. Intratreatment ADC_mean increase (decrease of diffusion restriction) and low SUV_max (persistent low or decrease of ¹⁸F-FDG uptake) were most predictive of LRC. Intratreatment persistent high or increase of perfusion on CT/MRI (i.e. blood flow, volume, permeability) also predicted LRC. Low SUV_max and total lesion glycolysis (TLG) predicted favorable OS. The optimal timing to perform functional imaging to predict LRC or OS was 2–3 weeks after treatment initiation.

https://ift.tt/2QhTW84

Lingual ectopic papillary thyroid carcinoma: Two case reports and review of the literature

Publication date: Available online 22 November 2018

Source: Oral Oncology

Author(s): Nai-si Huang, Wen-jun Wei, Ning Qu, Yu-long Wang, Yu Wang, Qing-hai Ji

Abstract

Ectopic thyroid occurs when it is not located on the normal thyroid compartment. While 90% of the ectopic thyroids were located at the base of the tongue, only 1% were lingual thyroid carcinoma (LTC). Only 56 LTC cases have been reported so far. Here we reported two cases of LTC. Patient 1 was a 47-year-old female with LTC and co-current sub-hyoid ectopic thyroid. She experienced major hematemesis and dyspnea requiring emergent tracheotomy. Patient 2 was a 61-year old female who was presented with LTC with multiple lymph node metastasis and bilateral lung metastasis. Both of the patients' lingual masses were removed via trans-submaxillary excisions. Pathology revealed ectopic papillary thyroid carcinoma. Then they were treated with radio-active iodine (RAI). These patients had full recovery and there were no complications. A review of literature was also presented.

https://ift.tt/2DE4Zlq