Diffusion Weighted Imaging in Predicting Progression Free Survival in Patients with Squamous Cell Carcinomas of the Head and Neck Treated with Induction Chemotherapy

Purpose Both concurrent chemoradiotherapy (CT-RT) and cetuximab radiotherapy (cetux-RT) have been established as the standard of care for the treatment of locally advanced squamous cell carcinoma of the head and neck. It was not known whether the addition of induction chemotherapy before cetux-RT could improve outcomes compared with standard of care CT-RT. Patients and Methods The current trial was restricted to patients with nonmetastatic N2b, N2c, or N3 squamous cell carcinoma of the head and neck and fit for taxotere, cisplatin, fluorouracil (TPF). Patients were randomly assigned to receive three cycles of TPF followed by cetux-RT versus concurrent carboplatin fluorouracil and RT as recommended in National Comprehensive Cancer Network guidelines. The trial was powered to detect a hazard ratio (HR) of 0.66 in favor of TPF plus cetux-RT for progression-free survival at 2 years. The inclusion of 180 patients per arm was needed to achieve 80% power at a two-sided significance level of .05. Results Between 2009 and 2013, 370 patients were included. All patients and tumors characteristics were well balanced between arms. There were more cases of grade 3 and 4 neutropenia in the induction arm, and the induction TPF was associated with 6.6% treatment-related deaths. With a median follow-up of 2.8 years, 2-year progression-free survival was not different between both arms (CT-RT, 0.38 v TPF + cetux-RT, 0.36; HR, 0.93 [95% CI, 0.73 to 1.20]; P = .58). HR was 0.98 (95% CI, 0.74 to 1.3; P = .90) for locoregional control and 1.12 (95% CI, 0.86 to 1.46; P = .39) for overall survival. These effects were observed regardless of p16 status. The rate of distant metastases was lower in the TPF arm (HR, 0.54 [95% CI, 0.30 to 0.99]; P = .05). Conclusion Induction TPF followed by cetux-RT did not improve outcomes compared with CT-RT in a population of patients with advanced cervical lymphadenopathy.

Download Full-text

Diffusion-weighted imaging in head and neck squamous cell carcinomas: A systematic review

Head & Neck ◽

10.1002/hed.23575 ◽

2014 ◽

Vol 37 (3) ◽

pp. 440-448 ◽

Cited By ~ 29

Author(s):

Juliette P. Driessen ◽

Paulina M. W. van Kempen ◽

Geert J. van der Heijden ◽

Marielle E. P. Philippens ◽

Frank A. Pameijer ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck ◽

Squamous Cell ◽

Diffusion Weighted Imaging ◽

Squamous Cell Carcinomas ◽

Diffusion Weighted

Download Full-text

Hyperfractionated Radiation Therapy With or Without Concurrent Low-Dose Daily Cisplatin in Locally Advanced Squamous Cell Carcinoma of the Head and Neck: A Prospective Randomized Trial

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.7.1458 ◽

2000 ◽

Vol 18 (7) ◽

pp. 1458-1464 ◽

Cited By ~ 345

Author(s):

Branislav Jeremic ◽

Yuta Shibamoto ◽

Biljana Milicic ◽

Nebojsa Nikolic ◽

Aleksandar Dagovic ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Radiation Therapy ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Low Dose ◽

Locally Advanced ◽

Progression Free Survival ◽

High Grade ◽

Free Survival

PURPOSE: To investigate whether the addition of cisplatin (CDDP) to hyperfractionation (Hfx) radiation therapy (RT) offers an advantage over the same Hfx RT given alone in locally advanced (stages III and IV) squamous cell carcinoma of the head and neck. PATIENTS AND METHODS: One hundred thirty patients were randomized to receive either Hfx RT alone to a tumor dose of 77 Gy in 70 fractions in 35 treatment days over 7 weeks (group I, n = 65) or the same Hfx RT and concurrent low-dose (6 mg/m2) daily CDDP (group II, n = 65). RESULTS: Hfx RT/chemotherapy offered significantly higher survival rates than Hfx RT alone (68% v 49% at 2 years and 46% v 25% at 5 years; P = .0075). It also offered higher progression-free survival (46% v 25% at 5 years; P = .0068), higher locoregional progression-free survival (LRPFS) (50% v 36% at 5 years; P = .041), and higher distant metastasis-free survival (DMFS) (86% v 57% at 5 years; P = .0013). However, there was no difference between the two treatment groups in the incidence of either acute or late high-grade RT-induced toxicity. Hematologic high-grade toxicity was more frequent in group II patients. CONCLUSION: As compared with Hfx RT alone, Hfx RT and concurrent low-dose daily CDDP offered a survival advantage, as well as improved LRPFS and DMFS.

Download Full-text

Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma

European Journal of Radiology ◽

10.1016/j.ejrad.2018.02.026 ◽

2018 ◽

Vol 101 ◽

pp. 162-169 ◽

Cited By ~ 7

Author(s):

Pravin Mundada ◽

Arthur Damien Varoquaux ◽

Vincent Lenoir ◽

Claudio de Vito ◽

Nicolas Dulguerov ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Diffusion Weighted Imaging ◽

Post Treatment ◽

Neck Squamous Cell Carcinoma ◽

Nodal Disease ◽

Diffusion Weighted ◽

And Diffusion

Download Full-text

Predictive value of quantitative diffusion-weighted imaging and 18-F-FDG-PET in head and neck squamous cell carcinoma treated by (chemo)radiotherapy

European Journal of Radiology ◽

10.1016/j.ejrad.2019.01.031 ◽

2019 ◽

Vol 113 ◽

pp. 39-50 ◽

Cited By ~ 11

Author(s):

Roland M. Martens ◽

Daniel P. Noij ◽

Thomas Koopman ◽

Ben Zwezerijnen ◽

Martijn Heymans ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Predictive Value ◽

Fdg Pet ◽

Diffusion Weighted Imaging ◽

Neck Squamous Cell Carcinoma ◽

Diffusion Weighted

Download Full-text

Diffusion-weighted magnetic resonance imaging of head and neck squamous cell carcinomas

European Journal of Radiology ◽

10.1016/j.ejrad.2007.10.011 ◽

2008 ◽

Vol 68 (3) ◽

pp. 493-498 ◽

Cited By ~ 19

Author(s):

Klaus M. Friedrich ◽

Wolfgang Matzek ◽

Stephan Gentzsch ◽

Irene Sulzbacher ◽

Christian Czerny ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Head And Neck ◽

Squamous Cell ◽

Squamous Cell Carcinomas ◽

Resonance Imaging ◽

Diffusion Weighted ◽

Weighted Magnetic Resonance Imaging

Download Full-text

A phase II study examining the feasibility of long-term and low-dose oral capecitabine in newly diagnosed head and neck squamous cell carcinoma after surgery, radiation, and/or chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.6053 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 6053-6053

Author(s):

A. Sukari ◽

H. Mulrenan ◽

K. Almhanna ◽

Z. Kafri ◽

H. Kim ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Head And Neck ◽

Squamous Cell ◽

Locally Advanced ◽

Progression Free Survival ◽

Definitive Treatment ◽

Free Survival ◽

Oral Capecitabine ◽

One Year

6053 Background: In advanced head and neck squamous cell carcinoma (HNSCC), the five-year survival rate is less than 40%. Although the efficacy and tolerability of continuous IV 5-Fluorouracil (5FU) therapy has been established in HNSCC, the feasibility and tolerability of long-term therapy of oral capecitabine has not been established in HNSCC. Our primary objective is to assess the feasibility of treating patients with squamous cell carcinoma of the head and neck (HNSCC) with adjuvant Capecitabine after undergone definitive treatment. The secondary objectives are to estimate time to recurrence, local-regional control and survival rates along with incidence of second primary tumors. Methods: Eligible patients with newly diagnosed locally advanced HNSCC received capecitabine 1,000 mg orally once daily for one year, after undergone definitive treatment. Patients’ compliance with oral capecitabine as will as the side effects profile was evaluated on monthly basis over the first 12 months. Feasibility, survival, progression and progression free survival were measured over 36 months. Results: Thirty five patients were enrolled in the study. 17 patients had stage IV b, 7 had stage III, and 5 had unknown primary HNSCC. All but one took at least 60% of dispensed tablets. Twenty six patients completed at least 7 months of capecitabine. Sixteen patients completed at least 10 month of capecitabine. Two years overall survival rate was 97%. Three years progression free survival was 86%. Conclusions: Adjuvant capecitabine in locally advanced HNSCC is a feasible approach with minimum side effects. A favorable 3-year progression-free survival was found as compare to historical results. We recommend a randomized phase III trail to examine the effect of one year of adjuvant capecitabine versus placebo in locally advanced HNSCC after definitive treatment. No significant financial relationships to disclose.

Download Full-text