Survival Associated With Consolidated Multidisciplinary Care in Head and Neck Cancer: A Retrospective Cohort Study

2021 ◽  
pp. 019459982110578
Author(s):  
Charles Meltzer ◽  
Nathalie T. Nguyen ◽  
Jie Zhang ◽  
Jillian Aguilar ◽  
Maruta A. Blatchins ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Retrospective Cohort ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Case Conference ◽  
Multidisciplinary Clinic ◽  
Disease Specific ◽  
Advanced Tumors

Objective To compare survival among patients with head and neck cancer before and after implementing a weekly multidisciplinary clinic and case conference. Methods A retrospective cohort study with chart review was conducted of 3081 patients (1431 preimplementation, 1650 postimplementation) diagnosed with stage I-IVB tumors in the oral cavity, oropharynx, hypopharynx, nasopharynx, or larynx. Pre- and postimplementation differences in overall and disease-specific survival 1, 2, and 3 years after diagnosis were assessed with unadjusted Kaplan-Meier curves and multivariable Cox proportional hazard regression models adjusted for demographic characteristics, comorbidity burden, smoking status, tumor site and stage, p16 status for oropharyngeal squamous cell cancer, and initial treatment modality. Results Patients less commonly presented with oropharyngeal squamous cell cancer and advanced tumors (III-IVB) and received primary treatment with surgery alone or with adjuvant therapy preimplementation than postimplementation. Overall survival at 3 years was 77.1% and 79.9% ( P = .07) and disease-specific survival was 84.9% and 87.5% ( P = .05) among pre- and postimplementation patients, respectively. At 3 years, preimplementation patients had slightly poorer overall (hazard ratio, 1.20; 95% CI, 1.02-1.40) and disease-specific (hazard ratio, 1.26; 95% CI, 1.03-1.54) adjusted survival than postimplementation patients. In unadjusted and adjusted analyses, survival improvements were more pronounced among patients with advanced disease. Discussion A multidisciplinary clinic and case conference were associated with improved outcomes among patients with head and neck cancer, especially those with advanced tumors. Implications for Practice All patients with head and neck cancer should receive multidisciplinary team management, especially those with advanced tumors.

In-human activity and pharmacology of homemade silver nanoparticles in highly refractory metastatic head and neck squamous cell cancer.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17533-e17533
Author(s):  
Jasmine Singh ◽  
Farjana Fattah ◽  
Tam Burks ◽  
Jie Zheng ◽  
Xingya Jiang ◽  
...  
Keyword(s):  
Silver Nanoparticles ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
The Body ◽  
Complete Regression ◽  
Silver Solution

e17533 Background: Silver nanoparticles (SNPs) show high efficacy as targeted therapy against cancer cell lines, but have never been tested in patient clinical trials. We present the first in-human trial of SNPs in a cancer patient with a dramatic outcome. Methods: Homemade SNP solution is prepared by the patient with online instructions. Current from 3 9-volt batteries is passed across 99.99% pure silver-bar electrodes in distilled water, until the metal content of the water measures 0.09-0.15 parts per million. The manufacturer is a 77-year old male who developed multiple recurrences of nasal cavity squamous cell cancer. Over 2 years he progressed on platinum and taxane based-chemotherapy, radiation twice and 2 surgical resections. Large hepatic and pulmonary metastases were observed on PET, MRI and CT; he was initiated on hospice. Without informing his oncologist he subsequently began manufacturing and consuming the SNP solution. Results: The patient ingested 120 ml daily of the solution for 3 months leading to clinical recovery and complete resolution of cancer at all sites, persisting for 18 months. Electron microscopy of the silver solution revealed bimodal SNP size distributions; 3 & 12 nm. Inductively coupled plasma mass spectrometry showed the basal blood silver ion concentrations of 32 ng/g. One hour after ingesting 60 ml of silver solution it rose to 46 ng/g. Urine showed no SNPs. Toxicities were not noted with this silver solution, with no evidence of myelosuppression, liver or kidney abnormalities on repeated testing. The patient underwent reconstructive surgery with excellent wound healing, and his performance status continues to improve. Conclusions: Ingestion of a SNP solution is associated with complete regression of highly refractory head and neck cancer in the absence of other anticancer therapy. Ingesting silver solution causes a noticeable and nearly immediate rise in blood silver concentration. Urinary excretion is not a major path of clearance from the body. Given these dramatic results that may be attributed to SNP in conjunction with strong preclinical data, further patient testing of SNP should be done to confirm its safety and efficacy in head and neck cancer.

Distant metastases in terminal head and neck cancer patients

1997 ◽  
Vol 111 (5) ◽  
pp. 454-458 ◽  
Author(s):  
Yoav P. Talmi ◽  
Daniel Cotlear ◽  
Alexander Waller ◽  
Zeev Horowitz ◽  
Abraham Adunski ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Primary Tumour ◽  
Cell Cancer ◽  
Distant Metastases ◽  
Clinical Series

AbstractWith improved control of cancer above the clavicles, distant metastases (DM) are frequently more seen and are becoming a more common cause of morbidity and mortality. The present study defined the incidence of distant metastases in a cohort of terminal head and neck cancer patients (HNCP) and compared it to current reported data. The incidence of distant metastases in relation to the primary tumour was evaluated and their impact on survival was assessed. A retrospective survey of patient charts was made, based on the hospice database and original referring hospital charts. Data of 59 patients admitted to the hospice were evaluated. The incidence and location of locoregional and distant disease were studied and effects on survival analyzed.The overall survival from diagnosis to demise was 42.7 months. Thyroid cancer was seen in 20.3 per cent of cases and squamous cell cancer was seen in 59.3 per cent. Distant metastases were found in 83 per cent and 48.6 per cent of patients respectively. Laryngeal cancer patients had a 54.5 per cent incidence of distant metastases. Locoregional disease was seen in 47 per cent of cases and 35.7 per cent of them had distant metastases while a 64.3 per cent incidence of distant metastases was found in cases without locoregional disease. Mean survival was 47.3 months with distant metastases vs 36.5 months without metastases. The difference was not statistically significant.The incidence of distant metastases in squamous cell cancer in terminalHNCP was 48.6 per cent. This is the highest reported incidence of metastases in a clinical series. Patients without locoregional disease had almost a two-fold incidence of metastases. Survival was not affected by metastases in this series.

Use of Tumor Markers in the Management of Head and Neck Cancer

2000 ◽  
Vol 15 (2) ◽  
pp. 179-183 ◽  
Author(s):  
G. Rosati ◽  
F. Riccardi ◽  
A. Tucci
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Tumor Markers ◽  
Neck Cancer ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Response To Treatment ◽  
Response To Chemotherapy ◽  
Undifferentiated Tumors

Serologic tumor markers have been evaluated in the diagnosis, management and follow-up of patients with head and neck cancer. However, to the authors’ knowledge no tumor marker has yet been shown to be useful for monitoring the response to chemotherapy in this type of disease, in particular for undifferentiated tumors. The pretreatment levels of CEA, TPA, SCC and ferritin were evaluated in 98 patients with advanced head and neck cancer. Of this group 64 patients were studied sequentially every month during planned chemotherapy and three weeks after treatment using standard commercial kits. The results showed the following sensitivity values: TPA 50%, CEA 36%, SCC 34% and ferritin 19%. The incidence and magnitude of the marker elevations were correlated with the extent of disease. In patients with squamous cell cancer SCC and CEA were elevated (by 68% and 54%, respectively) in tumors with good differentiation (G1), but only by 13% (both markers) in tumors classified as poorly differentiated (G3). CEA, SCC and ferritin serum levels were not correlated with response to chemotherapy, while TPA values correlated with the clinical response to treatment in 100% of patients with undifferentiated cancer and in 75% of those with squamous cell cancer. Our data indicate that in patients with head and neck cancer TPA appears to be a sensitive marker, followed in decreasing order of sensitivity by CEA, SCC and ferritin. However, SCC and CEA seem to be the most suitable markers for squamous cell cancer and in particular for more differentiated tumors (G1). Finally, TPA has proved to be a useful marker for monitoring the response to chemotherapy in patients with head and neck cancer, in particular for undifferentiated tumors.

Genetics of Head and Neck Cancer (Introduction)

1995 ◽  
Vol 112 (5) ◽  
pp. P90-P90
Author(s):  
Michael S. Benninger ◽  
Daniel Vandyke ◽  
Carol Bradford ◽  
Thomas Carey
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Human Cancer ◽  
Cell Cancer ◽  
Genetic Research ◽  
Educational Objectives ◽  
Human Cancers

Educational objectives: To review basic genetics and cytogenetics as they relate to human cancers and head and neck cancer and to become familiar with the basis of genetics of human cancer and successes in molecular and genetic research of squamous cell cancer.

Tumor-Infiltrating Lymphocytes in Patients With Advanced Laryngeal Cancer Undergoing Bioselection

2021 ◽  
pp. 019459982110137
Author(s):  
Molly E. Heft Neal ◽  
Joshua D. Smith ◽  
Andrew C. Birkeland ◽  
Catherine T. Haring ◽  
Steven B. Chinn ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Neck Cancer ◽  
Tertiary Care ◽  
Tumor Infiltrating Lymphocytes ◽  
Care Hospital ◽  
Disease Specific Survival ◽  
Infiltrating Lymphocytes ◽  
Disease Specific

Objective Bioselection to assess tumor response after induction chemotherapy has been introduced as an alternative treatment strategy to total laryngectomy for patients with advanced larynx squamous cell carcinoma (LSCC). Tumor-infiltrating lymphocytes (TILs) have proven to serve as prognostic biomarkers in head and neck cancer but have not been evaluated as a way to select patients for treatment paradigms. The aim of this study is to evaluate the role of pretreatment TILs in patients with advanced LSCC undergoing the bioselection paradigm. Study Design Retrospective study. Setting Tertiary care hospital. Methods Patients with advanced LSCC treated with bioselection and available tissue were included (N = 76). Patients were stratified into CD8-low and CD8-high cohorts by using the median TIL count. Kaplan-Meier survival analysis and multivariate cox regression were performed with SPSS version 26 (IBM). Results After controlling for tobacco use, tumor site, and stage, a high CD8 TIL count was an independent predictor of improved 5-year disease-specific survival (hazard ratio, 0.17 [95% CI, 0.03-0.84]; P = .03). CD8 TIL counts did not predict response to induction chemotherapy; however, subgroup analysis of patients treated with chemoradiation therapy revealed that CD8 TIL count was significantly associated with degree of response ( P = .012). Conclusion These findings support prior data published by our group showing that TILs are predictive of disease-specific survival in patients with head and neck cancer. CD8 TIL counts were significantly associated with degree of clinical response after induction chemotherapy. These results suggest that pretreatment assessment of tumor-infiltrating CD8 cells could be useful in selecting patients.

Multidisciplinary clinic care improves adherence to best practice in head and neck cancer

2013 ◽  
Vol 34 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Stephen L. Kelly ◽  
James E. Jackson ◽  
Brigid E. Hickey ◽  
Frank G. Szallasi ◽  
Craig A. Bond
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Best Practice ◽  
Multidisciplinary Clinic
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