What Did the Pandemic Teach Us About Palliative Radiation in Head and Neck Cancer?

Aim: To assess the feasibility and efficacy of palliative radiotherapy dose regimens for patients with locally advanced head and neck cancer. Methods: Fifty patients of previously untreated, inoperable, stage IVA and IVB squamous cell carcinoma of the head and neck, deemed unfit for radical treatment, were included in the study from May 2020 to June 2020. Two palliative radiotherapy regimens were used. First was a single fraction radiation with 8 Gy for patients with limited life expectancy and poor performance status, which was repeated after 4 weeks in case of good symptom relief. The second regimen was used for patients with good performance status and consisted of fractionated radiation with 30 Gy in 10 fractions over 2 weeks, which was followed by supplementary radiation with 25 Gy in 10 fractions over 2 weeks in patients with good symptomatic response at 2 weeks. Symptoms were assessed at baseline and at the end of 4 weeks after treatment completion using the numerical rating score. Patients were followed up for a median of 4.5 months and assessed for symptom control and overall survival. Results: Forty-eight patients completed treatment and were included for analysis. Of the 24 patients who received single fraction radiation, 13 (54.2%) were given the second dose. Improvement in pain and dysphagia were reported in 57.9% and 60% patients, respectively. A total of 55.5% noted decrease in size of the neck node. Twenty-four patients received fractionated radiation and 15 (62.5%) were given the second course after 2 weeks. Relief in pain and dysphagia was reported in 68.2% and 63.6% patients, respectively. There were no grade 3/4 toxicities. Symptom control lasted for at least 3 months in 30% of the patients who received single fraction radiation and 54.2% of the patients who received fractionated radiation. The estimated 6-month overall survival of the entire cohort was 51.4%. Conclusion: Judicious use of palliative radiation in advanced incurable head and neck cancers provides effective and durable symptom relief and should be used after careful consideration of patient prognosis, logistics of treatment, and goals of care.

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Oligometastatic head and neck cancer: Which patients benefit from radical local treatment of all tumour sites?

Radiation Oncology ◽

10.1186/s13014-021-01790-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Thomas Weissmann ◽

Daniel Höfler ◽

Markus Hecht ◽

Sabine Semrau ◽

Marlen Haderlein ◽

...

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Performance Status ◽

Local Treatment ◽

Distant Metastases ◽

Tumour Volume ◽

The Impact ◽

Total Tumour Volume

Abstract Background There is a large lack of evidence for optimal treatment in oligometastatic head and neck cancer and it is especially unclear which patients benefit from radical local treatment of all tumour sites. Methods 40 patients with newly diagnosed oligometastatic head and neck cancer received radical local treatment of all tumour sites from 14.02.2008 to 24.08.2018. Primary endpoint was overall survival. Time to occurrence of new distant metastases and local control were evaluated as secondary endpoints as well as prognostic factors in univariate und multivariate Cox’s regression analysis. To investigate the impact of total tumour volume on survival, all tumour sites were segmented on baseline imaging. Results Radical local treatment included radiotherapy in 90% of patients, surgery in 25% and radiofrequency ablation in 3%. Median overall survival from first diagnosis of oligometastatic disease was 23.0 months, 2-year survival was 48%, 3-year survival was 37%, 4-year survival was 24% and 5-year survival was 16%. Median time to occurrence of new distant metastases was 11.6 months with freedom from new metastases showing a tail pattern after 3 years of follow-up (22% at 3, 4- and 5-years post-treatment). In multivariate analysis, better ECOG status, absence of bone and brain metastases and lower total tumour volume were significantly associated with improved survival, whereas the number of metastases and involved organ sites was not. Conclusions Radical local treatment in oligometastatic head and neck cancer shows promising outcomes and needs to be further pursued. Patients with good performance status, absence of brain and bone metastases and low total tumour volume were identified as optimal candidates for radical local treatment in oligometastatic head and neck cancer and should be considered for selection in future prospective trials.

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Tumour Response After Palliative Radiotherapy: Influence on Head and Neck Cancer Patients Survival

Gazeta Médica ◽

10.29315/gm.v5i3.187 ◽

2018 ◽

Author(s):

Mafalda Cruz ◽

Cláudia Sousa ◽

Leila Khouri ◽

Joana Brandão ◽

Domingos Roda ◽

...

Keyword(s):

Computed Tomography ◽

Overall Survival ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Survival Rates ◽

Tumour Response ◽

Palliative Radiotherapy ◽

Complete Response

INTRODUCTION: Palliative radiotherapy provides improved quality of life in head and neck cancer patients. Little is known regarding the influence of palliative radiotherapy on locoregional control and survival rates. Our objective was to evaluate tumour response after palliative radiotherapy for head and neck cancer patients and its influence on overall survival.MATERIAL AND METHODS: Retrospective study of patients diagnosed with head and neck cancer who completed palliative radiotherapy to primary local-regional sites between January 2014 and December 2016. Tumour response patterns were evaluated following a cervical and chest computed tomography performed 4-6 weeks after the end of the treatment. Differences between groups were compared using ANOVA and Chi-square test.RESULTS: We included 53 patients in our study. Radiotherapy schemes were 50 Gy/20 fr in 35.8% of our patients, 30 Gy/10 fr (32.1%), 37.5 Gy/15 fr (18.9%) and 40 Gy/20 fr (13.2%). A percentage of 61.2% of the patients had a partial response on computed tomography and 10.2% had complete response. After a mean follow-up period of 27.2 months, mean overall survival was 9.55 months (± 9.3). There were no differences in overall survival between the four radiotherapy schemes (p = 0.41). Patients who had better tumour response on computed tomography had a propensity for longer overall survival (p = 0.011).CONCLUSION: There is no consensus regarding the choice of the optimal radiotherapy fractionation scheme used in palliative care of head and neck cancer patients. Patients with advanced incurable head and neck cancer have a poor prognosis but the addition of palliative radiotherapy provides better local-regional control of the disease with the possibility of longer survival rates.

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Swedish National Multicenter Study on Head and Neck Cancer of Unknown Primary: Prognostic Factors and Impact of Treatment on Survival

International Archives of Otorhinolaryngology ◽

10.1055/s-0040-1712106 ◽

2020 ◽

Author(s):

Lars Axelsson ◽

Erik Holmberg ◽

Jan Nyman ◽

Anders Högmo ◽

Helena Sjödin ◽

...

Keyword(s):

Head And Neck Cancer ◽

Prognostic Factors ◽

Head And Neck ◽

Neck Dissection ◽

Neck Cancer ◽

Multicenter Study ◽

Performance Status ◽

Cancer Of Unknown Primary ◽

Unknown Primary ◽

N Stage

Abstract Introduction Head and neck cancer of unknown primary (HNCUP) is a rare condition whose prognostic factors that are significant for survival vary between studies. No randomized treatment study has been performed thus far, and the optimal treatment is not established. Objective The present study aimed to explore various prognostic factors and compare the two main treatments for HNCUP: neck dissection and (chemo) radiation vs primary (chemo) radiation. Methods A national multicenter study was performed with data from the Swedish Head and Neck Cancer Register (SweHNCR) and from the patients' medical records from 2008 to 2012. Results Two-hundred and sixty HNCUP patients were included. The tumors were HPV-positive in 80%. The overall 5-year survival rate of patients treated with curative intent was 71%. Age (p < 0.001), performance status (p= 0.036), and N stage (p= 0.046) were significant factors for overall survival according to the multivariable analysis. Treatment with neck dissection and (chemo) radiation (122 patients) gave an overall 5-year survival of 73%, and treatment with primary (chemo) radiation (87 patients) gave an overall 5-year survival of 71%, with no significant difference in overall or disease-free survival between the 2 groups. Conclusions Age, performance status, and N stage were significant prognostic factors. Treatment with neck dissection and (chemo) radiation and primary (chemo) radiation gave similar survival outcomes. A randomized treatment study that includes quality of life is needed to establish the optimal treatment.

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Single fraction per day versus two fractions per day versus radiochemotherapy in the treatment of head and neck cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/0360-3016(90)90342-h ◽

1990 ◽

Vol 19 (6) ◽

pp. 1347-1350 ◽

Cited By ~ 127

Author(s):

F. Sanchíz ◽

A. Milla ◽

J. Torner ◽

F. Bonet ◽

N. Artola ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Single Fraction

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Which is the most suitable lymph node predictor for overall survival after primary surgery of head and neck cancer: pN, the number or the ratio of positive lymph nodes, or log odds?

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-015-2104-1 ◽

2015 ◽

Vol 142 (4) ◽

pp. 885-893 ◽

Cited By ~ 18

Author(s):

Mehmet Metin Yildiz ◽

Iver Petersen ◽

Ekkehard Eigendorff ◽

Peter Schlattmann ◽

Orlando Guntinas-Lichius

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Head And Neck ◽

Neck Cancer ◽

Primary Surgery ◽

Log Odds ◽

Positive Lymph Nodes

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Bioelectrical impedance phase angle as a prognostic indicator of survival in head-and-neck cancer

Current Oncology ◽

10.3747/co.23.3181 ◽

2016 ◽

Vol 23 (5) ◽

pp. 481 ◽

Cited By ~ 14

Author(s):

M.S. Wladysiuk ◽

R. Mlak ◽

K. Morshed ◽

W. Surtel ◽

A. Brzozowska ◽

...

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Head And Neck ◽

Phase Angle ◽

Neck Cancer ◽

Bioelectrical Impedance ◽

Impedance Analysis ◽

Neck Surgery ◽

Department Head ◽

Nutrition Status

Background Phase angle could be an alternative to subjective global assessment for the assessment of nutrition status in patients with head-and-neck cancer.Methods We prospectively evaluated a cohort of 75 stage iiib and iv head-and-neck patients treated at the Otolaryngology Department, Head and Neck Surgery, Medical University of Lublin, Poland. Bioelectrical impedance analysis was performed in all patients using an analyzer that operated at 50 kHz. The phase angle was calculated as reactance divided by resistance (Xc/R) and expressed in degrees. The Kaplan–Meier method was used to calculate survival.Results Median overall survival in the cohort was 32.0 months. At the time of analysis, 47 deaths had been recorded in the cohort (62.7%). The risk of shortened overall survival was significantly higher in patients whose phase angle was less than 4.733 degrees than in the remaining patients (19.6 months vs. 45 months, p = 0.0489; chi-square: 3.88; hazard ratio: 1.8856; 95% confidence interval: 1.0031 to 3.5446).Conclusions Phase angle might be prognostic of survival in patients with advanced head-and-neck cancer. Further investigation in a larger population is required to confirm our results.

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