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

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.

Beyond race: The impact of ethnicity on the treatment outcome of locally advanced head and neck cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16500-16500
Author(s):  
C. J. Calfa ◽  
M. Escalon ◽  
S. Zafar ◽  
E. Lopez ◽  
V. Patel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Statistical Significance ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Head ◽  
Kaplan Meier ◽  
The Impact

16500 Background: Self identified racial groups share an unequal burden of head and neck cancer . Recent evidence suggests that outcome among races is different and the causes are multifactorial. Nonetheless, differences among ethnic groups have not been reported. Herein, we decided to analyze differences in treatment response and outcome among our white and Hispanic patient population treated for locally advanced head and neck cancer. Methods: Patients were identified using the tumor registry. We reviewed retrospectively the data from medical records. 100 white Hispanics (WH) and 50 white non-Hispanics (WNH) diagnosed with locally advanced head and neck cancer and treated at our institution from 2004 to 2005, were eligible for the study. Standard statistical analysis, including Kaplan-Meier survival curve and Cox proportional hazard models were used. P value of <0.05 was considered for statistical significance. Results: Preliminary results reveal that, in our study population, median age at diagnosis, gender, performance status (ECOG 0–2) and squamous cell histology did not differ significantly between the two groups. Stage 4 at diagnosis was more commonly observed in Hispanics as opposed to WNH (85.7% vs 68.6%) (P = 0.1). Surgery was more commonly used as an initial treatment option in Hispanics than WNH (42.8% vs 28.6%) (P = 0.18) while chemotherapy was less likely to be used (78.6% vs. 91.4%) (P = 0.15). Hispanics were more likely to smoke than WNH (P = 0.0003) and were equally exposed to chronic alcohol use. Patients from the Hispanic group were more likely to respond to therapy than whites by Chi-squared analysis but this difference was not statistically significant (P = 0.09). No differences were seen in disease free survival. Kaplan-Meier estimate of median overall survival was 16 months for Hispanics vs. 25 months for whites but this difference did not reach statistical significance (P = 0.26). Final analysis will be available at the time of the annual meeting. Conclusion: In our experience, a trend for decrease overall survival was noted in the Hispanic ethnic group. This may be in part due to more advanced stage at presentation. Nonetheless, in order to definitively answer this question, further research is warranted. No significant financial relationships to disclose.

The impact of medical comorbidities on the quality of care for patients with head and neck cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e16030-e16030
Author(s):  
Brenda Ernst ◽  
Mary T Busowski ◽  
Randal S. Weber ◽  
Thomas D. Shellenberger
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Quality Indicators ◽  
Neck Cancer ◽  
Combined Modality Therapy ◽  
Performance Status ◽  
Care Quality ◽  
Chronic Obstructive ◽  
Medical Comorbidities ◽  
The Impact

e16030 Background: Objectively assessing the treatment of patients with cancer offers a basis for raising the standard of care. Quality indicators provide criteria by which the safety of care can be measured and compared to defined benchmarks. However, variables influencing the metrics in quality can limit generalizability and applicability. Medical comorbidities pose significant threats to the care of patients with head and neck cancer. We sought to investigate the impact of medical comorbidities on quality indicators for patients undergoing management by the multidisciplinary team. Methods: Comorbidities were assessed in relation to quality indicators in 49 patients treated for squamous cell carcinoma of the head and neck over a 16-month period. Treatment with surgery, radiation, and chemotherapy was classified by the number and type of modalities delivered. Surgical procedures were stratified by high and low acuity as defined by extent. By univariate and multivariate analysis, medical comorbidities were correlated with length of hospital stay, readmission within 30 days, return to the operating room within 7 days, 30-day mortality, use of blood products, and surgical site infection. Results: Cardiovascular disease was present in 49% of patients, diabetes mellitus in 12%, liver disease in 8%, previous congestive heart failure in 4%, and chronic obstructive pulmonary disease in 17%. The presence of any single comorbidity was correlated with each of the negative indicators (p<0.05), and with multiple negative indicators (p<0.05). Comorbidities occurred more frequently in patients undergoing high acuity surgery (p<0.05) and combined modality therapy (p<0.05). Decreasing performance status and major clinical predictors were the factors most strongly associated with negative quality indicators. Conclusions: Approaches to adjust for comorbid status are critical to accurate assessment of quality indicators. Risk stratification of patients at initial evaluation can offer valuable criteria for selecting treatment. Evaluation and management of comorbidities by evidence-based guidelines may improve care.

Which role plays specialized palliative care in patients with relapsed and/or metastatic head and neck cancer? A retrospective analysis in Southern Switzerland.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17503-e17503
Author(s):  
Vittoria G. Espeli ◽  
Claudia Gamondi ◽  
Tanja Fusi-Schmidhauser
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Unknown Primary ◽  
Early Palliative Care ◽  
Significant Difference ◽  
Specialized Palliative Care ◽  
The Impact

e17503 Background: early palliative care (PC) for patients with advanced cancer improves quality of life, promotes home deaths and can improve survival. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. To investigate the effect of introducing specialized PC in patients with relapsed and/or metastatic head and neck cancer. Methods: between October 2010 and December 2018, the medical charts of all patients treated in the Oncology Institute of Southern Switzerland with relapsed and/or metastatic HNC were reviewed. Site, status of disease (metastatic at diagnosis, locally or metastatic relapsed), type and lines of treatment, treatment response and referral to specialist palliative care (yes or no) were documented. Comparisons were made between patients referred and non-referred to PC. Results: sixty-two patients with relapsed/metastatic HNC were identified, 32 (51.6%) of which were referred to specialized PC. Patients were mainly men (47, 75.8%), with a median age of 66 years (range 43 – 86). Forty-two patients (67.7%) had a metastatic disease and the most common site of tumor was the oropharynx (35.5%), followed by oral cavity (32.3%), larynx (16.1%), hypopharynx (12.9%), and unknown primary (3.2%). Forty-eight patients (77.4%) were treated with systemic treatment (75% in the PC group and 80% in the non-PC group, p = 0.638). The median overall survival was 8.1 months for all patients, 8 months for the PC group and 8.7 months for the non-PC group, without significant difference (p = 0.440). Of the deceased patients, 70% of the PC group and 73.3% of the non-PC group received chemotherapy in the last three months of life. A greater percentage of patients in the PC group died at home, but without significant difference (39.2% vs. 19%, p = 0.134). Conclusions: only half of the patient had access to specialized PC. Whereas it did not seem to affect overall survival nor influence chemotherapy prescription, it seemed to favor home deaths. Further studies investigating the impact of early PC in recurrent and/or metastatic HNC are needed to improve access to PC and maximize benefits.

scholarly journals The Impact of COVID-19 on Head and Neck Cancer Treatment: Before and During the Pandemic

OTO Open ◽  
2021 ◽  
Vol 5 (4) ◽  
pp. 2473974X2110680
Author(s):  
Roberto N. Solis ◽  
Mehrnaz Mehrzad ◽  
Samya Faiq ◽  
Roberto P. Frusciante ◽  
Harveen K. Sekhon ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Care Center ◽  
Tertiary Care ◽  
Distant Metastases ◽  
Newly Diagnosed ◽  
Duration Of Symptoms ◽  
Time To Diagnosis ◽  
The Impact

Objectives To describe the impact that the coronavirus disease 2019 (COVID-19) pandemic had on the presentation of patients with head and neck cancer in a single tertiary care center. Study Design Retrospective cohort study. Setting Academic institution. Methods We performed a retrospective review of patients with newly diagnosed head and neck squamous cell carcinoma (HNSCC) who presented as new patients between September 10, 2019, and September 11, 2020. Patients presenting during the 6 months leading up to the announcement of the pandemic (pre–COVID-19 period) on March 11, 2020, were compared to those presenting during the first 6 months of the pandemic (COVID-19 period). Demographics, time to diagnosis and treatment, and tumor characteristics were analyzed. Results There were a total of 137 patients analyzed with newly diagnosed malignancies. There were 22% fewer patients evaluated during the COVID-19 timeframe. The groups were similar in demographics, duration of symptoms, time to diagnosis, time to surgery, extent of surgery, and adjuvant therapy. There was a larger proportion of tumors classified as T3/T4 (61.7%) in the COVID-19 period vs the pre–COVID-19 period (40.3%) ( P = .024), as well as a larger median tumor size during the COVID-19 period ( P = .0002). There were no differences between nodal disease burden ( P = .48) and distant metastases ( P = .42). Conclusion Despite similar characteristics, time to diagnosis, and surgery, our findings suggest that there was an increase in primary tumor burden in patients with HNSCC during the early COVID-19 pandemic.

Correlation of body mass index with toxicity and survival in locoregionally advanced head and neck cancer patients treated with induction chemotherapy and concurrent chemoradiotherapy

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6074-6074
Author(s):  
A. K. Jain ◽  
J. K. Salama ◽  
K. M. Stenson ◽  
E. Blair ◽  
E. E. Cohen ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Body Mass ◽  
Neck Cancer ◽  
Concurrent Chemoradiotherapy ◽  
Advanced Head ◽  
Pre Treatment ◽  
The Impact

6074 Background: Concurrent chemoradiotherapy (CRT) offers high functional organ preservation rates for locoregionally advanced head and neck cancer (LRAHNC) patients, but is associated with significant acute and chronic speech and swallowing toxicity. Recently, body mass index (BMI) has been suggested as a predictor of head and neck cancer patient outcome. In this analysis we sought to determine the impact of BMI on survival and toxicity outcomes in LRAHNC patients treated with CRT. Methods: 220 LRAHNC patients were treated on a multiinstitutional protocol consisting of induction carboplatin and paclitaxel followed by CRT. CRT was delivered for 4–5 cycles; each 14-day cycle consisted of 5 days concurrent paclitaxel, continuous infusion 5-FU, hydroxyurea, and 1.5 Gy twice daily radiation followed by 9 days without any treatment. Each patient's pre-treatment BMI was classified as overweight (BMI >= 25) or non-overweight (BMI < 25). As an independent variable, BMI was analyzed as a predictor of IndCT or CRT toxicity, locoregional control, and overall survival. BMI was analyzed as categorical variable, and also a continuous variable in a multivariate proportional hazards model. Results: There was no association between BMI and IndCT toxicity. During CRT overweight patients had significantly lower rates (24/103 vs 42/112) of grade 3 or higher neutropenia (p = 0.027), mucositis (p = 0.05), dermatitis (p = 0.028) and higher rates of anorexia (p = 0.05). Overweight patients had 12% long term PEG tube rate, compared to 34% of non-overweight patients (p < 0.001). On pooled survival analysis, patients with BMI > 25 had significantly better overall survival outcomes (mean 81.2 months, 95% CI 75.1–87.3 months) than patients with BMI < 25 (median 58.2 months; mean 56.5 months, 95% CI 49.6–63.3 months) (log-rank p < 0.001). Conclusions: Our data suggest patients with pre-treatment BMI > 25 experience lower rates of toxicity commonly associated with chemoradiation, and have a significantly better prognosis than patients with BMI < 25. Although the mechanism of BMI as an independent predictor of outcomes is unclear, we are continuing to explore mechanisms underlying this association. No significant financial relationships to disclose.

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

2021 ◽  
pp. 082585972110656
Author(s):  
Sushmita Ghoshal ◽  
Aditya Kumar Singla ◽  
Nagarjun Ballari ◽  
Ankita Gupta
Keyword(s):  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Performance Status ◽  
Symptom Relief ◽  
Symptom Control ◽  
Palliative Radiotherapy ◽  
Single Fraction ◽  
Fractionated Radiation

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.

Lack of evidence for a role of chemotherapy in the routine management of locally advanced head and neck cancer.

1986 ◽  
Vol 4 (7) ◽  
pp. 1121-1126 ◽  
Author(s):  
I F Tannock ◽  
G Browman
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Performance Status ◽  
Locally Advanced ◽  
Local Treatment ◽  
Poor Performance ◽  
High Rate ◽  
Poor Performance Status ◽  
Pilot Studies

Numerous single-arm studies have shown that chemotherapy may produce a high rate of response and rapid shrinkage of tumor when used before radiation and/or surgery in patients with squamous-cell carcinoma of the head and neck. Despite this high rate of tumor response, randomized controlled trials do not indicate any consistent improvement in survival for patients receiving chemotherapy as compared with patients receiving local treatment alone. This population of patients often has poor performance status, and chemotherapy invariable adds some toxicity. Also, studies in animals suggest that some types of chemotherapy given before local radiation or surgery might increase the probability of distant metastases. Apart from pilot studies of feasibility, all future trials of chemotherapy should involve a randomized comparison with a group of patients receiving radiation and/or surgery alone. At present, chemotherapy has no place in the routine management of primary head and neck cancer.

scholarly journals Novel Prognostic Score for Recurrent or Metastatic Head and Neck Cancer Patients treated with Nivolumab: Japanese Multi-Institutional Cohort Study

2021 ◽  
Author(s):  
Kiyoshi Minohara ◽  
Takuma Matoba ◽  
Daisuke Kawakita ◽  
Gaku Takano ◽  
Keisuke Oguri ◽  
...  
Keyword(s):  
Cohort Study ◽  
Head And Neck Cancer ◽  
Prognostic Factors ◽  
Head And Neck ◽  
Neck Cancer ◽  
Prognostic Score ◽  
Performance Status ◽  
Glasgow Prognostic Score ◽  
Individual Treatment ◽  
The Impact

Abstract Although several prognostic factors in nivolumab therapy have been reported in patients with recurrent or metastatic head and neck cancer (RM-HNC), these factors remain controversial. Here, we conducted a multicenter retrospective cohort study to investigate the impact of clinico-hematological factors on survival in RM-HNC patients treated with nivolumab. We retrospectively reviewed 126 RM-HNC patients from seven institutes. We evaluated the prognostic effects of clinico-hematological factors on survival using Cox proportional hazard models. The median overall survival (OS) was 12.3 months, and the 1 year-OS rate was 51.2 %. Patients without immune-related adverse events, lower relative eosinophil count, worse best overall response, higher performance status, and higher modified Glasgow Prognostic Score had significantly worse survival rates. The prognostic score, generated by combining these significantly worse prognostic factors, was more closely associated with prognosis than each factor (p for trend<0.001). Our novel prognostic score utilizing clinico-hematological factors might be useful to establish an individual treatment strategy in patients with RM-HNC treated with nivolumab therapy.

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