UNRESECTABLE HEAD AND NECK CARCINOMAS

Introduction: Cancers of the head and neck are estimated to be the most prevalent cancers in the world. Data from various cancer centers of Pakistan reveal that epithelial head and neck cancer is one of the most frequent cancers varying from 12 to 25% of the total new patients seenannually. Objectives: To see the effect of concomitant chemo-radiotherapy on the survival of patient, to assess the toxicity of different treatment arms and the effect of age, sex and bulk or tumour on survival and compare the literature. Setting: Radiotherapy Department, Nishtar Hospital, Multan. Duration: 2 years. Material and Methods: Sample Size: 200 patients. Results: Out of 130 patients, 83 were males and theremaining 47 were females. The male to female ratio being 1.8:1. The mean age of the patients included in the study was 52 years, range being 22-80 years. The patients of head and neck cancer in the trial had different sites of involvement. In the trial the patients presented with various symptoms such as pain, swelling, ulcer, bleeding, dysphagia, dyspnea, hoarseness of voice and nasal obstruction etc. No patient had early stage disease. All the patients in the trial had the experience of nausea and vomiting, it was more marked in patients having radiotherapy; either alone or in concomitant with chemotherapy. The patients having concomitant chemo-radiotherapy i.e. group-C also had diarrhoea as a side effect. The effect on the liver function test was more pronounced in patients of group-A. The renal function was seen to alter more in patients receiving chemotherapy with cisplatin, whether as induction or as a concomitant to radiotherapy. Conclusion: Concomitant chemo-radiotherapy in locally advanced, unresectable head and neck carcinoma is statistically superior to induction chemotherapy followed by radiotherapy and the standard radiotherapy alone.

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Postoperative Radiotherapy in Head and Neck Cancer

Otorhinolaryngology Clinics - An International Journal ◽

10.5005/jp-journals-10003-1016 ◽

2010 ◽

Vol 2 (1) ◽

pp. 43-51

Author(s):

Vedang Murthy ◽

Sayan Kundu ◽

Tanweer Shahid ◽

Ashwini Budrukkar ◽

Tejpal Gupta ◽

...

Keyword(s):

Head And Neck Cancer ◽

Targeted Therapy ◽

Head And Neck ◽

Neck Cancer ◽

Early Stage ◽

Postoperative Radiotherapy ◽

Locally Advanced ◽

Head And Neck Cancers ◽

Advanced Head ◽

Locoregional Failure

Abstract Though early stage head and neck cancers can be cured either by surgery or radiation, patients with locally advanced disease continues to pose a therapeutic challenge. Locoregional failure is the major cause of death in head and neck cancers. As the outcome of locally advanced head and neck cancer is less than promising, a combined modality approach is generally undertaken in this group of patients. The combination of surgery, radiation and more recently, chemotherapy and targeted therapy can improve outcomes in locally advanced head and neck cancer patients. This overview discusses the rationale and role of postoperative radiotherapy (PORT) in advanced head and neck cancers, the radiotherapy technique in brief and methods of enhancing the efficacy of postoperative RT by altering the fractionation schedules and adding chemotherapy and targeted therapy.

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The Effectiveness and Safety of Metronomic Chemotherapy in Patients with Head and Neck Carcinoma: A Systematic Review and Meta-analysis

10.21203/rs.3.rs-742254/v1 ◽

2021 ◽

Author(s):

Xingli Li ◽

Jianjian Wang ◽

Ting Zhang ◽

Jiabin Wang ◽

Zhangcai Zheng ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Meta Analysis ◽

Metronomic Chemotherapy ◽

Head And Neck Carcinoma ◽

Randomized Control Trials ◽

Neck Carcinoma ◽

Significant Difference ◽

Randomized Control

Abstract Background: Head and neck carcinoma, usually begins in the squamous cells, not only seriously endangers the quality of life, but brings a heavy financial burden for families and countries. Metronomic chemotherapy, a frequent administration of chemotherapeutic agents at a non-toxic dose, gives an alternative low-cost and tolerated approach for patients. We conducted a systematic review to find the effectiveness and safety of metronomic chemotherapy for head and neck cancer.Methods: We searched seven databases and Clinical.gov from the inception to July 14, 2021. The patients diagnosed head and neck cancer and older than 18 were included. Metronomic chemotherapy was defined as intervention. Randomized and non-randomized trials were all included. Quality assessment of included randomized control trials was performed using the Cochrane Risk-of-Bias criteria, cohort studies using The Newcastle-Ottawa Scale (NOS), single arm trials using the checklist recommended by The Agency for Healthcare Research and Quality (AHRQ). Studies were synthetized using a narrative approach. The indicators used for meta-analysis was hazard ratio (HR).Results: 310 Literatures were potentially eligible from 7 databases, finally 13 records were included. Five studies were of high quality, while eight were of moderate quality. The overall effect of HR for death of five trials reported had no statistically significant (HR=0.89, 95%CI 0.71-1.10). Subgroup analysis by different design showed a statistically significant HR (0.73, 95%CI 0.60-0.90) in randomized control trials while no significant difference in subgroup of prospective study design (HR=1.23, 95%CI 0.72-2.10). As for HR for PFS, there was no significant difference in overall effect of four studies. HR for PFS was 0.84 (95%CI 0.55-1.31). Subgroup analysis of study design showed that randomized control trials produced a significant HR (0.54, 95%CI 0.45-0.64), while prospective studies did not (1.25, 95%CI 0.73, 2.14).Conclusions: Metronomic chemotherapy has been an optimistic option for treatment for advanced head and neck cancer, especially in low income and medical resource-restricted regions.

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Treatment outcome of postoperative radiotherapy for squamous cell carcinoma of the head and neck

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175612 ◽

2017 ◽

Vol 4 (1) ◽

pp. 127

Author(s):

H. U. Ghori ◽

M. Sohaib ◽

Vivek Tiwari ◽

Manish Ahirwar

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Early Stage ◽

Postoperative Radiotherapy ◽

Locally Advanced ◽

Disease Status ◽

Patient Characteristics ◽

Neck Tumors ◽

Modality Approach

Background: Though early stage malignancy of head and neck can be cured by surgery or radiotherapy, cure of patients with locally advanced disease continues to pose a therapeutic challenge. Loco regional failure is the major cause of death in head and neck cancer. As the cure of locally advance head and neck cancer is less than expectation, a combined modality approach is generally used in these type of patients. The combination of surgery, radiotherapy and chemotherapy can improve outcome in locally advance head and neck cancer.Methods: This observational study reviewed cancer patients reported in our hospital with the following inclusion criteria: primary head and neck cancer, treatment with radical surgery, and multiple nodal metastases. The prescribed dose of postoperative radiotherapy was 60–66 Gy. Patient characteristics, treatment parameters and clinical outcome were recorded. Results: The primary end point was overall survival, and the secondary endpoint was disease status.Conclusions: Concurrent postoperative administration of chemotherapy and radiotherapy is a way to intensify treatment for resectable high-risk head and neck tumors.

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“CLINICALASSESSMENT OF TREATMENT RELATED TOXICITY AND RESPONSE BY CONCOMITANT CHEMORADIATION THERAPY IN LOCALLY ADVANCED HEAD AND NECK CARCINOMA”

10.36106/ijsr/0902974 ◽

2021 ◽

pp. 79-81

Author(s):

Swapan Kumar Mallick ◽

Rinki Saha

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Treatment Options ◽

Locally Advanced ◽

Stage Iv ◽

Head And Neck Carcinoma ◽

Complete Response ◽

Advanced Head

Introduction: Head and neck cancer is the commonest malignancy in India. Most of the cases present are at a locally advanced stage. Concurrent chemo radiotherapy is one of the treatment options in locally advanced Head & Neck Cancer patients. Materials & Methods: Locally advanced head and neck cancer patients attending the Out Patient Department of Radiotherapy from May 2018 to February 2020. Patients were treated with concurrent chemoradiation and followed for a minimum period of 9 months. Results: On analysing the pattern of response, it was noted that, in the chemoradiation complete response was seen in 20 patients (66.66%), partial response in 6 patients (20%), stable disease in 2 patients (6.66%) and progressive disease in 1 patient (3.33%). In our study, complete Response in case of Stage III was seen in 18 patients and other form of response was seen in 3 patients . In case of Stage IV A and IV B , Complete Response in 2 patients and other form of response was in 6 patients respectively. Haematological toxicities like neutropenia (3.3%), thrombocytopenia (0%) and anaemia (3.3%) were seen. Acute toxicities like oral mucositis and skin reaction were observed 10% in both the cases. Conclusions: The present study, Concomitant chemoradiotherapy improved overall survival and locoregional control. Preservation of function is a major endpoint of interest.

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Micro-RNA Profiling as a Predictor of Clinical Outcomes for Head and Neck Cancer Patients

Current Pharmaceutical Design ◽

10.2174/1381612823666170601100633 ◽

2017 ◽

Vol 23 (32) ◽

pp. 4729-4744 ◽

Cited By ~ 1

Author(s):

Tatyana Isayeva ◽

Margaret Brandwein-Gensler ◽

Maheshika Somarathna ◽

Lakisha D. Moore-Smith ◽

Timmy Lee

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Advanced Disease ◽

Early Stage ◽

Locally Advanced ◽

Micro Rna ◽

Treatment Modalities ◽

Survival Outcomes ◽

Recurrence Rates

Head and neck cancer is one of the leading malignancies worldwide. Due to the lack of symptoms in the early stage of the disease, about two thirds of patients present with locally advanced disease at the time of diagnosis. Even with significantly improved survival rates over the past two decades due to advanced imaging and treatment modalities, locoregional recurrence rates in patients with advanced disease ranges from 16% to 35%. Alternative therapeutic targets are being developed to improve survival outcomes. MicroRNAs (miRNA or miRs) are a family of small non-coding RNA species that have been demonstrated to regulate all cellular, physiological and developmental processes. Recently, there has been an exponential increase in the number of studies suggesting that miRNA is involved in regulating tumor metastasis, chemoresistance, radioresistance and survival outcomes. MiRNA candidates have been identified as potential prognostic biomarkers to diagnose cancer stages and progression, as well as to monitor follow-up treatment. In this review, we will discuss the miRNA profile in each stage of head and neck patients' therapy, with an emphasis on its application to clinical outcome prognosis.

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The Effect of Increasing Two-Week Wait Referrals for Head and Neck Cancer in East Kent

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363511x576164 ◽

2011 ◽

Vol 93 (6) ◽

pp. 217-220 ◽

Cited By ~ 4

Author(s):

S Haikel ◽

N Dawe ◽

G Lekakis ◽

M Black ◽

D Mitchell

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Late Stage ◽

Early Stage ◽

White Paper ◽

Early Stage Disease ◽

Stage Disease ◽

Late Stage Disease ◽

The Uk

In 1998 the UK government published its white paper The New NHS: Modern and Dependable, in which it first suggested that patients being referred with a suspicion of cancer should have a maximum wait of two weeks to see a specialist. The rationale for this was that outcomes for late-stage disease are significantly worse when compared with outcomes for early-stage disease (Table 1). It was assumed that reducing the wait to see a specialist would reduce the stage of disease at presentation.

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Second malignancy post-chemoradiation in head and neck cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e18525 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e18525-e18525

Author(s):

Gunjesh Kumar Singh ◽

Rohit Swami ◽

Vijay Maruti Patil ◽

Vanita Noronha ◽

Amit Joshi ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Locally Advanced ◽

Rank Test ◽

P Value ◽

Second Malignancy ◽

Continuous Variables ◽

Early Stage Disease

e18525 Background: There is limited data available in the literature regarding incidence and treatment of second malignancy post-chemo-radiation (CTRT) in head and neck cancer patients. Hence we planned this analysis to address this lacuna in the current literature. Methods: We have already published a randomized study of 536 head and neck cancer patients, comparing radical CTRT with weekly cisplatin with or without nimotuzumab. The database of this study was used for the current analysis. Data regarding occurrence, site, stage, treatment details and outcomes were extracted from the database. Continuous variables were expressed in terms of the median with range, while non-continuous variables were reported in percentage. Kaplan Meier method was used for estimating the overall survival (OS). Results: Out of 536 patients, 18 (3.35%) patients developed second malignancy. The most common site was head and neck (44.44%) followed by lung (27.77%), prostate, ovary, breast, gallbladder and thyroid. 16/18 (88.88%) patients developed metachronous, while 2/18 (11.11%) had synchronous second malignancy. Most of the patients (55.55%) presented with locally advanced and metastatic disease, while 44.44% of patients had early-stage disease. 8/18 (44.44%) patients received palliative treatment. Of these, 6/18 (33.33%) patients received best supportive care and 2/18 (11.11%) patients were given palliative chemotherapy and palliative radiotherapy. 10/18 (55.55%) patients received radical treatment in the form of radical surgery (22.22%), CTRT (11.11%) and radical radiotherapy (5.55%), while 16.66% patients were kept under observation only. The median OS after the diagnosis of second malignancy was 451 days (95% CI, 301.45-600.59). It was seen that median OS the diagnosis of second malignancy in the aerodigestive and non-aerodigestive system was 446 days (95% CI, 39.10 - 852.89) and 840 days (95% CI, 278.46 - 1401.53), log-rank test P-value = 0.24. Conclusions: Second malignancy is not an uncommon phenomenon in head and neck cancer patients after CTRT and if properly taken care of, the improved outcome can be expected.

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