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Head and Neck Cancer
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Lorcan O’Toole, Nicholas D. Stafford
TNM categories are organized into five groups designated stages based on prognosis (Table 3.3). Staging of HNC is uniform across most anatomical subsites but with important variations for HPV-positive oropharyngeal cancer, nasopharyngeal cancer, and unknown primary cervical nodes.
Big data and comparative effectiveness research in radiation oncology
Published in Jun Deng, Lei Xing, Big Data in Radiation Oncology, 2019
Sunil W. Dutta, Daniel M. Trifiletti, Timothy N. Showalter
The priorities of personalized medicine, which aims to take advantage of the rapid advances in genomics and molecular biology, have been well documented (Council of Advisors on Science and Technology, 2008). In a spatial sense, radiation therapy plans are already personalized in that dose calculations and technical details are patient-specific and customized to patient anatomy and tumor-related factors, similar to surgery. However, there are substantial evidence gaps that limit our ability to define and provide the optimal dose to each patient. For example, recent evidence suggests patients with human papillomavirus (HPV)–positive oropharyngeal cancer can safely receive less than the historically standard radiation dose (i.e., 70 Gy), with high progression-free survival and an improved toxicity profile (Chen et al., 2017). Currently, our field is limited by an inability to add to the evidence basis rapidly for such a clinical scenario in a way that can refine standard of care; the ability to use big data and CER methods to quickly generate evidence on such a specific topic is promising. As our understanding and identification of relevant markers from immunohistochemistry, human genomics, and molecular biology improves, further trials will be warranted to optimize radiation doses.
Applications of Robotics in Head and Neck Practice
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Chris Holsinger, Chafeek Tomeh, Eric M. Genden
In the UK, the PATHOS trial will recruit patients with low and intermediate staged HPV positive oropharyngeal cancer, managed by transoral excision followed by risk stratified radiation therapy. This trial aims to establish whether the de-intensification of adjuvant treatment in patients undergoing TLM/TORS for HPV-positive OPC, by reducing radiation dose or omitting chemotherapy, will confer improved swallowing outcomes at 1-year post-treatment whilst maintaining high cure rates. Thus, the treatment of this disease is rapidly evolving and significant changes can be expected in the next decade. A summary of these trials can be found in a recent review14 TORS has also been shown to have a clear role in resection of supraglottic15, 16 and hypopharyngeal cancers.17–19 A new role has been defined for TORS in diagnosing the unknown primary, using tongue base mucosectomy, where pick-up rates of between 50% and 60% have been demonstrated,20 even in patients who show no avidity on CT-PET imaging.21
Feasibility of p16 surrogate biomarker as adjunct diagnosis of oral and oropharyngeal malignancy in a resource-constrained country
Published in Acta Oto-Laryngologica, 2021
Marlinda Adham, Noval Aldino, Saffanah Zahra, Lisnawati Rachmadi, Saptawati Bardosono
We observed a moderate prevalence of HPV-positive oropharyngeal SCC in this population of Indonesian patients, accompanied by a lower prevalence of HPV-positive oral SCC. Our findings is similar to a review by Shaikh et al. showing HPV-positivity in 40.53% of oropharyngeal cancer patients, and 37.55% in oral cancer patients in Asia Pacific [2]. Our study further confirmed a lower HPV prevalence in an Asian population compared to North American population where HPV-associated oropharyngeal SCC prevalence was 59.9%, but of similar prevalence in Europe for oropharyngeal and oral cancer (39.9 and 26.6%, respectively) [6]. The most common risk factors in head and neck cancer, smoking, alcohol consumption, and oral sex, were also not prominent in this study. It is reported that an increase in oropharyngeal SCC occurred more in economically-developed countries, where it is associated with a change in sexual behaviour related to oral HPV exposure [7]. Whereas in Indonesia, it is still considered taboo to give out information regarding sexual behaviour, therefore the low prevalence of oral sex in this study may not reflect the actual condition. Although our study did not prove correlation between risk factors and HPV status, HPV-positive patients are often of younger age and non-smokers [8]. Additionally, known risk factors for poor prognosis among HPV-positive oropharyngeal cancer patients include smoking, large primary tumours and more advanced nodal disease [9].
Palliative chemotherapy in head and neck cancer: balancing between beneficial and adverse effects
Published in Expert Review of Anticancer Therapy, 2020
Akhil Rajendra, Vanita Noronha, Amit Joshi, Vijay Maruti Patil, Nandini Menon, Kumar Prabhash
There has been a limitation in the development of targeted therapy in HNSCC, as we have not managed to identify clinically relevant targets. With the presentation of KEYNOTE-048, the status of targeted therapies like cetuximab in the first-line setting will need to be clarified. Different subsites in the head and neck region have been historically clubbed together for research purposes as well as while planning therapy. However, different subsites behave differently, and this is potential area to study. There is a lot of interest in possible de-escalation of therapy in HPV-positive oropharyngeal cancer in the definitive setting. In the palliative setting, we still need to understand the optimal therapy for these patients. Immunotherapy is a relatively young therapeutic field and much needs to be further studied. We need to find the most appropriate biomarker that will predict for the response to immunotherapy. Currently, KEYNOTE-048 has established CPS as the standard, yet many centers globally do not yet report CPS. We need long term data on immunotherapy, and we also need to reevaluate our therapeutic strategy in the second line setting, after patients progress on immunotherapy with/without concurrent chemotherapy. Future areas that will be of interest include the use of single agent or combination immunotherapy regimens, the duration of therapy and the development of liquid biopsy in monitoring response to therapy.
Brachytherapy and osteoradionecrosis in patients with base of tongue cancer
Published in Acta Oto-Laryngologica, 2023
Daniel Danielsson, Eva Hagel, Sebastian Dybeck-Udd, Mats Sjöström, Göran Kjeller, Martin Bengtsson, Jahan Abtahi, Mathias von Beckerath, Andreas Thor, Martin Halle, Signe Friesland, Claes Mercke, Anders Westermark, Anders Högmo, Eva Munck-Wikland
The incidence of base of tongue cancer shows a steady and remarkable increase [1,2]. Today about 70% of these tumors are HPV-positive which implies a far better prognosis than the HPV-negative ones [3]. Patients with HPV-positive oropharyngeal cancer tend to be younger, nonsmokers, in overall better health than the traditional head and neck cancer patients and the proportion of cancer survivors increases. These patients also have a better chance of returning to everyday life, so the need to address treatment side effects and quality of life aspects after cancer treatment becomes even more imperative.