SPECT/CT-guided elective nodal irradiation for head and neck cancer is oncologically safe and less toxic: A potentially practice-changing approach.
SPECT/CT 引导下头颈部肿瘤选择性淋巴结照射在肿瘤学上是安全的，毒性较小: 一种潜在的改变实践的方法。
- 作者列表："de Veij Mestdagh PD","Walraven I","Vogel WV","Schreuder WH","van Werkhoven E","Carbaat C","Donswijk ML","van den Brekel MWM","Al-Mamgani A
BACKGROUND AND PURPOSE:Bilateral elective nodal irradiation (ENI) remains the standard treatment for head and neck squamous cell carcinoma (HNSCC). Unilateral ENI could reduce treatment toxicity and improve health-related quality-of-life (HRQOL). This prospective proof-of-principle trial (NCT02572661) investigated the feasibility, safety and clinical benefits of SPECT/CT-guided ENI of the node-negative contralateral neck. MATERIALS AND METHODS:Patients with lateralized T1-3N0-2bM0 HNSCC of the oropharynx, oral cavity, larynx and hypopharynx underwent SPECT/CT after peritumoral 99mTc-nanocolloid injection. Patients without contralateral lymph drainage received ipsilateral ENI only. If lymph drainage to only one contralateral hot spot was visible, ENI to the contralateral neck would be limited to only the level containing the hot spot. The primary endpoint was the incidence of contralateral regional failure (CRF) at 2 years. Toxicity and HRQOL were compared with a 1:1 matched historical cohort that received standard bilateral ENI (B-ENI) with identical planning and treatment techniques. RESULTS:Fifty patients were treated with SPECT/CT-guided ENI. After a median follow-up of 33 months (range 18-45), CRF was observed in one patient (2%; 95% confidence interval: 0-6%). Compared to the matched B-ENI group, patients treated with SPECT/CT-guided ENI had significantly lower incidences of grade ≥2 dysphagia (54% vs. 82%; p < 0.001), tube feeding (10% vs. 50%; p < 0.001) and late grade ≥2 xerostomia (9% vs. 54%; p < 0.001). Significant and clinically relevant HRQOL benefits of SPECT/CT-guided ENI were observed on the EORTC QLQ-C30 summary score, and QLQ-HN35 swallowing and dry mouth subscales. CONCLUSION:SPECT/CT-guided ENI is associated with a low risk of contralateral regional failure. Compared to B-ENI, SPECT/CT-guided ENI significantly reduces dysphagia, feeding tube placement, and late xerostomia and improves HRQOL.
背景和目的: 双侧选择性淋巴结照射 (ENI) 仍然是头颈部鳞状细胞癌 (HNSCC) 的标准治疗方法。单侧 ENI 可降低治疗毒性，改善健康相关生活质量 (HRQOL)。本前瞻性原理验证试验 (NCT02572661) 研究了 SPECT/CT 引导下淋巴结阴性对侧颈部 ENI 的可行性、安全性和临床获益。 材料和方法: 经口咽部、口腔、喉及下咽部偏侧 T1-3N0-2bM0 (HNSCC) 患者，瘤周注射 99mtc 纳米胶体后，行 SPECT/ct检查。无对侧淋巴引流的患者仅接受同侧 ENI。如果仅可见到一个对侧热点的淋巴引流，则对侧颈部的 ENI 将仅限于包含热点的水平。主要终点是 2 年时对侧区域衰竭 (CRF) 的发生率。毒性和 HRQOL 与接受标准双侧 ENI (B-ENI) 且计划和治疗技术相同的 1:1 匹配的历史队列进行比较。 结果: 50 例患者接受了 SPECT/CT 引导下 ENI 治疗。中位随访 33 个月 (范围 18-45) 后，1 例患者观察到 CRF (2%; 95% 置信区间: 0-6%)。与匹配的 B-ENI 组相比，接受 SPECT/CT 引导下 ENI 治疗的患者 ≥ 2 级吞咽困难的发生率显著降低 (54% vs. 82%; p < 0.001) 、管饲 (10% vs. 50%; p < 0.001) 和晚期分级 ≥ 2 ° 口干 (9% vs. 54%; p <0.001)。在 EORTC QLQ-C30 汇总评分以及吞咽和口干分量表中观察到 SPECT/CT 引导下 ENI 的显著和临床相关 QLQ-HN35 HRQOL 获益。 结论: SPECT/CT 引导的 ENI 与对侧区域失败的低风险相关。与 B-ENI 相比，SPECT/CT 引导下的 ENI 显著减少吞咽困难、喂养管放置和晚期口干，并改善 HRQOL。
METHODS:INTRODUCTION:Human papillomavirus (HPV) is the most common sexually transmitted infection and is associated with several types of cancer. The number of cases of HPV-associated head and neck squamous cell carcinomas (HNSCCs), especially oropharyngeal carcinomas, has increased significantly in recent years despite decreased tobacco smoking rates. Currently, no data concerning the risk factors and prevalence of HPV in HNSCC patients in all regions of Brazil are available, making it difficult to promote advances in this field of public health. Therefore, our goal is to determine the impact of infection by HPV, including HPVs with different genotypes, on head and neck cancer and the risk factors associated with the development of head and neck cancer in all regions of Brazil. METHODS AND ANALYSIS:This is a case-control study that will include 622 patients and 622 controls from all regions of Brazil. A questionnaire will be applied to gather information on sociodemographic, behavioural and health factors. Oral, cervical or penile/scrotal, and anal specimens and serum samples will be collected from all participants. Formalin-fixed paraffin-embedded tissue from tumour biopsies will be analysed only in the case group. Molecular and serological analyses will be performed to evaluate the presence and role of HPV in the development of head and neck cancer. ETHICS AND DISSEMINATION:This project was approved by the research ethical committee of the proposing institution (Hospital Moinhos de Vento, number 2.852.060). Ethical approval from the collaborators is currently under evaluation and is not yet complete. The results of this study will be presented at meetings with the Brazilian Ministry of Health through technical reports and to the scientific community at national and international events, with subsequent publication of scientific articles.
METHODS:BACKGROUND:Factors related to head and neck cancer and the treatment of the disease can affect quality of life. The aim of this study was to determine factors associated with the severity of impact on oral health-related quality of life (OHRQoL) in survivors of head and neck cancer using a multivariate analysis. METHODS:This cross-sectional study evaluated 90 volunteers who had completed radiotherapy at least 3 months earlier. OHRQoL was assessed using oral health impact profile (OHIP-14) and the data were analyzed using robust variance poisson regression models. RESULTS:The mean total OHIP-14 score was 23.98 ± 12.55. Patients with hyposalivation had 56% higher (worse) mean OHIP-14 total scores (CI:1.11-2.18) and patients with advanced stage tumors had 31% higher mean OHIP-14 total scores (CI:1.03-1.66) in multivariate analyses. CONCLUSION:OHRQoL of survivors of head and neck cancer experienced a negative impact following radiotherapy. The impact was associated with hyposalivation and advanced stage tumors.
METHODS:BACKGROUND:To immunohistochemically evaluate the association between the presence of cancer-associated fibroblasts (CAFs) and the tumour expression of podoplanin (PDPN) in head and neck squamous cell carcinoma (HNSCC) and their association with clinicopathological variables. MATERIAL AND METHODS:A tissue microarray (TMA) with biopsy sections from patients diagnosed with HNSCC was stained with antibodies against the CAFs marker, α-smooth muscle actin (α-SMA), and PDPN. We subsequently evaluated their expression to determine the association between them and with clinicopathological variables including age, primary tumour site, TNM stage, and tumour differentiation grade. RESULTS:Positive reaction to α-SMA was observed in the tumour stroma, revealing spindle-shaped cells compatible with CAFs, which showed a high expression in 62% of cases and a significant association with laryngeal carcinomas, advanced clinical stages, and lower tumour differentiation (P ≤ 0.05). PDPN staining on tumour cells showed low expression in 72% of cases, and it was not associated with any clinicopathological variable or with the presence of CAFs. CONCLUSIONS:The presence of CAFs in the tumour stroma is related to an aggressive phenotype and could increase as the disease progresses, although based on our findings, it would have no relationship, at least directly, with the expression of PDPN.