Advanced Head And Neck Cancer Research Articles

DNA repair- and apoptosis-pathways to regulate response to chemo-radiotherapy (CRT) in patients (p) with locally advanced head and neck cancer (HNC).

e17025 Background: Platinum-based CRT is preferred standard of care for locally advanced HNC. However, survival benefit is small, with substantial toxicity and biomarkers of CRT resistance could gu...

Hangeshashinto Improves the Completion Rate of Chemoradiotherapy and the Nutritional Status in Patients with Head and Neck Cancer

Purpose: Severe oral and pharyngeal mucositis is one of the most critical toxicities known to lead to the discontinuation of chemoradiotherapy (CRT) for head and neck cancer (HNC). Hangeshashinto (TJ-14) is a Kampo medicine that relieves chemotherapy-induced oral mucositis. We investigated the effect of TJ-14 on mucositis, nutritional status, and the completion rate of CRT. Methods: The study group comprised patients with advanced HNC who were treated with concomitant weekly cisplatin and 70 Gy of radiotherapy. The primary endpoint was the completion rate of chemotherapy, and the secondary endpoints were the grade of mucositis and the nutritional status. Results: A total of 57 patients were included in this study. The completion rate of CRT among patients who were treated with TJ-14 was 91.4%. There was a significant difference in the completion rate of CRT between the groups treated with and without TJ-14 (p = 0.0452). The reduction in body weight was significantly improved from 10.89 to 5.89% with TJ-14 administration (p = 0.003), and the reduction in serum albumin was also significantly decreased from 17.37 to 8.73%. (p = 0.024). Conclusion: This therapy allowed a high completion rate of CRT as well as significant benefits in terms of nutritional status. We plan to carry out a further large-scale study of TJ-14.

0-7-21 hypofractionated palliative radiotherapy: an effective treatment for advanced head and neck cancers.

We report our experience in providing palliative radiotherapy (RT) to patients with head and neck cancers (HNCs). Our hypofractionated regimen, "0-7-21", treats patients with 24 Gy in three fractions. Patients, disease and response data were retrieved for candidates of 0-7-21 from 2005 to 2012. Primary end points included symptom and tumour size responses to RT based on response evaluation criteria in solid tumours (RECIST) guidelines. Secondary end points included progression-free survival (PFS) within the irradiated field, overall survival (OS) and symptomatic PFS (SPFS), calculated using Kaplan-Meier method and adverse events. Cox proportional hazards regression and logistic regression were used to investigate for prognostic factors. A total of 110 patients were included. Among the patients, 40% and 31% had complete response for symptoms and tumour size, respectively; 42% and 50% had partial response for symptoms and tumour size, respectively; and 15% had stability of symptoms and tumour size. Median 6-month OS was 51%, and PFS within the irradiated field was 39%. Planning target volume was predictive of OS (p < 0.001), PFS (p < 0.001) and SPFS (p < 0.005), while higher TNM stage was associated with poorer tumour response (p = 0.02). 0-7-21 is an effective and well-tolerated palliative RT regimen for patients with HNC. There was excellent symptom and local control with acceptable toxicity profile in these patients. This is the first study to describe the outcomes of 0-7-21 in treating advanced HNCs. The positive results suggest that 0-7-21 provides excellent palliation with minimal toxicity, with significantly less on-treatment time than current published palliative RT regimen.

OC-014: Molecular screening for cancer treatment optimization in head and neck cancer (MOSCATO 01)

OC-014: Molecular screening for cancer treatment optimization in head and neck cancer (MOSCATO 01)

Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises.

Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.

Current Management of Locally Advanced Head and Neck Cancer: The Combination of Chemotherapy With Locoregional Treatments

This review will discuss the evolution of the role of chemotherapy in the treatment of locally advanced head and neck cancer (HNC), over the last few decades. Studies were identified by searching PubMed electronic databases. Surgery followed by radiotherapy (RT) or definitive RT are potentially curative approaches for locally advanced HNC. While chemotherapy itself is not curative, it can improve cure rates when given as an adjunct to RT. The benefit of combining chemotherapy with RT is related to the timing of the chemotherapy. Several prospective randomized trials have demonstrated that concurrent delivery of chemotherapy and RT (CRT) is the most promising approach, given that locoregional recurrence is the leading pattern of failure for patients with locally advanced HNC. Induction chemotherapy before CRT has not been shown to be superior to CRT alone and the added toxicity may negatively impact the compliance with CRT. Sequential chemotherapy administration, in the form of induction chemotherapy followed by RT or CRT, has been successful as a strategy for organ preservation in patients with potentially resectable laryngeal and hypopharyngeal cancer. Systemic chemotherapy delivered concurrently with RT is used as a standard treatment for locally advanced HNC.

Is aspiration as detected on pretreatment video fluorography, a harbinger of poor quality of life and early mortality in cancers of the upper aerodigestive tract treated with radiotherapy?

Background:Patients with cancers of the upper aerodigestive tract (head and neck cancer (HNC)) tend to aspirate, either due to disease or treatment. The association of aspiration (documented on video fluorography (VFG)) with quality of life (QOL) and unexpected mortality was studied prospectively in patients treated with simultaneous integrated boost technique of intensity-modulated radiotherapy (SIB-IMRT).Materials and Methods:Moderately advanced (stage III/IV) HNC were treated by SIB-IMRT delivering 66 Gy/30 fr, 60 Gy/30 fr, and 54 Gy/30 fr to high, intermediate, and low risk volumes, respectively. They underwent serial VFG and QOL assessments (Quality of Life Questionnaire-Core 30 (QLQ-C30) and head and neck-35 (HN35) European Organisation for Research and Treatment of Cancer (EORTC) tools) at 0, 3, and 6 months. Pharyngeal musculature (PM) was additionally delineated on planning computed tomography (CT) scans as potential organs at risk (OARs).Results:Between November 2009 and May 2011, 20 HNC were treated as per protocol. All patients were fit (Karnofsky performance status (KPS) ≥ 80). Based on VFG findings, seven patients (4/9 oropharynx and 3/11 laryngopharynx) were grouped as aspirators (A) and remaining 13 as non-aspirators (NA). The QOL study showed that pretreatment coughing and swallowing difficulties were greater in group A versus NA and remained persistently higher. In group A, deaths attributable to aspiration were seen in 3/7 patients, while none occurred in the NA group (Fisher's exact P = 0.03). The mean PM dose was 60 Gy in both the groups and mean V60 was similar at 69 and 67% in A and NA groups, respectively.Conclusions:VFG helps identify patients who aspirate and are at risk of premature death due to its complications, alerting caregivers to direct attention appropriately.

Usefulness of chest CT scan for head and neck cancer.

Chest computed tomography (CT) is not performed routinely or worldwide as the initial diagnostic procedure for patients with head and neck cancer (HNC). The significance of the chest CT scan for HNC diagnosis has not been thoroughly defined. The present study reports findings in an effort to broaden the acceptance and application of CT for HNC. Using medical records, we assessed initial chest CT scans of the patients with new-onset HNC between April 2004 and March 2010. The results were classified into three groups: nodules ≥ 1 cm, small nodules (< 1 cm) that were indeterminate and normal lungs without nodules. Lung nodules that increased in size and/or number at follow-up were regarded as malignant. First, the sensitivity of X-ray and CT for detection of lung nodules in patients with HNC was compared. Second, the nodules were estimated to be malignant or not malignant by follow-up chest CT. Third, statistical analyses were performed to determine the association between variables and distant lung metastases in patients with head and neck squamous cell carcinoma. In total, 332 patients underwent a chest CT scan as part of the initial examination. Lung nodules were detected on the initial chest CT in 77 patients: in contrast, lung nodules were detected on the initial chest X-ray in only five patients. On initial chest CT scans, lung nodules ≥ 1 cm were observed in 10 patients, small solitary lung nodules were observed in 67 patients, and lungs without nodules were observed in 255 patients. Lung nodules were detected in 77 (23.2%) patients, 25 (32.5%) of whom had malignant lung nodules. Moreover, in 18/67 patients (26.9%), small lung nodules initially classified as indeterminate were determined as malignant at follow-up. However, 30/255 patients (11.8%) without nodules at initial diagnosis developed lung nodules at follow-up. T3 or T4 disease (P = 0.006), N2 or N3 disease (P < 0.001) and stage 3 or 4 disease (P = 0.001) individually and significantly correlated with the development of lung metastases. In addition, lung nodules in initial CT scans (P = 0.004) and other distant metastases (P < 0.001) were significant predictors for the development of lung metastases at follow-up. Initial chest CT scan is recommended for patients with advanced HNC. Further, patients with advanced HNC with or without lung nodules, as detected on initial chest CT scans, should be followed up with additional scanning.

Induction Chemotherapy with Docetaxel, Cisplatin and Fluorouracil (Tpf) in Locally Advanced Head and Neck Cancer–Single Center Retrospective Analysis

ABSTRACT Aim: Background: Most patients with head and neck cancer (HNC) present with locally advanced disease (stage III and IV). For these patients, the prognosis is poor. Recurrence rates range between 40-60% and overall survival (OS) at 5 years is less than 20%. Although induction chemotherapy is not considered standard treatment, it has a role in irresectable tumors or in organ preservation strategy, avoiding total laryngectomy (larynx and hypofarynx cancer). The three drug regimen, adding taxane to cisplatin and fluorouracil backbone, has shown to be superior in terms of OS and progression-free survival (PFS) in several phase III studies. Methods: Retrospective analysis of a consecutive series of patients with a new diagnosis of locally advanced HNC, with no distant metastases, treated with primary chemotherapy with TPF, from May 2010 until December 2013. After 3 cycles, the response was evaluated with a computerized tomography scan. If there was no response the treatment strategy was modified. The primary end point was OS. Survival was calculated with Kaplan-Meier method considering the time difference between the date of death or last observation and the date of the first cycle of TPF. Toxicity was classified according to Common Toxicity Criteria of Adverse Event (Version 3). Results: A total of 143 patients were included, 93,2% were male, with a median age of 52,8 years (35-76 years). Most of the patients presented with stage IVA disease (67,8%), 19,6% with stage IVB and 12,6% with stage III. The median follow-up time was 23 months. The median overall survival was 22,5 months, with an estimated OS at 24 months of 45%. 80,4% of the patients completed 4 cycles of chemotherapy. The response rate was 70,6%, with 9,1% of total responses. Most of the patients (48,3%) were subsequently treated with concomitant chemo-radiotherapy. Mucositis was the most frequent toxicity (9%). Infection (Grade ≥3) was detected in 3,5% of the patients. The rate of death associated with toxic effects or within 30 days of last cycle was 7,6%. Conclusions: Our survival data are comparable with the phase III studies, strengthening the role of induction chemotherapy in locally advanced head and neck cancer. Disclosure: All authors have declared no conflicts of interest.

Efficacy and safety of early G-CSF administration in patients with head and neck cancer treated by docetaxel-cisplatin and 5-fluorouracil (DCF protocol): a retrospective study.

Induction chemotherapy with docetaxel-cisplatin and 5-fluorouracil (DCF) for locally advanced head and neck cancers (HNC) is associated with a high risk of severe neutropenia or febrile neutropenia (FN). We conducted a retrospective study to evaluate the efficacy and safety of administering granulocyte colony-stimulating factor (G-CSF) on day 3 (D3) during chemotherapy (early G-CSF stimulation) versus after the end of chemotherapy, as per current guidelines (i.e., after the end of 5-FU perfusion; D7), and its impact on patient outcomes. Patients ≥19 years old, with advanced HNC who received DCF induction chemotherapy (D and P 75 mg per meter squared (mg/m(2)) on day 1 and 5-FU 750 mg/m(2)/day from D1 to D5), were included in the analysis. Data of 70 patients were analyzed from 01 January 2003 to 01 December 2010. Mean age was 56 years (range 45 to 77 years). Thirty-six patients (51.4 %) received pegfilgrastim on D7, and 28 (40 %) started G-CSF prophylaxis during chemotherapy; 12 (17.1 %) had daily filgrastim and 16 (22.9 %) pegfilgrastim on D3. Overall response rate (ORR) was 89.6 % (three early deaths due to infectious complications; 4.3 %). The 3-year overall survival (OS) rate was 72.8 %. FN rate was 14.3 % and chemotherapy delay was 12.9 %. In the D7 G-CSF arm, incidence of grade 3-4 neutropenia (p = 0.023), FN (p = 0.029), and cycle delays (p = 0.006) was statistically higher than the "early" G-CSF arm. A decrease of OS was observed at 2 years (from 85.1 to 63.5 %) of chemotherapy discontinuation or FN (p = 0.0348). Early administration of G-CSF is safe and seems to be more effective than D7. Future prospective trials are required to confirm our results.

Symptom Burden and Quality of Life in Advanced Head and Neck Cancer Patients: AIIMS Study of 100 Patients.

Aim:Head and neck cancers (HNCa) are the most common cancers among males in India and 70-80% present in advanced stage. The study aims to assess symptom burden and quality of life (QOL) in advanced incurable HNCa patients at presentation.Materials and Methods:One hundred patients were asked to fill EORTC QLQ-C15-PAL questionnaire, which consisted of Global QOL, physical functioning (PF), emotional functioning (EF), fatigue (FA), nausea-vomiting (NV), pain (PA), dyspnea (DY), sleep (SL), appetite (AP), and constipation (CO). Additional questions pertaining to swallowing (SW), hoarseness (HO), cough (CG), weight loss (WL), using pain killers (PK), taste (TA), bleeding (BL), hearing (HE), pain in neck lump (PALMP), opening mouth (OM), and oral secretions (OS) were asked based on a modified EORTC-HN35 questionnaire. Scoring was according to EORTC scoring manual. Mean, median and range were calculated for each item for the entire cohort.Results:The female:male ratio was 17:83.42% of them were ≥60 years of age. Sixty-six patients had T4, 25 had T3, 36 had N2, and 33 had N3 disease. Median QOL was 50 (range 0-83.33) and PF was 77.78 (0-100). Median score for EF and FA was 50. Median score for PA, PK, and SL was 66.67 while that for AP was 33.33. Median value for SW, HO, WL, BL, PALMP, OM, and OS was 33.33 (100-0) while TA, CG, NV, DY, and HE had a median score of 0.00.Conclusion:Advanced HNCa has a significant burden of symptoms. These results would help in giving patients better symptom directed therapies and improve their QOL.

Race and competing mortality in advanced head and neck cancer

Black patients with head and neck cancer (HNC) have poorer survival and disease control compared to non-black patients, but disparities in death from non-cancer causes (i.e., competing mortality) are less well-studied. We conducted an analysis of 538 patients (169 black, 369 non-black) with stage III-IV HNC treated on one of six multi-institutional protocols between 1993 and 2004 involving multi-agent chemoradiotherapy with or without surgery. Competing mortality was defined as death due to intercurrent comorbid disease, treatment-related morbidity, or unknown cause in the absence of disease recurrence, progression, or second malignancy. Cox proportional hazards and competing risks regression were used to estimate the effect of black race on competing mortality. Black race was associated with increased rates of comorbidity, smoking, heavy alcohol use, advanced tumor stage, and poorer performance status (p<.001 for all). Compared to non-black patients, black HNC patients had a higher 5 year cumulative incidence of disease progression (31.4%; 95% CI, 24.4-38.5% vs 23.4%; 95% CI, 19.1-28.1%) and competing mortality (28.1%; 95% CI, 21.2-35.3% vs 14.5%; 95% CI, 11.0-18.5%). When adjusting for age, male sex, body mass index, distance traveled, smoking and alcohol use, performance status, comorbidity, and tumor stage, the black race was associated with death from comorbid disease (Cox hazard ratio 2.13; 95% CI, 1.06-4.28, p=0.033). Black patients with advanced HNC are at increased risk of both disease progression and death from competing non-cancer mortality, particularly death from comorbid disease. Improved strategies to manage comorbid disease may increase the benefit of treatment intensification in black patients.

Volumetric stratification of cT4 stage head and neck cancer.

BackgroundLocoregionally advanced stage head and neck cancer (HNC) is known for unfavorable outcome with only ~ 40–50 % 3-year overall survival (OS). Clinical T4 stage includes a wide range of tumor burden. The lack of further nonsurgical subgrouping of cT4 stage makes intercenter outcome of irradiated cohorts difficult. Aim of this analysis was to further stratify cT4 stage HNC using volumetric staging.Material and methodsBetween January 2002 and January 2013, a total of 201 cT4 stage squamous cell cancer (SCC) HNC patients referred to our center for curative definitive radiation were consecutively irradiated. Radiation was performed using modulated techniques. Total gross tumor volumes (tGTV: primary + nodal tumor volume) of all patients have retrospectively been stratified using a prospectively evaluated volumetric staging system which bases on 3 cut-offs (15/70/130 ml), translating into 4 prognostic subgroups [V1: 1–15 ml (n = 15), V2: 16–70 ml (108), V3: 71–130 ml (62), V4: > 130 ml (16)]. OS, disease-free survival (DFS), locoregional control (LRC), and distant metastasis-free survival (DMFS) rates were calculated.ResultsThe mean/median follow-up was 31/23 months (range 1–116 months). The 3-year OS, DFS, LRC, and DMFS rates of the entire cohort were 63, 44, 48, and 77 %, respectively. Volumetric staging revealed its potential to prognostically statistically significantly divide the cT4 cohort into 4 volume subgroups (V1/2/3/4): OS: 90 %/72 %/58 %/18 %; DFS: 83 %/50 %/39 %/10 %; LRC: 81 %/53 %/47 %/15 %; DMFS: 93 %/90 %/70 %/41 %, all p < 0.0001.ConclusionVolumetric staging allowed a highly statistically significant stratification of cT4 HNC stages into prognostic subgroups, which offers the chance of better intercenter comparability of irradiated advanced stage HNC cohorts.

Postoperative radiotherapy for advanced head and neck cancer in patients with cardiac pacemakers

AbstractThe clinical situation of coexisting significant cardiac arrhythmias complicating head and neck cancer (HNC) is uncommon, accounting for &lt;11% of comorbid illnesses present in this particular cohort of individuals. Little is documented about the outcomes of these people with cardiac pacemakers (CP) when surgery combined with postoperative radiotherapy is rendered. The authors report two cases wherein full-course postoperative irradiation was administered without any patient mishap. Appropriately indicated adjuvant radiotherapy for locally advanced HNC can be conducted safely and effectively in patients with CPs. Implementation of essential precautionary measures is encouraged to avoid any serious, unwanted cardiac events.

Repopulation of tumor cells after neoadjuvant chemotherapy in non-small cell lung cancer and head and neck cancer: A neglected factor.

e18533 Background: Neoadjuvant chemotherapy (NAC) has been widely used to patients with locally advanced Non-Small Cell Lung Cancer (NSCLC) or Head and Neck Cancer(HNC).Less is known about repopulation in human cancer after chemotherapy. It is hypothesized that NAC might be the preceding stimulus to activate the epidermal growth factor receptor (EGFR), which may trigger cellular repopulation. We aim to ananlyze whether NAC could trigger repopulation of surviving cells and evaluate the potential role of EGFR in molecular mechanisms that underlie accelerated repopulation after chemotherapy. Methods: Fifty-two patients with locally advanced NSCLC (28 cases) and HNC(24 cases) were studied. received platinum-based NACImmunohistochemical expressions of ki67 and EGFR were measured from biopsy before NAC and surgical specimens after NAC. Spearman rank correlation analysis and Chi-square test was used to determine whether pretreatment clinicopathological characteristics and time between last day of last chemotherapy and surgery are predictive of tumor cells repopulation. Results: The median duration between the last day of last chemotherapy and surgery was 15 days (range, 1–53 days).Twenty-one (40%) of fifty-two patients showed an increased Ki67 proliferative index PI after chemotherapy.The increased PI were significantly associated with poor clinical response and longer interval between last chemotherapy and surgery. No significant relationship was found between the change of Ki67 and clinicopathological characteristics including the location of the tumor, clinical stage, and histological grade,as well as the change of EGFR expression. A delay greater than 14 days produced greater increases in Ki-67 change ( p =0.028) than lesser delays. Conclusions: Our results suggest that tumor cell repopulation may frequently occur in patients with longer interval,especially greater than 14 days between the last day of last chemotheraoy and surgery. Our results did not suggest a higher EGFR expression lead to increased proliferation.

Cranial Nerves Contouring Among Patients Treated With IMRT for Base of Skull, Nasopharyngeal, and Paranasal Sinus Cancer

Purpose/Objectives: To develop a standardized methodology for cranial nerves IX-XII contouring among patients treated with intensitymodulated radiotherapy (IMRT) for head and neck cancer (HNC). Materials/Methods: Using anatomic texts, radiologic data, and T1/2 magnetic resonance imaging (MRI), a standardized method for delineating the cranial nerves IX-XII on computed tomography (CT) was performed. A neuroradiologist assisted with identification of the cranial nerves IX-XII and adjacent structures (i.e. Midbrain, Pons, and Medulla Oblongata). These organs at risk were then contoured on 5 consecutive patients undergoing IMRT for locally advanced HNC (i.e. base of skull, nasopharyngeal and Paranasal-sinus cancer). Dosevolume histogram (DVH) curves were generated by applying the proposed cranial nerves contour to the initial treatment plan. Due to anatomical nature and proximity of cranial nerves IX, X and XI, they were contoured as one structure while cranial nerve XII was contoured individually. Results: The median total dose to the planning target volume (PTV) was 70 (ranged from 66–70 Gy). The median cranial nerves (IX-XI) and (XII) volumes were 20 cm3 (15–25) and 18 cm3 (15–22) respectively. The median V50, V60, V66, and V70 of the cranial nerves (IX-XI) and (XII) volumes were (85, 77, 71, 65) and (88, 80, 74, 64) respectively. The maximal dose to the cranial nerves (IX-XI) and (XII) were 72 (66–77) and 71 Gy (64–78) respectively. Conclusions: The proposed methodology provides a highly reproducible, defined and standardized way for delineating the cranial nerves IX-XII organ at risk on IMRT based CT planning. Our dosimetric analysis should serve as pilot data for prospective studies for patients undergoing IMRT for HNC to establish a limiting dose for these structures at risk.

Quantitative Assessment of Volumetric Changes Using Fan Beam and Cone Beam Computed Tomography During Head and Neck Image Guided Radiotherapy

Purpose/Objectives: To develop a standardized methodology for cranial nerves IX-XII contouring among patients treated with intensitymodulated radiotherapy (IMRT) for head and neck cancer (HNC). Materials/Methods: Using anatomic texts, radiologic data, and T1/2 magnetic resonance imaging (MRI), a standardized method for delineating the cranial nerves IX-XII on computed tomography (CT) was performed. A neuroradiologist assisted with identification of the cranial nerves IX-XII and adjacent structures (i.e. Midbrain, Pons, and Medulla Oblongata). These organs at risk were then contoured on 5 consecutive patients undergoing IMRT for locally advanced HNC (i.e. base of skull, nasopharyngeal and Paranasal-sinus cancer). Dosevolume histogram (DVH) curves were generated by applying the proposed cranial nerves contour to the initial treatment plan. Due to anatomical nature and proximity of cranial nerves IX, X and XI, they were contoured as one structure while cranial nerve XII was contoured individually. Results: The median total dose to the planning target volume (PTV) was 70 (ranged from 66–70 Gy). The median cranial nerves (IX-XI) and (XII) volumes were 20 cm3 (15–25) and 18 cm3 (15–22) respectively. The median V50, V60, V66, and V70 of the cranial nerves (IX-XI) and (XII) volumes were (85, 77, 71, 65) and (88, 80, 74, 64) respectively. The maximal dose to the cranial nerves (IX-XI) and (XII) were 72 (66–77) and 71 Gy (64–78) respectively. Conclusions: The proposed methodology provides a highly reproducible, defined and standardized way for delineating the cranial nerves IX-XII organ at risk on IMRT based CT planning. Our dosimetric analysis should serve as pilot data for prospective studies for patients undergoing IMRT for HNC to establish a limiting dose for these structures at risk.

Energy intake and sources of nutritional support in patients with head and neck cancer—a randomised longitudinal study

Malnutrition decreases the cancer patient's ability to manage treatment, affects quality of life and survival, and is common among head and neck (HN) cancer patients due to the tumour location and the treatment received. In this study, advanced HN cancer patients were included and followed during 2 years in order to measure their energy intake, choice of energy sources and to assess problems with dysphagia. The main purpose was to explore when and for how long the patients had dysphagia and lost weight due to insufficient intake and if having a PEG (percutaneous endoscopic gastrostomy) in place for enteral nutrition made a difference. One hundred thirty-four patients were included and randomised to either a prophylactic PEG for early enteral feeding or nutritional care according to clinical praxis. At seven time points weight, dysphagia and energy intake (assessed as oral, nutritional supplements, enteral and parenteral) were measured. Both groups lost weight the first six months due to insufficient energy intake and used enteral nutrition as their main intake source; no significant differences between groups were found. Problems with dysphagia were vast during the 6 months. At the 6-, 12- and 24-month follow-ups both groups reached estimated energy requirements and weight loss ceased. Oral intake was the major energy source after 1 year. HN cancer patients need nutritional support and enteral feeding for a long time period during and after treatment due to insufficient energy intake. A prophylactic PEG did not significantly improve the enteral intake probably due to treatment side effects.

The Prognostic Value of Hypoxia-Reoxygenation During Chemoradiation Therapy in Locoregionally Advanced Head-and-Neck Cancer

Hypoxia is a characteristic feature of solid tumors and associated with poor clinical outcomes in advanced head and neck cancer (HNC). The purpose of the study was to evaluate the prognostic value of hypoxia/reoxygenation during chemoradiation therapy in locoregionally advanced HNC patients.

Evaluating the Prognostic Impact of Lean Body Mass on Head-and-Neck Cancer Outcomes

Chemoradiation (CRT) side effects in head and neck cancers (HNC) often result in substantial weight loss. Higher body mass index (BMI) is associated with improved recovery from CRT and survival. Emerging evidence suggests that BMI may be used in conjunction with other body composition indices, including skeletal muscle and visceral adipose loss to individualize nutritional assessment and survival prognostication. This study evaluates the effect of body composition changes on survival in a population-based cohort of patients with locally advanced HNC treated with curative intent.