Head And Neck Cancer Treatment Research Articles

Impact of radiotherapy for head and neck cancer on obstructive sleep apnea: a prospective study.

In recent years, a relatively high prevalence of obstructive sleep apnea (OSA) in patients following radiotherapy (RT) for head and neck cancer (HNC) has been reported; however, little is known regarding the impact of RT on sleep disorders and the underlying mechanisms. This aim of this study was to elucidate the pathogenesis of OSA by comparing the clinical and sleep test parameters and magnetic resonance imaging (MRI) findings before and after HNC treatment with radiation. This prospective study included patients scheduled for RT with or without chemotherapy or bioradiotherapy for HNC. Patients diagnosed with HNC between May 2017 and August 2020 were consecutively recruited. The results of the sleep tests were analyzed both before and after treatment. The clinical characteristics of the patients and cephalometric and MRI parameters were also measured. First, a total of 32 patients (64.8±11.8 years old; BMI, 22.7±3.6 kg/m2) underwent pre-treatment sleep tests. The prevalence of OSA [apnea hypopnea index (AHI) ≥5] in these patients was 81.3% (26 patients) before treatment, and the mean AHI was 20.8±19.0 events/hr. Next, 21 patients performed a sleep test both before and after treatment. Regarding subjective symptoms, there were no significant differences in the Epworth Sleepiness Scale (ESS) (P=0.142) or Pittsburgh Sleep Quality Index (PSQI) (P=0.935) after treatment; however, the BMI and neck circumference significantly decreased after treatment (P<0.0001 and P=0.0001, respectively). The incidence of OSA in these patients was 81.0% (17 patients) before treatment and 85.7% (19 patients) after treatment (P=1.0). Overall, the AHI was not significantly different, changing only from 14.5 to 14.9 after treatment (P=0.147). The MRI parameters showed that the retroglossal pharyngeal area increased significantly after treatment (P=0.007). This study found that the prevalence of OSA before and after RT for HNC was higher than that in the normal population, despite a significant decrease in BMI and increase in the retroglossal pharyngeal area after treatment. We suggest that physicians who manage patients with HNC should consider the occurrence of OSA before and after treatment.

Regulation of VEGFA, KRAS, and NFE2L2 Oncogenes by MicroRNAs in Head and Neck Cancer.

Mutations and alterations in the expression of VEGFA, KRAS, and NFE2L2 oncogenes play a key role in cancer initiation and progression. These genes are enrolled not only in cell proliferation control, but also in angiogenesis, drug resistance, metastasis, and survival of tumor cells. MicroRNAs (miRNAs) are small, non-coding regulatory RNA molecules that can regulate post-transcriptional expression of multiple target genes. We aimed to investigate if miRNAs hsa-miR-17-5p, hsa-miR-140-5p, and hsa-miR-874-3p could interfere in VEGFA, KRAS, and NFE2L2 expression in cell lines derived from head and neck cancer (HNC). FADU (pharyngeal cancer) and HN13 (oral cavity cancer) cell lines were transfected with miR-17-5p, miR-140-5p, and miR-874-3p microRNA mimics. RNA and protein expression analyses revealed that miR-17-5p, miR-140-5p and miR-874-3p overexpression led to a downregulation of VEGFA, KRAS, and NFE2L2 gene expression in both cell lines analyzed. Taken together, our results provide evidence for the establishment of new biomarkers in the diagnosis and treatment of HNC.

Considerations for developing supportive care interventions for survivors of head and neck cancer: A qualitative study.

This study aimed to describe considerations for developing supportive care interventions targeted to head and neck cancer (HNC) survivors. One-time semi-structured interviews (N=33) were conducted with HNC survivors who had recently finished treatment (n=20) and HNC providers (e.g., physicians, nurses; n=13). Interviews were transcribed verbatim and coded using inductive applied thematic analysis techniques to identify themes. HNC survivors (75% male; M=61years old) and providers (54% physicians; 62% female) were unanimously supportive of developing HNC-specific supportive care interventions. Participants described potential benefits of offering interventions at various points throughout the HNC treatment and survivorship trajectory rather than at a single critical time. Many participants preferred group-based interventions because of the high value of peer-support. Others described how group interventions may not be appropriate for all HNC survivors due to risks for negative social comparisons and exacerbated anxiety. Participants suggested topics that should be addressed in HNC-specific interventions including education about acute and long-term side effects, symptom management, nutritional support, relationship/social role changes, grief/loss, and fear of recurrence. HNC-specific supportive care interventions are critically needed, as survivors experience persistent symptoms and distinct psychosocial concerns that impact quality of life. Findings from this study can inform the development of supportive care interventions targeted to the unique psychosocial concerns of HNC survivors.

The Promise of Circulating Tumor DNA in Head and Neck Cancer.

Simple SummaryHead and neck cancer remains a challenging and deadly disease as it is often identified in more advanced stages due to limitations in screening and surveillance. Circulating tumor DNA (ctDNA) has the potential to improve outcomes by enhancing screening, early diagnosis, and surveillance in head and neck cancer patients. In this review, we discuss the current state of the literature using ctDNA as a biomarker for head and neck cancer screening, diagnosis, treatment response, and prognosis.As the seventh most common cancer globally, head and neck cancers (HNC) exert considerable disease burden, with an estimated 277,597 deaths worldwide in 2020 alone. Traditional risk factors for HNC include tobacco, alcohol, and betel nut; more recently, human papillomavirus has emerged as a distinct driver of disease. Currently, limitations of cancer screening and surveillance methods often lead to identifying HNC in more advanced stages, with associated poor outcomes. Liquid biopsies, in particular circulating tumor DNA (ctDNA), offer the potential for enhancing screening, early diagnosis, and surveillance in HNC patients, with potential improvements in HNC patient outcomes. In this review, we examine current methodologies for detecting ctDNA and highlight current research illustrating viral and non-viral ctDNA biomarker utilities in HNC screening, diagnosis, treatment response, and prognosis. We also summarize current challenges and future directions for ctDNA testing in HNC patients.

Abstract 1403: ROS metabolism and autophagy as potential targets to improve head and neck cancer treatment

Abstract Introduction: Cancer cells exhibit a high degree of plasticity to adapt the rapidly changing tumor microenvironment (TME), in part by altering cellular metabolic pathways at a faster and more efficient pace than normal cells. Cancer cell plasticity, with genetic and epigenetic alterations, promote the diversity of cancer cells contributing to heterogeneity within the tumor. Head and neck cancer (HNC) is a notable example of this diversity; HNC tumors harbor cells with a wide genetic and metabolic heterogeneity, including cancer stem cells (CSC). Despite current treatment approaches, more than 40% of HNC patients have disease recurrence. Thus, we developed a multimodal approach to effectively prevent the development of radio/drug-resistance. Experimental Procedures: Nuclear-localized mkate2 expressing HNC cell numbers detected for every 6 hours by using IncuCyte S3 instrument. Apoptotic cells detected via NucView 488 Caspase-3 substrate and ROS levels determined using CellROX green simultaneously with cell numbers in the IncuCyte S3 instrument. Synergy scores calculated according to viability in SynergyFinder 2.0 web-application. Results: Our preliminary data profiling of metabolic regulators as radiosensitizer indicate that auranofin (AUR, thioredoxin reductase inhibitor) and buthionine sulfoximine (BSO, γ-glutamylcysteine synthetase inhibitor), given in combination with radiation (RT+AUR+BSO): 1) significantly inhibit proliferation in HNC cell lines, 2) increase ROS accumulation, and 3) reduce the surviving fraction of cells in colony forming assays compared to individual/dual agent applications. Furthermore, we added an autophagy inhibitor, SAR405, in our treatment regimen because of the crosstalk between ROS levels and autophagy. Human (FaDu and UM-SCC-47) and murine (MOC1 and MOC2) HNC cell were treated with +/-AUR+/-BSO+/-SAR405 and high-throughput combinatorial screening of cell numbers obtained over time. The combination of AUR+BSO+SAR405 registered a higher synergy score than the double combinations. Furthermore, as compared to single or double drug applications, the AUR+BSO+SAR405 group had a greater apoptotic cell rate and ROS levels. Conclusion: We present here a high-throughput method to screen multi-drug synergy. Multi-modal approach is important to prevent recurrence by providing a broader effect on heterogenous cancer cells in tumor. Moreover, multi-drug combinations allow usage of lower doses of drugs effectively, hence lowers the treatment-related adverse effects. This approach indicated the possibility of HNC treatment by increasing the ROS levels beyond the containable threshold which is consistent with the recent findings about the alterations in redox metabolism, particularly upregulation in thioredoxin and glutathione pathways, in many cancer types. In vivo experiments are ongoing to evaluate the potential of this combination for clinical studies. Citation Format: Zafer Gurel, Qianyun Luo, Michael S. Luy, Randall J. Kimple. ROS metabolism and autophagy as potential targets to improve head and neck cancer treatment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 1403.

IMPACT OF COVID-19 PANDEMIC ON HEAD AND NECK CANCER SURGERY IN CENTRAL INDIA

Introduction At present the COVID 19 pandemic has resulted in unprecedented challenge for healthcare facilities worldwide. This study was conducted to assess the impact of COVID-19 pandemic and inability to treat Head and Neck Cancer(HNC) in a timely fashion in the present emergent situation and highlights the situation in India, which has one of the highest the highest incidence rates of HNC. To assess the effectAim: of COVID 19 Pandemic on the head and neck cancer surgeries. We assessed the records of the patients who underwentMaterials &amp; Methods: surgery for head and neck cancer between January and August 2020 and compared it with number of the surgery done in the previous two years i.e 2018 and 2019 between January and August months.Impact of COVID 19 was also assessed and possible reasons for inability to avail health-care were noted down as told by patients and surgeons through questionnaires. There was great decline in the number of surgeries beingResults: performed during the pandemic compared to previous year with most decline (100%) during the month of April 2019 followed by May having 80% decrease in number of surgery . Amongst the most common reason for not receiving treatment according to the patients were lack of transportation facilities fear of getting infected and lack of treatment facilities and doctors while for Surgeons it was lack of supporting nursing and paramedical staff followed by transportation facilities and clear guidelines were the most common reasons. This Pandemic has severely affectedConclusions: the treatment of HNC as result of which many patients are being rendered inoperable or require extensive surgeries. Clear Guidelines based on universal Consensus in management of HNC is needed to for better management of HNC during COVID 19 pandemic.

Influence of radiotherapy on dental implants placed in individuals before diagnosed with head and neck cancer: focus on implant-bed-specific radiation dosage.

The influence of radiotherapy on implants placed before diagnosed as head and neck cancer (HNC) is a potentially informative but poorly explored topic. The aims of this study were to investigate the influence of implant-bed-specific radiation dose on dental implants and to evaluate the impact of these implants on radiation dosimetry. We conducted a retrospective study with 58 irradiated patients that received dental implant restorations before undergoing radiation treatment for HNC. The radiological success rate and the peri-implant bone resorption values were measured radiographically at 1 and 3years after radiotherapy. Patients with no implants matching tumor site and stage served as a control group (n = 58). The median implant-bed-specific radiation dose was 40.3Gy, which was significantly lower than tumor bed 62.4Gy. An implant-bed-specific radiation dose higher than 40.0Gy showed a significantly decreased radiologic success rate when compared to lower doses. Finally, evaluation of the radiation treatment plans revealed similar radiation hot spots in the test group of patients with implants and those of the control group. Our study confirms that radiotherapy negatively worsens peri-implant bone resorption, especially for implant-bed-specific dose more than 40Gy, and the presence of implants within the radiation fields does not alter radiation dosimetry. The findings could be clinically informative to both surgeons and radio-oncologists. The interactions between radiotherapy and implants placed prior to radiotherapy treatment remain a largely unexplored topic. Based on the analysis of 3-dimensional modulated radiation plans, this study demonstrates the impact of implant-bed-specific radiation dose on marginal bone resorption of implants placed pre-radiation and considers the influence of these implants on radiation dosimetry. CHICTR2100051923: ( http://www.chictr.org.cn/usercenter.aspx ).

Pain Prevalence in Head and Neck Cancer

This study aimed to explicate the prevalence of pain in patients with head and neck cancer (HNC). Head and neck cancer is associated with intense, multi-modal treatment that may result in substantial morbidity. Research suggests a high prevalence of pain among patients with HNC, and the level of pain may predict patients' 5-year survival. Understanding the pain prevalence of patients with HNC during and after treatment may inform strategies for caring for patients with HNC. This study was a secondary analysis of a systematic review of symptom and function measures used by patients with HNC. A systematic search of CINAHL, PubMed, APA PsycInfo®, and Health and Psychosocial Instruments (HaPI) databases between January 2005 and April 2020 generated 529 titles. Articles that described symptoms and functional limitations in HNC and met quality criteria were retained and reviewed for reports of pain prevalence. The review was registered with the National Institute of Health Research (CRD42021242513) and conducted according to PRISMA guidelines. The literature review identified eight articles that contained 12 reports of pain prevalence in patients with HNC. The highest prevalence of pain occurred at week 4 or later during treatment for HNC (83.4%), 3 months after diagnosis (54.1%), and with metastatic disease (66%). Between 38% and 45% of patients continued to report pain 12 months after diagnosis. Pain is a critical problem in HNC during and after treatment. Early detection and intervention for pain may help patients with HNC better tolerate treatment, uncover early cancer recurrence, and improve quality of life. Research initiatives are needed to understand the biological underpinnings of chronic, post-treatment pain in HNC and develop pharmacologic and non-pharmacologic treatments. Grant support from the following sources: The Hartford Change AGEnts Initiative (supported by a grant to the Gerontological Society of American from the John A. Hartford Foundation), The Palliative Care Research Cooperative Group funded by the National Institute of Nursing Research (U24NR014637), Oncology Nursing Foundation, Johnson & Johnson Innovations, National Science Foundation (2106141), NYU Mega-Grants Initiative, and Research Challenge Fund.

AXL regulates neuregulin1 expression leading to cetuximab resistance in head and neck cancer

BackgroundThe receptor tyrosine kinase (RTK) epidermal growth factor receptor (EGFR) is overexpressed and an important therapeutic target in Head and Neck cancer (HNC). Cetuximab is currently the only EGFR-targeting agent approved by the FDA for treatment of HNC; however, intrinsic and acquired resistance to cetuximab is a major problem in the clinic. Our lab previously reported that AXL leads to cetuximab resistance via activation of HER3. In this study, we investigate the connection between AXL, HER3, and neuregulin1 (NRG1) gene expression with a focus on understanding how their interdependent signaling promotes resistance to cetuximab in HNC.MethodsPlasmid or siRNA transfections and cell-based assays were conducted to test cetuximab sensitivity. Quantitative PCR and immunoblot analysis were used to analyze gene and protein expression levels. Seven HNC patient-derived xenografts (PDXs) were evaluated for protein expression levels.ResultsWe found that HER3 expression was necessary but not sufficient for cetuximab resistance without AXL expression. Our results demonstrated that addition of the HER3 ligand NRG1 to cetuximab-sensitive HNC cells leads to cetuximab resistance. Further, AXL-overexpressing cells regulate NRG1 at the level of transcription, thereby promoting cetuximab resistance. Immunoblot analysis revealed that NRG1 expression was relatively high in cetuximab-resistant HNC PDXs compared to cetuximab-sensitive HNC PDXs. Finally, genetic inhibition of NRG1 resensitized AXL-overexpressing cells to cetuximab.ConclusionsThe results of this study indicate that AXL may signal through HER3 via NRG1 to promote cetuximab resistance and that targeting of NRG1 could have significant clinical implications for HNC therapeutic approaches.

Trajectory of Anxiety Related to Radiation Therapy Mask Immobilization and Treatment Delivery in Head and Neck Cancer and Radiation Therapists’ Ability to Detect This Anxiety

PurposeReceiving radiation therapy treatment with an immobilization mask is a source of anxiety in people with head and neck cancer (HNC). This study aimed to document the trajectory of situational anxiety during HNC treatment delivery and explore radiation therapists’ (RTs’) ability to identify it. Methods and MaterialsParticipants with HNC commencing radiation therapy completed the state-trait anxiety inventory at their mask-making session, and once each week immediately before and after their radiation treatment. Treating RTs independently rated their perception of participant's anxiety at the same time points. Participant- and RT-rated anxiety scores were calculated at each time point together with the proportion of participants reporting clinically significant anxiety (state-trait anxiety inventory ≥ 40). Intraclass correlations were calculated to assess concordance between participant- and RT-ratings. ResultsSixty-five participants and 16 RTs took part in this study. Participants were classified into 1 of 5 trajectory groups: stable high (16%), increasing (19%), decreasing (27%), fluctuating (19%), and no anxiety (19%). Nearly half (43%) of participants reported clinically significant anxiety before their mask-making session, and between 30% and 43% across trajectories reported significant anxiety immediately before treatments. Intraclass correlation values indicated poor agreement between participant- and RT-ratings. ConclusionsSituational anxiety is prevalent in people receiving HNC radiation therapy with mask immobilization. RTs did not reliably capture patients’ situational anxiety. There is no single best time point to provide intervention, suggesting people should be screened for anxiety regularly throughout their treatment. Resources and education should also be available to improve RT skills in providing psychosocial support.

To study the radiation induced oral mucositis in head and neck cancer - A prospective study

Patients suffering from Head and Neck Cancers (HNC), when treated with radiotherapy (RT), often experience Oral mucositis (OMS) side effects. OMS can complicate the treatment and worsen the management of HNC. The Radio-oncologist should find a way to minimize the incidence of OMS during the treatment of HNC. To study the Radiation-induced OMS in HNC patients and its associated factors. This prospective study was performed from October 2018 to September 2019. Total 80 patients of with HNC, who were treated with RT, were enrolled for the study with informed consent. In the study, 40 patients received RT and 40 received concurrent chemo-Radiotherapy (CCRT). Amongst 80 patients included in the study, 72.5% were found to be male. Poor oral hygiene was observed in 77.5% of patients in the study. The tongue cancer (35%) and Cancer of Stage IVa (47.5%) were more prevalent in the patients under study. OMS was observed maximum (60%) in 1 to 4 weeks of treatment. Inflammation response of epithelial mucosa to chemo- radiotherapy cytotoxic effects leads to mucositis, a painful side effect. This study gives proper understanding of Radiation-induced OMS and identifies the predisposing factors for OMS.

Dental Caries Postradiotherapy in Head and Neck Cancer.

Treatment for head and neck cancer (HNC) such as radiotherapy (RT) can lead to numerous acute and chronic head and neck sequelae, including dental caries. The goal of the present study was to measure 2-y changes in dental caries after radiotherapy in patients with HNC and test risk factors for caries increment. Cancer and dental disease characteristics, demographics, and oral health practices were documented before and 6, 12, 18, and 24 mo after the start of RT for 572 adult patients with HNC. Patients were eligible if they were age 18 y or older, diagnosed with HNC, and planned to receive RT for treatment of HNC. Caries prevalence was measured as decayed, missing, and filled surfaces (DMFS). The association between change in DMFS and risk factors was evaluated using linear mixed models. On average, DMFS increased from baseline to each follow-up visit: 6 mo, +1.11; 12 mo, +2.47; 18 mo, +3.43; and 24 mo, +4.29 (P < 0.0001). The increase in DMFS during follow-up was significantly smaller for the following patient characteristics: compliant with daily fluoride use (P = 0.0004) and daily oral hygiene (brushing twice daily and flossing daily; P = 0.015), dental insurance (P = 0.004), and greater than high school education (P = 0.001). DMFS change was not significantly associated with average or maximum RT dose to the parotids (P > 0.6) or salivary flow (P > 0.1). In the subset of patients who had salivary hypofunction at baseline (n = 164), lower salivary flow at follow-up visits was associated with increased DMFS. Increased caries is a complication soon after RT in HNC. Fluoride, oral hygiene, dental insurance, and education level had the strongest association with caries increment after radiotherapy to the head and neck region. Thus, intensive oral hygiene measures, including fluoride and greater accessibility of dental care, may contribute to reducing the caries burden after RT in HNC. The results of this study can be used by clinicians when deciding how to minimize oral complications related to cancer therapy for patients with head and neck cancer. Identification of modifiable factors (e.g., oral hygiene and prescription fluoride compliance) associated with increased caries risk can minimize radiation caries burden.

Nutrition Impact Symptoms in Relation to Head and Neck Cancer Survivor’s Vegetable Intake and Use of Seasoning

Background: Most head and neck cancer (HNC) patients undergoing aggressive treatments with chemoradiotherapy and surgical resection of tumors suffer from symptoms long after treatment is completed that hinder adequate oral food intake, collectively known as Nutrition Impact Symptoms (NIS). Our aim was to examine the correlations between NIS and HNC survivors’ vegetable intake and use of seasoning. Methods: We conducted a 29-item telephone administrated survey to collect vegetable intake and seasoning habits among HNC survivors (n=22, age 61.4 ± 9.8 years, mean ± standard deviation) who received radiation therapy between 6 months and 10 years before recruitment identified through the cancer registry at Carle Foundation Hospital. Treatment-related side-effects (11 items) including difficulty swallowing, dry mouth, and mouth sores reflected NIS. A mean composite score was created for all the symptoms where higher scores indicated greater NIS. Spearman correlations examined the relationships between NIS, vegetable intake, and seasoning. Results: Half (50%) of the participants reported no change in their vegetable intake since diagnosis of cancer, and on average, ate 1 cup/day of total vegetables. Higher NIS scores associated with higher pumpkin and sweet potatoes intake (r (20) = .43, p&lt;0.05), and there was a trend for higher scores of difficulties swallowing to be associated with lower corn and peas intake (r (20) =-.37, p=0.08). Participants with higher scores of problems with teeth and gums were less likely to use seasoning (r (20) = -.42, p&lt;0.05). Conclusion: The findings support that HNC treatment can affect vegetable intake long after completion of radiotherapy. However, it would be premature for any recommendations to be derived from the present study for health professionals. A larger, observational study with a longer follow-up is therefore needed to examine these correlations.

Acquisition repeatability of MRI radiomics features in the head and neck: a dual-3D-sequence multi-scan study

Radiomics has increasingly been investigated as a potential biomarker in quantitative imaging to facilitate personalized diagnosis and treatment of head and neck cancer (HNC), a group of malignancies associated with high heterogeneity. However, the feature reliability of radiomics is a major obstacle to its broad validity and generality in application to the highly heterogeneous head and neck (HN) tissues. In particular, feature repeatability of radiomics in magnetic resonance imaging (MRI) acquisition, which is considered a crucial confounding factor of radiomics feature reliability, is still sparsely investigated. This study prospectively investigated the acquisition repeatability of 93 MRI radiomics features in ten HN tissues of 15 healthy volunteers, aiming for potential magnetic resonance-guided radiotherapy (MRgRT) treatment of HNC. Each subject underwent four MRI acquisitions with MRgRT treatment position and immobilization using two pulse sequences of 3D T1-weighed turbo spin-echo and 3D T2-weighed turbo spin-echo on a 1.5 T MRI simulator. The repeatability of radiomics feature acquisition was evaluated in terms of the intraclass correlation coefficient (ICC), whereas within-subject acquisition variability was evaluated in terms of the coefficient of variation (CV). The results showed that MRI radiomics features exhibited heterogeneous acquisition variability and uncertainty dependent on feature types, tissues, and pulse sequences. Only a small fraction of features showed excellent acquisition repeatability (ICC > 0.9) and low within-subject variability. Multiple MRI scans improved the accuracy and confidence of the identification of reliable features concerning MRI acquisition compared to simple test-retest repeated scans. This study contributes to the literature on the reliability of radiomics features with respect to MRI acquisition and the selection of reliable radiomics features for use in modeling in future HNC MRgRT applications.

Oral health related quality of life in long-term survivors of head and neck cancer compared to a general population from the seventh Troms\xf8 study

BackgroundBoth the incidence and survival rate of head and neck cancer (HNC) is increasing, making quality of life of HNC survivors an important issue.MethodsIn this cross-sectional study we compared the oral health related quality of life (OHRQoL) of long-term HNC survivors to that of a general population cohort from the seventh survey of the Tromsø study with the Oral Impact on Daily Performances questionnaire. Comparisons were done with frequency analyses and cross tabulation. We also assessed OHRQoL’s association to sociodemographic and oral health related variables in both cohorts as well as with cancer related variables in the HNC cohort with regression analyses.ResultsThe HNC survivors had four times the risk of reporting problems with daily performances compared with the general population cohort. The ability to eat and enjoy food was most frequently affected in both cohorts. Moderate-poor self-rated dental health and general health as well as high frequency of dental visits were significantly associated with poorer OHRQoL. To have a history of oral or pharyngeal cancer was associated with more problems than having a history of laryngeal cancer.ConclusionsOur study shows that HNC treatment is associated with a strong and lasting impairment of OHRQoL, highlighting the need to find less toxic, yet effective ways to treat the disease, and to provide easy access to expert dental care at all stages of the disease to minimize morbidity. Given the widespread side effects of cancer treatment, a multidisciplinary approach might be required to improve the OHRQoL of HNC survivors.

Limited Toxicity of Hypofractionated Intensity Modulated Radiation Therapy for Head and Neck Cancer.

Hypofractionated radiation therapy is not commonly used in head and neck cancers (HNC) due to increased toxicity observed in historical cohorts. This study reviews our institutional experience using hypofractionated intensity modulated radiation therapy (H-IMRT) for HNC. A retrospective cohort study of 56 patients with HNC treated with H-IMRT with ≥50 Gy in 20 fractions was conducted. The primary outcomes were acute and late toxicity. Two-year locoregional control was 87% and median overall survival was 46 months. There were no acute or late grade 4 or 5 toxicities. Acute grade 2 and 3 toxicity was seen in 79% (N=44) and 25% (N=14), respectively. Late grade 2 toxicity was seen in 9% (N=5). No patients required the placement of a feeding tube or tracheostomy. H-IMRT for the definitive or post-operative treatment of HNC using ≥50 Gy in 20 fractions appears safe and well tolerated with modest toxicity.

Effect of treatments for head and neck cancer on sinus shadow on computed tomography

ObjectiveHead and neck surgeries may cause changes in the nasal airflow, and radiotherapy irreversibly damages paranasal sinus epithelial cells. Some chemotherapeutic drugs have been reported to negatively affect airway ciliary activity in mice, and chronic rhinosinusitis could be an adverse effect of head and neck cancer (HNC) treatment. To evaluate whether HNC treatment is a risk factor for developing sinonasal mucosal thickening that may reflect paranasal sinus inflammation, we compared pre- and post-treatment paranasal sinus computed tomography (CT) images of patients treated for HNC at a single university hospital. MethodsThe patients who received curative treatment for HNC (oral, pharyngeal, and laryngeal cancers) and started receiving first-line therapy between January 2015 and December 2019 were included. Data on age, sex, primary lesion, clinical stage, treatment, smoking history, drinking history, comorbidities (diabetes and chronic lung disease), and pre- and post-treatment (three months and one year after the final treatment) paranasal sinus CT images were analyzed from medical records. Pre- and post-treatment paranasal sinus CT images were scored using the Lund–Mackay (LM) staging system. ResultsIn total, 245 patients participated in this study. Three months after the final treatment, 80.4% of patients had no change in their total LM scores (p=0.621). Almost 80% of patients who underwent total laryngectomy also had no change in their total LM scores (p=0.833). One-third of patients with nasopharyngeal cancer (NPC) had worse LM scores after treatment (5/15), although no significant difference was observed (p=0.171). None of the various factors collected were significantly related to changes in LM scores three months after the completion of treatment. One year after the final treatment, 211 patients were included and no significant changes in the pre-and post-LM scores were observed in the same analyses, while changes in LM scores were significantly different between T categories (T1-2 vs. T3-4) (p=0.020). ConclusionWe found no significant changes in the LM scores after HNC treatment in all the patients, which implies that HNC treatment may not be an apparent risk factor for sinonasal mucosal inflammation.

Effects of Head and Neck Cancer Diagnosis and Treatment on Patient-Partner Intimacy

<h3>Purpose/Objective(s)</h3> Head and Neck cancer (HNC) diagnosis and treatment have the potential to significantly affect patient relationships. We aimed to understand the effects of a HNC diagnosis on patient and partner perceived intimacy at diagnosis and after treatment. Additionally, we sought to understand if the diagnosis of HPV related HNC influenced patients' and partners' levels of perceived intimacy. <h3>Materials/Methods</h3> A prospective, survey-based study was conducted using two cohorts of HNC patients and partners: HPV-positive and HPV-negative. Respondents completed a survey of questions adapted from the HPV Impact Profile, the Dyadic Adjustment Scale, and the Miller Social Intimacy Scale at two time points. Within 2 months of diagnosis prior to treatment and again after 3-6 months post treatment. Responses were then scored as: loss of intimacy (0-48), stable relationship (49-71), improvement in intimacy (72-120). Respondents were also asked whether changes in perceived intimacy were due to HPV or effects of cancer treatment. Survey responses were considered discordant if patient and partner scores equated to different levels of perceived intimacy. <h3>Results</h3> 25 patient-partner pairs completed the first survey. 68% of couples demonstrated concordant responses with 16 couples reporting increased intimacy, one couple reporting stable intimacy and none reporting decreased intimacy. 32% of patient-partner pairs showed some discordance in responses with 7 couples in which one partner reported stability and the other reported increase in intimacy and one couple in which one partner reported an increase and the other reported a decrease in intimacy. 15 patient-partner pairs completed the second survey 3-6 months post HNC treatment. 73% of patient-partner pairs demonstrated concordant responses with 8 couples reporting increased intimacy, two couples reporting stable intimacy and one couple reporting decreased intimacy. 27% of patient-partner pairs showed some discordance in responses, with four couples in which one partner reported an increase and the other reported stable intimacy. Overall scores were not significantly different between patients and partners at either timepoint (p=0.31, p=0.63). Mean scores were similar between HPV+ and HPV- groups at both timepoints (p=0.35, p=0.22); however, the patient and partner who reported loss of intimacy cited presence of HPV in diagnosis as a reason for the decline. <h3>Conclusion</h3> The majority of patients and partners surveyed reported either stable or increased intimacy both at diagnosis and after treatment. Further, most patients and partners agreed about their perceived level of intimacy. The simultaneous diagnosis of HPV related malignancy did not significantly affect intimacy scores; however, individuals who experienced a loss of intimacy reported that HPV was at the core of the decline.

Nanoparticle therapy for head and neck cancers.

The current review focuses on the therapeutic use of nanoparticles in head and neck cancer (HNC), highlighting nanoparticles at the most advanced clinical development stages. Literature review covers the three main approaches for therapeutic use of nanoparticles in HNC: first, enhancing radiotherapy effect; second, performing targeted delivery of chemotherapy, immunotherapy, or genome editing molecules; third, photothermal therapy. Nanoparticles are spherical nanoscale objects that have application in cancer therapies. Nanoparticles have diverse and often composite structure composition to ensure their function, increase their bioavailability in tumor tissues, and decrease off-target effects, sometimes by means of activating internal or external stimuli. Hafnium oxide nanoparticles are being tested in phase I to III trials for radiotherapy enhancement. Nanoparticle-based delivery of paclitaxel, cisplatin, and of the immune activator CpG-A DNA is being evaluated in phase II trials. No nanoparticle is currently approved for HNC treatment.

Experiences and perceptions of social eating for patients living with and beyond head and neck cancer: a qualitative study

PurposePatients with head and neck cancer (HNC) describe eating as more than a physical activity for nutrition and calories. After treatment for HNC, patients report a changed social experience around food, with eating and drinking in front of family and friends depicted as a challenge. However, there is limited research exploring how patients with HNC adapt and cope with social eating difficulties. This study aims to explore patients’ experiences and perceptions of social eating and drinking following treatment for HNC.MethodsA qualitative research design using semi-structured interviews was employed to understand the experiences of social eating of patients living with and beyond HNC. Reflexive thematic analysis was used to inductively develop key themes from the data.ResultsFourteen interviews were conducted with patients, and two key themes were identified: (1) “Social eating became a conscious process” and (2) “Strategies to maximise social eating participation”. To maximise social eating enjoyment, patients attempted to minimise the attention on their eating function and the fuss created around food. Patients with HNC established psychological and cognitive adaptations to manage expectations and promote positive participation in social eating.ConclusionThis paper identifies key barriers limiting or diminishing social eating for patients with HNC; including being self-conscious, lack of understanding from others and functional issues with eating and drinking. This research highlights the need to raise awareness of social eating challenges and for the social dimensions of eating to be addressed through family-centred, supportive holistic interventions implemented early in the patient’s cancer journey.