Head Cancer Patients Research Articles

Clinical Introduction of Stem Cell Sparing Radiotherapy to Reduce the Risk of Xerostomia in Patients with Head and Neck Cancer.

Studies have shown that dose to the parotid gland stem cell rich (SCR) regions should be reduced to lower the risk of xerostomia after radiotherapy (RT). This study aimed to assess whether stem cell sparing (SCS)-RT can be adopted in routine clinical practice. Multiple planning studies were performed to compare SCS-RT with standard (ST)-RT using 30 head and neck cancer patients. Shifts in mean dose to the SCR regions (Dmean,SCR) and other organs at risk and their estimated impact on normal tissue complication probability (NTCP) for side-effects were compared using Wilcoxon signed-rank test. A multicenter study was performed (eight institutions, three patients) to test the generalizability of SCS-RT using the Friedman test. Using photons, Dmean,SCR was reduced with median 4.1/3.5 Gy for ipsilateral/contralateral (p < 0.001). The largest reductions were when the SCR regions overlapped less with target volumes. Subsequently, NTCPs for xerostomia decreased (p < 0.001). Using protons, Dmean,SCR was also reduced (2.2/1.9 Gy for ipsilateral/contralateral, p < 0.002). Nevertheless, SCS-RT did not further decrease NTCPs for xerostomia (p > 0.17). Target coverage and prevention of other side-effects were not compromised. However, increased mean oral cavity dose was observed in some patients. Lastly, in the multicenter study Dmean,SCR could be reduced by slightly adjusting the standard optimization. Contralateral Dmean,SCR reductions differed between centers (p = 0.01), which was attributed to differences in ST-RT plans. Stem cell sparing radiotherapy can be clinically introduced by making small adjustments to the optimization strategy and can reduce the risk of xerostomia.

Treatment initiation and completion among head and neck squamous cell carcinoma patients in Tanzania

Abstract Objective Few studies characterizing clinical outcomes of head and neck cancer (HNC) patients in sub-Saharan Africa report the proportion of patients who initiate and complete treatment, information integral to contextualizing survival outcomes. This retrospective cohort study describes HNC patients who presented to Muhimbili National Hospital and Ocean Road Cancer Institute in 2018, the highest-volume oncology tertiary referral centers in Tanzania. Logistic regression was applied to assess predictors of treatment initiation and completion. Results Among the 176 head and neck squamous cell carcinoma (HNSCC) patients, 34% (59) had no treatment documented, 34%(59) had documentation of treatment initiation but not completion, and 33%(58) had documentation of treatment completion based on the modalities started. Univariate logistic regression showed that late-stage disease was associated with increased odds of initiating treatment (OR 8.24, 95% CI 2.05–33.11, p = 0.003) and trends toward completing treatment (OR 7.41, 95% CI 0.90–60.99, p = 0.063). At last visit, 36.9%(65) were alive with a median follow up of 5.6 months (IQR 1.64—12.5 months). A large proportion of HNC patients who presented to MNH and ORCI did not initiate or complete treatment. These metrics are critical to contextualize care outcomes of HNC patients in resource-constrained health systems and develop interventions.

Short- and Long-Term Swallowing Outcomes in Head and Neck Cancer Patients Receiving TORS and Adjuvant Therapy.

Dysphagia (difficulty swallowing) is a common morbidity resulting from the treatment of head-and-neck squamous-cell carcinoma (HNSCC) due to surgery and chemoradiation. Transoral robotic surgery (TORS) is a minimally invasive surgical technique for the management of HNSCC, which ideally avoids many of the known complications of open surgery. Research describing physiologic swallowing impairment after surgery using videofluoroscopy is lacking. We evaluated videofluoroscopic swallowing studies of 37 patients who received TORS for head and neck cancer using a validated scoring tool, the Modified Barium Swallow Impairment Profile (MBSImP), at three time points including baseline. Patients had worsened physiologic impairments in the immediate post-operative and late post-operative periods, particularly in components related to airway protection. Many patients also had baseline swallowing impairment. Further research is required to elucidate dysphagia at discrete time points before and after treatment as well as with different and evolving adjuvant therapy protocols.

Predictive Factors of the Degrees of Malnutrition According to GLIM Criteria in Head and Neck Cancer Patients: Valor Group.

Background: Malnutrition is highly prevalent in patients with head and neck cancer, with relevant consequences in the treatment results. Methods: Multicenter observational study including 514 patients diagnosed with HNC. The morphofunctional assessment was carried out during the first 2 weeks of radiotherapy treatment. A correlation analysis between nutritional variables and groups of malnutrition, a multivariate logistic regression analysis, and a random forest analysis to select the most relevant variables to predict malnutrition were performed. Results: In total, 51.6% were undernourished (26.3% moderately and 25.3% severely). There was a negative correlation between morphofunctional variables and a positive correlation between hsCRP and well vs. moderate and well vs. severe malnutrition groups. The increase in different bioelectrical and ultrasound parameters was associated with a lower risk of moderate and severe malnutrition when groups with different degrees of malnutrition were compared. To predict the importance of morphofunctional variables on the risk of undernutrition, a nomogram, a random forest, and decision tree models were conducted. For the well vs. moderate, for the well vs. severe, and for the moderate vs. severe malnutrition groups, FFMI (cut-off < 20 kg/m2), BCMI (cut-off < 7.6 kg/m2), and RF-Y-axis (cut-off < 0.94 cm), respectively, were the most crucial variables, showing a greater probability of mortality in the two last comparisons. Conclusions: Malnutrition is very prevalent in HNC patients. Morphofunctional assessment with simple tools such as electrical impedance and muscle ultrasound allows an early nutritional diagnosis with an impact on survival. Therefore, these techniques should be incorporated into the daily clinical attention of patients with HNC.

Impact of Tobacco, Marijuana, and Alcohol Use on Overall Survival in Recurrent Metastatic Head and Neck Cancer Patients Treated With Immune Checkpoint Inhibitors.

The response rates to immune checkpoint inhibitors (ICI) remain low (13%-20%) in metastatic head and neck cancer patients, indicating an urgent need to better understand factors predictive of response to these agents. This study explored the impact of smoking status, marijuana use, and alcohol consumption on treatment outcomes in recurrent-metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients treated with ICI. A retrospective analysis was performed on 201 R/M HNSCC patients treated with ICI between January 15th 2016 and April 9th 2020 at a single institution. Gender: 154 male (77%), 47 female (23%). Median age 61 (IQR: 55-68). ICI drug: pembrolizumab 100 (50%), nivolumab 91 (45%), nivolumab+ipilimumab 10 (5%). Line of therapy: first: 98 (49%), second and beyond: 103 (51%). Tumor site: oropharynx 84 (42%), oral cavity 45 (22%), larynx 26 (13%), other sites 46 (23%). p16 tumor status: negative 132 (66%), positive 69 (34%). Smoking status: former 111 (55%), never 54 (27%), current 36 (18%), median pack-year 18 (IQR: 0-37). Alcohol use: yes 110 (55%), no 91 (54%). Marijuana use: yes 47 (23%), no 154 (77%). Overall response rate: 36 (18%). Median OS: 12 months (95% CI: 9.4-14.8). Tobacco: former (HR: 0.75, 95% CI: 0.50, 1.11), current (HR: 0.58, 95% CI: 0.33, 1.02). Marijuana: yes (HR: 0.93, 95% CI: 0.58, 1.49). Alcohol: yes (HR: 1.04, 95% CI: 0.72, 1.49). In our cohort, smoking status, marijuana use, and alcohol consumption did not have a statistically significant impact on OS in patients with R/M HNSCC treated with ICI.

Impact of radiotherapy on body weight in head and neck cancer patients: A prospective study.

Patients with head and neck cancer (HNC) undergoing radiotherapy or chemoradiotherapy often experience symptoms that affect their ability to eat. This study aimed to explore the impact of radiotherapy on body weight in HNC patients and compare the characteristics of patients receiving enteral tube feeding with those maintaining an oral diet. In this prospective study, 52 patients with HNC were examined at diagnosis, at the start and end of radiotherapy, and six weeks after end of treatment. The nutritional assessment included measurements of body weight, food intake, and malnutrition using Patient-Generated Subjective Global Assessment (PG-SGA). Other variables were retrieved from the electronic patient record. Critical weight loss (defined as >5% from start of radiotherapy) was present in 60 % of the patients at the end of radiotherapy, and only half of these patients received any enteral nutrition therapy. The mean weight loss was 5.8% during radiotherapy, and an additional 2.1% at follow-up (n=48). A nasogastric feeding tube was used by 42% at the end of radiotherapy, and 29% at follow-up. The tube feeding users had a lower energy intake and higher weight loss than non-tube feeding users (22 vs 27kcal/kg body weight, 7.8 vs 4.4% weight loss) at the end of radiotherapy treatment. According to PG-SGA, 92% of the patients were malnourished at the end of treatment and 71% at follow-up (p<0.001). Critical weight loss and malnutrition were common in HNC patients after radiotherapy, and enteral tube feeding was initiated in only half of the cases with critical weight loss. Patients receiving enteral tube feeding may need closer monitoring to ensure adequate energy intake, and other treatment options may be necessary. These results emphasize the need for improved nutritional intervention during and after radiotherapy.

Lymph node ratio (LNR) and lymph node yield (LNY) in head and neck cancer: A systematic review and meta-analysis.

A growing amount of evidence points at lymph node yield (LNY) and lymph node ratio (LNR) as useful indicators in the prognostic evaluation of patients affected by head and neck squamous cell carcinoma (HNSCC) who require neck dissection. The aim of this study was to assess the importance of LNY and LNR in the prognostic evaluation of head and neck cancer patients. Included studies were those examining LNY and/or LNR in head and neck cancer patients. We excluded case reports or case series, thyroid cancer or salivary gland cancer studies, a sample size less than 20, and studies with incomplete or missing survival estimate. Of the 2435 studies identified through a database search, 95 were reviewed for full text and 63 were finally included for the final analysis. Electronic databases, including PubMed (MEDLINE), Embase, and Scopus were screened up to January 1, 2024. The systematic review was conducted according to the MOOSE checklist. A set of sub-group meta-analyses were performed for oral cavity, oropharynx, hypopharynx, larynx, and mixed subsites using a random-effects model. Overall survival (OS), Disease Specific Survival (DSS), and Disease-Free Survival (DFS) Hazard Ratios (HR) related to a prespecified LNR and LNY exact value were chosen as summary statistics. Cumulative Hazard Ratios with 95% Confidence Interval (CI) were presented, calculated through the inverse variance method. Heterogeneity was evaluated with I2 statistics. Results of the meta-analysis showed increased OS for a higher LNY (HR 1.33 95% CI 1.23-1.45). Regarding the LNR, a lower LNR value has an impact on survival, with an OS HR of 1.96 (95% CI 1.72-2.24). The same was true for DFS (HR 2.43 95% CI 1.82-3.23), and DSS (HR 2.07 95% CI 1.83-2.33). Our analysis confirms the importance of LNY and LNR as prognostic indicators. Future studies are needed to establish the optimal cut-off values for both factors. LNY and LNR have the potential to be routinely evaluated in patients who undergo neck dissection for HNSCC.

Evaluation of Thermal Liquid Biopsy Analysis of Saliva and Blood Plasma Specimens as a Novel Diagnostic Modality in Head and Neck Cancer.

Over the past decade, saliva-based liquid biopsies have emerged as promising tools for the early diagnosis, prognosis, and monitoring of cancer, particularly in high-risk populations. However, challenges persist because of low concentrations and variable modifications of biomarkers linked to tumor development when compared to normal salivary components. This study explores the application of differential scanning calorimetry (DSC)-based thermal liquid biopsy (TLB) for analyzing saliva and blood plasma samples from head and neck cancer (HNC) patients. Our research identified an effective saliva processing method via high-speed centrifugation and ultrafiltration, resulting in reliable TLB data. Notably, we recorded unique TLB profiles for saliva from 48 HNC patients and 21 controls, revealing distinct differences in thermal transition features that corresponded to salivary protein denaturation. These results indicated the potential of saliva TLB profiles in differentiating healthy individuals from HNC patients and identifying tumor characteristics. In contrast, TLB profiles for blood plasma samples exhibited smaller differences between HNC patients and had less utility for differentiation within HNC. Our findings support the feasibility of saliva-based TLB for HNC diagnostics, with further refinement in sample collection and the incorporation of additional patient variables anticipated to enhance accuracy, ultimately advancing non-invasive diagnostic strategies for HNC detection and monitoring.

Three-year trajectories and associated factors of fear of cancer recurrence in newly diagnosed head and neck cancer patients: a longitudinal study.

Limited data exists on the long-term course of fear of cancer recurrence (FCR) in head and neck cancer (HNC) patients. One in five patients was found to experience persistent high FCR in the first months after diagnosis. This study assessed the 3-year trajectories and associated factors of FCR in newly diagnosed HNC patients. Six hundred twenty-one patients from the NETherlands Quality of life and Biomedical Cohort study (NET-QUBIC) completed the FCR assessment at baseline, 3-, 6-, 12-, 24-, and 36-months posttreatment. Trajectories of FCR were identified using latent class growth analysis. Multinominal logistic regression analysis was used to assess associations between FCR trajectories and baseline demographic and medical variables, personality, and coping. Three FCR trajectories were identified: "consistently high" (n = 45, 7%), "elevated and declining" (n = 209, 34%), and "low and declining" (n = 367, 59%). Patients in the "elevated and declining" and "consistently high" trajectory were younger, had more comorbidities, higher negative adjustment, a higher level of neuroticism, more social support seeking, and more reliance on passive and palliative coping strategies. Three years following diagnosis, the majority of HNC patients showed a resilient FCR trajectory whereas a small percentage of HNC patients (7%) showed persistent high FCR over time. Younger patients and those with a higher level of neuroticism or maladaptive coping strategies were more vulnerable to have a consistent high level of FCR over time. It is important to identify these patients to provide optimal and tailored psychosocial support.

Nodal Yield From Neck Dissection Predicts the Anti-Tumor Immune Response in Head and Neck Cancers.

Lymph node count (LNC) from neck dissection has been associated with undernutrition and survival in head and neck squamous cell carcinoma (HNSCC). As local components of the immune system, cervical lymph nodes may reflect anti-tumor immune status. This study investigates the relationship between decreased LNC, formation of tertiary lymphoid structures (TLS), and primary tumor infiltration by lymphocytes in undernourished patients. A matched-cohort study was conducted in a tertiary medical center, where neck dissection quality was standardized for a total of 384 subjects that were evaluated. Six head and neck cancer patients that underwent primary surgery including neck dissection with low LNC and BMI (low BMI < 23, low LNC ≤ 5.6 per neck level) were matched by stage, p16 status, and subsite to 16 patients with normal BMI and high LNC. Multiplexed immunohistochemistry was used to evaluate the tumor-infiltrating lymphocytes and the number and quality of TLS within primary tumors. Whole primary cancers underwent automated analysis and counting of leukocytes after multiplexed immunohistochemistry staining of tumor slides. A head and neck pathologist blindly scored the number and maturity of TLS. Descriptive statistics were used to analyze outcomes. The patients with low BMI and low LNC had significantly fewer CD3 (p = 0.0136), CD8 (p = 0.0003), and CD20 (p = 0.0334) cells in their primary tumors compared to patients with normal BMI and LNC. The low BMI low LNC patients also had fewer mature TLS (0.83/tumor) in their primary cancers compared to patients with normal BMI and high LNC (5.4/tumor) and also had greater than fourfold lower mature TLS density (TLS per μm2 mean) (6.34 × 10-9 vs. 2.82 × 10-8), with significantly worsened survival relative to patients with low BMI and normal LNC and patients with normal BMI. Low LNC predicts worsened survival only in low BMI HNSCC patients with non-HPV related tumors and in these patients is associated with markers of immunosuppression such as fewer tumor-infiltrating CD8+ T-cells, CD20+ cells, and fewer TLS in primary cancers compared to matched normal BMI patients with high LNC.

Correlation Analysis Between Prognostic Nutritional Index Trajectory Categories and Radiotherapy-induced Severe Oral Mucositis in Head and Neck Cancer Patients Undergoing Radiotherapy.

To establish the potential prognostic nutritional index (PNI) trajectory categories and examine the association between these PNI trajectory categories and severe radiotherapy-induced oral mucositis (RIOM). This was a longitudinal retrospective observational study on 470 head and neck cancer inpatients who were to undergo radiotherapy from a grade-A tertiary hospital in Hunan Province between July 2022 and October 2023. The latent class growth model and growth mixed model were used to identify PNI trajectory categories. Logistic regression analysis was used to examine the correlation between PNI trajectory categories and severe RIOM. Three PNI trajectory categories were identified: 'PNI high-level group' (20.9%), 'PNI medium-level group' (61.3%) and 'PNI low-level group' (17.9%). The risk of severe RIOM was statistically significantly higher in the 'PNI medium-level group' and 'PNI low-level group' with OR 2.174 (95%CI 0.980-4.822) and OR 3.45 (95%CI 1.212-9.815), respectively. PNI trajectory categories and cancer type were independent risk factors for severe RIOM. PNI can be used as a biomarker to predict severe RIOM. Patients with head and neck cancer who have a lower PNI are at higher risk of severe RIOM.

Taste dysfunction symptoms experience in head and neck cancer patients undergoing proton and heavy ion therapy: a qualitative study.

Exploring the experiences and perceptions of head and neck cancer (HNC) patients undergoing proton heavy ion therapy who develop taste dysfunction during treatment to improve taste dysfunction management for these patients. A qualitative study design using a descriptive phenomenological approach. Conducted individual face-to-face semi-structured interviews in the Head and Neck Tumor Department of the Shanghai Proton and Heavy Ion Center from February to April 2024. The experiences of patients with HNC undergoing proton and heavy ion radiotherapy revealed four key themes: the diversity of taste dysfunction (including reduced or lost perception of sweet, sour, bitter, and other tastes, as well as altered and distorted taste of certain foods); the impact of taste dysfunction on quality of life (changes in dietary habits, malnutrition and weight fluctuations, mental health, and social impacts); strategies for coping with taste dysfunction (altering dietary habits and increasing the use of seasonings to compensate for taste reduction, seeking social support, and engaging in mental health activities to manage emotional distress); and expectations from the healthcare team (need for information and support, psychological support services, and monitoring and evaluation). Patients with HNC undergoing proton and heavy ion therapy experience significant taste dysfunction. Therefore, during proton and heavy ion therapy for HNC, it is crucial to closely monitor and effectively manage taste dysfunction to enhance patients' quality of life and treatment outcomes. Future research should further explore the mechanisms of taste dysfunction and develop interventions to better meet patients' needs and improve the individualization of treatment.

Toward Closing the Loop in Image-to-Image Conversion in Radiotherapy: A Quality Control Tool to Predict Synthetic Computed Tomography Hounsfield Unit Accuracy.

In recent years, synthetic Computed Tomography (CT) images generated from Magnetic Resonance (MR) or Cone Beam Computed Tomography (CBCT) acquisitions have been shown to be comparable to real CT images in terms of dose computation for radiotherapy simulation. However, until now, there has been no independent strategy to assess the quality of each synthetic image in the absence of ground truth. In this work, we propose a Deep Learning (DL)-based framework to predict the accuracy of synthetic CT in terms of Mean Absolute Error (MAE) without the need for a ground truth (GT). The proposed algorithm generates a volumetric map as an output, informing clinicians of the predicted MAE slice-by-slice. A cascading multi-model architecture was used to deal with the complexity of the MAE prediction task. The workflow was trained and tested on two cohorts of head and neck cancer patients with different imaging modalities: 27 MR scans and 33 CBCT. The algorithm evaluation revealed an accurate HU prediction (a median absolute prediction deviation equal to 4 HU for CBCT-based synthetic CTs and 6 HU for MR-based synthetic CTs), with discrepancies that do not affect the clinical decisions made on the basis of the proposed estimation. The workflow exhibited no systematic error in MAE prediction. This work represents a proof of concept about the feasibility of synthetic CT evaluation in daily clinical practice, and it paves the way for future patient-specific quality assessment strategies.

Persian version of the University of Washington Quality of Life Questionnaire (UW-QOL): Reliability and Validity Study

Background: The University of Washington quality of life questionnaire (UW-QOL) is widely used to evaluate the quality of life for head and neck cancer patients. The purpose of this study is translation of the UW-QOL questionnaire's into Persian. Methods: After translation and cultural adaptation of the UW-QOL, the questionnaire was distributed among 100 head and neck cancer patients. Internal reliability of the translated UW-QOL was determined using Cronbach's alpha coefficient. The validity was determined by Spearman correlation coefficient between UW-QOL and 12-Item Short Form Survey (SF-12). The test – retest reliability was measured by Intraclass Correlation Coefficient (ICC) after one week. Results: Cronbach's alpha coefficient was more than 0.75 and ICC coefficient was more than 0.80 in all variables. The UW-QOL questionnaire composite score had a positive significant association with SF-12 questionnaire total score (Spearman's Correlation Coefficient= 0.70, P&lt; 0.0001). Conclusion: In conclusion Persian translation of the UW-QOL questionnaire has acceptable reliability and validity and is as valid as the original English version in evaluating the quality of life for patients with head and neck cancer.

Post-Traumatic Stress Symptoms in Head and Neck Cancer Patients: The Impact of the COVID-19 Pandemic and Gene-Environment Interaction.

This study aimed to assess the occurrence of post-traumatic stress symptoms (PTSS) in head and neck cancer (HNC) patients. The goal also was to explore potential associations between PTSS, demographic factors, psychological variables, and specific genetic variants. This study included a total of 155 HNC patients, divided into pre-pandemic (n = 76) and COVID-19 pandemic (n = 79) groups. PTSS assessments were conducted using a standardized questionnaire. The assessment of adverse childhood experiences (ACEs) involved specific questionnaire items. Genetic variants were identified via RT-PCR. Statistical analysis employed linear multivariate regression, while mediation analysis examined gene-environment interactions. In the pre-pandemic, higher PTSS scores were found to be associated with younger age (p = 0.02) and a history of cumulative ACEs (p = 0.001). Mediation analysis revealed that ACEs had a direct impact on PTSS scores, with the FKBP5 CC genotype (rs1360780, C>T) mediating this association by 29%. In the pandemic, elevated PTSS scores were correlated with a history of depression (p = 0.001), the negative impact of the pandemic (p = 0.007), and undergoing palliative treatment (p = 0.02). Our findings provide insights into the psychosocial and genetic factors contributing to PTSS in HNC patients, considering the additional stressors introduced by the COVID-19 pandemic.

Fluconazole for Preventing Radiation-Induced Oral Mucositis: A Randomized Controlled Trial.

This study evaluated the efficacy of fluconazole prophylaxis in reducing radiation-induced oral mucositis (RIOM) and Candida carriage in head and neck cancer (HNC) patients undergoing concurrent chemoradiotherapy (CCRT). A prospective, double-blinded, randomized controlled trial was conducted with 78 HNC patients receiving either fluconazole (100 mg daily) or placebo during CCRT. The primary outcome was the incidence of grade 2 or higher RIOM. Secondary outcomes included positive Candida cultures and colony-forming units (CFUs). Mixed-effects ordinal logistic regression and logistic regression were used for analysis. Fluconazole significantly reduced the incidence of grade 2 or higher RIOM at week 7 (p = 0.039), positive Candida carriage at week 4 (p = 0.024) and week 7 (p = 0.029), and median CFUs at week 7 (p = 0.050). Fluconazole significantly reduces RIOM severity and Candida colonization in HNC patients undergoing CCRT, suggesting its efficacy as a prophylactic treatment.

Post-diagnosis statin use and survival among head and neck cancer patients: a cohort study in a universal health care system.

Little research has been conducted on the relationship between statin use and the survival of head and neck cancer patients. This study assessed whether statin use after head and neck cancer diagnosis is associated with overall survival among patients in the U.S. military health system (MHS) that provides universal health care to its beneficiaries. The study included 1842 patients with head and neck squamous cell carcinoma (HNSCC) from MHS. Statin use was extracted from the pharmacy database of the Military Health System Data Repository (MDR). Time-dependent multivariate Cox proportional hazards models were used to assess the relationship between post-diagnosis statin use and overall survival with the adjustment for potential confounders. Compared to non-users, increased post-diagnosis cumulative use of statins (per one-year of use) conferred a significant improved survival with adjusted hazard ratio (HR) of 0.70 (95% Confidence Interval, CI = 0.55 to 0.90). When analysis was stratified by status of statin use prior to HNSCC diagnosis, the HRs were 0.31 (95% CI = 0.15-0.65) and 0.81 (95% CI = 0.59-1.11) for post-diagnosis users who also used it before HNSCC diagnosis and those who only used it after the diagnosis, respectively. Prolonged statin use was associated with improved survival among HNSCC patients in MHS.

Nutritional Gender-Specific Differences in Head and Neck Cancer Patients Treated with (Chemo)Radiotherapy: Results from a Prospective Trial.

Background/Objectives: This analysis aims to evaluate gender-specific differences in nutritional status, body weight changes, and their impact on overall survival (OS) in head and neck cancer (HNC) patients undergoing (chemo)radiotherapy (CRT). Methods: Between 2018 and 2020, 61 HNC (17 female and 44 male) patients were prospectively recruited to receive curative (chemo)radiotherapy. Nutritional assessments included dietary questionnaire screenings and records, anthropometric methods (body mass index, BMI, body composition via bioelectrical impedance analysis (BIA)), and the determination of biomarkers like albumin and CRP. Assessments were conducted before, during, and after (chemo)radiotherapy. Results: Gender differences were observed at baseline in Karnofsky performance status (p = 0.01), daily calorie intake (p = 0.04), phase angle (PA) (p = 0.003), and fat-free mass index (FFMI) (p < 0.001). During CRT, males showed a larger increase in calorie deficit (p < 0.001) and greater reductions in BMI, FFMI, and PA compared to females. Malnutrition risk (MUST score) increased significantly in males (p = 0.008) but not in females. Albumin and total protein declined in both genders, with a more pronounced drop in albumin for females. Survival analysis revealed that, for males, several factors, including baseline calorie deficit, BMI, PA, and FFMI, were linked to survival. For females, only albumin at therapy end was significantly associated with survival (p < 0.001). In multivariable analysis, baseline PA remained a significant predictor of survival for males (p = 0.026). Conclusions: Our findings suggest distinct gender differences in the nutritional and biochemical responses of HNC patients undergoing CRT, indicating the importance of tailored, gender-specific nutritional support during treatment.

Cervical lymph node dissection fails to improve survival in T2N0M0 glottic squamous cell carcinoma: a large-scale real-world study.

This study aimed to evaluate the therapeutic efficacy of cervical lymph node dissection in patients with T2N0M0 glottic squamous cell carcinoma. Among 260,068 head and neck cancer patients, 861 cases of T2N0M0 glottic squamous cell carcinoma were selected, of which 113 underwent selective lymph node dissection, and 748 did not receive dissection. The overall survival rates and disease-specific survival rates were compared between the two groups to assess efficacy. There was no significant difference in overall survival rates (median survival time of 57 months vs. 62 months, p = 0.34) and disease-specific survival rates (p = 0.79) between the two groups. Patients aged ≥ 60 years were at a higher risk, whereas neck dissection, gender, and degree of differentiation did not show significant risk differences in this study. Cervical lymph node dissection in patients with T2N0 glottic squamous cell carcinoma did not demonstrate a significant advantage in survival rates.

Deep learning based super-resolution for CBCT dose reduction in radiotherapy.

Cone-beam computed tomography (CBCT) is a crucial daily imaging modality in image-guided and adaptive radiotherapy. However, the use of ionizing radiation in CBCT imaging increases the risk of secondary cancers, which is particularly concerning for pediatric patients. Deep learning super-resolution has shown promising results in enhancing the resolution of photographic and medical images but has not yet been explored in the context of CBCT dose reduction. To facilitate CBCT imaging dose reduction, we propose using an enhanced super-resolution generative adversarial network (ESRGAN) in both the projection and image domains to restore the image quality of low-dose CBCT. An extensive projection database, containing 2997 CBCT scans from head and neck cancer patients, was used to train two different ESRGAN models to generate super-resolution CBCTs. One model operated in the projection domain, using pairs of simulated low-resolution (low-dose) and original high-resolution (high-dose) projections and yielded CBCTSRpro. The other model operated in the image domain, using pairs of axial slices from reconstructed low-resolution and high-resolution CBCTs (CBCTLR and CBCTHR) and resulted in CBCTSRimg. Super-resolution CBCTs were evaluated in terms of image similarity (MAE, ME, PSNR, and SSIM), noise characteristics, spatial resolution, and registration accuracy, using the original CBCT as a reference. To test the perceptual difference between the original and super-resolution CBCT, we performed a visual Turing test. Visually, both super-resolution approaches in the projection and image domains improved the image quality of low-dose CBCTs. This was confirmed by the visual Turing test, that showed low accuracy, sensitivity, and specificity, indicating almost no perceptual difference between CBCTHR and the super-resolution CBCTs. CBCTSRimg (accuracy: 0.55, sensitivity: 0.59, specificity: 0.50) performed slightly better than CBCTSRpro (accuracy: 0.59, sensitivity: 0.61, specificity: 0.57). Image similarity metrics were affected by varying noise levels and did not reflect the visual improvements, with MAE/ME/PSNR/SSIM values of 110.4HU/2.9HU/40.4dB/0.82 for CBCTLR, 136.6HU/-0.4HU/38.6dB/0.77 for CBCTSRpro, and 128.2HU/1.9HU/39.0dB/0.80 for CBCTSRimg. In terms of spatial resolution, quantified by calculating 10% levels of the task transfer function, both CBCTSRpro and CBCTSRimg outperformed CBCTLR and nearly matched the reference CBCTHR (CBCTLR: 0.66lp/mm, CBCTSRpro: 0.88lp/mm, CBCTSRimg: 0.95lp/mm, CBCTHR: 1.01lp/mm). Noise characteristics of CBCTSRimg and CBCTSRpro were comparable to the reference CBCTHR. Registration parameters showed negligible differences for all CBCTs (CBCTLR, CBCTSRpro, CBCTSRimg), with average absolute differences in registration parameters being below 0.4° for rotations and below 0.06mm for translations (CBCTHR as reference). This study demonstrates that deep learning can be a valuable tool for CBCT dose reduction in CBCT-guided radiotherapy by acquiring low-dose CBCTs and restoring the image quality using deep learning super-resolution. The results suggest that higher quality images can be generated when super-resolution is performed in the image domain compared to the projection domain.