Neck Cancer Research Articles

Redefining Candidates for Deintensification in Locoregionally Advanced P16+ Oropharyngeal Cancer Based on Relative Risk

Randomized trials have found that patients with locoregionally advanced p16+ oropharyngeal squamous cell carcinoma (OPSCC) do not benefit from treatment deintensification, even among favorable risk groups. Although various methods have been used to identify candidates for treatment deintensification, the optimal approach is unknown. We conducted a multi-institutional cohort study of 444 patients with previously untreated p16+ OPSCC undergoing definitive radiation therapy with or without systemic therapy between 2009 and 2022. We compared the following 2 approaches for identifying candidates for deintensification: (1) favorable versus unfavorable risk, using NRG-HN005 eligibility criteria, and (2) low versus high relative risk of cancer events, using the Head and Neck Cancer Intergroup predictive classifier ("omega score"). We tested differences in outcomes and systemic therapy allocation by risk group using multivariable Cox models, competing event models, and logistic regression, and compared characteristics of hypothetical deintensification trials using the 2 approaches. Progression-free survival events were defined as cancer recurrence (locoregional or distant) or death from any cause. Median follow-up time was 52 months; 120 patients (27.0%) were favorable risk; a different 120 patients had low omega score; 28 patients (6.3%) met both criteria; 184 patients (41.4%) had discordant classification. On ordinal logistic regression, decreasing omega score was associated with a statistically significantly lower odds of receiving intensive therapy (normalized odds ratio, 0.37 per SD; 95% CI, 0.24-0.57), with a greater magnitude than favorable risk group (odds ratio, 0.66; 95% CI, 0.44-0.99). Among patients receiving cisplatin and/or platinum-based induction (n = 374), favorable risk was associated with significantly improved progression-free survival (hazard ratio, 0.59; 95% CI, 0.36-0.99), whereas lower omega score was associated with a significantly decreased relative hazard for cancer events (relative hazard ratio, 0.18; 95% CI, 0.070-0.46). In simulations, selecting patients with low omega scores increased the efficiency of hypothetical noninferiority trials. Considering patients' relative risk of cancer events can help define optimal populations for treatment deintensification in p16+ OPSCC.

Oral mucositis management with photobiomodulation, Bidens pilosa L. (Asteraceae) and Curcuma longa L. (Zingiberaceae), the FITOPROT herbal medicine, and its influence on inflammatory cytokine levels: a randomized clinical trial.

This randomized clinical trial aimed to compare the effects of a mucoadhesive formula, containing curcuminoids from Curcuma longa L. and glycerinated extract of Bidens pilosa L. (FITOPROT), associated with photobiomodulation (PBM), and of PBM exclusively, on the incidence of oral mucositis (OM)-induced by radiotherapy (RT) in the head and neck region, and the salivary expression of inflammatory cytokines, in patients with head neck cancer. Patients were randomly assigned into two intervention groups-FITOPROT + PBM (n = 25) or PBM (n = 27). PBM protocol comprised a wavelength of 660nm, 25 mW, 0.25J/point, and daily irradiation from the first until the last day of RT. FITOPROT was gargled twice a day. All patients underwent a preventive oral care program throughout the study. OM degree, salivary concentration of nitrite, and inflammatory (IL-1, TNFα, IL-6, IL-8, and IL-12p70), and anti-inflammatory (IL-10) cytokines were assessed at baseline, and at the 7th, 14th, 21st, and 30th RT sessions. There were no differences in the OM degree between groups, but the RT dose significantly affected the OM. The RT significantly affected the salivary nitrite, TNFα, IL-1β, and IL-10 concentrations. FITOPROT associated with PBM showed limited effects on preventing the incidence of severe OM compared to PBM alone. However, FITOPROT + PBM may be associated with nitrite and cytokine balance, which may contribute to the occurrence of fewer cases of severe OM. Brazilian Clinical Trials database (ReBEC; RBR-9vddmr), registered UTN code: U1111-1193-2066, registered in August 8th, 2017.

Clinical and Epidemiological Aspects of Head and Neck Cancer Patients in a Brazilian North-Eastern Oncology Hospital: A Retrospective Study

The purpose of this study is to describe the head and neck cancer patients who are receiving treatment at an oncology facility in a state in northeastern Brazil. Fisher's Exact test was used to analyze the data, which were taken from medical records, tabulated, and statistically analyzed to see whether the factors and the disease result (death or remission) were related. P < 0.05 values were regarded as statistically significant. 74.4% of the 86 medical records that were examined were male, 89% of them were over 40, and 38.4% of them involved smoking. The tongue was the most common anatomical site of cancer (36%). Surgery was the most often used treatment approach (44.2%). A poorer prognosis was linked to the existence of distant metastases (p = 0.041). Compared to individuals with cancer in the oral cavity and maxillary sinus, those with cancer in the nasopharynx, larynx, and oropharynx had a better prognosis (p=0.002). Men of mixed ethnicity, over 40, and mostly with tongue lesions made up the patient profile. Most patients had advanced clinical stages at diagnosis, and 47.7% of the sample perished.

Early circulating tumor DNA changes predict outcomes in head and neck cancer patients under re-radiotherapy.

Local recurrence after radiotherapy is common in locally advanced head and neck cancer (HNC) patients. Re-irradiation can improve local disease control, but disease progression remains frequent. Hence, predictive biomarkers are needed to adapt treatment intensity to the patient's individual risk. We quantified circulating tumor DNA (ctDNA) in sequential plasma samples and correlated ctDNA levels with disease outcome. Ninety four longitudinal plasma samples from 16 locally advanced HNC patients and 57 healthy donors were collected at re-radiotherapy baseline, after 5 and 10 radiation fractions, at irradiation end, and at routine follow-up visits. Plasma DNA was subjected to low coverage whole genome sequencing for copy number variation (CNV) profiling to quantify ctDNA burden. CNV-based ctDNA burden was detected in 8/16 patients and 25/94 plasma samples. Ten additional ctDNA-positive samples were identified by tracking patient-specific CNVs found in earlier sequential plasma samples. ctDNA-positivity after 5 and 10 radiation fractions (both: log-rank, p = .050) as well as at the end of irradiation correlated with short progression-free survival (log-rank, p = .006). Moreover, a pronounced decrease of ctDNA toward re-radiotherapy termination was associated with worse treatment outcome (log-rank, p = .005). Dynamic ctDNA tracking in serial plasma beyond re-radiotherapy reflected treatment response and imminent disease progression. In five patients, molecular progression was detected prior to tumor progression based on clinical imaging. Our findings emphasize that quantifying ctDNA during re-radiotherapy may contribute to disease monitoring and personalization of adjuvant treatment, follow-up intervals, and dose prescription.

Deep learning with uncertainty estimation for automatic tumor segmentation in PET/CT of head and neck cancers: impact of model complexity, image processing and augmentation

Objective. Target volumes for radiotherapy are usually contoured manually, which can be time-consuming and prone to inter- and intra-observer variability. Automatic contouring by convolutional neural networks (CNN) can be fast and consistent but may produce unrealistic contours or miss relevant structures. We evaluate approaches for increasing the quality and assessing the uncertainty of CNN-generated contours of head and neck cancers with PET/CT as input. Approach. Two patient cohorts with head and neck squamous cell carcinoma and baseline 18F-fluorodeoxyglucose positron emission tomography and computed tomography images (FDG-PET/CT) were collected retrospectively from two centers. The union of manual contours of the gross primary tumor and involved nodes was used to train CNN models for generating automatic contours. The impact of image preprocessing, image augmentation, transfer learning and CNN complexity, architecture, and dimension (2D or 3D) on model performance and generalizability across centers was evaluated. A Monte Carlo dropout technique was used to quantify and visualize the uncertainty of the automatic contours. Main results. CNN models provided contours with good overlap with the manually contoured ground truth (median Dice Similarity Coefficient: 0.75–0.77), consistent with reported inter-observer variations and previous auto-contouring studies. Image augmentation and model dimension, rather than model complexity, architecture, or advanced image preprocessing, had the largest impact on model performance and cross-center generalizability. Transfer learning on a limited number of patients from a separate center increased model generalizability without decreasing model performance on the original training cohort. High model uncertainty was associated with false positive and false negative voxels as well as low Dice coefficients. Significance. High quality automatic contours can be obtained using deep learning architectures that are not overly complex. Uncertainty estimation of the predicted contours shows potential for highlighting regions of the contour requiring manual revision or flagging segmentations requiring manual inspection and intervention.

Assessment of the stage of cachexia associated with head and neck squamous cell carcinoma: the CASCO instrument

OBJECTIVE: Carry out a literature review on the applicability of categorizing patients according to the severity of CAC associated with head and neck cancer, using the metric parameters of the CASCO instrument. METHODOLOGY: This is a literature review, in which 29 articles published in the last 10 years were analyzed, obtained through searches on the Scielo, Lilacs and PubMed platforms, using the descriptors: Cachexia; Head and Neck Neoplasms; Squamous Cell Carcinoma; Quality of Life. Cachexia associated with head and neck cancer, with a focus on the use of CASCO to stage this syndrome in patients affected by head and neck squamous cell carcinoma (HNSCC). LITERATURE REVIEW: The use of CASCO allows for a more precise and personalized assessment, potentially improving clinical outcomes. The tool is essential for monitoring the progression of cachexia and adjusting treatment strategies, especially those with cancer of the oral and maxillofacial complex, due to the direct impacts on masticatory and swallowing function. CONCLUSION: It is important to use tools that classify patients according to the severity of cachexia associated with head and neck squamous cell carcinoma, such as the CASCO.

Prevention of osteoradionecrosis in patients with head and neck cancer treated with radiation therapy.

Osteoradionecrosis is a long-term, serious side effect of head and neck radiation therapy and is associated with significant morbidity and quality of life issues. This paper sought to determine consensus on the prevention and management of osteoradionecrosis by an international panel of multidisciplinary professionals expert in the management of patients with head and neck cancer using a Delphi methodology. Unique to this work is our direct inclusion of the views of patients and carers in our findings. This study reached consensus on the importance of pre and post oral health assessment and education for patients with head and neck cancer. This was also noted by the patients and carers who took part in the study. This work highlights the need for a standardized oral health assessment tool and multidisciplinary care of patients to prevent and manage osteoradionecrosis.

855: Salvage HDR Interventional Radiotherapy (Brachytherapy) for Recurrent Head and Neck Cancers

855: Salvage HDR Interventional Radiotherapy (Brachytherapy) for Recurrent Head and Neck Cancers

1240: Fusobacterium associates with a better prognosis and radiosensitizes head and neck cancers

1240: Fusobacterium associates with a better prognosis and radiosensitizes head and neck cancers

1318: Long-term Outcome of Interstitial Alpha Radionuclide Treatment for Skin and Head and Neck Cancers

1318: Long-term Outcome of Interstitial Alpha Radionuclide Treatment for Skin and Head and Neck Cancers

3535: The role of brachytherapy (interventional radiotherapy) dose escalation for organ preservation in head & neck cancer

3535: The role of brachytherapy (interventional radiotherapy) dose escalation for organ preservation in head & neck cancer

859: Intrafraction changes of DWI-based high-risk subvolumes in head and neck cancer

859: Intrafraction changes of DWI-based high-risk subvolumes in head and neck cancer

2586: Quantitative DCE-MRI in head and neck cancer: a comparison of different modelling approaches

2586: Quantitative DCE-MRI in head and neck cancer: a comparison of different modelling approaches

1992: Hypothalamic-pituitary axis dysfunction after irradiation for brain and head and neck cancers

1992: Hypothalamic-pituitary axis dysfunction after irradiation for brain and head and neck cancers

1660: Quality of life in patients undergoing personalised follow-up in head and neck cancer

1660: Quality of life in patients undergoing personalised follow-up in head and neck cancer

1060: Validation of a parameterised automated VMAT technique for SIB radiotherapy of head and neck cancer.

1060: Validation of a parameterised automated VMAT technique for SIB radiotherapy of head and neck cancer.

1591: Acute side-effects from proton beam therapy for head & neck cancer: A 1-year, single centre review

1591: Acute side-effects from proton beam therapy for head & neck cancer: A 1-year, single centre review

2953: Reduction of organ-at-risk doses by omission of selected elective targets in head and neck cancer

2953: Reduction of organ-at-risk doses by omission of selected elective targets in head and neck cancer

Bleeding events in patients with cancer: incidence, risk factors, and impact on prognosis in a prospective cohort study

AbstractHemostatic imbalances are frequent in patients with cancer. Although cancer-associated thrombotic complications have been well characterized, data on bleeding events in patients with cancer are sparse. Therefore, we aimed to investigate the incidence, risk factors, and impact on prognosis of bleeding events in patients with cancer initiating systemic anticancer therapies in a prospective cohort study, the Vienna Cancer, Thrombosis, and Bleeding Study. The primary study outcome was defined as clinically relevant bleeding (CRB), comprising major bleeding (MB) and clinically relevant nonmajor bleeding. In total, 791 patients (48% female), with median age of 63 years (interquartile range [IQR], 54-70), with various cancer types, 65.5% stage IV, were included. Over a median follow-up of 19 months (IQR, 8.7-24.0), we observed 194 CRB events in 139 (17.6%) patients, of which 42 (30.0%) were tumor related, 64 (46.0%) gastrointestinal, and 7 (5.0%) intracerebral. The 12-month cumulative incidence of first CRB and MB was 16.6% (95% confidence interval [CI], 13.7-19.6) and 9.1% (95% CI, 6.8-11.3), respectively, in the whole cohort, and 14.4% (95% CI, 11.2-17.5) and 7.0% (95% CI, 4.7-9.2), respectively, in those without anticoagulation. Patients with head and neck cancer had the highest risk of CRB. Lower baseline hemoglobin and albumin were associated with bleeding in patients without anticoagulation. Seven (5.0%) bleeding events were fatal, of which 6 occurred in patients without anticoagulation. Patients with CRB were at an increased risk of all-cause mortality (multivariable transition hazard ratio, 5.80; 95% CI, 4.53-7.43). In patients with cancer, bleeding events represent a frequent complication and are associated with increased mortality.

2517: Kinomics identifies activated Src kinases as target for radiosensitization of head and neck cancer

2517: Kinomics identifies activated Src kinases as target for radiosensitization of head and neck cancer