Pharyngeal Cancer Patients Research Articles

Self-management intervention improves patient adherence to swallowing exercises during radiation for head and neck cancer.

While preventive swallowing exercises reduce the risk of radiation-associated dysphagia in patients with head and neck cancer, strategies are needed to improve patient adherence. Before radiation, all participants were taught preventive swallowing exercises and randomized to either an adherence intervention or enhanced usual care. During radiation, all participants met twice with a speech pathologist for swallowing assessment and reinforcement of exercises. Intervention participants met weekly with a counselor in-person or by phone. At 6-week post-radiation follow-up, all participants completed a follow-up assessment of self-reported adherence, which was then corroborated with medical record documentation. Newly diagnosed pharyngeal and laryngeal cancer patients without distant metastases were randomized (n = 265; 135 to intervention, and 130 to usual care). Intervention participants were more likely to adhere to exercises during radiation compared to the control group (p < 0.0001). The weekly in-person adherence intervention program significantly increased patient's adherence to preventive swallowing exercises during radiation.

May Nutritional Status Positively Affect Disease Progression and Prognosis in Patients with Esophageal and Pharyngeal Cancers? A Scoping Review of the Current Clinical Studies.

Malnutrition in esophageal and pharyngeal cancer patients constitutes a common and serious concern, which significantly reduces patients' prognoses. Cancers of the esophagus and the pharynx can considerably impair feeding in patients, resulting in severe undernutrition. This is a scoping review that intends to critically analyze the most well-designed clinical studies investigating the potential beneficial impact of diverse nutritional assessment tools on the prognosis of patients with esophageal and pharyngeal cancers. The most accurate and remarkable scientific databases were comprehensively explored utilizing relative keywords to detect clinical studies that investigate whether nutritional status may affect disease prognosis. Several assessment tools have evaluated and highlighted the potential beneficial impact of nutritional status on disease progression and patients' prognosis in both esophageal and pharyngeal cancers. Regarding esophageal cancer, CONUT, PNI, PG-SGA, and NRS-2002 are more commonly used, while albumin is also frequently evaluated. Regarding pharyngeal cancers, fewer studies are currently available. PNI has been evaluated, and its significance as a factor for shorter survival' times has been highlighted. The Comprehensive Nutritional Index has also been evaluated with positive results, as well as NRS 2002, GPS, and body-weight status. However, there is currently a lack of studies with an adequate number of women with cancer. An international literature gap was identified concerning follow-up studies with adequate methodology. Nutritional status may significantly affect disease progression and patients' survival, highlighting the significance of a great nutritional status in individuals with esophageal and pharyngeal cancers. Further large-scale and well-designed prospective surveys should be performed to verify the potential beneficial effects of adequate nourishment in people suffering from cancer of the esophagus and pharynx.

Change in the quality of life in the patients of laryngeal and pharyngeal carcinoma after receiving radiation therapy: A prospective and observational study

Background: The quality of life (QoL) of laryngeal and pharyngeal carcinoma patients is influenced by the side effects of treatment affecting functions such as swallowing, feeding, and speech, more so following conventional radiation using 2D technique. Aims and Objectives: This study was undertaken to determine the change in QoL of laryngeal and pharyngeal cancer patients after radiation using 2D technique in a Telecobalt unit in a resource constrained peripheral institution. Materials and Methods: In this prospective, observational, and single institutional study, fifty-one larynx and pharynx cancer patients were treated with radiation/chemoradiation in telecobalt unit using conventional 2D technique. QoL was evaluated using European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ) C30 and EORTC QLQ Head and Neck Module (HN43) pre-validated and locally adapted questionnaires at pre-treatment, immediately, 3 months and 6 months after radiation. The difference between the scores at different time points was verified using Friedman’s non-parametric test. Results: Of the 46 evaluable patients, 71% were male with median age of 56.5 years, median follow-up of 8 months; 15 patients (32%) had Stage II disease and 78% of patients received concurrent chemotherapy. There was statistically significant deterioration of global health status and functional scales immediately after radiation. All the symptom scales of QLQ C30 and QLQ HN43 except neck swelling showed significant worsening at the end of radiation. After 6 months, the Global health status and all functional scales showed statistically significant improvement. Most symptom scales of QLQ C30 (except appetite loss and fatigue) were statistically significantly improved. At the end of 6 months, most of the symptoms showed significant improvement reaching pre-treatment values. There were however worsening of symptoms such as dry mouth, sticky saliva, and mouth opening. Conclusion: Laryngeal and pharyngeal carcinoma patients suffered from a deterioration of QoL after radiation. Six months later, most of the QoL scales showed a statistically significant improvement. These negative impacts on QoL can be reduced by use of newer techniques of radiation therapy such as 3D conformal radiotherapy, intensity-modulated radiation therapy, and image-guided radiation therapy.

Topographic and Histological Distribution of Carcinoma Pharynx and Larynx: Fiber Optic Laryngoscopic (FOL) Study of 700 Cases

Background: In Bangladesh, in 2020 estimated number of new cancer cases were 156775 and number of deaths were 108990. Carcinoma pharynx and larynx in 2020 were 7.86% and 3.4% of total new cancer cases, 5.71% and 3% of total cancer deaths. Fiber optic laryngoscopy (FOL) has been established as a valuable diagnostic tool and its accuracy is 80.65%. Objectives: The primary objective of this study was to see the topographic and histological distribution of pharyngeal and laryngeal cancers and secondary objective was to assess the role of Flexible Endoscopic Biopsy (FEB) in the diagnosis of cancers. Methods: This descriptive cross-sectional study was done from March 2021 to October 2022 at Mount Adora Hospital, Akhalia, Sylhet, Bangladesh. All suspected pharyngeal and laryngeal cancer patients attending in this hospital for FOL and FEB were included in this study in a convenient sampling method. Benign, recurrence and residual cases were excluded from this study. Results: Total 700 patients of suspected pharyngeal and laryngeal tumour were included in this study. Sensitivity of FEB was 98.3%. FOL was 91% successful in acquiring a definite diagnosis. The age of the patients ranged from 15 to 100 years with a mean age of 58.48 year (SD=13.26). Male, Femaleratio was 5.92:1. Nasopharyngeal cancer affected younger age group (mean age 39.59 year). Pharyngeal cancer was more common (62.9%) than laryngeal cancer (37.1%). Hypopharynx (63.2%) was most common site for pharyngeal cancers. In laryngeal cancer, supraglottic was more common (60%). In hypopharyngeal cancer, pyriform fossa was the commonest site (87%). Squamous cell carcinoma (99.21%) was the most common histological diagnosis. Conclusion: Pharynx was more frequent site than larynx for cancers. Supraglottic region was the most common site for laryngeal and pyriform sinus was the most common site for hypopharyngeal cancers. Nasopharyngeal cancer affected younger age group. Common histological diagnosis was squamous cell carcinoma. Flexible Endoscopic Biopsy (FEB) was highly sensitive. Bangladesh Medical Res Counc Bull 2023; 49(1): 63-69

Incidence of second primary cancers in oral and pharyngeal cancer patients using a large medical claims database in Japan

Background/purposeAs the occurrence of second primary cancers (SPCs) is strongly related to the survival rate of patients with oral and pharyngeal cancers, early detection and treatment are important. Therefore, this study aimed to clarify the incidence of SPCs and their risk factors in patients with oral and pharyngeal cancer. Materials and methodsThis observational study was conducted using data from the administrative claims database of 21,736 participants with oral and pharyngeal cancer from January 2005 to December 2020. We evaluated the cumulative incidence of SPCs among patients with oral and pharyngeal cancers using the Kaplan–Meier method. The Cox proportional-hazard model was used for multivariate analysis. ResultsOf the 1633 patients with oral and pharyngeal cancer who qualified for analysis, 388 developed SPCs (incidence rate, 7.994/1000 person-months). The multivariate analysis showed that the risk of developing SPCs was affected by age at diagnosis of oral and pharyngeal cancer, cancer treatment, and anatomical site of the primary cancer. ConclusionPatients with oral and pharyngeal cancers are at a high risk of developing SPCs. The data from this study may be useful in providing accurate information to patients with oral and oropharyngeal cancer.

Hyperfractionated intensity-modulated proton therapy for pharyngeal cancer with variable relative biological effectiveness: A simulation study.

The relative biological effectiveness (RBE) of proton is considered to be dependent on biological parameters and fractional dose. While hyperfractionated photon therapy was effective in the treatment of patients with head and neck cancers, its effect in intensity-modulated proton therapy (IMPT) under the variable RBE has not been investigated in detail. To study the effect of variable RBE on hyperfractionated IMPT for the treatment of pharyngeal cancer. We investigated the biologically effective dose (BED) to determine the theoretical effective hyperfractionated schedule. The treatment plans of three pharyngeal cancer patients were used to define the ΔBED for the clinical target volume (CTV) and soft tissue (acute and late reaction) as the difference between the BED for the altered schedule with variable RBE and conventional schedule with constant RBE. The ΔBED with several combinations of parameters (treatment days, number of fractions, and prescribed dose) was comprehensively calculated. Of the candidate schedules, the one that commonly gave a higher ΔBED for CTV was selected as the resultant schedule. The BED volume histogram was used to compare the influence of variable RBE and fractionation. In the conventional schedule, compared with the constant RBE, the variable RBE resulted in a mean 2.6 and 2.7Gy reduction of BEDmean for the CTV and soft tissue (acute reaction) of the three plans, respectively. Moreover, the BEDmean for soft tissue (late reaction) increased by 7.4Gy, indicating a potential risk of increased RBE. Comprehensive calculation of the ΔBED resulted in the hyperfractionated schedule of 80.52Gy (RBE=1.1)/66 fractions in 6.5weeks. When variable RBE was used, compared with the conventional schedule, the hyperfractionated schedule increased the BEDmean for CTV by 7.6Gy; however, this was associated with a 7.8 Gy increase for soft tissue (acute reaction). The BEDmean for soft tissue (late reaction) decreased by 2.4Gy. The results indicated a potential effect of the variable RBE on IMPT for pharyngeal cancer but with the possibility that hyperfractionation could outweigh this effect. Although biological uncertainties require conservative use of the resultant schedule, hyperfractionation is expected to be an effective strategy in IMPT for pharyngeal cancer.

Effect of Maitake D-fraction in advanced laryngeal and pharyngeal cancers during concurrent chemoradiotherapy: A randomized clinical trial.

Concurrent chemo-radiotherapy (CCRT) is an ideal treatment for advanced head and neck squamous cell carcinoma (HNSCC). The performance of CCRT induces severe toxicities in HNSCC patients and decreases the quality of life (QOL). Maitake D-Fraction is proteoglycan which has anti-tumor function associated with its immunomodulatory capacity. The polysaccharides of Maitake also have anti-radiation effect in radiation therapy during cancer treatment. This research aimed to illustrate Maitake D-Fraction effects on CCRT-associated adverse events and QOL. During CCRT, Maitake capsules were taken orally 3 times a day, each time 4 capsules, one hour before meals. QOL were analyzed by EORTC QLQ-C30-Chinese version and EORTC QLQ-HandN-35-Chinese version. 141 patients were recruited and divided into an intervention group and a placebo group. Frequencies of severe CCRT-associated adverse events in intervention group were less than in placebo group. Global QOL score in intervention group was higher than in placebo group 5 weeks post treatment. The proportion of patients returning to baseline global QOL score at 6-month was increased by Maitake D-Fraction administration. In conclusion, this randomized clinical trial demonstrated that in advanced laryngeal and pharyngeal cancer patients, the oral administration of Maitake D-Fraction alleviated CCRT-related adverse events and deterioration in QOL.

Quality of life score as a prognosticator for pharyngeal cancer patients treated with radiotherapy

The purpose of this study was to evaluate the prognostic value of quality of life (QOL) scores acquired not only pre-treatment, but also 1 month after treatment for locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) in patients with pharyngeal cancer treated using radiotherapy. Data for 102 patients with naso-, oro-, or hypo-pharyngeal cancer treated between December 2008 and September 2017 were retrospectively analyzed. About 90% of the patients were male. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ-C30) was used for QOL assessments. Associations between QLQ-C30 scores before and 1 month after treatment and outcomes including LRC, DMFS, and OS were analyzed using Cox proportional hazard models. Median follow-up was 37 months (range, 5–117 months). Three-year LRC, DMFS, and OS rates were 77.8%, 60.0%, and 66.5%, respectively. Pre-treatment emotional functioning and diarrhea at 1 month after treatment were identified as significant predictors of LRC. Pre-treatment global QOL and diarrhea at 1 month after treatment were detected as significant predictors of DMFS. Pre-treatment emotional functioning, pre-treatment appetite loss, and diarrhea at 1 month after treatment were detected as significant predictors of OS. Diarrhea at 1 month after treatment was the most powerful QOL variable for predicting LRC, DMFS and OS. Our study revealed that several QOL scores not only before treatment but also 1 month after treatment correlated with LRC, DMFS and OS. In particular, the diarrhea domain of QOL at 1 month after treatment offered the most powerful prognosticator for pharyngeal cancer patients treated with radiotherapy.

Nutritional status at diagnosis is prognostic for pharyngeal cancer patients: a retrospective study.

Malnutrition in head and neck cancer (HNC) patients is associated with increased morbidity and mortality. Several nutrition indicators have been reported to be related to the prognosis of HNC. However, the prognostic effect of these multiple nutrition factors in HNC is not well elucidated. The aim of this study was to evaluate the prognostic effect of these factors, including the novel hemoglobin, albumin, lymphocyte, and platelet (HALP) score, for pharyngeal cancers. From 2008 to 2019, a total of 319 pharyngeal cancer patients were recruited. We collected adult patients with a diagnosis of nasopharyngeal carcinoma, oropharyngeal carcinoma and hypopharyngeal carcinoma. Patients who completed definite staging workup and treatment were selected for analysis. We traced nutritional and hematological parameters, including body mass index (BMI), albumin, and complete blood count, for survival analysis. We found that multiple nutritional markers, including BMI, hemoglobin, albumin, prognostic nutritional index (PNI), nutritional risk index (NRI) and HALP score, were important predictors for pharyngeal cancers in univariate Cox regression analysis. In multivariate analysis, we found that the HALP score was still an independent factor (HR: 1.62, 1.13-2.32 for overall survival [OS]) after adjusting of gender, age, cancer site, clinical stage, and BMI. The PNI was the most important independent factor for OS (HR: 3.12, 2.18-4.47) and cancer-specific survival (HR: 2.88, 1.88-4.41) in multivariate analysis. We found that multiple nutrition markers, including BMI, hemoglobin, albumin, PNI, NRI and HALP score, are important predictors for pharyngeal cancers. This is the first report confirming the prognostic effect of the HALP score for HNCs. Nutritional status at diagnosis should be given more attention in pharyngeal cancer patients.

Association of neutrophil-to-lymphocyte ratio with severe radiation-induced mucositis in pharyngeal or laryngeal cancer patients: a retrospective study

BackgroundThe neutrophil-to-lymphocyte ratio (NLR) is a marker of systemic inflammation that informs clinical decisions regarding recurrence and overall survival in most epithelial cancers. Radiotherapy for head and neck cancer leads to mucositis in almost all patients and severe radiation-mucositis affects their quality of life (QOL). However, little is known about the NLR for severe mucositis. Therefore, this study aimed to show the association between the NLR and severe radiation-induced mucositis in hypopharyngeal or laryngeal cancer patients.MethodsIn this retrospective study, we determined the incidence of grade 3 mucositis in 99 patients who were receiving definitive radiotherapy or chemoradiotherapy (CRT) for hypopharyngeal or laryngeal cancer. We performed univariate and multivariate logistic regression analyses to investigate the characteristics of grade 3 mucositis. Kaplan–Meier curves and log-rank tests were used to evaluate the occurrence of grade 3 mucositis between two groups with high (NLR > 5) or low (NLR < 5) systemic inflammation.ResultsThe incidence of grade 3 mucositis was 39%. Univariate logistic regression analysis showed that the NLR (Odd ratio [OR] = 1.09; 95% confidence interval [CI] = 1.02–1.16; p = 0.016) and smoking (OR = 1.02; 95% CI = 1.00–1.03; p = 0.048) were significantly associated with grade 3 mucositis. Multivariate logistic regression analysis showed that the NLR was independently associated with grade 3 mucositis (OR = 1.09; 95% CI = 1.01–1.17; p = 0.021). Kaplan–Meier curves also showed that patients with higher NLR (NLR > 5) prior to radiotherapy developed grade 3 mucositis more frequently than those with lower NLR during radiotherapy (p = 0.045).ConclusionThis study suggests that a higher NLR is a risk factor and predictor of severe radiation-induced mucositis in hypopharyngeal or laryngeal cancer patients.

Analysis of acute-phase toxicities of intensity-modulated proton therapy using a model-based approach in pharyngeal cancer patients

Pharyngeal cancer patients treated with intensity-modulated proton therapy (IMPT) using a model-based approach were retrospectively reviewed, and acute toxicities were analyzed. From June 2016 to March 2019, 15 pharyngeal (7 naso-, 5 oro- and 3 hypo-pharyngeal) cancer patients received IMPT with robust optimization. Simulation plans for IMPT and intensity-modulated X-ray therapy (IMXT) were generated before treatment. We also reviewed 127 pharyngeal cancer patients with IMXT in the same treatment period. In the simulation planning comparison, all of the normal-tissue complication probability values for dysphagia, dysgeusia, tube-feeding dependence and xerostomia were lower for IMPT than for IMXT in the 15 patients. After completing IMPT, 13 patients completed the evaluation, and 12 of these patients had a complete response. The proportions of patients who experienced grade 2 or worse acute toxicities in the IMPT and IMXT cohorts were 21.4 and 56.5% for dysphagia (P < 0.05), 46.7 and 76.3% for dysgeusia (P < 0.05), 73.3 and 62.8% for xerostomia (P = 0.43), 73.3 and 90.6% for mucositis (P = 0.08) and 66.7 and 76.4% for dermatitis (P = 0.42), respectively. Multivariate analysis revealed that IMPT was independently associated with a lower rate of grade 2 or worse dysphagia and dysgeusia. After propensity score matching, 12 pairs of IMPT and IMXT patients were selected. Dysphagia was also statistically lower in IMPT than in IMXT (P < 0.05). IMPT using a model-based approach may have clinical benefits for acute dysphagia.

Co-treatment with endoscopic laryngopharyngeal surgery and endoscopic submucosal dissection

ObjectiveEndoscopic laryngopharyngeal surgery (ELPS) is an effective and minimally invasive treatment for pharyngeal cancers. However, the disadvantages of ELPS are the interference of instruments in the operative field and the difficulty in approaching certain areas. To overcome these drawbacks, we began to perform combination treatment of ELPS and endoscopic submucosal dissection (ESD). The aim of the present study was to compare the efficacies of treatment with ELPS alone and ELPS combined with ESD. MethodsA total of 103 lesions in 73 patients who underwent pharyngeal ELPS for superficial pharyngeal cancer between August 2014 and January 2020 at our hospital were analyzed. Lesions were divided into the ELPS alone group and ELPS combined with ESD group. Lesion characteristics, technical results, adverse events, and long-term outcomes were analyzed. ResultsIn the ELPS combined with ESD group, procedure speed was shorter than the ELPS alone group (20.2 ± 10.0 mm2/min vs 13.0 ± 6.6 mm2/min, p < 0.001), and R0 resection rate was higher (67.4% vs 45.6%, p = 0.027). There were no significant differences in tumor size, depth of tumor invasion, and adverse events among the 2 groups. These results remained unchanged after propensity score matching. The overall and cause-specific survival rates at 3 years were 96.7% and 100% for the ELPS combined with ESD group and ELPS alone group, respectively. ConclusionsCombination treatment of ESD and ELPS enabled more efficient resection than ELPS alone. Cooperative treatment of pharyngeal cancer patients involving gastroenterologists and head and neck surgeons is effective and beneficial, and results in favorable long-term outcomes.

The impact of intensity-modulated radiation treatment on dento-alveolar microvasculature in pharyngeal cancer implant patients.

Dental rehabilitation post-radiotherapy often requires the consideration of dental implants. However, these are tentatively prescribed due to the concern of hypovascularisation and possible osteoradionecrosis. Hence, the current study assessed the microvasculature of the dento-alveolar bone at implant sites taking into consideration the exact radiotherapy dose received to the region. Bone cores were taken from nine patients during implant treatment and compared to nine control patients. Specimens were stained using CD31 and digitalised using a high-resolution scanner for qualitative and quantitative assessment of the microvasculature. Monaco® treatment planning system was used to volume the implant site providing mean dose (Dmean ) and maximum dose (Dmax ). A total of 23 bone cores were retrieved for analysis. The cohort had a Dmean of 38.4Gy (59.6-24.3Gy). Qualitative analysis identified a clear reduction in the miniscule terminal capillaries and high incidence of obliterated lumens with increasing radiotherapy. Microvasculature density of irradiated patients was markedly reduced (P=.0034) compared to the control group with an inverse correlation to RT doses (P<.0001). Specifically, doses up to 30Gy appear to preserve sufficient vascularisation (~77% in comparison with control) and tissue architecture. By contrast, exposure to higher doses 40%-61% of the micro-vessels were lost. Intensity-modulated radiotherapy doses above 30Gy identified reduction in microvasculature which is a lower threshold than previously accepted. In pharyngeal cancer patients' doses to the jaw bones often exceed this threshold. Coupled with favourable survival in certain oropharyngeal and nasopharyngeal cancer, dental rehabilitation via implants provides a significant clinical challenge.

Olfactory and gustatory functions after free flap reconstruction and radiotherapy for oral and pharyngeal cancer: a prospective follow-up study.

The senses of smell and taste can be adversely affected by both tumour- and treatment-related factors amongst head and neck cancer patients. The consequences may negatively impact nutritional status as well as quality of life in this patient population. This prospective longitudinal follow-up study is consisted of 44 patients treated for oral cavity, oropharyngeal or hypopharyngeal cancer with tumour resection and microvascular free tissue transfer reconstruction at the Helsinki University Hospital, Helsinki, Finland. Thirty-nine (89%) of them also received radiotherapy. The senses of smell (odour detection, identification and threshold test) and taste (electrogustometry) and quality of life (UW-QOL) were evaluated preoperatively, and at 6weeks, 3months, 6months and 12months, postoperatively. There were higher scores in the odour detection values in the 6-week and 3-month tests compared with preoperative values for the tumour side. Other detection scores did not differ statistically from the preoperative values neither in the tumour nor the contralateral side. However, in the odour identification test, all posttreatment values were statistically significantly higher than pretreatment ones. In the olfactory threshold test, no statistically significant differences were found between pre- and posttreatment values. Electrogustometry values for the taste on the tumour side were statistically significantly impaired at 6weeks (p < 0.05) and at 3months (p < 0.01) compared with the pretreatment results. They were also impaired at 6months and at 12months, although the differences were not statistically significant. The quality of life was impaired after treatment in this patient series. However, the correlation between quality of life and sense of tastewas found only at one time point (3months) and only with contralateral side measurements. We conclude that in oral and pharyngeal cancer patients the postoperative taste problems are related to the impairment on the taste sensation in the tongue but not with the sense of smell. Moreover, the impairment in the quality of life is not clearly related to the impaired sense of taste.

Tumor size affects the quality of voice in oral and pharyngeal cancers: A preliminary study

Objective: Clinical observations indicate that the growth of cancers in the oral and pharyngeal region affects the voice of the individual. Literature study indicates that most of the studies have been on laryngeal cancers and that there are no reports, indicating the impact of tumor growth on the quality of voice in people afflicted by cancer in the oral and pharyngeal regions. For the first time, we have attempted at understanding the impact of tumor growth on voice (pitch, jitter, and shimmer) in people with cancer in the oral or pharyngeal regions. Methodology: This was a prospective study and was done in newly diagnosed oral and pharyngeal cancer patients with confirmed histopathological reports. The voice analysis software PRAAT and a dynamic unidirectional AUD-59 × LR microphone were used to record the voice in a soundproof recording laboratory. Voice was also recorded of healthy age-matched volunteers and used as positive control. The results of the voice parameters accrued were analyzed according to the gender (male or female), the region (oral and pharyngeal), and the tumor size using analysis of variance with Bonferroni's multiple comparison. Results: The results of the study indicate that when compared to the healthy controls, the pitch was decreased in people with cancers and was more prominent for females (P = 0.001). The jitter increased and was significant for both oral and pharyngeal cancers (males P = 0.001; females P = 0.002). With respect to shimmer, there was a decrease in men even as it increased in women with oral cancers, while it increased in both the genders in pharyngeal cancers (P = 0.035 and P = 001). Conclusions: The results indicate that there was a significant alteration in the pitch, jitter, and shimmer in people with cancers in the oral and pharyngeal regions and that these changes were dependent on the size of the tumor.

Differential Prognostic Value of Metabolic Heterogeneity of Primary Tumor and Metastatic Lymph Nodes in Patients with Pharyngeal Cancer.

We aimed to explore the prognostic value of metabolic heterogeneity of 18F-FDG uptake in chemoradiotherapy-treated pharyngeal cancer patients. This study included 52 consecutive patients with pharyngeal cancer who underwent 18F-FDG PET/CT before definitive chemoradiotherapy. The heterogeneity factor (HF) was defined as the derivative (dV/dT) of a volume-threshold function for primary tumors and metastatic lymph nodes. The relationships between clinical parameters and HFs of primary tumors (pHF) and metastatic lymph nodes (nHF) were analyzed. The pHF (range=∓1.367 - -0.027; median=-0.152) was significantly correlated with the maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis. Induction chemotherapy response was not correlated with HF, whereas response to radiotherapy was significantly better in patients with high pHF (low heterogeneity). Consistently, the 2-year locoregional recurrence-free survival was significantly better in patients with high pHF (82.9% for pHF>-0.152 vs. 30.5% for pHF<-0.152, log-rank p=0.009). The nHF (range=-1.067 - -0.039; median=-0.160) was not correlated with response to radiotherapy and locoregional recurrences. pHF, but not nHF, was a significant predictor of response to radiotherapy and locoregional recurrence in pharyngeal cancer. Thus, HF use can prevent unnecessary treatment and surgical delays.

EP-1041: The Preliminary Report of PG2 in Improving QoL of Pharyngeal Cancer Patients in Chemoradiotherapy

EP-1041: The Preliminary Report of PG2 in Improving QoL of Pharyngeal Cancer Patients in Chemoradiotherapy

Epidemiology of oral, salivary gland and pharyngeal cancer in children and adolescents between 1970 and 2011

ObjectivesThe age of oral and pharyngeal cancer patients has reportedly decreased over the last decade, but most of the peer-reviewed literature regarding oral and pharyngeal cancer in individuals 0–19years of age (Y) is limited to specific tumor sites and/or types, or a small number of cases. Our aim is to characterize oral, salivary gland and pharyngeal cancer (OSPC) in 0–19Y in order to improve knowledge of the disease in young individuals. MethodsData on OSPC between 1970 and 2011 was taken from the Israel National Cancer Registry, and included patient age, gender, tumor site and tumor type. Data analysis was performed by using IBM SPSS, Winpepi software and Joinpoint Regression Program. alpha<0.05 was deemed statistically significant. ResultsA total of 13,863 OSPC cases were diagnosed with 2.6% (N=357) of 0–19Y. The male to female ratio was 1.5:1. The rates of diagnosis decreased between 1991 and 2011 and were not significantly different between the genders. The nasopharynx was the leading tumor site (42.3%) followed by the salivary glands (20.5%), and both were more common in 14–19Y. The tonsils and other pharyngeal sites were common among 0–13Y. The main tumor types were lymphomas (20.7%) and carcinomas (19.9%). ConclusionsThe general characteristics of OSPC remained unchanged over the last four decades. This may imply that environmental factors have not had any effect. Males are affected more than females and might have a genetic predisposition for nasopharyngeal malignancy. Health care providers should be aware of the common sites and tumor types among children and adolescents.

Patient-Linked Factors Associated with Delayed Reporting of Oral and Pharyngeal Carcinoma among Patients Attending National Cancer Institute, Maharagama, Sri Lanka

Background:Diagnosis of cancer at an early stage improves prognosis following treatment. Unfortunately a large proportion of oral and pharyngeal cancer patients are diagnosed at late stages which require radical treatment with considerable morbidity and mortality. Many researchers have examined different types of delay that could occur between the onset of symptoms and diagnosis. The objective of this research was to identify patient-linked delays between the time of first noticing symptoms and definitive diagnosis, and its association with the stage at diagnosis among oral and pharyngeal carcinoma patients attending the National Cancer Institute, Maharagama, Sri Lanka.Methods:A hospital-based descriptive cross-sectional study was carried out on 351 patients with histologically confirmed carcinoma of oral cavity and pharynx. Data were collected using an interviewer- administered questionnaire and a data extraction sheet. If a patient had taken more than three months to visit a Health Care Practitioner, it was considered as ‘Patient Delay-1’. If a patient had taken more than two weeks following referral to reach for specialized cancer care, it was considered as ‘Patient Delay 2’.Results:Proportions of ‘Patient Delay-1’ and ‘Patient Delay-2’ were 19% (n=252) and 16% (n=322) respectively. Mean time duration between noticing symptoms to definitive diagnosis was 14.1 weeks (SD=10.3). The proportion of advanced-stage cancers at diagnosis was 59.8%.Conclusion:Stage at diagnosis was significantly associated with ‘Patient Delay -1’ (p = 0.001) but not with ‘Patient Delay-2’. ‘Patient Delay-1’ was significantly associated with level of education (p = 0.001) and the cost of travelling (p = 0.048).

Application of the Weibull Distribution with a Non-Constant Shape Parameter for Identifying Risk Factors in Pharyngeal Cancer Patients

Background:In its standard form, the parametric survival model assumes that the shape parameter is constant and the scaling parameter is not. This article focuses on how a model with a non-constant shape parameter could make differences in oncology studies and lead to more precise results.Materials and Methods:Online data for part of a large clinical trial conducted by the Radiation Oncology Group in the United States available online on UMass Amherst`s website were employed. The full study included patients with squamous cell carcinoma from fifteen sites in the mouth and throat, although only data on three sites in the oropharynx reported by the six largest institutions were considered here. To identify clinical, pathological and biological characteristics of patients which might have had an effect on their survival, we compared Weibull distributions once with a constant shape parameter and again with a non-constant shape parameter. Analyzes were performed using SAS university edition. The level of significance was set at P ≤ 0.05.Results:Based on the model with a constant shape parameter only the patient status was identified as a risk factor and the AIC of this model was 2152.4, but based on the model with a non-constant shape parameter, sex, patient status, stage of the tumor and the institute at which the patient had been treated were significant, with an AIC of 2150.1.Conclusion:On the basis of the AIC, the second model with a non-constant shape parameter was suggested to be more accurate for identifying risk factors, leading to more precise results.