bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary squamous cell carcinoma of the oral cavity at presentation in Pakistan
Authors: Jamshed A. , Hussain R. , Rehman K. , Iqbal H. , Hameed S. , Majeed U. , Shah M. A. , Azhar R. , Ahmed Q. , Faruqui Z. 
Published: August 2020

e17002 Background: Squamous cell carcinoma of oral cavity (SCCOC) is characterized by marked geographical differences in frequency and site distribution. Pakistan is situated within the high risk zone on the global oral cancer map. However, no reliable data exists on oral cancer in this area. Our aim was to determine clinicopathological features and patterns at presentation of primary SCCOC in a comprehensive cancer centre in Pakistan. Methods: Demographic, risk factors, pathological and AJCC staging data for SCCOC treated at Shaukat Khanum Memorial Hospital for the period November 2003-October 2008 were obtained from the head and neck unit database. Results: The database identified 666 patients with biopsy proven primary SCCOC. Mean age was 53 years (range 12 - 90 years). Male (428): Female (238) ratio was M64%:F36%. The occurrence of major risk factors for oral cancer specifically smoking, betel quid chewing, naswar (smokeless tobacco) and alcohol use in males (428) was 45% (193), 28% (118), 29% (126), 3% (13), and in females (238) was 8% (20), 29% (68), 13% (30), 0% (0), respectively. Thirty-eight percent (411/666) had no association with tobacco, betel quid or alcohol use. Subsite within oral cavity; anterior tongue 41.1% (274), buccal mucosa 26.6% (177), lower gingival and alveolus 19.5% (130), upper gingival and alveolus 4.1% (27), lips 3.6% (24), retromolar trigone 2.9% (19), hard palate 1.7% (11), and floor mouth 0.6 (4). Broder's/World Health Organization histological grade; grade I 52% (334), grade II 34% (226), grade III 7% (49), and unknown 5% (36). According to AJCC 2002 system 0.2% (1), 10.8% (72), 12.2% (81), 13.2% (88), and 63.7% (420) had stage 0, I, II, III, and IV, respectively. Conclusions: Approximately 80% of patients with primary SCCOC present with stage III or IV disease with anterior tongue as the most common subsite in our hospital. While tobacco and betel quid chewing can be attributed to development of SCCOC in a significant proportion of patients, nearly 38% are unlinked to typical risks factors suggesting other environmental and genetic agents as etiological factors in this region. No significant financial relationships to disclose.
Alternative therapeutic approaches after induction chemotherapy for tonsil squamous cell carcinomas
Authors: Huguet F. , Gratacap M. , Ménard J. , Perie S. , Angelard B. , Jafari A. , Pène F. , Torti F. , Touboul E. , Lacau St Guily J. 
Published: August 2020

e17010 Background: The role of induction chemotherapy (ICT) in the treatment of head and neck squamous cell carcinomas (SCC) remains controversial. This retrospective study aims to evaluate the outcome of patients with tonsil SCC treated with ICT followed by surgery and/or external beam radiotherapy (EBRT). Methods: Between 1997 and 2007, 103 patients (pts) with tonsil SCC received an ICT in Tenon Hospital. Most of pts (88%) received cisplatin (25 mg/m2) and 5-fluorouracil (1,000 mg/m2) for 4 days with a mean of 2.5 cycles. After ICT, 85 pts were operated. After surgery, 69 pts received a dose of 50 to 70 Gy on the primary site depending on pathological findings (Group 1). Sixteen pts with negative margins and no lymph node metastasis didn't receive any EBRT (Group 2). The remaining 17 pts were treated by EBRT without surgery (Group 3). The mean follow-up was 38 months. Results: No significant difference appears between our different groups except for the TNM stage and the tumour pathological response to ICT. After ICT, pathological complete response was observed in 18 pts (25%) for the primary site and 20 pts (34%) for lymph nodes. Clinical and radiological assessment of response after ICT was not predictive of the pathological response. The TNM stage was the only predictive factor for complete response. The 5-year disease-free survival rates were 68% for the whole population, 73% for the Group 1, 43% for the Group 2, 68% for the Group 3 (p = 0.5). A poor pathological response after ICT was the single independent predictive factor of tumour relapse (p = 0.04). In the Group 2, 6 pts had a relapse, among them 4 had EBRT in a second time. The 5-year specific survival rates were 78% for the whole population, 76% for the Group 1, 76% for the Group 2, 39% for the Group 3 (p = 0.03). The radio-clinical evaluation of response, the surgery and the pathological response were predictive factors of specific survival. Conclusions: Pts with a complete pathological response after ICT who were not irradiated had a non significant increase of the relapse rate with a specific survival identical to the group of irradiated pts. This data have to be confirmed by a prospective trial. No significant financial relationships to disclose.
TS and MTHFR gene polymorphisms in patients (pts) with recurrent or metastatic squamous cell carcinoma of the head or neck (SCCHN) treated with pemetrexed (P) and bevacizumab (B)
Authors: Romkes M. , Feinstein T. M. , Zhong S. , Buch S. , Gibson M. K. , Skovira K. , Argiris A. 
Published: August 2020

e17011 Background: P inhibits multiple enzymes in folate metabolism. We examined polymorphisms in thymidylate synthase (TS) and methylenetetrahydrofolate reductase (MTHFR) in patients with SCCHN treated in a phase II clinical trial with P and B (ASCO 2008; A6069). Methods: All pts were treated with P 500 mg/m2 and B 15 mg/kg, given IV every 21 days until progression. Primary endpoint was time to progression (TTP). DNA was isolated from whole blood samples using commercially available kits. Polymorphisms examined were MTHFR (C677T, A1298C and G1793A) and TS (TS2R3R, TSG2RG and TSmut6). The MTHFR SNPs were detected using TaqMan based SNP genotyping kits from Applied Biosystems, run on the ABI Prism 7700 Sequence Detection systems v 1.7 (Foster City, CA). The TS promoter repeat and promoter SNP polymorphisms and the 3’ untranslated region 6 bp deletion polymorphism were determined using published methods to detect PCR product size and RFLP-PCR assays respectively. Results: 22 pts were genotyped from 34 enrolled. There was no significant difference in characteristics between pts with and without genotype data. For the MTHFR polymorphism C677T, there was a trend towards decreased disease control rate (DCR) (CR/PR/SD) (p = 0.058, Jonckheere-Terpstra trend test) and worse TTP (p = 0.04) transitioning from variant CC to CT to TT; comparing TT genotype versus CT and CC combined, pts with TT had inferior DCR (p = 0.03) and TTP (p = 0.0003); homozygotes with TT had a median TTP of 2.6 months (mo) 95% CI (1.4, NA) versus 5.6 mo (4.2, 11.4) for pts with CT or CC variants. For the MTHFR A1298C SNP, there was no significant difference in DCR between variants, median TTP for homozygotes pts with AA was 4.1 mo (2.6, NA) vs. 6.7 mo (5.1, NA) in pts with AC or CC variants (p = 0.084); median overall survival for AA was 10.2 mo (7.6, NA) and for AC or CC 17.6 mo (17, NA) (p = 0.045). The MTHFR G1793A and TS polymorphisms did not impact DCR, TTP or overall survival. There was no association between any polymorphism and the incidence of grade >2 toxicities. Conclusions: Polymorphisms in MTHFR are potentially associated with antitumor efficacy of P-based therapy in recurrent or metastatic SCCHN. These results warrant validation in larger studies with P in SCCHN. No significant financial relationships to disclose.
TPF induction therapy with radioimmunochemotherapy for the treatment of head and neck cancer
Authors: Jordan W. , Wildfang I. , Welkoborsky H. , Borghardt J. , Zakaria H. , Tschechne B. 
Published: August 2020

e17021 Background: As of the good data for radiotherapy with cetuximab and the promising results of an induction chemotherapy containing docetaxel we developed a combination of these regimes. This retrospective analysis evaluates the safety and feasibility of a TPF induction therapy under pegfilgrastim protection with a subsequent concomitant RT immunochemotherapy using cetuximab. Methods: 64 patients (8 female/56 male) with advanced (mostly metastatic; T3/T4) head & neck cancer were treated. Patients were between 39 and 78 years old (median 61), ECOG between 1 and 3. Induction therapy consisted of three 21-day-cycles TPF (75 mg/m2 docetaxel d1; 35 mg/m2 cisplatin d1,2; 750 mg/m2 5-FU d1–5) and on d7 a protective dose of 6 mg pegfilgrastim. Before and after induction therapy PET-CT was used to evaluate response. PET-CT allowed best possible RT-planning with best adapted field margins. Subsequent radioimmunochemotherapy consisted of 400 mg/m2 cetuximab on day 1 (initial dose) and seven weekly cycles of 250 mg/m2 cetuximab and 40 mg/abs cisplatin on day 1. Radiotherapy on d1–5/; 1,8 Gy/day for a median dose 61,2 Gy (59,4 - 70,2 Gy). During the whole treatment CRP was monitored twice weekly and if necessary antibiotics were administered iv. Results: All 64 patients were evaluated after therapy completion. One death occured which was not treatment related (myocard infarct). Five patients decided not to complete the treatment. The response rates were: CR 56% (36), PR 31% (20), SD 11% (7), and PD 2% (1). 10 grade 3/4 toxicities had to be observed during radioimmunotherapy (skin rash, diarrhoe). All toxicities were reversible. In five patients therapy had to be interrupted for two weeks (skin rash). Karnofsky index could be kept stable and in some cases even improved. Conclusions: The new regimen is safe, shows great promise and deserves further development. PET-CT as a diagnostic tool, pegfilgrastim as a myeloprotective agent and docetaxel/cetuximab make a good combination. Especially during the induction therapy QoL is drastically improved. No significant financial relationships to disclose.
Dosimetric analysis for thyroid disorders after radiotherapy to the neck
Authors: Akgun Z. , Atasoy B. , Ozen Z. , Gulluoglu B. , Abacioglu M. U. 
Published: August 2020

e17025 Background: In our study, we aimed to evaluate the possible predictors of thyroid disorders after radiotherapy to the neck, focusing on radiation dose-volume factors. Methods: Thyroid function was measured in 65 patients treated with radiation ports including the thyroid, between 2005 and 2008. All of the radiation-induced thyroid dysfunction was determined with an endpoint of abnormal thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and thyroxine (fT4), thyroglobulin antibodies (ATG), thyroid peroxidase antibodies (TPA), thyroid binding globulin (TBG) levels. In 65 patients, radiation dose-volume parameters were calculated; e.g. total volume of the thyroid, mean radiation dose to the thyroid, and percentage of the thyroid volume which received radiation doses of no less than 10–50 Gy (V10-V50). The evaluated risk factors for thyroid dysfunction included these dose-volume parameters, sex, age, treatment modality and primary disease. Results: Most patients (72.3%) had a normal thyroid function, 17 (26.2%) hypothyroidism, 1 (1.5%) hyperthyroidism, and 12 (18.4%) thyroiditis with normal thyroid function. Four of 17 patients with hypothyroidism had overt hypothyroidism. In our analysis, DVHs (dose volume histograms) were calculated and no associations were found between the V10, V20, V40, and V50 percentages and thyroid disorders. V30 and minimum absorbed thyroid dose (Dmin) more than 25 Gy appeared to be correlated with high TSH values (p = 0.01 and p = 0.04, respectively). The patients with hypothyroidism were between 40–60 years. Female gender was associated with a higher incidence of TBG abnormality. Baseline TSH values were available in 16 patients, and hypothyroidism was diagnosed in 4 (25%) of them. No correlation was found between tumor-related variables and incidence of thyroid disorders. Conclusions: Thyroid disorders after radiation therapy to the neck still represent a clinically underestimated problem. Further prospective well designed studies on dose-effect relationship for radiotherapy-induced thyroid toxicity are therefore needed, and thyroid should be considered as an organ at risk in all patients treated for head and neck tumors. No significant financial relationships to disclose.
Cetuximab versus cisplatin concurrent with IMRT in locally advanced head and neck cancer (LAHNC)
Authors: Galper S. L. , Deshpande H. , Rose M. G. , Decker R. H. 
Published: August 2020

e17030 Background: Concurrent chemoradiation of LAHNC with cetuximab or cisplatin improves survival. The purpose of this study is to compare cetuximab chemoradiation (ExRT) with cisplatin chemoradiation (ChRT) in patients treated with IMRT. Methods: Between January 2005 and August 2008, 24 patients with LAHNC were treated with definitive chemoradiation utilizing IMRT. ExRT was reserved for those whose age or comorbidities precluded ChRT. 15 patients were treated with ChRT and 9 patients were treated with ExRT. Patient charts and Tumor Registry data were reviewed for acute and late toxicity and for local/regional failure (LRF), distant metastases and death. Results: The ExRT cohort was significantly older (median age 71 vs 58, p=0.005) and had more larynx/hypopharynx primaries (44% vs 27%). The cohorts were otherwise balanced with respect to T- and N-stage. Median follow-up for the ExRT and ChRT cohorts was 11 and 12 months, respectively. Overall treatment time in compliant patients was lower in ExRT patients (46 vs 50 days, p=0.05), reflecting increased use of accelerated radiation fractionation (66% vs 40%). See Table for toxicity outcomes. There was a trend toward increased ≥G3 acute mucositis in the ExRT group (p=0.07). However, there was less weight loss (p=0.05). There were similar acute epidermitis and hospitalizations for malnutrition/hydration rates and a nonsignificant decrease in prolonged mucosal toxicity. 1 patient developed skin necrosis and another osteoradionecrosis in the ChRT group. 1-year freedom from LRF was 89% in the ChRT group vs 56% in the ExRT group (p=0.07). Overall survival (OS) at 1 year was 100% (ChRT) vs 88% (ExRT). Conclusions: ExRT showed a trend toward worse acute mucosal toxicity but not late toxicity despite increased rates of altered fractionation with a higher daily dose. ExRT was associated with worse LRC and OS. A randomized study would best compare outcomes and toxicity profiles. Until such analysis, cetuximab should be reserved for patients unable to tolerate ChRT. [Table: see text] No significant financial relationships to disclose.
Patterns of failures after definitive conformal radiation therapy for head and neck cancers
Authors: Jain S. , Gupta T. , Reenadevi P. , Agarwal J. , Laskar S. G. , Shrivastava S. K. 
Published: August 2020

e17037 Background: The primary objective of the study is to analyze patterns of failure in patients with head and neck cancer treated with definitive conformal radiotherapy with a focus on the location of failures in relation to the target volume coverage. Methods: Sixty patients with squamous cell carcinoma (stage: T1–3, N0–2b) were treated definitively on a prospective protocol with conformal techniques to conventional dose-fractionation equivalent of 70 Gy to the gross disease using standardized contouring guidelines. The recurrent or persistent tumor volume (Vf) was defined using positron imaging tomography (PET) and surgical-pathologic findings, and analyzed using dose-volume histograms. The failure was considered marginal when 20%-95% of Vf was within 95% isodose line. Results: At median follow-up of 12 months (range, 4–30) the 3-year actuarial local control, loco-regional control, disease-free survival, and overall survival Kaplan-Meier estimates were 86.4%, 80.5%, 62.6%, and 46.4% respectively. Of 12 (19.3%) patients with disease related events, 10 have loco-regional failures with a median time of 4 months (range, 0–22). Of 10 patients, 8 had in-field, one had marginal and one had failures of both patterns. Of seven (11.3%) local failure events, two were isolated and one had marginal failure. Of seven regional failure events, two were marginal including one with failure at peri-parotid contra-lateral neck. Another one had bilateral multiple nodal levels with supraclavicular recurrence. The remaining events were in-field were “true failures” with no apparent technical cause, none had out-field failures. Two patients were detected to have distant metastases and two developed second malignancies, one out-field and other marginal with upper esophagus carcinoma at gradient zone of previous radiation. Conclusions: Conformal radiotherapy does not compromise loco-regional control as compared to historical controls treated with conventional techniques. PET scans are useful in delineation of failure volumes. The majority of recurrences were ‘in-field‘ motivate studies of dose escalation to the highest risk regions and marginal failures in the high-dose gradient region highlight the potential hazard of high precision techniques and warrants careful consideration. No significant financial relationships to disclose.
Induction chemotherapy with cisplatin and epirubicin followed by radiotherapy and concurrent cisplatin in locally advanced nasopharyngeal carcinoma observed in a nonendemic population
Authors: Airoldi M. , Garzaro M. , Gabriele A. , Raimondo L. 
Published: August 2020

e17040 Background: Chemoradiotherapy (CRT) represents the main therapy choice in the treatment of locoregionally advanced nasopharyngeal carcinoma (NPC). Aim of this study was the clinical evaluation of neoadjuvant chemotherapy (NACT) followed by CRT in a non endemic population affected by advanced NPC. Methods: Patients with locoregionally advanced NPC were treated with three cycles of induction chemotherapy (CHT) with cisplatin (100 mg/m2) plus epirubicin (90 mg/m2), followed by cisplatin (100 mg/m2) and concomitant radiotherapy (70 Gy). Results: In 40 patients treated with such protocol, after the completion of induction CHT and CRT we observed the objective response rates of 90% and 100% respectively. Treatment tolerability and toxicity were easily controllable. With a median follow-up time of 54.5 months 3- and 5-years disease-free survival was 75% and 65.4% and 3- and 5-years overall survival was 84% and 77.5%. 3- and 5-years loco-regional control was 82.4% and 70.3%, and 5-years distant metastases-free survival was 75%. Conclusions: NACT with cisplatin and epirubicin followed by concomitant CRT represents a feasible, efficient treatment for patients with advanced NPC. This regimen ensures an excellent locoregional disease control and overall survival with a low incidence of distant metastases. No significant financial relationships to disclose.
A pilot study of proton beam theary for mucosal melanoma of the head and neck
Authors: Zenda S. , Kawashima M. , Kohno R. , Arahira S. , Nishio T. , Ogino T. 
Published: August 2020

e17042 Background: The aim of this study is to clarify the clinical profile of proton beam therapy for mucosal melanoma of the head and neck. Methods: Patients with mucosal melanoma of the head and neck fulfilling the following criteria were enrolled: histologically confirmed malignant melanoma; N0 and M0 disease. Proton therapy was delivered three times a week with planned total dose of 60 GyE in 15 fractions. Results: From January 2004 through January 2007, thirteen patients were enrolled in this study. Patients’ characteristics were as follows: median age, 75 years (range, 56 to 79); male/female, 7/6; T1/2/3/4/rec, 3/2/0/7/1. All could receive the full dose of proton therapy. The most common acute toxicities were mucositis (grade 3: 15%) and dermatitis (grade 2: 15%). One patient had unilateral impairment of visual acuity possibly related with treatment. Initial local control rate was 77.0% (10/13, 95%CI: 46.2–95.0%). With median follow up period of 33.7 months, median progression free survival was 18.9 months and median survival time was not reached. 2-year overall survival rate was 69.7% (95%CI: 31.6–86.1%). Most frequent site of first failure was cervical lymph nodes outside of PTV. Four patients died of disease; cachexia caused by distant metastases in three and carotid blowout because of nodal disease in one. Conclusions: Proton beam therapy for mucosal melanoma of the head and neck achieved favorable results in this limited number of patients, although further investigation about late toxicity is needed. Now, the phase II study of this treatment is ongoing. No significant financial relationships to disclose.
Use of cystatin C as a marker to detect renal insufficiency in head and neck cancer patients with cisplatin-based chemotherapy
Authors: Bölke E. , Gripp S. , Matuschek C. , Hermsen D. , Peiper M. , Budach W. 
Published: August 2020

e17048 Background: Knowledge of the usefulness of cystatin C measurement in the detection of chronic kidney disease in patients with head and neck cancer (HNC) is scant. The purpose of this study was to evaluate the ability of plasma cystatin C- and creatinine-based methods to predict glomerular filtration rate (GFR) and classify chronic kidney disease in HNC patients before receiving cisplatin based chemotherapy. Methods: The study population consisted of 43 HNC patients aged 39–76 years. Comparisons were made between measured plasma creatinine, cystatin C, creatinine clearance and GFR estimated by the Modification of Diet in Renal Disease (MDRD) formula. The plasma clearance of (51)Cr-EDTA served as a reference method. Results: The Pearson correlation coefficients between plasma clearance of (51)Cr-EDTA and the markers of GFR were calculated. The correlation coefficients were 0.765 for cystatin C, 0.688 for plasma creatinine, 0.585 for GFR values estimated by MDRD and 0.568 for plasma creatinine clearance. Conclusions: We recommend using cystatin C for the estimation of the GFR of HNC patients instead of solely creatinine or creatinine clearance in clinical practice. No significant financial relationships to disclose.
Nasopharyngeal carcinoma at the National Institute of Oncology
Authors: Hassan E. , Afqir S. , Ismaili N. , M’rabti H. , Boutayeb S. , Elghissassi I. 
Published: August 2020

e17055 Background: To evaluate the disease characteristics and outcome of patients with nasopharyngeal carcinoma treated at the National Institute of Oncology (NIO) Rabat, Morocco. Methods: Between 1999 and 2001, 468 patients with a diagnosis of nasopharyngeal carcinoma were treated at the NIO. The median age was 42 years (range 10 to 83). The male/female ratio was 2.5/1. Of the 468 patients, 88 (19%), and 380 (81%) had T1-T2, and T3- T4 (TNM International Union Against Cancer staging system, 1997), respectively. Ninety percent presented with nodal metastasis. 163 patients (35%) had lymph nodes >6 cm, and 229 (49%) had bilateral nodes at presentation. Histologically, 405 patients (86%) had undifferentiated carcinoma. Seventy-six percent received neoadjuvant multiagent chemotherapy containing cisplatin, followed by radiotherapy (RT). Results: After a median follow-up of 26 months, the disease-free survival (DFS) and overall survival (OS) rate for the entire group was 27% and 41%, respectively. Kaplan-Meier curves were used for evaluation of prognostic factors and were compared using the log-rank test. Nodal status had a significant impact on OS (p < 0.001). Complete responders to chemotherapy had superior DFS and OS. Conclusions: Combined modality management using chemotherapy and RT resulted in satisfactory locoregional control and OS in patients with nasopharyngeal carcinoma. Nodal involvement and response to chemotherapy were important prognostic factors. No significant financial relationships to disclose.